- Frank`s Hospital Workshop
Contents
1. Reconnect the concentrator monitor cable and the LED indicator panel cable The drain hose from the water trap must be pushed through the hole in the bottom of the concentrator Push the concentrator into the housing making sure that the drain hose does not get trapped between the bottom of the concentrator and the rim of the housing Make sure that the oxygen outlet tube from the oxygen reservoir is not kinked Also make sure that the water trap is not damaged or dislodged by the top housing or by the foam on the right hand side of the housing Realign it if necessary after it is inside When the concentrator is placed approximately in its final position align the rear right hand holes for the 6 mm hex screw with a short screwdriver and loosely screw it in a few turns Align the rear left hand holes and loosely screw the second hex screw here Then locate the remaining two front hex screws and tighten all screws Connect the oxygen supply hose to the bottom of the pressure regulator making sure that it is not kinked Connect the concentrator power switch cable 4 wires 2 blue 1 yellow 1 red Make sure that the battery wires are connected firmly to the battery on the rear panel black to black red to red Insert the two air inlet hoses into the air filter and lift up the rear panel ensuring that the hoses bend downwards between the zeolite canisters and do not kink when closing the rear panel Attach the rear panel to the housing with2. 2 O regulator assembly with yoke and contents gauge 8150 135 2 a O cylinder pressure gauge 1515 004 2 b O pipeline pressure gauge 1515 003 3 1 N O regulator assembly with yoke and contents gauge 8150 136 3 a N O cylinder pressure gauge 1515 004 3 b N O pipeline pressure gauge 1515 003 4 O 4 meter antistatic hose assembly with BS5682 connector 9950 017 5 N O 4 meter antistatic hose assembly with BS5682 connector 9950 027 6 Air filter Type AG2865 1300 069 ANAESTHESIA DELIVERY BREATHING 8 Flowmeter clear screen 3300 225 9 Flowmeter knob O and label 2300 012 5750 002 10 Flowmeter knob N O and label 2300 013 5750 004 11 Draw over vaporizer Isofluorane 9100 047 12 Draw over vaporizer Halothane 9100 048 13 Breathing pressure gauge assembly 1500 005 2150 034 1215 008 14 Reservoir bag 1300 070 15 Silicon breathing circuit 1300 082 16 Bellows 6650 022 17 Fenton balloon 6650 015 18 Balloon housing clear part 2100 094 19 Patient Taper 2150 056 20 O single tube flowmeter 1525 009 21 Vaporizer back bar with 2 liter reservoir air entrainment valve 9000 062 over pressure valve custom vaporizer connections 22 Manual Ventilator Manifold Assembly includes 2 unidirectional valves 8150 162 55 cmH O pressure relief valve and exhaust valve 23 Water trap and O seal 1300 068 1230 332 24 N O Cut Off Solenoid Assembly 8150 172 25 Exhaust non return valve and taper 2100 217 MONITORING 26 Control screen includes t
3. extra piece this may be discarded 7 Attach bellows assembly to UAM by placing it on top of the connector and firmly pushing down Then tighten knurled nut fully 8 Attach airway pressure gauge by pushing down collar and inserting gauge into the port Press firmly until collar springs up rvu l IST 9 Attach green reservoir bag to back bar as shown in photo 14 10 Attach patient circuit to inspiratory and expiratory ports 11 Attach green plastic 30M 30F connector to the scavenging hose by inserting the male side into the hose The female side attaches to the one way expiratory port underneath the Fenton balloon 12 Connect 30mm hose to scavenging port or attach standard scavenging device 13 Operate the bellows check that it fills freely with air from the air inlet and observe the Fenton balloon moves freely in it s housing when the bellows is moved Occlude the Y piece and check airway pressure reaches 45 55 cmH O 14 Connect and turn on mains power by pressing the green switch on the back of the UAM Wait about 10 seconds for the internal supply to come on and then check the screen to see if the oxygen monitor shows green This indicates the mains supply is working correctly NOTE GRADIAN HEALTH SYSTEMS STRONGLY RECOMMENDS CONNECTING THE UAM TO A 2000 WATT VOLTAGE STABILIZER LileFuze a ly AUTOMATIC VOLTAGE REGULATOR MODEL LR 2000 15 Calibrate oxygen monitor using 100 O from cylinde
4. if required BREATHING SYSTEM CHECKS 19 Turn on the oxygen flow with patient Y Piece blocked and ensure that the reservoir bag fills and excess gas escapes through the pressure relief valve and that maximum circuit pressure is around 5 cmH 0 Confirm that the apnea alarm sounds with a full bellows after 30 seconds and that it repeats every 30 seconds 20 Turn off the flowmeter and cycle the bellows and ensure that air is drawn in through the under pressure valve this is indicated by a slight fluttering of the reservoir bag when it is empty 21 Check condition of reservoir bag 22 Check that the bellows assembly is securely connected to the machine and is undamaged check for splits in the bellows or displacement of the end plates loosen and re clamp centrally if required 23 Cycle the bellows assembly with the inspiratory port blocked and ensure that 55 cmH O can be achieved when the bellows is pushed down for inspiration 24 Check the patient system water trap is correctly screwed in place without leaks 25 Check the correct function of the Fenton balloon Attach the Y piece patient connection and occlude the distal end Operate the bellows and observe the free movement of the balloon in its tube Apply sustained pressure on the bellows and check the pressure rises to at least 45 cm H O If patient system pressure is not achieved unscrew the balloon cover remove balloon and perform checks see page 20 26 Cycle the bellows and ensure
5. ring and make sure it is not cracked or deformed 6 To clean place all the parts in a small bowl with isopropyl alcohol and let them soak for a few minutes 30 7 Wipe each part with a medical grade cotton swab ensuring that there are no visible stains or debris 8 Once cleaned completely dry all of the parts REPLACING THE CLEANED PRESSURE RELIEF VALVE 9 Place the stainless steel ball into the body of the valve and screw on by hand the plug onto the body 10 With the 5mm hexagonal wrench screw in the assembled pressure relief valve into the back bar until tight making sure not to exert too much force 11 Test the operation of the pressure relief valve ensuring that it relieves pressure at 5 cmH O 12 If the pressure relief valve does not function correctly replace it with a new one PROBLEM SOLVING PROBLEM POSSIBLE CAUSES SOLUTIONS Both the Oxygen concentrator and the control gt Check that both mains isolator swith and O concentrator are switched on Screen do not turn on General supply voltage instability power surges low voltage spikes Use voltage stabilizer gt Faulty socket outlet general power cut gt Malfunctioning mains isolator switch gt Malfunctioning voltage switcher gt Broken mains plug or cable gt Malfunctioning voltage stabilizer if fitted between UAM and wall socket UAM shuts down and re starts gt General supply voltage instability powe
6. that the pressure relieves at 55 cmH O NOTE The above verification can only be performed if the oxygen sensor has been calibrated with 100 oxygen VAPORIZER CHECKS 27 Check that the vaporizer is full fully turned off and that it indicates the level of liquid 28 Turn on the concentrator and set an oxygen flow of 6 liters per minute and wait until the output has stabilised Set the vaporizer output to 5 Verify that after 2 minutes that the oxygen concentration has dropped by 5 NOTE This is a very basic test and can only indicate approximate output The vaporizer output is affected by temperature flow and time Ideally the above test should be conducted at an ambient temperature of 22 degrees Celsius RESIDUAL FLOW CHECK 29 Turn on the concentrator and allow it to run for at least 5 minutes with the oxygen rotameter fully closed Turn the concentrator off and set the oxygen rotameter flow to 200 ml min You should observe this level of flow for at least 5 minutes If this test fails this could indicate a leak anywhere between the oxygen concentrator reservoir tank and the rotameter 30 Ensure that the service record see appendix IV is completed and filed Attach a label see appendix V with your initials and the date to let the users know that the VAM has received periodic maintenance and testing MAINTENANCE PROCEDURES CLEANING OR REPLACING THE OXYGEN CONCENTRATOR FILTER Materials and tools required gt 3mm hexagonal wren
7. the 6 screws NOTE When finished assembling verify that the drain hose is protruding from the orifice as picture below 13 Test the oxygen flow and concentration of the concentrator and test that the control screen works on battery and that the battery charges REPLACING THE CONTROL SCREEN BATTERY Materials and tools required 2 5 mm Allen key Long nose pliers Remove the six screws from the lower rear panel Tilt the panel back and remove both tubes from the air filter Rest the panel against the left side of the VAM being careful not to stress the cables connected to the panel With the long nose pliers disconnect the positive and negative battery wires Remove the four screws on the back of the panel that attach the battery holder NANANG Remove battery and replace with a new one NOTE Replacement batteries can be ordered from Gradian Part number 1419 005 but they may be less expensive and quicker to obtain from a local battery supplier Battery details YUASA NP1 2 12 12V 1 2 AH sealed lead acid battery 7 Assemble by following the above steps in reverse NEGATIVE BATTERY WIRE CONTROL SCREEN BATTERY POSITIVE BATTERY WIRE BATTERY HOLDER CONTROL SCREEN BATTERY REMOVING INSPECTING AND CLEANING THE PRESSURE RELIEF VALVE Materials and tools required y 5mm hexagonal wrench A mole wrench also known as vise grips or locking pliers A small cloth Medical grade cotton swa
8. 5 mm Height 50 mm REPLACING THE OXYGEN SENSOR Materials and tools required gt New sensor Replace the oxygen sensor every 12 months or when an alarm message on the oxygen sensor indicates that the sensor has failed to calibrate Always keep a spare sensor and store it unopened in its sealed pouch The sensor begins to decay when you open the packaging and expose it to air To replace the oxygen sensor 1 Disconnect the oxygen sensor cable 2 Turn the existing sensor anticlockwise to disconnect it 3 Remove the new sensor from its container and remove the extension piece covering the bottom of the sensor 4 Place the sensor in position and turn it clockwise to screw it into place Do not over tighten NOTE Take care to engage the thread correctly and ensure that the replacement cell is fitted with a suitable O ring to prevent leaks from the breathing system Replacement sensors include a new O ring 5 Connect the oxygen sensor cable 6 Recalibrate the oxygen sensor REMOVING AND REPLACING THE DRAW OVER VAPORIZER Materials and tools required gt 4mm Allen key 1 Ensure that the UAM is turned off 2 With a fine tipped pencil draw a line on the back bar along the right edge of the right hand block This will help align the block when re assembling 3 Use a 4mm Allen key to turn the right hand block s 4 screws counter clockwise Slide the block off the vaporizer Slide the vaporizer to the right t
9. Gradian Health Systems Universal Anaesthesia Machine ES Maintenance Manual ES HOW TO GET HELP GENERAL DESCRIPTION OF THE UNIVERSAL ANAESTHESIA MACHINE SPECIFICATIONS COMPONENTS OF THE UAM UNPACKING AND PREPARING FOR USE RECOMMENDED UAM MAINTENANCE SCHEDULE FULL FUNCTION TEST MAINTENANCE PROCEDURES Cleaning or Replacing the Oxygen Concentrator Filter Replacing the Oxygen Sensor Removing and Replacing the Draw Over Vaporizer Cleaning the Halothane Vaporizer Replacing the Fenton Balloon Replacing the Control Screen Circuit Board Replacing the Concentrator Loss of Power Alarm Battery Removing the Concentrator Installing the Concentrator Replacing the Control Screen Battery Removing Inspecting and Cleaning the Pressure Relief Valve PROBLEM SOLVING MAIN PARTS ILLUSTRATED PARTS APPENDIX I BREATHING CIRCUIT DIAGRAM APPENDIX Il OXYGEN CONCENTRATOR FLOW DIAGRAM APPENDIX ELECTRICAL DIAGRAM APPENDIX IV UAM SERVICE RECORD APPENDIX V UAM INSPECTION LABEL APPENDIX VI PRESSURE CONVERSIONS amp COLOUR IDENTIFICATION FOR MEDICAL GASES Copyright 2013 by Gradian Health Systems LLC All rights reserved Gradian Health Systems VAM and the Gradian logo are registered trademarks of Gradian Health Systems LLC registered in the United States Printed in the United States of America Rev 1 0 P N 1974 005 December 2013 CE 0120 The UAM is manufactured by OES Medical Ltd Witn
10. NDER amp PIPELINE INPUT EEN SILICONE ANALYZER BELLOWS SAMPLING 55 CMH O PORT PRESSURE RELIEF VALVE INSPIRATION BELLOWS BLOCK 2 VALVES TO PATIENT EXPIRATION GAS FLOW INLET E Y PIECE OUTLET SCAVENGER INFLATING BALLOON BALLOON VALVE ACTUATOR PIPE 38 APPENDIX II OXYGEN CONCENTRATOR FLOW DIAGRAM COOLER WATER TRAP 5 CONTROL VALVE AIR FILTER WATER DRAIN HOSE COMPRESSOR SIEVE TANK 2 MUFFLER OXYGEN OUTPUT NITROGEN 90 95 OUTPUT FLOWMETER SIEVE TANK 1 AIR ONE WAY VALVES OXYGEN NITROGEN OXYGEN RESERVOIR TANK o WATER APPENDIX III ELECTRICAL DIAGRAM MAINS ISOLATOR SWITCH BR 24V POWER SUPPLYUNIT BR G Y CABLE G Y O2 SENSOR Fe R BR BATTERY CONTROL mes SCREEN R dh N20 SPEAKER CUT OFF VALVE 12V 1 2AH POWER LOSS ALARM BATTERY 9V OXYGEN FUSES 5A CONCENTRATOR BL FRONT SWITCH 40 APPENDIX IV UAM SERVICE RECORD MACHINE SERIAL CONCENTRATOR TOTAL HOURS RUN NEXT SERVICE CHECK DUE DATE CONTROL SCREEN SOFTWARE REVISION GASES USED check if available and write down pressure reading OXYGEN CYLINDER i KPa OXYGEN PIPELINE KPa NITROUS CYLINDER 3 i Kpa NITROUS PIPELINE u Kpa TEST DESCRIPTION Correspond to PASS P PROBLEM FOUND steps of the Full Function Test FAIL F and work carried out SYSTEM 1 No modifications amp
11. accessories such as the breathing circuit oxygen sensor and standard connectors for the oxygen and nitrous oxide supplies The UAM is also designed for simple field service Most components can be removed with standard tools and local technicians can install replacement parts without removing the workstation from the hospital The VAM carries the CE Mark having passed EU regulatory inspections It is manufactured in an ISO certified factory in England It is used in a wide variety of hospitals from internationally recognized academic centres to resource constrained district hospitals The Universal Anaesthesia Machine ensures that an adequate supply of oxygen and anaesthesia is always available to meet patient demand no matter what the environment The UAM provides several ways to deliver oxygen including connections for cylinder and pipeline Most importantly the machine produces its own oxygen using an integrated concentrator that converts room air into 95 oxygen Air is drawn into the UAM and is purified by 2 different filters Ambient air is made up of 78 nitrogen 21 oxygen and 1 other gases The electrically powered oxygen concentrator in the UAM removes nitrogen from room air creating a mixture that is 95 oxygen and 5 other gases The compressed air passes into a canister filled with a powdered material called Zeolite Nitrogen sticks to the Zeolite while oxygen and other gases flow through it to a reservoir tank The UAM produces
12. all spares and accessories present 2 Frame hardware wheels Mains cable and gas supply hoses 4 Charging indicator 5 Mains failure icon 6 Battery condition icon 7 Cylinder yokes 8 Cylinder pressure gauges 9 Pipeline pressure gauges 10 Maximum O and N O flows 11 Zero O and N O flows 12 Emergency O inlet OXYGEN CALIBRATION SAFETY AND QUALITY 13 Calibration with 100 O 14 Calibration with Air 15 Upper and lower O alarms 16 NO cut off 17 O sensor disconnect alarm 18 O concentrator output BREATHING SYSTEM 19 Apnea alarm 20 i Air intake valve 21 Reservoir bag 22 Bellows assembly condition 23 3 Bellows expiratory pressure 24 Patient water trap 25 Fenton balloon operation 26 Pressure relief valve VAPORIZER 27 Vaporizer condition and indicator 28 Vaporizer performance 29 Residual flow test i 30 Complete and adhere service label Service carried out by name of technician Signature Date 41 APPENDIX V UAM INSPECTION LABEL AS Gradian Health Systems UAM INSPECTION LABEL DATE BY RE INSPECT BEFORE APPENDIX VI PRESSURE CONVERSIONS Using the Table 1 Find the units you wish to convert FROM in the left hand Column 2 Find the units you wish to convert TO in the top row 3 Insert the multiplier shown at the intersection into the follo
13. aside 2 Remove accessories from underneath and along the sides of the VAM and set aside 3 Unlock the front wheels and carefully roll the machine out of the packing case supporting the weight as you lower the machine to the floor Remove all packing material Unpack work tray from its cardboard packaging Remove film from work tray and place on top of the drawer Y Connect pipeline hoses and cylinders 6 Screw in oxygen sensor and connect telephone style cable Some oxygen sensors come with an extra piece this may be discarded See photo on next page USING OXYGEN The UAM accepts an E size pin index oxygen cylinder The cylinder connects via a yoke and Bodok seal and the pressure is displayed on the pressure gauge on the front of the machine Bull nose cylinders may be attached to the pipeline inlet using an approved 4 Bar medical regulator USING A PIPELINE CONNECTOR The UAM accepts pipeline connections for oxygen Each machine is supplied with an oxygen hose connecting to the UAM s NIST inlet The other end is typically shipped with a BS 5682 probe which is the British standard Probes for other connector types can be arranged Pipeline pressure is displayed on the gauge on the front of the machine USING THE EMERGENCY OXYGEN INLET An emergency oxygen supply connection is mounted on the back of the machine It accommodates differing tube sizes from ward style flow meters CAUTION Oxygen from this source is not controlled
14. bs Isopropyl alcohol also know as rubbing alcohol or surgical spirit typically 70 isopropyl and 30 distilled water A small bowl On occasion the 5 cmH O pressure relief valve located on the top of the back bar may not perform optimally due to accumulation of dust and other contaminants such as liquids If you notice that the valve is not opening at 5 cmH O then you will need to remove it inspect it and clean it by following these steps REMOVING THE PRESSURE RELIEF VALVE 1 2 Turn off the VAM Using a 5mm hexagonal wrench loosen the plug on the top of the pressure relief valve and remove it NOTE It may be possible that when removing the plug the body of the pressure relief valve may loosen up from the back bar This is not a problem and in fact eliminates the need for the next step 28 3 With a mole wrench and a cloth grab the body of the pressure relief valve and turn it counter clockwise to loosen it up and free it form the back bar NOTE If you do not cover the pressure relief valve with a cloth before you grab it with the mole wrench it may get damaged 4 Once removed make sure that you see the following parts the relief valve plug the relief valve body the stainless steel ball and the O ring attached to the valve s body INSPECTING AND CLEANING THE PRESSURE RELIEF VALVE 5 Inspect all of the parts to ensure that there are no stains debris moisture or rust Inspect the condition of the O
15. by the glass flow meter on the front of the UAM Rather it must be controlled with an external flow meter attached to the cylinder providing the emergency oxygen The user can confirm that oxygen is being given by observing the oxygen monitor NOTE Use only 1 liter min flow to conserve the oxygen in the external cylinder This will provide 30 35 oxygen to the patient USING NITROUS OXIDE The UAM supports cylinder and pipeline sources of nitrous oxide The flow of N O is controlled by the right hand side flow meter The N O flow knob has a different size and shape to distinguish it from the oxygen flow meter control knob The UAM automatically cuts off nitrous oxide if the percent of oxygen in the anaesthetic mix falls to 25 and below The oxygen monitor must be powered on and working correctly for nitrous oxide delivery to occur An exhausted oxygen sensor or battery will shut off N O supply The cut off mechanism is electrical unlike older style mechanical interlocks The N O valve is closed in its resting position and must receive a current from the oxygen monitor to open Any interruption of that current including a decrease in oxygen below 25 will shut off the flow of nitrous oxide NOTE Do not open the package of the spare oxygen sensor until it is needed The oxygen sensor will start to deplete as soon as it comes into contact with air 6 Screw in oxygen sensor and connect telephone style cable Some oxygen sensors come with an
16. ch gt 5 flare nut wrench The oxygen concentrator includes a replaceable filter that cleans the room air entering the oxygen concentrator Keeping it clean will extend the life of the concentrator To remove the filter 1 Turn off the VAM and disconnect it from the mains power supply At the lower back panel loosen the six hex screwss using a 3mm hexagonal wrench Carefully tilt the rear panel back from the top taking care not to disconnect the wires attached to it Detach the two hoses leading to the air filter Press the orange collar to release the hose Do not pull on the hose without depressing the collar Remove the cover plate that holds the filter in place by removing the centre 5 nut Filters may be cleaned by shaking or vacuuming If the filter is too dirty to clean replace it with a new one Install the new filter and replace the cover plate Replace the back panel connect the mains power supply and turn the UAM on BUN onau NOTE Replacement filters can be ordered from Gradian Part number 1300 069 but they may be less expensive and quicker to obtain from local automotive parts suppliers 18 Filter Details Type AG285 Applications Used in automobiles made by Ford Audi Volkswagen Citroen Seat Skoda and Saab Replacement options Factory Number FRAM CA4739 GMC 93152533 MEYLE 7126080390 MONARK 30780031 PUROLATOR AF3561 TEHO 2247 Dimensions Outer Diameter 241 mm Inner Diameter 18
17. e ee ee nn 15 C 22 C 25 C 30 C 35 C TYPICAL HALOTHANE VAPORIZER PERFORMANCE WITH TEMPERATURE ene EO LL ALL aas mimm mum tt a see MU E E AS 3LPM aLpm 5LPM 6LPM 8LPM TYPICAL ISOFLURANE VAPORIZER PERFORMANCE WITH FLOW eee eee 4 3 2 1 4 3 2 1 5 1 5 6 5 4 3 OA OOOO ADA G 1 EEE E 1 O 15 C 22 C 25 C 30 C 35 C TYPICAL ISOFLURANE VAPORIZER PERFORMANCE WITH TEMPERATURE REAR PANEL CONNECTORS Mains isolator switch 2 UK style power sockets gt Oxygen and nitrous pipeline NIST connectors and cylinder yokes gt Multi diameter external oxygen hose connector COMPONENTS OF THE UAM Patient Vital Signs Monitor Oxygen monitor and control screen Oxygen and Nitrous Oxide Flow Meters Back bar with air inlet pressure relief valve and 2 liter reservoir bag Low resistance vaporizer Oxygen concentrator on off switch Oxygen cylinder and pipeline pressure gauges Nitrous Oxide cylinder and pipeline gauges Bellows Pressure relief valve and gauge Fenton Balloon expiratory valve Y piece connectors Water trap Oxygen concentrator status screen Integrated oxygen concentrator Castors front lockable SEE INSET PAGE 7 Back bar Low resistance vaporizer Oxygen monitor and control screen Oxygen and Nit
18. e cloth Do not spill agent on to the UAM especially on to the oxygen sensor Refer to the fill level window 20 Place all manuals and training materials in drawer and secure a location for extras such as the additional oxygen sensor spare balloons and so forth NOTE High levels of relative humidity in the environment will affect the performance of the UAM It is recommended that the UAM be used in areas where the humidity can be controlled After operating the UAM in humid environments water drainage should be observed underneath the machine once the concentrator is turned off and has depressurized IF YOU HAVE PURCHASED THE PATIENT VITAL SIGNS MONITOR 1 Unpack monitor and insert the battery The battery is in a white box inside the foam protectors holding the monitor securely in the cardboard box Mounting the monitor Please refer to the mounting instructions for the particular model of monitor obtained Connect patient cables to monitor NIBP SPO2 TEMP and ECG Connect mains lead from monitor to one of the three prong sockets on the back of the UAM Allow batteries in patient monitor and control screen to charge for 24 hours RECOMMENDED MAINTENANCE SCHEDULE FREQUENCY ACTION Daily or prior to use user Perform operational check see UAM User Manual and Checklist on the UAM Every 3 months Perform full function test Every 6 months i Perform full function test Check air filter clean or replace i
19. ey Oxon UK 1 2 2 5 11 15 15 16 17 17 17 18 18 18 19 19 20 21 22 23 24 25 26 27 30 31 32 33 33 37 38 39 40 41 42 42 43 HOW TO GET HELP EMAIL service gradianhealth org WEB www gradianhealth org PHONE 1 212 537 0340 ADDRESS Gradian Health Systems 160 Fifth Avenue 7th Floor New York NY 10010 USA NOTE For the latest UAM specifications and technical materials please visit us online at http ww gradianhealth org universal anaesthesia machine DESCRIPTION OF THE UNIVERSAL ANAESTHESIA MACHINE The UAM combines elements from both continuous flow and draw over designs to provide a workstation that delivers controlled anaesthesia in all hospital settings The breathing system is a low pressure limited to 5 cm H20 continuous flow system that defaults to a demand flow draw over system when the supply fails There are three one way valves and a balloon operated inflating valve which provide this uniquely versatile method of anaesthesia delivery Oxygen can be provided from a variety of sources and if none of those sources is available the machine will automatically draw in room air without the need for the user to change settings The vaporizer provides calibrated delivery of anaesthetic agent and the manual bellows ensures that safe assisted respiration can continue without requiring a high pressure gas source The system has been designed to accept standard anaesthesia
20. f needed Every 12 months i Perform full function test Check air filter clean or replace if needed Replace oxygen sensor Replace oxygen concentrator loss of power battery 9V Remove and inspect Fenton balloon Every 3 years i Replace oxygen monitor battery Every 5 years Contact Gradian Health Systems for complete maintenance check service gradianhealth org 1 212 537 0340 16 FULL FUNCTION TEST SEE CHECKLIST IN APPENDIX IV SYSTEM CHECKS 1 Check that no unauthorised modifications have been made to the VAM Check that the Ayre s T piece is present and spares as originally supplied are present Check oxygen tubing for venturi Hudson type mask is available 2 UAM frame check for any loose screws or panels and tighten as required Check wheels Check mains cable and gas supply tube condition and repair as required 4 Connect mains supply turn on mains isolator note that there will be a delay of around 10 seconds while the mains filter starts and check that the control screen and patient monitor if fitted yellow charging LED s are visible 5 Turn off the machine mains isolator and ensure that the Mains power Icon goes red this indicates mains failure 6 Check that the battery indicator icon shows three green segments and that it discharges with mains off and recharges with mains on NOTE Battery must be replaced every three years or sooner if battery life is low 7 Check that the cylinder yoke seals a
21. it board Apnoea alarm does not activate gt Mute option is selected gt Pressure transducer needs to be calibrated gt Malfunctioning control screen circuit board Oxygen concentrator output measures less than 90 gt Oxygen sensor needs to be calibrated to both 100 and 21 oxygen gt Malfunctioning water trap in oxygen concentrator is allowing moisture to saturate the zeolite material in the Adsorption Towers gt Air filter is dirty and obstructing air flow gt compressor is malfunctioning gt Switching valve is malfunctioning gt Water in system due to clogged or defective water trap Clean or replace gt Air filter is dirty and obstructing air flow Clean or replace gt compressor is malfunctioning gt Switching valve is malfunctioning Oxygen concentrator output does not reach 10 gt Concentrator output regulator needs to be adjusted liters minute and or flow fluctuates Concentrator alarm does not activate when power gt 9 volt alarm battery is discharged and should be replaced is lost Breathing system pressure too high gt Pressure relief valve not opening Remove and clean gt Balloon valve malfunctioning Remove and clean or replace 31 32 MAIN PARTS ITEM NO DESCRIPTION PART NUMBER GAS SUPPLY 1 Oxygen concentrator 8150 181 1 a Main concentrator control board N A 1 b Compressor pump N A 1 c O concentrator switching valve N A 1 d Zeolite Cylinder Set N A 1 e Fan N A 1 f Water Trap N A
22. n and close during expiration The bellows will not fill with exhaled gas The bellows is used for intermittent positive pressure ventilation also known as IPPV or controlled ventilation When the bellows is raised supply gas flows through the first non return valve into the bellows The second non return valve remains closed As the bellows are pushed down the supply gas flows out through the second non return valve into the inspiratory limb The first non return valve is closed Another pressure relief valve ensures that excessive manual force on the bellows cannot cause harm to the patient The VAM uses a conventional Y piece patient connection Exhaled gas returns to the VAM via the expiratory limb of the Y piece and then passes by the Fenton balloon and a third one way valve to the scavenger port The balloon acts as an inflating valve which enables controlled ventilation of the lungs the third valve prevents back flow during spontaneous breathing SPECIFICATIONS PHYSICAL AND ELECTRICAL gt Workstation 146cm x 53cm x 69cm 130kg aluminium frame vertical dove mount side rails on both sides nylon internal tubing gt Shelf 46cm x 31cm 88cm above floor 35kg weight limit gt Drawer 10cm x 29cm x 32cm 35kg weight limit stainless steel removable for cleaning gt shelf Epoxy powder coated pressed aluminium side slots for nylon strap to secure equipment optional monitor brackets are available to bolt items t
23. o remove it from the back bar Lift the vaporizer off the back bar To replace the draw over vaporizer repeat the above steps in reverse order using the pencil mark as a guide to align the right hand block NOTE Ensure that the O ring in the back of the right hand block is in position during reassembly CLEANING THE HALOTHANE VAPORIZER Materials and tools required gt Metal bowl or container Drain Halothane vaporizers every 3 months to prevent thymol build up Excess thymol can damage the selector wheel mechanism over time 1 2 3 Unscrew the filler on the front of the vaporizer Place a metal bowl or container underneath the vaporizer Halothane is corrosive and can damage the VAM if spilled Using the filler cap insert the key on the bottom of the cap into the receptacle just below the window on the front of the vaporizer Turn the filler cap anticlockwise to open the drain underneath the window When finished turn the filler cap clockwise until the drain if fully closed Do not over tighten Re fill the vaporizer with halothane Dispose of the old anaesthetic agent using your hospital s procedures for disposing of medical waste 20 REPLACING THE FENTON BALLOON Materials and tools required gt New Balloon 1 Unscrew the tube assembly unit which includes the top aluminium ring the clear plastic housing and the valve assembly attached to the bottom Turn using the top ring to make s
24. o the top of the top shelf 54 cm W x 37 cm D Load maximum 35 kg with even load distribution gt Work surface Stainless steel removable for cleaning 46 cm W x 31 D x 88 cm H above ground gt Mains power supply 220V 50 60Hz gt Power 500 Watts 220v 2 27 amps gt Control screen power CE marked fused and medical grade Mains powered with battery backup for one day of use gt Automatic over under voltage mains power isolator protects oxygen concentrator and sockets for monitor and accessories gt 3 5 TFT touch screen for oxygen display and alarm setting gt Membrane switch for oxygen and alarm settings gt Casters 150 mm diameter single wheel antistatic casters front lockable casters OXYGEN SUPPLY AND MONITORING gt Oxygen concentrator flow rate to 10 0 liters per minute gt Maximum oxygen concentration 95 NOTE The oxygen concentration may vary according to ambient humidity and maintenance of the air filter Alternative sources cylinder yoke pipeline or other external flow regulated portable oxygen source Automatic room air intake when patient minute volume exceeds supply gas flow Accuracy of glass rotameters 2 5 when using 100 O Integrated inspiratory oxygen monitoring uses MOX 3 oxygen sensor Calibration for room air 21 and 100 oxygen Pressure sensitive apnea or high flow alarm vr lll Adjustable minimum and maximum oxygen alarm settings gt Up to ten hour batter
25. ouch screen and housing NPN 27 Control screen circuit board 1400 009 28 Oxygen sensor 1300 075 29 Speaker 8150 179 30 Vital signs monitor 1419 221 ELECTRICAL 31 32 33 34 35 36 38 39 40 41 FRAME 42 43 44 45 46 O concentrator on off switch Fuses for concentrator and sockets 5 x 5 Fuses for control screen 5oo Max 5 Main incoming fuse 13 amp x 5 Mains inlet cable with UK style plug 4 meters Electrical sockets 15 amp UK style Mains isolator rocker switch Power supply for control screen 24V 15W Automatic voltage switcher Battery for control screen YUASA NP1 2 12 12V 1 2 AH sealed lead acid battery Stainless steel work surface Stainless steel drawer Casters with brakes Casters without brakes Top monitor shelf ILLUSTRATED PARTS REFER TO ITEM NUMBERS IN PARTS LIST 8150 174 1419 009 1419 010 1419 011 NPN 1450 010 1450 009 1419 211 1450 015 1419 005 5150 093 5150 063 1300 092 1300 091 5150 067 13 16 28 17 30 D 46 26 11 12 20 14 2 16 15 42 43 24 1 45 44 18 25 23 o 40 36 27 29 24 APPENDIX I BREATHING CIRCUIT DIAGRAM OXYGEN CONCENTRATOR LOW RESISTANCE VAPORIZER 5 CMH O PRESSURE RELIEF VALVE pe EXTERNAL O INLET AIR INTAKE O N O VALVE FLOW CONTROL 2 LITER O ALARM amp RESERVOIR BAG O N O CYLI
26. ove from flow meter Pull touch screen connector clamp to disconnect the ribbon cable Disconnect screen display cable by flipping up the clamp using a thumbnail Remove the 4 printed circuit board securing screws using a 2 5 mm Allen key Reverse sequence using new board cet r e etit mie o oot REPLACING THE CONCENTRATOR LOSS OF POWER ALARM BATTERY Materials and tools required gt 3mm Allen key gt 9 volt battery Turn off the UAM and disconnect it from the mains power supply Loosen the hex screws on the back lower panel Lift and remove the panel and place it so that it rests on the left side of the UAM making sure not to pull on the cables At the back left side of the concentrator disconnect the battery Install anew 9 volt battery Reuse the Velcro strip from the old battery Replace the panel MANAN Ang Ano warx Kaye d PIO Du BATTERY CONNECTOR VELCRO 9V BATTERY REMOVING THE CONCENTRATOR Materials and tools required as gt N 6 mm Allen key 2 5 mm Allen key 5 flare nut wrench Long flat screw driver or other long and flat metal tool Engage the brakes on both of the UAM s front castors Remove the six screws from the lower rear panel Tilt the panel back and remove both hoses from the air filter by carefully pushing the orange plastic rings towards the filter and pulling the hoses away Rest the panel against the left side of the VAM being ca
27. r or pipeline if available NOTE If cylinder or pipeline do not deliver 100 O only calibrate on room air as described below in 15 a Using 100 cylinder pipeline oxygen set oxygen flowmeter to 6 L minute and wait for maximum reading on monitor b Press CAL then O then GO When the calibration is finished press EXIT twice c Turn off the oxygen Draw room air through the system with the bellows until the reading reaches its lowest value d Press CAL then AIR then GO When the calibration is finished press EXIT twice 16 Calibrate Apnea alarm pressure transducer as follows a Make sure flow meters are set to zero flow and reservoir bag is empty b Press CAL then PRESSURE CAL then GO When the calibration is finished press EXIT twice 17 Turn on oxygen concentrator using the black switch on the front of the machine Set the oxygen output to 6 liters per minute and ensure that oxygen reaches at least 90 to 95 output after a few minutes 18 If using nitrous oxide check the function of the Nitrous Oxide cut off at 25 oxygen concentration as follows a Set oxygen flow to 6 liters per minute b Set Nitrous Oxide flow to 4 liters per minute c Gradually turn down the oxygen flow to reduce FiO to 25 and lower nitrous oxide flow should cut off 19 Fill the vaporizer to maximum with correct anaesthetic agent See the directions in the User Manual WARNING Do not overfill the vaporizer Cover the oxygen sensor with a protectiv
28. r surges low voltage spikes Use voltage stabilizer gt Fault in local wiring or other device in or near the operating theatre Check other electrical devices in the operating theatre such as air conditioner sterilizer theatre lights Switch off all devices except UAM and switch on other devices at intervals one by one Oxygen concentrator does not turn on or a gt Blown 5A fuse noticeable hot smell Malfunctioning front switch gt Malfunctioning mains isolator switch Malfunctioning voltage switcher gt Malfunctioning oxygen concentrator circuit board gt Compressor failure Control screen does not turn on Blown 24V Power Supply Unit fuse 500mA gt Defective 24V Power Supply Unit gt Circuit board failure Oxygen monitor displays 104 at higher oxygen gt Oxygen sensor needs to be calibrated with 100 oxygen concentrations Oxygen sensor will not calibrate or monitor gt Oxygen sensor is exhausted and needs to be replaced readings are erratic gt Sensor cable is disconnected or broken Audible alarms not working gt Disconnected speaker connector gt Malfunctioning speaker gt Malfunctioning control screen circuit board Control screen shuts off when mains power is lost gt Battery needs recharging or is disconnected gt Battery has lost its capacity to charge and should be replaced N O does not cut off when oxygen percentage is gt Malfunctioning cut off solenoid valve less than 25 gt Malfunctioning control screen circu
29. re fitted and replace if damaged or missing 8 Connect the cylinders to the yokes and ensure that the cylinder pressure is indicated on the correct pressure gauge nitrous oxide and oxygen when turned on individually 9 Connect the machine pipeline hoses to the supply outlets wall outlet or bullnose cylinder regulator and ensure that pipeline pressure is indicated on the correct pressure gauge nitrous oxide and oxygen when connected and turned on individually 10 Turn on the oxygen and the nitrous oxide flowmeter control knobs using each gas supply concentrator cylinder and pipeline and ensure that the maximum flow of IOLPM is achieved for each gas 11 Close the flowmeter control knobs and ensure that the flow stops 12 Check that the emergency oxygen inlet functions by observing an increase of oxygen on the monitor N OXYGEN CALIBRATION SAFETY AND QUALITY CHECKS 13 Turn on the control screen and ensure that the vaporizer is off Turn on the oxygen cylinder or pipeline to provide 100 oxygen turn on a 6 liter flow and wait for the oxygen sensor to stabilize then press CAL Oxygen GO then wait then back to the main display If the oxygen sensor fails to calibrate or an oxygen sensor exhausted alarm is present replace the oxygen sensor NOTE For the most accurate performance over the entire range of possible oxygen concentrations the oxygen sensor must be calibrated with both 100 oxygen and 21 oxygen room air If 100 o
30. reful not to stress the cables connected to the panel With the nut wrench unscrew the nut on the ground post terminal on the bottom right of the panel to remove the ground wire connecting the panel to the concentrator Disconnect the concentrator power switch cable 4 wires 2 blue 1 yellow 1 red 7 Disconnect the white nylon tube going from the concentrator to the bottom of the regulator by carefully pushing up the orange plastic ring from the metal connector and pulling the tube down 8 Remove the 4 6mm hex screws surrounding the rectangular opening underneath the VAM 9 Push the top of the concentrator module tilting it towards the front of the VAM and with a very large flat screwdriver or another hard flat tool separate the bottom of the concentrator from the bottom surface of the UAM s interior 10 Once the concentrator is separated from the base lift it and pull it towards you and letting it rest on the back edge of the bottom surface of the VAM being careful not to pull on the concentrator monitor and LED indicator panel cables 11 Disconnect the concentrator monitor cable and LED indicator panel cable 12 Lift and lower the concentrator module to the floor right behind the UAM 24 INSTALLING THE CONCENTRATOR Materials and tools required gt Bun 8 9 10 11 12 6 mm Allen key 3 mm Allen key 5 flare nut wrench Lift up and balance the concentrator on the rim of the chassis
31. rous Oxide Flow Meters a Air inlet valve b Pressure relief valve c Reservoir bag Oxygen concentrator on off switch Oxygen cylinder and pipeline pressure gauges Nitrous Oxide cylinder and pipeline gauges Oxygen sensor Bellows Pressure relief gauge Y piece connectors Fenton Balloon inflating valve Pressure relief valve Y piece connectors Fenton Balloon inflating valve Water trap Fenton Balloon Inflating Valve One Way Valve and scavenging 30mm taper connection Percent Oxygen shows the oxygen percentage of the anaesthetic gas measured before inspiration THE CONTROL SCREEN Battery charge status Calibration settings to calibrate oxygen sensor and apnea alarm FK High oxygen percentage 96 HIGH alarm user adjusted 1 Mode opens screen for system settings OXYGEN LOW Low oxygen percentage alarm user adjusted Message Area Apnoea alarm on off Mains power indicator machine is on mains power supply 10 Pin indexed connectors for E size oxygen and nitrous oxide cylinders Oxygen inlet Pipeline connections for oxygen and nitrous oxide Mains isolator Power On Off Fuses for oxygen monitor oxygen concentrator British style fused 3 pin plugs UNPACKING THE UAM AND PREPARING FOR USE 1 Remove front panel from the crate and remove the internal wooden crossbeam If applicable remove the vital signs monitor box and set it
32. up to 10 liters per minute of up to 95 oxygen The oxygen then travels through the flow meter into the back bar and reservoir bag GAS FLOW IN THE PATIENT SYSTEM The flow meter controls the amount of oxygen entering the back bar and available for the patient The spinning bobbin shows the flow rate in liters per minute The back bar provides the following functions 1 The reservoir bag stores up to 2 liters of oxygen 2 The pressure relief valve limits pressure in the back bar to 5 centimetres of water protecting the patient from harm 3 The air inlet valve allows room air to be drawn in whenever the supply of oxygen is less than the demand as expressed by the patient s minute volume The low resistance draw over vaporizer adds volatile agent to the carrier gas passing through it Volatile agent is added by using the selector wheel to achieve the desired percentage The resulting anaesthetic supply gas is comprised of oxygen volatile agent and a variable amount of room air The anaesthetic supply gas flows from the back bar at low pressure to the breathing block and the bellows An oxygen monitor measures the oxygen concentration of the supply gas passing to the patient The reading is displayed on the control screen As the supply gas flows from the oxygen sensor it passes the first one way valve then the bellows chamber followed by the second one way valve During spontaneous breathing both non return valves open for inspiratio
33. ure that it comes off as one piece Make sure that the O ring above does not fall down 2 With fingers on the neck of the balloon carefully peel off the balloon from its mounting 3 With a small amount of moisture on the neck slide the new balloon on to its mounting and move it up so that the top ring locates in the groove on the mounting 4 Replace the tube assembly unit taking care not to catch the balloon in the screw threads Use a rotating action to make sure the balloon is fully visible inside the tube before locating the screw threads REPLACING THE CONTROL SCREEN CIRCUIT BOARD Materials and tools required E 4 mm Allen key 2 5 mm Allen key Long nose pliers Switch off mains power Remove the six monitor shelf retaining screws and washers using a 4 mm Allen key and lift off the monitor shelf Disconnect the oxygen sensor cable note that the clip must be squeezed in to disconnect Pull off the silicon tube from the pressure transducer do not put any stress on the transducer support the body and use a slight twisting action Disconnect the 4 way power supply connector note that the clip must be squeezed in to disconnect Disconnect the speaker connector pull connector body out with long nose pliers do not pull on cable Disconnect the solenoid connector pull connector body out with long nose pliers do not pull on cable Remove the two screen securing screws using a 2 5 mm Allen key Slide screen up to rem
34. wing formula FROM units X MULTIPLIER TO units Example 100 psi x 6 894757 689 475 kPa DESIGNATION PSI KPA CM OF H20 BAR PSI B 1 B 6 894757 70 306927 06894757 KPA 1450377 1 10 19745 01 OF H20 u 0142229 0980634 1 O00980634 BAR 14 5038 100 1019 7466 1 42 COLOR IDENTIFICATION FOR MEDICAL GASES GAS OXYGEN NITROUS OXIDE MEDICAL AIR SUCTION 44 NOTES Gradian gt Systems Gradian Health Systems 160 Fifth Avenue 7th Floor New York NY 10010 USA gradianhealth org email service gradianhealth org tel 1 212 537 0340
35. xygen is not available then the cell should at least be calibrated with 21 oxygen If the sensor has not been calibrated at 100 oxygen then the monitor will display 104 at higher oxygen concentrations Calibrating the cell at 100 oxygen can clear this condition NOTE The oxygen sensor will need to be replaced approximately every 12 months An alarm will indicate when the oxygen sensor is exhausted 14 With the oxygen turned off cycle the bellows to draw in air wait for the oxygen sensor to stabilize then press CAL AIR GO then wait then press EXIT to go to the main display If the sensor fails to calibrate and a oxygen sensor exhausted alarm is present replace the oxygen sensor 15 Check that the upper and lower alarms can be adjusted and that they function this is achieved by turning up the oxygen supply to exceed the high alarm or increasing the entrained air to fall below the lower alarm 16 Increase the nitrous oxide flow and ensure that it cuts off when the oxygen concentration is 25 or lower 17 Disconnect the oxygen sensor mounted by the bellows ensure that the disconnect alarm sounds and that nitrous oxide if fitted turns off 18 Set a 6 liter flow from the oxygen concentrator and ensure that the output stabilizes at 90 96 oxygen concentration increase the flow rate to 10 liters per minute and ensure that the output remains at 90 or better If the output concentration is low check the filter condition and replace it
36. y backup trickle recharge from mains power gt Membrane keypad and touch screen OPTIONAL USE OF NITROUS OXIDE gt Sources pipeline or cylinder Hypoxic cut off A solenoid automatically shuts off nitrous oxide delivery if supply gas O level falls below a minimum of 25 gt Flow of N O stops if electrical power fails gt Sight and touch differentiated flow control knob per ISO standards gt Accuracy of glass rotameter for N O 2 596 VENTILATION gt Bellows for adult and paediatric use made from durable long lasting silicone rubber gt 1600cc capacity gt Inspiratory pressure relief of 55 cmH O for pressure created during mechanical ventilation gt Aluminium bellows block gt Silicone balloon inflating valve at the expiratory port gt 15mm female 22mm male ISO standard taper connection for breathing circuit 30mm male ISO standard taper connection for AGSS scavenging equipment VAPORIZERS gt Stainless steel and plated brass construction gt Draw over flow type gt Pour filler type gt Separate units for isoflurane and halothane per ISO standards gt Agent delivery range 0 5 to 4 gt 120ml capacity gt Performance 4 5 4 3 5 3 4 2 5 1 DA qe se 1 1 De u s e S S a u e bod sd s ul so en M 5 AUD terroren O ALPM 5LPM 6LPM BSLPM TYPICAL HALOTHANE VAPORIZER PERFORMANCE WITH FLOW 4 5 eee ese eee AO DOO OD GOD DNO OD e
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