1. Turn on the Pumani CPAP. - Rice 360˚ Institute for Global health
Contents
1. Tubing correctly attached to the pump outlet Pump Repair Step 1 You should have 4 Unscrew and remove the 4 screws surrounding tubes 4 screws the pumps using a Phillips head screwdriver and 4 washers 41 Pump Repair Step 2 42 Turn the pump upside down Unscrew the 4 screws on the bottom of the pump using a flathead screwdriver Pump Repair Step 3 43 Separate the mounting bracket from the pump base Pump Repair Step 4 Separate the pump base from the pump housing 44 Pump Repair Step 5 Once the pump is open check the following Apply glue under the screw head and tighten the center screw Is the center screw loose Inspect the diaphragms and replace any diaphragms which appear broken or worn If gasket is loose push the gasket back into the hole If the leg holding the Are the diaphragms damaged Are the gaskets loose or broken gasket breaks replace the pump 45 46 Pump Repair Step 6 To replace a broken diaphragm remove the nut securing the broken diaphragm to the lever arm and rotate the lever arm away from the diaphragm Do NOT remove the center screw Pump Repair Step 7 Record work done PUMANI UNIT SERVICE LOG ay Fu Remove the broken diaphragm and replace it with a new diaphragm Record all work done in the Pumani Unit Service Log in the spare parts kit and on the maintenance label on2. rd Stone lign G RICE For questions concerning the Pumani bCPAP Design and Manufacture in partnership with 3 d Stone Design 3 d Stone Design LLC 30 Castro Ave San Rafael CA 94901 1 415 454 3005 info 3rdstonedesign com www 3rdstonedesign com This manual is made possible through the generous support of the Saving Lives at Birth partners the United States Agency for International Development USAID the Government of Norway the Bill amp Melinda Gates Foundation Grand Challenges Canada and UK Aid It was prepared by William Marsh Rice University and does not necessarily reflect the views of the Saving Lives at Birth Partners DCO 038 3 378 Pumani CPAP User Manual Rev B
3. not tight on the patient s head patient s head Remove the hat and replace the hat with a new hat 31 Part V Disinfection Instructions Instructions for Disinfection After each use 33 L oe EE Place patient on 2 L of oxygen turn off the Pumani CPAP and place elastics and pins in the storage cabinet Throw away the hat and OG tube Disconnect bottle tubing patient tubing prongs and bottle Throw away the water in the bottle Soak the bottle tubing patient tubing prongs bottle and lid in a 0 596 bleach solution for 10 minutes or follow your hospital s standard disinfection procedures Bleaching time should not exceed one hour Rinse all bleached components under clean water hang tubing to dry and leave bottle and prongs out to dry Clean oxygen concentrator filter on the back of the concentrator by removing debris and thoroughly rinsing under water Part VI Troubleshooting Pumani CPAP Troubleshooting Problem Possiblecause Solution The Pumani CPAP does not have power er P ohne vr MO The Pumani CPAP in and that the outlet is switched on does not turn on anew enamine Gant E Turn switch to on position A red light P should be lit when the Pumani CPAP is on Water does not The bottle tubing and patient tubing are Correctly connect tubing Connectors should bubble when not correctly connected snap into place cover the prongs i i P 8 ee ee NUR MAS Slightly increase
4. the back of the machine 47 To reassemble the pump repeat steps 1 6 in reverse order Appendix A Setting the Flows for a Specific Percent Oxygen Delivered to Patient 1 Find the column with the chosen blended flow rate to deliver to the patient known as the Blended Flow Rate L min 2 Find the row with the chosen Percent Oxygen Delivered to Patient 96 3 The table value where the chosen column and row meet is your An Example Setting is shown in the table to the right A patient requires a Blended Flow Rate of 8 L min and an Oxygen Concentration of 50 Therefore an should be delivered to the patient 48 4 f BILL MELINDA USAID EJ P4 ROM THE AMERICAN PEOR E o ORWEGIAN MINISTRY S foundation OF FOREIGN AFFAIRS GAI I i For questions concerning the Pumani bCPAP Clinical Evaluation and Implementation in Malawi College of Medicine University of Malawi Private Bag 360 Blantyre 3 Malawi Clinical inquiries contact local ARI coordinator or K Kawaza 0992217282 Technical inquiries Shannon O Neill 4265 994174276 amp MK Quinn 265 996458336 Grand Challenges Canada Grands D fis Canada UKaid For questions concerning the Pumani bCPAP Development as part of the Rice 360 Institute for Global Health Technologies Rice 360 Institute for Global Health Technologies 6500 Main St MS636 Houston TX 77005 1 713 348 4549 rice360 rice edu www rice360 rice edu
5. wait for the The patient has not settled patient to settle This may take a few minutes Part VII Pumani CPAP Repair Instructions Opening the Pumani CPAP Unscrew and remove the 6 screws around the top of the CPAP using an Allen wrench Remove the bottle tube Pull the lid of the CPAP away from the machine 38 Spare Kit Bag Contents The Spare Kit Bag found on the back left wall of the Pumani CPAP contains Spare kit bag Two packages of diaphragm sets 4 diaphragms total 3 One small black zip tie 4 One white zip tie 5 Bottle tubing 6 Iwo screws 7 Two bottle tubing connectors 8 Pumani Unit Service Log 39 Pump Troubleshooting 40 With the lid removed reattach the bottle tubing Turn on the Pumani CPAP and set the flow as close to 10 L min as possible Inside of the Pumani CPAP check that the tubing is attached to all pump outlets and that the outlets are intact not broken e If the tubing is not attached reattach it e If the tubing and the white connector have come off the pump reglue the connector to the pump outlet e fthe pump outlet has broken off replace the pump Pinch the tubing to block air flow from each of the two pumps one at a time e If the flow decreases by half when the flow from one pump is blocked the blocked pump is operating properly e If the flow does not change when the flow from one pump is blocked the pump is broken Go to Repair Step 1
6. Pumani CPAP User Manual SEER rrr res la e some oes ie LF ocre me m ee RTS he Lg P AA PA OM PGE zm CTO a hase qn OORT pour c wn css IT P4 rrr ar p Ur PAL LATE 2127 PAL p FA we a FOATILIT n Grand Cha enges C anada D d anada UK GA 57 Grands D fis i 1 MINISTRY LIAL i EOPLE OF FOREIGN AFFAIRS FROM THE AMERICAN PEOPL SS US Baylor College of Medicine BCM e RICE Introduction Respiratory failure is a leading cause of neonatal mortality in the developing world Bubble continuous positive airway pressure bCPAP is a safe effective intervention for infants with respiratory distress and is widely used in developed countries The Pumani bCPAP is a low cost easy to use easy to repair device to treat infants in respiratory distress and it has been designed specifically to operate in low resource settings Clinical results show that use of the Pumani bCPAP can significantly reduce neonatal mortality in low resource settings The Pumani bCPAP has been developed at the Rice 360 Institute for Global Health Technologies at Rice University in Houston TX in partnership with Queen Elizabeth Central Hospital and the College of Medicine in Blantyre Malawi the Malawi Ministry of Health Baylor College of Medicine and Texas Children s Hospital in Houston TX and 3 Stone Design in San Rafael CA Table of Contents Part How to Assemble the Pumani CPAP 4 Pumani CPAP Components 5 Assembly I
7. easurement Insert the OG tube in the mouth to this depth Check that the OG tube is in the stomach by placing the end of the tubing in water If it does not bubble it is in the correct place You can also aspirate the OG tube with a syringe to check for stomach contents Tape the OG tube to the chin Note if the abdomen is distended consider aspirating the tube with a syringe Part Ill How to Attach the Baby to the Pumani CPAP Prongs amp Hat Components 2 Elastics 4 Safety Pins Stockinette Prongs connected to the CPAP 21 Step 1 Making the Hat Stockinette Stockinette Length Width Hat Size 1 em Qn 66 em 26 im 71 em 28 in 1 Select hat size based on size of the patient s head 2 Measure length and cut stockinette 3 Twist stockinette in the middle 4 Pull one half of the stockinette over the other half 5 Fold bottom edge 3 times to make a 22 5 cm brim Step 2 Placing the Hat on the Patient 1 Place hat on the patient Make sure that the hat fits tightly to prevent the prongs from moving e The back of the hat should be low near the baby s neck e Hat may need to be replaced at least every 24 hours to keep a tight fit on the baby s head 23 Step 3 Inserting the Prongs Turn on the Pumani CPAP Make sure the flows are still set correctly 3 Add saline drops in the nose Place the prongs into the nose There should be a cm space between the pr
8. not need oxygen Do not connect the oxygen concentrator Close the oxygen flow meter Step 10 Determining Oxygen Flow and Blended Flow Most patients will start at the same settings DE Concentrator Flow Oxygen Flow Blended Flow 1 2 3 Set the concentrator gt then the oxygen flow gt then the blended flow 15 For a larger range of flow options see Appendix A Step 11 Checking the Bubbling Function 16 1 Cover the prongs Water in the bottle should bubble 2 Remove fingers from prongs Bubbling should stop 3 If the bubbling does not start or stop refer to the Pumani CPAP troubleshooting page 35 4 Turn the Pumani CPAP off and continue to Part Il How to Prepare the Baby for CPAP 17 Part Il How to Prepare the Baby for CPAP Step 1 Suctioning the Nose amp Mouth 18 Measure from the nose to the ear and halfway back to determine suction depth of the nose For example if the distance is 6 cm the depth should be 9 cm 643 9 Briefly remove the O tube from the nose Put a drop of saline in one nostril insert the tube to the determined depth then cover the suction port as you pull out the suction tube Repeat in the other nostril 4 Place the O tube back into the nose Suction the mouth Step 2 Inserting the OG Tube 19 e N e UT Measure from the mouth to the ear and then to the bottom of the sternum Make note of the m
9. nstructions 6 16 Part Il How to Prepare the Baby for CPAP 17 Part Ill How to Attach the Baby to the Pumani CPAP 20 Prong amp Hat Components 21 Attachment Instructions 22 27 Part IV How to Monitor the Baby 28 Part V Disinfection Instructions 32 Part VI Troubleshooting 34 Pumani CPAP Troubleshooting 35 Prong Troubleshooting 36 Part VII Pumani CPAP Repair Instructions 37 Appendix A Setting the Flows for a Specific Percent O 48 Part How to Assemble the Pumani CPAP Pumani CPAP Components Patient Tubing Port Bottle Tubing Port Pumani Oxygen Flow Meter CHEESE Blended Flow Meter 15 2 Bottle Strap Bottle and Lid Oxygen Port Power Switch Patient Tubing Elbow Connector Nasal Prongs Bottle Tubing Power Cord eoe oe m YS eere W Ne O Step 1 Filling and Connecting the Bottle 1 Fill bottle with water and attach 2 Place bottle into bottle strap the lid to the bottle and connect the bottle tubing Most patients start at 6 cm to the bottle and to the of water pressure Pumani CPAP machine Step 2 Connecting the Patient Tubing Connect the patient tubing to the Pumani CPAP at the patient tubing port Step 3 Determining Prong Size Weight Range Hudson Prong Size 1 Use the patient s weight as a guide to choose the prong size 2 The prong size is located between the nasal prongs You can use the prong size guide on the next page to determine the prong size Step 4 P
10. ongs and the nose Donotuse creams or ointments as these can cause breakdown of the tissue and block the prongs 24 Step 4 Attaching the Safety Pins 1 Hold the prongs on the hat you can mark on the hat where the pins should be placed Make sure the prongs stay in the nose 2 Important place fingers under the brim of the hat to maintain space between the hat and the head when placing the safety pins 3 Insert two safety pins through each side of the hat e Keep the sharp end of the pin away from the patient s face Donot put the pins all the way through to the baby s head 25 e The pins should never be in contact with the patient Step 5 Attaching the Prongs 1 Hold the tubing between the pins 2 Wrap the elastic over one pin across the tubing and over the other pin 3 Wrap the other elastic over the 2 pins on the other side of the hat 26 Step 6 Check the Prongs This is how the prongs should appear once they are attached Hat Patient Tubing Safety Pins Elastic du cm space between the prongs and the nose Prongs 27 Part IV How to Monitor the Baby Checking the Respiratory Rate 1 Once the patient is settled on the Pumani CPAP the respiratory rate should be measured 2 To measure the respiratory rate Uncover the patient s abdomen so you can view the chest Pressthe respiratory rate timer to start the 60 second count e As soon as you press the timer begin c
11. ounting the patient s breaths The timer will beep once after 30 seconds do not stop counting When the timer beeps twice stop counting Record the respiratory rate 29 Checking the Oxygen Saturation 1 Once the patient is settled on the Pumani CPAP the oxygen saturation should be checked with a pulse oximeter 2 Place the pulse ox probe on the patient Forsmaller babies wrap the probe around the palm of the baby s hand Forlarger babies place the finger probe on the patient s finger 3 Turn the pulse oximeter on 4 Watch the waveform for 1 2 minutes until it looks constant Good Waveform Bad Waveform DEVON DEVON Spie 11142188 PR eJ um 95 106 5 Record the oxygen saturation and heart rate 6 If the oxygen saturation is 9096 increase the oxygen flow rate by 1 L min Patient Monitoring Checklist If the power is NOT on Remove the prongs immediately Place the patient on oxygen TUE nul If possible take the Pumani CPAP to a ward with power Document how long the patient was off CPAP and how long the patient was on oxygen Pe ee See a If the patient s nostrils are not moist Place saline drops in the patient s nostrils If the prongs are not in the patient s nose Are the prongs in the Re insert the prongs into the patient s nose patient s nose You may need to reposition the hat pins or elastics to keep the prongs in place Is the hat tight on the If the hat is
12. rong Size Guide Place the nasal prongs on the pictures to determine the prong size Step 5 Checking Prong Size Curved side down TA 10 1 Check the prong size by placing the prongs in the patient s nose e The prongs should be placed curved side down as shown The prongs should completely fill each nostril Immediately remove the prongs 2 If the nostrils are not completely filled air will leak and the patient will not get the necessary pressure You will need to replace the prongs with the next largest prong size Step 6 Connecting the Prongs Patient Tubing Elbow Connector 1 Connect the elbow connector 2 Connect the other side of the to one side of the prongs prongs to the patient tubing 11 Step 7 Checking the Pumani CPAP Assembly Make sure all of the CPAP components are properly assembled 1 Patient Tubing 2 Bottle Tubing 3 Bottle and Lid 4 Prongs 12 Step 8 Turning the Pumani CPAP On 1 Connect the power cord to the 2 Turn on the Pumani CPAP back of the Pumani CPAP and power switch A red light to an electrical outlet should be lit when the Pumani CPAP is on 13 Step 9 Attaching the Oxygen Concentrator If the patient needs oxygen 1 Open the oxygen flow meter on the Pumani CPAP 2 Attach tubing from the oxygen concentrator to the O port Make sure the oxygen concentrator is turned on Pumani bCPAP If the patient does
13. the blended flow until the with my fingers water starts to bubble bubbl Tuo CINES Check for and resolve any pinches or blocks Water bubbles pinched or blocked yP ee ee lightly d he blended fl il th are uncovered The blended flow is too high PUB URGE SHE a EL water stops bubbling connected Make sure the concentrator is plugged in turned on and the nozzle is completely attached There is no O flow The concentrator is improperly connected 35 Prong Troubleshooting Water does not The prongs are too small Replace the prongs with a larger size bubble when the The prongs are positioned incorrectly Reposition the prongs prongs are ae ly cl h hf f placed in the Air is leaking out of the mouth ene een ees were i airway moments to encourage nose breathing The prongs are too small Replace the prongs with a larger size The Prone do The hat is stretched out or too large Replace the hat with a new or smaller hat not stay in the nose The pins are improperly aligned Realign the pins Th he hat is i iei LL AREARE Reposition the tubing on the hat positioned The prongs are too small or are pinching WM Replace the prongs with a larger size on the patient s septum Increase space between the prongs and the septum Consider replacing the prongs with a larger size The patient does The prongs are pushing up against the not tolerate the septum prongs After the prongs are placed
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