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Tafonius Software Manual

1. Leak Compliance Lanquage User Manual Ui C Demo Mode Exit Windows Event Viewer Resolve Resolve All System Tab The System tab contains buttons for System Errors Leak Compliance test settings Language and User Manual options Currently the Language is set to English only Other language options will become available in due course The User Manual button also presents options which at the time of writing are not yet available System Errors Any error or fault condition that occurs in the Tafonius software is reported in this System Errors list An error is indicated by the flashing of the border of the System button in red and an audible alarm The purpose of the list is to indicate the source of an unexpected alarm or fault condition and to assist with trouble shooting Some errors are transient and will self clear in which case no action is Printed 10 Mar 09 Page 16 of 61 DOCA4941B USING THE TafoniusS SOFTWARE necessary Some errors will not self clear or will remain for example after a device has been removed In these instances select the error and then click or touch on the Resolve button If the error is no longer present then it is resolved and disappears from the list Windows Event Viewer This is reserved for use as a trouble shooting tool A field service engineer or someone from technical support may ask you to use this button to view any error sequences that have arisen during the use of Tafonius Do
2. Recover Anaesthetic Records Touching or clicking this button will create a new Anaesthetic Record chart if the original has been destroyed or corrupted for some reason Company Name Enter your practice or company name here This will appear on the Tafonius shell as well as at the top of the Anaesthetic Record chart Shutdown This will shut down the PC and put the PC in an off condition The PC can be started again by either turning on the Tafonius ventilator or by pressing the large ON OFF button on the side of the PC Printed 10 Mar 09 Page 59 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Appendix A SLOW DATA INFORMATION Monitoring data recorded in the Slow Data File includes the following User control settings CPAP PEEP Maximum PEEP or CPAP reading cm H20 Set Tidal Volume L Compliance compensated tidal volume L Respiratory Rate breaths per minute Inspiratory Time in milliseconds Inspiratory Pause time in milliseconds Resultant parameters calculated from user settings MV Flow 1 E Ratio Exp Time Measured during Standby TV Insp Time Exp Time Minute Volume L Inspiratory Flow L min Inspiratory Expiratory ratio Expiratory time in milliseconds Spontaneous breath Tidal Volume in mls Inspiratory time in ms Expiratory time in ms Resultant parameters calculated from MEASURED values during Standby RR MV Iflow 1 E Ratio Airway Pressure Measurements CPAP PEEP PIP Gas analysis Measureme
3. By default when the software is started details appear for a patient called Anonymous with a patient ID of 000000 The green arrow next to the patient name shows that these patient details are in use Patient details cannot be deleted if they are in use you must first select another patient Touching or clicking the New button opens the Patient details tab ready for new patient information To change patients click or touch the patient name or ID and then click or touch the Select button The selected patient information is then used for the current recording session When the monitoring recording session is finalised the Patient details in use at that time will be the ones used to create the recording files During the Finalising procedure a dialog box will appear to check that the Patient details to be saved are correct The patient name and ID is always shown at the bottom of the Tafonius screen Click or touch either of these two screen areas to open the Patient attribute dialog Printed 10 Mar 09 Page 10 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Data Logging Tab In this tab the options for Slow Data Recording and Anaesthetic Record chart heart rate can be set Because Tafonius has 3 means of monitoring heart rate ECG IBP amp Pulse Ox it is necessary to select one to be used for the Anaesthetic Record chart Unless you have specific reasons for changing the Slow Data Logging time leave this set at 5 seconds For Anaesthesia
4. T1 T2 Delta Close For a detailed description of how traces are managed and moved around the screen see the section entitled Adding and Removing Traces atthe start of the section above Printed 10 Mar 09 Page 50 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Alarms Alerts and Critical Error Messages Printed 10 Mar 09 Page 51 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Creating an Anaesthetic Record Chart The Tafonius software creates an automatic record that can be viewed as an Anaesthetic Record Chart Every 5 minutes monitoring data is recorded and entered on the chart in a similar manner to a manual record Information about the patient surgeon anaesthetist and other details can all be recorded All non clinical information is entered via the Patient Data button This process is covered fully in the section entitled Entering Initial Patient Information During a patient Session there are effectively two recorded sets of data One set of data is saved as the Slow Data file This records periodically default is every 5 seconds all of the information relating to the running of Tafonius For a more details explanation of the Slow Data files see the section entitled Data Recording using the Slow Data File The other set of data is data saved as the Anaesthetic Record file This file consists of data saved every 5 minutes as plotted or tabled data as well as header information such as name of Anaesthetist o
5. 50 mm sec Notch gt 100 mm sec ECG 200 mm sec IBP Heart Rate Close Synchronise O Beep On ECG Trace options ECG Sensitivity controls the height of the ECG trace seen on the screen Sweep Controls the screen sweep speed in rates of mm second Filter Allows the setting of a digital filter to remove unwanted signal noise Use a notch filter for mains interference Use a Low pass filter for tremors due to movement e g shivering Move the slider in the Filter box to control the degree of filtering Shift Shifts the base line of the ECG up and down the screen Use the shift option to centralise the ECG for optimum viewing Heart Rate Select the box next to Beep on ECG to produce an audible beep with every detected ECG complex Since Tafonius only has one audio output device only one monitor can be made to beep at any time Selecting ECG for example will mean that any previous selection is overridden To change between ECG and IBP attributes touch the appropriate radio button at the left hand side of the ECG IBP tab Select ECG IBP Synchronise Synchronising the ECG and IBP waveforms ECG and IBP waveforms can be synchronised in time as long as they have the same trace width on the screen Normally they would be placed one above the other so that a visual association between the Printed 10 Mar 09 Page 40 of 61 DOCA4941B USING THE TafoniuS SOFTWARE two traces can be made If the two trac
6. Page 7 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Entering initial patient information Touch the Patient Data button om oe Om Configure Events A new window appears in the information area Hospital Number Species Unknown Patient Name Anonymous Breed Type Sener Name Age oly Olm Patient ID PID 111111 Sex i Weight 0 Kg Close Enter the Hospital Number if used and then use the tab key to move to the next data entry field Fields that take numerical data entry will bring up the small on screen numerical key pad which can be used instead of a keyboard By default the patient s name is Anonymous Edit this to enter your own patient s name When the details have been entered touch the At Presentation tab Anaesthetist M Ica RR Surgeon Ea PCY Procedure l k TP CRT 1 Fasted Pant st M BUN O Yes No O Yes No MM Pink Pulse Anesthetic Risk Status Temp 2 63 4 65 FE Fahrenheit Celcius Fill in the procedure details along with the rest of the presenting clinical information Printed 10 Mar 09 Page 8 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Entries can be left blank The Anaesthetist Surgeon and Procedure fields are used when an Anaesthetic Record chart is produced The Anaesthetist Surgeon and Procedure entries
7. USING THE TafoniuS SOFTWARE The Patient Data button Entering patient data has been described under the section Entering Initial Patient Information This covers the Patient Details and At Presentation tabs found once the Patient Data button is pressed Also found here are the Data Logging and Data View tabs Data Logging All physiological data and many automatic events are recorded in a file called the Slow Data SD file How often data is entered in this SD file is dictated by the setting in the Data Logging tab The default value is 5 seconds A range between 1 second and several minutes can be entered Some natural events such as inspiration and expiration can be entered into the SD file This however can fill the file with information that may not necessarily be required Spontaneous breaths or ventilated breaths can be selected or deselected for entry in the SD file by checking or un checking the respective tick boxes The time that a particular recording session began and its duration are also shown in this tab Finalise Recording As soon as the Tafonius software starts data is recorded in the SD file When a patient session is ended the recording should be finalised To do this push on the Finalise Recording button A dialog box may appear asking to save the current Preset see the section on User Presets and then a further dialog box will appear stating that the data will be committed and
8. 0 3 6 9 Inspired Expired BPM C02 Oo The larger figure represents the expired value and the smaller figure shows the inspired value The third value to the right is the respiratory rate in breaths per minute If a period of apnoea occurs then the alarm will sound and the respiratory rate will be replaced by a red box which displays the number of seconds elapsed since the last breath 0 CO2 APNOEA 0 0 Inspired Expired Gii C02 o Printed 10 Mar 09 Page 33 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Clicking or touching this red box will silence the Apnoea alarm The box will remain red and continue to count the seconds since the last recorded breath A fresh breath will clear the Apnoea state and return to displaying Respiratory Rate RR During periods of Apnoea the inspired values are constantly updated indicating the gas concentrations in the breathing circuit Printed 10 Mar 09 Page 34 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Other Control buttons Alarm Silence amp Freeze Traces Alarm Silence Press the button once for a 5 second silence of all alarms After 5 seconds the alarms if active will again sound Press and hold the Alarm Silence button until it shows the legend Locked The audio portion of all current alarms are then suppressed Any new alarm condition will override the locked out condition and again sound the alarm Freeze T
9. 25 mm sec Sytem Heel Lowpass i 50 mm sec O Notch 100 mm sec Push to Configure A 200 mm sec g Ventilate Select ECG IBP Heart Rate Synchronise Beep On ECG Events Help USING THE TafoniusS SOFTWARE Before the Tafonius software can be used to control the ventilator the ventilator needs to be initialised This initialisation process is covered in the section Getting Started with Tafonius Once initialised there are some common steps to take when preparing for a patient Pre filling the system Entering patient information Choosing a Preset Starting a Session cadence secdedeads cendcedactenccevedaatacasutsschdacauedsdateisesetsecic dng MMe ntbscduedsaessGeduededsudusaduGunscizesdesde 6 The Finalise Recording ProCedure ceeecceseeeeeseeeeeeeseneeseseneeeeaseececeeeeeeeeeenneeeeseeeeceeeneeeeeseeeeeneeneeseeeees 7 Entering initial patient information c cess eeseeeeeeeeeeeeneeee ee seneeseeeeeeeeeneeeeeeseeeeseseeeeeseseeeesneeneeseeeeeseenes 8 The Ventilator CONtIOIS ssssssosonnsssnunnnuunnnnennnn nn Monte sdadsreetsadavenececsanenucienuanes MMMM senn nananana nae 12 Tidal Volume ee ee aaaeeeaa O aana naaaa 13 Respiratory Rate aesseeesssssssirerrrrerrinensesenorrrnereeee oe sae a eccestateese 13 Inspiratory TMC 2 2 ccccccccce eee imme cence ence teen R cere ee eens nee enaseeeeeseeenseneaaneeseneeeenneeaeen
10. Arterial Pressure To set any alarm value click or touch the associated edit box The numerical keypad will appear on the right of the screen Use this or the main keyboard to enter the numerical value and then click or touch Enter Heart Rate Upper and lower alarm values can be set for the heart rate and these can be independently enabled by touching or clicking the Enable box next to the appropriate Alarm edit box Systolic Set high and low limits for the systolic blood pressure value High and Low alarms can be independently enabled Diastolic Set high and low limits for the diasystolic blood pressure value High and Low alarms can be independently enabled Mean Arterial Pressure Set high and low limits for the mean arterial blood pressure value High and Low alarms can be independently enabled Printed 10 Mar 09 Page 42 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The CO2 Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Slow Fast Properties Units Trace Scale Yolume Line 0 10 o Beep On O mmHg Filled O 0 20 O kPa Close Properties Units Set the displayed units as Volume millimetres of mercury mmHg or as kilopascals kPa When units are changed there is an automatic change in the units applied to alarms so that the corresponding value in the new units is used Trace Select whether to display the Capnogram as a filled trace or as a simple line curve Scale Fixes the
11. ECG IBP Attribute tab icc die erie Co ee a ea eee dee 40 The CO2 Attribute tab cnet sascha ee cre crete ceded ce aettes epipecmen ca a tcee doe EAEE EA anie eelenaenedad 43 The Airway Pressure AP Attribute tab 0 0ccccccccccccesecneeceeeeceneeeeeeeseceeaeeeeeesesnsueeeeeeeeees 44 The Oxygen Attribute tab 20 5 2 seek aii ec eed ees ieee 45 Printed 10 Mar 09 Page 3 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The SPO2 Attributeitab sicicice cco delice decal hed deeded vanced Woeavnd evodlinsaeh ade Meade eens 46 The Agent Attribute tab 3 csici isccedes cose beves ed deb oe labia dahon estan eE aaae 47 The N20 Attribute tab sci cisceetiveecs siete ei as iid stdin Fi eA el ied 48 The Temperature Attribute tab 0 0 cccccccccceceececeeceeeeeeeeeeeaeeeeeeeeeneeeeeeseeseneeaeeeeeesesnnieeeeeeenees 49 The Traces Trends Attribute tab ci ccccccccccceeeecessseueeeeeeseeeeeseeueeeeeeseeueeeeeeseeeneneeeseds 50 Alarms Alerts and Critical Error Messages cccscecssseeeeeseenesseeeeeeseeeeesneeeeeeseeeesaseneeeesseeeeenseneeeneene 51 Creating an Anaesthetic Record Chart 0 cccccccecceceeeeseeceeneeecenneeestnneeeeseeeeeeseaeeeeenneeeeseeeeeneaas 52 Altering the Start Time of the Anaesthetic Record chart 00 0 ccccccecccceeeeeesetteeeeeeeees 52 Viewing the Anaesthetic Record chatt 22 ccccccccccecceceeeeensneceeeeteseaaeceesecnecneaeeesestessaeeeeeneeneaas 52 Data Recording
12. Mode Pulse Ox AA p N O SPO2 ISO Ef fee Inspired Expired Inspired Expired Pulse 82 Tidal Volume Respiratory Rate Inspiratory Time Minute Volume Inspiratory Flow IE Ratio Expiratory Time 0 0 1 0 0 50 litres 150 litres minute 1 2 8 seconds AIC Off g Batt Gili Batt2 Gi PID 000001 Patient Name Anonymous 16 September 2008 16 17 42 ECG IBP bpm CO2 ma RR 3 a 11 Inspired Expired BPM AP cmH20 O o Oxygen 15 Inspired Expired Alarm Silence Freeze Traces Patient Data a ae Push to ventilate Help The trace region is centralised on the screen and in the picture above contains the ECG CO2 Airway Pressure and Pulse Oximetry trace This area can be organised as required by placing any trace or combination of traces here The trace region itself is divided into three horizontal areas each of which is one trace high It is possible to place a trace in any of these 3 horizontal areas Additionally it is possible to have multiple traces in any one of these horizontal areas Printed 10 Mar 09 Page 37 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Adding and Removing Traces To change the trace screen viewing options touch any trace A new editing box appears at the bottom of the screen ECG IBP CO2 AP Oxygen SpO2 Agent N20 Temp Traces Trends C02 Selected Drag and Drop or click the
13. Record Slow Data Logging sec Log Heart Rate From Time ECG Start 14 27 55 Elapsed 00 04 14 O IBP O Record Spontaneous Breaths O Pulse ox Record Yentilated Breaths Anaesthetic Record Start Finalise Recording When all the patient information has been entered click or touch the Close button Printed 10 Mar 09 Page 11 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The Ventilator controls The ventilator controls consist of Tidal Volume Respiratory Rate Inspiratory Time Maximum Working Pressure Limit and a CPAP or PEEP setting These are the only controls that can be set for ventilation The main controls Tidal Volume Respiratory Rate amp Inspiratory Time have two sets of numbers associated with them These numbers change depending on whether the system is in Standby spontaneous breathing mode or Ventilate mode In Standby mode the large blue numbers are the measured values derived from the patient s respiratory efforts The Airway Servo System is working as a respiratory monitor The smaller black numbers are the ventilator settings that will be used in Ventilate mode If no breathing is detected after 60 seconds the blue values are all set to zero Tidal Volume Respiratory Rate Inspiratory Time Inspiratory Flow 150 litres minute When you touch a button it changes colour and becomes ready to accept a new value A numeric keypad appears in the lower right hand corner of the screen where you can ente
14. Sensor tab Used for fault diagnostic information only Errors tab Used for fault diagnostic information only Config tab Used for fault diagnostic information only Data tab Location of the Zero option for the IRMA monitor See the section on Use of the IRMA Monitor for full information on when and how to use the Zero option found in this tab In most situations it is only necessary for users to use the Data tab Information from the other tabs may be requested by a service engineer or a technical support person during fault diagnosis Printed 10 Mar 09 Page 27 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Gas monitoring tab with the Artema AION Gas Analyser Configuration System Modes Status Status Alarms Cmds Demo Calib Op Mode ISOAccuracy Comm Mode Normal SNE Water Trap Adult 1021 Message Pump Regulating Flow 202 Command oK Modes Status Used for fault diagnostic information only Status Used for fault diagnostic information only Alarms Used for fault diagnostic information only Cmds Used for fault diagnostic information only Demo Used for demonstration purposes only Calib Used for fault diagnostic information only Close In most situations it is only necessary for users to use the Cmds tab for performing a zero calibration Information from the other tabs may be requested by a service engineer or a technical support person during fault diagnosis Pr
15. alarm An alarm will sound when a temperature probe is discovered to be absent When starting the software if no temperature sensors are present an alarm may sound and the border of the temperature gauge will flash red Touch the temperature gauge to open this Attribute tab and use the Silence button to silence the alarm The Traces Trends Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends q Trace Ax an Pressure IBP Trend T1 T2 Delta Close For a detailed description of how traces are managed and moved around the screen see the section entitled Adding and Removing Traces atthe start of the section above Printed 10 Mar 09 Page 50 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Alarms Alerts and Critical Error Messages Printed 10 Mar 09 Page 51 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Creating an Anaesthetic Record Chart The Tafonius software creates an automatic record that can be viewed as an Anaesthetic Record Chart Every 5 minutes monitoring data is recorded and entered on the chart in a similar manner to a manual record Information about the patient surgeon anaesthetist and other details can all be recorded All non clinical information is entered via the Patient Data button This process is covered fully in the section entitled Entering Initial Patient Information During a patient Session there are effectively two recorded sets of data One set of data is saved
16. and compliance values can then be measured Uninitialised Initialised piston piston background is background is hatched green and Image also has shows piston a red flashing volume in litres border Leak amp Compliance This button begins the process of first leak testing and then measuring the compliance of the system For leak testing the piston is taken to the mid point of the cylinder and then the piston produces a pressure of 20cm H20 During this pressure phase the piston movement and hence leak is measured The measured leak should be below 1500mls min and in normal circumstances is less than 500 mls minute Values above or around 1500 mls minute represent a serious leak and should be investigated However due to the way Tafonius maintains pressures and controls piston movement even leaks of 1500mls minute are unlikely to affect ventilator performance They do however represent a loss of gas and agent Printed 10 Mar 09 Page 17 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Running the Leak amp Compliance procedure Press the Leak Compliance button on the System tab to begin the procedure Configuration System Freeze Traces System Errors Speier Leak Compliance Demo Mode Exit Windows Event Viewer Resolve Resolve All A dialog appears announcing that it is establishing a connection with the Auxiliary controller This can take 5 10 seconds After that a second dialog appears asking that any patient be
17. and the chart can be viewed from the Tafonius Shell via the View Data button Viewing the Anaesthetic Record chart The Anaesthetic Record chart can only be viewed from the Tafonius Shell whilst Tafonius is NOT running Click or touch the View Data button in the Tafonius Shell Use the Record Picker to select a patient and then click Select Then highlight the AR file and click or touch Select This will open a pdf version of the Anaesthetic Record in Adobe Viewer Printed 10 Mar 09 Page 52 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Data Recording using the Slow Data File The Slow Data file is an automatically generated file that records all information gathered during a Session Data contained in this file includes all the monitoring information in terms of numerical and trend data This periodic data Default is every 5 seconds also contains all events that occur during use If an alarm condition occurs this is recorded in the Slow Data file Similarly a change of anaesthetic agent type or the level of the MWPL setting is recorded in the Slow Data file This raw file is non editable so that the user can be sure that all events that occurred are recorded For a full description of the data saved in the Slow Data file see Appendix A Slow Data Information The Slow Data file can be exported to a Flash disk using the Export data function accessed from the Tafonius shell See the section entitled Export Data later in this manual I
18. buttons Alarm Silence amp Freeze Traces ccccsseeccsseneeeesneeeesseeeeeeseneesesseeeeenseneeeneene 35 Ala CNICE 5 is NI Sie ee ee te ee eee 35 FPR PLACES oo E E EE E A E E 35 The countdown time for Freeze Traces is determined by the Countdown value set in the Initial settings attiB te panel m sssssnnsenunnuuneosssonnnnnnunnnunnunuounnssnn nn nun nunun unnan sanna nnna n nanenane 35 Monitoring Softwate MMs asiccnntasisansu ui sapasenctsicuecs csnuildveanauadvniunaushabsuvanstalawvasacutuicwaestuubipaneaidiui eaaeuied 36 Monitoring OP TIO Tamm lt lt lt sec S03 bs Ses ook ude le ee bp sat cas Deceased Gece ede ales ease ees a eee 36 Organisation OF ACES 3 sionais a a a a aa wade Peseta as acute te tens 37 Adding and Removing Traces cccecececeseeceeesneeeeseaaeeeeeaaeeeeeaeeeeeseaaeeeeeaaeeeeseeeetenaaeeeeeeeees 38 Controlling the appearance Of traces c ccc cnet tee ceee ee tena cette neces teeeeeeseaaeeestneeeeteneeeeneaae 38 The ECG IBP Attribute tab icc die erie Co ee a ea eee dee 40 The CO2 Attribute tab cnet sascha ee cre crete ceded ce aettes epipecmen ca a tcee doe EAEE EA anie eelenaenedad 43 The Airway Pressure AP Attribute tab 0 0ccccccccccccesecneeceeeeceneeeeeeeseceeaeeeeeesesnsueeeeeeeeees 44 The Oxygen Attribute tab 20 5 2 seek aii ec eed ees ieee 45 Printed 10 Mar 09 Page 3 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The SPO2 Attributeitab s
19. calibration IRMA Monitor General Description The IRMA breath monitor unit is a small cube shaped unit housing a replaceable Airway Adaptor and Oxygen sensor The main housing for the unit has an LED in one corner which indicates the status of the sensor These states are described in detail in the section IRMA Status amp Error Messages The IRMA unit connects to the Tafonius monitoring system via a 9 Way Female D Type connector When the unit is connected and the unit powered ON the IRMA device runs through a self test sequence This is indicated by the LED on the main housing changing alternately through GREEN RED BLUE a number of times Once the initialisation sequence is complete the LED stays GREEN If the IRMA unit has the capability of detecting anaesthetic agents then the LED will turn BLUE in the presence of these agents IRMA units may be connected disconnected while powered without any problems Calibration self test and reset The IRMA unit is self calibrating and does not require scheduled calibration on a monthly or even annual basis Calibration is achieved in a number of ways but must be done while the unit is plugged in and powered ON ALL CALIBRATION MUST BE DONE WITH THE UNIT IN FREE AIR AND NOT WHILST CONNECTED IN A PATIENT CIRCUIT Oxygen Recalibration For calibration of the Oxygen sensor removal of the Airway adaptor forces an automatic recalibration to 21 For this reason it is important that the removal and refi
20. from either ECG or IBP depending which is in use or which is more reliable in the current circumstances ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Trace Alarm Limits Trace me Heart Rate Enable MAP Enable Low Obpm F Low OQ mmHg d Source ECG OIBP Systolic Enable Diastolic Enable Close M Synchronise Low OQ mmHg o Low 0 mmHg oO Alarm Limits This group of alarms includes alarms for Heart Rate Systolic Diastolic and Mean Arterial Pressure To set any alarm value click or touch the associated edit box The numerical keypad will appear on the right of the screen Use this or the main keyboard to enter the numerical value and then click or touch Enter Heart Rate Upper and lower alarm values can be set for the heart rate and these can be independently enabled by touching or clicking the Enable box next to the appropriate Alarm edit box Systolic Set high and low limits for the systolic blood pressure value High and Low alarms can be independently enabled Diastolic Set high and low limits for the diasystolic blood pressure value High and Low alarms can be independently enabled Mean Arterial Pressure Set high and low limits for the mean arterial blood pressure value High and Low alarms can be independently enabled Printed 10 Mar 09 Page 42 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The CO2 Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Slow Fast Propert
21. it is necessary to set the agent being used Select the appropriate radio button next to the agent in use This change will be reflected in the Agent button on the screen Sweep Use the Sweep slider control to change the speed at which the Agent trace moves across the screen Scale Use this control to set the full scale height of the Agent trace window Note that there is no shift feature with this trace To view Agent values in excess of 5 the 0 10 scale range must be used Alarm Options Click or touch the Alarms button to show the Alarm options for Agent ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Enable Inspired High E Low Expired High Low Close Alarm Limits Set the alarm limits required for a particular agent here Note that different alarm limits can be set for each and every agent Click or touch the Enable box to enable the alarm and then enter the appropriate value Printed 10 Mar 09 Page 47 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The N20 Attribute tab ECG IBP CO2 Oxygen Agent N20 Spo2 AP Temp TracesfTrends iN Alarms Sweep Slow 9 Fast Scale O 0 50 Alarm Options Click or touch the Alarms button to show the Alarm options for N20 ECGABP CO2 Oxygen Agent N20 SpO2 AP _ Temp Traces Trends Alarm Limite Enable Inspired High D Expired High o Alarm Limits This tab allows the alarm limits to be set Alarms can be set for High Inspired and Expi
22. new editor which lists all the current Standard Events These can be Edited or Deleted using the Edit Delete buttons To add new items to the Standard Event list click or touch the Add button and then type your new Event title Standard Events Start Procedure B Fluid Administration Premed Down Anaesthetic Induction End Anaesthesia Arrival At Recovery Site Extubation Once a new Event has been entered it will appear last on the list To change the position of this new item in the list use the UP and Down buttons to move the item Once the new Event and the order of Events has been set click ort touch the Close button to leave the Standard Events editor To add your own entry click or touch in the Event Details box and start typing Event Details 05 November 2008 J 17 50 45 E Add a custom event here A t ccep Standard Events l v Add Remove Standard Events Click or touch Accept to add it to the SD file Use the Clear button to remove an entry from the Event Details edit box Printed 10 Mar 09 Page 55 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Tafonius Shell The Tafonius Shell is the starting point for using the Tafonius Ventilator software and also the starting point for various related utilities Peroni TAFONIUS Services Ltd Hallowell EMC Tafonius View Data Export Data Options ew Shutdown The buttons Taf
23. piece is capped turn the vaporizer to the required pre fill concentration and turn on the manual oxygen flow meter to fill the cylinder with gas The cylinder icon on the left of the screen indicates the volume of gas in litres in the cylinder Fill the cylinder to a level equal to the maximum expected patient s tidal volume PLUS 2 5 Litres e g 500kg horse Average tidal volume predicted is 5 0L so a larger breath of 7 5L can reasonably be expected Then add 2 5L which is the buffer volume used by the ventilator Total pre fill volume 10L When the cylinder graphic shows it is at the required volume turn off the oxygen flow This sets the volume of the Virtual Bag for spontaneous breathing The concept of the Virtual Bag is central to how Tafonius operates This action of the ventilator maintains a minimum system volume thereby reducing anaesthetic and oxygen consumption as well as decreasing the system s time constant The Piston as a Virtual bag When the ventilator is in standby mode and a patient is connected the system behaves like a perfect bag When the patient breathes out there is no expiratory resistance and when the patient breathes in there is no inspiratory resistance This ideal performance is accomplished with the Airway Servo System employed by Tafonius The airway pressure is sensed at the centre of the Y piece As soon as a pressure deviation in excess of 0 5cm H20 from the ambient pressure is detected t
24. reference calibration should be performed with great care and only when requested by IRMA or if there are obvious evidence of offset errors when verifying gas readings with a reference instrument Would you like to continue Make sure the conditions for re calibration are correct before continuing then click or touch Yes If you are unsure about the conditions required for calibration click or touch No and read the above paragraphs carefully before running the Zero option again Printed 10 Mar 09 Page 32 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Using the ARTEMA AION Gas Analyser The Artema AION Gas Analyser is a sidestream gas analyser drawing the sampled gas from the Y piece Other than the physical differences and the inherent latency between breathing and waveform display the reporting and display of all gas parameters is the same as with the IRMA Gas Analyser Sidestream sampling port capped The sidestream sampling line connects to the sampling catheter that enters the Y piece as shown The sampling catheter extends down into the ET tube for optimum sampling Display of Measured Values THE Gas Anlayser IRMA or AION will continuously display and update the numerical and trace information for the patient The trace region shows the capnogram as either a line or filled trace The main numerical data region associated with the trace shows the inspired and expired values of COs CO2 0
25. removed from the circuit When the breathing circuit is ready press the Leak amp Compliance button Alarm Silence Configure Disconnect Patient and Push Leak amp Compliance Leak amp i Zero Pisto CE Skip At this point a stopper must be applied to the Y piece to seal the system Then press the Leak amp Compliance button Fit Stopper to end of Y Piece Piston is initialised Leak amp 7 Compliance Skip The piston is moved to the mid point and then stops briefly before establishing a system pressure of 20cm H20 Fit Stopper to end of Y Piece Moving Piston to Mid Point Please Wait CC Printed 10 Mar 09 Page 18 of 61 DOCA4941B USING THE TafoniusS SOFTWARE If for any reason there is an excessive leak the following message appears The leak flow rate was too high Retry Skip In this instance seal the leak and press the Retry button If the leak test is successful the leak value is displayed and the system then proceeds to perform the two compliance measurements Tafonius ver 0 1 1114 0 Tafoniu CO2 mm RR Inspired Expired BPM AP cmH20 0 0 N O Oxygen ISO a f aa m f aa 7x el A m f aa R Inspired Expired Inspired Expired Inspired Expired 19 Complian
26. that you wish to Reset then click or touch OK Printed 10 Mar 09 Page 26 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Gas Monitoring This tab displays all of the status and diagnostic information for the current Gas Monitor in use At the current time a mainstream device called IRMA or a sidestream device called Artema AION is used for CO2 O2 N20 and Agent monitoring Your machine will be fitted with one or other of these units Gas monitoring tab with the IRMA Gas Analyser Clicking on the Gas Monitoring tab reveals a Window with 5 further tab options Status Sensor Errors Config amp Data Configuration System Presets IRMA 15b Status Sensor Errors Config Data Initial Settings eel ID Sil O BDET UNSPEC_ACC es Menierna Atm 102 1 kPa APNOEA SENS ERR Sp02 O02_ Low O02_CALIB M Enabled 11 02_REPL CHK_ADAPT a Sensor Serial No 2741 Secut Frame Err 0 Status tab Used for fault diagnostic information only Sensor tab Used for fault diagnostic information only Errors tab Used for fault diagnostic information only Config tab Used for fault diagnostic information only Data tab Location of the Zero option for the IRMA monitor See the section on Use of the IRMA Monitor for full information on when and how to use the Zero option found in this tab In most situations it is only necessary for users to use the Data tab Information from the other tabs ma
27. 6 Save AS NeW ccccsccssetseesssessttteessesererriereesesec eres tiie aaaeeeaeo 26 CCW ee E Ce re 26 R name nent ear ee ere renee ery Seri e e a treet 26 Switch ee a ee 26 DS ie A ee 26 Reset Factory Default 2 cece M cece eee tence eee eeee eee seerne ree Aig eee ee eee eee eee 26 CCC a ey ee ae 27 Gas monitoring tab with the IRMA Gas Analyser 0 c cece cece ee tener eeeenneeeeeeeeeeeeenaeeeeea 27 Gas monitoring tab with the Artema AION Gas Analysef 0 cccccceeeceeeeeeeeeeeeeeeeeeneeeeee 28 IRMA SQUID rierren oe A ena OR ce a St ry eta lhe 29 Pre Use CheCK 2 1 ccccccccccerecnecee cree NI gg eee NR ea ee ean neeee neces eeeeaaeenesneeeeneneesenes 31 IRMA Monitor General Description 00 ccccccceeet cite e cect ee cenne nee ttneeeececeeeceaeeeeteneeeeseaaeeeenaeeeeey 31 Calibration self test and gi ES Chin ccc he lt lt LT nas ssesecesencecscccensccsseesecececsscsesenscasenee 31 Oxygen Recalibrati q iiagrr ee SEMI eee cee eece MD cece sc eee eee neeeeseeeeensseeeesenenseeesenseeeee 31 CO Nitrous and Agent Calibration Zero reference calibration 0c ccceeeeeeees 32 Using the ARTEMA AION Gas Analysef ccccccccceccccee teense eteneeeeenneeeeteneeeesnaaeeeeteeeeetnaneeeneaas 33 Display Of Measure GQ alues Aap yooo ccc ccnceccesenecneeaneeesenseeensnensaneeaaneneeteceesnereaeeees 33 Other Control
28. 9 Page 22 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Viewing Recorded data from the Tafonius Shell Click or touch on the View Data button in the Tafonius Shell screen This opens a Record Picker box to choose the Data Record to view Data is presented in date order with the most recent at the top Pick a record to view and then click touch the Select button A file or list of files will be shown that begin with SD These are the Slow Data files recorded during a session Touch or click or touch on the one required and then press the Select button A spreadsheet viewer opens to display the recorded data Touching a cell within a column representing measured physiological data will display that data automatically as a trend graph To create graphs for other parameters that are not physiological such as the set Tidal Volume or Compliance Compensated Tidal Volume it is necessary to export the data to a spreadsheet viewer of your choice This is easily done from the Tafonius Shell Exporting Data From the Tafonius Shell click or touch on the Export Data button An Export Data dialog box opens listing the recorded data on the Tafonius computer Data is presented in date order with the most recent at the top Choose the Record folder required and then click or touch on the Next button Then choose the destination for your exported data Typically this will be a USB flash drive inserted in the hub at the front o
29. ALIBRATION MUST BE DONE WITH THE UNIT IN FREE AIR AND NOT WHILST CONNECTED IN A PATIENT CIRCUIT THE IRMA UNIT MUST BE ALLOWED TO WARM UP AND BE RUNNING FOR AT LEAST 15 MINUTES BEFORE A ZERO REFERENCE CALIBRATION IS PERFORMED To RESET the IRMA device click or touch the Zero button in the Data tab of the Gas Monitoring Window found in the Configuration Setup A warning dialog box will appear with the following message IRMA Zero Calibration D Zero reference calibration should be performed with great care and only when requested by IRMA or if there are obvious evidence of offset errors when verifying gas readings with a reference instrument Would you like to continue Make sure the conditions for re calibration are correct before continuing then click or touch Yes If you are unsure about the conditions required for calibration click or touch No and read the above paragraphs carefully before running the Zero option again Printed 10 Mar 09 Page 32 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Using the ARTEMA AION Gas Analyser The Artema AION Gas Analyser is a sidestream gas analyser drawing the sampled gas from the Y piece Other than the physical differences and the inherent latency between breathing and waveform display the reporting and display of all gas parameters is the same as with the IRMA Gas Analyser Sidestream sampling port capped The sidestream sampling line connects to the sampling cat
30. E TafoniusS SOFTWARE Other Control buttons Alarm Silence amp Freeze Traces Alarm Silence Press the button once for a 5 second silence of all alarms After 5 seconds the alarms if active will again sound Press and hold the Alarm Silence button until it shows the legend Locked The audio portion of all current alarms are then suppressed Any new alarm condition will override the locked out condition and again sound the alarm Freeze Traces Use this button to freeze all trace information on the screen All other monitoring activities continue as normal The button will change colour to indicate that it is active Also a countdown timer will begin showing on the button At the end of the countdown period the freeze option will be lifted Alternatively simply clicking or touching the Freeze button once more will release the freeze option The countdown time for Freeze Traces is determined by the Countdown value set in the Initial settings attribute panel Printed 10 Mar 09 Page 35 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Monitoring Software Monitoring options Tafonius has the options of monitoring the following parameters via its in built software Single Channel ECG Single Channel Invasive Direct Blood Pressure Breath Analysis Inspired Expired CO2 Inspired Expired O2 Inspired Expired N20 Inspired Expired Anaesthetic Agent Halothane Isoflurane Sevoflurane Desflurane Enflurane Single Channel Puls
31. FTWARE The Oxygen Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends iN Alarms Sweep Slow Fast lt Scale O 0 50 Sweep Use this slider control to set the sweep speed of the Oxygen trace across the screen Scale Use this control to set the full scale height of the Oxygen trace window Note that there is no shift feature with this trace To view Oxygen values in excess of 50 the 0 100 scale range must be used Alarm Options Click or touch the Alarms button to show the Alarm options for Oxygen ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarm Limits Enable Inspired High Oo Low _ oO Expired High oO Low oO FiO2 l C 7 The Oxygen Alarm options allow the alarm limits for Inspired and Expired oxygen to be set Alarms can be set for High and Low Inspired and Expired values Click or touch the Enable box to enable the alarm and then enter the alarm value by clicking or touching the appropriate alarm edit box FiO2 This option is not yet implemented and will be available in the future Printed 10 Mar 09 Page 45 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The SPO2 Attribute tab ECGABP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarms iN Sweep Slow gt Fast Sound O Beep On SpO2 Pulse Close Sweep Use the Sweep slider control to change the speed at which the SpO2 trace moves across the screen Sound Click or touch the box next to Beep
32. ING THE TafoniuS SOFTWARE The ECG IBP Attribute tab There are two active sections to this tab Traces and Alarms In the Traces section all the controls relate to how the trace can be viewed Values can be set for either ECG or IBP options by selecting the appropriate option in the Select box ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Trace Sensitivity Sweep Filter Shift to 12 5 mm sec None s 25 mmjsec Lowpass Select 50 mm sec Notch gt 100 mm sec ECG 200 mm sec IBP Heart Rate Close Synchronise O Beep On ECG Trace options ECG Sensitivity controls the height of the ECG trace seen on the screen Sweep Controls the screen sweep speed in rates of mm second Filter Allows the setting of a digital filter to remove unwanted signal noise Use a notch filter for mains interference Use a Low pass filter for tremors due to movement e g shivering Move the slider in the Filter box to control the degree of filtering Shift Shifts the base line of the ECG up and down the screen Use the shift option to centralise the ECG for optimum viewing Heart Rate Select the box next to Beep on ECG to produce an audible beep with every detected ECG complex Since Tafonius only has one audio output device only one monitor can be made to beep at any time Selecting ECG for example will mean that any previous selection is overridden To change between ECG and IBP attributes touch
33. Init Requested 08 09 35 695 Auxiliary Controller No Watchdog 08 09 35 705 Auxiliary Controller No Position data 08 09 35 895 Auxiliary Controller Watchdog data established 08 09 37 237 FMSO ON 65535ms 08 09 37 247 Init Requested 08 09 37 778 Auxiliary Controller Position data established Thursday March 27 2008 08 09 38 Records Started Tafonius Version 0 1 1092 0 Every entry has a time associated with it and describes the event that occurred Printed 10 Mar 09 Page 61 of 61 DOCA4941B
34. On SpO2 Pulse to enable audible beeps associated with each detected pulse waveform This will over ride any other beep selection Alarm Options Click or touch the Alarms button to show the Alarm options for SpO2 ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarm Limits Enable Mams Pulse Rate High ee bpm O Low bpm Oo Saturation Low F Sound O Beep On SpO2 Pulse Close Alarm Limits Click or touch the enable box to enable the alarm and then enter the appropriate value Sound Click or touch the tick box to select audible beeps every time a pulse wave on the SPO2 monitor is detected Printed 10 Mar 09 Page 46 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Agent Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends rece in use Sweep Halothane Enflurane Scale Isoflurane 0 5 Sevoflurane O 0 10 Desflurane In Use The IRMA OR detector used for agent monitoring does not have automatic agent ID so it is necessary to set the agent being used Select the appropriate radio button next to the agent in use This change will be reflected in the Agent button on the screen Sweep Use the Sweep slider control to change the speed at which the Agent trace moves across the screen Scale Use this control to set the full scale height of the Agent trace window Note that there is no shift feature with this trace To view Agent values in excess of 5 the 0 10 scale
35. R Z 11 Inspired Expired BPM AP cmH20 0 0 60 Pulse Ox AirwayPressure Y S Printed 10 Mar 09 Page 38 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The monitoring attribute panels appear at the bottom of the screen opened at the ECG tab Note that the ECG attribute tab shares its place with the IBP attribute tab as they are both located on this common ECG IBP tab When the left hand side of the ECG IBP panel is touched the ECG attributes are shown If the right hand side of the ECG panel is touched which has the IBP values then the attribute tab will be opened with the IBP attributes showing To change between ECG and IBP attributes touch the appropriate radio button at the left hand side of the ECG IBP tab All alarm settings and trace settings are particular to any given Preset and so the Preset should be saved after making adjustments to any of the controls in the monitoring attribute panels Printed 10 Mar 09 Page 39 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The ECG IBP Attribute tab There are two active sections to this tab Traces and Alarms In the Traces section all the controls relate to how the trace can be viewed Values can be set for either ECG or IBP options by selecting the appropriate option in the Select box ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Trace Sensitivity Sweep Filter Shift to 12 5 mm sec None s 25 mmjsec Lowpass Select
36. RE Record Picker Please select the patient folder and click select cy Patients2008SEP16 D Patients2008SEP15 im Patients200 7OCT30 To view the Slow Data information highlight the appropriate file and then touch or click the Select button The Slow Data is viewed in a spreadsheet format and can be used to show monitoring trends By touching any of the measured parameter columns e g ECG heart rate Pulse Ox saturation a trend view of the data over the course of the procedure is shown at the bottom of the screen Touching the column again hides the trend view For greater versatility export the data to a USB stick and view the data in a commercial spreadsheet of your choice All Slow Data files are saved as CSV or comma separated value files To view the Anaesthetic Record chart highlight the desired AR file and then touch or click Select A new window opens to show the Anaesthetic Record pdf file For printing and archiving of either the Slow Data or the Anaesthetic Record use the Export Data button from the Tafonius Shell to save the data to a USB flash drive and then open the files in your host computer Printed 10 Mar 09 Page 57 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Export Data This button opens a browser to allow you to choose the data to export All data in the browser is listed in date order with the most recent files at the top of the browser Export Data Please select the patient folder you would like
37. Risk Status Temp 2 63 4 65 FE Fahrenheit Celcius Fill in the procedure details along with the rest of the presenting clinical information Printed 10 Mar 09 Page 8 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Entries can be left blank The Anaesthetist Surgeon and Procedure fields are used when an Anaesthetic Record chart is produced The Anaesthetist Surgeon and Procedure entries are all taken from a Drop Down list To view the list click or touch the down arrow in the blue box next to the field you wish to enter details for If the item you require appears on the list click or touch it to select it This provides a quick way to enter commonly used information If the item does not appear on the list then it may be added by touching or clicking on the ellipse button Clicking or touching the Ellipse button opens an editor Here the Anaesthetist Drop Down list has been opened for editing Anaesthetists Dr Andrews Lorraine Gosch Dr Simpson John Irving House Surgeon Add Edit Delete Close Items in the list may be ordered using the Up amp Down buttons The Add Edit and Delete buttons allow standard editing of the entries in the list When editing is complete click or touch the Close button to return to the At Presentation tab Notes Tab Any notes that you want to enter relating to the case can be entered as free text in the No
38. Using the Tafonius software 008 16 48 06 ECG 69 CO2 14 2 a Inspired Expired BPM AP cmH20 O o ee Se oe Inspired Expired Inspired Expired N O ISO _ SPO2 Oxygen J 100 P Sensor l gor zigna a Inspired Expired F102 ECG IBP C02 AP_ Oxygen SpO2 Agent N20 Temp Traces Trends Sensitivity Sweep Filter Shift Alarm Silence Freeze Traces eam ie i jarms 25 mm sec Sytem Heel Lowpass i 50 mm sec O Notch 100 mm sec Push to Configure A 200 mm sec g Ventilate Select ECG IBP Heart Rate Synchronise Beep On ECG Events Help USING THE TafoniusS SOFTWARE Before the Tafonius software can be used to control the ventilator the ventilator needs to be initialised This initialisation process is covered in the section Getting Started with Tafonius Once initialised there are some common steps to take when preparing for a patient Pre filling the system Entering patient information Choosing a Preset Starting a Session cadence secdedeads cendcedactenccevedaatacasutsschdacauedsdateisesetsecic dng MMe ntbscduedsaessGeduededsudusaduGunscizesdesde 6 The Finalise Recording ProCedure ceeecceseeeeeseeeeeeeseneeseseneeeeaseececeeeeeeeeeenneeeeseeeeceeeneeeeeseeeeeneeneeseeeees 7 Entering initial patient information c cess eeseeeeeeeeeeeeneeee e
39. adsheet viewer Viewing Recorded data during a recording To view data on the fly click or touch on Patient Data and then the Data View tab Alarm Silence Cases Patient Details Notes At Presentation Data Loggfhg Data View OOOO Hospital Number Species MOQ i Patient Name Anonymous Breed Type System etal ee ________ a Owner Name Age oly ol a Patient ID PID 111111 Configure A trend viewer pops up showing the trend of the selected parameter from the beginning of the recording session to the current time This data is constantly updated at a rate set by the Slow Data logging period Use the drop down list to select a different parameter Sex Weight 0 Kg Patient Details At Presentation Data Logging Data View 200 E Systolic E Diastolic o Mean 150 100 50 08 56 31 09 50 01 10 43 31 11 37 01 12 30 36 Invasive Blood Pressure v Close Viewing the instantaneous a Drop Down List Click or touch a point in the graph area of the Data View tab A line appears at the point of touch At the bottom of the line on the x axis of the graph is the time at which that point of data was recorded Along the right hand side of the line are the instantaneous value s of the associated data Cases Patient Details Notes At Presentation Data Logging Data View Systolic Diastolic 13 41 35 Invasive Blood Pressure v Close Printed 10 Mar 0
40. are all taken from a Drop Down list To view the list click or touch the down arrow in the blue box next to the field you wish to enter details for If the item you require appears on the list click or touch it to select it This provides a quick way to enter commonly used information If the item does not appear on the list then it may be added by touching or clicking on the ellipse button Clicking or touching the Ellipse button opens an editor Here the Anaesthetist Drop Down list has been opened for editing Anaesthetists Dr Andrews Lorraine Gosch Dr Simpson John Irving House Surgeon Add Edit Delete Close Items in the list may be ordered using the Up amp Down buttons The Add Edit and Delete buttons allow standard editing of the entries in the list When editing is complete click or touch the Close button to return to the At Presentation tab Notes Tab Any notes that you want to enter relating to the case can be entered as free text in the Notes tab These notes will appear in the Anaesthetic Record chart in the area under the Header of general information Printed 10 Mar 09 Page 9 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Cases Tab Details relating to cases can be pre entered as a list of patients Associated case data can be entered and then recalled when required Patient Name Patient ID PID Anonymous 0000000 Select Alfonzo 192837465 EJ Diamond Sunset 198725463 Delete
41. as the Slow Data file This records periodically default is every 5 seconds all of the information relating to the running of Tafonius For a more details explanation of the Slow Data files see the section entitled Data Recording using the Slow Data File The other set of data is data saved as the Anaesthetic Record file This file consists of data saved every 5 minutes as plotted or tabled data as well as header information such as name of Anaesthetist or Surgeon Altering the Start Time of the Anaesthetic Record chart It is not uncommon to prepare Tafonius some time in advance of connection to the patient During this time there will be continual recording of non meaningful data To avoid this the Start time for the Anaesthetic Record data can be set using the Anaesthetic Record Start button Pressing this button will reset the start time for the Anaesthetic Record data ONLY Slow data information is not affected The Anaesthetic Record Start button is found in the Data Logging tab of the Patient Data dialogs The following dialog will appear Anaesthetic Record Start A re you sure you want to set the start of anaesthetic recording From now Anaesthetic Record data and Trend data prior to this point will not be viewable This procedure can be repeated as many times as required noting that each time data prior to selecting this option will no longer be available After this creation of the Anaesthetic Record chart is automatic
42. ats 23 The Configure button cissedcsccdactedacrsacstescadetianasasevsceidacadedvastacsetstabsdaadtvacsnctcedvesncuuenstunsdidctectadasedsGaecsaveceas 24 A EEA aa ood clots ie aut cay et eda ade E E E EAEE 24 PYAR AL SOUS 20565 E as iti ted lel A E dante aes Neale ates 25 UET RT italo E EPE ica iad eens EE lie lanes Seca tae EE E 25 Changing Presets eeessssosssoerrnersrreeenssesrerrerrrrererneeosseerrerrerree gM ea cho noes ee ace ics a eee atte tet 26 Save AS NeW ccccsccssetseesssessttteessesererriereesesec eres tiie aaaeeeaeo 26 CCW ee E Ce re 26 R name nent ear ee ere renee ery Seri e e a treet 26 Switch ee a ee 26 DS ie A ee 26 Reset Factory Default 2 cece M cece eee tence eee eeee eee seerne ree Aig eee ee eee eee eee 26 CCC a ey ee ae 27 Gas monitoring tab with the IRMA Gas Analyser 0 c cece cece ee tener eeeenneeeeeeeeeeeeenaeeeeea 27 Gas monitoring tab with the Artema AION Gas Analysef 0 cccccceeeceeeeeeeeeeeeeeeeeeneeeeee 28 IRMA SQUID rierren oe A ena OR ce a St ry eta lhe 29 Pre Use CheCK 2 1 ccccccccccerecnecee cree NI gg eee NR ea ee ean neeee neces eeeeaaeenesneeeeneneesenes 31 IRMA Monitor General Description 00 ccccccceeet cite e cect ee cenne nee ttneeeececeeeceaeeeeteneeeeseaaeeeenaeeeeey 31 Calibration self test and gi ES Chin ccc he lt lt LT nas ssesecesencecscccensccsseesecececsscsesenscasenee 31 Oxy
43. cccccttcccccacccctcsccctteccceonsccctececconcceceo nec QMO cccccccecuscecceceganuccectonscatcececesss AM cccceceeseacecees 56 VICW Datta ucccccceccccccecocseccccncceccecececoneccecceceaneacecseece SOOM ce ceece A NO ruccectonscaceees 56 Export Data enoni acon aes an spate ney etn ods ode A sto spe aes veep ees 58 Touch Screen Alignment a cect tcc en oa oieee oeeie eee nceeanenensaneessneceeneeeeneneenneens 59 Recover Anaesthetic Records Dy eee ce gece naneceeaeeaaeceeccecanecececseanececeeeeanes 59 Company Name cccccccccccecccce seer A eee Re AI cece eect nee nearer eeeneeeoneeseneneenteees 59 Se a hil nnn 59 Appendix A SLOW DATA INFORMATION cceseeeecsseeeeeseseeeesneeeeesseaneesseeeeeeseneeseeseaneseseneeseenes 60 Printed 10 Mar 09 Page 4 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Pre filling the system After Tafonius has been initialised the piston is left at the bottom of the cylinder ready for filling Make sure the Y piece is capped turn the vaporizer to the required pre fill concentration and turn on the manual oxygen flow meter to fill the cylinder with gas The cylinder icon on the left of the screen indicates the volume of gas in litres in the cylinder Fill the cylinder to a level equal to the maximum expected patient s tidal volume PLUS 2 5 Litres e g 500kg horse Average tidal volume predicted is 5 0L so a larger breath of 7 5L can reasonably be expected The
44. ce check initialisation in progress dian since pore tacea Please wait a er Data Leak is 660mls min Configure Vertiate gt A compliance measurement is made at the top cylinder position and at the 5 0L cylinder position and uses the leak value obtained in the first test At the end of the test the leak and both compliance values are shown Note that the values obtained will vary markedly depending on the nature of the breathing circuit connected The two compliance values are used to obtain the equation for the straight line graph of compliance for your machine and the breathing system in use at that time This equation is then used to compute the compliance compensation required at any piston position and pressure Printed 10 Mar 09 Page 19 of 61 DOCA4941B USING THE TafoniusS SOFTWARE CO2 mmf RR Inspired Expired BPM i AP cmH20 j 0 0 N O PIP CPAP hail ISO SPO2 AirwayPressure2 Oxygen Iso CET pm m fan a e A CET pm TE Inspired Expired Inspired Expired T Inspired Expired 0 Leak and Compliance test complete damana A sen raer Leak is 660mls min Configure iis Compliance at 19 11 amp 4 41 is 39 0mls cmH20 amp 29 2mls emH20 ba Events Help Press Finish to leave the Leak amp Compliance test procedure Printed 10 Mar 09 Page 20 of 61 DOCA4941B
45. compliance of the system The patient actually receives the TV you set regardless of the length of the breathing systems tubes This is very helpful when 20 or 30 ft tubes are connected to reach a patient in an MRI Tidal Volume units are Litres Respiratory Rate In Standby mode The blue figures show the measured respiratory rate recalculated every 10 seconds on a rolling 1 minute basis This gives a true reflection of respiratory rate The smaller black figure shows the respiratory rate that will be used in Ventilate mode In Ventilate Mode The large black number shows the respiratory rate in use Respiratory Rate units are Breaths per Minute Inspiratory Time The Inspiratory Time button controls the total length of the Inspiratory phase There is also a smaller sub button located within the Inspiratory Time button that allows a pause to be included in the Inspiratory time This inspiratory pause is limited to 40 of the time It can be displayed in either seconds or percent of time by repeated touches of the sub button In Standby Mode The blue figures show the measured inspiratory time recalculated after every breath i e on a breath to breath basis The smaller black figure shows the total Inspiratory Time that will be used in Ventilate mode In Ventilate Mode The large black figure indicates the total time for inspiration This may not be the same as the Inspiratory flow time depending on the setting for Inspiratory Pause I
46. d use the Export Data button from the Tafonius Shell to save the data to a USB flash drive and then open the files in your host computer Printed 10 Mar 09 Page 57 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Export Data This button opens a browser to allow you to choose the data to export All data in the browser is listed in date order with the most recent files at the top of the browser Export Data Please select the patient folder you would like to export and press next CI Patients2008SEP16 D Patients2008SEP15 CI Patients200 7OCT30 First select the patient that you wish to export data for and then click or touch the Next button Then choose your destination drive usually a USB flash drive named D and touch or click the Export button The Slow Data and the Anaesthetic Record data will be copied to your chosen destination Printed 10 Mar 09 Page 58 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Options This opens a small window with 3 facilities Options Recover Anaesthetic Records Touch Screen Alignment Company Name Vetronic Services LTD Touch Screen Alignment Touching or clicking this button starts a utility to align the touch screen to your computers screen Simply touch the red circles in the way you would normally use the touch screen and follow the prompts to reset the alignment If you make a mistake simply wait and the utility will time out and be cancelled You can then try again
47. destination window Trace wh ie an ah 02 N20 Agent IBP Trend T1 T2 Delta Close The text in the yellow strip indicates the trace that has been touched selected Here the user has two options Touching inside the Trace Trend dialog box will remove the trace from the screen and place it in the reserve area Alternatively touching the screen in another area of the trace region will place that trace alongside and to the left of any other traces in that horizontal area Any monitor that has been placed in the reserve area can be put back on the screen in any of the three horizontal areas at any time To do this touch any number box e g the ECG heart rate box The set of tabbed attribute panels appear at the bottom of the screen Select the Traces Trends tab and then select and drop the desired monitor trace back on the screen Pick and put the desired trace where you want it Controlling the appearance of traces All traces have various attributes associated with them that determine for example their height speed shift and alarm options amongst others To access these options for any monitor touch the number panel associated with the monitor For example to access the options for the ECG monitor touch the left hand side of the ECG IBP panel at the top right of the screen Touch here Tafonius ver 0 1 1114 0 Tafonius Foal Manual Control Made 6 September 2008 16 48 06 CO2 R
48. displayed in the trace window By selecting a long Time period trends can easily be visualised By choosing a short time period details in trace changes are more easily observed Temperature Scales Choose to use either Fahrenheit or Celsius as the temperature scale Alarm values change accordingly Alarm Options Click or touch the Alarms button to show the Alarm options for Temperature ECGABP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends y S n E Ams Alarm Limits Enable High s C O Low C oO Close Alarm Limits There are 3 alarm options Alarms for T1 temperature probe Alarms for T2 temperature probe and Alarms for the Delta temperature The Delta temperature is the difference in temperature between the two temperature readings of T1 and T2 Click or touch the enable box to enable the alarm and then enter the appropriate value Printed 10 Mar 09 Page 49 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Alarm Silence Use this button to silence a temperature alarm An alarm will sound when a temperature probe is discovered to be absent When starting the software if no temperature sensors are present an alarm may sound and the border of the temperature gauge will flash red Touch the temperature gauge to open this Attribute tab and use the Silence button to silence the alarm The Traces Trends Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends q Trace Ax an Pressure IBP Trend
49. e shows the respiratory rate that will be used in Ventilate mode In Ventilate Mode The large black number shows the respiratory rate in use Respiratory Rate units are Breaths per Minute Inspiratory Time The Inspiratory Time button controls the total length of the Inspiratory phase There is also a smaller sub button located within the Inspiratory Time button that allows a pause to be included in the Inspiratory time This inspiratory pause is limited to 40 of the time It can be displayed in either seconds or percent of time by repeated touches of the sub button In Standby Mode The blue figures show the measured inspiratory time recalculated after every breath i e on a breath to breath basis The smaller black figure shows the total Inspiratory Time that will be used in Ventilate mode In Ventilate Mode The large black figure indicates the total time for inspiration This may not be the same as the Inspiratory flow time depending on the setting for Inspiratory Pause Inspiratory Pause In Standby Mode Has no action In Ventilate Mode Controls the portion of the Inspiratory phase that is held as a pause The maximum pause is limited to 40 of the total Inspiratory time Increasing the Pause time will increase the time the inspiratory volume is held at the end of the Inspiration stroke The total Inspiratory Time is unaffected so Inspiratory Flow rates will increase as more Pause time is added Touch the Pause button to acti
50. e Oximeter Dual Channel Temperature with delta Airway Pressure Printed 10 Mar 09 Page 36 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Organisation of traces The monitoring screen consists of 3 main regions a trace region where all time traces are displayed a numerical region where all values are displayed and a status region where status information about Tafonius is displayed Tafonius ver 0 1 1114 0 Tafonius Foal Manual Control Mode Pulse Ox AA p N O SPO2 ISO Ef fee Inspired Expired Inspired Expired Pulse 82 Tidal Volume Respiratory Rate Inspiratory Time Minute Volume Inspiratory Flow IE Ratio Expiratory Time 0 0 1 0 0 50 litres 150 litres minute 1 2 8 seconds AIC Off g Batt Gili Batt2 Gi PID 000001 Patient Name Anonymous 16 September 2008 16 17 42 ECG IBP bpm CO2 ma RR 3 a 11 Inspired Expired BPM AP cmH20 O o Oxygen 15 Inspired Expired Alarm Silence Freeze Traces Patient Data a ae Push to ventilate Help The trace region is centralised on the screen and in the picture above contains the ECG CO2 Airway Pressure and Pulse Oximetry trace This area can be organised as required by placing any trace or combination of traces here The trace region itself is divided into three horizontal areas each of which is one trace high It is possible to plac
51. e a trace in any of these 3 horizontal areas Additionally it is possible to have multiple traces in any one of these horizontal areas Printed 10 Mar 09 Page 37 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Adding and Removing Traces To change the trace screen viewing options touch any trace A new editing box appears at the bottom of the screen ECG IBP CO2 AP Oxygen SpO2 Agent N20 Temp Traces Trends C02 Selected Drag and Drop or click the destination window Trace wh ie an ah 02 N20 Agent IBP Trend T1 T2 Delta Close The text in the yellow strip indicates the trace that has been touched selected Here the user has two options Touching inside the Trace Trend dialog box will remove the trace from the screen and place it in the reserve area Alternatively touching the screen in another area of the trace region will place that trace alongside and to the left of any other traces in that horizontal area Any monitor that has been placed in the reserve area can be put back on the screen in any of the three horizontal areas at any time To do this touch any number box e g the ECG heart rate box The set of tabbed attribute panels appear at the bottom of the screen Select the Traces Trends tab and then select and drop the desired monitor trace back on the screen Pick and put the desired trace where you want it Controlling the appearance of traces All traces have various attributes associat
52. e is held constant during all phases of breathing In Ventilator Mode PEEP or Positive End Expiratory Pressure applies during IPPV Ventilating pressures rise during the Inspiratory phase as normal but are allowed only to fall as far as the PEEP setting during expiration Validating entries All entries are validated once complete This means that any invalid entries that would exceed minimum or maximum settings that Tafonius is capable of delivering will not be accepted When this occurs a warning sound is issued and a description of the input error is shown at the bottom of the screen as a black on yellow text message In most circumstances the limiting factor preventing the input is also shown Here for example a value of 1 0 second has been entered as a Pause Time during an Inspiration Time of 2 0 seconds This represents 50 of the Inspiratory Time thus exceeding the maximum of 40 and so is disallowed The maximum allowable entry of 0 8 seconds is used Increasing the It to 2 5 seconds would allow a 0 5 second pause The Pause Time box is outlined in red to indicate the source of the error Tidal Volume Respiratory Rate Inspiratory Time 0 8 Minute Volume Inspiratory Flow LE Ratio Expiratory Time 0 0 1 0 0 25 litres 250 litres minute 1 5 10 seconds Printed 10 Mar 09 Page 14 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Dependant Values The four buttons below the ventilator controls show the derived values for Min
53. e seneeseeeeeeeeeneeeeeeseeeeseseeeeeseseeeesneeneeseeeeeseenes 8 The Ventilator CONtIOIS ssssssosonnsssnunnnuunnnnennnn nn Monte sdadsreetsadavenececsanenucienuanes MMMM senn nananana nae 12 Tidal Volume ee ee aaaeeeaa O aana naaaa 13 Respiratory Rate aesseeesssssssirerrrrerrinensesenorrrnereeee oe sae a eccestateese 13 Inspiratory TMC 2 2 ccccccccce eee imme cence ence teen R cere ee eens nee enaseeeeeseeenseneaaneeseneeeenneeaeenes 13 Inspiratory PaUSe ccccccccceec ee O eg ee ig een nee en annenensneenaneeaanenssneeeenseeaentes 13 Maximum Working Pressure Limit MWPL 0 cccccccccscecccceencneteceeeetecececeeeeseaaeetecteteeaseseeneess 14 CPAP PEEP 0000nao e D EN OO Saanaa ae neoe eeaeee eeina reee 14 Validating entries lt a An sunna nunnu nunnu snan 14 Dependant Values S s seseo onse AEn annesse nonnene EED anaso ssnnn sannan nunnu anses annn nsn unnu n nnee sn ssa anns nananana 15 The System button SBD Laa o e o NEEM eee ce cec ee ceaeteeeeneeeeeseeeasnneoonsenensneenaeeceeeseeenensenneees 16 System Tab A GI AR cee neeeceeeceeeeeceeeeceseeeeeeeaeeeeseesenessceeeseseeeeseeeneeeeees 16 SYS lS I cece cide ca oy eu se es aoe eg ta ede a tae an aes eh ae de eee na tee amedebcnreanee 16 Windows Event Viewer cccccecccsceceeeeeeeeeeee cee ceneeaeeeeeeseeaeeeeeseneceeeeeeeesacesaeeeeeesesesieeeeeeenees 17 Lee COMP ia Ce Neem NEED
54. ear Accept Findings Do you accept these findings Hospital Number Patient Name Owner Name Patient ID Species Breed T ype Age Sex Body Weight Notes At Presentation Anaesthetist Surgeon Procedure Respiration Rate Temperature PCY TTP BUN Anaesthetic Risk Status 12345678 Alfonzo Smithers 192837465 Equine Arab 4 M 500Kg This dialog presents the current information associated with the recording session If these are all correct then click or touch the Accept button To edit any feature shown click or touch the Change button This will take you to back to the Patient Data edit region where any of the details can be changed Alfonzo notes John Irving House Surgeon 0 Breaths min Pulse ODegC CRT MM Pant Fasted 1 0 Beats min lsec Pink No No To accept these findings press Accept to clear the finding press Discard or to return to the application and change the findings press Change If all of the details are correct then clicking or touching the Accept button will cause the following to happen automatically e The Session is ended e The patient details are used to create the appropriately named Slow Data and Anaesthetic Record files e Anew Session is started using either the next set of patient information in the Case list or the default Patient Anonymous details e Recording for the new Session is started Printed 10 Mar 09
55. ed with them that determine for example their height speed shift and alarm options amongst others To access these options for any monitor touch the number panel associated with the monitor For example to access the options for the ECG monitor touch the left hand side of the ECG IBP panel at the top right of the screen Touch here Tafonius ver 0 1 1114 0 Tafonius Foal Manual Control Made 6 September 2008 16 48 06 CO2 RR Z 11 Inspired Expired BPM AP cmH20 0 0 60 Pulse Ox AirwayPressure Y S Printed 10 Mar 09 Page 38 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The monitoring attribute panels appear at the bottom of the screen opened at the ECG tab Note that the ECG attribute tab shares its place with the IBP attribute tab as they are both located on this common ECG IBP tab When the left hand side of the ECG IBP panel is touched the ECG attributes are shown If the right hand side of the ECG panel is touched which has the IBP values then the attribute tab will be opened with the IBP attributes showing To change between ECG and IBP attributes touch the appropriate radio button at the left hand side of the ECG IBP tab All alarm settings and trace settings are particular to any given Preset and so the Preset should be saved after making adjustments to any of the controls in the monitoring attribute panels Printed 10 Mar 09 Page 39 of 61 DOCA4941B US
56. ee ee ce ees ccceceeec cence neeeeennsceeeeenseeeeesaeeeeesseeeeseeasseeeseeeeeseseeeeeneensenenes 17 Reson Initialisation SA SMB ccccccccceeesceeeeeeneeeescceeeedseceeeseeeeneseeaeseeeseeesseeeeseseeeeneseeaeetees 17 Leakg amp Compliance A SM sos 2 cee csc le ea cee ede ted secon nv need keene dene ce 17 Running the Leak amp Compliance procedure ccccseseeeseeeeeseeeeeeseeeeeeeseneeseseeeeeesseeeeeaseneesesseeeeesneenees 18 The Patient Data Qin Amey cessscssssesscsssnsssessessessensessesessessensossenssnennersesenseansasessesssseansorsssespensenessensens 21 BETE Mole lo la l epee RE a E eee are 21 Finalise Recording arrien ea ae a a eee EAA A aus ce tate teats Neila as 21 Data Storage Locations nmas irienner ee eee 21 Viewing Recorded Data aare aaa aar mane eaa e aeaaaee a aaa aaaeeeaa Aee aaa A Aaaa Eea Aaea aa AAE eean aA aaan aa aiaia 22 Viewing Recorded data during a r COrding 1 ccccccccieecetteeee tenes eeteeneeeceaeeeeenneeeeteaaeeeseaeeenes 22 Viewing the instantaneous value using Data View c ccc ceneeeeeeeeeeeeeeeeeeeeeaeeeeeneees 22 Printed 10 Mar 09 Page 2 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Viewing Recorded data from the Tafonius Shell 00 ccccccccceteeeee cece ee eenteeeeeeneeeeeeneeesenaeeenes 23 ES oola LaLe M Date cae ciecsk da snudidacsoctbecssadstuadenstadecesvaducasucsasedaitduudetenacuadnducuuvads decudaucunadstacwadedaacaetdussacdstnedevetste
57. een Airway Pressure Alarms To access the Airway Pressure Alarms click or touch the Alarms button ECG IBP CO2 Oxygen Agent N20 Sp02 AP Temp Traces Trends Alarm Limits Enable CPAP l d Close The CPAP alarm allows an alert condition when the measured CPAP pressure deviates outside of the required CPAP value Alarm units are in percentage values of the set CPAP value Printed 10 Mar 09 Page 44 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Oxygen Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends iN Alarms Sweep Slow Fast lt Scale O 0 50 Sweep Use this slider control to set the sweep speed of the Oxygen trace across the screen Scale Use this control to set the full scale height of the Oxygen trace window Note that there is no shift feature with this trace To view Oxygen values in excess of 50 the 0 100 scale range must be used Alarm Options Click or touch the Alarms button to show the Alarm options for Oxygen ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarm Limits Enable Inspired High Oo Low _ oO Expired High oO Low oO FiO2 l C 7 The Oxygen Alarm options allow the alarm limits for Inspired and Expired oxygen to be set Alarms can be set for High and Low Inspired and Expired values Click or touch the Enable box to enable the alarm and then enter the alarm value by clicking or touching the appropriate alarm edit box F
58. ehaves as a Virtual Bag The MWPL setting can be useful for patients that are fighting the ventilator to prevent excessive pressures developing CPAP PEEP In Standby Mode CPAP or Continuous Positive Airway Pressure can he applied during spontaneous breathing With CPAP patients inspire and expire normally with no added effort although the end expiratory pressure is elevated to the CPAP setting This aids in maintaining open alveoae The airway pressure is held constant during all phases of breathing In Ventilator Mode PEEP or Positive End Expiratory Pressure applies during IPPV Ventilating pressures rise during the Inspiratory phase as normal but are allowed only to fall as far as the PEEP setting during expiration Validating entries All entries are validated once complete This means that any invalid entries that would exceed minimum or maximum settings that Tafonius is capable of delivering will not be accepted When this occurs a warning sound is issued and a description of the input error is shown at the bottom of the screen as a black on yellow text message In most circumstances the limiting factor preventing the input is also shown Here for example a value of 1 0 second has been entered as a Pause Time during an Inspiration Time of 2 0 seconds This represents 50 of the Inspiratory Time thus exceeding the maximum of 40 and so is disallowed The maximum allowable entry of 0 8 seconds is used Increasing the It to 2 5 seconds
59. emain for example after a device has been removed In these instances select the error and then click or touch on the Resolve button If the error is no longer present then it is resolved and disappears from the list Windows Event Viewer This is reserved for use as a trouble shooting tool A field service engineer or someone from technical support may ask you to use this button to view any error sequences that have arisen during the use of Tafonius Do not use this button during normal use as there may be an effect on the performance and behaviour of the Tafonius software Leak Compliance A leak test and Compliance measurement is offered whenever the Tafonius software is launched However sometimes it is convenient or necessary to run either utility without having to close the program and start again Clicking on the Leak Compliance button starts a sequence of events that proceeds in the following order If the piston is not initialised then Piston Initialisation must be done before either leak testing or compliance measurement Piston Initialisation This involves making sure that there is nothing attached to the Y piece before the piston is sent to the bottom of the cylinder to identify and reset its zero position If the piston has not been initialised since turn on then the cylinder representation on the screen will have a hatched background Once the piston has been initialised this changes to a solid green background Leak testing
60. eral patients or sessions may be held in this folder if no patient information is entered during any of the day s operations e g An operation on September 12 2008 where no patient information was entered will be stored in a folder called Patients2008Sep12 If patient data has been entered then the folder name will be derived from the Patient s name and the patients ID e g Wild Billy ID 1786394 will have a session folder created called WildBilly_ 1786394 If there is more than one session recorded for Wild Billy on that day then all sessions will be stored in this folder Recorded data can be easily viewed and or exported using the utilities supplied with the Tafonius software See the sections Viewing Recorded Data and Exporting Data Printed 10 Mar 09 Page 21 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Viewing Recorded Data Recorded data can be viewed by two methods During a recording session in the ventilator control software or after a session in a spreadsheet viewer Viewing Recorded data during a recording To view data on the fly click or touch on Patient Data and then the Data View tab Alarm Silence Cases Patient Details Notes At Presentation Data Loggfhg Data View OOOO Hospital Number Species MOQ i Patient Name Anonymous Breed Type System etal ee ________ a Owner Name Age oly ol a Patient ID PID 111111 Configure A trend viewer pops up showing t
61. erval for Periodic Data in the Slow Data File The interval for periodic data can be changed in the Data Logging tab of the Patient Data dialog Click or touch the Patient Data button and then select the Data Logging tab In the Slow Data Logging edit box enter the value in seconds to be used as the logging interval Note that this value will have an effect on the final file size Logging every second will create a substantially larger file than every 5 seconds Note also the effect of the logging interval as explained below Effect of the Logging Interval on the Slow Data entries Whatever the interval period between logging of entries automatic event entry will always be logged For example if the Ventilate button is pressed an automatic event will be generated and added to a temporary list of events When the next logging episode occurs all events stored since the previous logging event will be entered into the SD file This is different from the physiological monitoring data which is simply grabbed at the instant of the periodic logging Care should be used when interpreting periodic logged data because events that appear at the same logging could be separated by up the periodic logging interval Printed 10 Mar 09 Page 53 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Adding Events during a procedure Events can be added to the Slow Data SD record during a procedure Events can be pre existing in a drop down list or may be added as a new tex
62. es 13 Inspiratory PaUSe ccccccccceec ee O eg ee ig een nee en annenensneenaneeaanenssneeeenseeaentes 13 Maximum Working Pressure Limit MWPL 0 cccccccccscecccceencneteceeeetecececeeeeseaaeetecteteeaseseeneess 14 CPAP PEEP 0000nao e D EN OO Saanaa ae neoe eeaeee eeina reee 14 Validating entries lt a An sunna nunnu nunnu snan 14 Dependant Values S s seseo onse AEn annesse nonnene EED anaso ssnnn sannan nunnu anses annn nsn unnu n nnee sn ssa anns nananana 15 The System button SBD Laa o e o NEEM eee ce cec ee ceaeteeeeneeeeeseeeasnneoonsenensneenaeeceeeseeenensenneees 16 System Tab A GI AR cee neeeceeeceeeeeceeeeceseeeeeeeaeeeeseesenessceeeseseeeeseeeneeeeees 16 SYS lS I cece cide ca oy eu se es aoe eg ta ede a tae an aes eh ae de eee na tee amedebcnreanee 16 Windows Event Viewer cccccecccsceceeeeeeeeeeee cee ceneeaeeeeeeseeaeeeeeseneceeeeeeeesacesaeeeeeesesesieeeeeeenees 17 Lee COMP ia Ce Neem NEED ee ee ce ees ccceceeec cence neeeeennsceeeeenseeeeesaeeeeesseeeeseeasseeeseeeeeseseeeeeneensenenes 17 Reson Initialisation SA SMB ccccccccceeesceeeeeeneeeescceeeedseceeeseeeeneseeaeseeeseeesseeeeseseeeeneseeaeetees 17 Leakg amp Compliance A SM sos 2 cee csc le ea cee ede ted secon nv need keene dene ce 17 Running the Leak amp Compliance procedure ccccseseeeseeeeeseeeeeeseeeeeeeseneeseseeeeeesseeeeeaseneesesseeeeesneenees 18 The Patien
63. es are not synchronised then select the Synchronise option in the ECG IBP tab If the two traces do not have the same width they cannot be synchronised and the option will be greyed Trace options IBP ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Tee Sensitivity Sweep Shift z 2 12 5 mm sec i PV 25 mm sec E o 0 1 gt ae 20 50 mm sec E O 30 100 mm sec O ECG 60 200 mm sec IBP Heart Rate Synchronise O Beep On IBP Close Sensitivity Moving this slider will change the full scale height of the IBP trace in accordance with the legend on the right hand side of this scale Note that there is an automatic levelling feature in the IBP trace that means that the bottom of the IBP trace is adjusted after every sweep to lie on the base line This will always keep the IBP trace in view even if the blood pressure values are slowly changing Sweep Selecting one of the radio buttons will setthe sweep speed for the IBP trace Note that this option may be further controlled or changed depending on the state of the Synchronise check box and or the presence of ECG and IBP traces on the Tafonius screen If the ECG and IBP signals are not synchronised then the sweep speed of ECG and IBP traces can be different If the traces are synchronised then the IBP sweep speed will be set to and follow the ECG sweep speed Shift The Shift slider alters the position of the baseline of the IBP trace Heart Rate Select
64. ewer Printed 10 Mar 09 Page 52 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Data Recording using the Slow Data File The Slow Data file is an automatically generated file that records all information gathered during a Session Data contained in this file includes all the monitoring information in terms of numerical and trend data This periodic data Default is every 5 seconds also contains all events that occur during use If an alarm condition occurs this is recorded in the Slow Data file Similarly a change of anaesthetic agent type or the level of the MWPL setting is recorded in the Slow Data file This raw file is non editable so that the user can be sure that all events that occurred are recorded For a full description of the data saved in the Slow Data file see Appendix A Slow Data Information The Slow Data file can be exported to a Flash disk using the Export data function accessed from the Tafonius shell See the section entitled Export Data later in this manual In addition to automatic events user events can be added to the Slow Data file These can be added by clicking or touching the Events button at the bottom right hand side of the Tafonius screen These events will appear in the Slow Data file as well as being used for the events shown in the Anaesthetic Record chart For more information on entering manual Events see the section entitled Adding Events During a Procedure later in this manual Changing the int
65. f all of the details are correct then clicking or touching the Accept button will cause the following to happen automatically e The Session is ended e The patient details are used to create the appropriately named Slow Data and Anaesthetic Record files e Anew Session is started using either the next set of patient information in the Case list or the default Patient Anonymous details e Recording for the new Session is started Printed 10 Mar 09 Page 7 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Entering initial patient information Touch the Patient Data button om oe Om Configure Events A new window appears in the information area Hospital Number Species Unknown Patient Name Anonymous Breed Type Sener Name Age oly Olm Patient ID PID 111111 Sex i Weight 0 Kg Close Enter the Hospital Number if used and then use the tab key to move to the next data entry field Fields that take numerical data entry will bring up the small on screen numerical key pad which can be used instead of a keyboard By default the patient s name is Anonymous Edit this to enter your own patient s name When the details have been entered touch the At Presentation tab Anaesthetist M Ica RR Surgeon Ea PCY Procedure l k TP CRT 1 Fasted Pant st M BUN O Yes No O Yes No MM Pink Pulse Anesthetic
66. f the screen When the destination has been set click or touch on the Export button to copy the data across to the selected device Data is exported as a Comma Separated Value CSV file The Anaesthetic Record chart in pdf format will be exported at the same time Printed 10 Mar 09 Page 23 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Configure button The Configure button is used to access the following Presets Initial Settings Gas Monitoring and SPO2 setup The Security button in the Configure window is not active at this time Presets Presets are a means of individually saving Tafonius software layouts and initial settings that suit a particular purpose For example you may have a preset called Foals or a preset called Colics or even Senior Anaesthetist Each Preset saves the way the screen is configured including how the traces are arranged as well as all the initial values used when the program starts as well as all the alarm settings and whether they are enabled or not There are two ways in which Presets are used to load values at the start of a procedure There are the Initial Settings which describe the preferred initial values for such items as Tidal Volume Respiratory rate etc and there are the user settings which remember the preferred settings for e g ECG speed and trace position The values for Initial Settings can be changed by clicking on the Configure button at the bottom right ha
67. file How often data is entered in this SD file is dictated by the setting in the Data Logging tab The default value is 5 seconds A range between 1 second and several minutes can be entered Some natural events such as inspiration and expiration can be entered into the SD file This however can fill the file with information that may not necessarily be required Spontaneous breaths or ventilated breaths can be selected or deselected for entry in the SD file by checking or un checking the respective tick boxes The time that a particular recording session began and its duration are also shown in this tab Finalise Recording As soon as the Tafonius software starts data is recorded in the SD file When a patient session is ended the recording should be finalised To do this push on the Finalise Recording button A dialog box may appear asking to save the current Preset see the section on User Presets and then a further dialog box will appear stating that the data will be committed and that no further changes can be made Click or touch OK to commit the data and begin a new session When a session is Finalised those patient details are removed from the Patient List in the Cases tab Data Storage Locations Where the data is stored will depend whether any Patient Information has been entered If no Patient data has been entered then the data is stored in a folder that is named using the word Patients the calendar month and the day Sev
68. files recorded during a session Touch or click or touch on the one required and then press the Select button A spreadsheet viewer opens to display the recorded data Touching a cell within a column representing measured physiological data will display that data automatically as a trend graph To create graphs for other parameters that are not physiological such as the set Tidal Volume or Compliance Compensated Tidal Volume it is necessary to export the data to a spreadsheet viewer of your choice This is easily done from the Tafonius Shell Exporting Data From the Tafonius Shell click or touch on the Export Data button An Export Data dialog box opens listing the recorded data on the Tafonius computer Data is presented in date order with the most recent at the top Choose the Record folder required and then click or touch on the Next button Then choose the destination for your exported data Typically this will be a USB flash drive inserted in the hub at the front of the screen When the destination has been set click or touch on the Export button to copy the data across to the selected device Data is exported as a Comma Separated Value CSV file The Anaesthetic Record chart in pdf format will be exported at the same time Printed 10 Mar 09 Page 23 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Configure button The Configure button is used to access the following Presets Initial Settings Gas Monit
69. ge the position of this new item in the list use the UP and Down buttons to move the item Once the new Event and the order of Events has been set click ort touch the Close button to leave the Standard Events editor To add your own entry click or touch in the Event Details box and start typing Event Details 05 November 2008 J 17 50 45 E Add a custom event here A t ccep Standard Events l v Add Remove Standard Events Click or touch Accept to add it to the SD file Use the Clear button to remove an entry from the Event Details edit box Printed 10 Mar 09 Page 55 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Tafonius Shell The Tafonius Shell is the starting point for using the Tafonius Ventilator software and also the starting point for various related utilities Peroni TAFONIUS Services Ltd Hallowell EMC Tafonius View Data Export Data Options ew Shutdown The buttons Tafonius Launches the Tafonius ventilation and monitoring software View Data This opens a browser for selecting a patient All data records are shown in date order with the most recent data at the top of the list Choose the Patient Record you would like to View and click or touch the Select button Each patient will have a Slow Data file SD file and an Anaesthetic Record file AR file Printed 10 Mar 09 Page 56 of 61 DOCA4941B USING THE TafoniusS SOFTWA
70. gen Recalibrati q iiagrr ee SEMI eee cee eece MD cece sc eee eee neeeeseeeeensseeeesenenseeesenseeeee 31 CO Nitrous and Agent Calibration Zero reference calibration 0c ccceeeeeeees 32 Using the ARTEMA AION Gas Analysef ccccccccceccccee teense eteneeeeenneeeeteneeeesnaaeeeeteeeeetnaneeeneaas 33 Display Of Measure GQ alues Aap yooo ccc ccnceccesenecneeaneeesenseeensnensaneeaaneneeteceesnereaeeees 33 Other Control buttons Alarm Silence amp Freeze Traces ccccsseeccsseneeeesneeeesseeeeeeseneesesseeeeenseneeeneene 35 Ala CNICE 5 is NI Sie ee ee te ee eee 35 FPR PLACES oo E E EE E A E E 35 The countdown time for Freeze Traces is determined by the Countdown value set in the Initial settings attiB te panel m sssssnnsenunnuuneosssonnnnnnunnnunnunuounnssnn nn nun nunun unnan sanna nnna n nanenane 35 Monitoring Softwate MMs asiccnntasisansu ui sapasenctsicuecs csnuildveanauadvniunaushabsuvanstalawvasacutuicwaestuubipaneaidiui eaaeuied 36 Monitoring OP TIO Tamm lt lt lt sec S03 bs Ses ook ude le ee bp sat cas Deceased Gece ede ales ease ees a eee 36 Organisation OF ACES 3 sionais a a a a aa wade Peseta as acute te tens 37 Adding and Removing Traces cccecececeseeceeesneeeeseaaeeeeeaaeeeeeaeeeeeseaaeeeeeaaeeeeseeeetenaaeeeeeeeees 38 Controlling the appearance Of traces c ccc cnet tee ceee ee tena cette neces teeeeeeseaaeeestneeeeteneeeeneaae 38 The
71. grabbed at the instant of the periodic logging Care should be used when interpreting periodic logged data because events that appear at the same logging could be separated by up the periodic logging interval Printed 10 Mar 09 Page 53 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Adding Events during a procedure Events can be added to the Slow Data SD record during a procedure Events can be pre existing in a drop down list or may be added as a new text entry To add an event click or touch on the Events button at the bottom right hand side of the screen Patient nal Configure This will open a new editor panel at the bottom of the screen gdi Event List 06 01 2009 15 50 Fluid Administration 06 01 2009 15 49 Intubation 06 01 2009 15 49 Anaesthetic Induction Add Close Click or touch on the Add button and then click or touch on the arrow of the Standard Events drop down box In the example below Anaesthetic Induction has been chosen from the Drop Down List Event Details 05 November 2008 17 40 58 Anaesthetic Induction Standard Events Anaesthetic Induction v Add Remove Standard Events Printed 10 Mar 09 Page 54 of 61 Accept Cancel DOCA4941B USING THE TafoniuS SOFTWARE Standard Events can be added or removed from the Drop Down List by using the Add Remove Standard Events button Clicking or touching this button opens a
72. gram using the main ON OFF switch Printed 10 Mar 09 Page 25 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Changing Presets When the Tafonius software starts it uses by default the last Preset in use To change a Preset click or touch on Configure The Preset list is displayed Along the bottom of the Preset Window are 5 buttons used to control how Presets are created named selected and deleted plus two other buttons to Reset Factory Defaults or Close the Configuration dialog The Preset currently in use is indicated by the word Active in brackets after the Preset name This name is also displayed at the top of the screen in the title bar Configuration System Presets Thoroughbred Active Reset Initial Settings Snr Anaesthestist Factory Default Gas Monitoring Spo2 5 Close Security Save As New Save Active Rename Switch To Delete 1 Pll Save As New This button creates a copy of the Active Preset and names it Custom Preset Use the Rename button to change the name to one of your choice If you have made changes to the stored active preset the new stored preset will include those changes Save Active This button saves any changes made to the Active Preset Rename This button allows a Preset to be renamed Type the new name in the edit box that appears and click or touch Ok Switch To Use this button to change to a different Preset from the Active one To use this button click or
73. he trend of the selected parameter from the beginning of the recording session to the current time This data is constantly updated at a rate set by the Slow Data logging period Use the drop down list to select a different parameter Sex Weight 0 Kg Patient Details At Presentation Data Logging Data View 200 E Systolic E Diastolic o Mean 150 100 50 08 56 31 09 50 01 10 43 31 11 37 01 12 30 36 Invasive Blood Pressure v Close Viewing the instantaneous a Drop Down List Click or touch a point in the graph area of the Data View tab A line appears at the point of touch At the bottom of the line on the x axis of the graph is the time at which that point of data was recorded Along the right hand side of the line are the instantaneous value s of the associated data Cases Patient Details Notes At Presentation Data Logging Data View Systolic Diastolic 13 41 35 Invasive Blood Pressure v Close Printed 10 Mar 09 Page 22 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Viewing Recorded data from the Tafonius Shell Click or touch on the View Data button in the Tafonius Shell screen This opens a Record Picker box to choose the Data Record to view Data is presented in date order with the most recent at the top Pick a record to view and then click touch the Select button A file or list of files will be shown that begin with SD These are the Slow Data
74. hen the piston is moved so as to negate this pressure change If the patient breathes out then the piston withdraws upwards effectively filling the bag If the patient inspires then the piston moves down effectively emptying Because the piston is driven by a motor it is the motor that overcomes the resistances of any piping valve or soda lime To the patient if feels like breathing into room air albeit through and ET tube Dictating the size of the Virtual Bag With varying sizes of patients it is beneficial to keep the size of any reservoir bag in the system to a minimum This then allows rapid responses to changes in anaesthetic or oxygen concentrations The setting of the Tidal Volume and the concept of fixed buffer volumes control the size of the Virtual Bag in Tafonius tafonius employs two fixed buffer volumes an upper and a lower The lower buffer volume is 1 5L and the upper buffer volume is 1 0L These volumes are constant and are added to the set Tidal Volume to determine the virtual Bag size thereby creating upper and lower volume limits The upper volume limit Lower Buffer Tidal Volume Upper Buffer The lower volume limit Lower Buffer Whenever the piston volume exceeds the upper limit gas is removed from the system When the piston volume falls below the lower limit then gas is added to the system Printed 10 Mar 09 Page 5 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Starting a Session Tafon
75. heter that enters the Y piece as shown The sampling catheter extends down into the ET tube for optimum sampling Display of Measured Values THE Gas Anlayser IRMA or AION will continuously display and update the numerical and trace information for the patient The trace region shows the capnogram as either a line or filled trace The main numerical data region associated with the trace shows the inspired and expired values of COs CO2 0 0 3 6 9 Inspired Expired BPM C02 Oo The larger figure represents the expired value and the smaller figure shows the inspired value The third value to the right is the respiratory rate in breaths per minute If a period of apnoea occurs then the alarm will sound and the respiratory rate will be replaced by a red box which displays the number of seconds elapsed since the last breath 0 CO2 APNOEA 0 0 Inspired Expired Gii C02 o Printed 10 Mar 09 Page 33 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Clicking or touching this red box will silence the Apnoea alarm The box will remain red and continue to count the seconds since the last recorded breath A fresh breath will clear the Apnoea state and return to displaying Respiratory Rate RR During periods of Apnoea the inspired values are constantly updated indicating the gas concentrations in the breathing circuit Printed 10 Mar 09 Page 34 of 61 DOCA4941B USING TH
76. his pressure phase the piston movement and hence leak is measured The measured leak should be below 1500mls min and in normal circumstances is less than 500 mls minute Values above or around 1500 mls minute represent a serious leak and should be investigated However due to the way Tafonius maintains pressures and controls piston movement even leaks of 1500mls minute are unlikely to affect ventilator performance They do however represent a loss of gas and agent Printed 10 Mar 09 Page 17 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Running the Leak amp Compliance procedure Press the Leak Compliance button on the System tab to begin the procedure Configuration System Freeze Traces System Errors Speier Leak Compliance Demo Mode Exit Windows Event Viewer Resolve Resolve All A dialog appears announcing that it is establishing a connection with the Auxiliary controller This can take 5 10 seconds After that a second dialog appears asking that any patient be removed from the circuit When the breathing circuit is ready press the Leak amp Compliance button Alarm Silence Configure Disconnect Patient and Push Leak amp Compliance Leak amp i Zero Pisto CE Skip At this point a stopper must be applied to the Y piece to seal the system Then press the Leak amp Compliance button Fit Stopper to end of Y Piece Piston is ini
77. iO2 This option is not yet implemented and will be available in the future Printed 10 Mar 09 Page 45 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The SPO2 Attribute tab ECGABP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarms iN Sweep Slow gt Fast Sound O Beep On SpO2 Pulse Close Sweep Use the Sweep slider control to change the speed at which the SpO2 trace moves across the screen Sound Click or touch the box next to Beep On SpO2 Pulse to enable audible beeps associated with each detected pulse waveform This will over ride any other beep selection Alarm Options Click or touch the Alarms button to show the Alarm options for SpO2 ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarm Limits Enable Mams Pulse Rate High ee bpm O Low bpm Oo Saturation Low F Sound O Beep On SpO2 Pulse Close Alarm Limits Click or touch the enable box to enable the alarm and then enter the appropriate value Sound Click or touch the tick box to select audible beeps every time a pulse wave on the SPO2 monitor is detected Printed 10 Mar 09 Page 46 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Agent Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends rece in use Sweep Halothane Enflurane Scale Isoflurane 0 5 Sevoflurane O 0 10 Desflurane In Use The IRMA OR detector used for agent monitoring does not have automatic agent ID so
78. icicice cco delice decal hed deeded vanced Woeavnd evodlinsaeh ade Meade eens 46 The Agent Attribute tab 3 csici isccedes cose beves ed deb oe labia dahon estan eE aaae 47 The N20 Attribute tab sci cisceetiveecs siete ei as iid stdin Fi eA el ied 48 The Temperature Attribute tab 0 0 cccccccccceceececeeceeeeeeeeeeeaeeeeeeeeeneeeeeeseeseneeaeeeeeesesnnieeeeeeenees 49 The Traces Trends Attribute tab ci ccccccccccceeeecessseueeeeeeseeeeeseeueeeeeeseeueeeeeeseeeneneeeseds 50 Alarms Alerts and Critical Error Messages cccscecssseeeeeseenesseeeeeeseeeeesneeeeeeseeeesaseneeeesseeeeenseneeeneene 51 Creating an Anaesthetic Record Chart 0 cccccccecceceeeeseeceeneeecenneeestnneeeeseeeeeeseaeeeeenneeeeseeeeeneaas 52 Altering the Start Time of the Anaesthetic Record chart 00 0 ccccccecccceeeeeesetteeeeeeeees 52 Viewing the Anaesthetic Record chatt 22 ccccccccccecceceeeeensneceeeeteseaaeceesecnecneaeeesestessaeeeeeneeneaas 52 Data Recording using the Slow Data File 2 eeceteeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeneeeeeeeeaeeeeea 53 Changing the interval for Periodic Data in the Slow Data File 0 ccccceeseeeeeteseertees 53 Effect of the Logging Interval on the Slow Data entries neiere reenen 53 The Tafonius Shell ccccsccccssseccscsccssesecccesccccssecceencccsns A MMOMieeaecncnneececencccnnsncccencena Oea nnan nananana nananana 56 TAPOMIUS oc ccccc
79. ies Units Trace Scale Yolume Line 0 10 o Beep On O mmHg Filled O 0 20 O kPa Close Properties Units Set the displayed units as Volume millimetres of mercury mmHg or as kilopascals kPa When units are changed there is an automatic change in the units applied to alarms so that the corresponding value in the new units is used Trace Select whether to display the Capnogram as a filled trace or as a simple line curve Scale Fixes the vertical scale of the CO2 trace Beep on Breath Select this tick box to produce an audible beep with every detected breath Alarm Options To set Alarms associated with CO2 measurement click or touch the Alarms button ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarm Limits Enable Inspired High R oO Expired High e g Low E g Beep On Breathing High bpm O To set an alarm place a tick in the enable box and then enter the appropriate alarm value Printed 10 Mar 09 Page 43 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Airway Pressure AP Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends ena 120 Sweep i gt 60 Slow 9 Fast 30 1 9 Sensitivity This slider sets the scales of the Airway Pressure trace The value next to the pointer represents the maximum positive height of the trace window Sweep This slider sets the sweep speed of the Airway Pressure trace which is the speed at which the trace is drawn across the scr
80. information see the section entitled Entering Initial Patient Information later in this manual For more information on the production of an Anaesthetic Record see the section entitled Creating An Anaesthetic Record Chart later in this manual Printed 10 Mar 09 Page 6 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The Finalise Recording procedure Using any of the first three Finalising methods listed above will cause the following dialog to appear Accept Findings Do you accept these findings Hospital Number Patient Name Owner Name Patient ID Species Breed T ype Age Sex Body Weight Notes At Presentation Anaesthetist Surgeon Procedure Respiration Rate Temperature PCY TTP BUN Anaesthetic Risk Status 12345678 Alfonzo Smithers 192837465 Equine Arab 4 M 500Kg This dialog presents the current information associated with the recording session If these are all correct then click or touch the Accept button To edit any feature shown click or touch the Change button This will take you to back to the Patient Data edit region where any of the details can be changed Alfonzo notes John Irving House Surgeon 0 Breaths min Pulse ODegC CRT MM Pant Fasted 1 0 Beats min lsec Pink No No To accept these findings press Accept to clear the finding press Discard or to return to the application and change the findings press Change I
81. ing devices and or professional human judgements of patient condition The IRMA multi gas analyser is intended to be used by trained and authorised veterinary professionals only It is not intended to be used in outdoor transport applications such as in cars or in aircrafts IRMA Setup Plug the IRMA device into the IRMA socket located on the bulkhead behind and below the utility drawer on the Right Hand Side of the machine Snap the IRMA sensor head on top of the IRMA airway adaptor It will click into place when properly seated A green LED indicates that the IRMA sensor is ready to use Printed 10 Mar 09 Page 29 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Connect the 15mm male IRMA Airway adaptor connector to the breathing circuit When used with a foal 22mm circuit connect the IRMA device as shown in the next 2 images Connect the 15mm female IRMA Airway adaptor connector to the patient s endotracheal tube When used with a 50mm mainstream adaptor the IRMA adaptor is integrated into the Large airway adaptor as shown Printed 10 Mar 09 Page 30 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Always position the IRMA sensor with the O2 cell or top pointing upwards Pre Use check Before connecting the IRMA adaptor to the breathing circuit verify the O2 calibration by checking that the O2 reading on the monitor is correct 21 See the following section Oxygen Recalibration on how to perform room air
82. inted 10 Mar 09 Page 28 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Using the PHASEIN IRMA Monitor Important Note The IRMA mainstream multi gas probe is intended to be connected to a patient breathing circuit for monitoring of inspired expired gases of patients in intensive care anaesthesia and emergency care It is not intended to be used as the only means of monitoring a patient It shall always be used in combination with other vital signs monitoring devices and or professional human judgements of patient condition The IRMA multi gas analyser is intended to be used by trained and authorised veterinary professionals only It is not intended to be used in outdoor transport applications such as in cars or in aircrafts IRMA Setup Plug the IRMA device into the IRMA socket located on the bulkhead behind and below the utility drawer on the Right Hand Side of the machine Snap the IRMA sensor head on top of the IRMA airway adaptor It will click into place when properly seated A green LED indicates that the IRMA sensor is ready to use Printed 10 Mar 09 Page 29 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Connect the 15mm male IRMA Airway adaptor connector to the breathing circuit When used with a foal 22mm circuit connect the IRMA device as shown in the next 2 images Connect the 15mm female IRMA Airway adaptor connector to the patient s endotracheal tube When used with a 50mm mainstream adaptor the IRMA adapt
83. irtual Bag With varying sizes of patients it is beneficial to keep the size of any reservoir bag in the system to a minimum This then allows rapid responses to changes in anaesthetic or oxygen concentrations The setting of the Tidal Volume and the concept of fixed buffer volumes control the size of the Virtual Bag in Tafonius tafonius employs two fixed buffer volumes an upper and a lower The lower buffer volume is 1 5L and the upper buffer volume is 1 0L These volumes are constant and are added to the set Tidal Volume to determine the virtual Bag size thereby creating upper and lower volume limits The upper volume limit Lower Buffer Tidal Volume Upper Buffer The lower volume limit Lower Buffer Whenever the piston volume exceeds the upper limit gas is removed from the system When the piston volume falls below the lower limit then gas is added to the system Printed 10 Mar 09 Page 5 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Starting a Session Tafonius uses the concept of anaesthetic or procedure Sessions for the collection and recording of data As soon as the Tafonius software starts then information begins to be stored in the Slow Data file and the Session is started This storage of data continues until a session is Finalised A session may be Finalised by one of the following Clicking or touching the Finalise Recording button in the Data Logging tab Exiting the program through the System and then Exi
84. ius uses the concept of anaesthetic or procedure Sessions for the collection and recording of data As soon as the Tafonius software starts then information begins to be stored in the Slow Data file and the Session is started This storage of data continues until a session is Finalised A session may be Finalised by one of the following Clicking or touching the Finalise Recording button in the Data Logging tab Exiting the program through the System and then Exit buttons Exiting the program by pressing and holding the Mains Control button An abrupt program closure such as power loss closure of Windows without closing Tafonius non controlled shutdown In all but the last procedure the data will be saved and associated with all the patient information In the event of a non controlled shutdown there will be NO DATA LOSS although the patient information will not be associated with the data In this instance the Files associated with the session will be saved with the word Patients as a prefix and the Slow Data and Anaeathetic Record will use only the date as identifiers For example a session interrupted by a non controlled shutdown on January 7 2009 will have a record named Patients2009Jan07 with Slow Data and Anaesthetic Records named AR2009Jan7 8_50_56 and SD2009Jan7 8 50_56 respectively The suffix 8 50 56 indicates that the session began at 08 50 56 on the morning of January 7 For more information on entering Patient and case
85. ive Airway Pressure in cm H2O FiO2 Desired initial oxygen fraction not available in software version 1 0 APNOEA Length of time allowed between breaths before Apnoea alarm sounds Countdown Length of countdown timer before pop up menus close automatically in seconds Countdown _ Enable the countdown timer for closing pop up menus Mousel Enable the mouse cursor on the screen When done click or touch on the Preset tab again and then choose Save Active The next time this Preset is loaded these new initial values will be used User settings During the course of using the Tafonius program you may make changes to the screen appearance or to the appearance of a certain monitor trace When changes such as these are made that affect the personal way that the screen is viewed the Preset will be marked as altered and an asterisk will appear next to the name in the title bar Tafonius ver 0 1 1114 0 Tafonius Custom Preset Manual Control Mode At any time or at the end of a procedure this unique set up of Tafonius can be saved by again choosing to save the Preset If this is not done explicitly during use then you will be prompted to save the Preset when finalising a patient session You can choose to change the active preset by touching SAVE or you may save the current setup as a new setup by touching SAVE AS NEW and renaming it as desired Note that you will not be prompted to save a changed Preset when you shut down the Pro
86. n add 2 5L which is the buffer volume used by the ventilator Total pre fill volume 10L When the cylinder graphic shows it is at the required volume turn off the oxygen flow This sets the volume of the Virtual Bag for spontaneous breathing The concept of the Virtual Bag is central to how Tafonius operates This action of the ventilator maintains a minimum system volume thereby reducing anaesthetic and oxygen consumption as well as decreasing the system s time constant The Piston as a Virtual bag When the ventilator is in standby mode and a patient is connected the system behaves like a perfect bag When the patient breathes out there is no expiratory resistance and when the patient breathes in there is no inspiratory resistance This ideal performance is accomplished with the Airway Servo System employed by Tafonius The airway pressure is sensed at the centre of the Y piece As soon as a pressure deviation in excess of 0 5cm H20 from the ambient pressure is detected then the piston is moved so as to negate this pressure change If the patient breathes out then the piston withdraws upwards effectively filling the bag If the patient inspires then the piston moves down effectively emptying Because the piston is driven by a motor it is the motor that overcomes the resistances of any piping valve or soda lime To the patient if feels like breathing into room air albeit through and ET tube Dictating the size of the V
87. n addition to automatic events user events can be added to the Slow Data file These can be added by clicking or touching the Events button at the bottom right hand side of the Tafonius screen These events will appear in the Slow Data file as well as being used for the events shown in the Anaesthetic Record chart For more information on entering manual Events see the section entitled Adding Events During a Procedure later in this manual Changing the interval for Periodic Data in the Slow Data File The interval for periodic data can be changed in the Data Logging tab of the Patient Data dialog Click or touch the Patient Data button and then select the Data Logging tab In the Slow Data Logging edit box enter the value in seconds to be used as the logging interval Note that this value will have an effect on the final file size Logging every second will create a substantially larger file than every 5 seconds Note also the effect of the logging interval as explained below Effect of the Logging Interval on the Slow Data entries Whatever the interval period between logging of entries automatic event entry will always be logged For example if the Ventilate button is pressed an automatic event will be generated and added to a temporary list of events When the next logging episode occurs all events stored since the previous logging event will be entered into the SD file This is different from the physiological monitoring data which is simply
88. nd side of the screen A new smaller window area appears below the traces area Configuration System Presets Custom Preset Active Reset Initial Settings Factory Default Gas Monitoring Sp02 Close Security Save As New Save Active Rename Switch To Delete Choose the preset you want to change by clicking on it in the Presets list If it is already in use it will have the word Active after the preset name If not then click or touch on the required Preset and then choose the Switch To button The selected Preset will be loaded Then click or touch on the Initial Settings button on the left hand side 1 PLE Printed 10 Mar 09 Page 24 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Initial Settings Configuration System Initial Settings Custom Preset 1 ne We Sota TV 5 litres MWPL 35 cmH20 gt Manual RR 5 bpm IP O secs Auto B FiO2 100 0 Ipm I E Ratio 1 ARNOESI 20 secs ames Exp Time Al Countdown 60 secs 51sec ty S Countdown 4 Mouse Using the keyboard or the on screen keypad enter the initial values you would like in each of the named fields The fields have the following meanings TV Tidal Volume in litres RR Respiratory rate in breaths per minute It Total Inspiratory time MWPL Maximum Working Pressure Limit IP Inspiratory Pause in seconds Show IP as _ Shows the Inspiratory pause as a percentage of the It CPAP Continuous Posit
89. ng as a respiratory monitor The smaller black numbers are the ventilator settings that will be used in Ventilate mode If no breathing is detected after 60 seconds the blue values are all set to zero Tidal Volume Respiratory Rate Inspiratory Time Inspiratory Flow 150 litres minute When you touch a button it changes colour and becomes ready to accept a new value A numeric keypad appears in the lower right hand corner of the screen where you can enter a new value Or the value may be changed by means of the UP DOWN arrows When the new value has been entered do one of the following Touch the body of the button again Touch_the Enter button on the numeric keypad or Touch the body of the next button whose value you want to change Printed 10 Mar 09 Page 12 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Tidal Volume In Standby mode The set Tidal Volume is indicated by the smaller black number and is the volume that will be delivered per breath when the switch is made to Ventilate mode It also sets the volume of the Virtual Bag used by the patient The blue value indicates the breath by breath tidal volume of the spontaneously breathing patient In Ventilate Mode Sets the actual volume delivered to the patient Tafonius uses automatic compliance compensation so the volume received by the patient is the volume entered The volume displaced by the cylinder will be more than the set value to compensate for the volume lost to the
90. not use this button during normal use as there may be an effect on the performance and behaviour of the Tafonius software Leak Compliance A leak test and Compliance measurement is offered whenever the Tafonius software is launched However sometimes it is convenient or necessary to run either utility without having to close the program and start again Clicking on the Leak Compliance button starts a sequence of events that proceeds in the following order If the piston is not initialised then Piston Initialisation must be done before either leak testing or compliance measurement Piston Initialisation This involves making sure that there is nothing attached to the Y piece before the piston is sent to the bottom of the cylinder to identify and reset its zero position If the piston has not been initialised since turn on then the cylinder representation on the screen will have a hatched background Once the piston has been initialised this changes to a solid green background Leak testing and compliance values can then be measured Uninitialised Initialised piston piston background is background is hatched green and Image also has shows piston a red flashing volume in litres border Leak amp Compliance This button begins the process of first leak testing and then measuring the compliance of the system For leak testing the piston is taken to the mid point of the cylinder and then the piston produces a pressure of 20cm H20 During t
91. nspiratory Pause In Standby Mode Has no action In Ventilate Mode Controls the portion of the Inspiratory phase that is held as a pause The maximum pause is limited to 40 of the total Inspiratory time Increasing the Pause time will increase the time the inspiratory volume is held at the end of the Inspiration stroke The total Inspiratory Time is unaffected so Inspiratory Flow rates will increase as more Pause time is added Touch the Pause button to activate it and open the numeric keypad Touch it again to toggle between setting the pause as a of Inspiratory time or as a finite time Enter the actual time or percentage required Press Enter on the numeric keypad when done In general as with the ventilator settings above any button shaded green on the display is a value you can set These include the following Printed 10 Mar 09 Page 13 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Maximum Working Pressure Limit MWPL The Maximum Working Pressure Limit control sets a level above which ventilation is prevented This is particularly useful when dealing with neonates or during open chest surgery when lung expansion is not restricted by a closed thorax The Maximum Working Pressure Limit is an absolute value and is unaffected by any settings of PEEP or CPAP If the MWPL value is reached during an Inspiratory phase then the ventilator immediately sounds an alarm and changes to the expiratory phase where once again the cylinder b
92. nted 10 Mar 09 Page 10 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Data Logging Tab In this tab the options for Slow Data Recording and Anaesthetic Record chart heart rate can be set Because Tafonius has 3 means of monitoring heart rate ECG IBP amp Pulse Ox it is necessary to select one to be used for the Anaesthetic Record chart Unless you have specific reasons for changing the Slow Data Logging time leave this set at 5 seconds For Anaesthesia Record Slow Data Logging sec Log Heart Rate From Time ECG Start 14 27 55 Elapsed 00 04 14 O IBP O Record Spontaneous Breaths O Pulse ox Record Yentilated Breaths Anaesthetic Record Start Finalise Recording When all the patient information has been entered click or touch the Close button Printed 10 Mar 09 Page 11 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The Ventilator controls The ventilator controls consist of Tidal Volume Respiratory Rate Inspiratory Time Maximum Working Pressure Limit and a CPAP or PEEP setting These are the only controls that can be set for ventilation The main controls Tidal Volume Respiratory Rate amp Inspiratory Time have two sets of numbers associated with them These numbers change depending on whether the system is in Standby spontaneous breathing mode or Ventilate mode In Standby mode the large blue numbers are the measured values derived from the patient s respiratory efforts The Airway Servo System is worki
93. nts Insp CO2 Exp CO2 Resp Rate Insp Agent Exp Agent Insp O2 Exp O2 Atmospheric Pressure Nonin SpO2 Measurements SPO2 HR Saturation Printed 10 Mar 09 Respiratory rate in breaths per minute Minute Volume in litres Inspiratory flow rate in L min Inspiratory Expiratory ratio CPAP Standby or PEEP Ventilate values in cm H2O Peak Inspiratory Pressure in cm H2O Fractional Volume measurement of inspired CO2 Fractional Volume measurement of expired CO2 Breathing rate in breaths per minute Inspired Agent Fractional Volume measurement Expired Agent Fractional Volume measurement Inspired Oxygen Volume measurement Expired Oxygen Volume measurement Current Atmospheric pressure in mm Hg Heart rate from pulse oximeter device Percentage oxygen saturation of arterial blood Page 60 of 61 DOCA4941B IBP Measurements Mean USING THE TafoniusS SOFTWARE Mean arterial blood pressure mean 4 average Systolic Systolic blood pressure mean 4 average Diastolic Disatolic blood pressure mean 4 average Heart Rate Patient heart rate from blood pressure device Temperatures Ti Temperature from Thermometer 1 in either C or F T2 Temperature from Thermometer 2 in either C or F ECG HR Heart rate from ECG monitoring device Battery Data Batt1 Voltage level of battery 1 lower 12v battery Current1 Charging rate of battery 1 in amps Batt2 Voltage level of battery 2 upper 12v battery Current2 Charging rate of batte
94. onius Launches the Tafonius ventilation and monitoring software View Data This opens a browser for selecting a patient All data records are shown in date order with the most recent data at the top of the list Choose the Patient Record you would like to View and click or touch the Select button Each patient will have a Slow Data file SD file and an Anaesthetic Record file AR file Printed 10 Mar 09 Page 56 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Record Picker Please select the patient folder and click select cy Patients2008SEP16 D Patients2008SEP15 im Patients200 7OCT30 To view the Slow Data information highlight the appropriate file and then touch or click the Select button The Slow Data is viewed in a spreadsheet format and can be used to show monitoring trends By touching any of the measured parameter columns e g ECG heart rate Pulse Ox saturation a trend view of the data over the course of the procedure is shown at the bottom of the screen Touching the column again hides the trend view For greater versatility export the data to a USB stick and view the data in a commercial spreadsheet of your choice All Slow Data files are saved as CSV or comma separated value files To view the Anaesthetic Record chart highlight the desired AR file and then touch or click Select A new window opens to show the Anaesthetic Record pdf file For printing and archiving of either the Slow Data or the Anaesthetic Recor
95. or Close the Configuration dialog The Preset currently in use is indicated by the word Active in brackets after the Preset name This name is also displayed at the top of the screen in the title bar Configuration System Presets Thoroughbred Active Reset Initial Settings Snr Anaesthestist Factory Default Gas Monitoring Spo2 5 Close Security Save As New Save Active Rename Switch To Delete 1 Pll Save As New This button creates a copy of the Active Preset and names it Custom Preset Use the Rename button to change the name to one of your choice If you have made changes to the stored active preset the new stored preset will include those changes Save Active This button saves any changes made to the Active Preset Rename This button allows a Preset to be renamed Type the new name in the edit box that appears and click or touch Ok Switch To Use this button to change to a different Preset from the Active one To use this button click or touch on the Preset you wish to use and then click or touch on the Switch To button Delete This button removes the highlighted Preset Note that it is not possible to delete an active preset Reset Factory Default This button will apply all the default factory settings to the Active Preset Note that the Preset must be Active for the changes to be made to it A confirmation dialog box appears stating which Preset will be changed If this is the Preset
96. or is integrated into the Large airway adaptor as shown Printed 10 Mar 09 Page 30 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Always position the IRMA sensor with the O2 cell or top pointing upwards Pre Use check Before connecting the IRMA adaptor to the breathing circuit verify the O2 calibration by checking that the O2 reading on the monitor is correct 21 See the following section Oxygen Recalibration on how to perform room air calibration IRMA Monitor General Description The IRMA breath monitor unit is a small cube shaped unit housing a replaceable Airway Adaptor and Oxygen sensor The main housing for the unit has an LED in one corner which indicates the status of the sensor These states are described in detail in the section IRMA Status amp Error Messages The IRMA unit connects to the Tafonius monitoring system via a 9 Way Female D Type connector When the unit is connected and the unit powered ON the IRMA device runs through a self test sequence This is indicated by the LED on the main housing changing alternately through GREEN RED BLUE a number of times Once the initialisation sequence is complete the LED stays GREEN If the IRMA unit has the capability of detecting anaesthetic agents then the LED will turn BLUE in the presence of these agents IRMA units may be connected disconnected while powered without any problems Calibration self test and reset The IRMA unit is self calibrating and does no
97. oring and SPO2 setup The Security button in the Configure window is not active at this time Presets Presets are a means of individually saving Tafonius software layouts and initial settings that suit a particular purpose For example you may have a preset called Foals or a preset called Colics or even Senior Anaesthetist Each Preset saves the way the screen is configured including how the traces are arranged as well as all the initial values used when the program starts as well as all the alarm settings and whether they are enabled or not There are two ways in which Presets are used to load values at the start of a procedure There are the Initial Settings which describe the preferred initial values for such items as Tidal Volume Respiratory rate etc and there are the user settings which remember the preferred settings for e g ECG speed and trace position The values for Initial Settings can be changed by clicking on the Configure button at the bottom right hand side of the screen A new smaller window area appears below the traces area Configuration System Presets Custom Preset Active Reset Initial Settings Factory Default Gas Monitoring Sp02 Close Security Save As New Save Active Rename Switch To Delete Choose the preset you want to change by clicking on it in the Presets list If it is already in use it will have the word Active after the preset name If not then click or touch on
98. r Surgeon Altering the Start Time of the Anaesthetic Record chart It is not uncommon to prepare Tafonius some time in advance of connection to the patient During this time there will be continual recording of non meaningful data To avoid this the Start time for the Anaesthetic Record data can be set using the Anaesthetic Record Start button Pressing this button will reset the start time for the Anaesthetic Record data ONLY Slow data information is not affected The Anaesthetic Record Start button is found in the Data Logging tab of the Patient Data dialogs The following dialog will appear Anaesthetic Record Start A re you sure you want to set the start of anaesthetic recording From now Anaesthetic Record data and Trend data prior to this point will not be viewable This procedure can be repeated as many times as required noting that each time data prior to selecting this option will no longer be available After this creation of the Anaesthetic Record chart is automatic and the chart can be viewed from the Tafonius Shell via the View Data button Viewing the Anaesthetic Record chart The Anaesthetic Record chart can only be viewed from the Tafonius Shell whilst Tafonius is NOT running Click or touch the View Data button in the Tafonius Shell Use the Record Picker to select a patient and then click Select Then highlight the AR file and click or touch Select This will open a pdf version of the Anaesthetic Record in Adobe Vi
99. r a new value Or the value may be changed by means of the UP DOWN arrows When the new value has been entered do one of the following Touch the body of the button again Touch_the Enter button on the numeric keypad or Touch the body of the next button whose value you want to change Printed 10 Mar 09 Page 12 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Tidal Volume In Standby mode The set Tidal Volume is indicated by the smaller black number and is the volume that will be delivered per breath when the switch is made to Ventilate mode It also sets the volume of the Virtual Bag used by the patient The blue value indicates the breath by breath tidal volume of the spontaneously breathing patient In Ventilate Mode Sets the actual volume delivered to the patient Tafonius uses automatic compliance compensation so the volume received by the patient is the volume entered The volume displaced by the cylinder will be more than the set value to compensate for the volume lost to the compliance of the system The patient actually receives the TV you set regardless of the length of the breathing systems tubes This is very helpful when 20 or 30 ft tubes are connected to reach a patient in an MRI Tidal Volume units are Litres Respiratory Rate In Standby mode The blue figures show the measured respiratory rate recalculated every 10 seconds on a rolling 1 minute basis This gives a true reflection of respiratory rate The smaller black figur
100. races Use this button to freeze all trace information on the screen All other monitoring activities continue as normal The button will change colour to indicate that it is active Also a countdown timer will begin showing on the button At the end of the countdown period the freeze option will be lifted Alternatively simply clicking or touching the Freeze button once more will release the freeze option The countdown time for Freeze Traces is determined by the Countdown value set in the Initial settings attribute panel Printed 10 Mar 09 Page 35 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Monitoring Software Monitoring options Tafonius has the options of monitoring the following parameters via its in built software Single Channel ECG Single Channel Invasive Direct Blood Pressure Breath Analysis Inspired Expired CO2 Inspired Expired O2 Inspired Expired N20 Inspired Expired Anaesthetic Agent Halothane Isoflurane Sevoflurane Desflurane Enflurane Single Channel Pulse Oximeter Dual Channel Temperature with delta Airway Pressure Printed 10 Mar 09 Page 36 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Organisation of traces The monitoring screen consists of 3 main regions a trace region where all time traces are displayed a numerical region where all values are displayed and a status region where status information about Tafonius is displayed Tafonius ver 0 1 1114 0 Tafonius Foal Manual Control
101. range must be used Alarm Options Click or touch the Alarms button to show the Alarm options for Agent ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Enable Inspired High E Low Expired High Low Close Alarm Limits Set the alarm limits required for a particular agent here Note that different alarm limits can be set for each and every agent Click or touch the Enable box to enable the alarm and then enter the appropriate value Printed 10 Mar 09 Page 47 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The N20 Attribute tab ECG IBP CO2 Oxygen Agent N20 Spo2 AP Temp TracesfTrends iN Alarms Sweep Slow 9 Fast Scale O 0 50 Alarm Options Click or touch the Alarms button to show the Alarm options for N20 ECGABP CO2 Oxygen Agent N20 SpO2 AP _ Temp Traces Trends Alarm Limite Enable Inspired High D Expired High o Alarm Limits This tab allows the alarm limits to be set Alarms can be set for High Inspired and Expired values Click or touch the Enable box to enable the alarm and then enter the alarm value by clicking or touching the appropriate alarm edit box Printed 10 Mar 09 Page 48 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The Temperature Attribute tab ECGABP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends me Time Temperature Scal 20min Fahrenheit 1hr Celcius O 2hrs O 5hrs Time Selecting an option here sets the amount of data
102. rcuit connected The two compliance values are used to obtain the equation for the straight line graph of compliance for your machine and the breathing system in use at that time This equation is then used to compute the compliance compensation required at any piston position and pressure Printed 10 Mar 09 Page 19 of 61 DOCA4941B USING THE TafoniusS SOFTWARE CO2 mmf RR Inspired Expired BPM i AP cmH20 j 0 0 N O PIP CPAP hail ISO SPO2 AirwayPressure2 Oxygen Iso CET pm m fan a e A CET pm TE Inspired Expired Inspired Expired T Inspired Expired 0 Leak and Compliance test complete damana A sen raer Leak is 660mls min Configure iis Compliance at 19 11 amp 4 41 is 39 0mls cmH20 amp 29 2mls emH20 ba Events Help Press Finish to leave the Leak amp Compliance test procedure Printed 10 Mar 09 Page 20 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The Patient Data button Entering patient data has been described under the section Entering Initial Patient Information This covers the Patient Details and At Presentation tabs found once the Patient Data button is pressed Also found here are the Data Logging and Data View tabs Data Logging All physiological data and many automatic events are recorded in a file called the Slow Data SD
103. red values Click or touch the Enable box to enable the alarm and then enter the alarm value by clicking or touching the appropriate alarm edit box Printed 10 Mar 09 Page 48 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The Temperature Attribute tab ECGABP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends me Time Temperature Scal 20min Fahrenheit 1hr Celcius O 2hrs O 5hrs Time Selecting an option here sets the amount of data displayed in the trace window By selecting a long Time period trends can easily be visualised By choosing a short time period details in trace changes are more easily observed Temperature Scales Choose to use either Fahrenheit or Celsius as the temperature scale Alarm values change accordingly Alarm Options Click or touch the Alarms button to show the Alarm options for Temperature ECGABP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends y S n E Ams Alarm Limits Enable High s C O Low C oO Close Alarm Limits There are 3 alarm options Alarms for T1 temperature probe Alarms for T2 temperature probe and Alarms for the Delta temperature The Delta temperature is the difference in temperature between the two temperature readings of T1 and T2 Click or touch the enable box to enable the alarm and then enter the appropriate value Printed 10 Mar 09 Page 49 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Alarm Silence Use this button to silence a temperature
104. ry 2 in amps Piston Position Units Shows the piston position in absolute units In addition to these headings in the file there will be additional events recorded The table below shows some typical events that have been recorded 08 09 33 21 Preset Loaded Custom Preset 08 09 33 191 Leak 600 0 Compliance Low 27 4 Compliance High 63 3 08 09 33 201 MWPL 35 08 09 33 311 Cylinder Open 08 09 33 702 FMSO ON 65535ms 08 09 33 722 Init Requested 08 09 35 695 Auxiliary Controller No Watchdog 08 09 35 705 Auxiliary Controller No Position data 08 09 35 895 Auxiliary Controller Watchdog data established 08 09 37 237 FMSO ON 65535ms 08 09 37 247 Init Requested 08 09 37 778 Auxiliary Controller Position data established Thursday March 27 2008 08 09 38 Records Started Tafonius Version 0 1 1092 0 Every entry has a time associated with it and describes the event that occurred Printed 10 Mar 09 Page 61 of 61 DOCA4941B Using the Tafonius software 008 16 48 06 ECG 69 CO2 14 2 a Inspired Expired BPM AP cmH20 O o ee Se oe Inspired Expired Inspired Expired N O ISO _ SPO2 Oxygen J 100 P Sensor l gor zigna a Inspired Expired F102 ECG IBP C02 AP_ Oxygen SpO2 Agent N20 Temp Traces Trends Sensitivity Sweep Filter Shift Alarm Silence Freeze Traces eam ie i jarms
105. t Data Qin Amey cessscssssesscsssnsssessessessensessesessessensossenssnennersesenseansasessesssseansorsssespensenessensens 21 BETE Mole lo la l epee RE a E eee are 21 Finalise Recording arrien ea ae a a eee EAA A aus ce tate teats Neila as 21 Data Storage Locations nmas irienner ee eee 21 Viewing Recorded Data aare aaa aar mane eaa e aeaaaee a aaa aaaeeeaa Aee aaa A Aaaa Eea Aaea aa AAE eean aA aaan aa aiaia 22 Viewing Recorded data during a r COrding 1 ccccccccieecetteeee tenes eeteeneeeceaeeeeenneeeeteaaeeeseaeeenes 22 Viewing the instantaneous value using Data View c ccc ceneeeeeeeeeeeeeeeeeeeeeaeeeeeneees 22 Printed 10 Mar 09 Page 2 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Viewing Recorded data from the Tafonius Shell 00 ccccccccceteeeee cece ee eenteeeeeeneeeeeeneeesenaeeenes 23 ES oola LaLe M Date cae ciecsk da snudidacsoctbecssadstuadenstadecesvaducasucsasedaitduudetenacuadnducuuvads decudaucunadstacwadedaacaetdussacdstnedevetsteats 23 The Configure button cissedcsccdactedacrsacstescadetianasasevsceidacadedvastacsetstabsdaadtvacsnctcedvesncuuenstunsdidctectadasedsGaecsaveceas 24 A EEA aa ood clots ie aut cay et eda ade E E E EAEE 24 PYAR AL SOUS 20565 E as iti ted lel A E dante aes Neale ates 25 UET RT italo E EPE ica iad eens EE lie lanes Seca tae EE E 25 Changing Presets eeessssosssoerrnersrreeenssesrerrerrrrererneeosseerrerrerree gM ea cho noes ee ace ics a eee atte tet 2
106. t buttons Exiting the program by pressing and holding the Mains Control button An abrupt program closure such as power loss closure of Windows without closing Tafonius non controlled shutdown In all but the last procedure the data will be saved and associated with all the patient information In the event of a non controlled shutdown there will be NO DATA LOSS although the patient information will not be associated with the data In this instance the Files associated with the session will be saved with the word Patients as a prefix and the Slow Data and Anaeathetic Record will use only the date as identifiers For example a session interrupted by a non controlled shutdown on January 7 2009 will have a record named Patients2009Jan07 with Slow Data and Anaesthetic Records named AR2009Jan7 8_50_56 and SD2009Jan7 8 50_56 respectively The suffix 8 50 56 indicates that the session began at 08 50 56 on the morning of January 7 For more information on entering Patient and case information see the section entitled Entering Initial Patient Information later in this manual For more information on the production of an Anaesthetic Record see the section entitled Creating An Anaesthetic Record Chart later in this manual Printed 10 Mar 09 Page 6 of 61 DOCA4941B USING THE TafoniuS SOFTWARE The Finalise Recording procedure Using any of the first three Finalising methods listed above will cause the following dialog to app
107. t entry To add an event click or touch on the Events button at the bottom right hand side of the screen Patient nal Configure This will open a new editor panel at the bottom of the screen gdi Event List 06 01 2009 15 50 Fluid Administration 06 01 2009 15 49 Intubation 06 01 2009 15 49 Anaesthetic Induction Add Close Click or touch on the Add button and then click or touch on the arrow of the Standard Events drop down box In the example below Anaesthetic Induction has been chosen from the Drop Down List Event Details 05 November 2008 17 40 58 Anaesthetic Induction Standard Events Anaesthetic Induction v Add Remove Standard Events Printed 10 Mar 09 Page 54 of 61 Accept Cancel DOCA4941B USING THE TafoniuS SOFTWARE Standard Events can be added or removed from the Drop Down List by using the Add Remove Standard Events button Clicking or touching this button opens a new editor which lists all the current Standard Events These can be Edited or Deleted using the Edit Delete buttons To add new items to the Standard Event list click or touch the Add button and then type your new Event title Standard Events Start Procedure B Fluid Administration Premed Down Anaesthetic Induction End Anaesthesia Arrival At Recovery Site Extubation Once a new Event has been entered it will appear last on the list To chan
108. t of expired CO2 Breathing rate in breaths per minute Inspired Agent Fractional Volume measurement Expired Agent Fractional Volume measurement Inspired Oxygen Volume measurement Expired Oxygen Volume measurement Current Atmospheric pressure in mm Hg Heart rate from pulse oximeter device Percentage oxygen saturation of arterial blood Page 60 of 61 DOCA4941B IBP Measurements Mean USING THE TafoniusS SOFTWARE Mean arterial blood pressure mean 4 average Systolic Systolic blood pressure mean 4 average Diastolic Disatolic blood pressure mean 4 average Heart Rate Patient heart rate from blood pressure device Temperatures Ti Temperature from Thermometer 1 in either C or F T2 Temperature from Thermometer 2 in either C or F ECG HR Heart rate from ECG monitoring device Battery Data Batt1 Voltage level of battery 1 lower 12v battery Current1 Charging rate of battery 1 in amps Batt2 Voltage level of battery 2 upper 12v battery Current2 Charging rate of battery 2 in amps Piston Position Units Shows the piston position in absolute units In addition to these headings in the file there will be additional events recorded The table below shows some typical events that have been recorded 08 09 33 21 Preset Loaded Custom Preset 08 09 33 191 Leak 600 0 Compliance Low 27 4 Compliance High 63 3 08 09 33 201 MWPL 35 08 09 33 311 Cylinder Open 08 09 33 702 FMSO ON 65535ms 08 09 33 722
109. t require scheduled calibration on a monthly or even annual basis Calibration is achieved in a number of ways but must be done while the unit is plugged in and powered ON ALL CALIBRATION MUST BE DONE WITH THE UNIT IN FREE AIR AND NOT WHILST CONNECTED IN A PATIENT CIRCUIT Oxygen Recalibration For calibration of the Oxygen sensor removal of the Airway adaptor forces an automatic recalibration to 21 For this reason it is important that the removal and refitting of the airway adaptor is done in conditions where the airway concentration is at 21 such as in a well ventilated room Remove the Airway Adaptor by pulling the white plastic connector away from the main housing Wait until the LED flashes RED and the alarm sounds on the monitor Replace the Airway Adaptor Check that the LED turns green Check that the O2 reading on the Monitor is 21 OP ON Printed 10 Mar 09 Page 31 of 61 DOCA4941B USING THE TafoniusS SOFTWARE CO Nitrous and Agent Calibration Zero reference calibration These can all be reset from the Windows software via the Configure Gas Monitoring Data tab route Only perform this function when asked to do so by the Windows program or when indicated by the following conditions 1 A repeated Gas Concentration out of Range error message that appears when measuring room air and is not cleared by disconnecting and re connecting the IRMA device 2 Incorrectly reported high Inspiratory CO2 concentrations ALL C
110. tes tab These notes will appear in the Anaesthetic Record chart in the area under the Header of general information Printed 10 Mar 09 Page 9 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Cases Tab Details relating to cases can be pre entered as a list of patients Associated case data can be entered and then recalled when required Patient Name Patient ID PID Anonymous 0000000 Select Alfonzo 192837465 EJ Diamond Sunset 198725463 Delete By default when the software is started details appear for a patient called Anonymous with a patient ID of 000000 The green arrow next to the patient name shows that these patient details are in use Patient details cannot be deleted if they are in use you must first select another patient Touching or clicking the New button opens the Patient details tab ready for new patient information To change patients click or touch the patient name or ID and then click or touch the Select button The selected patient information is then used for the current recording session When the monitoring recording session is finalised the Patient details in use at that time will be the ones used to create the recording files During the Finalising procedure a dialog box will appear to check that the Patient details to be saved are correct The patient name and ID is always shown at the bottom of the Tafonius screen Click or touch either of these two screen areas to open the Patient attribute dialog Pri
111. that no further changes can be made Click or touch OK to commit the data and begin a new session When a session is Finalised those patient details are removed from the Patient List in the Cases tab Data Storage Locations Where the data is stored will depend whether any Patient Information has been entered If no Patient data has been entered then the data is stored in a folder that is named using the word Patients the calendar month and the day Several patients or sessions may be held in this folder if no patient information is entered during any of the day s operations e g An operation on September 12 2008 where no patient information was entered will be stored in a folder called Patients2008Sep12 If patient data has been entered then the folder name will be derived from the Patient s name and the patients ID e g Wild Billy ID 1786394 will have a session folder created called WildBilly_ 1786394 If there is more than one session recorded for Wild Billy on that day then all sessions will be stored in this folder Recorded data can be easily viewed and or exported using the utilities supplied with the Tafonius software See the sections Viewing Recorded Data and Exporting Data Printed 10 Mar 09 Page 21 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Viewing Recorded Data Recorded data can be viewed by two methods During a recording session in the ventilator control software or after a session in a spre
112. the appropriate radio button at the left hand side of the ECG IBP tab Select ECG IBP Synchronise Synchronising the ECG and IBP waveforms ECG and IBP waveforms can be synchronised in time as long as they have the same trace width on the screen Normally they would be placed one above the other so that a visual association between the Printed 10 Mar 09 Page 40 of 61 DOCA4941B USING THE TafoniuS SOFTWARE two traces can be made If the two traces are not synchronised then select the Synchronise option in the ECG IBP tab If the two traces do not have the same width they cannot be synchronised and the option will be greyed Trace options IBP ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Tee Sensitivity Sweep Shift z 2 12 5 mm sec i PV 25 mm sec E o 0 1 gt ae 20 50 mm sec E O 30 100 mm sec O ECG 60 200 mm sec IBP Heart Rate Synchronise O Beep On IBP Close Sensitivity Moving this slider will change the full scale height of the IBP trace in accordance with the legend on the right hand side of this scale Note that there is an automatic levelling feature in the IBP trace that means that the bottom of the IBP trace is adjusted after every sweep to lie on the base line This will always keep the IBP trace in view even if the blood pressure values are slowly changing Sweep Selecting one of the radio buttons will setthe sweep speed for the IBP trace Note that this option ma
113. the box next to Beep on IBP to produce an audible beep with every detected pulse waveform Since Tafonius only has one audio output device only one monitor can be made to beep at any time Selecting Beep On IBP for example will mean that any previous beep selection is overridden Zero IBP When a direct arterial sampling line has been placed and the sensor positioned at the level of the patient s heart but with connection to ambient pressure not arterial pressure the Zero IBP button is used to set the current output to zero Printed 10 Mar 09 Page 41 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Alarm options ECG amp IBP Click or touch the Alarms button on the ECG IBP tab to show the alarm options for ECG and IBP monitors Because the monitor is intended for use with only one animal at a time there are potentially several sources of heart rate data not least of which are ECG and IBP When setting a heart rate alarm it is possible to choose to derive the heart rate from either ECG or IBP depending which is in use or which is more reliable in the current circumstances ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Trace Alarm Limits Trace me Heart Rate Enable MAP Enable Low Obpm F Low OQ mmHg d Source ECG OIBP Systolic Enable Diastolic Enable Close M Synchronise Low OQ mmHg o Low 0 mmHg oO Alarm Limits This group of alarms includes alarms for Heart Rate Systolic Diastolic and Mean
114. the required Preset and then choose the Switch To button The selected Preset will be loaded Then click or touch on the Initial Settings button on the left hand side 1 PLE Printed 10 Mar 09 Page 24 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Initial Settings Configuration System Initial Settings Custom Preset 1 ne We Sota TV 5 litres MWPL 35 cmH20 gt Manual RR 5 bpm IP O secs Auto B FiO2 100 0 Ipm I E Ratio 1 ARNOESI 20 secs ames Exp Time Al Countdown 60 secs 51sec ty S Countdown 4 Mouse Using the keyboard or the on screen keypad enter the initial values you would like in each of the named fields The fields have the following meanings TV Tidal Volume in litres RR Respiratory rate in breaths per minute It Total Inspiratory time MWPL Maximum Working Pressure Limit IP Inspiratory Pause in seconds Show IP as _ Shows the Inspiratory pause as a percentage of the It CPAP Continuous Positive Airway Pressure in cm H2O FiO2 Desired initial oxygen fraction not available in software version 1 0 APNOEA Length of time allowed between breaths before Apnoea alarm sounds Countdown Length of countdown timer before pop up menus close automatically in seconds Countdown _ Enable the countdown timer for closing pop up menus Mousel Enable the mouse cursor on the screen When done click or touch on the Preset tab again and then choose Save Acti
115. tialised Leak amp 7 Compliance Skip The piston is moved to the mid point and then stops briefly before establishing a system pressure of 20cm H20 Fit Stopper to end of Y Piece Moving Piston to Mid Point Please Wait CC Printed 10 Mar 09 Page 18 of 61 DOCA4941B USING THE TafoniusS SOFTWARE If for any reason there is an excessive leak the following message appears The leak flow rate was too high Retry Skip In this instance seal the leak and press the Retry button If the leak test is successful the leak value is displayed and the system then proceeds to perform the two compliance measurements Tafonius ver 0 1 1114 0 Tafoniu CO2 mm RR Inspired Expired BPM AP cmH20 0 0 N O Oxygen ISO a f aa m f aa 7x el A m f aa R Inspired Expired Inspired Expired Inspired Expired 19 Compliance check initialisation in progress dian since pore tacea Please wait a er Data Leak is 660mls min Configure Vertiate gt A compliance measurement is made at the top cylinder position and at the 5 0L cylinder position and uses the leak value obtained in the first test At the end of the test the leak and both compliance values are shown Note that the values obtained will vary markedly depending on the nature of the breathing ci
116. tilator or by pressing the large ON OFF button on the side of the PC Printed 10 Mar 09 Page 59 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Appendix A SLOW DATA INFORMATION Monitoring data recorded in the Slow Data File includes the following User control settings CPAP PEEP Maximum PEEP or CPAP reading cm H20 Set Tidal Volume L Compliance compensated tidal volume L Respiratory Rate breaths per minute Inspiratory Time in milliseconds Inspiratory Pause time in milliseconds Resultant parameters calculated from user settings MV Flow 1 E Ratio Exp Time Measured during Standby TV Insp Time Exp Time Minute Volume L Inspiratory Flow L min Inspiratory Expiratory ratio Expiratory time in milliseconds Spontaneous breath Tidal Volume in mls Inspiratory time in ms Expiratory time in ms Resultant parameters calculated from MEASURED values during Standby RR MV Iflow 1 E Ratio Airway Pressure Measurements CPAP PEEP PIP Gas analysis Measurements Insp CO2 Exp CO2 Resp Rate Insp Agent Exp Agent Insp O2 Exp O2 Atmospheric Pressure Nonin SpO2 Measurements SPO2 HR Saturation Printed 10 Mar 09 Respiratory rate in breaths per minute Minute Volume in litres Inspiratory flow rate in L min Inspiratory Expiratory ratio CPAP Standby or PEEP Ventilate values in cm H2O Peak Inspiratory Pressure in cm H2O Fractional Volume measurement of inspired CO2 Fractional Volume measuremen
117. to export and press next CI Patients2008SEP16 D Patients2008SEP15 CI Patients200 7OCT30 First select the patient that you wish to export data for and then click or touch the Next button Then choose your destination drive usually a USB flash drive named D and touch or click the Export button The Slow Data and the Anaesthetic Record data will be copied to your chosen destination Printed 10 Mar 09 Page 58 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Options This opens a small window with 3 facilities Options Recover Anaesthetic Records Touch Screen Alignment Company Name Vetronic Services LTD Touch Screen Alignment Touching or clicking this button starts a utility to align the touch screen to your computers screen Simply touch the red circles in the way you would normally use the touch screen and follow the prompts to reset the alignment If you make a mistake simply wait and the utility will time out and be cancelled You can then try again Recover Anaesthetic Records Touching or clicking this button will create a new Anaesthetic Record chart if the original has been destroyed or corrupted for some reason Company Name Enter your practice or company name here This will appear on the Tafonius shell as well as at the top of the Anaesthetic Record chart Shutdown This will shut down the PC and put the PC in an off condition The PC can be started again by either turning on the Tafonius ven
118. touch on the Preset you wish to use and then click or touch on the Switch To button Delete This button removes the highlighted Preset Note that it is not possible to delete an active preset Reset Factory Default This button will apply all the default factory settings to the Active Preset Note that the Preset must be Active for the changes to be made to it A confirmation dialog box appears stating which Preset will be changed If this is the Preset that you wish to Reset then click or touch OK Printed 10 Mar 09 Page 26 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Gas Monitoring This tab displays all of the status and diagnostic information for the current Gas Monitor in use At the current time a mainstream device called IRMA or a sidestream device called Artema AION is used for CO2 O2 N20 and Agent monitoring Your machine will be fitted with one or other of these units Gas monitoring tab with the IRMA Gas Analyser Clicking on the Gas Monitoring tab reveals a Window with 5 further tab options Status Sensor Errors Config amp Data Configuration System Presets IRMA 15b Status Sensor Errors Config Data Initial Settings eel ID Sil O BDET UNSPEC_ACC es Menierna Atm 102 1 kPa APNOEA SENS ERR Sp02 O02_ Low O02_CALIB M Enabled 11 02_REPL CHK_ADAPT a Sensor Serial No 2741 Secut Frame Err 0 Status tab Used for fault diagnostic information only
119. tting of the airway adaptor is done in conditions where the airway concentration is at 21 such as in a well ventilated room Remove the Airway Adaptor by pulling the white plastic connector away from the main housing Wait until the LED flashes RED and the alarm sounds on the monitor Replace the Airway Adaptor Check that the LED turns green Check that the O2 reading on the Monitor is 21 OP ON Printed 10 Mar 09 Page 31 of 61 DOCA4941B USING THE TafoniusS SOFTWARE CO Nitrous and Agent Calibration Zero reference calibration These can all be reset from the Windows software via the Configure Gas Monitoring Data tab route Only perform this function when asked to do so by the Windows program or when indicated by the following conditions 1 A repeated Gas Concentration out of Range error message that appears when measuring room air and is not cleared by disconnecting and re connecting the IRMA device 2 Incorrectly reported high Inspiratory CO2 concentrations ALL CALIBRATION MUST BE DONE WITH THE UNIT IN FREE AIR AND NOT WHILST CONNECTED IN A PATIENT CIRCUIT THE IRMA UNIT MUST BE ALLOWED TO WARM UP AND BE RUNNING FOR AT LEAST 15 MINUTES BEFORE A ZERO REFERENCE CALIBRATION IS PERFORMED To RESET the IRMA device click or touch the Zero button in the Data tab of the Gas Monitoring Window found in the Configuration Setup A warning dialog box will appear with the following message IRMA Zero Calibration D Zero
120. using the Slow Data File 2 eeceteeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeeaeeeeeneeeeeeeeaeeeeea 53 Changing the interval for Periodic Data in the Slow Data File 0 ccccceeseeeeeteseertees 53 Effect of the Logging Interval on the Slow Data entries neiere reenen 53 The Tafonius Shell ccccsccccssseccscsccssesecccesccccssecceencccsns A MMOMieeaecncnneececencccnnsncccencena Oea nnan nananana nananana 56 TAPOMIUS oc ccccccccccttcccccacccctcsccctteccceonsccctececconcceceo nec QMO cccccccecuscecceceganuccectonscatcececesss AM cccceceeseacecees 56 VICW Datta ucccccceccccccecocseccccncceccecececoneccecceceaneacecseece SOOM ce ceece A NO ruccectonscaceees 56 Export Data enoni acon aes an spate ney etn ods ode A sto spe aes veep ees 58 Touch Screen Alignment a cect tcc en oa oieee oeeie eee nceeanenensaneessneceeneeeeneneenneens 59 Recover Anaesthetic Records Dy eee ce gece naneceeaeeaaeceeccecanecececseanececeeeeanes 59 Company Name cccccccccccecccce seer A eee Re AI cece eect nee nearer eeeneeeoneeseneneenteees 59 Se a hil nnn 59 Appendix A SLOW DATA INFORMATION cceseeeecsseeeeeseseeeesneeeeesseaneesseeeeeeseneeseeseaneseseneeseenes 60 Printed 10 Mar 09 Page 4 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Pre filling the system After Tafonius has been initialised the piston is left at the bottom of the cylinder ready for filling Make sure the Y
121. ute Volume Inspiratory Flow E Ratio and Expiratory Time They are dependent upon the settings of TV RR and Itime In Standby Mode The large blue figures show the values calculated from the measurements made during normal inspiration and expiration Respiratory rate is calculated on a rolling minute average that is updated every 10 seconds The measured minute volume is an integral of the ventilated volume over the last minute Again this is updated every 10 seconds If no respiration is detected during a period of 60 seconds then these blue values are all reset to zero The smaller black figures show the calculated values based on the values set for the three independent ventilator settings TV RR amp IT In Ventilate Mode The large black figures show the calculated values based on the values set for the 3 independent controls TV RR amp IT Printed 10 Mar 09 Page 15 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Control buttons Controlling the Software There are three buttons that control the look feel and behaviour of the Tafonius software These three buttons System Patient Data amp Configure are located at the bottom right hand side of the screen The System button The System button opens a two tab screen that contains a System and a Configuration tab The Configuration tab can be entered directly from the Configure button on the lower right hand side of the screen Configuration System System Errors
122. uttons that control the look feel and behaviour of the Tafonius software These three buttons System Patient Data amp Configure are located at the bottom right hand side of the screen The System button The System button opens a two tab screen that contains a System and a Configuration tab The Configuration tab can be entered directly from the Configure button on the lower right hand side of the screen Configuration System System Errors Leak Compliance Lanquage User Manual Ui C Demo Mode Exit Windows Event Viewer Resolve Resolve All System Tab The System tab contains buttons for System Errors Leak Compliance test settings Language and User Manual options Currently the Language is set to English only Other language options will become available in due course The User Manual button also presents options which at the time of writing are not yet available System Errors Any error or fault condition that occurs in the Tafonius software is reported in this System Errors list An error is indicated by the flashing of the border of the System button in red and an audible alarm The purpose of the list is to indicate the source of an unexpected alarm or fault condition and to assist with trouble shooting Some errors are transient and will self clear in which case no action is Printed 10 Mar 09 Page 16 of 61 DOCA4941B USING THE TafoniusS SOFTWARE necessary Some errors will not self clear or will r
123. vate it and open the numeric keypad Touch it again to toggle between setting the pause as a of Inspiratory time or as a finite time Enter the actual time or percentage required Press Enter on the numeric keypad when done In general as with the ventilator settings above any button shaded green on the display is a value you can set These include the following Printed 10 Mar 09 Page 13 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Maximum Working Pressure Limit MWPL The Maximum Working Pressure Limit control sets a level above which ventilation is prevented This is particularly useful when dealing with neonates or during open chest surgery when lung expansion is not restricted by a closed thorax The Maximum Working Pressure Limit is an absolute value and is unaffected by any settings of PEEP or CPAP If the MWPL value is reached during an Inspiratory phase then the ventilator immediately sounds an alarm and changes to the expiratory phase where once again the cylinder behaves as a Virtual Bag The MWPL setting can be useful for patients that are fighting the ventilator to prevent excessive pressures developing CPAP PEEP In Standby Mode CPAP or Continuous Positive Airway Pressure can he applied during spontaneous breathing With CPAP patients inspire and expire normally with no added effort although the end expiratory pressure is elevated to the CPAP setting This aids in maintaining open alveoae The airway pressur
124. ve The next time this Preset is loaded these new initial values will be used User settings During the course of using the Tafonius program you may make changes to the screen appearance or to the appearance of a certain monitor trace When changes such as these are made that affect the personal way that the screen is viewed the Preset will be marked as altered and an asterisk will appear next to the name in the title bar Tafonius ver 0 1 1114 0 Tafonius Custom Preset Manual Control Mode At any time or at the end of a procedure this unique set up of Tafonius can be saved by again choosing to save the Preset If this is not done explicitly during use then you will be prompted to save the Preset when finalising a patient session You can choose to change the active preset by touching SAVE or you may save the current setup as a new setup by touching SAVE AS NEW and renaming it as desired Note that you will not be prompted to save a changed Preset when you shut down the Program using the main ON OFF switch Printed 10 Mar 09 Page 25 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Changing Presets When the Tafonius software starts it uses by default the last Preset in use To change a Preset click or touch on Configure The Preset list is displayed Along the bottom of the Preset Window are 5 buttons used to control how Presets are created named selected and deleted plus two other buttons to Reset Factory Defaults
125. vertical scale of the CO2 trace Beep on Breath Select this tick box to produce an audible beep with every detected breath Alarm Options To set Alarms associated with CO2 measurement click or touch the Alarms button ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends Alarm Limits Enable Inspired High R oO Expired High e g Low E g Beep On Breathing High bpm O To set an alarm place a tick in the enable box and then enter the appropriate alarm value Printed 10 Mar 09 Page 43 of 61 DOCA4941B USING THE TafoniusS SOFTWARE The Airway Pressure AP Attribute tab ECG IBP CO2 Oxygen Agent N20 SpO2 AP Temp Traces Trends ena 120 Sweep i gt 60 Slow 9 Fast 30 1 9 Sensitivity This slider sets the scales of the Airway Pressure trace The value next to the pointer represents the maximum positive height of the trace window Sweep This slider sets the sweep speed of the Airway Pressure trace which is the speed at which the trace is drawn across the screen Airway Pressure Alarms To access the Airway Pressure Alarms click or touch the Alarms button ECG IBP CO2 Oxygen Agent N20 Sp02 AP Temp Traces Trends Alarm Limits Enable CPAP l d Close The CPAP alarm allows an alert condition when the measured CPAP pressure deviates outside of the required CPAP value Alarm units are in percentage values of the set CPAP value Printed 10 Mar 09 Page 44 of 61 DOCA4941B USING THE TafoniusS SO
126. would allow a 0 5 second pause The Pause Time box is outlined in red to indicate the source of the error Tidal Volume Respiratory Rate Inspiratory Time 0 8 Minute Volume Inspiratory Flow LE Ratio Expiratory Time 0 0 1 0 0 25 litres 250 litres minute 1 5 10 seconds Printed 10 Mar 09 Page 14 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Dependant Values The four buttons below the ventilator controls show the derived values for Minute Volume Inspiratory Flow E Ratio and Expiratory Time They are dependent upon the settings of TV RR and Itime In Standby Mode The large blue figures show the values calculated from the measurements made during normal inspiration and expiration Respiratory rate is calculated on a rolling minute average that is updated every 10 seconds The measured minute volume is an integral of the ventilated volume over the last minute Again this is updated every 10 seconds If no respiration is detected during a period of 60 seconds then these blue values are all reset to zero The smaller black figures show the calculated values based on the values set for the three independent ventilator settings TV RR amp IT In Ventilate Mode The large black figures show the calculated values based on the values set for the 3 independent controls TV RR amp IT Printed 10 Mar 09 Page 15 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Control buttons Controlling the Software There are three b
127. y be further controlled or changed depending on the state of the Synchronise check box and or the presence of ECG and IBP traces on the Tafonius screen If the ECG and IBP signals are not synchronised then the sweep speed of ECG and IBP traces can be different If the traces are synchronised then the IBP sweep speed will be set to and follow the ECG sweep speed Shift The Shift slider alters the position of the baseline of the IBP trace Heart Rate Select the box next to Beep on IBP to produce an audible beep with every detected pulse waveform Since Tafonius only has one audio output device only one monitor can be made to beep at any time Selecting Beep On IBP for example will mean that any previous beep selection is overridden Zero IBP When a direct arterial sampling line has been placed and the sensor positioned at the level of the patient s heart but with connection to ambient pressure not arterial pressure the Zero IBP button is used to set the current output to zero Printed 10 Mar 09 Page 41 of 61 DOCA4941B USING THE TafoniusS SOFTWARE Alarm options ECG amp IBP Click or touch the Alarms button on the ECG IBP tab to show the alarm options for ECG and IBP monitors Because the monitor is intended for use with only one animal at a time there are potentially several sources of heart rate data not least of which are ECG and IBP When setting a heart rate alarm it is possible to choose to derive the heart rate
128. y be requested by a service engineer or a technical support person during fault diagnosis Printed 10 Mar 09 Page 27 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Gas monitoring tab with the Artema AION Gas Analyser Configuration System Modes Status Status Alarms Cmds Demo Calib Op Mode ISOAccuracy Comm Mode Normal SNE Water Trap Adult 1021 Message Pump Regulating Flow 202 Command oK Modes Status Used for fault diagnostic information only Status Used for fault diagnostic information only Alarms Used for fault diagnostic information only Cmds Used for fault diagnostic information only Demo Used for demonstration purposes only Calib Used for fault diagnostic information only Close In most situations it is only necessary for users to use the Cmds tab for performing a zero calibration Information from the other tabs may be requested by a service engineer or a technical support person during fault diagnosis Printed 10 Mar 09 Page 28 of 61 DOCA4941B USING THE TafoniuS SOFTWARE Using the PHASEIN IRMA Monitor Important Note The IRMA mainstream multi gas probe is intended to be connected to a patient breathing circuit for monitoring of inspired expired gases of patients in intensive care anaesthesia and emergency care It is not intended to be used as the only means of monitoring a patient It shall always be used in combination with other vital signs monitor

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