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User`s Manual - Frank`s Hospital Workshop

1. When valid data is received the value will display If the parameter is lost the value will return to dashes The following parameters are measured and and displayed on various screens as shown below DATA SET STANDARD Parameter Abbreviation Parameter Description How to Access ETCO End tidal carbon dioxide All screens except SETUP CONFIGU RESP Respiration rate RATION and DATA ENTRY SpO Oxygen saturation PULSE Pulse rate MV spon Minute Volume for spontaneous mechanical DATA key MV mech breaths and total MV total MV alv spon Alveolar Minute Ventilation for spontaneous MV alv total also MV alv mech mechanical breaths and total found with CO MV alv total Some literature refers to MV alv as MV eff effec PLETH key tive minute ventilation Vti Inspired tidal volume DATA key Vte Expired tidal volume Vt alv Alveolar tidal volume tidal volume less airway deadspace Vd aw Airway deadspace includes added mechanical deadspace proximal to the flow sensor PIP Peak inspiratory pressure MAP Mean airway pressure over entire breath PEEP auto PEEP NIP Negative inspiratory pressure COSMO Plus User s Manual 47 Section 5 48 DATA SET STANDARD RESP spon Respiration rate of spontaneous and mechanical DATA key RESP mech breaths PIF Peak Inspiratory Flow rate PEF Peak Expiratory Flow rate LE Ratio of inspiration time ti to expiration time te Ti Insp
2. Adult ear Optional placements WARNING Inspect the site often for adequate circulation at least once every four hours When applying sensors take note of patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate Y Sensor Quick Check With the Y Sensor connected to the monitor but not applied to patient position the sensor heads so that they face each other the red light shines at the detector Is PROBE OFF displayed Tape the Y Sensor to your index finger Does the monitor show reasonable SpO and pulse rate values A YES to BOTH 1 and 2 indicates that the sensor is working properly Apply the sensor to the patient as instructed above The quick check is also a functional test of the extension cable COSMO Plus User s Manual 41 Section 4 SpO gt Sensors Single Patient Use SpO Sensors Select a Y Strip or foam wrap based on the patient type and intended sensor location A Single Patient Use Pediatric Adult Sensor Catalog No 6455 Vj TA e The single patient use SpO sensor can be used when monitoring adult or pediatric patients with Novametrix Pulse Oximeters SuperBright PA series Single Patient Use Neonatal Pediatric Sensor Catalog No 6480 bok e The single patient use SpO sensor can be used when monitoring neonatal or p
3. Dop A Trend CO production SpOs section Time base Trend tidal volume for ventilator breaths showing alveolar and airway dead space components Trend spontaneous breaths showing alveolar and airway deadspace components Trend Memory In addition to on screen trends the COSMO Plus has internal trend memory that stores up to 30 calculated parameters for 24 hours at a one minute resolution see below for trend list These parameters are stored as the average value over the one minute period If installed SpO is stored as the minimum over one minute Stored parameter values can be downloaded transferred to a PC and viewed using the optional COSMO Plus for Windows PC software package from Novametrix CO2SMO Plus Trended Parameter List Resp rate total Cdyn dynamic compliance PeCO mixed expired CO Resp rate spon e Resp rate mech e ETCO e PEF peak expiratory flow e Insp CO e MV total e VCO e MV spon e VT alveolar spon ml kg e MV mech e VT alveolar mech Im kg Rev 02 COSMO Plus User s Manual 55 Section 5 VT EXP mech avg VT EXP spon avg Raw inspired Raw expired MAP mean airway pressure PIP peak inspiratory pressure PEEP positive end expiratory pressure Data Screens Data Set Standard ENTER WEIGHT DATA Calculated based on entered patient weight DATA i 7 mms 56 COSMO Plus User s Manual VT alveolar spon VT alveolar mech MV alveol
4. tot L 117 tot L 10 The pointer next to spon spontaneous or mech mechanical indicates the current breath type identified by the monitor mmHg FESP seon COSMO Plus User s Manual 57 Screen Displays Section 5 Data Set Protocol om cmHz20 MOWITORIHG SCREEH x Cdan mLeom RESP HU alo tot L SFO a SFO 0 0 ech 4 11 6 yack M DATA DATA EVEHT KEY MARK ABG mmHg Fac z DATA Calculated based on entered patient weight Calculated based on entered PaCO value Rev 02 58 COSMO Plus User s Manual Screen Displays Monitoring Setup Screen Refer to Setup and Configuration Settings on page 16 for more information SAMPLE PUMP OFF FLOW Ole COz ZERO HOW PURGE Holl A SCALE B 54 SPOH THRESH 6 amp cmHz0 Pointer SWEEP SPEED H PoE SAGTIER B IH amp BALAHCE Al PULSE VOLUME OFF Sez AUG 8 sec IABP MODE OFF Press and hold for 3 seconds Ue OH H mm Poner SERT i NOUACURS AUTO HIGE ZS Adjust selected parameter Press to move pointer to desired parameter SZ Adjust selected parameter Values are accepted when changed Press any key to exit pressing lt returns to the previous screen Alert Settings Screen Refer to Alerts and Messages on page 73 for more information Respiration rate CO section ee Current limits a S 07 65 HOLE SET ALERTS ABSESS SET ALERTS SpO gt section ee ae Pointe
5. Sampling Adapter on page 30 for more information Flow Sensor Connection Connection for flow sensors See Sensors and Patient Connections on page 23 and Monitoring Flow Respiratory Mechanics Separately on page 28 for more information Rev 02 COSMO Plus User s Manual 7 Section 1 Rear Panel Connections and Labeling Rear Panel Connections and Labeling Equipotential connection SpO gt sensor connection 25 pin D connector for communications CONNECT ONLY TO IEC601 APPROVED DEVICES CAUTION FEDERAL U S A LAW RESTRICTS THIS DEVICE 0 5A S B E00 120V TO SALE DISTRIBUTION OR USE BY Ai ON THE ORDER OF A LICENSED MEDICAL PRACTITIONER CAUTION EQUIPMENT MUST BE GROUNDED AT ALL TIMES TO AVOID DANGEROUS ELECTRICAL SHOCK HAZARD CO sensor connection Fuse power setting compartment AC power switch Power cord receptacle Sampling system exhaust Equipotentiality Connection to monitor s chassis Patient isolation Identifies connection as type BF Attention Consult manual for detailed information Mains fuse rating for replacement fuses co AC mains switch ON connection to mains O OFF disconnection from mains Recyclable item This symbol is found on the internal battery and should not concern the common user Refer to qualified service personnel when battery replacement is required Separate collection Appropriate steps mu
6. CO SMO RESPIRATORY PROFILE MONITOR Model 8100 October 10 1997 Catalog No 6758 23 02 Novametrix Medical Systems Inc PO Box 690 5 Technology Drive Wallingford Connecticut U S A 06492 Revision History 08 Jan 97 Release Rev 00 17 Jan 97 Production release Rev 01 10 Oct 97 Revision 02 software Rev 02 COSMO Plus and CAPNOSTAT are registered trademarks and Y Sensor SuperBright and OxySnap are trade marks of Novametrix Medical Systems Inc Velcro is a registered trademark of Velcro USA Inc Cidex is a trademark of Arbook Inc Nafion is a registered trademark of Dow Corning Corp Copyright 1997 Novametrix Medical Systems Inc This document contains information which is proprietary and the property of Novametrix Medical Systems Inc and may not be reproduced stored in a retrieval system translated tran scribed or transmitted in any form or by any means without prior explicit written permission from Novametrix Med ical Systems Inc Rev 02 COSMO Plus User s Manual _ iii Thank you for selecting the COSMO Plus Respiratory Profile Monitor You are the operator of one of the most advanced state of the art respiratory instruments available today Our engineering staff in collaboration with the medical community has invested considerable effort to produce a highly accurate and extremely versatile instrument for respiratory monitoring While we expect that the COSMO Plus will meet your specific needs we
7. How to Access screen Parameter Abbreviation Parameter Description Ctot Total compliance MV alv mech Averaged Mechanical alveolar minute volume Standard data set only MV alv spon Averaged Spontaneous alveolar minute volume Standard data set only P0 1 Pressure at first 100 milliseconds of inspiration Slope of phase II Slope of phase II of the capnogram Slope of phase III Slope of phase III of the capnogram Vd Vt airway Averaged Airway deadspace to tidal volume ratio Vt alv spon Averaged Spontaneous alveolar tidal volume Vt exp mech Averaged Mechanical expired tidal volume Vt exp spon Averaged Spontaneous expired tidal volume Vt insp mech Averaged Mechanical inspired tidal volume Vt insp spon Averaged Spontaneous inspired tidal volume WOB imp Imposed work of breathing Available via the optional PC based CO2SMO Plus for Windows program COs respiratory rate and the capnogram are the only data available when using the CAPNOSTAT COs sensor with the sampling airway adapter 52 COSMO Plus User s Manual Rev 02 Screen Displays Monitoring Screen Displays The following screens are displayed on the COSMO Plus Waveform Screens Respiration rate Flow parameters Neos mle l 1 L 1 mmHg PES PLETH Fi SpO value CO section ETCO value SpO section Capnogram Pulse rate Press key for combination c
8. s memory A reference channel accounts for optical changes in the sensor allowing the system to remain in calibration without user intervention Respiration Rate The respiration rate is calculated from the flow signal generated whenever a flow or combined CO flow sensor is connected to the CO2SMO Plus If a flow or combined CO flow sensor is not connected and a CAPNOSTAT CO sensor is connected then the respiration rate is calculated from the CAPNOSTAT CO sensor signal In the event that there is no flow CO flow or CAPNOSTAT CO sensor connected the respiratory rate will not be calculated SpO gt The COSMO Plus determines oxygen saturation using sensors that contain red and infrared 660 and 940 nanometer light sources called light emitting diodes LEDs The light energy from each LED is beamed through a tissue sample a pulsating vascular bed such as the patient s finger or toe The remaining light energy not absorbed by the tissue sample reaches a photodiode light receptor in the sensor Oxygen saturated blood absorbs different amounts of light at each wavelength as compared to desaturated blood Therefore the amount of light absorbed by the blood in each pulse can be used to calculate oxygen saturation The COSMO Plus is calibrated to display functional saturation This differs from the fractional saturation value displayed by most co oximeters Functional saturation is defined as HbO 100 COHb MET
9. 2 heart rate 120 bpm IABP 1 3 then displayed Pulse Rate should be 120 120 3 180 beats min When in IABP MODE the Pulse Rate can be affected by motion or other artifact the accuracy of the Pulse Rate can usually be used as an indicator of the quality of the SpOz display SPON THRESH The SPONTANEOUS THRESHOLD SETTING adjusts the pressure threshold which the CO2SMO Plus uses to identify breaths as spontaneous or mechanical If PIP PEEP is greater than threshold setting the breath is identified as mechanical if it is less than PIP PEEP the breath is identified as spontaneous The default value for the SPONTANEOUS THRESHOLD is 6 cmH 0 above the pressure baseline This setting is found in the SETUP screen and may be set to different levels depending on the mode of ventilation Whatever the setting 6 cmH O 10 cmH O or 20 cmH O the COSMO Plus automatically sets the threshold to that level above the baseline If the baseline is zero the spontaneous threshold setting is 6 cmH O Any breaths that do not cross 6 cmH O will be identified as spontaneous and any that do cross will be mechanical If any PEEP is added then the spontaneous threshold automatically adjusts to 6 cmH O or whatever value is set above the PEEP level or baseline So with PEEP such as 5 cmH 0O the spontaneous threshold is now automatically set to 11 cmH O Which means that any breath that has a pressure reading below 11 cmH 0 between 11 and 5 cmH 0 is co
10. SWEEF SPEEDS aHa AME a AGTIES amp IH Fz i BALANCE AIR TABP MODE LYS S7 Change selected parameter using UP and DOWN arrow keys 16 COSMO Plus User s Manual Rev 02 Setup and Configuration Settings Rev 02 Preparation for Use SETUP options are described below Parameter Description Factory Default CO Setup eae MINE Turns the CO sampling pump ON OFF for using sidestream OFF sampling adapter CO2 ZERO Blank NOW Press ZX arrow key to enter the adapter zero menu an Choose a 0 50 0 75 or 0 100 scale for the CO waveform dis SCALE 0 50 play Choose a sweep speed for the CO waveform slow medium SWEEP SPEED Jor fast the flow and pressure waveforms will also be set to Medium this selected sweep speed Gas Comp AGT Choose the closest setting to true gases in the breathing circuit Setup Anesthetic Agent see below for details Adjust expired EX and inspired IN 0 0 Concentration values in increments of 1 from 0 20 Select balance Air NyO O gt gt 60 O3 or Heliox 60 He BALANCE Air 35 Op Resp FLOW ZERO s Blank Mech Setup NOW Press arrow key to zero the flow sensor lines PURGE NOW Press A arrow key to purge the flow sensor lines Blank Adjust pressure threshold which CO2SMO Plus uses to Sac ae identify spontaneous or mechanical breaths 6 cm H O from 0 60 cmH30 in increments of 1 cmH 0 SpOz Setup PULSE Choose OFF or ON with a volume level of 1 th
11. 6720 00 Series 3 Neonatal Pediatric Combined CO Flow Sensor 10 per box CO AIRWAY ADAPTERS REUSABLE For monitoring CO with the CAPNOSTAT CO sensor Also available in lower quantities 7007 00 Pediatric Adult Airway Adapters 10 per box 7053 00 Neonatal Pediatric Airway Adapters 10 per box CO AIRWAY ADAPTERS SINGLE PATIENT USE For monitoring CO with the CAPNOSTAT sensor 6063 00 Pediatric Adult Single Patient Use Airway Adapters 10 per box 6063 25 Pediatric Adult Single Patient Use Airway Adapters 25 per box 6421 00 Pediatric Adult Single Patient Use Airway Adapters with mouthpiece 10 per box 6421 25 Pediatric Adult Single Patient Use Airway Adapters with mouthpiece 25 per box 6312 00 Neonatal Pediatric Single Patient Use Airway Adapters 10 per box 6312 25 Neonatal Pediatric Single Patient Use Airway Adapters 25 per box SAMPLING ADAPTER and ACCESSORIES 5843 00 Sampling Adapters with tubing 10 per box 8908 00 Nafion Dehumidification Tubing 10 per box 8781 00 Nasal CO Sampling Cannula Adult 10 per box 8780 00 Nasal CO Sampling Cannula Pediatric 10 per box 8906 00 Nasal CO Sampling and O Delivery Cannula Adult 10 per box 8907 00 Nasal CO Sampling and O Delivery Cannula Pediatric 10 box 8909 00 Sidestream Monitoring Kit for Pediatric Tracheostomy Patients 10 per box COSMO Plus User s
12. Manual 97 Section 11 98 Catalog No FLOW SENSORS 6717 00 6718 00 Description For monitoring airway flow without an adapter for the CAPNOSTAT CO sensor Series 3 Pediatric Adult Flow Sensor 10 per box Series 3 Neonatal Flow Sensor 10 per box SpO SENSORS and ACCESSORIES REUSABLE OxySnap SpO SENSORS AND CABLES 8793 00 8744 00 8853 00 8898 00 OxySnap Y Sensor use with OxySnap Extension Cable OxySnap Finger Sensor use with OxySnap Extension Cable OxySnap Extension Cable 8 ft use with OxySnap sensors OxySnap Long Extension Cable 12 ft use with OxySnap sensors OTHER SpO SENSORS 8776 00 8791 00 8789 00 5238 00 SuperBright Finger Sensor 10 ft sensor cable SuperBright Y Sensor 10 ft sensor cable Special Use SuperBright Finger Sensor 8 inch sensor cable Special Use SuperBright Finger Sensor amp 25 ft shielded cable Y STRIP TAPES FOAM WRAPS and EAR CLIPS for use with the Y Sensor 8828 00 8829 00 8831 00 8832 00 8836 00 8943 00 6131 50 6131 25 20mm Wrap Style Y Strip Taping System 100 per box Use on neonatal foot and hand or on pediatric toe or finger 20mm tapes use Blue color coded liners 25mm Wrap Style Y Strip Taping System 100 per box Use on neonatal foot and hand 25mm tapes use Green color coded liners 20mm Finger Style Y Strip Taping System 100 per box
13. No 6718 e For intubated patients with endotracheal tube diameters equal to or less than 4mm Adds less than 1 cc of deadspace 2 Attach the Flow sensor to the monitor and patient circuit as described in Combined CO and Flow on page 26 COSMO Plus User s Manual Rev 02 Monitoring COs Separately Rev 02 1 2 Sensors and Patient Connections Monitoring CO Separately To monitor CO without flow respiratory mechanics Select an airway adapter based on the patient and monitoring situation Pediatric Adult Single Patient Use Adult Airway Adapter Catalog No 6063 e For intubated patients with endotracheal tube diameters greater than 4 mm Adds approximately 5 cc of deadspace e For connecting to anesthesia non rebreathing or BIPAP CPAP masks for non intubated patients Pediatric Adult Adult Reusable Airway Adapter Catalog No 7007 e For intubated patients with endotracheal tube diameters greater than 4 mm Adds approximately 5 cc of deadspace e For connecting to anesthesia non rebreathing or BIPAP CPAP masks for non intubated patients Pediatric Adult Single Patient Use Airway Adapter with mouthpiece Catalog No 6421 e For point of care monitoring of pediatric or adult patients Adds approximately 8 cc of deadspace Neonatal Pediatric Single Patient Use Airway Adapter Catalog No 6312 e For intubated patients with endotracheal tube diameters no more t
14. Operational Overview Indicators Battery Alert Icon Iluminates when the unit is on battery power and the battery charge is critically low When battery is near exhaustion an audible alert will sound and BATTERY VERY LOW PLUGIN AC POWER will appear in the display screen Refer to AC Battery Operation on page 15 for information on connecting AC power and charging the battery N AC Power Indicator Icon Illuminates when the monitor is connected to an AC power source and the rear panel power switch is ON In this condition the internal battery is charging Two Minute Silence Icon Illuminates when the two minute silence is active Audible Alert Disabled Icon Flashes when audible alerts have been disabled Miscellaneous Top cover instructions Explosion hazard WARNING Carrying handle Alert bar Sampling system inlet Flow sensor connection Graphic Display Graphic blue white 240 X 64 pixel dot matrix display COSMO Plus User s Manual Rev 02 Operational Overview General Description Alert Bar Flashes red when alert conditions are detected When ALERTS LATCHED in the SYSTEM CONFIGURATION is set to ON the alert bar is latched This means that when an alert is active the alert bar will flash even if the condition that caused the alert has been corrected To reset the latched alert bar press the B key Sampling System Input Input connection for sampling system tubing See
15. The Novametrix Technical Support Department can provide technical product support at a level appropriate to most customers protocol and budget requirements Please contact the Technical Support Group at Novametrix for additional information Additional Novametrix Technical Support Programs e Focus Series Technical Training Seminars Test Equipment and Test Kits e Service Contract Part Insurance Plans e On Site Technical Support e 24 hr telephone support e Demand Services Flat rate parts exchange Flat rate return for repair Time and material Full warranty discounted replacement sensors 96 COSMO Plus User s Manual Rev 02 Rev 02 Section 11 Accessories COSMO Plus Model 8100 Respiratory Profile Monitor Catalog No Description 6758 00 CO SMO Plus Respiratory Profile Monitor Model 8100 with CAPNOSTAT CO Sensor Cat No 7167 OxySnap SuperBright finger sensor Cat No 8744 and one each pediatric adult and neonatal combined CO flow sensor CAPNOSTAT MAINSTREAM CO SENSOR and ACCESSORIES 7167 00 CAPNOSTAT CO Sensor with Adult Airway Adapter Cat No 7007 and 5 ea Sensor Cable Holding Clips Cat No 8751 8751 00 _CAPNOSTAT CO Sensor Cable Holding Clips 50 per box COMBINED CO FLOW SENSORS SINGLE PATIENT USE The following are airway adapters for the CAPNOSTAT CO sensor combined with a flow sensor 6719 00 Series 3 Pediatric Adult Combined CO Flow Sensor 10 per box
16. WEIGHT Mark ABG SCREEN Event Key Vd Vt phy Deadspace physiological to tidal volume ratio Vd phy Physiological deadspace Vd alv Alveolar deadspace DATA SET PROTOCOL Parameter Parameter Howto access Abbreviation Description All screens except SSi SETUP pa gt ETCO Averaged End tidal carbon dioxide CONFIGURATION INSP CO Averaged Inspired carbon dioxide and DATA ENTRY RESP Averaged Respiratory rate RESP also at DATA SpO Averaged Oxygen saturation key Pulse Rate Averaged Pulse rate DATA key SETUP screen PEEP Positive end expiratory pressure AUTO will dis PEEP also at FLOW play in place of the units whenever Auto PEEP is PRES key detected intrinsic PIP Peak inspiratory pressure NIP Negative inspiratory pressure NIP also at WEAN ING DATA screen VCO Averaged CO production volume of carbon dioxide VCO also at CO gt exhaled per minute PLETH key TREND key MONITORING and WEANING DATA screen Vt alv mech Averaged Vt alv mech also at TREND key LE Ratio of inspiratory time ti to expiration time te COSMO Plus User s Manual 49 DATA SET PROTOCOL DATA key ee MONITORING Raw i Dynamic inspired airway resistance A 2 screen Static Raw i is measured with inspiratory pause and is available in Adult mode only STAT is displayed in place of the units Raw e Dynamic expired airway resistance Static Raw e is measured with inspiratory pause and is a
17. Zoom In softkey will increase the resolution of the trend graph in increments of one half hour 1 hour 2 hours and 3 hours Zoom Out This selection decreases the trend resolution The zoom feature uses the Vertical Time Bar as the marker for the point in time that you wish to view Pressing the Zoom Out softkey will decrease the resolution of the trend graph in increments of one half hour 1 hour 2 hours and 3 hours Change Scale This selection changes the scale of the graphic trends Vital Signs Pressing this softkey returns you to the Vital Signs trend window Alarms and Messages Alarms and messages are not transmitted from the COSMO Plus unit to the Hewlett Packard VueLink module All alarms and messages must be viewed directly from the CO2SMO Plus To Stop Monitoring with the COSMO Plus 1 Press the power key on the front panel of the CO2SMO Plus The COSMO Plus screen will clear and the screen will turn off The COSMO Plus data will clear from the screen of the Hewlett Packard patient monitor es The VueLink Module may be left in the HP monitoring system module rack Rev 02 COSMO Plus User s Manual 71 Section 6 To Stop Monitoring with the CO2SMO Plus This page intentionally blank 72 COsSMO Plus User s Manual Rev 02 Rev 01 Section 7 Alerts and Messages Alerts Alerts are generated for ETCO respiration rate SpO and pulse rate These alerts occur when the limits for a particular pa
18. continuously at the bedside such as CO production Vco and deadspace parameters as well as conventional capnography pulse oximetry and respiratory mechanics The continuous respiratory profile provided by the COSMO Plus provides the clinician with immediate feedback that allows precise and efficient patient ventilator management Indication for use The COSMO Plus is intended to be used for monitoring end tidal CO respiration rate functional oxygen saturation pulse rate and respiratory mechanics in monitoring environments such as ventilatory support emergency and anesthesia CO2SMO Plus is designed to monitor adult pediatric and neonatal patients CO2SMO Plus is not intended for any other purposes Components of this product and its associated accessories which have patient contact are free of latex Gas compositions other than those selected in the SETUP screen can influence CO and flow measurement Unpacking The box that your COSMO Plus was shipped in should contain the items shown below Please contact us at 1 800 243 3444 or contact your local sales representative if any items are missing or damaged or to order additional accessories Combined CO Flow Sensor SpO gt Sensor CAPNOSTAT COs Sensor Monitor NOVAMETRIX lt lt MEDICAL SYSTEMS INC User s Manual Rev 02 COSMO Plus User s Manual 1 Section 1 Operational Overview Operational Overview Parameters Measured The
19. limits for ETCO Respiratory Rate SpO and Pulse Rate No respiration alert selectable between 20 and 60 seconds Visible alert is immediate audible alert can be delayed until 10 seconds after set limit is exceeded e 2 Minute Silence When 4 key is pressed audible alerts are deactivated for two minutes Indicated by illuminated E 2 minute LED e Audio Off Press and hold B key for 3 seconds to deactivate audible alerts Indicated by flashing Audio Off LED Trend Memory 24 hour trend memory capacity battery backed On screen trends for VCO mechanical and spontaneous alveolar minute ventilation mechanical and spontaneous alveolar tidal volume and airway deadspace Other parameters are stored internally and can be downloaded to a PC e Digital Data Output Serial RS232 connect only to IEC601 approved devices e Sampling System Standard Allows gas sampling of non intubated patients e Internal Real Time Clock e Red Alert Bar Rev 02 COSMO Plus User s Manual 93 Section 9 Additional Features This page intentionally blank 94 COSMO Plus User s Manual Rev 02 Rev 02 Section 10 Warranty Equipment manufactured or distributed by Novametrix Medical Systems Inc is fully guaranteed covering materials and workmanship for a period of one year from the date of shipment except for certain disposable products and products with stated guarantees other than one year Novametrix reserves the right to perform guara
20. parameters in the Auxiliary Plus window are frozen The waveform is not The values displayed on the Main Screen are not frozen Update Values When selected the parameters in the Auxiliary Plus window resume updating Select Device When selected a list of devices available with the VueLink module that you are using will display Refer to the Hewlett Packard Operator s Manual for further information Select Data This softkey is used to select the waveforms and parameters you want displayed on the monitor Pressing Select Data opens an Auxiliary Plus window with the waveforms listed on the left and the parameters listed on the right If you have chosen two waveforms they are listed as Wave and Wave 2 and show the waveform label that has been selected for that waveform slot along with a color block for that waveform The Number slots 1 through 6 are listed along with the parameters that they have been assigned the six parameters chosen above To change a waveform or parameter Press the Module Setup key Press the COSMO Plus softkey An Auxiliary Plus window opens Press the Select Data softkey Press the Next Channel softkey or press any of the lighted arrow keys to cycle through the list until you get to the waveform or parameter that you wish to change When you have reached the waveform or parameter that you want to change press the Select Signal softkey If you are changing a waveform a list of the available waveform
21. remove the parameter from the graph trend list Up to 3 of the 6 parameters shown on the Main Screen may be graphically trended Zoom In This selection increases the trend resolution e Press the Zoom In softkey once and the resolution increases to every 15 minutes e Press the Zoom In softkey twice and the resolution increases to every 5 minutes e Press the Zoom In softkey three times and the resolution increases to every minute Zoom Out This selection decreases the trend resolution e Press the Zoom In softkey once and the resolution decreases to every 15 minutes e Press the Zoom In softkey twice and the resolution decreases to every 5 minutes e Press the Zoom In softkey three times and the resolution decreases to every minute Print Vitals Prints the trended vital signs Refer to the Hewlett Packard Operator s Manual for more information on printing Graph Trends This selection brings up the Graph Trends window Graphical Trends To open the Graphical Trends window press the Graph Trends softkey from the Vital Signs screen The Graphical Trends window menu selections are Next Graphs Use this selection to cycle through the Graphical Trends pages Zoom In This selection increases the trend resolution The zoom feature uses the Vertical Time Bar as the marker for the point in time that you wish to zoom 70 COSMO Plus User s Manual Rev 02 To Stop Monitoring with the CO2SMO Plus HP VueLink Interface Pressing the
22. the proper mains operating voltage is displayed x Line operating voltage ASHL 88 COSMO Plus User s Manual Rev 02 Mains Voltage Configuration Maintenance Changing the Mains Voltage Setting 1 Check that the monitor is OFF 2 Set the rear panel power entry module switch to OFF O Remove the line cord from the power entry module Replace fuses with same type and rating Verify proper fuse value for mains voltage setting see table below Mains Voltage Fuses Slo Blo 100 120 Vac 0 5 A 250V 200 240 Vac 250mA 250V 3 Using a flat blade screwdriver pry the fuse access door open to expose the fuse housing Pry the fuse housing out from the power entry module Fuse housing Fuse access door 4 Install the proper type and rating fuse for the mains voltage setting required 5 Position the housing into the power entry module so that the desired voltage is furthest away from the switch see below Set for 100 120V operation Set for 200 240V Operation 6 Close the fuse access door and verify that the proper mains operating voltage is displayed Line operating voltage Rev 02 COSMO Plus User s Manual 89 Section 8 Mains Voltage Configuration This page intentionally blank 90 COSMO Plus User s Manual Rev 02 Section 9 S
23. APNOSTAT flow sensor pulse oximeter probe and AC power cord as described in Sections 3 and 4 of this User s Manual 2 Connect the 25 pin male connector on the VueLink Interface Cable to the 25 pin female connector on the rear panel of the COSMO Plus Tighten screws Connect the other end of the cable to the VueLink module by grasping the end of the connector and pushing it into the receptacle on the VueLink module VueLink Interface Cable TO SALE DISTRIBUTION OR USE BY OR ON THE ORDER OF Rear panel 0 5A S An CAUTION FEDERAL U S A LAW RESTRICTS THIS DEVICE A LICENSED MEDICAL PRACTITIONER AR CAUTION EQUIPMENT MUST BE GROUNDED AT ALL TIMES TO AVOID DANGEROUS ELECTRICAL SHOCK HAZARD eer 100 ene V vac EXHAUST 3 Power up the COSMO Plus by setting the rear panel power switch to ON I and pressing the power key 4 Press and hold the key on the front of the COSMO Plus until the CONFIGURATION menu appears 5 Press the key until the arrow is pointing to the SERIAL selection 6 Press the A up or down arrow to cycle through the selections until the VUELINK selection appears 7 Press any key to leave the CONFIGURATION menu The serial output of the COSMO Plus is now set to communicate to the VueLink module 8 Plug the VueLink Module into an available slot in the Hewlett Packard monitoring system module rack 9 After 30 seconds the selected waveforms and parameters will appear on the di
24. COSMO Plus measures and calculates various respiratory parameters for patient ventilator management Refer to Monitoring on page 47 for a complete parameters list Front Panel Controls and Indicators COSMO afo ERER om NOVAMETRIX 36 Cit cl DATA SETUP i o 5 fe E E Te BICER Controls or Power Key Press the POWER key to place the unit into operate mode ON or to place the unit into standby OFF There are four states of the unit e No AC Power power icon off not in operate mode In this condition the AC switch is off or the power cord is not plugged into an AC outlet or the outlet is not powered No monitoring may occur in this state Battery is not being charged e AC Power power icon on not in operate mode standby In this condition the unit may be placed into operate mode by pressing the key Battery is charging in this mode e AC Power power icon on in operate mode In this condition the unit is in operating mode and the battery is being charged e Battery power power icon y off battery is not being charged In this condition the unit is in the operating mode and the battery is not being charged When the monitor powers up a self test is performed in which all indicators will temporarily illuminate and the monitor will emit a short beep Following the self test the monitor will display ERASE STORED TRENDS YES A NO v The monitor must be in stan
25. Hb Functional Saturation HbO Fractional Oxyhemoglobin COHb Carboxyhemoglobin METHb Methemoglobin This can be considered to represent the amount of oxyhemoglobin as a percentage of the hemoglobin that can be oxygenated Dysfunctional hemoglobins COHb and METHb are not included in the measurement of functional saturation COSMO Plus User s Manual 9 Section 1 Principle of operation Pulse Rate is calculated by measuring the time interval between peaks of the infrared light waveform The inverse of this measurement is displayed as pulse rate The oxygen saturation and pulse rate values are updated once each second Presence of a pulse is indicated visibly by a plethysmogram graphic display and audibly by a beep The COSMO Plus must be used in conjunction with SuperBright Sensors See Accessories for a list of available sensors and accessories Flow Flow measurements in the COSMO Plus are made by a fixed orifice differential pressure pneumotachometer Respired gas flowing through the flow sensor causes a small pressure drop across the two tubes connected to the sensor This pressure drop is transmitted through the tubing to a differential pressure transducer located inside the monitor and is correlated to flow according to the factory stored calibration User calibration is not required due to the ability of the plastic injection mold to repeatedly produce precision flow sensors The pressure transducer i
26. S YES A NO 9 EVENT MARKER INSUFFICIENT DATA TO MARK ABG EVENT NOT ENOUGH DATA TO SET ETCO LIMITS NOT ENOUGH DATA TO SET ETCO amp RR LIMITS NOT ENOUGH DATA TO SET ETCO gt amp SpO LIMITS NOT ENOUGH DATA TO SET ETCOp gt SpO amp RR LIMITS NOT ENOUGH DATA TO SET SpO LIMITS NOT ENOUGH DATA TO SET SpO amp RR LIMITS NOT ENOUGH DATA TO SET RR LIMITS SETTINGS RESET TO FACTORY DEFAULTS TRENDS ERASED TRENDS RETAINED WARNING CHECK TIME DATE HOLD SETUP KEY WAVEFORM FROZEN UNFREEZE PRESS EVENT KEY COSMO Plus User s Manual Alerts Meaning of message This prompt appears each time the monitor is turned on To erase stored trends press A To keep stored trends press Q or allow the message to time out or press any other key This message appears in the message center when the key is pressed The monitor will not allow an ABG event to be marked when data such as PeCO or tidal volume is not available This message is displayed when the monitor could not successfully determine the auto alert limits for ETCOs This message is displayed when the monitor could not successfully determine the auto alert limits for ETCO gt and respiratory rate This message is displayed when the monitor could not successfully determined the auto alert limits for ETCO and SpOo This message is displayed when the monitor could not successfully determined the auto alert limits for ETCO5 SpO and resp
27. T tube and the elbow pediatric adult circuit as this may allow patient secretions to block the adapter windows e Position the airway adapter with its windows in a vertical and NOT a horizontal position this helps keep patient secretions from pooling on the windows e To prevent rain out and moisture from draining into the airway adapter do NOT place the airway adapter in a gravity dependent position e Periodically check the flow sensor and tubing for excessive moisture or secretion build up Rev 02 COSMO Plus User s Manual 27 Section 4 Monitoring Flow Respiratory Mechanics Separately e For routine performance of airway care separate the system between the ET tube and the airway adapter neonatal circuit or between the ET tube and elbow pediatric adult circuit Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the airway adapter windows NOTE For non intubated patients the combined CO adapter flow sensor with mouthpiece can be used CAPNOSTAT CO sensor To atmosphere Mouthpiece GL Monitoring Flow Respiratory Mechanics Separately To monitor flow respiratory mechanics without CO3 1 Select a Series 3 flow sensor based on the patient Pediatric Adult Flow Sensor Catalog No 6717 e For intubated patients with endotracheal tube diameters greater than 4mm Adds approximately 6 5 cc of deadspace Neonatal Flow Sensor Catalog
28. Use on pediatric finger or on small adult finger Omm tapes use Blue color coded liners 2 25mm Finger Style Y Strip Taping System 100 per box Use on adult finger 25mm tapes use Green color coded liners Non Adhesive Foam Wraps 25 per box For use with Y Sensor Neonatal Pediatric Non Adhesive Foam Wraps 25 per box For use with Y Sensor Ear Clips For use with Y Sensor 5 per box Ear Clips For use with Y Sensor 25 per box EXTENSION CABLES FOR SpO SENSORS with Hypertronics connector 4941 00 4942 00 4943 00 5266 00 Saturation Sensor Extension Cable 4 feet Saturation Sensor Extension Cable 6 feet Saturation Sensor Extension Cable 10 feet Saturation Sensor Extension Cable 25 feet SINGLE PATIENT USE SpO SENSORS AND CABLES 6455 00 COSMO Plus User s Manual Pediatric Adult Single Patient Use SpO Sensor Terminates in DB9 connector 10 per box Rev 02 Rev 02 Catalog No 6455 25 6480 00 6480 25 8933 00 8936 00 MISCELLANEOUS 7104 10 600026 5334 00 5335 00 6758 90 Accessories Description Pediatric Adult Single Patient Use SpO Sensor Terminates in DB9 connector 25 per box Neonatal Pediatric Single Patient Use SpO Sensor Terminates in DB9 connector 10 per box Neonatal Pediatric Single Patient Use SpO Sensor Terminates in DB9 connector 25 per box DB9 Extension Cable For use with Single Patie
29. Vm L CO Production VCO ml min Mixed Expired CO PECO mmHg Airway Deadspace VD aw ml Physiologic deadspace to tidal volume ratio VdVtPh COSMO Plus User s Manual 65 Section 6 66 Preparing for Use Total Alveolar Tidal Volume VT alvt ml Spontaneous Alveolar Tidal Volume VT alvs ml Mechanical Alveolar Tidal Volume VT alv m ml Alveolar Minute Volume Total MV alv L Transmitted Waveforms Waveform Label Units Airway Flow AWF L Volume AWV ml Airway Pressure AWP cmH 0 CO Capnogram CO mmHg kPa Plethysmogram PLETH N A Preparing for Use This section details the setup and connection of the COSMO Plus to the Hewlett Packard VueLink module To prepare the COSMO Plus for operation you will need the following e COSMO Plus with software revision 2 0 or greater part number 6758 00 e COSMO Plus VueLink Adapter Novametrix part number 550034 e Hewlett Packard Patient Monitor with software revision C 9 xx or higher e Hewlett Packard VueLink module Auxiliary Plus B with Open Interface product number M1032 option A05 e Hewlett Packard 4 meter VueLink to COsSMO Plus Interface Cable part number K6B NOTE The Hewlett Packard Patient Monitor VueLink Module and Hewlett Packard interface cable are supplied by Hewlett Packard COSMO Plus User s Manual Rev 02 Preparing for Use HP VueLink Interface Component Setup 1 Connect the C
30. and Configuration Settings on page 16 The and X7 keys are also used to respond to monitor prompts such as ERASE STORED TRENDS YES A NO V7 CO SMO P ER on WAVEFORMS AGES ERTS os on si EVENT co FLow aT ur fex ar freo va MODEL 8100 oro fooam Fs of mj SET ALERTS AUDIO 34 NO RESP BABETCOst 55 RESP f HOLD SET ALERTS FOR Bs 20 25 3 65 SeOz t 166 PULSET 138 AUT ABF RESS SET ALERTS TO EXI 0 T fe moves pointer ASVZ press to change value EVENT FREEZE 4 CO SMO Plus User s Manual RESP MECH S FLOW ZERO NOW PURGE NOW SPON THRESH ScmHz0 PULSE VOLUME OFF AUG SeOz AY 8 sec IABP_MODE OFF fe moves pointer ASZ press to change value Uz H COz AUG 10 sec COz AW G 1 SERIAL NOURCOMS SCALE AUTO HIDE Rev 02 General Description Operational Overview anyjea eBueyo o ssaud Z C7 Jajuiod seaow a nge Ryd 43 LN4 sseooe 0 Aoy dNLIS y ploy pue ssalq NUSU NOILWYNOIANOO y Ul p 9 S ase SUBAIOS elep JOOOLOYd 10 CHVANVLS soyepdn asemyos aininy uum Area Aew Susasos J LON SSLN3 asd SN3JH9S VIVG CYVONVLS am aa sen Oy 00 anaa as Usnuossawm 7 MOLINOW F14ONS gt Xia VAON AMOI Aso aseq aul sobueyo pen Eig H1la1d OO 5 COSMO Plus User s Manual Rev 02 Section 1
31. apnogram plethysmogram display Respiration rate CO section Capnogram ETCO value mmHg PLETH T SpO value SpO section ery a Pleth Signal Bar p Pulse rate Plethysmogram Rev 02 COSMO Plus User s Manual 53 Section 5 Screen Displays Respiration rate CO section N ETCO2 hig Flow waveform ae MAP 11 FEEF FLOW cmH 0 JemHzo SpO2 ae Pulse rate P SpO section Pressure waveform Respiration rate CO section Flow waveform ETCO value Lemin 5H FLOW PRES SpO2 oo cs SpO section y Volume waveform Pulse rate CO section Respiration rate Flow volume loop ETCO value mmHg RESP PRES SpO value SpOb gt section Pressure volume loop Pulse rate Refer to SCALE setting in the CONFIGURATION screen see Configuration Settings on page 19 to display or hide scales and for manual or automatic scale adjustment 54 COSMO Plus User s Manual Rev 02 Screen Displays Monitoring Trend Screens On screen trends are displayed as bar graphs with 20 bars each Using the key the time base can be selected for 20 minutes 1 4 8 12 or 24 hours The value of each bar is the average value in the corresponding time interval For example each bar in a 20 minute trend corresponds to one minute New data is added on the right side of the screen Trend alveolar minute ventilation showing ventilator and spontaneous components 3 14 il lalu mech CO section
32. apped water Connect a sampling tubing set to the SAMPLING SYSTEM INLET Block the open end of the tubing with your finger Alternate blocking and unblocking the tubing end at least ten times Use a quick brisk motion when blocking and unblocking the tubing Keep the tubing blocked and unblocked for several seconds at a time Repeat the same blocking and unblocking action with your finger on the sampling exhaust port Allow the sampling system to run for at least 30 minutes without the sampling assembly tubing and the sampling exhaust tubing connected This will speed dry the system pneumatics Once these cleaning and disinfection instructions have been completed normal sampling system operation can be resumed See Sampling Airway Adapter Maintenance Schedules When the monitor powers up a self test is performed which checks the internal electronics of the monitor If this self test fails remove the monitor from use and contact qualified service personnel The monitor should undergo routine inspection and safety checks on a quarterly basis or according to hospital protocol The COSMO Plus Service Manual Catalog No 6758 90 contains procedures and safety test instructions component parts lists circuit diagrams theory of operation and other information to assist qualified service personnel in servicing the monitor Battery Maintenance If the monitor has not been used or powered by AC mains for an extended time 3 months or m
33. ar total MV alveolar spon MV alveolar mech e SpO pulse rate Screen Displays MARK ABG EVENT KEY Patte mmHo Val e phy aly WW Fha Calculated based on entered PaCO value Wel aw H IF mb cmH20 Rev 02 Screen Displays Rev 02 Monitoring To enter PaCO for calculation of Vd Vt phy Vd phy and Vd alv While this screen is displayed press the fan key when a blood sample is drawn A time and date marker will be placed below the PaCO value When the ABG results are known return to this screen and use the A Z keys to enter the PaCO value Pressing the up arrow once will display the PeCO mixed expired CO value that will be used for the calculations When this screen is exited the PaCO value will be locked To enter a new ABG value press the ee key while viewing this screen Vd Vt Phy Vd Phy and Vd alv are calculated based on the PaCO value last entered and are not updated until the next time the PaCO value is entered or changed To enter patient weight for calculation of Vt kg and VCO kg Press to move the pointer to the weight value Use the keys to enter weight A time and date marker will be placed below the weight value NOTE Vt ml kg tidal volume per kilogram and VCO kg CO production per kilogram are updated with every breath based on the most recently entered patient weight 14 32 Pal 45 hl aly mi SFO mechd 1 mech
34. atal mode the automatic flow sensor zero occurs every 30 seconds during the warming period and changes to every 3 minutes when the nominal temperature is reached A flow sensor zero occurs after every purge cycle 62 COSMO Plus User s Manual Rev 02 Notes on Patient Monitoring Monitoring Rev 02 Manual flow zero Neonatal mode A manual flow sensor zero may be used if a positive or negative offset of the flow waveform from zero baseline is observed This condition mainly occurs if the orientation of the COSMO Plus has changed since the last flow sensor zero To manually zero the system press the key on the front panel of the COSMO Plus then press the key until the pointer is next to FLOW ZERO NOW Press the up arrow A to initiate a flow zero There is no message to alert you that the flow zero has occurred while viewing the SETUP screen Press the key to return to the flow waveform screen and observe the flow waveform If the offset has not been corrected repeat the procedure If the offset does not clear after another flow sensor zero replace the flow sensor with a new one and observe the flow waveform If the offset is still present contact your biomedical engineering department Intra Aorta Blood Pump See IABP MODE in Setup and Configuration Settings on page 16 for SpO and pulse rate calculations when using an intra aortic balloon pump Reference Handbooks For a discussion on waveform interpretations r
35. atric Adult Flow CO Sensor is connected Airway pressure transducer detects an error Optical encoders identified that flow sensor is not connected Flow sensor pressure transducer was not able to be zeroed Optical encoders identified that a Neonatal Flow Sensor is connected Optical encoders identified that a Neonatal Flow CO Sensor is connected The monitor is attempting to clear the flow sensor tubing Optical encoders identified that an incompatible flow sensor is connected Displayed while a flow sensor zero is in progress Appears when the SCALE selection from the CONFIGURATION screen is set to MAN SHOW and the loops flow pressure waveforms require rescaling Oxygen Saturation Messages Message AMBIENT LIGHT COVER PROBE OR CHANGE SITE BAD SPO SIGNAL CHECK PROBE OR CHANGE SITE FAULTY PROBE LOW LIGHT CHANGE SITE LOW SpO SIGNAL Meaning of message Interference due to ambient lighting conditions is detected bright room lights heat lamps billilights Not enough light signal is being detected by the SpO probe s pho todetector Try applying the probe to a different location An acceptable pulse signal could not be detected The SpO probe or extension cable if used needs to be replaced Not enough light signal is being detected by the SpO probe s photodetector Try applying the probe to a different location The SpO signal is low this could be due to poor sensor placeme
36. broken or damaged sensor or one with wet contaminated or corroded connectors e Perform a Quick Check to verify the integrity of the sensor See Finger Sensor Quick Check on page 35 SpO gt Y Sensor Do not immerse connector on the Y Sensor e The Y Sensor may be immersed up to but not including the connector in a 2 glutheralhyde solution or 10 bleach solution Refer to manufacturer s instructions and standard hospital protocols to determine recommended times for disinfection and sterilization e Rinse thoroughly with water and dry before use do not rinse the connector e Do not attempt to sterilize Y Sensor except as stated above Rev 02 COSMO Plus User s Manual 83 Section 8 Cleaning and Sterilization e After cleaning or sterilizing the Y Sensor verify that the sensor is physically intact with no broken or frayed wires or damaged parts Make certain that the connectors are clean and dry with no signs of contamination or corrosion Do not use a broken or damaged sensor or one with wet contaminated or corroded connectors e Perform a Quick Check to verify the integrity of the sensor See Y Sensor Quick Check on page 41 SpO gt Y Strip Tapes and Foam Wraps e Treat Y Strip Tapes and foam wraps in accordance with hospital protocol for single patient use items Ear Clip e Do not immerse the ear clip e Clean the ear clip with a cloth dampened with 70 isopropyl alcohol After cl
37. creen appears Make sure that the audible alert volume is not set too low to be heard over ambient noise levels Rev 01 COSMO Plus User s Manual 81 Section 7 Alert Audio This page intentionally blank 82 COSMO Plus User s Manual Rev 01 Section 8 Maintenance Cleaning and Sterilization Follow the cleaning and sterilization instructions listed below to clean and or sterilize the monitor and its accessories Monitor e Turn the monitor off and unplug the line cord from the AC power source before cleaning e The monitor can be cleaned and disinfected with solutions such as a 70 isopropyl alcohol 2 glutheralhyde or 10 bleach solution Then wipe down with a water dampened clean cloth to rinse Dry before use e Do not immerse the monitor e Do not attempt to sterilize the monitor SpO gt Finger Sensor e The sensor can be cleaned and disinfected with solutions such as a 70 isopropyl alcohol 2 glutheralhyde or 10 bleach solution Then wipe down with a water dampened clean cloth to rinse Dry before use e Make certain that the finger sensor windows are clean and dry before reuse e Do not immerse the finger sensor e Do not attempt to sterilize the finger sensor e After cleaning the finger sensor verify that the sensor is physically intact with no broken or frayed wires or damaged parts Make certain that the connectors are clean and dry with no signs of contamination or corrosion Do not use a
38. cted CAPNOSTAT COs sensor is currently on the reference cell The CAPNOSTAT CO sensor s temperature is above normal operating temperature CAPNOSTAT CO sensor not connected to the monitor or is damaged CAPNOSTAT CO sensor has not reached the required temperature The CAPNOSTAT COs sensor has not reached operating temperature while attempting to zero Rev 01 Alerts Rev 01 Message ETCO OUT OF RANGE FAULTY SENSOR X GAS COMP INSP CO3 XX X PUT ON 0 CELL NO RESP XX NOT CALIBRATED PUT ON 0 CELL OCCLUSION PUT CO SENSOR ON REFERENCE CELL PUT COs SENSOR ON ADAPTER IN ROOM AIR OK 2 CANCEL 7 REMOVE FROM CELL AND PUT ON AIRWAY ADAPTER SAMPLING LEAK SENSOR ON CELL CO ZERO NOT REQUIRED AT THIS TIME WRONG SENSOR ZERO ERROR CHANGE SENSOR OR CALL SERVICE Alerts and Messages Meaning of message The detected ETCO gt value is beyond the measurement range of the monitor 0 100mmHg 0 12 5 or kPa CAPNOSTAT CO sensor needs servicing X service code Gas compensation SETUP screen is set to a value other than zero percent anesthetic agent and room air balance GAS COMP message replaces RESP label An inspired CO level of 3mmHg or 0 4 or kPa was detected for 15 consecutive seconds Place the CAPNOSTAT COs sensor on the 0 zero cell located on the sensor cable A breath has not been detected for the indicated time XX sec onds This mes
39. d a flow sensor zero will occur approximately once per minute As the temperature reaches nominal the frequency of the flow sensor zero increases to every 10 minutes If the CO2SMO Plus is placed into operation from the standby mode the flow sensor zero will occur every 10 minutes since the CO2SMO Plus is already at its nominal temperature Also a flow sensor zero will occur after every automatic or manual purge Manual flow zero Adult Pediatric mode A manual flow sensor zero may be used if a positive or negative offset of the flow waveform from zero baseline is observed This condition mainly occurs if the orientation of the COSMO Plus has changed since the last flow sensor zero To manually zero the system press the f key on the front panel of the COSMO Plus then press the key until the pointer is next to FLOW ZERO NOW Press the up arrow A to initiate a flow zero There is no message to alert you that the flow zero has occurred while viewing the SETUP screen Press the Es key to return to the flow waveform screen and observe the flow waveform If the offset has not been corrected repeat the procedure If the offset does not clear after another flow sensor zero replace the flow sensor with a new one and observe the flow waveform If the offset is still present contact your biomedical engineering department Automatic flow zero Neonatal mode The automatic flow sensor zero occurs under the same conditions as the adult but in the neon
40. d by mode in order for the CAPNOSTAT CO sensor to remain heated when the monitor is off 2 COSMO Plus User s Manual Rev 02 Operational Overview General Description Rev 02 If the A or key is not pressed within five seconds trends will be retained The monitor is now ready for operation o Contrast Press or hold to adjust the display s contrast for different up down viewing angles Alert Silence Press for 2 minute silence audible alerts muted for two minutes The amp icon will illuminate for the duration of the two minute silence Press again to cancel Press and hold for 3 seconds to disable audible alerts and the icon will flash Press and hold again to cancel Press to acknowledge a latched alert If preconfigured not to allow the audio off function the key will not disable the audible alerts when pressed the two minute silence is still active SET Set Alert Limits Press to set alert limits manually or hold to set automatically Press again to accept the displayed limits and return to the previous screen For more detailed information on setting alert limits see Setting Alert Limits on page 80 EVENT FREEZE Event Freeze Press the key to freeze the waveforms and loops for sixty seconds An EVENT MARKER with time and date will appear in the message center for three seconds followed by WAVEFORM FROZEN UNFREEZE PRESS EVENT KEY To resume normal display press again otherwise th
41. d holding the ALERT SILENCE key the audio off icon will illuminate and flash as long as the ALLOW AUDIO OFF setting is set to YES Factory default setting is NO If the ALLOW AUDIO OFF is set to NO the audible alert tone may not be silenced In addition to audible alerts several visual indicators are generated for parameter violations the red ALERT BAR will flash and a flashing up or down arrow will appear next to the violated parameter that denotes whether a high or low violation occurred Standby States A standby state is indicated by dashes in place of numeric values for a particular parameter This will occur when the monitor is first turned on and before any valid patient data is obtained When monitoring if valid data is received then lost for ETCO respiratory rate SpOs or pulse rate an alert condition will occur If the 4 key is pressed and valid data is still not available the numeric value of the parameter in question will display If the 4 key is not pressed within 30 seconds after the loss of data the display will automatically turn to COSMO Plus User s Manual 79 Section 7 Setting Alert Limits Setting Alert Limits The alert limits for the monitor can be manually or automatically adjusted When the monitor is turned off the alert limit settings will be retained even if AC power and the battery are disconnected The monitor can be configured to power up with the default limit values by settin
42. e 1 Select a Series 3 CO flow sensor based on the patient Pediatric Adult Combined CO Flow Sensor Catalog No 6719 e For intubated patients with endotracheal tube diameters greater than 4mm Adds approximately 6 5 cc of deadspace Neonatal Combined CO Flow Sensor Catalog No 6720 e For intubated patients with endotracheal tube diameters equal to or less than 4mm Adds less than 1 cc of deadspace 2 Connect flow and CO sensors to the COSMO Plus Use only Series 3 CO flow sensors COSMO fe EE oe Monitor rear RIS x o jo lA e BES amp Flow sensor connector CAPNOSTAT COs sensor connector refer to Initializing the CAPNOSTAT CO2 Sensor at the beginning of this section 26 COSMO Plus User s Manual Rev 02 Combined CO and Flow Sensors and Patient Connections 3 Connect the CAPNOSTAT CO sensor to the combined CO flow sensor W CAPNOSTAT COs sensor CAPNOSTAT CO sensor Pediatric adult __ Neonatal Combined CO gt Flow sensor Combined CO gt flow sensor added deadspace 6 5cc added deadspace lt 1 cc 4 Connect the combined CO flow sensor to the patient breathing circuit To ventilator To patient Combined neonatal COo flow with CO flow sensor with CAPNOSTAT COs sensor attached CAPNOSTAT COs sensor attached To patient NOTE e Do NOT place the airway adapter between the E
43. e Rev 02 e The Neonatal Airway Adapter Cat No 7053 may be sterilized using ETO ethylene oxide gas Be sure to use appropriate aeration times e Before reusing the adapter ensure that the windows are dry and residue free and that the adapter has not been damaged during handling or by the cleaning sterilization process External Sampling System Components e The Nasal Sampling Cannulas are for single patient use e The Sampling Adapter with tubing Cat No 5843 may be cleaned by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant It should then be rinsed with sterile water and dried Single Patient Use Airway Adapters e Treat all single patient use airway adapters in accordance with hospital protocol for single patient use items Internal Sampling System Components Acceptable fluids for cleaning and sterilizing the internal pneumatic parts of the Sampling System include isopropyl alcohol Cidex or equivalent or a 5 25 water solution by weight of sodium hypochlorite bleach Do not attempt to pump cleaning sterilizing liquid with the sampling pump This may cause accelerated wear on the pump bearings Always flush liquids with a syringe as described in the following instructions To clean and disinfect the pumping system Turn the monitor off and disconnect the AC line cord Remove both the sampling inlet tubing set and the sampling exhaust tubing if any Attach an exhaust
44. e waveform will resume again in 60 seconds Pressing this key when viewing the DATA entry screen allows you to enter the patient s PaCO for calculation of Vd Vt phy Vd phy and Vd alv cos CO Waveform Plethysmogram Press to switch waveform display between capnogram and capnogram with plethysmogram FLOWS Flow Pressure Waveforms Press to switch waveform display between flow and pressure waveforms or loops or flow and volume waveforms and loops flow vs volume and volume vs pressure display re Trend Press to switch between trend screens COSMO Plus User s Manual 3 Section 1 Operational Overview Data Screen Press to switch between data screens numeric values only and data entry screen to enter weight and PaCO see Data Screens on page 56 for details a Setup Configuration Press to display the SETUP screen or hold for three seconds to display the CONFIGURATION screen for advanced settings Press again to accept the displayed settings and return to the previous screen Refer to Setup and Configuration Settings on page 16 gS Adjustment Keys Press to select different parameters in SETUP CONFIGURATION SET ALERTS or DATA ENTRY screen Press A and XZ to change value or state of the currently selected parameter The key is also used to e Select different time bases on the Trend screens see Trend on page 3 e Rescale various waveforms if scaling is set to manual see Setup
45. e center strip does not effect sensor operation its purpose is to aid putting the sensor into the 25 mm tape and to keep the distance between the sensor heads at 25 mm 3 Press the button on the back of each sensor head through a hole in the tape Press in from the sticky side of the tape The tape will stretch to fit the sensor button Y Sensor placed on Y Sitrip tape LURI Liner this Side top Y Strip tape A Cross section Button 4 Remove the remaining release liner s if applicable and apply the sensor tape to the patient Make certain that the sensor heads are directly opposite each other through the tissue This prevents the sensor from being placed on a site too thick for proper operation Position the sensor so that the tape does not extend over the space between the fingers or toes to insure that there will be no light transmission through this space 5 To maximize sensor life secure the cable along the limb with tape as shown in the following illustrations Rev 02 COSMO Plus User s Manual 37 Section 4 SpO Sensors Leave slack in the wires between the tape and the sensor Adult pediatric finger Neonatal hand Neonatal pediatric foot WARNING Do not wrap the tape around the limb so tightly that circulation is restricted Inspect the site often for adequate circulation at least once every four hours When applying sensors take note of patient s physiological condit
46. eaning wipe the ear clip down thoroughly with a clean water dampened cloth to rinse Flow Sensors and Combined CO Flow Sensors e Treat all flow and CO flow sensors in accordance with hospital protocol for single patient use items CAPNOSTAT CO Sensor e Clean the sensor surface with a damp cloth e Make certain that the sensor windows are clean and dry Do not immerse the CAPNOSTAT CO sensor e Do not attempt to sterilize the CAPNOSTAT CO sensor Reusable Adult Airway Adapter e The Adult Airway Adapter Cat No 7007 may be cleaned by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant pasteurized or sterilized by soaking in glutaraldehyde It should then be rinsed with sterile water and dried e The Adult Airway Adapter Cat No 7007 may be sterilized using either steam autoclave or ETO ethylene oxide gas methods Be sure to use appropriate aeration times e Before reusing the adapter ensure that the windows are dry and residue free and that the adapter has not been damaged during handling or by the cleaning sterilization process Reusable Neonatal Airway Adapter e The Neonatal Airway Adapter Cat No 7053 may be cleaned by rinsing in a warm soapy solution followed by soaking in a liquid disinfectant pasteurized or sterilized by soaking in glutaraldehyde It should then be rinsed with sterile water and dried 84 COSMO Plus User s Manual Rev 02 Cleaning and Sterilization Maintenanc
47. ediatric Adult Flow 6 5 Pediatric Adult CO Flow 8 COSMO Plus User s Manual Rev 02 Monitor Specifications Specifications Monitor Specifications e Classification IEC601 1 Class I internal power source type BF continuous operating mode e Operating Environment 50 104 F 10 40 C 0 90 relative humidity non condensing e Size Height 3 3 in 8 38 cm Width 9 in 22 86 cm Depth 8 in 20 32 cm e Weight 8 pounds 3 63 kg e Power 100 120 200 240 Vac 50 60 Hz 40VA e Fuse Rating 100 120 200 240 VAC 0 5 A 250 V Slo Blo x2 200 240 VAC T 250 mA 250 V x2 e Battery Sealed lead acid gel cell not externally removable rechargeable 2 hour life on full charge on screen life indicator 12 hours recharge time non standard 178mm x 34mm x 64mm LxWxH e Display 1 5 x 5 inch 3 81 x 12 7 cm Cold Cathode Display CCD e Electromagnetic Emissions Conforms to EMC Directive 89 336 EEC CISPR Class A Tested to EN55011 1991 and CISPR11 1990 e Electromagnetic Immunity Conforms to EMC Directive 89 336 EEC EN50082 1 1992 Tested to IEC801 3 1984 Radiated Immunity Conforms to Medical Device Directive 93 42 EEC EN60601 1 1992 Tested to IEC801 2 1991 ESD IEC801 4 1988 EFT and IEC1000 4 5 1995 Surge Immunity Additional Features e Audible SpO Trend Feature Pitch of Pulse Rate beep tracks the SpO value user selectable volume e Alert Limits Automatic or menu selected high and low
48. ediatric mode Occasionally purging may be required in between the automatic purge cycle The manual purge may be used as often as needed and may be used at all times except when a very low battery condition exists During very low battery conditions automatic and manual purging is not allowed To manually purge press the key on the front panel Press the key until the arrow is next to the PURGE NOW selection Press the up arrow A to start the manual purge The system will purge one side of the line and then the other during each purge cycle Automatic Purge Neonatal mode The automatic purge cycle used in the neonatal mode is fixed at every 5 minutes regardless of circuit pressure Unlike the adult purge mode the neonatal purge mode does not use the full force of the internal pump but rather pressurizes an internal reservoir which is used for the purge This minimizes the pressure delivered to the ventilator circuit but does deliver a sufficient pressure to purge the pressure sense lines The other significant difference in the neonatal mode is that only one side of the pressure sense line is purged during each purge cycle The purge will only occur during the exhalation portion of the ventilator cycle regardless of exhalation time Manual purge Neonatal mode To manually purge press the key on the front panel Press the key until the arrow is next to the PURGE NOW selection Press the up arrow A to start the manual purge The system
49. ediatric patients with Novametrix Pulse Oximeters SuperBright series Use the Single Patient Use sensor and DB9 extension cable only with Novametrix SuperBright compatible pulse oximeters Use with any other device may result in equipment damage or patient injury These SpO sensors are intended for single patient use The sensors can be reapplied to various sites on the same patient but should not be used on multiple patients Do not attempt to clean or disinfect the sensor as system performance will be compromised The Single Patient Use sensor should be discarded if sensor integrity becomes questionable 42 COSMO Plus User s Manual Rev 02 SpO Sensors Sensors and Patient Connections Single Patient Use SpO Sensor Application 1 Connect the DB 9 extension cable to the COSMO Plus rear panel connector a 2 CA A REPLACE FUSE AS MARKED 200 RS232C NOVAMETRIX ACCESSORIES CAUTION FEDERAL U S A LAW RESTRICTS THIS DEVICE aR OE TO SALE DISTRIBUTION OR USE BY OR ON THE ORDER OF ALICENSED MEDICAL PRACTITIONER etait CAUTION EQUIPMENT MUST BE GROUNDED AT ALL TIMES TO AVOID DANGEROUS ELECTRICAL SHOCK HAZARD POWER 100 120 200 240 VAC SAMPUNG BHAT SO GOHZ AOVA SuperBright series connector 2 Press the connector on the end of the extension cable into the connector on the end of the Single Patient Use sensor DB 9 connector on extension cable P
50. efer to the Novametrix Reference Handbooks on capnography respiratory mechanics and pulse oximetry Contact Novametrix Customer Service or your local sales representative for more information COSMO Plus User s Manual 63 Section 5 Notes on Patient Monitoring This page intentionally blank 64 COSMO Plus User s Manual Rev 02 Transmitted Parameters Rev 02 Section 6 HP VueLink Interface HP VueLink Interface The COSMO Plus interface to the Hewlett Packard VueLink module provides a pathway for COSMO Plus data to be viewed on the Hewlett Packard Patient Monitoring System Twenty eight parameters and five waveforms are transmitted to the Hewlett Packard Patient Monitor These are available for display in conjunction with the other parameters configured for display on the Hewlett Packard Patient Monitor Transmitted Parameters Parameter Label Units Dynamic Compliance Cdyn ml cemH 0 Inspired Airway Resistance Dynamic RAW i cmH O L S Expired Airway Resistance Dynamic RAW e cmH O L S Peak Inspiratory Pressure PIP cmH O Positive End Expiratory Pressure PEEP cmH O Mean Airway Pressure Pmean cmH O Pulse Rate Pulse bpm SpO2 SpO5 ETCO ETCO mmHg kPa Respiratory Rate AWRR rpm Peak Expiratory Flow PEF L min Inspired Tidal Volume TVin ml Expired Tidal Volume TVex ml Total Minute Volume MVt L Spontaneous Minute Volume MVs L Mechanical Minute Volume M
51. etween the sensor heads needs to be reduced to less than 25 mm Rev 02 COSMO Plus User s Manual 35 Section 4 SpO Sensors Sensor heads S Strip may be removed Y Sensor Application using Y Strip Tapes or Foam Wrap Select a Y Strip or foam wrap based on the patient type and intended sensor location Wrap Style Tapes Y Strip tapes are available in two color coded sizes 25 mm tapes have green liners and 20 mm tapes have blue liners The size refers to the Z ZVZ distance between the holes in the tape e Catalog No 8828 20mm blue neonatal foot hand pediatric toe finger e Catalog No 8829 25mm green neonatal foot hand Finger Style Tapes e Catalog No 8831 20mm blue pediatric finger adult finger Ji Cie e Catalog No 8832 25mm green adult finger Non Adhesive Foam Wraps c e Catalog No 8836 Large adult pediatric finger neonatal pediatric foot or hand e Catalog No 8943 Small neonatal foot or hand pediatric toe or finger 36 COSMO Plus User s Manual Rev 02 SpO Sensors Sensors and Patient Connections To use the Y Strip tapes 1 Remove the portion of the release liner containing the holes Remove release liners with holes Se Pa A Wrap style tape Finger style tape 2 Omit this step if using the 25 mm Y Strip tape If using the 20 mm Y Strip tape carefully remove the Y Sensor center strip using a pair of scissors or a sharp blade Th
52. ey RESP spon Spontaneous respiratory rate RESP mech Mechanical respiratory rate Vti Inspired single breath tidal volume Also at Vte Expired single breath tidal volume PE Ee DATA key MAP Mean airway pressure Also at FLOW PRES key Pplat Pressure of the plateau during an inspiratory adult mode only pause Ti Inspiratory time Te Expiratory time PIF Peak inspiratory flow PeCO FeCO Averaged Mixed expired CO averaged expired CO concentration over the last eight breaths or one minute whichever is less VCO kg Averaged CO production per kilogram of body weight WOBvt Work of breathing imposed by the breathing circuit and ventilator DATA key ENTER WEIGHT DATA ENTRY page Vt ml kg mech requires patient Tidal volume per kilogram of body weight weight entry MARK ABG EVENT KEY Vd Vt phy requires PaCO entry Physiologic deadspace to tidal volume ratio Also at DATA key MONITORING screen Vd phy requires PaCO entry Vd alv requires PaCO entry Physiologic deadspace Alveolar deadspace An asterisk next to a parameter abbreviation denotes that the parameter is trended in COSMO Plus and that the trend is downloaded to COSMO Plus for Windows COSMO Plus User s Manual 51 Section 5 Parameters not displayed In addition to the parameters listed above the following parameters are also calculated and communicated through the RS232 output for display on a PC but are not displayed on the COSMO Plus
53. g the RETAIN LIMITS option in the CONFIGURATION menu to NO The default settings can also be set while the monitor is on and displaying the ALERT SETTINGS screen by pressing and holding the cir key Manually Setting Alert Limits Press the ha key to display the ALERT SETTINGS screen Use the menu control keys to adjust the settings as desired Press to move the arrow pointer to the desired parameter for adjusting Use the A and Y keys to change the selected value The RESP and PULSE high and low alert settings may be set independently for example the HIGH RESP rate may be set to OFF with a LOW limit set When a limit is off high or low for either parameter a bell with a slash appears next to the corresponding parameter The bell will appear at the top of the parameter or the bottom of the parameter depending on which limit is off 14 foot mmHg RESP ALERTS Fi HOLE SET ALERTS FOR PRESS SET ALERTS TO Auto Alert Limits Press and hold the cir key for two seconds and the monitor will automatically set alert limits based on recent patient data The ALERT SETTINGS screen will appear with an AUTO ALERT LIMITS SET message After a few seconds the display will return to the previous screen If auto alert limits cannot be determined the message NOT ENOUGH DATA TO SET LIMITS will appear Alert Latching Latched alerts will continue to visually indicate that an alert occurred even when the alert condition is no longer presen
54. h other through the tissue This prevents the sensor from being placed on a site too thick for proper operation a Neonatal hand Neonatal pediatric foot Pediatric toe Ep Adult pediatric finger Adult toe 4 Position the sensor so that the foam wrap does not extend over the spaces between the fingers or toes This ensures no light transmission through this space To maximize sensor life secure the cable along the limb with tape as shown in the following illustrations Treat foam wrap in accordance with hospital protocol for single patient use Check site regularly to ensure adequate circulation and proper sensor positioning Rev 02 COSMO Plus User s Manual 39 Section 4 SpO Sensors Y Sensor Application using Ear Clip 1 Remove center strip from the Y Sensor Sensor heads 2 Slide each Y Sensor head into the ear clip s receptacles The heads should face each other w _ _ Sensor head Sk oe Ear clip receptacle Squeeze here to apply gt 4 3 Gently squeeze the end of the ear clip shown in diagram and apply the sensor to the patient 40 COSMO Plus User s Manual Rev 02 SpO gt Sensors Rev 02 Sensors and Patient Connections If a satisfactory reading cannot be obtained rub the site and or use adhesive dots for better response The adhesive dots Catalog No 8700 included with the ear clips will also help in preventing the ear clip from falling off during exercise for example
55. h the CAPNOSTAT CO sensor and the flow sensor are disconnected from the COSMO Plus The COSMO Plus automatically identifies the type of flow sensor neonatal or pediatric adult when it is connected If a flow sensor identification message is not displayed when a flow or CO flow sensor is first connected DO NOT use the sensor If the condition persists refer the monitor to qualified service personnel COSMO Plus User s Manual 11 Section 2 e Periodically check the flow sensor and tubing for excessive moisture or secretion build up Although the COsSMO Plus automatically purges the lines excessive moisture or secretions may still remain e While using the flow sensor a system leak such as that caused by uncuffed endotracheal tubes or a damaged flow sensor may significantly effect flow related readings These include flow pressure dead space CO production and other respiratory mechanics parameters e Connect the line cord to a grounded hospital grade outlet COsSMO Plus should be connected to the same electrical circuit as other equipment in use on the patient Outlets of the same circuit can be identified by the hospital s engineering department e The COSMO Plus has no protection against the ingress of water CAUTIONS Indicates a condition that may lead to equipment damage or malfunction e Do not operate COsSMO Plus when it is wet due to spills or condensation e Do not operate COSMO Plus if it appea
56. han 4 mm Adds approximately 5 cc of deadspace Neonatal Pediatric Reusable Airway Adapter Catalog No 7053 e For intubated patients with endotracheal tube diameters no more than 4 mm Adds approximately 5 cc of deadspace Sampling Adapter Catalog No 5843 e For monitoring non intubated patients with nasal cannulas e For monitoring pediatric tracheostomy patients sensor or see the following section if using the sampling adapter COSMO Plus User s Manual Attach the CAPNOSTAT CO sensor to the monitor and adapter as described for the Combined CO flow 29 Section 4 Monitoring CO Separately Sampling Adapter The sampling airway adapter with tubing Catalog No 5843 should be used in conjunction with a nasal sampling cannula to monitor non intubated patients 1 Verify that the windows are clean and dry Clean or replace the adapter if necessary 2 Align the arrow on the bottom of the sampling adapter with the arrow on the bottom of the CAPNOSTAT CO sensor and press the sensor and adapter together until they click 3 Connect the sampling tubing to the SAMPLING SYSTEM INLET port located on the front of the monitor 4 Connect a dehumidification tubing set to the sampling adapter Use of the Nafion Dehumidification Tubing Set Cat No 8908 is optional but highly recommended especially during high humidity or lengthy monitoring episodes 5 Connect a Nasal CO sampling cannula to t
57. he dehumidification tubing set or to the sampling adapter if not using the dehumidification tubing Cat No Cannula Type 8781 Nasal CO Sampling Cannula Adult 8780 Nasal CO Sampling Cannula Pediatric 8906 Nasal CO Sampling and O Delivery Cannula Adult 8907 Nasal CO Sampling and O Delivery Cannula Pediatric CAPNOSTAT CO sensor Nasal CO cannula Cat No 8781 8780 8906 or 8907 D Sampling adapter with tubing Cat No 5843 J Dehumidification tubing Cat No 8908 Sampling tubing To monitor SAMPLING INLET 6 Ensure that the sampling pump is turned on the pump icon will be displayed To turn the sampling pump on or off e Press the key e Use the key until the arrow points to the PUMP selection e Use the AZ keys to turn the pump ON or OFF Nafion is a registered trademark of Dow Corning Corp 30 COSMO Plus User s Manual Rev 02 Monitoring CO Separately Sensors and Patient Connections 7 Adapter zero is necessary when the pump is first turned on to set the sampling system alert thresholds and adjust to the optical characteristics of the sampling adapter After the first sampling adapter zero subsequent patient setups using the sampling adapter do not require an adapter zero unless e Different tubing lengths or configurations have been used since the last use with a sampling adapter e The system was zeroed to a different adapter for example a
58. he monitor is connected to AC power the rear panel power switch is ON I and the front panel Ag icon is green Excessive alerting reduces battery life when operating on battery power When the monitor is operating on battery power and the battery is sufficiently charged the battery icon on the front panel F will be off and a battery icon will appear on the display The battery level is reflected on the display by a different icon by shading inside the battery icon for example battery fully charged jig battery low 4 Should the battery become exhausted the front panel icon will begin flashing red the monitor will sound an audible alert then when the battery is depleted turn itself off Reconnect the monitor to the AC line to recharge the battery The battery will be fully recharged in 12 hours Long Term Storage If the monitor has not been used or powered by AC mains for an extended timet 3 months or more allow the battery to charge for 12 hours before use The monitor may not power up on battery power if the The monitor must be in stand by mode in order for the CAPNOSTAT CO sensor to remain heated when the monitor is off The internal battery may slowly discharge over long periods of non use Rev 02 COSMO Plus User s Manual 15 Section 3 Setup and Configuration Settings battery is not sufficiently charged Allow the battery to charge for 12 hours before initial use refer to the following d
59. i 000 000 b gt 3 To disconnect the DB 9 extension cable from the sensor grasp the connectors and pull them apart To disconnect the DB 9 connector from the COSMO Plus press the latch release lever on the extension cable connector and pull the connector straight back away from the monitor DO NOT twist the connector o Sensor connector Press down on latch release Then pull out i mA MNN MNN Rev 02 COSMO Plus User s Manual 43 Section 4 SpO Sensors 4 Select the appropriate size sensor based on the patient type Pediatric adult sensor Adult toe Adult finger Neonatal pediatric sensor Neonatal hand Pediatric toe Neonatal foot 44 COSMO Plus User s Manual Rev 02 SpO Sensors Sensors and Patient Connections 5 To apply the sensor place the blue side of the sensor wrap against the skin wrap it around the site and secure with Velcro tab The Velcro tab on the neonatal pediatric version is removable to allow the foam wrap to be cut before applying to the patient Neonatal pediatric sensor E Ky a Reattach Cut excess off lt lt Velcro tab Vx Make certain that the sensor heads are positioned directly opposite each other through the tissue The adhesive dots Catalog No 8700 which are included with each sensor can be applied to the sensor before patient application for additional adhesion to the site 6 For additional support secure
60. iagram for charging instructions NOTE When the battery is low blinking E on front panel the monitor will not zero the flow sensor This may cause the calculations based on the flow signal to drift outside of normal performance specifications Connect to AC power as soon as possible To charge the battery connect the line cord to an AC source and set the rear panel power switch ON I Check that the front panel Ng icon is green Charge the battery for 12 hours CA S2S20 NOVAMETRIX ACCESSORIES 05A 8 8 2 100 120V CAUTION FEDERAL U S A LAW RESTRICTS THIS DEVICE TO SALE Diaj Habis BY OF ON THE ORDER OF T250mA Boor 20y A UCENE R Setup and Configuration Settings The SETUP and CONFIGURATION screens can be programmed by the user to customize the COSMO Plus The SETUP screen also allows a CO adapter zero a flow sensor zero or a flow sensor purge to be performed upon request To access the SETUP screen press the fee key Use the key to move the flashing pointer to the parameter to be set then adjust using the A and XZ arrow keys Any changes made will be retained when the monitor is turned off NOTE To reset the monitor to its factory default settings with the monitor off press and hold the cir key while pressing the key to turn the monitor on Use NEXT key to move pointer SAMPLE PUMP FLOW ZERO HON COz ZERO Holl PURGE HOW CALE SPOM THRESH PULSE VOLUME 5 i 54
61. ing for sidestream adapter and allow the CAPNOSTAT CO sensor to reach operating temperature DO NOT USE THE CABLE 0 CELL FOR THIS PROCEDURE Press then select ZERO NOW using the key then press 4 The monitor will display PUT CO2 SENSOR ON ADAPTER IN ROOM AIR OK A CANCEL amp or ATTACH CANNULA ON ADAPTER IN ROOM AIR OK A CANCEL if the sampling pump is on Room air must be in the airway adapter and it must be out of the ventilator circuit Press A to start the adapter zero 24 COSMO Plus User s Manual Rev 02 Rev 02 Sensors and Patient Connections If the monitor detects breaths at this time the message BREATHS DETECTED will be displayed and the adapter zero will not be allowed until 20 seconds has passed with no detected breaths The monitor will respond ZEROING CO2 ON AIRWAY ADAPT XX or ZEROING CO2 ON CANNULA XX if the sampling pump is on XX seconds remaining On Cable Verifier Cells The on cable verifier cells consist of a zero 0 and a reference REF or CO cell They are used for CAPNOSTAT CO sensor initialization for sensor zeroing when prompted by the monitor only if changes in the sensor are detected verifying the accuracy of the sensor or for parking the sensor when not monitoring On cable REF or VCO cell On cable 0 cell The CAPNOSTAT CO sensor can be placed on the reference cell labelled as CO on some verifier cells whenever the u
62. ion For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate Pediatric toe To use the non adhesive foam wrap 1 With the blue side of the foam wrap facing up press the buttons on the back of each Y sensor head through the holes in the foam wrap The wrap will stretch to fit the buttons Y Sensor Head sacs Button Cross section pee Foam of Sensor head Ua Center Strip in the foam wrap _White Fabric may be removed Y Sensor placed on foam wrap Widdi stio moved 38 COSMO Plus User s Manual Rev 02 SpO Sensors Sensors and Patient Connections If using the first and third holes on the foam wrap it may be necessary to cut the middle strip off the Y sensor 2 Face the blue side of the wrap toward the skin and wrap around the site cut excess foam if necessary on small version Secure with the Velcro tab Do not wrap the tape around the limb so tightly that circulation is restricted Inspect the site often for adequate circulation at least once every four hours When applying sensors take note of patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate 3 Ensure the sensor heads are directly opposite eac
63. ion and application of sensors associated with the COSMO Plus Covers combination CO flow separate CO and flow monitoring and SpO probes andela stalie MEA ected E cece Sete ct ved E E A Alea cece E 47 Parameters monitored screen displays sample waveforms viewing and entering patient data and notes on patient monitoring AP Vue ink INte race a a raer aaaea ck Sead a aaao paara Cass Sea a a aaae tos aaa SA deccasidecetan 65 Preparation setup and use of the COSMO Plus with the Hewlett Packard VueLink module Transmitted parameters and waveforms Alerts and Messages 5 c 25 222s cch 20c fcadccce oied Seccd caccdecachecedasacececadsascacueehecesctecddd cctcaesssececcueteds 73 Information on setting alerts alert indications audio and messages related to alerts and other circumstances MAINTENANCE aossen e aaan beeen ee eE a aE Raira RLA Eada aE oea cone OEA Nia aE daai 83 General maintenance and cleaning of the monitor and its accessories Specifici ONS a a a a a aa aa aasa aaa aa e aaan a a r aap aa seen doaaherdgcidad sane secueesdaaeseennee 91 WINAY ai E A E E E TE 95 IACCOSSOMCS eiir e EE E A 97 COSMO Plus User s Manual V vi COSMO Plus User s Manual Rev 01 Section 1 General Description Through the combination of capnography airway flow and pressure and pulse oximetry the COSMO Plus provides the clinician with a respiratory profile of the patient This includes information that was previously difficult to obtain
64. ion of the violation ALERTS OFF or ON see below for explanation OFF LATCHED RETAIN YES or NO see below for explanation YES LIMITS TIME 24 hour format DATE Day number short month name year e g 14 DEC 1997 CO UNITS Select the desired units for both the capnogram and ETCO values CO AVG CO Averaging Select the interval from which the displayed value of end tidal CO ETCO gt is calculated VCO AVG VCO Averaging Select the averaging time for the displayed value of CO production VCO DATA SET The STANDARD set configures the data in like groups such as volumes and pressures The PROTOCOL set configures the data screens in a ventilator management mode Included in the PROTOCOL set are screens for ventilator SETUP MONITORING and WEANING SERIAL Select the device that will be connected to the RS232C NOVAMETRIX ACCESSORIES connector on the rear panel DISPLAY HELD Display Held Timer The Display Held Timer activates if the pulse oximeter portion of the monitor cannot detect a regular and rhythmic pulsatile signal for periods longer than 10 seconds While the Display Held Timer is active S902 SEARCH XX is displayed in the Message Center and the SpO and Pulse Rate values are not updated and the last valid values are Held The timer display XX indicates in seconds how old the displayed SpO and pulse rate information is Note that when the DISPLAY HELD selection is set to OFF
65. iration time time taken for inspiration portion of breaths Te Expiration time time taken for expiration of breath WOBvt Work of breathing imposed by the breathing circuit and ventilator Raw i Dynamic inspired airway resistance Static Rawiis DATA key measured with inspiratory pause and is available in Raw i and Cdyn Adult mode only STAT is displayed in place of the also found with units FLOW PRES key Raw e Dynamic expired airway resistance Static Raw e is measured with inspiratory pause and is available in Adult mode only STAT is displayed in place of units Cdyn or Cst Dynamic compliance Static compliance displayed with inspiratory pause Pplat Pressure of the plateau during an inspiratory pause VCO CO production volume of carbon dioxide exhaled VCO also at CO per minute PLETH key VCO kg CO production per kilogram of body weight PeCO FeCO Mixed expired CO average expired CO concen trations over the last eight breaths or one minute whichever is less C20 C C20 C Dynamic compliance over the last 20 of neonatal the breath as a percentage of dynamic compliance mode only over the total breath RSBI Rapid shallow breathing index respiratory rate adult mode only divided by tidal volume COSMO Plus User s Manual Rev 02 Monitoring DATA SET STANDARD Enter Weight DATA key to ENTER ABG Vt ml kg mech Tidal volume per kilogram of body weight
66. iratory rate This message is displayed when the monitor could not successfully determine the auto alert limits for SpOo This message is displayed when the monitor could not successfully determine the auto alert limits for SpO and respiration rate This message is displayed when the monitor could not successfully determine the auto alert limits for respiration rate All setup and alert settings have just been reset to factory default values The trends stored in the monitor s memory have been erased The trends in the monitor s memory have not been erased New trend data will be appended to the currently stored data Time and date may not be properly set The time and date can be adjusted in the CONFIGURATION screen accessed by holding the SETUP key for three seconds This message appears in the message center when the key is pressed while displaying waveforms or loops Rev 01 Alerts Rev 01 Alerts and Messages Respiratory Mechanics Flow Messages Message ADULT FLOW SENSOR IDENTIFIED ADULT FLOW CO2 SENSOR IDENTIFIED AIRWAY PRESSURE ZERO ERROR NO SENSOR CONNECTED FLOW SENSOR ZERO ERROR NEONATAL FLOW SENSOR IDENTIFIED NEONATAL FLOW CO2 SENSOR IDENTIFIED PURGING INCOMPATIBLE FLOW SENSOR FLOW ZERO IN PROGRESS PRESS NEXT KEY TO RESCALE Meaning of message Optical encoders identified that a Pediatric Adult Flow Sensor is connected Optical encoders identified that a Pedi
67. isplay 11 Using the CAPNOSTAT CO sensor holding clip secure the sensor in a convenient place such as the on the patient s clothing or bedding NOTE If possible position the Sampling Adapter with its windows in a vertical and NOT a horizontal position this helps keep moisture from pooling on the windows To prevent rain out and moisture from draining into the Sampling Adapter do NOT place the Sampling Adapter in a gravity dependent position 12 The twist clips may be used to connect the sensor cable and sampling tubing together NOTE CO respiratory rate and the capnogram are the only data available when using the CAPNOSTAT CO sensor with the sampling airway adapter Rev 02 COSMO Plus User s Manual 31 Section 4 Flow Calibration Zeroing Flow Calibration Zeroing Flow sensor calibration is not necessary due to the consistency from one flow sensor to the next Also the flow signal is automatically zeroed periodically by internal valves The flow zero will freeze any displayed waveform for one second and display a FLOW ZERO IN PROGRESS message during the zero If additional flow sensor zeros are desired press and then press until the pointer is next to the FLOW ZERO NOW selection in the RESP MECH setup section then press the A key When the battery is low blinking E on front panel the monitor will not Zero the flow sensor This may cause the calculations based o
68. mon in all but heavily sedated patients can swamp the true pulsatile signal or distort it enough to produce significant errors in the SpO and Pulse Rate calculations The validator algorithms reject distorted plethysmographic signals or those that lack a regular rhythmic pattern therefore only valid pulsatile signals are allowed to affect the monitor s SpO and Pulse Rate calculations Rare conditions exists where the pulsatile waveform truly is distorted and lacks a fixed rhythm specifically during use of an Intra Aortic Pump IABP During IABP procedures the pulsatile signal can be massively distorted without affecting the patient s SpO In order to accommodate these IABP procedures without compromising the monitor s superior artifact rejection algorithm IABP MODE is available IABP MODE allows the user to turn off the validator algorithm so that all pulsatile data are allowed to influence the SpO and Pulse Rate calculations NOTE With IABP MODE turned ON the clinician must exercise prudence in assessing the validity of the SpO and Pulse Rate displays because any motion or other artifact not just that associated with the IABP can have a significant affect on the SpO and Pulse Rate calculations While in IABP MODE the displayed Pulse Rate reflects true pulsatile signal heart rate plus the IABP ratio e g 1 heart rate 120 bpm IABP ratio 1 1 then displayed Pulse Rate should be 120 120 1 240 beats min e g
69. n adult airway adapter since the last use with a sampling adapter e The monitor displays ATTACH CANNULA ON ADAPTER IN ROOM AIR OK A CANCEL 7 To perform a Sampling Adapter zero e Press the key the pointer should be next to the CO ZERO NOW selection if not use the key to select CO ZERO NOW in the CO2 SETUP section e Press the A key Verify that the cannula and dryer tubing if used is attached to the adapter and sampling room air and that the adapter tubing is attached to the monitor Place the cannula away from all sources of CO including patient and operator breath and ventilator exhaust valves e Press the key to initiate the zero a countdown timer will count from 10 seconds If the monitor detects changing CO levels breaths during an adapter zero BREATH DETECTED is displayed followed by ATTACH CANNULA AND SAMPLE ROOM AIR To continue remove the source of COs wait 30 seconds and press the A key 8 If using a Nasal CO Sampling and O Delivery Cannula attach the O tubing to the administration device and set the device to the prescribed O setting 9 Position the cannula on the patient Insert the cannula tips into the nostrils pass the cannula tubing over the ears then slide the retaining sleeve up the tubing toward the neck to a comfortable fit under the chin 10 Check that the connections have been made properly by examining the CO waveform capnogram on the monitor d
70. n the flow signal to drift outside of normal performance specifications Connect to AC power as soon as possible 32 COSMO Plus User s Manual Rev 02 SpO Sensors Sensors and Patient Connections SpO gt Sensors This section explains how to select an SpO sensor how to connect the sensor to the monitor and how to apply the sensor to the patient Connect only Novametrix SpO sensor extension cables and or SuperBright SpO sensors to the COSMO Plus Do not use other SpO gt sensors or accessories with CO2SMO Plus Before connecting to the patient or to the monitor ensure that sensor extension cables and or sensors are physically intact with no broken frayed or damaged components To attach a SuperBright sensor or sensor extension cable to COSMO Plus 1 Plug the connector into the rear panel SpO sensor input Spo NOVAMETRIX EN CAUTION FEDERAL U S A LAW RESTRICTS THIS DEVICE Tona HA TO SALE DISTRIBUTION OR USE BY OR ON THE ORDER OF A LICENSED MEDICAL PRACTITIONER 240 CO INPUT CAUTION EQUIPMENT MUST BE GROUNDED AT ALL TIMES amp TO AVOID DANGEROUS ELECTRICAL SHOCK HAZARD POWER 100 120 200 240 VAC SAMPLING NS 50 60Hz 40VA SuperBright series connector The connector clicks into place when properly seated Do not twist the connector Sensors may be connected or removed whether or not the monitor is turned on 2 To disconnect press the la
71. nonetheless are interested in receiving any comments you may have Please review this manual prior to using the monitor We are available to help you with servicing or applications questions You may call toll free at 1 800 243 3444 In Connecticut call collect at 203 265 7701 Sincerely NOVAMETRIX MEDICAL SYSTEMS INC PHONE TOLL FREE 1 800 243 3444 WALLINGFORD CT U S A 06492 Ps Aine a ee FAX 203 284 0753 WORLD WIDE WEB http www novametrix com INTERNET Customer Service sales novametrix com Technical Service techline novametrix com Declaration of Conformity with European Union Directives The authorized representative for Novametrix Equipment is European Compliance Services Limited Oakdene House Oak Road Watchfiled Swindon Wilts SN6 8TD UK iv COSMO Plus User s Manual Rev 02 Rev 01 Contents General Description wis sccc cei cceteeeececccestee decccee ce deeseeetedeeet ae eenteesebec cueacebeeudedeeseersenmeceeueenessebeeys 1 Indication for use unpacking operational overview of the monitor and principles of operation Warnings cautions and notes on the use of the CO2SMO Plus monitor and its accessories PreparatiGN fOr USe sirae naa AAAA SAREES AAEN Aa TENEO EANET AEEA EAN RE 15 AC battery operation setup and configuration settings Sensors and Patient Connections ccccssececesceceseseeseeceaesusseseeesuaeseseeeeeeuaensesenseanaessesenes 23 Detailed information on connect
72. nsidered spontaneous and any that cross above 11 cmH O is mechanical 18 COSMO Plus User s Manual Rev 02 Setup and Configuration Settings Preparation for Use Rev 02 With ventilators that have a PRVC pressure regulated volume control mode the SPONTANEOUS THRESHOLD SETTING will have to be adjusted This mode combines mechanical ventilation with pressure support for spontaneous breaths This pressure support is set on the ventilator to a percentage of the total mechanical PIP Unless the Spontaneous threshold on the COSMO Plus is adjusted all breaths mechanical and spontaneous will cross above our default SPONTANEOUS THRESHOLD SETTING and will be identified as mechanical When using this mode of ventilation identify the two peak pressure readings the PIP of the mechanical breath and the PIP for the spontaneous breath during the pressure support breath then set the SPONTANEOUS THRESHOLD SETTING approximately 3 5 cmH 0 below mechanical PIP As an example if the readings were 5 cmH O PEEP a mechanical PIP of 30 cmH 0 and the PIP for the spontaneous breath with pressure support at 15 cmH O you would adjust the COSMO Plus SPONTANEOUS THRESHOLD SETTING to 20 cmH 0 ScmH O PEEP 20 cmH 0 25 cmH 0 You may have to occasionally change this setting depending on patient conditions Configuration Settings Additional features can be adjusted in the CONFIGURATION screen by pressing and holding the key for three seconds Use the key to move
73. nt or low perfusion COSMO Plus User s Manual 75 Section 7 76 Message PROBE OFF PULSE OUT OF RANGE SpO2 HDW ERROR SPO PROBE SpO SEARCH XX Capnography Messages Message ATTACH CANNULA AND SAMPLE ROOM AIR OK 2 CANCEL 7 BREATH DETECTED SENSOR PASSED CAN T ZERO CHANGE SENSOR OR CALL SERVICE CHECK ADAPTER HELP PRESS A CHECKING ON CELL CO OVER TEMP CO SENSOR CO WARM UP PLEASE WAIT FOR SENSOR CANCEL PRESS COSMO Plus User s Manual Alerts Meaning of message The SpOsz probe is off the patient The pulse rate is beyond the measurement range of the monitor 30 250 beats min An error with the monitor s internal circuitry has been detected Refer servicing to qualified personnel SpO probe is disconnected or damaged The monitor is currently searching for an acceptable pulse signal The XX will indicate in seconds the duration of the search Meaning of message Pump was just turned on or pump was already on and an adapter zero is required or pump was already on and a zero was manually requested A changing level of CO was detected during an adapter zero procedure CAPNOSTAT COs sensor is within acceptable calibration limits An error has occurred during a CO zero Refer servicing to qualified personnel Excessive moisture or secretions detected in the adapter Adapter type has been changed e g reusable to single patient use No adapter dete
74. nt Use sensor above DB9 OxySnap Connector cable Use to connect Single Patient Use sensors to OxySnap connector Side Pouch for accessories included with monitor Power Cord included with monitor Cable Serial Output to Personal Computer with 25 pin connector Cable Serial Output to Personal Computer with 9 pin connector Service Manual CO2SMO Plus Model 8100 Respiratory Profile Monitor COSMO Plus User s Manual 99 Section 11 This page intentionally blank 100 COSMO Plus User s Manual Rev 02
75. ntee service s at its factory at an authorized repair station or at the customer s installation Novametrix obligations under this guarantee are limited to repairs or at Novametrix option replacement of any defective parts of our equipment except fuses batteries and calibration gasses without charge if said defects occur during normal service Claims for damages during shipment must be filed promptly with the transportation company All correspondence concerning the equipment must specify both the model name and number and the serial number as it appears on the equipment Improper use mishandling tampering with or operation of the equipment without following specific operating instructions will void this guarantee and release Novametrix from any further guarantee obligations Service Department For factory repair service call toll free 1 800 243 3444 In Connecticut call Collect 203 265 7701 Facsimile 203 284 0753 World Wide Web http www novametrix com Internet techline novametrix com Caution Federal U S A law restricts this device to sale distribution or use by or on the order of a licensed medical practitioner Copyright 1997 Novametrix Medical Systems Inc This document contains information which is proprietary and the property of Novametrix Medical Systems Inc and may not be reproduced stored in a retrieval system translated transcribed or transmitted in any form or by any means without
76. oduct abuse or misuse will be considered non warranty and invoiced at the prevailing service rate Any replaced defective material is expected to be returned to Novametrix within 10 days of being provided in order to avoid additional charges Exchanged material should be returned promptly and directly to Novametrix using the return paperwork and shipping label s provided Transferring return materials to local sales or dealer representatives does not absolve return responsibility Novametrix manufactures equipment that is generally user serviceable and can usually be repaired with the replacement of a plug in electro mechanical assembly by the clinical end user When repair parts are provided the recipient can call into Novametrix for on line replacement assistance and repair assurance In the event a replacement part requires increased technical capability Technical Support may request Biomedical assistance provide on site technical support or complete replacement equipment If the customer requires the return of their original product the exchange material will be considered loaner material and exchanged again after the customer equipment is repaired Novametrix promotes customer participation in warranty repairs should they become necessary This program allows for customer training and a smooth transition into self maintenance after warranty which can provide substantial cost savings on repairs throughout the product s life
77. ore allow the battery to charge for 12 hours before use The monitor may not power up on battery power if the battery is not sufficiently charged Allow the battery to charge for 12 hours before initial use refer to the following diagram for charging instructions When the battery is low blinking E on front panel the monitor will not zero the flow sensor This may cause the calculations based on the flow signal to drift outside of normal performance specifications Connect to AC power as soon as possible 2 The internal battery may slowly discharge over long periods of non use COSMO Plus User s Manual Rev 02 Mains Voltage Configuration Maintenance To charge the battery connect the line cord to an AC source and set the rear panel power switch ON I Check that the front panel icon is green Charge the battery for 12 hours 05A 8 8 2 100 120V CAUTION FEDERAL U S A LAW RESTRICTS THIS DEVICE 250MA Bloor 200y TOSAE D E BY OR ON THE ORDER OF If the battery requires replacement refer to the COSMO Plus Service Manual Catalog No 6758 90 for instructions Have this procedure performed by qualified service personnel only there are no user serviceable parts inside the monitor Mains Voltage Configuration The rear panel power entry module indicates the mains voltage setting for the monitor Check that the voltage is correct before attaching the AC line cord and powering the monito
78. pecifications General Specifications for the Novametrix COSMO Plus Monitor Model 8100 are listed for informational purposes only and are subject to change without notice Capnograph e Principle of Operation Non Dispersive Infrared NDIR absorption dual wavelength ratiometric single beam optics e Sensor Type Mainstream no gas sample drawn from breathing circuit e Initialization Time Capnogram in 15 seconds full specifications in 60 seconds e Response Time Less than 75 ms e O N gt 0 Heliox O gt 60 Anesthetic Agent Compensation Operator selectable e Barometric Pressure Compensation Automatic range 400 800 mmHg e CAPNOSTAT CO Sensor and Airway Adapter Weight Less than 2 oz 57 g without cable Sensor Size 1 3 4 x 1 1 2 x 3 4 inches 4 45 x 3 81 x 1 91 cm 8 foot cable 2 44 m Construction Durable high performance plastic ultra flexible cable Shock Resistant Sensor will withstand a 6 foot drop to a tile floor e Airway Adapter Single Patient Use or reusable less than 5 cc deadspace meets ANSI Z 79 e End Tidal CO Range 0 100 mmHg 0 12 5 Kpa or Accuracy 2 mmHg for 0 40 mmHg 5 of reading for 41 70 mmHg 8 of reading for 71 100 mmHg Display Resolution 0 50 mmHg scale 0 9 mmHg 0 75 mmHg scale 0 6 mmHg e Respiratory Rate Range 0 150 breaths min Accuracy 1 breath min Range 0 70 when used with sampling airway adapter Rev 02 COSMO Plus User s Manual 91 Section 9 Pulse Oxime
79. port line 1 8 inch or 3 16 inch I D tubing from the Sampling Exhaust port to a suitable container located below the bottom level of the monitor Use a 60 cc catheter tip syringe Fit it to the SAMPLING SYSTEM INLET connector Flush the sterilizing solution slowly through the pumping system Push the entire 60 cc of solution through the SAMPLING INLET Repeat this process two more times to use a total of 180 cc of solution Remove the syringe and leave the cleaning sterilizing fluid within the sampling pump system for 30 minutes to disinfect the system Follow sterilant manufacturer s instructions for disinfection After 30 minutes fill the syringe with distilled water and flush the system three times Allow the cleaning disinfection solution and distilled water to drain through the SAMPLING EXHAUST output Push several syringes of air slowly through the system to ensure that most of the liquid has been drained 1 Cidex is a trademark of Arbook Inc COSMO Plus User s Manual 85 Section 8 86 10 11 12 13 14 Maintenance Schedules Follow this with at least three more syringes of distilled water followed by at least two more syringes of air to make sure that most of the distilled water has been drained Remove the syringe from the unit Do not connect the sampling inlet tubing Connect the AC line cord and turn the monitor on Allow the sampling pump to operate for several minutes This will help to remove any tr
80. prior explicit written permission from Novametrix Medical Systems Inc COSMO Plus User s Manual 95 Section 10 Service Policy Service Policy Novametrix Medical Systems Inc will provide Warranty Service Support to its customers within 48 hours of receiving a telephone request for technical support This 48 hour period begins once a service request is placed through the Factory Technical Support Department in Wallingford Connecticut Novametrix provides factory direct technical support to its customers through a technical support group located in Wallingford Connecticut and company service representatives located throughout the United States All Technical Support for Novametrix products is provided Factory Direct Novametrix provides 24 hour a day technical support accessibility via telephone numbers 800 243 3444 or 203 265 7701 After hours technical support requests before 8 00 AM and after 5 00 PM Eastern Time will be responded to promptly by the Technical Support On Call staff It is suggested that any person calling in for technical support have the inoperative equipment available for preliminary troubleshooting as well as product identification Novametrix reserves the right to repair or replace any product found to be defective during the warranty period Repair may be provided in the form of replacement exchange parts or accessories on site technical repair assistance or complete system exchanges Repairs provided due to pr
81. quipment should be accomplished following the national requirements Contact the local Novametrix representative for questions concerning disposal Rev 02 COSMO Plus User s Manual 13 Section 2 This page intentionally blank 14 COSMO Plus User s Manual Rev 02 Section 3 Preparation for Use AC Battery Operation Press the POWER key to place the unit into operate mode ON or to place the unit into standby OFF The status of the unit is dependent upon both the key and the power source e No AC Power power icon off not in operate mode In this condition the AC switch is off or the power cord is not plugged into an AC outlet or the outlet is not powered No monitoring may occur in this state Battery is not being charged e AC Power power icon on not in operate mode standby In this condition the unit may be placed into operate mode by pressing the key Battery is charging in this mode e AC Power power icon on in operate mode In this condition the unit is in operating mode and the battery is being charged e Battery power power icon y off battery is not being charged In this condition the unit is in the operating mode and the battery is not being charged The COSMO Plus uses battery power when the line cord is disconnected or the rear panel power switch is OFF O The monitor can operate for up to two hours while powered from its internal battery fully charged The battery is charging only when t
82. r Pulse rate Adjust selected parameter a Press to move pointer to desired parameter SpO gt value Adjust selected parameter 7 Values are accepted when changed Press any key to exit pressing peal returns to the previous screen Rev 02 COSMO Plus User s Manual 59 Section 5 Notes on Patient Monitoring Notes on Patient Monitoring Flow CO Sensor Tubing Purge The COSMO Plus includes an automatic and manual purge feature which provides a flow rate of room air to keep the pressure sense lines free from water condensation and patient secretions This feature is available for the adult pediatric and the neonatal mode Automatic purge Adult Pediatric mode The system automatically purges the pressure sense lines every 2 minutes 5 minutes or 10 minutes depending on system conditions A double lumen connecting line connects the Series 3 flow CO sensor to the CO2SMO Plus The system will purge one side of the line and then the other during each purge cycle The frequency of the purge is primarily dependent on ventilator circuit pressure At low circuit pressure 0 20 cmH O the system will purge every 10 minutes As circuit pressure increases 21 40 cmH O the system purges every 5 minutes When the circuit pressure is greater than 40 cmH O the system purges every 2 minutes This action anticipates increased moisture migration into the pressure sense lines due to the increase in circuit pressure Manual purge Adult P
83. r The COSMO Plus can be set to operate from 100 120 VAC 50 60Hz or 200 240 VAC 50 60Hz Instructions for fuse replacement and changing the mains voltage setting follow CAUTION Replace fuses with same type and rating Verify proper fuse value for mains voltage setting see table below Fuse Replacement 1 Check that the monitor is OFF 2 Set the rear panel power entry module switch to OFF O Remove the AC line cord from the power entry module 3 Using a flat blade screwdriver pry the fuse access door open to expose the fuse housing Note the orientation of the fuse housing this determines the mains operating voltage Mains Voltage Fuses Slo Blo 100 120 Vac 0 5 A 250V 200 240 Vac 250mA 250V Rev 02 COSMO Plus User s Manual 87 Section 8 Mains Voltage Configuration FN PRSR Power entry module Fuse housing Fuse access door 4 Pry the fuse housing out from the power entry module Fuse housing NOTE 5 mm X 20 mm fuses are installed toward the back of the fuse housing as shown 3AG type 5 X 20mm type 5 Replace the blown fuse s with the proper type and rating 6 Reinstall the fuse housing When positioning the housing into the power entry module make sure that it is oriented correctly Press the fuse housing back into the power entry module 7 Close the fuse access door and verify that
84. rameter are exceeded There is also an alert when there is a loss of respiration for a consecutive twenty seconds other limit times may be selected see Manually Setting Alert Limits on page 80 The NO RESPIRATION alert is not generated when both the CAPNOSTAT CO sensor and the flow sensor are disconnected from the COSMO Plus Alert messages are displayed in the message center or in the particular area of the display when they occur For example a CO message will be displayed in the CO section of the screen Flow and system messages COs messages SpO messages _ gt Status messages indicate conditions that should be corrected or monitored they may or may not be tied to an alert condition Status messages are displayed on the screen in the same manner as alert messages Following is a list of status messages that may appear on the monitor System Messages Message Meaning of message AUDIO OFF DISABLED The AUDIO OFF feature is disabled by choice of the institution AUTO ALERT LIMITS SET This message is displayed when the monitor has successfully determined and set the auto alert limits for SpOs pulse rate ETCO and respiratory rate BAROMETRIC Barometric pressure is out of range 400 800 torr PRESSURE ERROR BATTERY VERY LOW Battery power has been depleted and the monitor will shut off PLUG IN AC POWER shortly COSMO Plus User s Manual 73 Section 7 74 Message ERASE STORED TREND
85. rence with our equipment or another manufacturer s equipment notify your Novametrix representative NOTES Indicates points of particular interest or emphasis for more efficient or convenient operation e Components of this product and its associated accessories which have patient contact are free of latex e As with all flow measuring devices adverse conditions may affect the accuracy of the flow measurement See page 10 for a discussion of flow measurement e If CO is being measured while not using a flow sensor certain rebreathing circuits or the presence of artifacts such as cardiogenic oscillations may cause CO2SMO Plus to react to non respiratory CO fluctuations as if they were breaths This condition affects only the numerical displays the capnogram display continues to provide an accurate picture of the CO waveform 12 COSMO Plus User s Manual Rev 02 Safety e When anew CAPNOSTAT CO sensor is attached to the monitor or is moved from one monitor to another it must be initialized before use The CAPNOSTAT CO sensor does not have to be initialized again as long as it is used with the same monitor e If you use the COSMO Plus for transport or if you drastically change the orientation of the COSMO Plus the flow sensor must be manually re zeroed See page 32 for more information on the flow sensor zero procedure e After the life cycle of our equipment and all accessories has been met disposal of the e
86. rently attached to the zero cell and a cell zero is in progress Performing a zero operation with the nasal cannula attached A zero error has occurred A cannula zero is required by the monitor This would be displayed while using the sampling adapter with cannula Rev 01 Battery Status and Alerts Alerts and Messages Rev 01 Battery Status and Alerts The LED on the front panel flashes when the battery is extremely low this will be accompanied by an audible alert When this occurs connect the power cord to the monitor s rear panel power entry module set the rear panel power switch to I ON then connect to an AC power source Verify that the front panel AC icon illuminates green ERAL U S A LAW RESTRICTS THIS DEVICE ION OR USE BY OR ON THE ORDER OF PRACTITIONER BE GROUNDED AT ALL TIMES STRICAL SHOCK HAZARD Alerts ETCO respiratory rate SpO and pulse rate have both high and low alert settings that when violated generate audible and visual alerts In all cases the audible alert tone may be silenced for two minutes by pressing and releasing the ALERT SILENCE key the 2 minute silence icon will illuminate The audible alert tone may also be silenced for 2 minutes in advance of an anticipated alert such as during suctioning by pressing and releasing the ALERT SILENCE key the 2 minute silence icon will illuminate The audible alert tone may be silenced permanently by pressing an
87. rough 10 OFF VOLUME SPO2 AVG Choose 2 sec or 8 sec SpO averaging 8 sec IABP MODE OFF or ON see below for explanation OFF GAS COMP Use this setting to enter the gas composition in order to compensate the flow measurement for gas density Any setting other than the default 0 agent balance air will cause the monitor to display GAS COMP on the screen below the respiration rate value the RESP label moves above the respiration rate value Selected Expired Compensation values for selected balance Balance CO O N3 N O He Air 5 17 78 0 0 N20 03 5 35 0 60 0 gt 60 O 5 75 20 0 0 Heliox 5 35 0 0 60 COSMO Plus User s Manual 17 Section 3 Setup and Configuration Settings Assumed inspired concentrations based on selected expired concentrations e Inspired CO 0 e Inspired O gt Expired setting 4 Volume e Inspired N Expired setting e Inspired N O Expired setting 1 Volume e Inspired He Expired setting e Anesthetic agent AGT When the expired agent compensation is adjusted the inspired value will automatically change to match the expired setting If the inspired value is then adjusted it will change independently from the expired value until the next time the expired value is adjusted IABP MODE COSMO Plus uses advanced SpO signal processing algorithms to distinguish valid pulsatile signals from signals generated by motion or other artifact Motion artifact very com
88. rs to have been dropped or damaged e Keep COSMO Plus and its accessories clean e Never sterilize or immerse the monitor in liquids e Do not sterilize or immerse sensors except as directed in this manual e Do not apply excessive tension to any sensor cable or pneumatic tubing e Do not store the monitor or sensors at temperatures less than 14 F 10 C or above 131 F 55 C e Do not operate the monitor or sensors at temperatures below 50 F 10 C or above 104 F 40 C e Federal U S A law restricts this device to sale distribution or use by or on the order of a licensed medical practitioner e DONOT attach an SpO sensor distal to a blood pressure cuff Valid data CANNOT be processed when the cuff is inflated Attach the sensor to the limb opposite to the site used for the blood pressure cuff e Excessive moisture in the flow sensor may affect the accuracy of the flow measurement e To avoid the effects of excessive moisture in the measurement circuit insert the flow sensor in the ventilator circuit with the tubes upright as shown by arrows The striped tube is positioned closest to the patient Improper placement will result in erroneous data e Itis recommended that the CO Flow sensor be removed from the circuit whenever an aerosolized medication is delivered This is due to the increased viscosity of the medications which may contaminate the sensor windows causing the sensor to fail prematurely e Incase of interfe
89. ry low battery condition automatic and manual purging is not allowed Monitoring A purge can also be initiated upon request if the flow waveform appears as though the lines are paritally occluded see example below and the purge did not initiate automatically mmHg Normal PULSE mm Occluded PULSE To initiate a purge Press f then until the pointer is next to PURGE NOW then press the key NOTE If the purge does not sufficiently clear the flow tubing lines the flow sensor should be changed Rev 02 CO2SMO Plus User s Manual 61 Section 5 Notes on Patient Monitoring Below is an example of a waveform that exhibits a small leak in the flow sensor tubing Replace flow sensor if problem persists refer monitor to qualified service personnel 17 ateo H Small leak mmHg RESP in flow tubing Flow Sensor Zeroing The systems ability to maintain a flow zero reference during all monitoring conditions is controlled by the automatic and manual flow zero feature The frequency of the automatic flow zero depends on monitoring conditions and whether you are in the adult pediatric or neonatal mode In either the automatic or manual mode the flow sensor zero takes no longer than 2 to 3 seconds Automatic flow zero Adult Pediatric mode When the COSMO Plus is placed into the operate mode from a cold start the internal temperature of the system will gradually warm to its nominal operating temperature During this perio
90. s The COSMO Plus calculates various flow CO and pulse oximetry related parameters Flow CO and pulse oximetry sensors can be used simultaneously or in any combination Initializing the CAPNOSTAT CO Sensor When a new CAPNOSTAT CO sensor is attached to the monitor or is moved from one monitor to another the monitor will prompt PUT SENSOR ON 0 CELL This will enable the monitor to initialize the CAPNOSTAT CO sensor The CAPNOSTAT CO sensor will not need to be initialized again as long as it is used with the same monitor When PUT ON 0 CELL appears in the CO section of the display 1 Place the CAPNOSTAT CO sensor on the cable 0 cell The monitor will respond ZEROING ON 0 CELL XX XX seconds remaining CAPNOSTAT COs sensor Cable 0 cell 2 After approximately 10 seconds the message PUT CO2 SENSOR ON REFERENCE CELL is displayed Place the CAPNOSTAT CO sensor on the cable REF cell may be labelled CO The monitor should display CHECKING ON CELL CAPNOSTAT CO sensor Cable REF or VCO cell Rev 02 COSMO Plus User s Manual 23 Section 4 The monitor sounds a short beep and will display SENSOR PASSED After a few seconds the message PUT CO2 SENSOR ON ADAPTER IN ROOM AIR OK amp CANCEL Y will display The CAPNOSTAT CO sensor has been initialized BUT IS NOT READY FOR PATIENT USE Place the CAPNOSTAT CO sensor on a new or clean reusable airwa
91. s automatically zeroed to correct for changes in ambient temperature and electronics The COSMO Plus system software compensations allow accurate flow and volume measurements in the presence of high oxygen concentrations anesthetic gases and helium oxygen mixtures When compensated gas density and viscosity effects do not cause significant errors in flow measurement For maximum flow sensor performance 1 keep the pressure sensing ports oriented upward 2 keep the sensor clear of accumulations by proper breathing circuit maintenance 3 confirm that the gas compositions entered correspond to best known values refer to Setup and Configuration Settings on page 16 10 COSMO Plus User s Manual Rev 02 Rev 02 Section 2 Safety The COSMO Plus monitor is electrically isolated Patient leakage current flowing from the instrument to ground is limited to less than 100 uA at 120 220 VAC 50 60Hz For maximum patient and operator safety you must follow the following warnings and cautions WARNINGS Indicates a potentially harmful condition that can lead to personal injury Explosion Hazard DO NOT use COSMO Plus in the presence of flammable anesthetics Use of this instrument in such an environment may present an explosion hazard Electrical Shock Hazard Always turn CO2SMO Plus off and remove the line cord before cleaning it Refer servicing to qualified service personnel Never sterilize or immer
92. s will appear If you are changing a parameter a list of available parameters will appear You may not select the same waveform for both waveform slots and you may not display a parameter twice COSMO Plus User s Manual 69 Section 6 Trends Calcs You may select a new waveform by pressing the lighted right or left arrow key until you get to the desired selection You may select a new parameter by pressing any of the lighted arrow keys until you get to the desired selection When you have made the changes that you want select the Main Screen key to return to the Main Screen or press the Module Setup key to return to the Auxiliary Plus window Trends Calcs The parameters that are selected for display will be trended in tabular and graphical format by the Hewlett Packard Patient Monitor Select one type of display from the HP menu Vital Signs Trends To open the Vital Signs window press the Trends Calcs key on the front of the Hewlett Packard patient monitor From the Trends Calcs menu press the Vital Signs softkey The Vital Signs window appears The Vital Signs window menu selections are Next Page Use this selection to cycle through the vital signs pages On Off Graph This key selects the parameters that you want to graphically trend Use the lighted up or down arrow keys to cycle through the parameters that you want to graphically trend then select the On Off Graph softkey to add a parameter to the graph trend list or
93. sage appears when the time since the end of expiration of the last detected breath exceeds the NO RESP time setting in the SET ALERTS screen A cell zero cable 0 cell is required by the monitor Possible occlusion detected in CO sampling tubing set A cell zero was just completed by the monitor and the calibration needs to be verified Place the CAPNOSTAT CO sensor on the reference cell marked REF or COz located on the sensor cable User has requested to zero the CAPNOSTAT CO sensor to the airway adapter or this procedure is required by the monitor Remove the CAPNOSTAT COs sensor from the reference or zero cell and place on the airway adapter that is to be used Possible leak detected in CO sampling tubing set CAPNOSTAT CO sensor is currently on zero cell but the monitor does not require a zero at this time An incompatible CO sensor is detected The monitor was not able to perform the required zero operation After five seconds the appropriate message returns for retrying the zero operation If it fails again the appropriate sensor error will be displayed COSMO Plus User s Manual 77 Section 7 78 Message ZEROING CO ON AIRWAY ADAPT XX ZEROING CO ON 0 CELL XX ZEROING CO ON CANNULA ZERO ERROR ZERO ON CANNULA COSMO Plus User s Manual Alerts Meaning of message An airway adapter zero is in progress XX indicates the number of seconds remaining CAPNOSTAT CO sensor is cur
94. se the monitor in liquids Do not operate COSMO Plus when it is wet due to spills or condensation Do not operate COSMO Plus if it appears to have been dropped or damaged Failure of Operation If the monitor fails to respond as described do not use it until the situation has been corrected by qualified personnel The COSMO Plus is not intended to be used as a primary diagnostic apnea monitor and or recording device Patient Safety Care should be exercised to assure continued peripheral perfusion distal to the SpO sensor site after application Inspect the SpO gt sensor site often for adequate circulation at least once every four hours When applying sensors take note of patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate Data Validity As with all pulse oximeters inaccurate SpO and Pulse Rate values may be caused by Incorrect application or use of sensor Significant levels of dysfunctional hemoglobin carboxyhemoglobin or methemoglobin Significant levels of indocyanine green methylene blue or other intravascular dyes Exposure to excessive illumination such as surgical lamps especially those with a xenon light source or direct sunlight Excessive patient movement Venous pulsations Electrosurgical interference A NO RESPIRATION alert is not generated when bot
95. ser wishes to verify the sensor s accuracy Once placed on the reference cell the monitor will display CHECKING ON CELL The ETCO value should read between 36 and 40 mmHg The monitor will sound a short beep display SENSOR PASSED for 15 seconds then enter a standby state CO section of the display only The zero cell can also be used to park the CAPNOSTAT CO sensor When the sensor is placed on the zero cell prior to placing the unit into operation or before CO is detected the message SENSOR ON CELL CO2 ZERO NOT REQUIRED AT THIS TIME will be displayed for 15 seconds After 15 seconds have passed the CO section of the display will enter a standby state The only time that the monitor will perform a zero on the zero cell is for initialization of a sensor or if the monitor detects a change in the sensor in which case it will display PUT ON 0 CELL Should this occur follow the screen instructions to zero the sensor The monitor will request a reference check following an on cable cell zero If the reference ETCO value is not between 36 and 40 mmHg another cell zero will be requested If the situation is not corrected within three repetitions of this sequence the monitor will request service COSMO Plus User s Manual 25 Section 4 Combined CO and Flow Combined CO and Flow To monitor flow respiratory mechanics and CO a combined CO airway adapter and flow sensor CO flow sensor is availabl
96. splay NOTE If you need detailed installation and operating instructions for the Hewlett Packard VueLink Module and the Hewlett Packard Patient Monitor refer to the Hewlett Packard Operator s Manual Rev 02 COSMO Plus User s Manual 67 Section 6 Module Setup Module Setup A total of 28 parameters are trended in the CO2SMO Plus unit 17 of these parameters can be transmitted to the Hewlett Packard Patient Monitor From this list of 17 pre selected parameters shown below you may choose up to 6 for display on the HP Main Screen Pre selected Parameters Parameter Label Units Dynamic Compliance Cdyn ml cemH 0 Inspired Airway Resistance Dynamic RAW i cmH O L S Expired Airway Resistance Dynamic RAW e cmH O L S Peak Inspiratory Pressure PIP cmH O Positive End Expiratory Pressure PEEP cmH O Pulse Rate Pulse bpm SpO SpO ETCO ETCO mmHg kPa Respiratory Rate AWRR rpm Expired Tidal Volume TVex ml Total Minute Volume MVt L CO Production VCO ml min Mixed Expired CO PECO mmHg Airway Deadspace VD aw ml Physiologic deadspace to tidal volume ratio VdVt Ph Total Alveolar Tidal Volume VT alv t ml Alveolar Minute Volume Total MV alv L Auxiliary Plus Task Window Press the VueLink button on the VueLink module or press the Module Setup key on the front of the Hewlett Packard Patient Monitor then press the softkey under the CO2SMO Plus selection of
97. st be taken to ensure that spent bat teries are collected separately when disposed of This symbol is found on the internal battery and should not concern the common user Refer to qualified service personnel when battery replacement is required Indicates heavy metal content specifically lead This symbol is found on the Pb internal battery and the monitor enclosure and should not concern the common user Refer to qualified service personnel when battery replacement is required 8 COSMO Plus User s Manual Rev 02 Principle of operation General Description Rev 02 Principle of operation CO COSMO Plus uses the CAPNOSTAT CO sensor to measure CO by using the infrared absorbtion technique which has endured and evolved in the clinical setting for over two decades and remains the most popular and versatile technique today The principle is based on the fact that CO molecules absorb infrared IR light energy of specific wavelengths with the amount of energy absorbed being directly related to the CO concentration When an IR beam is passed through a gas sample containing COs the electronic signal from the photodetector which measures the remaining light energy can be obtained This signal is then compared to the energy of the IR source and calibrated to accurately reflect CO concentration in the sample To calibrate the photodetector s response to a known concentration of CO is stored at the factory in the monitor
98. t The alert bar and the up down indicator arrow for the exceeded limit will flash audio does not remain on during a latched alert This will continue until the 4 key is pressed to reset the alert In this condition pressing 4 does not affect the 2 minute silence Alerts are latched when the ALERT LATCH in the CONFIGURATION screen is set to ON Setting the ALERT LATCH to OFF in the CONFIGURATION screen will result in having an alert condition reset itself when the condition no longer exists The factory default setting for ALERT LATCH is OFF 80 COSMO Plus User s Manual Rev 01 Alert Audio Alerts and Messages Alert Audio An audible alert is generated any time an alert condition is detected provided that neither the 2 minute silence nor the audible alert muting are enabled When the ALERT DELAY in the CONFIGURATION menu is set to ON there is a 10 second delay before the audible alert is generated from the time the alert is detected This is to minimize nuisance alerts If the ALERT DELAY is set to OFF then audible alerts are generated immediately Press the B key to silence an audible alert for 2 minutes Press again to cancel Press and hold the B key to disable audible alerts Press and hold again to cancel The monitor will always power up with audible alerts enabled The audible alert volume can be adjusted from the SET ALERTS menu It is the first item when this screen is displayed therefore simply press the and Y when the s
99. tch release lever then pull the connector from the monitor Do not twist the connector Press down on latch release B Then pull out mi MNN ti Rev 02 COSMO Plus User s Manual 33 Section 4 SpO Sensors OxySnap Connectors To connect an OxySnap extension cable to an OxySnap SuperBright sensor 1 Align the arrows on the OxySnap connectors and press the connectors together Finger grips meccxy L9G WIZI AAA mam BS CE OxySnap connector 2 To disconnect grasp the connectors at the finger grips and pull them apart Finger Sensor The reusable Finger Sensor is intended for adult or appropriate size pediatric fingers and is not designed for neonatal applications OxySnap extension cable 1 Gently squeeze the grips at the rear of the sensor indicated by arrows below Placement guide Cable exits above finger 2 Position fingertip against placement guide with fingernail toward the red light Do not position the finger so as to protrude past the placement guide 34 COSMO Plus User s Manual Rev 02 SpO Sensors Sensors and Patient Connections 3 Release the finger grips WARNING Inspect the site often for adequate circulation at least once every four hours When applying sensors take note of patients physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration s
100. ter 92 Pulse Oximeter e Oxygen Saturation Range 0 100 Accuracy 2 for 80 100 unspecified for 0 79 approximately 68 of the observations are within the accuracy claim Display Resolution 1 Averaging Time Menu selectable 2 or 8 seconds e Pulse Rate Range 30 250 beats per minute Accuracy 1 of full scale approximately 68 of the observations are within the accuracy claim Display Resolution 1 beat per minute Averaging Time fixed at 8 seconds Flow Sensor Specifications e Flow Range L min Neonatal Flow 0 25 to 28 Neonatal CO Flow 0 25 to 28 Pediatric Adult Flow 2 to 180 Pediatric Adult CO Flow 2 to 180 Flow Accuracy Neonatal Flow Greater of 3 reading or 125 L min Neonatal CO Flow Greater of 3 reading or 125 L min Pediatric Adult Flow Greater of 3 reading or 5 L min Pediatric Adult CO Flow Greater of 3 reading or 5 L min e Minute Volume Range L min Neonatal Flow 0 1 to 15 Neonatal CO Flow 0 1 to 15 Pediatric Adult Flow 2 to 60 Pediatric Adult CO Flow 2 to 60 Tidal Volume Range ml Neonatal Flow to 500 Neonatal CO Flow 1 to 500 Pediatric Adult Flow 100 to 3000 Pediatric Adult CO Flow 100 to 3000 e Airway Pressure Range cm H 0 Neonatal Flow 120 to 120 Neonatal CO Flow 120 to 120 Pediatric Adult Flow 120 to 120 Pediatric Adult CO gt Flow 120 to 120 e Added Dead Space ml Neonatal Flow less than 1 ml Neonatal CO Flow less than ml P
101. the cable along the limb with tape WARNING Do not wrap the sensor around the limb so tightly that circulation is restricted Inspect the site often at least every four hours for adequate circulation When applying sensors take note of patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate Single Patient Use SpO Sensor Quick Check 1 With the sensor connected to the monitor but not applied to patient position the sensor heads so that they face each other the red light shines at the detector Is PROBE OFF displayed on the screen 2 Attach the Single Patient Use sensor to your index finger Does the monitor show reasonable SpO and pulse rate values 3 A YES to BOTH 1 and 2 indicates that the sensor is working properly Apply the sensor to the patient as instructed above This quick check is also a functional test of the extension cable Velcro is a registered trademark of Velcro USA Inc Rev 02 COSMO Plus User s Manual 45 Section 4 SpO gt Sensors This page intentionally blank 46 COSMO Plus User s Manual Rev 02 Rev 02 Section 5 Display of Data Monitoring The COSMO Plus measures and displays respiratory mechanics carbon dioxide and pulse oximetry data Until valid data is recieved for any parameter that parameter will show a dash
102. the flashing pointer to the parameter to be set then adjust using the and 7 arrow keys Any changes made will be retained when the monitor is turned off 1 min HOWACOMS AUTO HIBE Options are listed below with descriptions following er Factory Parameter Description Default CO UNITS mmHg kPa mmHg CO AVG 1 Br 10 sec 20 sec Inst instantaneous 10 sec VCO AVG 1 Br 8 Br 1 min 3 min 5 min 10 min 1 min SERIAL Select serial interface OFF NOVACOM3 used when connected to OFF an external PC with optional software SATDIAG system diagnosis VUELINK HP VUELINK Open Interface COSMO Plus User s Manual 19 Section 3 Setup and Configuration Settings SCALE When set to AUTO SHOW the loops and flow pressure waveforms AUTO have reference scales and automatically adjust when changes occur HIDE When set to AUTO HIDE the loops and flow pressure waveforms do not show reference scales but will automatically adjust when changes occur When set to MANUAL SHOW all scale changes are made manually by pressing the frex key when prompted The CO scale is shown and is changed manually through theft key It will not autoscale DATA SET The DATA SET selection toggles between the STANDARD and PROTOCOL data screen configurations DISPLAY OFF or ON see below for explanation OFF HELD ALERT DELAY ON or OFF Audible alerts are delayed for ten seconds upon the ON detect
103. the menu Either action brings up the Auxiliary Plus window This window lists all of the transmitted parameters and has additional menu selections that allow for the module setup 68 COSMO Plus User s Manual Rev 02 Auxiliary Plus Task Window HP VueLink Interface Rev 02 fore cS Scale Wave This selection allows you to set the scales for the waveforms When selected the parameter table in the Auxiliary Plus window will clear and the available scale settings for the waveform currently being viewed in the Auxiliary Plus window will be displayed You may select the desired waveform scale by using the lighted right or left arrow keys on the front of the Hewlett Packard monitor When the scale is selected press the Module Setup key to return you to the Auxiliary Plus window or press the Main Screen key to return you to the Main Display Waveform Scale Selections Flow AWF 100 50 25 Liters per minute Pressure AWP 60 30 15 cmH O0 Tidal Volume AWV 2000 1000 500 ml CO 100 50 25 mmHg Plethysmogram none Next Wave A total of five 5 COSMO Plus waveforms are transmitted Up to two waveforms may be displayed on the Hewlett Packard Patient Monitor Main Screen at one time One of these waveforms will be displayed in the Auxiliary Plus window You may toggle between the two selected waveforms by pressing the Next Wave softkey while viewing the Auxiliary Plus window Freeze Values When selected the
104. the values are still held but the SpO2 SEARCH time is not displayed The Display Held Timer can be activated by e excessive motion e improper sensor placement e interference from electrosurgical devices e ambient light interference e low pulsatile signal strength 20 COSMO Plus User s Manual Rev 02 Setup and Configuration Settings Preparation for Use Rev 02 ALERT DELAY When set to ON the monitor will delay the audible alert for 10 seconds upon the detection of an alert violation ALERTS LATCHED The monitor will indicate an alert condition once detected If this option is set to ON the visual alert indication will continue even if the condition no longer exists The monitor will continue to indicate an alert until acknowledged by pressing the B key RETAIN LIMITS When set to YES all alert limits and setup and configuration settings will be retained when power is cycled If set to NO then the factory default alert limits and settings will be loaded the next time the monitor is turned on TIME and DATE Select to program or change the time and date The format is TIME HH MM DDmmmYYYY where HH hours from 00 23 MM minutes from 00 59 DD days of the month from 01 31 mmm month YYY Y year using all four digits COSMO Plus User s Manual 21 Section 3 Setup and Configuration Settings This page intentionally blank 22 COSMO Plus User s Manual Rev 02 Section 4 Sensors and Patient Connection
105. uch as more frequent site checks may be appropriate 4 To remove sensor gently squeeze grips and slide the sensor from the finger Overstretching the pulse oximeter finger sensor can damage the sensor and potentially affect pulse oximeter readings Do not stretch the finger sensor open beyond the limit for which it was designed Overstretching can be prevented avoid opening the sensor by any means other than squeezing the grips DO NOT force the sensor onto large objects such as a bedrail Finger Sensor Quick Check 1 Is PROBE OFF displayed when the sensor is connected to the monitor but not applied to the patient 2 Apply the sensor to your index finger Are reasonable SpO and pulse rate values displayed 3 A YES to BOTH 1 and 2 indicates that the sensor is OK Apply the sensor to the patient as instructed above The quick check is also a functional test of the extension cable Y Sensor The reusable Y Sensor is a flexible sensor designed for use on any patient It is secured to the patient using a Y Strip tape foam wrap or ear clip see below OxySnap extension cable The Y Sensor center strip is not a functional part of the sensor Its twofold purpose is to aid in the placement of the sensor into the Y Strip or other securing system and to keep the distance between the sensor heads to no more than 25 mm The center strip may be removed carefully cut away if the distance b
106. vailable in Adult mode only STAT is displayed in place of units Cdyn Dynamic compliance Cdyn also at FLOW Static compliance displayed with PRES key inspiratory pause VCO Averaged CO production volume of carbon dioxide VCO also at CO exhaled per minute PLETH key TREND key SETUP and WEANING DATA screen Vd Vt phy only Physiologic deadspace to tidal volume ratio updated when a PaCO is entered PEF Peak expiratory flow rate PEF also at FLOW PRES key DATA key Vt alv spon ml kg Averaged Spontaneous alveolar tidal volume divided by WEONINS een body weight Vt alv mech ml kg Averaged Mechanical alveolar tidal volume divided by body weight MV alv tot Averaged Total alveolar minute volume MV alv total also at TREND key VCO Averaged CO production volume of carbon dioxide VCO also at CO exhaled per minute PLETH key TREND key SETUP and MONITORING DATA screen RSBI Rapid shallow breathing index respiratory rate adult mode only divided by tidal volume C20 C C20 C Dynamic compliance over the last 20 neonatel mode of the breath as a percentage of dynamic compli only ance over the total breath NIP Negative pressure NIP also at SETUP DATA screen COSMO Plus User s Manual Rev 02 Rev 02 Monitoring DATA SET PROTOCOL DATA key MV spon Spontaneous minute volume MV mech Mechanical minute volume MV total Total minute volume Vd aw Airway deadspace Also at TREND k
107. will purge one side of the line during each purge cycle The purge is synchronized to the exhalation phase of the ventilator cycle and will not exceed exhalation time 60 COSMO Plus User s Manual Rev 02 Notes on Patient Monitoring NOTE Water that accumulates in the Neonatal Combo CO Flow and Neonatal Flow Sensors or the sensor tubing may cause the reported Tidal Volumes to be higher than set volumes If reported values are higher or lower than expected and water is seen in the line or sensor body purge the lines If purging does not clear the water remove the sensor from the circuit and remove the water by shaking the sensor or by flowing Oxygen or Compressed Air through the tubing or sensor until the water is removed Do not use high pressure for water removal To minimize the effects of aerosolized medications on the flow CO sensor it is recommended that the flow CO sensor be removed from the ventilator circuit prior to the delivery of the medication The decision to remove or not remove the flow CO sensor is the responsibility of the clinician During the purge cycle the pump will be heard Water will condense in the pressure sense lines at a faster rate when used in cooler ambient temperatures Always keep the flow CO sensor tubing pointed in an up position position of the arrow to minimize pooling of water and secretions at the pressure sense line openings The automatic purge mode may not be disabled During a ve
108. y adapter of the type that is to be used Room air must be in the airway adapter and it must be out of the ventilator circuit DO NOT USE THE CABLE 0 CELL FOR THIS PROCEDURE Press A to begin adapter zero If the monitor detects breaths at this time the message BREATHS DETECTED will be displayed and the adapter zero will not be allowed until 20 seconds has passed with no detected breaths The monitor will respond ZEROING CO2 ON AIRWAY ADAPT XX XX seconds remaining Refer to the following section for other CAPNOSTAT CO sensor zero requirements Whenever a CAPNOSTAT CO sensor is initialized an adapter zero must follow Once an adapter zero has been performed it does not have to be performed again unless until a different type of airway adapter or the sidestream adapter is used Adapter Zero An adapter zero allows the monitor to accommodate the optical characteristics of each different type of adapter The monitor will prompt for an adapter zero whenever the type of adapter single patient use reusable adult pediatric or neonatal being used to monitor the patient is changed An adapter zero should also be done each time the tubing set is changed when using the sidestream adapter When the monitor prompts CHECK ADAPTER HELP PRESS A and the A key is pressed the following screen will appear CHECK_ADAFTER To perform an adapter zero Place the CAPNOSTAT CO sensor on the adapter or cannula tub

User`s Manual - Frank`s Hospital Workshop

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