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1. _ ABSORBER a INTERFACE BRACKET DC CONNECTOR TO REMOTE BATTERY CHARGER Narkomed MRI Operator s Manual 2 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Gas Delivery System Color Coding The pneumatic system can simultaneously deliver up to three gases and one anesthetic agent Gas is supplied to the system through pipelines and cylinders Pipeline connections for oxygen air and nitrous oxide are standard Gas cylinder yokes are provided for one oxygen cylinder and one nitrous oxide cylinder WARNING Use only nonmagnetic aluminum E cylinders with this machine Steel cylinders can cause serious injury or death if brought into an MRI scanning room Each connection valve gauge and flowmeter is labeled and color coded for the appropriate gas as shown in the table below Table 2 1 Gas System Color Coding Gas Entry Through the Pipeline Pipeline Pressure Gauges 2 4 GAS MARKING USA ISO Air AIR Yellow Black White Checkered Nitrous Oxide 0 Blue Blue Oxygen White Gas from the hospital pipelines enters the Narkomed MRI through hoses connected to indexed pipeline inlets located on the side of the flowmeter housing
2. 11 5 Measurement Error Due to Incorrect Calibration 11 8 Section 12 Respiratory Volume Monitoring Figure 12 1 Respiratory Volume System 0 12 2 Figure 12 2 Monitor Display 12 3 Figure 12 8 Monitor Controls 0 12 4 Section 13 Breathing Pressure Monitoring Figure Figure Figure Figure Figure Figure Figure 13 1 13 2 13 3 13 4 13 5 13 6 13 7 Absorber Monitoring 13 4 Monitor Displays lisse RR Ih 13 5 Breathing Pressure Monitor Window 13 6 Breathing Pressure Trace Window 13 7 Breathing Pressure Trace Window with Examples of High Alarm Limit Markers 13 8 Monitor Controls 1 13 9 Sample Threshold Limit Settings 13 12 Section 14 Routine Maintenance and Cleaning Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure Figure vi 14 1 Replacing the Absorbent 14 3 14 2 Replacing the Oxygen Sensor 14 4 14 3 Open Reservoir Scavenger M
3. 4107650 Ring Nut inspiratory or expiratory valve upper ring nut 2109228 Gasket flat washer inspiratory or expiratory valve mount 1101690 4106874 Spring Clip absorber rod 1100097 O ring 020 Silicone absorber mount 4105868 O ring 237 Silicone dust cup fitting 4102940 Breathing Breathing Hose 22 mm x 23 long 9995123 bs LM Breathing Hose 22 mm x 32 long 9995132 Breathing Hose 22 mm x 40 long 9995140 Rubber Good Set includes Y Piece Mask Elbow 2 Liter Breathing Bag and 2 each 32 Breathing Hoses 1101071 Gas Hose 19 mm 10 long 9995210 Reems Hose 19 mm x 20 long 9995220 Hose 19 mm x 30 long 9995230 Hose 19 mm x 48 long 9995248 A 2 Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Bags Bellows Appendix Spare and Replacement Parts A Description Part Number RUP eR AAW ae Wet dade t RE E od ac 9995320 ne wey ekg ee ee ee 9995350 Adult Latex Free Bellows 4106930 001 Oxygen Monitoring Accessori
4. 13 13 Breathing Pressure Alarm Messages 13 13 Problem Resolution cscs serere eye e bebe se ER Rd P xU a Ed e x X Rm 13 15 Section 14 Routine Maintenance and Cleaning DEEST 14 2 Routine Maintenance 4 4444 4444 Rh nn 14 2 Removing Parts for Cleaning and Disinfection 14 11 Disassembling Parts for Cleaning and Disinfection 14 13 General Guidelines for Cleaning and Disinfection 14 16 Reassembly Instructions 14 23 Section 15 Specifications General seh REPRE E de 15 2 Environmental dans manne bls today dard ye aug eR Eg i Ed 15 2 Electrical sese RO nh ERE EXC RE Ps ioe aces wales c 15 2 Gas Delivery System isis REA dee bie red ieee eee dade 15 2 vag patie nimes meme MR meted ai ne Sn dt ant eee 15 3 AV2 Ventilator a cesi ages teed b agb ARX aies ie ee Uo EY EORR RE 15 3 Absorber System 28 coe bee pa de ec a o e be RO KE VOR URS 15 4 Oxygen Monitoring vce sait sad wd dees eee Ea ee Rond ee Ra b Ou ene ee RE 15 4 Breathing Pressure Monitoring
5. 15 4 Respiratory Volume Monitoring 15 5 Appendix Spare and Replacement Parts Manuals er Dinde dead amid Padus dac dee ae Pat deed ed ara A 2 Absorber System sara tam aeg Bie BE Ro pl Race et ecc c pa cae de apio get wg A 2 El m rPM A 3 Oxygen Monitoring Accessories A 3 Respiratory Volume Monitoring Accessories A 3 Power Supply Accessories A 3 Part Number 4113877 003 Rev F Narkomed MRI Operators Manual iii Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Figures Section 2 General Description Figure 2 1 Narkomed MRI Front View 2 2 Figure 2 2 Narkomed MRI Back View 2 3 Figure 2 3 Pressure Gauge and Flowmeter Arrangement 2 5 Figure 2 4 Fresh Gas Outlet 15 mm 2 9 Figure 2 5 Fresh Gas Outlet 15 22 mm 2 10 Figure 2 6 Auxiliary Oxygen 2 11 Figure 2 7
6. EEG 1 cm H0 Accuracy oi eraa kaiene ni 3 cm H O or 10 of reading Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Specifications 15 whichever is greater Waveform display range full 0 100 cm 5 Waveform resolution 1cm Waveform accuracy 3 cm H O or 10 of reading whichever is greater Waveform display scales 0 20 0 50 0 100 cm H30 Respiratory Volume Monitoring Minute Volume Tidal Volume Respiratory Rate Display Range sus danse ses een heehee Reseed eels 0 1 50 0 1 areata ead 0 11 Accuracy 10 of reading or 0 01 1 x breath rate whichever is greater Display 0 01 2 0 1 Note the standard bellows will deliver up to 1 5 1 R solution d eeu ee acid Sa dress 0 011 Accuracy 10 of reading 0 015 1 whichever is greater Volume Apnea Threshold 0 021 Numeric display range 2 99 bpm Resolutions 2 dic wie es wd EE ee V 1 bpm Accuracy 10 of reading or 1 bpm whichever is greater exclusive of hose compliance effects Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 15 5 Ag x
7. HI or ME conditions are active the tone associated with the highest existing alarm condition sounds The alarm continues to sound once every minute for up to 3 minutes or until alarm conditions have been cleared for 10 seconds NOTE All continuous audible alarms are automatically silenced for 2 minutes following power up During this period the occurrence of a new alarm produces a non repeating tone pattern appropriate for that alarm s level of urgency 10 10 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Monitoring anesthesia machine This section describes the oxygen monitoring of the Narkomed MRI Narkomed MRI Operator s Manual gt 11 2 fer 11 3 Manitor CONtTOlS RPM PER TC LL 11 3 Seino Alam DIES sans 11 4 Calibrating the Oxygen Sensor 11 4 Unguccesstul Mem 11 7 Oxygen Alarm Messages 11 9 Low Oxygen Supply Whistle 11 10 Problem Resolution beni DER 11 10 Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 11 Oxygen Monitoring Overview Inspiratory oxygen concentration is measured with a dual galvanic cell sensor which is attached to the inspiratory valve dome The sensor co
8. NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS A Appendix Spare and Replacement Parts This section describes the spare and replacement parts for the Narkomed MRI anesthesia machine along with their part numbers Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS A Appendix Spare and Replacement Parts Description Part Number Manuals Narkomed MRI Binder and Instruction Assembly 4113942 Narkomed MRI Technical Service Manual 4114210 Narkomed MRI Setup and Installation Manual 4113943 Absorber System Gasket Canister Top 4105848 Gasket Canister Bottom 4105849 Gasket Absorber Bottom 1101001 Screen Canister 1100022 uia d opa Ra RA Ae ola mR d ded keh Re t s 4105852 Breathing Pressure Gauge Assembly 4105853 001 Dome Inspiratory Expiratory Valve no port 2109230 Dome Inspiratory Valve with sensor port 4108329 Plug Assembly for inspiratory valve dome with sensor port 4106837 Valve Assembly Inspiratory with ported dome assembly and plug assembly 4107649 Valve Assembly Expiratory
9. SENSOR HOUSING COVER 8 A INSPIRATORY VALVE DOME INSPIRATORY VALVE P DOME PLUG M 4 Remove the replacement sensor capsule from its shipping container and install it in the housing Ensure that the copper rings on the capsule mate with the electrical contacts in the sensor housing 5 Wait 15 minutes to allow the sensor capsule to stabilize 6 Restore power to the machine and perform an oxygen sensor calibration as described in Calibrating the Oxygen Sensor on page 11 4 14 4 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Open The scavenger should be cleaned at least once every six months Reservoir Scavenger 1 Clean the outer surface of the scavenger with a soft cloth moistened Maintenance with mild detergent and water 2 Remove and inspect all scavenger hoses for signs of deterioration Replace any worn hoses 3 Ifapplicable unscrew the wing nut until the needle valve assembly can be removed from its seat Remove the nut and disassemble the valve Inspect the needle valve and seat for lint or dust accumulation Clean with compressed air if necessary Figure 14 3 Open Reservoir Scavenger Maintenance VACUUM BLOCK SOURCE p TERMINAL N p ADAPTER E z NEEDLE VALVE ASSEMBLY INPUT PORT CAP i FLOWMETER UM TOP OP00146 Part
10. p BELLOWS PILOT LINE RELIEF VALVE BODY NN WINGNUT 2X Disassembling Parts for Cleaning and Disinfection Disassem bling the Oxygen Sensor Assembly The following parts must be further disassembled for thorough cleaning and disinfection oxygen sensor assembly respiratory sensor flow housing transducer assembly e ventilator bellows assembly e inspiratory expiratory valves Unscrew the cover from the sensor housing and remove the sensor capsule Take care not to drop the sensor housed inside The sensor is not connected to the housing Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 14 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Disassem bling the Flow Housing Transducer Assembly Disassem bling the Ventilator Bellows Assembly Disassem bling the Inspiratory and Expiratory Valves 14 14 1 Press down on the lever under the flow housing and pull the flow housing transducer assembly out of the electronics housing 2 Pull both transducers out of the flow housing 1 Remove the bellows from the ventilator bottom assembly by unscrewing it in a counterclockwise direction until it is released 2 Unscrew the knurled ring nut around the ventilator relief valve and pull the relief valve dome and pilot line away from the relief valve body CAUTION Take special care not to change the position
11. 11 Pipeline Supply Verification a b d Inspect the supply hoses for cracks or wear Connect the appropriate hospital pipeline supply hoses from the wall outlet fittings to the pipeline inlet connectors Check for a sufficient pipeline pressure on the pipeline pressure gauges located below the flow control valves The pressure for each gas should be between 50 55 psi Open the flow control valve for each gas to a moderate value The pressure indicated at the pipeline pressure gauge must not decrease more than 5 psi Verify that the correct gases are supplied to the anesthesia machine inlets 12 Vaporizer Verification a b Check for a sufficient supply of liquid anesthetic in the vaporizer using the vaporizer sight glass The liquid level must be between the minimum and maximum markings Make sure the vaporizer fill and drain valves are completely closed 13 Check the flowmeters Adjust the flow control knob for each gas and verify the proper operation of the corresponding flowmeters The float must move freely over the full range of each flowmeter 14 Calibrate the oxygen monitor by exposing the sensor to ambient air and activate the calibration key See Calibrating the Oxygen Sensor on page 11 4 for more information a b Place the oxygen sensor securely in the sensor mount Verify that the correct gas concentrations are supplied to the anesthesia system from the supply cylinder Na
12. Dilute cleaning agents before use by strictly following the manufacturer s instructions Do not use abrasives such as steel wool liquid abrasives or powder abrasives on the machine Do not let any liquid enter the interior of the machine not submerge any part of the system unless specifically instructed to do so in this manual Do not pour or spray liquid directly on the machine during cleaning Always moisten a soft lint free cloth with the appropriate cleanser before applying it to the machine Wipe any spills and cleanser off the equipment surfaces immediately Clean painted plated and plastic surfaces with a soft lint free cloth moistened with mild detergent and water Follow up with a 70 to 90 diluted solution of ethyl or isopropyl alcohol or sodium hypochlorite 5 2 household bleach at 1 500 dilution 100 ppm chlorine NOTE Draeger Medical makes no claims about the efficacy of these agents or this method of cleaning for infection control Consult your hospital s infection control officer or epidemiologist Contact with oxygen ether mineral or vegetable oils phenols cresois terpenes hydrocarbon solvents chlorinated hydrocarbons esters or oxidizing acids hastens the deterioration process for rubber goods Check the hoses mask elbow and breathing bag often for signs of deterioration including swelling tackiness or cracking Replace the affected parts when any of these condition
13. Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 3 Daily Checkout This section provides you with instructions detailing the steps for you to perform a daily checkout of the Narkomed MRI anesthesia machine Daly Checkout Procedure Luise derseien ed 3 2 Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 3 Daily Checkout Daily Checkout Procedure Initial Setup and Verification Battery Power Verification 3 2 Before operating the Narkomed MRI perform the following checkout procedure to make sure the machine is ready for use This is a recommended procedure Follow your institution s policies regarding specific checkout procedures If the anesthesia system fails any procedures identified by an asterisk do not use the machine Contact an authorized representative of Dr gerService to inspect the unit WARNING Do not place any object on this machine unless it is specifically labeled to be used in an MRI scanning room and on the Narkomed MRI anesthesia system Objects placed on this machine that are not designed for use with this anesthesia system may be strongly attracted to the magnet and may cause serious injury or death when the machine is used in an MRI scanning room NOTE Do not insert any additional components or
14. OP00643B DUST CUP 5 Taking care not to chip or crack the canisters add new absorbent to each one When using absorbent prepacks remove all packaging materials some have clear plastic wrappers and place a prepack into each canister When using loose absorbent fill the canister to the fill line Do not overfill 6 Stack one canister on top of the other and center the stack on the gasket of the bottom dome 7 Raise the bottom dome remove and empty the dust cup if loose absorbent is present and replace the dust cup Pull the canister release lever up to close the absorber system Perform the absorber portion of the daily checkout procedure provided in the Daily Checkout section to verify proper reassembly Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 14 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Replacingthe Replace the oxygen sensor capsule when its sensor is depleted because a Oxygen depleted sensor cannot correctly analyze oxygen concentrations Sensor 1 Turn the SYSTEM POWER switch to STANDBY 2 Pull the oxygen sensor housing from the inspiratory valve dome It is a press fit 3 Unscrew the cover from the sensor housing and remove the sensor capsule Figure 14 2 Replacing the Oxygen Sensor SENSOR HOUSING OP00321 SENSOR CAPSULE TO VPO p MONITOR
15. f Turn the SYSTEM POWER switch to ON g Open the oxygen flow control valve to a flow of 8 l min h Occlude the bag mount opening and watch for a pressure increase on the breathing system pressure gauge This pressure increase must not exceed 3 cmH5O Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 4 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 4 Preuse Checkout Breathing 8 Perform a breathing and fresh gas delivery system pressure test This System Leak test detects leaks from the patient breathing system and fresh gas Test delivery system To perform the test a Close all flow control valves on the anesthesia machine b Turn the SYSTEM POWER switch to the STANDBY position c Turn the vaporizer to 0 concentration d Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose e Set the manual automatic selector valve to BAG f Close the APL valve by turning the knob fully clockwise to its stop position g Check that the breathing pressure gauge is on 0 h Attach the supplied test terminal to the breathing bag mount i Connect a sphygmomanometer squeeze bulb available from Draeger Medical to the hose barb on the test terminal j Pump the squeeze bulb by hand until the breathing system pressure gauge indicates pressure of at least 50 cmH O not to exceed 80 cmH3O k Observe the pressure
16. 2 General Description AV2 Ventilator The AV2 anesthesia ventilator is a volume preset time cycled pressure limited ventilator with electronic timing pneumatic circuitry and independent controls for frequency inspiratory to expiratory I E ratio inspiratory flow rate tidal volume and inspiratory pressure limit Pneumatic power bellows drive gas to the ventilator is supplied through the hospital oxygen pipeline supply or through the reserve cylinder on the anesthesia machine The supply gas pressure must be between 40 and 60 psi The ventilator will not function properly if this pressure drops below 32 psi Electrical power is supplied by the AC power source or by the battery A fully charged battery can power the ventilator for up to three hours The anesthesia ventilator designed for use with a Draeger Medical absorber system has a manual automatic selector valve Use this valve to select the breathing bag and adjustable pressure limiter APL valve for manual ventilation or the ventilator bellows for automatic ventilation During automatic ventilation the manual automatic selector valve isolates the APL valve from the breathing system The ventilator has a relief valve mounted behind the bellows chamber to compensate for introducing continuous fresh gas into the breathing system When the bellows is completely filled any excess gas in the system is released to the scavenger system through the ventilator relief valve A
17. AIR d J PA msi oo p N FLOW TUBE l min INDICATOR FLOAT FLOW CONTROL VALVE FLOWMETER GUARD KNOB PIPELINE PRESSURE GAUGE CYLINDER PRESSURE GAUGE OP00199 When the machine is connected to an active pipeline supply each gauge must indicate 50 55 psi A deviation from this range indicates that the pipeline gas supply system is improperly adjusted and may adversely affect operation fluctuating pipeline supply pressure for example would cause a corresponding fluctuation in the gas flow delivered from that pipeline An excessively low pipeline pressure may activate the corresponding reserve cylinder and deplete its contents if the reserve cylinder valve was left in the open position CAUTION Toensure that gas supplies are at adequate pressure pipeline Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual pressure gauges must indicate steady pressures of 50 55 psi 2 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Gas Entry Through Cylinder Yokes The Narkomed MRI is equipped with one oxygen cylinder and one nitrous oxide cylinder hanger yoke located in back of the machine To prevent a cylinder from being improperly connected the yokes are labeled color coded and keyed for gas specific cylinders using a pin indexed safety system A filter in each yoke prevents foreign material fro
18. 13 2 Draeger Medical has no control over the type of breathing hoses and Y pieces that are ultimately used with Draeger Medical absorber systems and pressure monitors specifically whether such user supplied components include a terminal for pressure monitoring at or near the Y piece In order to ensure that some form of pressure monitoring is always used provisions have been made for pressure monitoring at the absorber the quick connect fitting on the absorber gas pipe However do not construe this provision for monitoring at the absorber as a recommendation from Draeger Medical for this pressure monitoring location In fact arguments can be made for pressure monitoring at either the Y piece or at the absorber Advocates of Y piece pressure monitoring first claim that it more accurately reflects the pressure developed in the patient s lungs They also claim that a blocked breathing system can be more easily detected with this method when compared with pressure monitoring at the absorber For example if the inspiratory breathing hose became kinked or blocked during automatic ventilation the ventilator bellows would continue to cycle against the blocked hose A pressure monitor connected at the Y piece downstream of the occlusion could sense either an absence of pressure fluctuation and alarm or could sense a reduced pressure fluctuation below the threshold pressure alarm limit and alarm In contrast a pressure monitor connected
19. All rights reserved No part of this publication may be reproduced transmitted transcribed or stored in a retrieval system in any form or by any means electronic or mechanical including photocopying and recording without written permission of Draeger Medical Inc Trademark Notices Disclaimer Datagrip Dr gerService Narkomed Narkomed GS ORM Quality Service For Life Respitone Vigilance Audit Vitalert and Vitalink are registered trademarks of Draeger Medical Inc All other products or name brands are trademarks of their respective owners The content of this manual is furnished for informational use only and is subject to change without notice Draeger Medical Inc assumes no responsibility or liability for any errors or inaccuracies that may appear in this manual Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 1 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 1 Introduction Recommendations In the interest of patient safety Draeger Medical strongly advocates the use of an oxygen analyzer pressure monitor a volume monitor and an end tidal monitor in the breathing circuit at all times Because of the sophisticated nature of Draeger Medical anesthesia equipment and its critical importance in the clinical setting it is highly recommended that only appropriately trained and experienced professionals be permitted to service and maintain this equipment P
20. CYLINDER C HEAD ALUMINUM ae _ GAS CYLINDER CYLINDER fo COLOR CODED WRENCH Connecting the Fresh Gas Hose To connect the fresh gas hose pull out the fresh gas locking bar located on the front of the machine to its extended position Insert the 15 mm male fitting on the fresh gas hose into the 15 mm female terminal Release the spring loaded locking bar over the fitting allowing it to lock the fitting into place WARNING Do not pinch or kink the fresh gas hose leading from the fresh gas outlet to the absorber Adjusting the Gas Flow To adjust the gas flow 1 Turn the flow control knob located below the flowmeter tube for the preferred gas Turning the valve knob counterclockwise increases flow Turning the knob clockwise decreases flow 2 While adjusting the flow control knob observe the flow rate Flow rate is indicated by the flowmeter scale reading at the center of the float CAUTION The flow of oxygen cannot be completely shut off see Minimum Oxygen Flow on page 2 7 Do not force the oxygen flow control knob past the zero stop to shut off the minimum flow Forcing the knob can damage the valve seat Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Gas Delivery System Operation 5 Using the Oxygen Flush To use the oxygen flush press the oxygen flush button located on the front of the mach
21. Figure 14 10 Open Reservoir Scavenger Connections VENTILATOR APL VALVE _ RELIEF VALVE o 19MM SCAVENGER HOSE TERMINAL ABSORBER POLE 19MM SCAVENGER i HOSE 19MM SCAVENGER LT HOSE TERMINAL Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual OP00143B 49MM SCAVENGER HOSE VACUUM TERMINAL OPEN RESERVOIR SCAVENGER 14 25 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Passive Systems Scavenger Connections Figure 14 11 Passive Systems Scavenger Connections SHORT 19MM SCAVENGER HOSE VENTILATOR RELIEF VALVE 19MM SCAVENGER HOSE TERMINAL 19MM SCAVENGER HOSE 7s ABSORBER POLE Ke _ SCAVENGER INTERFACE FOR NON ACTIVE SYSTEMS 4 HOSPITAL lt TOMM REPRE opooies EXHAUST SYSTEM 14 26 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Specifications anesthesia machine Narkomed MRI Operator s Manual This section describes the specifications of the Narkomed MRI LE MR REN 15 2 xr laicus maaa 15 2 S E TA 15 2 Gas Delivery scenara ana Ana 15 2 MAPONZETS sicim ninad 15 3 scr iri o Ker 15 3 Absorber VSI 15 4
22. If at the end of the calibration period the Oxygen Monitor window is blank the calibration was not successful This condition is also indicated by the O2 CAL DUE oxygen sensor should be calibrated more than 18 hours have passed since calibration O2 CAL ERR oxygen percentage greater than 103 or O2 NOT CAL unit did not calibrate properly due to sensor error condition during calibration LO messages in the Alarm window An unsuccessful calibration can also be caused by several other conditions as described in Table 11 2 Table 11 2 Unsuccessful Calibration Causes and Solutions Cause Solution Sensor was exposed to an excessively lean or excessively rich oxygen calibration mixture Make sure that the sensor is exposed to room air only for the entire calibration period Sensor was exposed to a constantly changing calibration mixture Make sure that the sensor is exposed to room air only for the entire calibration period Sensor did not receive the proper waiting period If the sensor capsule was removed from the sensor assembly a waiting period equal to the time that the capsule spent outside the sensor assembly up to one week is necessary prior to calibration New sensors require a 15 minute waiting period Sensor is exhausted If the oxygen sensor has decayed beyond its useful service life see the Specifications section of the manual replace the decayed sensor with a new sensor and a
23. If the machine has been out of use or in storage replace the absorbent before using the machine Draeger Medical recommends establishing a routine schedule with a sufficient safety margin for replacing absorbent When using loose absorbent do not fill above the maximum fill level line located about a quarter inch from the top of the canister The clearance and the ratio of canister diameter to screen opening minimize the potential for channeling In channeling gas flows through the canister along the path of least resistance The gas depletes the efficiency of the absorbent along this route bypassing absorbent in the other areas of the absorber WARNING Absorbent is caustic and is a strong irritant to the eyes skin and respiratory tract When replacing the absorbent take care not to spill its caustic contents To replace the absorbent 1 Pull the canister release lever down 2 Remove the canisters from the absorber system 3 Empty the contents of the canisters into an appropriate refuse container 4 Check the canisters to make sure they are not chipped or cracked Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Figure 14 1 Replacing the Absorbent ABSORBER DOME AND GASKET 7 CANISTER N CANISTER a GASKET CANISTER S CANISTER Y GASKET BOTTOM DOME AND GASKET
24. Oxygen MOnitoring Sn 15 4 Breathing Pressure Monitoring 15 4 Respiratory Volume Monitoring 15 5 Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 15 Specifications General Dimensions WxHxD 31 x 58 x 27 inches Weight approximates anesthesia machine 200 lbs remote battery charger 15 lbs Environmental Operating Temperat re PT 50 95 Humidity 30 75 relative humidity noncondensing Barometric Pressure 4s ed 80a ss EAS 787 to 528mmHg Storage Temperat r oos si dits et let 14 122 F Humidity 10 90 relative humidity noncondensing Barometric Pressure 787 to 523mmH g Electrical Equipment class IEC 601 Class 1 Type B Continuous operation IPX0 non APG Leakage current eek td lt 300 microamps UL 544 Ground impedance lt 0 1 ohm 60 Hz source Dielectric withstand mains to chassis 1500 VAC UL 544 Charger chassis resistance between any metallic point and ground pin on power cord lt 0 1 ohm on AC powered component Power Supply Nominal input voltage acceptable range 100 240 VAC 50 60 Hz Inpu
25. Set the absorber s manual automatic selector valve to BAG Turn the APL valve control knob fully counterclockwise Verify that the suction waste gas disposal system is active Adjust the scavenger needle valve to a flowmeter indication between the two white lines Close all flow control valves on the anesthesia system Occlude the absorber breathing bag terminal and observe the breathing pressure gauge on the absorber The gauge should indicate only a negligible negative pressure no lower than 0 5 cmH 0 To test for positive pressure relief n Perform steps through E Adjust the scavenger needle valve to a completely closed position by turning it fully clockwise Open the oxygen flow control valve to a flow of 10 l min and occlude the absorber breathing bag terminal The flow of oxygen must now exit through the relief ports located on top of the canister The absorber system s breathing pressure gauge must indicate a pressure less than 5 cmH 0 After the test adjust the scavenger needle valve to a flowmeter indication halfway between the two white lines To test the scavenger interface for a passive systems 5 Make sure 19 mm scavenger hose is connected between the ventilator relief valve and the scavenger interface Make sure a 19 mm scavenger hose is connected between the APL valve on the absorber and the 19 mm hose terminal on the back of the absorber pole Make sure a 19 mm scavenger hose
26. 12 FT POWER SUPPLY CORD MRI ROOM ACCESSS PANE PLATE POWER SUPPLY CHARGER ASSEMBLY NOTE ACTUAL CABLE LENGTHS MAY VARY DEPENDING UPON THE POWER CABLE OPTION SELECTED FOR A PARTICULAR SITE OP00316 2 20 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Battery System Machine Functions on Battery Power General Description 2 The battery system consists of a rechargeable battery that powers the machine when the power supply charger assembly is inactive Although most hospitals have emergency generators that provide AC power when line power fails a delay may occur before the generator power comes online When the Narkomed MRI is plugged into an AC outlet the battery system automatically provides power during the period between a line power failure and activation of the hospital s emergency generator The battery also provides power if the power cord is accidentally unplugged When the hospital s emergency generator comes online or when a disconnected power cord is reconnected the Narkomed MRI automatically switches back to AC power and recharges its battery The battery charging system charges the battery any time the power cord is connected to an active AC power source The charger can recharge a fully discharged battery in about 16 hours with the Narkomed MRI in the Standby mode When the battery system is use
27. Absorber System 0 2 12 Figure 2 8 Open Reservoir 5 2 14 Figure 2 9 Scavenger Interface for Passive Systems 2 15 Figure 2 10 AV2 Ventilator ERE hh hr 2 17 Figure 2 11 AC Power Failure 2 18 Figure 2 12 Power Supply System 0 2 20 Figure 2 13 Monitor Screen and Controls 2 22 Figure 2 14 Alarm Display 2 22 oe Se eee ee dba das ERE ERG PER 2 23 Section 5 Gas Delivery System Operation Figure 5 1 Gas Fittings and Yokes 5 2 Figure 5 2 Connecting the Pipeline Gas Supply 5 4 Figure 5 3 Connecting the Gas 5 6 Figure 5 4 Using the Oxygen Flush 5 7 Section 6 Open Reservoir Scavenger Operation Figure 6 1 Open Reservoir 5 6 2 Figure 6 2 Connecting the Open Reservoir Scavenger 6 4 Section 7 Scavenger Interface for Passive Systems Operation Figure 7 1 Scavenger Interface
28. Always check the pressure indicated by the breathing system pressure gauge and waveform when adjusting the inspiratory flow control Setting the Inspiratory Pressure Limit The pressure limit control located above the bellows canister is used to adjust the pressure limit This control determines the maximum pressure delivered by the ventilator during the inspiratory phase of the respiratory cycle The scale is only a reference because of patient circuit variables Read the pressure from the breathing system pressure gauge or the monitor When the pressure limit control is turned fully counterclockwise the peak inspiratory pressure will be less than or equal to 15 cmH 0 When the control is turned fully clockwise the peak inspiratory pressure is less than or equal to 120 cmH 0O Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 9 5 9 AV2 Ventilator Operation RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY Excessive PEEP Improperly adjusted ventilator relief valve Contact an authorized representative of Dr gerService Insufficient suction scavenger flow setting Increase suction scavenger flow valve Inverse l E ratios Reset ratios Excessive NEEP Excessive suction scavenger flow Reduce suction scavenger flow rate Bellows won t reach tidal volume stop setting during expiration Fre
29. Oxygen Sensor Housing Cover X X X Inspiratory Expiratory Valves x x x x Ultrasonic Flow Sensor Housing and X Transducers Ultrasonic Flow Sensor Cable X Breathing System Pressure Gauge X Breathing Pressure Pilot Line x Absorber Canisters Gaskets and Dust x X Vaporizer Exterior x x Corrugated Scavenger Hoses do not normally need disinfection Open Reservoir Scavenger does not X X X normally need disinfection Passive Scavenger Interface does not X x X normally need disinfection gt Heat sterilization autoclaving including steam or hot air use manufacturer s recommendations Ethylene oxide gas use manufacturer s recommendations Glutaraldehyde based formulations 2 Wet pasteurization at 70 C for 30 minutes after detergent cleaning Sodium hypochlorite 5 2 household bleach 1 500 dilution 100 ppm free chlorine Ethyl or isopropyl alcohol 70 to 90 m OO Part Number 4113877 003 Rev Narkomed MRI Operator s Manual 14 17 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Cleaning and Disinfecting Exterior Surfaces Cleaning and Disinfecting Corrugated Breathing Hoses Mask Elbow and Bag 14 18 CAUTION To avoid damaging the Narkomed MRI Do not use Betadine Povodine Sagrotan Mucocit acetone ketone xylene or anesthetic agents for cleaning
30. Reservoir Scavenger 6 2 VACUUM DISS HOSE TERMINAL THREADED INPUT PORT CAP 19MM SCAVENGER HOSE TERMINAL RELIEF PORT OP75121 Narkomed MRI Operator s Manual LOCK NUT NEEDLE VALVE KNOB 19MM SCAVENGER gt HOSE TERMINAL FLOWMETER RESERVOIR ye CANISTER Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Open Reservoir Scavenger Operation 6 Connecting the Open Reservoir Scavenger System The open reservoir scavenger system is installed on the Narkomed MRI before shipping However the hoses must be connected before operation CAUTION Take special care not to accidentally force 19 mm scavenger hoses over 22 mm breathing hose terminals Carefully follow the hose connection instructions for installing the scavenger and the absorber To connect the scavenger hoses 1 Attach 19 mm scavenger hose between the 19 mm terminal marked SCAVENGER HOSE on the bottom of the absorber pole and the 19 mm terminal marked SCAVENGER HOSE on the right side of the scavenger WARNING Make sure the 19 mm scavenger hoses leading from the absorber are not pinched kinked or blocked in any manner Attach the short 19 mm scavenger hose between the 19 mm terminal marked SCAVENGER HOSE on the rear of the APL valve and the 19 mm terminal marked SCAVENGER HOSE on the rear of the a
31. Y piece rests with you the operator Your clinical considerations over which Draeger Medical has no control must be included in this decision Draeger Medical is available to discuss with you in detail the positive and negative aspects of each pressure monitoring approach Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 13 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 13 Breathing Pressure Monitoring Installing the Breathing Pressure Pilot Line For breathing pressure monitoring at the absorber install the short pilot line which has quick connect fittings on both ends as follows refer to Figure 13 1 1 Connect one end of the pilot line to the fitting mounted on the rear of the pipe extending from the absorber top assembly 2 Connect the other end of the pilot line to the BREATHING PRESSURE interface on the rear of the ventilator monitor Figure 13 1 Absorber Monitoring P e REAR PANEL A OF MONITOR 4 QUICK CONNECT FITTINGS SHORT PILOT LINE OP00315 ABSORBER TOP ASSEMBLY 13 4 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Pressure Monitoring 13 Information about the patient s breathing pressure is presented in two windows at the bottom of the monitor display a
32. and Controls 2 22 PR eee E E eet AE ET 2 23 Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Overview The Narkomed MRI is a continuous flow anesthesia system used for spontaneous manually assisted or automatic ventilation delivery of gases and anesthetic vapor and monitoring oxygen concentration breathing pressure and respiratory volume The Narkomed MRI can be used in MRI scanner rooms with magnets of 1 5 tesla or less A front view is shown in the figure below Figure 2 1 Narkomed MRI Front View 2 2 VENTILATOR MAIN SWITCH PANEL MONITOR r VENTILATOR BELLOWS SCAVENGER I OPEN RESERVOIR ABSORBER 7 FLOWMETER BANK VAPORIZER PRESSURE GAUGES OP00323 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description 2 A back view is shown in the figure below Figure 2 2 Narkomed MRI Back View VAPORIZER _ MOUNT PIPELINE GAS FITTINGS CYLINDER GAS YOKES TETHERED CYLINDER WRENCH POWER CORD MOUNT BATTERY BOX OP00319 Part Number 4113877 003 Rev F VPO MONITOR
33. appears in the Alarm window if there is an internal sensor fault or if the electronics housing is not properly seated on the flow housing transducer assembly When the volume alarms have been set to Standby the LO message VOL ALM STBY appears in the Alarm window If the Narkomed MRI detects an internal electronic failure that would prevent proper operation the LO message SERVICE VENT MON appears in the Alarm window If this happens contact an authorized representative of Dr gerService Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 12 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 12 Respiratory Volume Monitoring Problem Resolution Table 12 1 Respiratory Volume Monitoring Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY Blank display area Blank display area VOL SEN DISC alarm message in Alarm window One full minute has not elapsed for minute volume and respiratory rate since respiration began Wait one full minute to read display Apnea condition Correct apnea condition Ensure sensor is properly connected to the expiratory valve Sensor fault Replace sensor assembly Electronics housing is not properly seated on flow housing transducer assembly Reseat electronics housing on the flow housing transducer assembly and ensure it is locked in place REVERSE FLOW alarm message in Alarm window Expiratory valve
34. be adversely affected by the operation of electrosurgical equipment or short wave or microwave diathermy equipment in the vicinity Do not place any objects on top of the machine All the warnings and cautions above are provided below in French AVERTISSEMENT L utilisateur de l appareil d anesth sie doit se Part Number 4113877 003 Rev F conformer aux avertissements mises en garde et proc dures de v rification imprim s sur l appareil ou sur le panneau r tractable N gliger de faire cela risque de provoquer des blessure chez le patient l op rateur ou d autres personnes et risque galement d endommagement l appareil Narkomed MRI Operators Manual 1 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 1 introduction 1 8 AVERTISSEMENT AVERTISSEMENT AVERTISSEMENT AVERTISSEMENT AVERTISSEMENT AVERTISSEMENT AVERTISSEMENT Toute personne charg e de la pr paration de l utilisation ou de l entretien de l appareil d anesth sie Narkomed MRI doit tr s bien conna tre le contenu de ce manuel d utilisation Ne placer aucun objet sur cet appareil moins qu il n ait t sp cifiquement approuv pour l utilisation dans une salle IRM avec un appareil d anesth sie Narkomed MRI Tout objet non conforme d pos sur cet appareil pourrait tre fortement attir par l aimant et pourrait occasionner des blessures graves ou fatales lorsque l appareil d anesth sie est uti
35. breathing system Make sure the fresh gas hose of the breathing system is connected securely to the fresh gas outlet c Make sure a 22 mm patient breathing circuit is connected between the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor d Make sure a 22 mm breathing hose is connected between the ventilator hose terminal and the manual automatic selector valve breathing hose terminal e Make sure a breathing bag of proper capacity and appropriate construction is connected to the breathing bag terminal of the breathing system f Make sure the breathing pressure pilot line is properly connected between the BREATHING PRESSURE interface and either the absorber quick connect fitting or the appropriate fitting at or near the patient Y piece g Make sure the oxygen sensor and flow sensor are properly installed Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS APL Valve 5 7 Preuse Checkout 4 Make sure the absorber canister is filled with absorbent Consult the absorbent manufacturer s literature for what signs to expect when the absorbent is exhausted Replace the absorbent when it appears exhausted Make sure that the color change represents the absorbent s true state of depletion and is not due to regeneration after a rest period Flushing the anesthesia machine continuously with 1
36. drop at the breathing system pressure gauge When the pressure is at 50 cmH O begin counting seconds Thirty seconds or longer are needed for a pressure drop from 50 to 30 cmH 0 Scavenger 9 Verify the performance of the scavenger system system To test the open reservoir scavenger system a Make sure a 19 mm scavenger hose is connected between the ventilator relief valve and the scavenger interface b Make sure a 19 mm scavenger hose is connected between the APL valve on the absorber and the 19 mm hose terminal on the back of the absorber pole c Make sure a 19 mm scavenger hose is connected between the bottom of the absorber pole and the scavenger interface d Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found e Verify the safe performance of the open reservoir scavenger system With the scavenger system properly installed and operating test for positive and negative pressure relief 4 4 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Preuse Checkout 4 To test for negative pressure relief f Connect a vacuum hose to the DISS threaded terminal on the left hand side of the scavenger or attach a wall suction hose onto the adapter s hose barb fitting Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose
37. for Passive Systems 7 2 Figure 7 2 Scavenger Interface Hose Connections 7 8 Section 8 Main Switch Panel Operation Figure 8 1 Main Switch hh rn 8 2 Section 9 AV2 Ventilator Operation Figure 9 1 AV2 Anesthesia Ventilator 9 3 Section 10 Monitoring System Figure 10 1 Power On 10 2 Figure 10 2 Monitor Screen and System Controls 10 3 Figure 10 3 Monitor Screen 1 10 4 Figure 10 4 Left Keypad 4 4 282 10 5 Figure 10 5 Right Keypad 2 10 6 Figure 10 6 Configure Screen 1 10 7 Figure 10 7 Alarm Log take chad end Ue m bx Rees ub n CL aU cR a eee ee 10 9 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Section 11 Oxygen Monitoring Figure Figure Figure Figure 11 1 11 2 11 3 11 4 Monitor Display REESE EM REESE see ORE EE ERR 11 3 Monitor Controls cated wok de dont ed RR ERR era RO C RR RR REA 11 3 Calibrating the Oxygen Sensor
38. is a pneumatic oxygen nitrous oxide interlock system designed to maintain a fresh gas oxygen concentration of 25 4 It provides independent control of the oxygen and nitrous oxide flows The ORC works by proportionally limiting the nitrous oxide flow whenever the selected oxygen and nitrous oxide flow control valve settings would otherwise result in a hypoxic fresh gas mixture For example if you open the nitrous oxide flow control valve excessively without making a corresponding increase in the oxygen flow control valve setting the nitrous oxide flow will not increase even though its flow control valve setting was greatly increased Similarly if you decrease the oxygen flow without also decreasing the nitrous oxide flow the nitrous oxide flow automatically drops in proportion to the oxygen flow WARNING In circle systems the gas mixture in the patient circuit is not necessarily the same as that in the fresh gas flow This is particularly true at low fresh gas flow rates when the patient rebreathes a significant portion of previously exhaled gases It is important to monitor the gas mixture in the patient circuit and to adjust the fresh gas flow to meet the patient s requirements and to compensate for patient uptake system leakage or any gas withdrawn through sample lines and not returned The fresh gas outlet delivers the fresh gas mixture consisting of oxygen nitrous oxide air and vapors of a liquid anesthetic to the patient brea
39. modify the anesthesia system after the checkout procedure is started NOTE When the peak breathing circuit pressure is reduced by more then approximately fifty 50 cmH 0 the apnea pressure alarm will become latched Avoid producing this condition during the checkout procedures by keeping the maximum breathing circuit pressure below fifty 50 cmH 0 while the monitor is energized or by bringing successive peak pressures down in twenty five 25 cmH O increments until the peak pressure is below fifty 50 cmH 0 1 Enter the serial number located on the right rear leg into the anesthesia record 2 Make sure there is a valid inspection sticker on the back of the machine indicating that it was serviced and inspected by an authorized representative of Dr gerService 9 Verify that a cylinder wrench is tethered to the back of the machine next to the cylinder 4 Ifthe anesthesia machine is not already plugged in connect the electrical power cable to an active AC outlet that accepts and properly grounds the power cable Do not use cheater plugs The term cheater plug implies any and all electrical plugs or other devices that can inhibit or prohibit the proper grounding of the anesthesia machine Turn the SYSTEM POWER switch to the ON position Wait for the monitor to complete its diagnostic checks Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD RO
40. not closing completely during inspiration Check expiratory valve disc and pins Clean repair or replace expiratory valve Defective sensor Replace sensor assembly 12 8 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Pressure Monitoring Narkomed MRI Operator s Manual This section describes the breathing pressure monitoring of the Narkomed MRI anesthesia machine Eoi oo o Pr E 13 2 Choice of Breathing Pressure Monitoring Location 13 2 Installing the Breathing Pressure Pilot Line 13 4 Monit r Displays e Manaus 13 5 Monitor CONUS sionisme 13 9 Setting the Threshold Pressure Alarm Limit 13 10 Turning the Apnea Pressure Alarm Off 13 13 Turning the Apnea Pressure Alarm On 13 13 Breathing Pressure Alarm Messages 13 13 Problem a en ica 13 15 Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 13 Breathing Pressure Monitoring Overview Breathing pressure is measured with a solid state pressure transducer that can sense pressure at either the absorber or patient Y piece depending on which pilot line is used Choice of Breathing Pressure Monitoring Location
41. of the adjustment lock ring on the ventilator relief valve dome Do not attempt to loosen the knurled relief valve ring nut by twisting the pilot line hose barb Unscrew and remove the ring nut around the plastic valve dome Separate the plastic dome dome gasket and valve disk from the valve body Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Figure 14 9 Disassembling the Inspiratory and Expiratory Valves INSPIRATORY 5 VALVE DOME gt PLUG DOME PINS INSIDE INSPIRATORY VALVE DOME EXPIRATORY VALVE DOME EXPIRATORY VALVE BODY ji CAPTIVE RING NUT A INSPIRATORY VALVE BODY EXPIRATORY VALVE MOUNT INSPIRATORY d VALVEMOUNT OP00642 Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 14 15 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning General Guidelines for Cleaning and Disinfection 14 16 The frequency level and need for disinfection of the Narkomed MRI is determined by the user facility based on the conditions of use and hospital infection control policy Draeger Medical recommends using disposable patient breathing circuits that can be replaced after single use If disinfection is required first clean dry and
42. on the display as long as the monitor detects a peak pressure at least 10 cm H50 greater than PEEP pressure When this pressure difference drops and remains below 10 cm H90 for more than 60 seconds the numeric data is cleared When the ventilator is off The ME condition does not occur until 30 seconds have elapsed the HI condition does not occur until 60 seconds have elapsed Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 13 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 13 Breathing Pressure Monitoring APNEA P ALM STBY LO BR PRS ERR LO CONTNG PRES HI O2 MON ERR LO PEEP gt 4 LO PEEP gt 25 ME SUB ATM PRES HI 13 14 Any time that the apnea pressure alarm threshold pressure alarm limit has been set to Standby the LO message APNEA P ALM STBY appears in the Alarm window If the Narkomed MRI detects an internal electronic failure that would prevent proper operation the LO message BR PRS ERR appears in the Alarm window If this happens contact an authorized representative of DragerService If the measured breathing pressure remains above the threshold pressure alarm limit for more than 15 seconds the breathing pressure display area is cleared the HI message CONTNG PRES appears in the Alarm window and an intermittent audible alarm sounds When the measured breathing pressure drops below the threshold pressure alarm limit alarm an
43. one minute history of exhaled volume is not available Minute Volume Alarm Limit Indicates the volume below which an alarm condition occurs Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 12 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 12 Respiratory Volume Monitoring Monitor Controls You use the respiratory volume monitor control keys and the arrow keys on the right keypad to set the minute volume low alarm limit and to turn the volume alarms on and off The respiratory volume monitor control keys are located next to the Respiratory Volume Monitor window See Figure 12 3 Figure 12 3 Monitor Controls LOW MINUTE VOLUME ___ VOLUME ALARMS ALARM LIMIT KEY E d VOLUME ALARMS ON KEY _ ARROW KEYS OP87013 Fixed alarms are provided for low tidal volume apnea volume low minute volume and reverse flow through the sensor While the ventilator is on apnea volume alarms are generated at 15 seconds ME and 30 seconds HI if the respiratory volume monitor does not sense a valid breath While the ventilator is off these alarms are generated at 30 seconds ME and 60 seconds HI The Narkomed MRI s volume alarms are automatically enabled when the ventilator power switch is turned to the ON position A disconnected or damaged sensor causes a sensor failure alarm 12 4 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETUR
44. s Manual This section describes routine maintenance and cleaning for the Narkomed MRI anesthesia machine 14 2 osseuses 14 2 Removing Parts for Cleaning and Disinfection 14 11 Disassembling Parts for Cleaning and Disinfection 14 13 General Guidelines for Cleaning and Disinfection 14 16 Reassembly Instrict lil 14 23 Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Overview This section outlines procedures for maintaining and cleaning the Narkomed MRI WARNING Do not place any object on this machine unless it is specifically labeled to be used in an MRI scanning room and on a Narkomed MRI anesthesia system Objects placed on this machine that are not designed for use with this anesthesia system may be strongly attracted to the magnet and may cause serious injury or death when the machine is used in an MRI scanning room Routine Maintenance Replacingthe Absorbent 14 2 Routine maintenance must be performed regularly to ensure safe and effective operation Regularly check the condition of the absorbent and the overall condition of the machine power cord hoses and breathing bag When the carbon dioxide absorbent in the absorber system is exhausted it must be replaced Refer to the manufacturer s instructions for the signs to expect when the absorbent is exhausted
45. to change the high or low alarm limit 1 Press the oxygen High Limit or Low Limit key depending on which alarm limit you want to change A box is drawn around the selected alarm limit 2 Press the up arrow or down arrow key to increase or decrease the highlighted alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different alarm limit key The new value is saved as the alarm limit Calibrating the Oxygen Sensor To calibrate the oxygen sensor correctly make sure it is exposed only to room air during the entire calibration period You should calibrate the oxygen sensor as part of the daily preoperative setup of the anesthesia equipment Refer to Figure 11 3 1 Remove the sensor assembly from the inspiratory valve dome and close off the dome with the inspiratory valve dome plug Do not disassemble the sensor assembly further 2 Expose the sensor to ambient air only 21 oxygen concentration and allow it to stabilize for several minutes To ensure an ambient air 11 4 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Monitoring 11 exposure hold the sensor away from any open part of the breathing system 3 With the sensor exposed only to room air press the Cal key Calibration begins 4 View the monitor screens to track progress of the calib
46. 00 oxygen for at least one minute before the first case of the day is recommended Remove accumulated absorbent dust and water from the absorber dust cup WARNING Absorbent is caustic and is a strong eye skin and respiratory tract irritant When emptying the absorber dust cup take care not to spill its caustic contents NOTE When changing the absorbent take care not to chip or crack the absorbent canister Check the canister for signs of damage especially around the rim before reinstallation Close the vaporizer and flow control valves Check for free gas passage in the patient breathing system With a surgical mask over your mouth inhale and exhale through the breathing system each limb individually if possible Verify the unidirectional flow in each limb and then reconnect the tubing Check the APL valve to be sure it can relieve excess gas from the breathing system into the scavenger system To check the APL valve s flow resistance a Ensure that the ventilator on off switch is in the off position the autobag selector switch does not control the ventilator on the Narkomed MRI b Set the manual automatic selector valve to BAG c Remove the bag from the swivel arm bag mount d Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm hose e Completely open the APL valve by turning the control knob fully counterclockwise to its stop position
47. 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cylinder Pressure Gauges Oxygen Supply Pressure Failure Protection Device OFPD Flowmeters Minimum Oxygen Flow General Description 2 Each cylinder gas circuit has a cylinder pressure gauge located at the bottom of the flowmeter panel on the front of the machine see the Flowmeter and Pressure Gauge Assembly figure shown earlier in this section Each gauge is labeled and color coded on the flowmeter housing for its respective gas When a cylinder valve is open the pressure gauge indicates the cylinder gas pressure The dial is marked with concentric scales for psi and kPa For a nonliquefied gas such as oxygen the indicated pressure is proportional to the gas content of the cylinder For a liquefied gas such as nitrous oxide the gauge indicates the vapor pressure of the liquefied gas in the cylinder This pressure remains constant until all of the liquid in the cylinder is vaporized When the liquid is vaporized the cylinder pressure decreases proportionally as gas is removed from the cylinder The oxygen failure protection device OFPD is a pneumatically operated valve that protects the patient if a partial or complete loss of oxygen pressure occurs The valves are located in the internal supply lines for all gases except oxygen The gas pressure in the oxygen supply line controls the valves When the oxygen pressure is adequat
48. 003 Rev F Narkomed MRI Operator s Manual 12 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 12 Respiratory Volume Monitoring Respiratory Volume Alarm Messages APNEA VOL HI ME MIN VOL LOW ME REVERSE FLOW LO 12 6 The following list contains all HI ME and LO alarms associated with respiratory volume monitoring The Narkomed MRI continuously monitors the expiratory flow in the patient breathing system By processing the expiratory flow pattern the monitor can determine whether a valid breath has occurred A valid breath has a tidal volume of 20 ml or greater When the ventilator is on e If 15 seconds pass and a valid breath is not detected the ME message APNEA VOL appears in the Alarm window and an intermittent audible alarm sounds e Ifan additional 15 seconds pass 30 seconds total and a valid breath is not detected the ME message APNEA VOL is upgraded to HI in the Alarm window and a continuously repeating audible alarm sounds When the ventilator is off The ME condition does not occur until 30 seconds have elapsed The HI condition does not occur until 60 seconds have elapsed During apneic conditions the respiratory volume measurements disappear after 30 seconds When a valid breath is detected alarm annunciation ceases and a tidal volume measurement appears in the display window However a full minute of respiratory activity must be registered b
49. 03 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 9 AV2 Ventilator Operation Overview 9 2 The AV2 anesthesia ventilator is a volume preset time cycled pressure limited ventilator with electronic timing pneumatic circuitry and independent controls for frequency inspiratory to expiratory I E ratio inspiratory flow rate tidal volume and inspiratory pressure limit Pneumatic power bellows drive gas to the ventilator is supplied through the hospital oxygen pipeline supply or through the reserve cylinder on the anesthesia machine The pressure of the supply gas must be between 40 and 60 psi The ventilator will not function if this pressure drops below 32 psi Electrical power is supplied by the AC power source or by the battery A fully charged battery can power the ventilator for up to three hours The anesthesia ventilator is designed for use with a Draeger Medical absorber system which incorporates a manual automatic selector valve This valve is for selecting either the breathing bag and adjustable pressure limiter APL valve for manual ventilation or the ventilator bellows for automatic ventilation During automatic ventilation the manual automatic selector valve isolates the absorber s APL valve from the breathing system To compensate for the continuous introduction of fresh gas into the breathing system the ventilator incorporates a relief valve mounted behind the bellows cha
50. 113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Monitoring System 10 Configuring the Anesthesia Machine You can configure the following parameters on the Narkomed MRI Trace Speed Speed of the breathing pressure waveform trace either FAST or SLOW e Current Time The current hour and minute in 24 hour format hour minute Current Date The current day month and year LCD Contrast Adjusting the LCD contrast of the display When you start the anesthesia machine it uses the values that were established the last time the machine was configured You can view or change these values on the Configure screen Displaying To display the Configure screen press the Config key which is located on theConfigure the left keypad Screen The Configure screen replaces the standard Monitor screen You must Config Figure 10 6 Configure Screen ALARM WINDOW CONFIGURE SCREEN Part Number 4113877 003 Rev F VOL M MIN VOL LOW LO THRESHOLD LO ALARM LOG CONFIGURE SCREEN TRACE SPEED FAST TIME 11 10 SELECT DATE 18 JUN 1996 LCD CONTRAST EN EXIT Narkomed MRI Operator s Manual begin configuration within 1 minute or the Monitor screen will replace the Configure screen OP00312 KEY LABELS 10 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 10 Monitori
51. 3000 psi Cylinder Gas OXY BON ER ei 1900 psi 13100 kPa Nitrous oxide 745 psi 5130 kPa loads at 70 F Use only E size nonmagnetic aluminum cylinders 21 C Flowmeter Oxygen Nitrous Oxide Air Fine 100 1000 ml min 2 5 FS Oxygen Nitrous Oxide Air Coarse 1 10 l min 2 5 FS mmHg Air Dual Tapered 0 2 1 l min 50 ml min of reading 2 10 l min 5 FS Carbon prr EXE wene X P We EYES 0 05 1 0 l min 5 FS Oxygen Auxiliary Oxygen 1 10 l min 5 FS Vaporizers For technical specifications for vaporizers available for use with the Narkomed MRI see the appropriate separate manual AV2 Ventilator Frequency 1 99 1 BPM in 1 BPM increments ratio Standard range 1 1 1 4 5 0 1 in increments of 0 5 Extended range 4 1 3 1 2 1 Inspiratory 10 100 l min uncalibrated Tidal volume 3 Deep REIN BE RR s 20 1500 ml 100 ml Pressure limit control adjustment range 15 120 cmH 0 Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 15 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 15 Specifications Absorber System Inspiratory Mounting ring nut 1 M35 x 1 Valve Hoscctera nal dev cies bo DUO ER e dela een ds 22 mm male E
52. BLE OF CONTENTS 10 Monitoring System Monitor The Monitor screen displays information in five separate windows as Screen shown in Figure 10 3 Figure 10 3 Monitor Screen ALARM WINDOW _ OXYGEN MONITOR WINDOW C VOL 995m T MEEMIN VOL LOW 33 LO THRESHOLD LO TID VOL BPM MIN VOL 0 71 11 7 8 ee 50 PEAK E MONITOR WINDOW MEAN PEEP BREATHING BREATHING PRESSURE PRESSURE TRACE WINDOW MONITOR WINDOW 10 4 Alarm Window Displays up to three of the highest priority alarms Oxygen Monitor Window Displays the patient s oxygen concentration and the anesthesia machine s oxygen alarm limits Respiratory Volume Monitor Window Displays the patient s tidal volume respiratory rate breaths per minute and minute volume as well as the anesthesia machine s minute volume low alarm limit Breathing Pressure Monitor Window Displays the patient s peak airway pressure mean airway pressure and positive end expiratory pressure PEEP Breathing Pressure Trace Window Displays a trace or waveform of the patient s breathing pressure and the anesthesia machine s breathing pressure alarm limits to the left of the waveform Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Monitoring System 10 Left Ke
53. CD ROM TABLE OF CONTENTS Manual and Automatic Ventilation Systems 25 Daily Checkout 3 p Open the oxygen flow control valve to a flow of 10 l min and occlude the absorber breathing bag terminal q The flow of oxygen must now exit through the relief ports located on top of the canister The absorber system s breathing pressure gauge must indicate a pressure less than 5 cmH 0 r After the test adjust the scavenger needle valve to a flowmeter indication halfway between the two white lines To test the scavenger interface for passive systems s Make sure a 19 mm scavenger hose is connected between the ventilator relief valve and the scavenger interface t Make sure a 19 mm scavenger hose is connected between the APL valve on the absorber and the 19 mm hose terminal on the back of the absorber pole u Make sure a 19 mm scavenger hose is connected between the bottom of the absorber pole and the scavenger interface v Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found w Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose x Set the absorber s manual automatic selector valve to AUTO Open the oxygen flow control valve to a flow of 10 l min and occlude the 19 mm scavenger terminal labeled EXHAUST z After the ventilator bellows inflates the flow of oxygen exits the system through the posi
54. F CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 10 Monitoring System Overview In addition to monitoring clinical parameters the Narkomed MRI performs diagnostic self tests every time the machine is turned on After the initial power on screen appears the Monitor screen is displayed This section of the manual describes these screens and explains how to establish general monitoring settings Power On Screen When you turn the SYSTEM POWER switch to the ON position the Narkomed MRI performs extensive self tests on its internal hardware As these diagnostics are performed each test and its result appear on the screen The result PASS or FAIL indicates the status of the tested component See Figure 10 1 Figure 10 1 Power On Screen FUNCTIONAL CONDITION ALLY FUNCTIONAL 10 2 NARKOMED MRI COPYRIGHT 2000 DRAEGER MEDICAL INC VERSION 1 00 NM MRI SOFTWARE ID 3B31 DIAGNOSTIC TESTS FIRMWARE PASS RAM PASS VIDEO PASS A D CONVERTER PASS AUDIO PASS CLOCK PASS NON VOLATILE MEMORY PASS PERIODIC CERTIFICATION DUE FUNCTIONAL OP00313 At the end of the self diagnostics one of three possible conclusions to the self tests is posted on the screen Every component of the monitoring system is in satisfactory operational order After a brief delay the Monitor screen appears A noncritical fault was detected such as a low inspiratory oxygen percentage The Narkomed MRI may be used but an authorize
55. M TABLE OF CONTENTS Emergency Ventilation Equipment High Pressure System Verification 8 Daily Checkout 3 Check the battery power Press the BATTERY TEST button on the main switch panel The green indicator must light The yellow BATTERY LOW indicator must remain unlit NOTE This test assumes the anesthesia machine has been plugged in for 16 hours The battery charging system works only when the machine is plugged into an active AC power source The charging system takes about 16 hours to charge a fully discharged battery Verify that backup ventilation equipment is available and functional Check the oxygen cylinder supplies a Disconnect all pipeline gas supply hoses and drain the system b Close the oxygen cylinder valve and remove the cylinder from the yoke Verify that there is only one cylinder gasket and there are two index pins Verify that the cylinder matches the yoke label Replace the cylinder Open the oxygen cylinder and check the cylinder pressure gauge A full oxygen cylinder registers a pressure of about 1900 psi Replace any cylinder with pressure less than 1000 psi To check for a high pressure leak close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure With the oxygen cylinder closed press the oxygen flush button on the front of the anesthesia machine Hold the button in until the pressure gauges indicate no pressure 10 Check the nitro
56. N TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Respiratory Volume Monitoring 12 If the low minute volume falls below the minute volume low alarm limit an alarm condition occurs The alarm limit is automatically set to a default of 1 0 liter min at power up You can change the default to a value within the range of 0 2 liters min to 10 0 liters min Setting the Minute Volume Low Alarm Limit Follow these steps to adjust the minute volume low alarm limit 1 Press the Breathing Volume Low Limit key A box is drawn around the minute volume low alarm limit 2 Press the up arrow or down arrow key to increase or decrease the highlighted alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different alarm Limit key The new value is saved as the alarm limit Turning Respiratory Volume Alarms Off To turn off the respiratory volume alarms press the Breathing Volume Off key The alarms stop sounding and their messages are erased from the display In addition the LED next to the Breathing Volume Off key lights to indicate the Off condition Turning Respiratory Volume Alarms On To turn on the respiratory volume alarms press the Breathing Volume On key The LED next to the Breathing Volume On key lights to indicate that the volume alarms are enabled NOTE After power up the volume alarms are in standby Part Number 4113877
57. Number 4113877 003 Rev F Narkomed MRI Operator s Manual 14 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Scavenger Interface for Passive Systems Maintenance 14 6 4 The flowmeter has a small port located on its underside that is open to the atmosphere For the flowmeter to work properly this port must remain open Remove the flowmeter from the block and inspect this port If it is blocked clean it with compressed air Remove the reservoir canister from the scavenger body by unscrewing the four socket head cap screws located at the top of the canister Replace the cleaned needle valve assembly and reservoir canister Verify that all parts are completely dry before reassembly Perform the open reservoir scavenger portion of the daily checkout procedure provided in Daily Checkout The scavenger should be cleaned at least once every six months oF TN Clean the scavenger body with a moist cloth Inspect all scavenger hoses for deterioration Replace any worn hoses Remove the relief valve housing by unscrewing it counterclockwise Inspect the rubber o ring If it is worn replace it Remove the relief valve by twisting it counterclockwise out of the housing You can use the tips of a needle nose pliers to turn the valve but take care not to damage the relief valve s fragile valve disk Brush any accumulated lint or dust off the valv
58. OM TABLE OF CONTENTS General Description 2 Oxygen The oxygen supply pressure alarm activates if the oxygen supply pressure Supply in the system falls below about 37 psi When the alarm is activated the Pressure red O9 SUPPLY PRESSURE indicator lights continuously the LO O2 Alarm SUPPLY message appears on the monitor and an audible alarm sounds NOTE The oxygen supply pressure alarm will not activate if only one source of oxygen supply pressure either the cylinder or pipeline fails and the other maintains proper supply pressure in the machine s oxygen supply lines Power Supply System The Narkomed MRI is equipped with a battery backed up power supply for the ventilator and alarm system When in use the Narkomed MRI should be plugged into an AC outlet WARNING The power supply charger assembly must not be taken into the magnet room Damage to the equipment MRI system or personal injury could result Part Number 4113877 003 Rev Narkomed MRI Operator s Manual 2 19 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Figure 2 12 Power Supply System E 4 P _ Fy V A 2 li Pe 3 BATTERY BOX 30 FT POWER SUPPLY CABLE CIS 6 FT POWER SUPPLY CABLE INSIDE BOX POWER SUPPLY INSIDE MRI ROOM FILTER BOX ASSEMBLY OUTSIDE MRI ROOM
59. ONTENTS RETURN TO CD ROM TABLE OF CONTENTS Introduction 1 How This Manual Is Organized All users of the Narkomed MRI must read this manual completely before using the machine To make this document more convenient for future reference it is divided into several independent sections Section 2 General Description on page 2 1 provides a summary of Narkomed MRI features and functions Section 3 Daily Checkout on page 3 1 contains the checkout procedures that must done on a daily basis Section 4 Preuse Checkout on page 4 1 contains the checkout procedures to be performed between successive cases Sections 5 through 13 provide detailed instructions on the use and operation of each functional component of the system Section 14 Routine Maintenance and Cleaning on page 14 1 provides cleaning maintenance and replacement procedures Section 15 Specifications on page 15 1 lists the specifications for all system components Conventions Used in This Manual Typefaces Warnings and Cautions This manual has several conventions to help organize the information presented Please read about these conventions carefully to understand their significance in the manual Different typefaces are used throughout the manual to differentiate between narrative information and machine messages and labels All parts of this manual contain warning and caution statements about the Narkomed MRI War
60. OR OP91018c Activating the Ventilator Using the Ventilator ON OFF Control Part Number 4113877 003 Rev F The ventilator is activated by using the ventilator ON OFF control The anesthesia machine s SYSTEM POWER switch must be set to ON for the ventilator to function When the ventilator is activated the pneumatic and electric power to the ventilator are turned on and the alarm system is active When the ventilator is turned off the FREQUENCY and I E RATIO displays remain lighted but the ventilator does not function The ventilator ON OFF control is a momentary switch that returns to its center position after being turned in either direction To activate the ventilator turn the switch clockwise The green ON indicator lights and the switch returns to its center position Narkomed MRI Operator s Manual 9 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 9 AV2 Ventilator Operation To shut down the ventilator turn the switch counterclockwise The green ON indicator is then turned off and the switch returns to its center position NOTE The ventilator can not be turned on or off using the manual automatic selector valve Adjusting the Tidal Volume The tidal volume is adjusted using a self locking knob located above the bellows assembly The control knob positions a stop within the bellows canister that limits the upward travel of the bellows and sets the maximum tidal volume of
61. R switch has two positions ON and STANDBY In the Power Switch ON position the gas pneumatic and electric power circuits for the ventilator and alarm circuits are on The green indicator next to the switch lights In the STANDBY position the switch shuts down the gas supplies and all electrical power to the machine The battery charging circuit remains on Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 2 17 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description AC Power Failure Indicator The yellow AC POWER FAIL indicator AC PWR FAIL ME on display signals an AC power disruption The indicator lights whenever the battery supplies power to the electronic ventilator If the battery is completely discharged the AC power failure indicator does not have power and will not function Figure 2 11 AC Power Failure Indicator 2 18 RED 02 SUPPLY _ PRESSURE LOW INDICATOR YELLOW AC POWER LOW INDICATOR YELLOW Pa BATTERY LOW INDICATOR P P GREEN BATTERY TEST INDICATOR K 02 SUPPLY PRESSURE AC POWER FAIL BATTERY LOW Y STANDBY SYSTEM POWER Narkomed MRI Operators Manual BATTERY i BUTTON 1 SYSTEM POWER E d SWITCH OP20050 Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD R
62. RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Drager Drager Medical Inc Operator s Instruction Manual Part Number 4113877 003 Rev Date 31 January 2002 2002 Draeger Medical Inc Narkomed MRI Anesthesia System Ag x NTENTS TAE NT i RETURI C RETURN TO CD ROM TABLE OF CONTENTS Contents Section 1 Introduction Operator s Responsibility for Patient Safety 1 2 Limitation of Liability 1 1222 kae RR sean Ge de ata aan aretha ede 1 2 RESHICHON x wna Gave see cere ee oa wor Fur E Re eu OM oor aide ede en 1 3 Mc En Anais ee 1 3 Trademark Notices ita ee i nets da dee d euch ur Ra e dan eee ce re E eR qn e 1 3 nd en acai dade ee Lae ene tee we Re ed eee aad a 1 3 Recommendations ss a ue eee exe pu OM ee ee en ar duse ee aa 1 4 SYMBOL DSHMMON she ee DA ate 1 4 Purpose of This teens 1 4 How This Manual Is Organized 1 5 Conventions Used in This Manual 1 5 General Warnings Cautions 1 6 Section 2 General Description S Ic c 2 2 G
63. The indexed connector system reduces the risk of delivering the wrong gas to a patient by preventing incorrect connection of gas pipes The inlets have check valves which prevent backflow leakage into the atmosphere when supply hoses are not connected or into the attached supply hoses when reserve cylinders are in use Each pipeline connection is equipped with a filter to prevent foreign material from entering the internal gas piping Pipeline gases must be supplied at 50 55 psi Pipeline pressure gauges for oxygen air and nitrous oxide are standard These gauges are located directly below their corresponding flowmeters and flow control valves They are labeled and color coded for their respective gases on the flowmeter shield Concentric scales in psi and kPa indicate the pipeline supply pressure A typical pressure gauge and flowmeter arrangement is shown in the following figure Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description 2 Figure 2 3 Pressure Gauge and Flowmeter Arrangement THREE GAS FLOWMETER AND PRESSURE GAUGE ASSEMBLY 8 lb Ibs Kib tls l lle l m ie Ib IN lle I B fos N PIPELINE 0 T A H Il Q N A PIPELINE
64. URN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 10 Monitoring System Setting Alarms to Standby When the ventilator is off you can use the All Stby key to turn off audible Stby tones and message displays associated with the breathing pressure alarm and respiratory volume alarms The alarms remain in this standby condition until the monitor detects a valid breath NOTE When the ventilator is on pressing the All Stby key places the volume alarm in Standby until the next breath is detected It has no effect on the pressure alarm The pressure alarm cannot be turned off when the ventilator is on To set alarms to standby press the All Stby key The LED next to the All Stby key lights to indicate the standby condition Silencing Alarms ER You can silence all audible alarm tones for 2 minutes while retaining the 04 alarm message display on the monitor Oy To silence alarm tones for 2 minutes press the Silence Alarms key The LED next to the Silence Alarms key lights and remains lit for the duration of the silence period Pressing the Silence Alarms key while the LED is lit restarts the 2 minute silence period If a new alarm condition occurs during the silence period a single tone pattern sounds corresponding to the priority of the alarm After the silence period one of the following occurs e Ifno alarm conditions are active audio annunciation reverts to normal
65. VOWICW EPIIT 6 2 Connecting the Open Reservoir Scavenger System 6 3 Operating the Open Reservoir Scavenger System 6 4 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Section 7 Scavenger Interface for Passive Systems Operation OV TVIQW Pu ee wah ede Made et Ve wa eed dee AE ue eod ane ned moe 7 2 Operating the Scavenger Interface for Nonactive Systems 7 3 Section 8 Main Switch Panel Operation e hu elapse de eh oP ee eee ane ee deh 8 2 System Power AVE nat 8 3 Testing the set accede seas dae Sens wage FREE petite Dies Ae ee eee ee MER we de 8 3 Section 9 AV2 Ventilator Operation e a ah epee wae 9 2 Activating the Ventilator eir ane Do ad ee PEOR RE ERE ds 9 3 Adjusting the Tidal Volume 24 9 4 Setting the Respiratory Frequency 9 4 Setting the Inspiratory Expiratory I E Phase Time 9 5 Setting the Inspiratory Flow Rate 9 5 Setting the Inspi
66. aintenance 14 5 14 4 Scavenger Interface for Passive Systems Maintenance 14 7 14 5 Clearing Condensation in the Ultrasonic Flow Sensor 14 8 14 6 Battery Maintenance 14 10 14 7 Removing Parts for Cleaning and Disinfection 1 14 12 14 8 Removing Parts for Cleaning and Disinfection 2 14 13 14 9 Disassembling the Inspiratory and Expiratory Valves 14 15 14 10 Open Reservoir Scavenger Connections 14 25 14 11 Passive Systems Scavenger Connections 14 26 Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Tables Section 2 General Description Table 2 1 Gas System Color Coding 2 4 Table 2 2 Cylinder Recommended Gas Pressure 2 6 Section 3 Daily Checkout Table 3 1 Nitrous Oxide Cylinder PSI Levels 3 4 Section 10 Monitoring System Table 10 1 Control Key Functions in the Configure 10 8 Section 11 Oxygen Monitoring Table 11 1 Alarm LIMIS RR Rhe
67. al 1 5 General Warnings and Cautions 1 6 Part Number 4113877 003 Rev 1 introduction RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Operator s Responsibility for Patient Safety Draeger Medical anesthesia products are designed to provide the greatest degree of patient safety that is practically and technologically feasible The design of the equipment the accompanying literature and the labeling on the equipment take into consideration that the purchase and use of the equipment are restricted to trained professionals and that certain inherent characteristics of the equipment are known to the trained operator Instructions warnings and caution statements are limited therefore to the specifics of the Draeger Medical design This publication excludes references to hazards that are obvious to a medical professional to the consequences of product misuse and to potentially adverse effects in patients with abnormal conditions Product modification or misuse can be dangerous Draeger Medical disclaims all liability for the consequences of product alterations or modifications as well as for the consequences that might result from the combination of Draeger Medical products with products supplied by other manufacturers if such a combination is not endorsed by Draeger Medical The operator of the anesthesia system must recogniz
68. and negative pressure control Figure 2 8 Open Reservoir Scavenger LOCK NUT VACUUM DISS HOSE TERMINAL NEEDLE VALVE KNOB 19MM E SCAVENGER 3 D HOSE TERMINAL THREADED _ Ur E INPUT PORT 19MM j SCAVENGER _ HOSE TERMINAL bw i T eee P RESERVOIR CANISTER R E L E F PORT ae OP75121 2 14 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description 2 Scavenger The scavenger interface for passive systems is used with nonrecirculating Interface for HVAC systems exhaust systems This scavenger is a closed system Passive with a spring loaded valve for positive pressure relief Systems WARNING Do not use this device with a waste gas disposal system capable of applying a negative pressure to the scavenger interface a suction or vacuum waste gas disposal system Figure 2 9 Scavenger Interface for Passive Systems SAFETY RELIEF VALVE SHOWN CLOSED WASTE GAS WASTE GAS INPUT PORT INPUT PORT 19MM HOSE 19MM HOSE TERMINAL TERMINAL INPUT O PORT WASTE GAS EXHAUST PORT 19MM HOSE TERMINAL OP76131 Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 2 15 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS
69. as Delivery System 4 444 44444 nhe 2 4 MADONZON MN EP 2 11 ADSOIDGr c r 2 12 Scavenger Systems 4 4 444 2 14 AV2 Ventilator zonae ete tae hehe ved tO Reg d obe Blend a adonde RR dates ER ded 2 16 Main Switch Panel dau eo De che hu Red UR Kool ero helen ur s 2 17 Power Supply iisu ne aa a aaia a eee 2 19 Monitoring 44e eee 2 22 Monitor Screen and 5 re 2 22 Alarm System LE A oa CE 2 23 Section 3 Daily Checkout Daily Checkout Procedure 4 4 4 22 3 2 Section 4 Preuse Checkout Preuse Checkout 4 2 Section 5 Gas Delivery System Operation OVGIV OW RARE de ee PEU NME RE RG DES de bb eho en 5 2 Connecting the Pipeline Gas 000 cette eee 5 3 Connecting the Gas cc ttt teens 5 5 Connecting the Fresh Gas Hose 1 5 6 Adjusting th Gas FlOW ised ee x EERe uam eee eee ee Ea ha xu 5 6 Using the Oxygen Flush ccc tn teen ees 5 7 Section 6 Open Reservoir Scavenger Operation O
70. at the absorber upstream of the occlusion could sense a pressure fluctuation above the threshold pressure alarm limit and thus would not alarm Both of these scenarios assume that the occlusion does not cause a peak pressure high enough to activate the peak pressure alarm which is meant to detect pressures likely to cause barotrauma However Draeger Medical disagrees with the idea of relying on pressure monitoring to detect a blocked breathing circuit Carbon dioxide monitoring and respiratory flow monitoring provide superior detection of blocked breathing paths when compared to pressure monitoring which detects such conditions only in some instances Draeger Medical pressure monitors are therefore not promoted for detection of blocked breathing paths Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Pressure Monitoring 13 Further Y piece pressure monitoring has several disadvantages that could collectively cause the operator to neglect connecting the pressure monitoring pilot line Examples include increased contamination of the pilot line due to its proximity to secretions buildup of condensation within the pilot line and the introduction of additional disconnection points if the pilot line connects to a 15 mm adapter In conclusion the responsibility for the selection of pressure monitoring at either the absorber or the
71. bly does not fit easily into the electronics housing make sure the flow housing is facing the right direction Compare the direction to the illustration on the electronics housing The index pin on the electronics housing should align with the hole in the flow housing 11 Slide the flow sensor onto the bracket 12 Connect the patient hose to the expiratory hose terminal on the flow sensor 13 Install the connector hose assembly between the flow sensor and the expiratory valve and secure it by turning the ring nut clockwise Battery The backup battery is located in the battery box at the bottom of the Maintenance machine Access to the battery requires removal of the battery box cover 1 Turn the System Power switch to STANDBY and remove the power cable from the back of the battery box Remove the top cover from the battery box Disconnect the battery wire harness from J2 on the PCB Remove the two retainer nuts and remove the battery retainer Remove the battery from the battery box 99 Rem If needed transfer the wire harness to the replacement battery yellow wire to terminal black wire to terminal and ensure that the replacement battery is wrapped in a protective bag in the same manner as the original 7 Place the replacement battery in the battery box oriented as shown in the illustration Record the installation date on the battery Reinstall the battery retainer and the two retainer nuts Part Numb
72. bsorber pole Attach another 19 mm scavenger hose between the 19 mm terminal marked SCAVENGER HOSE on the ventilator relief valve and the 19 mm terminal marked SCAVENGER HOSE on the left hand side of the scavenger WARNING Make sure the 19 mm scavenger hose leading from the ventilator relief valve is not pinched kinked or blocked in any manner Attach a wall suction hose between the wall suction outlet and the suction terminal DISS or hose barb with adapter on the scavenger Verify the proper functioning of the scavenger system Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 6 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 6 Open Reservoir Scavenger Operation Figure 6 2 Connecting the Open Reservoir Scavenger System VENTILATOR APL VALVE RELIEF VALVE s 19MM SCAVENGER HOSE TERMINAL ABSORBER POLE OP00143B 19MM SCAVENGER de HOSE x N 19MM SCAVENGER VACUUM TERMINAL HOSE 19MM SCAVENGER NN OPEN RESERVOIR HOSE TERMINAL SCAVENGER Operating the Open Reservoir Scavenger System 6 4 Because the reservoir canister is open to the atmosphere it does not require spring loaded relief valves If the waste gas flow rate from the patient breathing system exceeds the disposal system s suction flow rate the canister initially accommodates excess waste gas After excess waste gas fills the canister waste
73. ceeds the threshold pressure alarm limit by more than 6 cm H30 at threshold pressure alarm limit settings of 5 20 cm H30 or by more than 8 cm H 0 at threshold pressure alarm limit settings of 21 29 cm H 0 Setting the threshold pressure alarm limit at 30 cm H20 disables the THRESHOLD LO alert If the measured breathing pressure exceeds the high pressure limit the HI message VENT PRES HI appears in the Alarm window and a continuously repeating audible alarm sounds This alarm condition is cleared when the measured breathing pressure drops below the high pressure alarm limit However the alarm message is extended for 5 seconds to allow for a momentary high pressure condition Problem Resolution Table 13 1 Breathing Pressure Monitoring Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY No pressure readout in display area during ventilation Pilot line not connected Make sure pilot line is properly connected Pilot line blocked or kinked Make sure that lumen of pilot line is free of obstructions Erratic readings Condensation accumulation in pilot line Drain and reconnect pilot line Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 13 15 Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 1 4 Routine Maintenance and Cleaning Narkomed MRI Operator
74. connect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose Set the manual automatic selector valve to BAG Close the APL valve by turning the knob fully clockwise to its stop position Check that the breathing pressure gauge is on 0 Attach the supplied test terminal to the breathing bag mount Connect a sphygmomanometer squeeze bulb available from Draeger Medical to the hose barb on the test terminal Pump the squeeze bulb by hand until the breathing system pressure gauge indicates pressure of at least 50 cmH5O not to exceed 80 cmH3O Part Number 4113877 003 Rev F Narkomed MRI Operators Manual 3 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 3 Daily Checkout Scavenger System Verification 3 8 k Observe the pressure drop at the breathing system pressure gauge When the pressure is at 50 cmH 0 begin counting seconds The pressure must not drop more than 20 cmH 0 in 30 seconds 24 Verify the performance of the scavenger system To test the open reservoir scavenger system a Make sure a 19 mm scavenger hose is connected between the ventilator relief valve and the scavenger interface Make sure a 19 mm scavenger hose is connected between the APL valve on the absorber and the 19 mm hose terminal on the rear of the absorber pole Make sure a 19 mm scavenger hose is connected between the bottom of the absorbe
75. control the ventilator on the Narkomed MRI d the manual automatic switch is set to BAG e all flowmeters are indicating 0 or minimum f the patient suction level is adequate g the breathing system is ready to use bag in place and all hoses connected properly WARNING Always lock the casters after this anesthesia machine has been positioned near the MRI scanner magnet Magnetic attractive forces between the magnet and the anesthesia machine may cause unintentional movement of the anesthesia machine if the casters are unlocked Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 4 7 Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Gas Delivery System Operation Narkomed MRI Operator s Manual This section provides you with a description of the Gas Delivery System of the Narkomed MRI anesthesia machine 5 2 Connecting the Pipeline Gas Supply 5 3 Connecting the Gas Cylinder 5 5 Connecting the Fresh Gas Hose 5 6 Adjusting the Gas PRAE nano 5 6 Using the Oxygen 5 7 Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 5 Gas Delivery System Operation Overview The Narkomed MRI is a continuous flow anesthes
76. d representative of Dr gerService should be notified to correct the problem When you are ready to resume operation press any key on the keypad Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS NON FUNCTIONAL Monitoring System 10 A serious fault was detected such as an audio transducer failure and operation of the monitor is inhibited Do not use the machine Immediately notify an authorized representative of DragerService to correct the problem Monitor Screen and Controls Following a successful power up monitoring information is displayed on the Monitor screen The control keys to the left and right of this screen allow you to establish monitoring settings See Figure 10 2 Figure 10 2 Monitor Screen and System Controls OP00306 Oxygen ong BEE APNEA VOL SX righ tow BIEMIN VOL LOW 33 lem LO THRESHOLD LO Breathing Volume Liters TID VOL BPM MIN VOL 0 71 11 7 8 EJO Breathing Pressure High 7 Limit 2 a 3 D 50 Alarms AC PEEP LEFT MONITOR RIGHT KEYPAD SCREEN KEYPAD Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 10 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TA
77. d the yellow AC POWER FAIL indicator on the alarm panel lights the AC PWR FAIL ME monitor display message appears When the battery reserve approaches depletion the yellow BATTERY LOW indicator lights the BATTERY LOW LO monitor display message appears NOTE When battery reserves are low the BATTERY LOW indicator lights automatically during an AC power loss or when the BATTERY TEST button is pressed while AC power is applied The BATTERY LOW indicator signifies that 30 minutes or less of battery power remains from the time the alarm was activated When the battery is depleted the gas supply system remains operative However you must perform manual ventilation by bag because power to the ventilator is cut off The monitoring and alarm functions will not work until AC power is restored NOTE Ifthe power cord is not plugged into an active AC outlet for a period of 30 days or more the battery may become depleted Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 2 21 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Monitoring System The anesthesia machine s monitoring system integrates the functions of the electronic monitors and organizes information from these monitors onto the screen which is located on the front panel of the machine The Narkomed MRI monitors the following measurements e oxygen concentration breathing pressure respirato
78. d during monitoring the LO message O2 CAL DUE O2 CAL ERR or O2 NOT CAL appears in the Alarm window and operation continues Try to recalibrate the sensor if the message remains replace the sensor cell Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 11 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 11 Oxygen Monitoring O2 NOT CAL SERVICE VENT MON LO The LO message O2 NOT CAL appears in the Alarm window when the unit did not calibrate properly due to sensor error condition during calibration If a sensor error condition is detected during monitoring the LO message O2 CAL DUE O2 CAL ERR or O2 NOT CAL appears in the Alarm window and operation continues Try to recalibrate the sensor if the message remains replace the sensor cell If the Narkomed MRI detects an internal electronic failure that would prevent proper operation the LO message SERVICE VENT MON appears in the Alarm window If this happens contact an authorized representative of Dr gerService Low Oxygen Supply Whistle If the Narkomed MRI is configured to do so it sounds a 10 second whistle when the oxygen supply drops too low to properly pressurize the fresh gas circuit below about 37 psi If this alarm sounds it cannot be silenced Problem Resolution Table 11 3 Oxygen Monitoring Problem Resolution 11 10 PROBLEM POSSIBLE CAUSE REMEDY Display area remains blank when a reading
79. e PEEP The length of the plateau from peak pressure to the decrease in pressure corresponding to expiration is equivalent to the length of the inspiratory pause if present Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 13 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 13 Breathing Pressure Monitoring The horizontal dotted line on the waveform and the adjacent marker on the Y axis both represent the threshold pressure apnea alarm limit The horizontal dotted line is always displayed but the marker on the Y axis appears only when the threshold pressure alarm limit is less than or equal to the top of the scale set by the system There is a marker in the illustration above because the threshold pressure alarm limit 12 cm H30 is less than the top of the scale 20 cm H 0 The pressure high alarm limit is denoted by a marker on the Y axis only when it is less than or equal to the top of the scale set by the system In Figure 13 4 the pressure high alarm limit 35 cm H90 is greater than the top of the scale 20 cm H30 When a high alarm limit marker is displayed its appearance depends on whether the pressure high alarm limit is less than or equal to the top of the scale Figure 13 5 illustrates the difference in appearance Note that a threshold pressure alarm limit marker is also displayed in these examples Figure 13 5 Breathing Pressure Trace Window with Examp
80. e the valves remain open with an unrestricted gas flow Oxygen pressure loss causes the valves to close proportionally to the loss of pressure As a result OFPD controlled gases can be restricted or shut down in response to loss of oxygen pressure Gas flow reductions are indicated on the flowmeter When the oxygen supply from the pipeline or reserve cylinders drops below about 37 psi the red O SUPPLY PRESSURE indicator light on the main switch panel lights the LO O2 SUPPLY message appears on the monitor and a continuous audible alarm sounds If only one source of oxygen supply pressure either reserve cylinders or pipeline fails and the other source maintains proper supply pressure within the machine s oxygen supply lines the OFPD and LOW O2 SUPPLY alarm are not activated The flowmeters are located directly above their corresponding flow control valves They indicate the delivered flow rate of each gas in the fresh gas mixture Dual tapered flowmeter tubes are used for oxygen nitrous oxide and air All flowmeters are labeled at the lower end of the flowtube A typical flowmeter arrangement appears in the Flowmeter and Pressure Gauge Assembly figure shown earlier in this section Each flowmeter has a float indicator To determine the flow rate read the flowmeter scale at the center of the float The oxygen dispensing system has a calibrated bypass flow of 150 50 ml min at 50 psi pipeline pressure which delivers this volume of ox
81. e Alarm Off You can turn the apnea pressure alarm off only when the ventilator is off When the ventilator is on the alarm is automatically forced on to ensure notification of problem conditions To turn off the apnea pressure alarm press the Breathing Pressure Off key Audio annunciation of the alarm is disabled and pressure alarm messages are erased from the display The LED next to the Breathing Pressure Off key lights to indicate that the apnea pressure alarm is disabled Turning the Apnea Pressure Alarm On To turn on the apnea pressure alarm press the Breathing Pressure On key The LED next to the Breathing Pressure On key lights to indicate that the apnea pressure alarm is enabled NOTE After power up the pressure alarms are in the standby state Breathing Pressure Alarm Messages APNEA PRESSURE HI ME The following list contains all HI ME and LO alarms associated with breathing pressure monitoring When the ventilator is on If the measured breathing pressure remains below the threshold pressure alarm limit for more than 15 seconds the ME message APNEA PRES appears in the Alarm window and an intermittent audible alarm sounds If the breathing pressure remains below the threshold pressure for an additional 15 seconds 30 seconds total the ME message APNEA PRES is upgraded to a HI message in the Alarm window and a continuously repeating audible alarm sounds During the HI condition numeric data remains
82. e as close as possible to the sensed peak pressure without exceeding it For details see Threshold Limit Guidelines and Sample Threshold Limit Settings in this section To set the threshold pressure alarm limit manually follow these steps Remember that the value must be within the range of 5 30 cm H30 and less than the pressure high alarm limit 1 Press the Breathing Pressure Threshold key A box is drawn around the threshold pressure alarm limit 2 Press the up arrow or down arrow key to increase or decrease the threshold pressure alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different Alarm Limit key The new value is saved and displayed as the threshold pressure alarm limit If the alarm limit is on or below the upper limit of the scale a marker appears next to the alarm limit and a dotted line extends from the alarm limit horizontally across the scale You can have the monitoring system automatically set the threshold pressure alarm limit to an optimum value based on the current peak pressure To automatically set the threshold pressure alarm limit press and then release the Breathing Pressure Auto Set key The LED next to the Breathing Pressure Auto Set key lights briefly when you press it The threshold pressure limit is automatically set 4 cm H 0 below the current peak pressure measurement to a minimum of 5 cm H50 and a maximu
83. e that the means of monitoring and discovering hazardous conditions are specific to the composition of the system and the various components of the system It is the operator and not the various manufacturers or suppliers of components who has control over the final composition and arrangement of the anesthesia system used in the clinical practice Therefore the responsibility for choosing the appropriate safety monitoring devices rests with the operator and user of the equipment Patient safety may be achieved through a variety of different means depending on the institutional procedures the preference of the operator and the application of the system These means range from electronic surveillance of equipment performance and patient condition to simple direct contact between operator and patient direct observation of clinical signs The responsibility for the selection of the best level of patient monitoring belongs solely to the equipment operator To this extent the manufacturer Draeger Medical disclaims responsibility for the adequacy of the monitoring package selected for use with the anesthesia system However Draeger Medical is available for consultation to discuss monitoring options for different applications Limitation of Liability 1 2 Draeger Medical s liability whether arising from or related to the manufacture and sale of the products their installation demonstration sales representation use performance or other
84. e tone audible alarm sounds If the oxygen sensor cord becomes disconnected or is damaged enough to cause an open circuit the LO message O2 SENS DISC appears in the Alarm window and a single tone audible alarm sounds The LO message O2 CAL DUE appears in the Alarm window when the oxygen sensor needs to be calibrated more than 18 hours have elapsed since the last calibration During oxygen sensor calibration the Narkomed MRI checks the sensor s output against a range of acceptable output voltages There are three possible causes for deviation from within this range e Exhausted sensor If the sensor s capacity is exhausted its output voltage will not meet the required minimum Incorrect calibration environment If the sensor is exposed to an excessive oxygen during calibration the sensor s output will be above or below the acceptable output range Improper waiting If the proper waiting period is not allowed for a new sensor or for a sensor removed from the sensor housing the sensor s output may be above or below the acceptable output range If a sensor error condition is detected during monitoring the LO message O2 CAL DUE O2 CAL ERR or O2 NOT CAL appears in the Alarm window and operation continues Try to recalibrate the sensor if the message remains replace the sensor cell The LO message O2 CAL ERR appears in the Alarm window when the oxygen percentage is greater than 103 If a sensor error condition is detecte
85. e with a soft brush The valve can be further cleaned with a low flow of clean air or oxygen Reinstall the valve into the housing making sure that it is threaded all the way into the housing and that the plastic washer is properly seated on its upper surface Verify that the interior of the valve body is completely dry Reinstall the valve housing onto the scavenger body making sure that the o ring is properly seated Perform the scavenger interface for passive systems portion of the daily checkout procedure provided in Daily Checkout Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Figure 14 4 Scavenger Interface for Passive Systems Maintenance SECONDARY WASTE GAS INPUT PORT INPUT PORT CAP OP00277 Part Number 4113877 003 Rev F d SAFETY RELIEF VALVE HOUSING PLASTIC WASHER gt SAFETY RELIEF VALVE P O RING WASTE GAS INPUT PORT WASTE GAS La EXHAUST PORT Narkomed MRI Operator s Manual 14 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Clearing Condensa tion in the Ultrasonic Flow Sensor Depending on the conditions of use and the environment condensat
86. ea 12 3 Monitor Controls uaaa aaeeea 12 4 Setting the Minute Volume Low Alarm Limit 00000 eee 12 5 Turning Respiratory Volume Alarms Off 2 12 5 Turning Respiratory Volume Alarms On 4 22 12 5 Respiratory Volume Alarm Messages 12 6 Problem Resolution scra Di ae acere re Re nk RH Rb Va a a RU Ee da 12 8 ii Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Section 13 Breathing Pressure Monitoring OVEWICW dura dor ME RUPEE e Pada bee ee end iss rate ails 13 2 Choice of Breathing Pressure Monitoring Location 13 2 Installing the Breathing Pressure Pilot Line 13 4 Monitor Displays sas x atin et AG ag anges Bid codes Da die D ge ae 13 5 Monitor Controls sina es ARE qp euge Robe a euo UA eae co ae 13 9 Setting the Pressure High Alarm Limit llle re 13 9 Setting the Threshold Pressure Alarm Limit 13 10 Turning the Apnea Pressure Alarm Off 13 13 Turning the Apnea Pressure Alarm On
87. ease in oxygen concentration in the breathing system b Check the delivered oxygen concentration Repeatedly flush the patient breathing system by pressing the oxygen flush button Open the oxygen flow control valve to 8 l min flow and close the other flow control valves The oxygen measurement display area should indicate 97 to 100 oxygen concentration Make sure the vaporizer is closed Open the oxygen flow control valve to an 8 l min flow and close all other flow control valves Sniff the gas coming from the fresh gas common outlet There should be no noticeable odor To check the absorber system a Check the hose connections in the breathing system Make sure the fresh gas hose of the breathing system is securely connected to the fresh gas outlet c Make sure a 22 mm patient breathing circuit is connected between the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 3 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 3 Daily Checkout 20 21 3 6 d Make sure a 22 mm breathing hose is connected between the ventilator hose terminal and the manual automatic selector valve breathing hose terminal e Make sure a breathing bag of proper capacity and appropriate construction is connected to the breathing bag terminal of the breathing system f Make sure the breathing pressure pilot li
88. ed or the valve seat is damaged Each absorber unit has two transparent plastic canisters to contain absorbent The absorbent soda lime or barium hydroxide lime can be purchased in loose granular or prepacked cartridge form The canisters are interchangeable A removable transparent plastic cup located below the bottom assembly collects absorbent dust and excess moisture that could cause increased flow resistance in the system The absorber system is equipped with a pressure gauge for quick visual checks of breathing circuit pressure The gauge is marked for measurements from 20 to 80 cmH 0 in increments of 2 cmH 0 WARNING You must frequently observe the breathing system pressure gauge to ensure adequate pressure buildup and relief regardless of the mode of operation NOTE The PEEP valve option described in the Absorber System Operator s Manual is not available for Narkomed MRI products Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 2 13 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Scavenger Systems The Narkomed MRI can be equipped with one of two kinds of scavenger systems for the best match with the hospital s waste gas disposal system Open The open reservoir scavenger is used with suction vacuum waste gas Reservoir disposal systems This scavenger is an open system with continually Scavenger open relief ports for positive
89. edures Clean the ventilator bellows bottom assembly with a soft lint free cloth moistened with mild detergent and water followed by a distilled water rinse Allow the assembly to drip dry After cleaning use an EtO process for disinfection Follow manufacturer s guidelines Wipe the oxygen sensor capsule with a soft lint free cloth moistened with mild detergent and water Make sure the capsule is dry before replacing it CAUTION Do not immerse or autoclave the oxygen sensor capsule 14 19 Narkomed MRI Operators Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Cleaning and Disinfecting the Oxygen Sensor Housing Cleaning and Disinfecting the Oxygen Sensor Housing Cover Cleaning and Disinfecting the Inspiratory and Expiratory Valves Cleaning and Disinfecting the Ultrasonic Flow Sensor Housing and Transducers Cleaning and Disinfecting the Ultrasonic Flow Sensor Electronics Housing and Cable 14 20 After cleaning the capsule perform an EtO process at a temperature not exceeding 50 C Aerate the sensor according to the manufacturer s instructions The oxygen sensor housing can be immersed for cleaning and disinfection Use mild detergent and water for cleaning For disinfection follow up with either sodium hypochlorite 5 2 household bleach 1 500 dilution 100 ppm free chlorine or 70 to 90 ethyl or isopropyl alc
90. een BATTERY TEST indicator lights A fully charged battery can power the electrical components of the anesthesia machine for up to three hours NOTE The BATTERY LOW indicator lights when the battery reserve approaches depletion Do not rely solely on this indicator for an assessment of battery capacity Always perform the preuse battery test If the battery becomes completely depleted and the machine does not have AC power the BATTERY LOW indicator light has no source of power and does not function WARNING Do not start an anesthetic procedure if the BATTERY LOW indicator light is illuminated Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 8 3 Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 9 AV2 Ventilator Operation This section describes the AV2 anesthesia ventilator in the Narkomed MRI anesthesia machine ahaa eet 9 2 Activating the Yentilator 1soduesaice pinoeiie Lcid daa Hacer 9 3 Adjusting the Tidal VOIUITIB anus 9 4 Setting the Respiratory Frequency 9 4 Setting the Inspiratory Expiratory I E Phase Time Ratio 9 5 Setting the Inspiratory Flow Rate 9 5 Setting the Inspiratory Pressure Limit 9 5 Problem Resolution e 9 6 Narkomed MRI Operators Manual Part Number 4113877 0
91. efore the minute volume and respiratory rate appear NOTE You can disable volume related alarms by pressing the Breathing Volume Off key NOTE During some breathing system disconnects when the ventilator is in use the ventilator s dynamics may cause a small volume of gas to be drawn through the expiratory valve and the ultrasonic flow sensor Because of the enhanced sensitivity of the flow sensor this volume may be detected as a valid breath However the disconnect will still be detected by the airway pressure monitor which is always on and can not be turned off when the ventilator is in use Whenever the Narkomed MRI measures a minute volume less than the low minute volume alarm limit the ME message MIN VOL LOW appears in the Alarm window and an intermittent audible alarm sounds If a reverse flow in excess of 20 ml is detected the LO message REVERSE FLOW appears in the Alarm window and a single tone audible alarm sounds Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS VOL SEN DISC LO VOL ALM STBY LO SERVICE VENT MON LO Respiratory Volume Monitoring 12 A forward flow greater than 20 ml clears the alarm condition The REVERSE FLOW alarm message remains on the screen for 5 seconds after the resumption of forward flow to allow for recognition of an intermittent reverse flow condition The VOL SEN DISC LO message
92. ement Figure 11 4 Measurement Error Due to Incorrect Calibration 100 90 V4 At calibration sensor exposed 80 to lt 21 O2 Thus displayed O2 ra gt will be higher than actual O2 4 _ 70 F4 P N u x 9 60 a Q zi 50 Ow 40 30 Correct calibration of room air 21 O2 for entire calibration period Displayed O2 actual O2 20 C At calibration sensor exposed 10 to gt 21 O2 Thus displayed O2 will be ower than actual O2 0 10 20 30 40 50 60 70 80 90 100 OP10098 ACTUAL O2 PERCENTAGE 11 8 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Monitoring 11 Oxygen Alarm Messages OXYGEN LOW HI OXY GEN HIGH LO 02 SENS DISC LO O2 CAL DUE LO O2 CAL ERR The following list contains all HI ME and LO alarms associated with oxygen monitoring The Narkomed MRI continuously compares the current inspiratory oxygen percentage with the preset low oxygen alarm limit If the measured oxygen concentration falls below the low alarm limit the HI message OXYGEN LOW appears in the Alarm window and a continuous audible alarm sounds If the measured inspiratory oxygen concentration exceeds the preset high alarm limit the LO message OXYGEN HIGH appears in the Alarm window and a singl
93. er 4113877 003 Rev F Narkomed MRI Operator s Manual 14 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning Figure 14 6 Battery Maintenance End of Life Battery Disposal 14 10 RETAINER NUT 2X A TR BATTERY TERMINAL SCREW RETAINER AND NUT 2X BATTERY _ pue WIRE HARNESS ELECTRONICS MODULE BATTERY BOX AT BOTTOM OF MACHINE SHOWN WITH COVER REMOVED OP00324 J2 10 Reconnect the battery wire harness to J2 on the PCB 11 Reinstall the battery box top cover 12 Reconnect the power cable to the connector on the back of the battery box 13 Perform the PMS Procedure in the Narkomed MRI Setup and Installation Manual Dispose of a spent rechargeable sealed lead acid battery in conformance with local waste disposal regulations Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Removing Parts for Cleaning and Disinfection L 2 Turn the SYSTEM POWER switch to STANDBY Disconnect the 22 mm breathing circuit hoses between the ventilator and the absorber and from the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor Remove the Y piece mask and mask elbow from the hoses Disconnect the 19 mm scavenger hoses c
94. er interface is a closed system which uses a spring loaded valve for positive pressure relief WARNING Do not use this device with a waste gas disposal system capable of applying a negative pressure to the scavenger interface a suction or vacuum waste gas disposal system Figure 7 1 Scavenger Interface for Passive Systems 2777777 SAFETY RELIEF aaa Y VALVE SHOWN 7 CLOSED B 2 S WASTE GAS E c3 WASTE GAS INPUT PORT INPUT PORT 19MM HOSE 19MM HOSE TERMINAL TERMINAL C SNL MEE INPUT PORTCAP WASTE GAS EXHAUST PORT 19MM HOSE TERMINAL OP76131 7 2 Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Scavenger Interface for Passive Systems Operation 7 Operating the Scavenger Interface for Nonactive Systems In a typical anesthesia circle system waste gas exits from the breathing system APL or ventilator relief valves and passes through the scavenger to the exhaust system If the hospital exhaust system stopped functioning or if the path between the scavenger and the exhaust system becomes blocked positive pressure builds up within the scavenging and breathing systems To prevent such a harmful pressure buildup the scavenger s positive pressure relief valve is set to open at a pressure of 5 cm H 0 Waste gas then exits through the holes in the relief valve h
95. es Oxygen Sensor Capsule 6850645 Sensor Housing amp Cable Assembly 4115351 Inspiratory Valve Dome 4108329 Inspiratory Valve Dome Plug 4106387 Respiratory Volume Monitoring Accessories Flow Sensor Assembly MRI 4116236 Connector Hose Assembly 4114912 Flow Housing 4114444 PE 4114445 O rmg uc marins foods ine Awe Hee der a 4115147 Power Supply Accessories 30 foot ASM MRI power cable 4114158 6 foot ASM power cord 4110334 Battery 12V rechargeable 4111957 Power Supply Relocate Assembly MRI Filter Box 4114946 Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual A 3 Ag x NTENTS TAE NT i RETURI C Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Dr ger Medical Inc Drager Draeger Medical Inc 3135 Quarry Road Telford PA 18969 Tel 215 721 5404 800 462 7566 Fax 215 721 9561 Web www draegermedical com Printed in the U S A
96. essages When there are more than 100 HI and ME messages the oldest message is deleted to make room for the newest Follow this procedure to display the Alarm Log 1 From the Monitor screen press the Config key The Configure screen is displayed Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Low Limit Monitoring System 10 2 From the Configure screen press the ALARM LOG key The Alarm Log appears with the first HI or ME message that occurred at the top of the list 3 Ifthe list extends beyond the page scroll forward by pressing the down arrow key and scroll backward by pressing the up arrow key Figure 10 7 Alarm Log Clearing the Alarm Log High Limit 2 Exiting the Alarm Log CLEAR LOG ALARM LOG TIME MESSAGE 12 49 OXYGEN LOW 14 03 APNEA PRES 14 03 APNEA VOL 14 03 APNEA PRES 14 03 APNEA VOL 14 03 MINUTE VOL LO EXIT To delete all of the messages from the Alarm Log press the CLEAR LOG key The messages are permanently deleted from the Log To exit the Alarm Log immediately press the EXIT key NOTE The monitoring system automatically exits the Alarm Log if a minute passes and no keys are pressed When you exit the Alarm Log you are returned to the Monitor screen Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 10 9 RET
97. essure high alarm limit 2 Press the up arrow or down arrow key to increase or decrease the pressure high alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different Alarm Limit key The new value is saved and displayed as the pressure high alarm limit If the alarm limit is on or below the upper limit of the scale a marker appears next to the alarm limit Part Number 4113877 003 Rev F 13 9 Narkomed MRI Operators Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 13 Breathing Pressure Monitoring Setting the Threshold Pressure Alarm Limit Manually Setting the Threshold Limit Automatically Setting the Threshold Limit Auto Set 224 13 10 The threshold pressure alarm limit defines the level below which apneic alarm condition exists When the patient s breathing pressure falls below the threshold limit a message appears in the Alarm window and an audible alarm sounds The threshold pressure alarm limit is automatically set to 12 cm H O at power up The setting can be changed to any value from 5 30 cm H 0 as long as it is less than the pressure high alarm limit You can change the alarm limit manually to a value you select or have the system set it automatically to an optimum value based on the current peak pressure WARNING The threshold pressure alarm limit should b
98. f the breathing circuit so they do not require disinfection If the user facility requires disinfection refer back to the instructions provided in Cleaning and Disinfecting Corrugated Breathing Hoses Mask Elbow and Bag to select a compatible process Check the hoses frequently for signs of deterioration including swelling tackiness or cracking Replace the affected parts when any of these conditions are evident Reassembly Instructions Make sure all parts are complete dry and adequately aerated before reassembling the machine after cleaning and disinfection procedures 1 Reassemble the ventilator bellows assembly Fit the relief valve dome onto the relief valve body and tighten the knurled ring nut Place the ventilator bellows on bellows bottom assembly and turn it clockwise until it is secure 2 Replace the bellows assembly Fit the bellows assembly into the ventilator bellows canister and tighten the two wing nuts 3 Replace the absorber Fit the absorber assembly on the absorber pole making sure the o ring is in place Use a 3 16 inch hex screwdriver to tighten the hex screw securing the absorber system assembly to the absorber pole 4 Replace the pressure gauge Place the pressure gauge assembly on the gauge mount making sure that the o ring is in place between the pressure gauge assembly and the gauge mount Slide the knurled ring nut over the threads on the gauge mount Turn the knurled ring nut clockwise until i
99. fresh halothane up to the maximum level then drain completely 3 Dispose of the drained halothane in accordance with standard practices at your facility For information about filling and draining the vaporizer see the appropriate separate manual supplied with vaporizers that are available for use with the Narkomed MRI The scavenger interface does not normally need to be disinfected However if the user facility requires disinfection an EtO process can be used after cleaning Refer back to the cleaning instructions provided under the Routine Maintenance section in this chapter CAUTION Do not autoclave the open reservoir scavenger The scavenger s flowmeter cannot withstand the heat of autoclaving Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the Passive Scavenger Interface Disinfecting the Scavenger Hoses Routine Maintenance and Cleaning 14 The scavenger interface does not normally need to be disinfected However if the user facility requires disinfection an EtO process can be used after cleaning Refer back to the cleaning instructions provided under the Routine Maintenance section in this chapter CAUTION Do not autoclave the scavenger interface for passive systems The scavenger s relief valves cannot withstand the heat of autoclaving The scavenger hoses are not part o
100. gas delivered to the patient To adjust the tidal volume press the self locking knob so it can turn then set the preferred tidal volume by the setting indicator on the bellows chamber scale marked 200 1400 ml The tidal volume can be adjusted for volumes between 20 and 1500 ml Smaller tidal volumes can be adjusted by setting the pointer below the 200 ml marking on the bellows chamber Larger tidal volumes can be selected by setting the pointer above the 1400 ml calibration As in any volume preset anesthesia ventilator the actual tidal volume delivered to the patient s lungs may differ from the preset volume at the bellows due to the compliance of the breathing system and fresh gas flow To accurately set the tidal volume refer to the tidal and minute volume measurements The position of the tidal volume indicator can be calibrated for a specific combination of fresh gas flow and equipment compliance by an authorized representative of DragerService Setting the Respiratory Frequency Use the frequency control knob to set the respiratory frequency from 1 to 99 breaths per minute BPM in 1 BPM increments Rotating the control knob clockwise increases the frequency setting while counterclockwise rotation decreases the frequency setting 9 4 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS AV2 Ventilator Operation 9 Setting the Inspira
101. gas then exits through the relief ports around the top of the canister In this way positive pressure does not build up within the patient breathing system CAUTION Waste gas vented from the relief ports may contaminate the operating room To prevent such contamination be sure to adjust the needle valve properly If the disposal system s flow rate suction exceeds the waste gas flow rate from the patient breathing system the disposal system draws room air through the relief ports In this way the disposal system does not apply a negative pressure to the patient breathing system Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Adjusting the Needle Valve Open Reservoir Scavenger Operation 6 Adjust the needle valve wing nut to regulate the waste gas exhaust flow and prevent waste gas contamination in the operating room To adjust the needle valve 1 Attach all appropriate hoses and verify that the waste gas disposal system is active 2 Turn the needle valve wing nut until the flowmeter indicates a flow halfway between the two white lines etched on the scavenger s flowmeter This setting corresponds to a suction flow rate of about 25 min Depending on the fresh gas flow rate the needle valve setting may need to be increased or decreased to settings either above or below the lines on the flowmeter If the suction flow rate i
102. h other NAD breathing pressure gauges be sure to return the MRI compatible gauge to the MRI anesthesia unit Refer to the instructions provided earlier in this chapter under the heading Replacing the Absorbent for instructions on removing the absorbent canister assemblies from the absorber Clean the canisters frequently Remove used absorbent and clean absorbent residues for the canister and gasket surfaces Check the dust cup periodically Empty and clean it when necessary WARNING Absorbent is caustic Avoid contact with the skin and eyes After removing the canister assemblies and dust cup from the absorber system wash these parts with mild alkali detergent and water The canister assemblies and dust cup can be immersed or wiped with a soft lint free cloth Allow the parts to dry Several methods can be used for disinfection Wet pasteurization autoclaving EtO and immersion or wiping with 2 glutaraldehyde based solution are all acceptable If an EtO process is used make sure the parts are properly aerated before returning them to service Turn the APL valve control knob fully counterclockwise before cleaning or disinfecting the absorber system After cleaning an EtO procedure can be used Follow manufacturer s guidelines CAUTION Do not autoclave the absorber assembly 14 21 Narkomed MRI Operator s Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Main
103. hold retains its setting When the ventilator is turned back on the threshold is restored to its previous set value Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 13 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS 13 Breathing Pressure Monitoring RETURN TO CD ROM TABLE OF CONTENTS Sample Figure 13 7 illustrates the effects of correct and incorrect settings of the Threshold threshold pressure alarm limit Limit Settings Figure 13 7 Sample Threshold Limit Settings 1 Threshold pressure alarm limit correctly set to within 6 cm H20 of peak pressure for alarm limit settings of 5 through 20 cm H20 35 2 Thus after partial breathing system disconnection or leak small pressure fluctuation does not cross threshold pressure alarm limit Operator is warned of apnea condition PEAK 18 MEAN 7 PEEP 2 gt 1 Threshold pressure alarm limit incorrectly set gt 6 cm H20 below peak pressure 35 2 Thus after partial breathing system disconnection or leak small pressure fluctuation in system satisfies incorrectly set threshold pressure alarm limit Operator is not alerted of apnea condition PEAK 18 MEAN 7 PEEP 2 OP87018 13 12 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Pressure Monitoring 13 Turning the Apnea Pressur
104. ia system with pneumatic circuitry for mixing and delivering gases and anesthetic agent vapor The pneumatic system can deliver up to three gases and one anesthetic agent simultaneously Oxygen air and nitrous oxide are standard In addition one vaporizer can be mounted on the machine Vaporizers are available for halothane enflurane isoflurane and sevoflurane Figure 5 1 Gas Fittings and Yokes OP00320 PIPELINE SUPPLY GAS FITTINGS N O YOKE O YOKE 5 2 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Gas Delivery System Operation 5 Connecting the Pipeline Gas Supply Gas from the hospital pipelines enters the anesthesia machine through hoses connected to indexed inlets located on the side of the flowmeter housing Depending on the country s standards and regulations the available inlets are Diameter Indexed Safety System DISS inlets body or nut fitting or National Institute for Standards and Technology NIST inlets To connect a pipeline supply 1 Connect the gas fitting on the supply hose to the corresponding gas fitting on the side of the flowmeter housing Use a wrench to tighten the hex nut WARNING Carefully check hoses each time you connect the machine to a wall or ceiling outlet to ensure that both ends of the hose are indexed for the same gas Pipeline delivery hoses used between wall outlets and ane
105. id such Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Monitor Display Respiratory Volume Monitoring 12 erroneous measurements defer reading the display until a full minute has elapsed after the irregular flow has stopped Information about the patient s respiratory volume is presented in the Respiratory Volume Monitor window in the middle of the monitor display as shown in Figure 12 2 From left to right numerical values are shown in large type for tidal volume respiratory rate and minute volume At the extreme right in small type is the minute volume low alarm limit Figure 12 2 Monitor Display MINUTE VOLUME MEASUREMENT l min TID VOL BPM MIN VOL 0 71 11 7 8 OP00309 MINUTE VOLUME ALARM LIMIT TIDAL VOLUME BREATHING RATE MEASUREMENT MEASUREMENT breaths min Tidal Volume Measurement TID VOL Displays the volume for each breath If the monitor does not detect a valid breath within 30 seconds the display area goes blank Breathing Rate Measurement BPM Shows the number of breaths during the previous minute of respiration If the BPM display is blank a full minute of respiration has not occurred Minute Volume Measurement MIN VOL Continuously displays the volume of exhaled gas accumulated during the previous minute of respiration A blank MIN VOL display area indicates that a full
106. if necessary Alarm limits can be adjusted at the beginning of or during a procedure Also make sure that any external monitors if any are connected properly Test the alarm functions Simulate alarm conditions and check for appropriate alarm signals Flush the system for at least one minute with 100 oxygen by pressing the oxygen flush button When the end of the daily checkout procedure is complete verify that a the vaporizer is off the handwheel is set to 0 b the APL valve is open fully counterclockwise c the manual automatic switch is set to BAG d all flowmeters indicate 0 or minimum e the patient suction level is adequate f the breathing system is ready to use with the bag in place and all hoses connected properly WARNING Always lock the casters after this anesthesia machine has been positioned in the MRI scanner room Magnetic attractive forces between the magnet and the anesthesia machine may cause unintentional movement of the anesthesia machine if the casters are unlocked Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 4 Preuse Checkout This section provides you with instructions detailing the steps for you to perform a preuse checkout of the Narkomed MRI anesthesia machine Preuse Checkout Procedure 4 2 Narkomed MRI Operators Manual Part Numbe
107. ine ventilator or breathing system except for certain approved exceptions Contact Dr gerService for further information Not for use with flammable anesthetics To avoid explosion hazards do not use flammable anesthetic agents such as diethyl ether and cyclopropane with this machine Only anesthetic agents which comply with the requirements for non flammable anesthetic agents per IEC standard or national equivalent shall be used with this anesthetic machine When moving the anesthesia machine remove the absorber system and use only the machine handles or push pull bars The anesthesia machine should only be moved by people who are physically capable of handling its weight Draeger Medical recommends that two people move the anesthesia machine to aid in maneuverability Exercise special care so that the machine does not tip when moving up or down inclines around corners and across thresholds for example in door frames and elevators Do not attempt to pull the machine over any hoses cords or other obstacles on the floor Use manufacturer authorized replacement parts only Failure to do so may result in machine malfunction injury or death The Narkomed MRI is designed for MRI use only as a system The user should not assume that individual components of the system can be safely used with MRI scanners Although the Narkomed MRI is designed to minimize the effects of ambient radio frequency interference machine functions may
108. ine for a few seconds This introduces an unmetered flow of pure oxygen into the breathing circuit at a rate of about 55 l min Figure 5 4 Using the Oxygen Flush OP79056 FRESH GAS d m ua m OUTLET lt _ Ee eer ET HANDLE O2 FLUSH CONTROL BUTTON FRESH GAS LOCKING BAR RELEASE TO EXTENDED POSITION LOCK Part Number 4113877 003 Rev F Narkomed MRI Manual 5 7 Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 6 Open Reservoir Scavenger Operation This section describes the open reservoir scavenger used in the Narkomed MRI anesthesia machine sn ic ue 6 2 Connecting the Open Reservoir Scavenger System 6 3 Operating the Open Reservoir Scavenger System 6 4 Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 6 Open Reservoir Scavenger Operation Overview The open reservoir scavenger is intended for use with suction vacuum waste gas disposal systems This scavenging approach applies a continuous suction to transfer waste gas from the scavenger to the disposal system The open reservoir scavenger is an open system which uses continually open relief ports to provide positive and negative pressure relief Figure 6 1 Open
109. ion can accumulate in the flow sensor housing Moderate amounts of condensation should not affect operation Excessive condensation can result in erratic measurements or total loss of flow measurement To remove condensation 1 Remove the connector hose assembly between the flow sensor and expiratory valve by turning the ring nut counterclockwise 2 Remove the patient hose from the expiratory hose terminal on the flow sensor Lift the flow sensor off the bracket Press down on the lever under the flow housing and remove the flow housing transducer assembly from the electronics housing 5 Pull both transducers out of the flow housing Figure 14 5 Clearing Condensation in the Ultrasonic Flow Sensor 14 8 OP00318 ELECTRONICS INDEX HOUSING PIN SENSOR CABLE LEVER FLOW HOUSING TRANSDUCER 2X Tip and shake the flow housing to release fluid trapped in the housing Make sure that all large droplets are cleared from the transducer ports Pat the transducers dry with a soft lint free cloth Press the transducers back into their ports in the flow housing Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 10 Slide the electronics housing over the flow housing transducer assembly Be sure that it clicks into place NOTE Ifthe flow housing transducer assem
110. is connected between the bottom of the absorber pole and the scavenger interface Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 4 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 4 Preuse Checkout Manual and Automatic Ventilation Systems Monitor System Flush Final Position 4 6 10 11 12 13 14 w Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose x Set the absorber s manual automatic selector valve to AUTO Open the oxygen flow control valve to a flow of 10 l min and occlude the 19 mm scavenger terminal labeled EXHAUST z After the ventilator bellows inflates the flow of oxygen exits the system through the positive pressure safety relief valve At this point the absorber system s breathing pressure gauge must indicate a pressure of less than 10 cmH 0 Check for proper pressure and flow at the Y piece during the inspiratory and expiratory phases Turn the SYSTEM POWER switch and ventilator power switch to their ON positions Place the manual automatic selector valve in the AUTO position Adjust the oxygen flow control valve to a 3 l min flow Set the ventilator frequency to 3 BPM the I E ratio to 1 2 and the tidal volume to about 1 liter Adjust the ventilator fl
111. is expected O2 NOT CAL message appears in Alarm window Needs calibration Perform proper calibration Remove sensor assembly from breathing circuit Make sure sensor is exposed to room air only Then press the Cal key analyzer fails to retain calibration O2 NOT CAL message appears in Alarm window Backup memory power not available Check battery circuit breaker Allow backup battery to recharge and recalibrate the analyzer Hardware malfunction Contact an authorized representative of Dr gerService Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Monitoring 11 PROBLEM POSSIBLE CAUSE REMEDY Pressing Cal does not initiate calibration O2 SENS DISC message appears in Alarm window Sensor is disconnected Insert sensor cord connector into OXYGEN SENSOR interface underneath rear panel of ventilator box Sensor cord is damaged Replace housing cord assembly Pressing Cal initiates calibration but Oxygen Monitor window is blank at end of calibration period O2 NOT CAL message appears in Alarm window Sensor is exposed to incorrect oxygen concentration Sensor exposed to constantly changing calibration mixture Expose sensor to room air for 21 calibration Sensor capsule was removed from housing for a prolonged peri
112. lease contact Dr gerService at 800 543 5047 for service of this equipment Draeger Medical also recommends that its anesthesia equipment be serviced at three month intervals Periodic Manufacturer s Service Agreements are available for equipment manufactured by Draeger Medical For further information concerning these agreements contact Dr gerService at 800 543 5047 Symbol Definition AN A The following symbols appear the labeling on the back of the Narkomed MRI and are defined below CAUTION Refer to accompanying documents before operating equipment ATTENTION Consulter les documents ci joints avant de faire fonctionner l apparail CAUTION Risk of electric shock do not remove cover Refer servicing to an authorized representative of Dr gerService ATTENTION Risque de choc electrique ne pas enlever le couvercle Ne faire reparer que par un representant technique autorise Dr gerService Degree of protection against electric shock Class 1 Type B Protection contre le risque de choc electrique Class 1 Type B Purpose of This Manual 1 4 This manual provides operating instructions for the Narkomed MRI Anesthesia System It is intended for use by trained clinical professionals familiar with accepted medical procedures practices and terminology used in delivery of anesthesia and patient monitoring Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF C
113. les of High Alarm Limit Markers HORIZONTAL MARKER STEP LIKE MARKER PRESSURE HIGH ALARM PRESSURE HIGH ALARM LIMIT lt TOP OF SCALE LIMIT TOP OF SCALE SCALE 0 50 cm H 0 OP87020 13 8 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Monitor Controls You use the breathing pressure monitor control keys to set breathing pressure alarm limits turn the apnea threshold pressure alarm off or on and automatically set the threshold pressure The breathing pressure monitor control keys are located next to the Breathing Pressure Monitor window See Figure 13 6 Figure 13 6 Monitor Controls OP87014 PRESSURE HIGH ALARM LIMIT KEY THRESHOLD PRESSURE ALARM LIMIT KEY Breathing Pressure Monitoring 13 PRESSURE ALARM ON KEY L PRESSURE ALARM Breathing Pressure cm H20 lt OFF KEY hin EST 1l Limit JA f 4 ARROW KEYS THRESHOLD PRESSURE AUTO SET KEY Setting the Pressure High Alarm Limit The pressure high alarm limit is automatically set to 50 cm H50 at power up You can change this limit to any value from 30 120 cm H30 as long as it is greater than the threshold pressure alarm limit High Limit To adjust the pressure high alarm limit follow these steps 1 Press the Breathing Pressure High Limit key A box is drawn around the pr
114. linders can cause serious injury or death if brought into an MRI scanning room To connect a gas cylinder to its yoke 1 Place a new washer on the seat of the yoke gas inlet connection WARNING Use only one cylinder washer for each yoke Using more than one washer could cause cylinder gas leakage and compromise the pin indexing system 2 Verify that the two index pins below the gas inlet are intact WARNING Check cylinder yokes for the integrity of the two index pins each time you attach a cylinder to the machine 3 Insert the head of a gas cylinder with matching gas into the yoke from below The gas outlet and index holes on the cylinder head must face the gas inlet and index pins on the yoke assembly 4 Fit the index pins with the index holes Screw the yoke handle clockwise against the cylinder head until the point of the yoke handle bolt aligns with the recess on the back of the cylinder head 5 Verify that the sealing washer is in place that the index pins are engaged and that the cylinder hangs vertically Tighten the yoke handle securely Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 5 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 5 Gas Delivery System Operation Figure 5 3 Connecting the Gas Cylinder YOKE YOKE r INDEX HANDLE ASSEMBLY PINS OP20035 N GAS INLET YOKE PLUG CYLINDER VALVE SEALING Pd WASHER
115. lis dans la salle IRM Toujours bloquer les roues apr s avoir plac cet appareil d anesth sie l endroit voulu dans la salle IRM Les forces d attraction magn tique entre l aimant et l appareil d anesth sie peuvent provoquer un d placement impr vu de ce dernier si les roues ne sont pas bloqu es Ne pas amener le chargeur de batterie dans la salle IRM car cela pr senterait un risque d endommagement du mat riel et du syst me IRM ou de blessure corporelle Cette appareil d anesth sie t v rifi e avec des aimants poss dant des champs magn tiques jusqu 1 5 tesla Install l appareil pr s d un aimant plus puissant plus de 1 5 tesla pourrait amener l appareil mal fonctionner ou produire des forces d attractions incontr lables qui pourrait causer des blessures s rieuses ou la mort Ce syst me d anesth sie ne r agit pas automatiquement certains changements de l tat physiologique du patient aux erreurs de l op rateur ou aux d faillances des composants Il a t con u de mani re tre utilis sous le contr le permanent de l op rateur Utiliser uniquement des bouteilles de type E non magn tiques en aluminium avec cet appareil L utilisation de bouteilles en acier dans la salle IRM pourrait occasionner des blessures graves ou mortelles Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Introd
116. llow the proper waiting period Sensor is defective If there is too great a difference between the outputs of the two sensor halves replace the defective sensor with a new sensor and allow the proper waiting period prior to calibration Sensor is disconnected When the sensor is disconnected the display area is blank and the message O2 SENS DISC appears in the Alarm window If this happens reconnect the sensor cord to the OXYGEN SENSOR interface beneath the rear panel of the ventilator box and try to calibrate the oxygen sensor again Part Number 4113877 003 Rev F Narkomed MRI Operators Manual RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 11 Oxygen Monitoring Conse If the oxygen sensor is improperly calibrated it can cause inaccurate quences measurements When a calibration gas mixture is excessively rich or lean in oxygen the Narkomed MRI will not complete an attempted calibration however if the calibration gas is rich or lean but is within certain limits the Narkomed MRI will complete the calibration As a result when displaying sensor measurements the Narkomed MRI displays an oxygen percentage either greater or less than the actual oxygen percentage Therefore make sure that the sensor is exposed only to room air during the entire calibration period Figure 11 4 illustrates the relationship between the calibration mixture and the accuracy of oxygen measur
117. lse tone pattern that is initially repeated every few seconds until the alarm condition is resolved ME athree pulse tone pattern that is repeated every 30 seconds e LO a single tone or no sound at all depending on the urgency of the alert Only the highest priority currently active alarm condition is annunciated Tones for lower priority alarm conditions are temporarily suppressed to minimize the confusion caused by simultaneous alarms When the system power switch is turned from STANDBY to ON the volume and pressure apnea alarms default to Standby to allow machine setup without nuisance alarms An interlock with the ventilator ensures that when the ventilator is turned on the alarms are enabled You can also enable the alarms individually using the keypad When the ventilator is turned off the following events occur e Ifthe pressure apnea threshold was greater than 15 cm H 0 when the ventilator was turned off the threshold setting is changed to 15 cm H30 If the pressure apnea threshold was less than 15 cm H30 when the ventilator was turned off the threshold retains its setting The ME and HI alarms associated with apnea alarms change from activation after 15 and 30 seconds of apnea to 30 and 60 seconds respectively When the ventilator is turned back on the pressure apnea threshold is restored to its previous set value and the apnea alarms revert to activation after 15 seconds ME and 30 seconds HI of apnea
118. m entering the internal gas piping A check valve in each yoke prevents backflow into the cylinder or leakage into the atmosphere if the cylinder is not mounted on the yoke Place the attached yoke plug between the yoke handle s threaded bolt and the yoke s gas inlet When attaching a cylinder make sure that only one washer is installed between the cylinder and the yoke gas inlet Using multiple washers may compromise the pin indexed safety system Be sure to verify the integrity of both index pins when installing a new cylinder WARNING Check the cylinder yokes to make sure the two index pins are intact each time you attach a cylinder to the machine Use only one cylinder gasket for each yoke Using more than one gasket could cause cylinder gas leakage and compromise the pin indexed safety system Cylinders attached to the hanger yokes must contain gas at the recommended pressures outlined in the table below Replace any cylinders that contain less than the recommended minimum shown in the table with new full cylinders WARNING Use only nonmagnetic aluminum E cylinders with this machine Steel cylinders can cause serious injury or death if brought into an MRI scanning room Table 2 2 Cylinder Recommended Gas Pressure 2 6 GAS PSI FULL PSI MIN Nitrous Oxide 745 600 Oxygen 1900 1000 Indicated pressures are those of E size cylinders at 70 F 21 C Narkomed MRI Operators Manual Part Number 4113877
119. m of 30 cm H90 Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Threshold Limit Guidelines Breathing Pressure Monitoring 13 If the alarm limit is on or below the upper limit of the scale a marker appears next to the alarm limit and a dotted line extends from the alarm limit horizontally across the scale If a breathing system leak or partial disconnection occurs when the threshold pressure alarm limit is set significantly lower than the peak pressure continued positive pressure ventilation can produce a pressure fluctuation great enough to exceed the threshold and thereby satisfy the alarm yet not great enough to provide adequate ventilation To address the problem the LO message THRESHOLD LO appears in the Alarm window when either of the following conditions occurs e The sensed peak pressure exceeds the set threshold by more than 6 cm H30 at threshold pressure alarm limit settings of 5 20 cm H30 e The sensed peak pressure exceeds the set threshold by more than 8 cm H30 at threshold pressure alarm limit settings of 21 29 cm H30 NOTE The threshold setting may be affected when the ventilator is turned on or off If you turn the ventilator off while the threshold is set to a value greater than 15 cm H 0 the setting is changed to 15 cm H3O If the threshold is set lower than 15 cm when the ventilator is turned off the thres
120. mber When the bellows is completely filled any excess gas in the system is released to the scavenger system through the ventilator relief valve As in any ascending bellows the force needed to overcome gravity acting on the bellows causes a positive end expiratory pressure PEEP within the breathing system For the Narkomed MRI the PEEP is about 2 cmH 0 WARNING Regardless of the indications of any alarm or monitoring device patient chest movement must be the primary indication of a securely connected properly ventilated patient A front view of the AV2 anesthesia ventilator is shown in the following figure Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS AV2 Ventilator Operation 9 Figure 9 1 AV2 Anesthesia Ventilator RATIO CONTROL INSPIRATORY FLOW GAUGE EXTENDED RANGE INSPIRATORY ACCESS FLOW CONTROL RATIO DISPLAY VENTILATOR FREQUENCY ONSE CONTROL CONTROL FREQUENCY DISPLAY AN AN SES PR NSPRATOR FREQUENCY 6 LE RATIO AD RANGE gt S zu er vOLUM D TIDAL VOLUME E CONTROL ES PRESSURE LIMIT CONTROL TIDAL BELLOWS CANISTER VOLUME O FT SETTING INDICATOR BREATHING CIRCUIT CONNECT
121. ms requiring a prompt response LO the lowest priority alarms requiring the operator s awareness The Narkomed MRI provides both visual and audible notification of the most urgent conditions Alarm The Narkomed MRI presents messages for active alarm conditions in the Display Alarm window at the top of the monitor screen as shown in Figure 2 14 Messages are displayed for up to three of the highest priority active alarm conditions Any additional lower priority active alarm conditions are retained in the monitor s memory Messages for these lower priority conditions are displayed when the higher priority alarm conditions have been resolved and their messages have been removed from the display Figure 2 14 Alarm Display ALARM WINDOW APNEA VOL N VOL LOW RESHOLD LO LA OP00305 Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 2 23 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Alarm Annunciation Ventilation Alarms 2 24 NOTE Ifa HI or ME message is removed from the Alarm window before you have a chance to read it you can view the message in the Alarm Log The Alarm Log is a separate screen that displays a sequential record of up to 100 of the most recent HI and ME messages For more information see Using the Alarm Log on page 10 8 Each alarm category is associated with a specific audible signal HI a five pu
122. n 11 4 Table 11 2 Unsuccessful Calibration Causes and Solutions 11 7 Table 11 3 Oxygen Monitoring Problem Resolution 11 10 Section 12 Respiratory Volume Monitoring Table 12 1 Respiratory Volume Monitoring Problem Resolution 12 8 Section 13 Breathing Pressure Monitoring Table 13 1 Breathing Pressure Monitoring Problem Resolution 13 15 Section 14 Routine Maintenance and Cleaning Table 14 1 General Guidelines for Cleaning and Disinfection 14 17 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Introduction This section introduces you to the Narkomed MRI Operator s Manual Narkomed MRI Operator s Manual Operator s Responsibility for Patient Safety 1 2 Limitation 1 2 PS 1 3 eoo 1 8 Tadermark 1 3 1 3 Hecommerndaldlts samedi 1 4 DENO inre 1 4 Purposs or This MOUSE ie 1 4 How This Manual Is Organized 1 5 Conventions Used in This Manu
123. n each limb and then reconnect the tubing Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Daily Checkout 3 APL Valve 22 Check the adjustable pressure limiter APL valve which functions Verification as the patient system relief valve The APL valve must be capable of relieving excess gas from the breathing system into the scavenger system To check the APL valve s flow resistance a Set the manual automatic selector valve to BAG b Remove the bag from the swivel arm bag mount c Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm hose d Completely open the APL valve by turning the control knob fully counterclockwise to its stop position e Turn the SYSTEM POWER switch to ON f Open the oxygen flow control valve to a flow of 8 l min g Occlude the bag mount opening and watch for a pressure increase on the breathing system pressure gauge This pressure increase must not exceed 3 cmH O Breathing 23 Perform a breathing and fresh gas delivery system pressure test This System Leak test detects leaks from the patient breathing system and fresh gas Test delivery system To perform the test a b Close all flow control valves on the anesthesia machine Turn the SYSTEM POWER switch to the STANDBY position Turn the vaporizer to 0 concentration Inter
124. ne is properly connected between the BREATHING PRESSURE interface and either the absorber quick connect fitting or the appropriate fitting at or near the patient Y piece g Make sure the oxygen sensor and flow sensor are properly installed Make sure the absorber canisters are filled with CO absorbent and that the absorbent is useable Consult the absorbent manufacturer s literature for information about what signs to expect when the absorbent is exhausted Replace the absorbent when it appears exhausted Make sure that the color change represents the absorbent s true state of depletion and is not due to regeneration after a rest period Flushing the anesthesia machine continuously with 100 oxygen for at least one minute before the first case of the day is recommended Remove accumulated absorbent dust and water from the absorber dust cup WARNING Absorbent is caustic and is a strong eye skin and respiratory tract irritant When emptying the absorber dust cup take care not to spill its caustic contents NOTE When changing the absorbent take care not to chip or crack the absorbent canister Check the canister for signs of damage especially along the rim before reinstallation Close all vaporizers and gas flow sources Check for free gas passage in the patient breathing system Wear a surgical mask to inhale and exhale through the breathing system each limb individually if possible Verify the unidirectional flow i
125. ng System Understand ing the Keys When the Configure screen is displayed the system control keys function according to the labels on the screen as explained in Table 10 1 Table 10 1 Control Key Functions in the Configure Screen Changing Parameter Values High Limit J Exiting the Configure Screen Using the Alarm Log Displaying the Alarm Log Config 10 8 Key Label Function Low ALARM Displays the Alarm Log a separate screen that Limit LOG lists HI ME and LO messages that have i occurred High SELECT Selects a parameter by highlighting it with a box Limit A EXIT Exits the Configure screen and returns to the JN Monitor screen Follow this procedure for each parameter you want to change 1 Press the SELECT key until the variable you want to change is highlighted with a box 2 Press the up or down arrow key to increase or decrease the value of the highlighted variable To exit the Configure screen immediately press the EXIT key NOTE The monitoring system automatically exits the Configure screen if a minute passes and no keys are pressed When you exit the Configure screen the values displayed on the screen are saved The monitoring system uses these values until they are changed If you miss a HI or ME message in the Alarm window you can look for it in the Alarm Log It contains up to 100 of the most recent HI and ME m
126. ning statements give important information that if ignored could lead directly to a patient s or operator s injury Caution statements give important information that if ignored could lead directly to equipment damage and indirectly to a patient s injury Part Number 4113877 003 Rev F Narkomed MRI Operators Manual 1 5 1 Introduction RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Warnings and Cautions The following list of warnings and cautions apply to general operation and maintenance of the Narkomed MRI Warnings and cautions about installing and operating specific parts appear with those topics 1 6 WARNING WARNING WARNING WARNING WARNING WARNING WARNING WARNING The user of this anesthesia machine must comply with warnings cautions and checkout procedures printed on the machine or on the pullout panel Failure to do so may result in injury to the patient operator others or equipment Any person involved with the setup operation or maintenance of the Narkomed MRI anesthesia system must be thoroughly familiar with this instruction manual Do not place any object on this machine unless it is specifically labeled to be used in an MRI scanning room and on the Narkomed MRI anesthesia system Objects placed on this machine that are not designed for use with this anesthesia system may be strongly attracted to the magnet and may cause serious inju
127. ntains two independent electrochemical cells or sensor halves When the sensor takes in oxygen an electrochemical reaction occurs within each cell The oxygen monitor reads the voltage produced in each cell computes an average for the two cells and translates the average into an oxygen concentration measurement CAUTION Never remove an oxygen sensor from its housing except to replace it If a sensor is removed from its housing you must do the following before continuing normal operations e Reinstall the sensor in the housing e Wait for a period equal to the time that the sensor spent outside the housing e Calibrate the sensor CAUTION Only the oxygen sensor assembly supplied with a Narkomed MRI should be used Use of any other oxygen sensor assembly may result in the corruption of the MRI image NOTE When the machine is not in use remove the oxygen sensor assembly from the inspiratory valve dome and insert the inspiratory valve dome plug into the inspiratory valve dome Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Monitoring 11 Monitor Display Information about the oxygen analysis is presented in the Oxygen Monitor window at the top right of the monitor display as shown in Figure 11 1 The numerical value for inspiratory oxygen concentration is shown in large type To the right of this figure in small type are
128. nunciation ceases If the Narkomed MRI detects an internal electronic failure that would prevent proper operation the LO message O2 MON ERR appears in the Alarm window If this happens contact an authorized representative of DragerService Any time the monitor measures a PEEP of 5 cm H50 or greater the LO message PEEP gt 4 appears in the Alarm window When the measured PEEP drops below 5 cm H30 the LO message is cleared from the display Any time that the monitor measures a PEEP of 26 cm H50 or greater the ME message PEEP gt 25 appears in the Alarm window and an intermittent audible alarm sounds Alarm annunciation ceases when the measured PEEP drops below 26 cm H 0 Also an APNEA or CONTNG PRES alarm condition will clear this alarm condition If the measured breathing pressure falls below 10 cm H 0 the HI message SUB ATM PRES appears in the Alarm window and a continuously repeating audible alarm sounds This alarm condition is cleared when the sensed pressure rises above 10 H O However the alarm message is extended for 5 seconds to allow the recognition of a momentary subatmospheric pressure condition Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS THRESHOLD LO LO VENT PRES HI HI Breathing Pressure Monitoring 13 The LO message THRESHOLD LO appears in the Alarm window any time the sensed peak pressure ex
129. od Allow a waiting period equal to duration of capsule removal New capsule not given proper waiting period Allow 15 minute waiting period Exhausted or defective sensor capsule Replace housing cable assembly O2 SENS DISC message appears in alarm window during monitoring Defective sensor housing and cable Replace housing cable assembly Sensor cord is disconnected Insert sensor cord connector into OXYGEN SENSOR interface underneath rear panel of ventilator box Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 11 11 Ag x NTENTS TAE NT i RETURI C 12 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Respiratory Volume Monitoring Narkomed MRI Operator s Manual This section describes the respiratory volume monitoring of the Narkomed MRI anesthesia machine a 12 2 soins mean S 12 3 nn se ee 12 4 Setting the Minute Volume Low Alarm Limit 12 5 Turning Respiratory Volume Alarms Off 12 5 Turning Respiratory Volume Alarms On 12 5 Respiratory Volume Alarm Messages 12 6 Problemi Resolution 12 8 Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 12 Respiratory Vol
130. ohol The oxygen sensor housing cover can be immersed or wiped during cleaning and disinfection Use mild detergent and water for cleaning For disinfection follow up with a 2 glutaraldehyde based formulation wet pasteurization at 70 C for 30 minutes or an EtO process The inspiratory and expiratory valves come into contact with the patient s breath Clean these parts with soft lint free cloth moistened with mild alkali detergent and water Dry the parts before reassembling The valve assemblies can be immersed in a 2 glutaraldehyde based solution wet pasteurized gas sterilized or autoclaved at a temperature not exceeding 121 C The valve disks can also be autoclaved in certain instances but should not be autoclaved routinely Be careful while handling the valve disks Improper handling can damage them After cleaning or disinfecting the inspiratory or expiratory valve assembly verify that the valve disk and all internal pins are undamaged and that the valve disks are correctly reinstalled Wash the flow housing and transducers with mild detergent and water Follow with a distilled water rinse These components can be immersed The flow housing and transducers can be autoclaved at a temperature not exceeding 121 C Follow the autoclave instructions for the process Allow the transducers to normalize for 30 minutes under room ambient conditions before using them Wipe the electronics housing and sensor cable with a clean soft clo
131. onnecting the APL valve to the absorber pole and the ventilator relief valve to the scavenger NOTE The scavenger interface generally does not need disinfection However if your facility requires a disinfection process for the scavenger interface and hoses remove the scavenger and all 19 mm hoses Refer back to the cleaning instructions under Open Reservoir Scavenger Maintenance or Scavenger Interface for Passive Systems Maintenance for disassembly instructions Remove the oxygen sensor assembly from the inspiratory valve and disconnect the cable that connects the sensor to the monitor Remove the connector hose assembly between the flow sensor and the expiratory valve by turning the ring nut counterclockwise Lift the flow sensor off the bracket Disconnect the fresh gas hose from the fresh gas outlet Disconnect the breathing pressure pilot line from the absorber and the monitor Remove the absorbent canisters and dust cup Discard the absorbent Refer back to Replacing the Absorbent for instructions WARNING Absorbent is caustic and a strong irritant to the eyes skin 10 11 12 and respiratory tract When removing the absorbent take care not to spill its caustic contents Remove the inspiratory and expiratory valves by turning their ring nuts counterclockwise until they are free of the system Remove the ultrasonic flow sensor by turning its ring nut counterclockwise until it is free of the abs
132. orber dome Remove the pressure gauge by turning the knurled ring nut that connects the pressure gauge to the gauge mount counterclockwise Lift the pressure gauge assembly off the gauge mount Do not misplace the o ring CAUTION Only the pressure gauge supplied with a Narkomed MRI should be used Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 14 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning WARNING Use manufacturer authorized replacement parts only Failure to do so may result in machine malfunction injury or death Figure 14 7 Removing Parts for Cleaning and Disinfection 1 RING NUT MRI COMPATIBLE BREATHING O RING PRESSURE GAUGE GAUGE MOUNT OP00262 13 Remove the absorber using a 3 16 inch hex screwdriver to loosen the hex screw securing the absorber assembly to the absorber pole Do not remove the screw Lift the absorber off the absorber pole Do not misplace the o ring 14 Remove the bellows assembly by loosening the two wing nuts on the bottom of the assembly until the assembly releases from the canister 14 12 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Figure 14 8 Removing Parts for Cleaning and Disinfection 2 OP00260A BELLOWS CANISTER AL J
133. ousing so you do not need to adjust this scavenger However make sure that hoses are properly connected and that the positive pressure safety relief valve is functioning WARNING The positive pressure relief valve must be inspected and cleaned if necessary at 6 month intervals Figure 7 2 Scavenger Interface Hose Connections SHORT 19MM SCAVENGER HOSE VENTILATOR RELIEF VALVE 19MM SCAVENGER HOSE TERMINAL 19MM SCAVENGER HOSE SCAVENGER INTERFACE FOR NON ACTIVE SYSTEMS HOSPITAL lt oponas EXHAUST SYSTEM Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual __ ABSORBER POLE 19MM SCAVENGER HOSE 7 3 Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 8 Main Switch Panel Operation This section describes the main switch panel in the Narkomed MRI anesthesia machine 8 2 sstem Fower SII 8 3 Testing the Battery SL pu ds 8 3 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 8 Main Switch Panel Operation Overview The main switch panel located between the ventilator bellows and flowmeter bank incorporates the SYSTEM POWER switch and indicator lights for low Os supply pressure AC power failure and battery low alarm
134. ow control to the maximum of the low zone on the flow gauge Occlude the patient side of the Y piece Fill the ventilator bellows by pressing the oxygen flush button Observe the breathing system pressure gauge as the ventilator cycles The pressure gauge must indicate a pressure over 30 cmH 0 when the bellows completes its downward travel At the end of the expiratory phase when the bellows completes its upward travel the pressure should not exceed cmH 0 Check the alarm limit settings The monitor alarm limits are automatically set to a default configuration when the SYSTEM POWER switch is turned on Check these settings and adjust them if necessary Alarm limits can be adjusted at the beginning of or during a procedure Also make sure that any external monitors if any are connected properly Test the alarm functions Simulate alarm conditions and check for appropriate alarm signals Flush the system with 100 oxygen by pressing the oxygen flush button At the end of the checkout procedure verify that the final status of the machine is as follows a the vaporizer is off handwheel is set to 0 b the APL valve is open fully counterclockwise Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Preuse Checkout 4 c Ensure that the ventilator on off switch is in the off position the autobag selector switch does not
135. quency too high for selected tidal volume Decrease frequency Increase expiratory phase time Improperly adjusted ventilator relief valve Contact an authorized representative of DragerService Breathing system leak Repair leak Ventilator won t cycle Low oxygen supply pressure Provide sufficient oxygen supply pressure Bellows won t compress during inspiration Absorber manual automatic selector valve in BAG position Place selector valve in AUTO position Inspiratory flow control setting on ventilator too low Increase inspiratory flow control setting Frequency too high Decrease frequency Inspiratory pressure limit setting on ventilator too low Increase inspiratory pressure limit setting 9 6 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Monitoring System anesthesia machine Narkomed MRI Operator s Manual This section describes the monitoring system of the Narkomed MRI EI po eR ri ue art 10 2 PowerON nm entend 10 2 Monitor Screen and Controls 10 3 Configuring the Anesthesia Machine 10 7 Setting Alarms to Standby iussisse id E MEER LEMMA 10 10 SENENG ir dq m 10 10 Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE O
136. r 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 4 Preuse Checkout Preuse Checkout Procedure Battery Power Verification Absorber System Verification 4 2 Perform the following abbreviated checkout procedure when the Narkomed MRI is used in successive cases It may be performed only after the initial daily checkout procedure given in Section 3 is performed This is a recommended procedure only Follow your institution s policies regarding specific checkout procedures If the anesthesia system fails any procedures identified by an asterisk do not use the machine Contact an authorized representative of Dr gerService to inspect the unit NOTE Do not insert any additional components into or modify the anesthesia system after the checkout procedure is started 1 Turn the SYSTEM POWER switch to the ON position 2 Wait for the monitor to complete its diagnostic checks 3 Check the battery power Press the BATTERY TEST button on the main switch panel The green indicator must light The yellow BATTERY LOW indicator must remain unlit NOTE This test assumes the anesthesia machine has been plugged in for 16 hours The battery charging system works only when the machine is plugged into an active AC power source The charging system takes about 16 hours to charge a fully discharged battery 4 To check the absorber system a Check the hose connections in the
137. r pole and the scavenger interface Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found Verify the safe performance of the open reservoir scavenger system With the scavenger system properly installed and operating test for positive and negative pressure relief To test for negative pressure relief f Connect a vacuum hose to the DISS threaded terminal on the left hand side of the scavenger or attach a wall suction hose onto the adapter s hose barb fitting Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose Set the absorber s manual automatic selector valve to BAG Turn the APL valve control knob fully counterclockwise Verify that the suction waste gas disposal system is active Adjust the scavenger needle valve to a flowmeter indication between the two white lines Close all flow control valves on the anesthesia system Occlude the absorber breathing bag terminal and observe the breathing pressure gauge on the absorber The gauge should indicate only a negligible negative pressure no lower than 0 5 cmH 0 To test for positive pressure relief n Perform steps A through E Adjust the scavenger needle valve to a completely closed position by turning it fully clockwise Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO
138. rate manual that is supplied with vaporizers available for use with the Narkomed MRI If a vaporizer is dropped during handling or if its handwheel exhibits a lack of resistance spins freely or if a gas analyzer maintains a zero reading after the handwheel has been turned to a labeled concentration do not use the vaporizer Return the vaporizer to Dr gerService Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 2 11 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Absorber An absorber system is available for absorbing exhaled carbon dioxide in the rebreathing circuit of the anesthesia machine It incorporates an adjustable pressure limiter APL valve a breathing system pressure gauge a fresh gas line and connections for sensing breathing pressure respiratory volume frequency and oxygen concentration Figure 2 7 Absorber System _ RESPIRATORY VOLUME SENSOR 4 ULTRASONIC FLOW SENSOR OXYGEN SENSOR EXPIRATORY VALVE OP00322 APL VALVE INSPIRATORY VALVE N MANUAL ABSORBENT AUTOMATIC SELECTOR CANISTER VALVE BREATHING FRESH GAS SYSTEM HOSE PRESSURE N GAUGE ae ral BREATHING CANISTER RELEASE LEVER The absorber system is designed for spontaneous manually assisted or automatic ventilation The absorber system has a manual automatic selector valve for selecting manual or automatic ventilation WARNING Wa
139. ration During calibration the LED next to the Cal key lights and the label CAL appears in the Oxygen Monitor window Following successful calibration the currently sensed oxygen concentration appears in the Oxygen Monitor window If the calibration was not successful the Oxygen Monitor window is blank See Unsuccessful Calibration on page 11 7 for further information Typically calibration lasts less than 30 seconds However the time may vary depending on the amount of oxygen the sensor was exposed to before calibration Oxygen Exposure Typical Calibration Time 21 10 seconds gt 21 up to 50 seconds Figure 11 3 Calibrating the Oxygen Sensor REAR PANEL OF SENSOR MONITOR HOUSING e L Ay p 4 E d INSPIRATORY 6 EL VALVE DOME 9 A B INSPIRATORY SENSOR n VALVE DOME CORD PLUG CONNECTOR M LT OP00314 IN PA Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 11 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 11 Oxygen Monitoring 5 When the Narkomed MRI successfully completes the calibration pull the inspiratory valve dome plug and reinsert the sensor assembly 11 6 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Oxygen Monitoring 11 Unsuccessful Calibration
140. ratory Pressure uaua m ee 9 5 Problem ReSolution s ssasanredssucpumgenatens actus 9 6 Section 10 Monitoring System QNI CPC 10 2 Power On SCr en sa ce a teet wha d epe eue Gna es idol UR E qr PR acea eee 10 2 Monitor Screen and Controls 2 hr 10 3 Configuring the Anesthesia 10 7 Setting Alarms to Standby 10 10 Silencing Alarms cis usus cubre tee ge tee eae Pte bandes ane ware qs 10 10 Section 11 Oxygen Monitoring OVERVIEW 2 RNA RIT pee ded ewes hE ee eda ee es 11 2 Monitor Display enin REC XR eens SEEN P Pee XR geese 11 3 Monitor Controls ess ids ve annee REN prex Re EE EUR Ne 11 3 Setting Alarm Limit nee tee as sage 11 4 Calibrating the Oxygen Sensor 11 4 Unsuccessful Calibration 0 0 0 0 cc mme 11 7 Oxygen Alarm Messages 11 9 Low Oxygen Supply Whistle 2 22 11 10 Problem Resolutlon ssiczus e erit RPE SEER EE REE REG RL EE LEA EE 11 10 Section 12 Respiratory Volume Monitoring MEET 12 2 Monitor Display 2 d d PE d Pe bee ee ash ar
141. rcuit adapters When using a 15 mm fitting place the spring loaded locking bar over the male fitting to secure it to the female fitting a22mm female fitting with a load bearing threaded mount such the ones for Magill circuits or ISO type nonrebreathing adapters When using an ISO type nonrebreathing adapter swing the spring loaded locking bar to the side to gain access to the threaded load bearing fitting Figure 2 5 Fresh Gas Outlet 15 mm 22 mm O2 FLUSH CONTROL Pi BUTTON a MN HANDLE FRESH GAS LOCKING BAR OP79057 FRESH GAS va RELEASE TO HOSE LOCK 2 10 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Auxiliary Oxygen Flowmeter General Description 2 To deliver a metered flow of pure oxygen for example delivery of oxygen through a nasal cannula an auxiliary oxygen flowmeter is mounted on the left side of the main switch panel This flowmeter can be used when the machine is turned off A zero stop prevents damage to the flow control valve seat Figure 2 6 Auxiliary Oxygen Flowmeter Vaporizer Handling the Vaporizer ELS AUXILIARY OXYGEN FLOWMETER V AC POWER FAIL BATTERY Low O BATTERY TEST OP00155 The Narkomed MRI can be equipped with a vaporizer for administering liquid anesthetics For complete information see the appropriate sepa
142. rkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS OFPD Verification ORC Verification Oxygen Flush Verification Fresh Gas Verification Absorber System Verification 15 16 17 18 19 Daily Checkout 3 c Close the cylinder supplies and deplete the pressure from the system Check the oxygen failure protection device OFPD With all gases available on the machine set to a flow of about 4 l min discontinue the oxygen supply by disconnecting the oxygen pipeline supply hose and closing the oxygen cylinder Check the flowmeters The flow of all other gases must decrease proportionally to the decrease in oxygen flow and eventually shut off Check the oxygen ratio controller ORC Open the nitrous oxide flow control valve to a flow of 10 l min Vary the oxygen flow with the oxygen flow control valve The nitrous oxide flow indicated on the nitrous oxide flowmeter must automatically vary in response to the oxygen flow control valve adjustments The ORC must maintain a fresh gas oxygen nitrous oxide flow ratio of at least 25 4 oxygen NOTE When the nitrous oxide flow control valve is open and oxygen is flowing at a minimum rate 150 200 ml min nitrous oxide flows at about 500 ml min Check the oxygen flush a Pressthe oxygen flush button Listen for an audible gas flow sound accompanied by a marked incr
143. rmation as long as it detects a peak pressure at least 10 cm greater than PEEP pressure When this pressure difference drops below 10 cm H50 the numeric information remains 1 minute longer and then disappears 13 6 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Breathing Pressure Trace Window Breathing Pressure Monitoring 13 The Breathing Pressure Trace window displays the breathing pressure waveform and the pressure high and threshold pressure alarm limits Pressure measurements are displayed in units of cm and are automatically scaled from 0 20 0 50 or 0 100 cm H30 If the scale changes the positions of the waveform and alarm limits also change relative to the new scale The window shown below in Figure 13 4 has a scale of 0 20 cm H O Figure 13 4 Breathing Pressure Trace Window INSPIRATORY lt PEAK INSPIRATORY PAUSE FLOW RATE i SLOPE PRESSURE _ HIGH ALARM LIMIT THRESHOLD PRESSURE ALARM LIMIT PEEP OP87016 The peak of the waveform corresponds to the peak pressure The slope of the trace as it rises toward the peak pressure is correlated with the inspiratory flow rate the steeper the slope the higher the flow rate The amount of pressure that the baseline is raised from zero corresponds to the patient s positive end expiratory pressur
144. ry or death when the machine is used in an MRI scanning room Always lock the casters after this anesthesia machine has been positioned in the MRI scanner room Magnetic attractive forces between the magnet and the anesthesia machine may cause unintentional movement of the anesthesia machine if the casters are unlocked The power supply charger assembly must not be taken into the magnet room Damage to the equipment MRI system or personal injury could result This anesthesia machine has been tested only with magnets with field strengths of up to 1 5 tesla Moving the machine near higher strength magnets greater than 1 5 tesla could result in machine malfunction or unmanageable attractive forces that could lead to serious injury or death This anesthesia system will not respond automatically to certain changes in patient condition operator error or failure of components The system is designed to be operated under the constant surveillance and control of a qualified operator Use only nonmagnetic aluminum E cylinders with this machine Steel cylinders can cause serious injury or death if brought into an MRI scanning room Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS WARNING WARNING WARNING WARNING CAUTION CAUTION CAUTION Introduction 1 No third party components shall be attached to the anesthesia mach
145. ry volume The anesthesia machine also monitors key anesthesia system functions such as oxygen supply pressure and backup battery status Monitor Screen and Controls All monitoring data and alarm messages are shown on the machine s monitor screen The control keys on either side of the screen allow you to establish monitoring settings With the left keypad you can control system wide settings such as alarm annunciation and monitor configuration With the right keypad you can control settings for specific monitors oxygen concentration breathing pressure and respiratory volume See Figure 2 13 Figure 2 13 Monitor Screen and Controls OP00306 Oxygen EIE APNEA VOL OXYGEN 8 WERMIN VoL Low 33 Lem Je LO THRESHOLD LOK Breathing Volume Gen 0 71 11 7 8 77 50 T 00 0 o El 5 v T o o o o 3 z Alarms GIO AG lt GG LEFT MONITOR RIGHT KEYPAD SCREEN KEYPAD 2 22 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description 2 Alarm System Alarms are organized into three categories depending on the urgency of the alarm condition HI the highest priority alarms requiring an immediate response second priority alar
146. s A continuous alarm sounds when the supply pressure is low Figure 8 1 Main Switch Panel 8 2 RED 02 SUPPLY _ PRESSURE LOW INDICATOR YELLOW AC POWER LOW INDICATOR YELLOW BATTERY LOW a S o GREEN BATTERY TEST INDICATOR C 02 SUPPLY PRESSURE AC POWER FAIL BATTERY LOW STANDBY SYSTEM POWER Narkomed MRI Operator s Manual P FR BATTERY TEST NN E BATTERY i TEST PUSH BUTTON SYSTEM POWER SWITCH OP20050 Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Main Switch Panel Operation 8 System Power Switch The SYSTEM POWER switch has two positions_ON and STANDBY In the ON position the gas pneumatic and electric power circuits for the ventilator and alarm system are turned on The green indicator next to the switch lights In the STANDBY position the gas supplies and all electrical power to the ventilator monitor and alarm system are shut down The battery charging circuit remains on NOTE The battery charging circuit is active whenever the power cable is attached to an active wall receptacle regardless of the switch setting Testing the Battery Test the battery system before each use To test the battery 1 Turn the SYSTEM POWER switch to ON 2 Press and hold the BATTERY TEST button 3 Ifthe battery is sufficiently charged the gr
147. s are evident Thoroughly clean rubber goods with mild alkali detergent and water before disinfecting them Then thoroughly rinse them with water to remove all detergent To prevent water spots use distilled or demineralized water Avoid using hard bristle brushes Manufacturers of rubber goods recommend that reusable rubber goods be soaked in a liquid disinfection agent Always follow the agent manufacturer s instructions for use CAUTION Disinfectants containing phenol or phenyl compounds destroy rubber goods Latex and rubber goods treated with disinfectants having a quaternary ammonium base will be damaged if subsequently autoclaved Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the Y Piece and Mask Cleaning and Disinfecting the Ventilator Bellows Cleaning and Disinfecting the Ventilator Bellows Bottom Assembly Cleaning and Disinfecting the Oxygen Sensor Capsule Part Number 4113877 003 Rev F Routine Maintenance and Cleaning 14 Use 2 glutaraldehyde based formulations for more than 20 minutes or wet pasteurization at 70 C for 30 minutes after detergent cleaning Thoroughly rinse the corrugated hoses mask elbow and breathing bag after contact with chemicals Use sterilized water to prevent contamination by tap water organisms Thoroughly dry rubber goods before returning them to
148. s housing The index pin on the electronics housing should align with the hole in the flow housing Slide the flow sensor onto the bracket Connect the patient hose to the expiratory hose terminal on the flow sensor Install the connector hose assembly between the flow sensor and the expiratory valve and secure it by turning the ring nut clockwise Replace the oxygen sensor in the inspiratory valve port Connect the sensor cord to the monitor Connect the fresh gas hose to the fresh gas outlet on the machine WARNING Do not pinch or kink the fresh gas hose leading form the fresh gas outlet to the absorber Reconnect the breathing pressure pilot line to the absorber and the monitor Replace the 22 mm hoses and other breathing circuit accessories Replace the 19 mm hose that connects the APL valve to the absorber pole Replace the 19 mm hoses that connect ventilator relief valve and absorber pole to the scavenger as illustrated in the following drawings If the scavenger hoses were removed from the scavenger replace the scavenger hoses as illustrated on the following pages Turn the SYSTEM POWER switch to ON Perform the daily checkout procedure provided in this manual before operating the machine Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Open Reservoir Scavenger Connections
149. s in any ascending bellows the force needed to overcome gravity acting on the bellows causes a positive end expiratory pressure PEEP within the breathing system The PEEP is about 2 cmH3O The pressure limit control is used to set the peak inspiratory pressure produced by the ventilator to prevent barotrauma The pressure limit control can also improve ventilation for patients with reduced lung compliance neonatal pediatric patients and patients with adult respiratory distress syndrome because it limits the peak inspiratory pressure during the inspiratory phase of ventilation The AV2 ventilator is shown in the following drawing 2 16 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description 2 Figure 2 10 AV2 Ventilator RATIO CONTROL INSPIRATORY FLOW GAUGE EXTENDED RANGE TE b INSPIRATORY ACCESS FLOW CONTROL RATIO DISPLAY v d X VENTILATOR ON OFF FREQUENCY CONTROL A N CONTROL FREQUENCY A ee DISPLAY f im YOU TIDAL VOLUME CONTROL PRESSURE LIMIT CONTROL a TIDAL E BELLOWS CANISTER VOLUME SETTING INDICATOR BREATHING CIRCUIT OP91018c CONNECTOR Main Switch Panel The main switch panel is located between the ventilator bellows and flowmeter bank System The SYSTEM POWE
150. s set too low waste gas will exit the canister through the relief ports around the top of the canister and contaminate the operating room If the suction flow rate is too high the waste gas disposal system s suction capacity will be needlessly depleted and the system will be noisy The needle valve setting may need readjusting during a case For example a shared suction disposal system may give a varying suction flow rate depending on the number of users at any given time Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 6 5 Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Scavenger Interface for Passive Systems Operation This section describes the scavenger interface for passive systems used in the Narkomed MRI anesthesia machine devi Tc 7 2 Operating the Scavenger Interface for Nonactive Systems 7 3 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 7 Scavenger Interface for Passive Systems Operation Overview The scavenger interface for passive systems is intended for use with nonrecirculating HVAC systems also called exhaust systems This scavenging approach relies on the waste gas pressure to transfer the gas from the scavenger to the disposal system The scaveng
151. s shown in Figure 13 2 Monitor Displays Figure 13 2 Monitor Displays OP00311 50 J PEAK BREATHING BREATHING PRESSURE PRESSURE TRACE WINDOW MONITOR WINDOW Breathing Pressure Trace Window This large window on the left displays a breathing pressure trace or waveform To the left of the waveform in small type are the pressure high and threshold pressure alarm limits Breathing Pressure Monitor Window This small window on the right contains numerical breathing pressure measurements Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 13 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 13 Breathing Pressure Monitoring Breathing The Breathing Pressure Monitor window shown in Figure 13 3 contains Pressure breathing pressure measurements expressed in units of cm H30 Monitor Window Figure 13 3 Breathing Pressure Monitor Window OP00310 PEAK BREATHING a PRESSURE 49 MEAN g MEAN BREATHING PRESSURE PEEP POSITIVE END EXPIRATORY PRESSURE PEAK Breathing Pressure The highest instantaneous pressure value for each breath MEAN Breathing Pressure The average of all the instantaneous pressure values recorded during each breath PEEP Positive End Expiratory Pressure The breathing pressure at the end of exhalation During apneic conditions the pressure monitor displays numeric info
152. service The corrugated hoses mask elbow and breathing bag can be autoclaved at 121 C However such temperatures accelerate the natural aging of rubber goods Autoclaved rubber goods can also harden over time as a result of the loss of softeners Exposure to ozone or ultraviolet light also accelerates the natural aging of rubber goods Reusable rubber goods can also be gas sterilized with ethylene oxide After EtO sterilization properly aerate rubber goods before returning them to service Always follow manufacturer s instructions for these procedures CAUTION Do not autoclave face masks Autoclaving causes rapid deterioration of face mask cushions The Y piece and mask can be disinfected by wiping or immersion with glutaraldehyde based formulations EtO and wet pasteurization processes can also be used The ventilator bellows and its bottom assembly are the only ventilator components that come in contact with the patient s breath Refer back to Cleaning and Disinfecting Exterior Surfaces for instructions on cleaning and disinfecting the surface of the ventilator bellows assembly Clean the bellows with a soft lint free cloth moistened with mild alkali detergent and water followed by a distilled water rinse Let the bellows drip dry After cleaning use wet pasteurization at 70 C for 30 minutes a glutaraldehyde based solution or an EtO process to disinfect the ventilator bellows Follow manufacturer s guidelines for these proc
153. ste gas scavenging systems used with Draeger Medical absorber systems must have safety features to ensure that excessive subatmospheric pressure lower than 0 5 cmH 0 and excessive positive pressure higher than 0 5 cmH 0 are not possible at the connection point 2 12 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Inspiratory and Expiratory Valves Canister Dust Cup Breathing System Pressure Gauge Peep Valve Option General Description 2 The inspiratory and expiratory valves control the direction of gas flow in the absorber system The inspiratory valve is labeled INSPIRATION and the expiratory valve is labeled EXPIRATION The valves are unidirectional permitting gas flow in one direction only e The inspiratory valve allows gas to flow toward the patient only with no backflow to the absorber The expiratory valve allows gas to flow into the absorber only with no backflow to the patient The valves are not interchangeable They must be connected to the correct mounts for the proper flow direction through the absorber system Different size mounting threads on each valve prevent connecting a valve to the wrong mount WARNING Do not use the inspiratory or expiratory valves if the pins in the plastic valve domes or in the valve bodies are bent damaged or missing the valve disks are missing or damag
154. sthesia machines have caused accidents when an oxygen fitting was placed on one end of the hose and a nitrous oxide fitting on the other end 2 Connect the other end of the supply hose to the appropriate functioning hospital pipeline supplies 3 Check the pipeline pressure gauge located on the front panel for sufficient pipeline pressure 50 55 psi Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 5 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 5 Gas Delivery System Operation Figure 5 2 Connecting the Pipeline Gas Supply NIST OPTION DISS BODY OPTION v wv CN _ O2 DISS BODY O2 NIST GAS FITTING GAS FITTING GAS FITTING hs MJ N20 DISS BODY N20 NIST EN E c GAS FITTING O2 DISS NUT GAS FITTING DISS M OPTION AIR DISS NUT GAS FITTING OP14700 5 4 Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Gas Delivery System Operation 5 Connecting the Gas Cylinder When attaching a cylinder make sure that only one washer is installed between the cylinder and the yoke gas inlet Using multiple washers may compromise the pin indexed safety system Be sure to verify the integrity of both index pins when installing a new cylinder WARNING Use only nonmagnetic aluminum E cylinders with this machine Steel cy
155. t Current PN eara a 2 amps max Battery Battery type sealed lead acid 12 VDC 17 AH Charging sires CCo Ce tonneau 16 hours Reserve power time from full charge 3 hours Gas Delivery System Pipeline inlet connections DISS male Nut with nipple Canada Pipeline inlet pressure 50 55 psi 345 380 kPa O5 N50 Air Pipeline gauge accuracy 3 psi 0 25 psi 2 psi 26 75 psi 3 psi 76 100 psi 15 2 Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Specifications 15 Cylinder connections Pin indexed hanger yokes CGA V 1 1994 Over pressure relief valve 95 psi 655 kPa Over pressure relief valve Canada 75 psi 520 kPa CSA Standard Z168 3 M84 Fresh gas common outlet 15 mm female Canada 15 mm female 22 mm male Fresh gas oxygen concentration ORC 25 4 Oxygen flush flow rate 55 10 l min Minimum oxygen flow at 50 psi pipeline pressure 150 x50 ml min Low oxygen supply pressure alarm 34 40 psi Cylinder gauge accuracy 90 psi 0 750 psi 60 psi 750 2250 psi 90 psi 2250
156. t is secure Check the gauge needle s zero position and adjust it if necessary 5 Replace the canisters and dust cup making sure the gaskets and O ring are in place Pull the canister lever up until it clicks in place 6 Reassemble the inspiratory and expiratory valves Place the valve disk and dome gasket in the valve body then replace the dome and ring nut Turn the ring nut clockwise to tighten 7 Replace the inspiratory valve assembly and gasket on the valve mount Turn the valve assembly clockwise to secure it to the valve mount Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 14 23 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 14 Routine Maintenance and Cleaning 14 24 10 11 12 13 14 15 16 17 18 19 20 Replace the expiratory valve assembly and gasket on the absorber Turn the valve assembly clockwise to secure it to the absorber dome Reassemble the ultrasonic flow sensor Press the transducers into their ports on the flow housing Ensure that the three O rings on each transducer are not damaged and are properly seated Slide the flow housing transducer assembly into the electronics housing Be sure that it clicks into place NOTE Ifthe flow housing transducer assembly does not fit easily into the electronics housing make sure the flow housing is facing the right direction Compare the direction to the illustration on the electronic
157. tenance and Cleaning Cleaning and Disinfecting the Vaporizer Exterior Cleaning and Disinfecting the Open Reservoir Scavenger 14 22 Clean the vaporizer with a soft lint free cloth moistened with mild detergent and water Follow up with a 70 to 90 diluted solution of ethyl or isopropyl alcohol or sodium hypochlorite 5 2 household bleach at 1 500 dilution 100 ppm chlorine Do not sterilize the vaporizer WARNING Water and other liquids with the exception of the appropriate anesthetic that enter the vaporizer chamber can cause injury to the patient or form corrosive products that affect the function of the vaporizer CAUTION Do not immerse the vaporizer or allow water or any other liquid to enter the fill or drain ports or fresh gas inlet or outlet ports Any vaporizer suspected of contamination with water or any other liquid must be returned to Dr gerService for a complete overhaul Additional care must be taken with halothane vaporizers Halothane contains a stabilization additive called thymol which evaporates more slowly than halothane and collects in the vaporizer Over time thymol may decompose into compounds that affect the wick material and turn the halothane yellow If you see particles in the sight glass of a halothane vaporizer or if the halothane turns yellow rinse the vaporizer chamber with fresh halothane as follows 1 Drain the discolored halothane from the vaporizer 2 Fill the vaporizer with
158. th moistened with mild detergent and water Take care not to allow any fluid to access the interior of the electronics housing The electronics housing and sensor cable can be wiped with a clean soft lint free cloth moistened with a 70 to 90 diluted solution of ethyl or isopropyl alcohol or sodium hypochlorite 5 2 household bleach at 1 500 dilution 100 ppm chlorine Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Cleaning and Disinfecting the Breathing System Pressure Gauge Cleaning and Disinfecting the Absorber Canister Assemblies and Dust Cup Cleaning and Disinfecting the Absorber Assembly Part Number 4113877 003 Rev F Routine Maintenance and Cleaning 14 NOTE Draeger Medical makes no claims about the efficacy of these agents or this method of cleaning for infection control Consult your hospital s infection control officer or epidemiologist Wipe the pressure gauge assembly with a soft lint free cloth moistened with mild detergent and water Dry the assembly before reinstalling The gauge can be disinfected with ethylene oxide gas followed by appropriate aeration Follow the manufacturer s instructions CAUTION The breathing system pressure gauge cannot withstand immersion or the heat and pressure of autoclaving CAUTION The MRI breathing system gauge is MRI compatible When disinfecting the gauge wit
159. the high and low oxygen concentration alarm limits Figure 11 1 Monitor Display Monitor Controls INSPIRATORY OXYGEN CONCENTRATION OXYGEN 3 100 m HIGH OXYGEN CONCENTRATION ALARM LIMIT LOW OXYGEN CONCENTRATION ALARM LIMIT OP00308 You use the oxygen monitor control keys and the arrow keys on the right keypad to set oxygen concentration alarm limits and calibrate the oxygen sensor The oxygen monitor control keys are located next to the Oxygen Monitor window See Figure 11 2 Figure 11 2 Monitor Controls HIGH OXYGEN CONCENTRATION ALARM LIMIT KEY LOW OXYGEN CONCENTRATION ALARM LIMIT KEY OP87011 Part Number 4113877 003 Rev F CALIBRATION KEY Oxygen High Low f Limit Limit ARROW KEYS Narkomed MRI Operator s Manual 11 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 11 Oxygen Monitoring Setting Alarm Limits At power up the oxygen high and low alarm limits are automatically set to pus their system defaults You can adjust these limits within specified ranges E Valid settings for the alarm limits and their system defaults are shown in Table 11 1 Low Limit Table 11 1 Alarm Limits Alarm Limit Default Valid Settings High 100 19 100 must be greater than low alarm limit Low 30 18 99 must be less than high alarm limit Follow these steps
160. then disinfect the Narkomed MRI and its parts according to the guidelines provided in this chapter Determining the need and frequency of cleaning or disinfecting any particular component is the responsibility of the user institution These procedures should be performed according to procedures established by the user institution following the specific instructions provided by the manufacturer of the equipment or agent used For additional information about infection control practice refer to the APIC Guideline for Selection and Use of Disinfectants This guideline was developed by the Association for Professionals in Infection Control and Epidemiology Inc and published in AJIC Vol 24 No 4 pp 313 342 August 1996 The following table of recommended disinfection methods for the Narkomed MRI was adapted from the APIC Guideline for Selection and Use of Disinfectants Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Routine Maintenance and Cleaning 14 Table 14 1 General Guidelines for Cleaning and Disinfection Part A B C D E F Exterior Painted Plated and Plastic X X Surfaces Corrugated Breathing Hoses Mask Elbow Breathing Bag Y Piece and Mask x x x Ventilator Bellows x x x Ventilator Bellows Bottom Assembly x Oxygen Sensor Capsule X Oxygen Sensor Housing x x
161. thing system It is located on the front of the anesthesia machine Narkomed MRI Operator s Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description 2 The outlet s 15 mm cylindrical female fitting is designed to accept a 15 mm male fitting on the absorber fresh gas hose The male fitting slides into a retaining slot in the spring loaded safety locking bar to prevent the fresh gas hose from being disconnected accidentally The 15 mm male fitting on the fresh gas hose is unique to Draeger Medical design and should not be replaced by a hose from any other manufacturer Figure 2 4 Fresh Gas Outlet 15 mm OP79056 FRESH GAS md p B OUTLET c 2 RELEASE TO EXTENDED POSITIO LOCK Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual HANDLE LL O2 FLUSH CONTROL BUTTON FRESH GAS LOCKING BAR N 2 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Fresh Gas The fresh gas outlet delivers the fresh gas mixture consisting of oxygen Outlet nitrous oxide air and vapors of a liquid anesthetic to the patient 15 breathing system It is located the front of the anesthesia machine 22 mm The outlet has a dual fitting to accommodate al5 mm male fresh gas hose fitting such as those supplied with Draeger Medical absorbers and Bain ci
162. tive pressure safety relief valve At this point the absorber system s breathing pressure gauge must indicate a pressure of less than 10 cmH 0 Check for proper pressure and flow at the Y piece during the inspiratory and expiratory phases Turn the SYSTEM POWER switch and ventilator power switch to their ON positions Place the manual automatic selector valve in the AUTO position Adjust the oxygen flow control valve to a 3 l min flow Set the ventilator frequency to 3 BPM the I E ratio to 1 2 and the tidal volume to about 1 liter Adjust the ventilator flow control to the maximum of the low zone on the flow gauge Occlude the patient side of the Y piece Fill the ventilator bellows by pressing the oxygen flush button Observe the breathing system pressure gauge as the ventilator cycles The pressure gauge must indicate a pressure over 30 cmH5O when the bellows completes its downward travel The pressure should not exceed cmH 0 at the end of the expiratory phase when the bellows completes its upward travel Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 3 9 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 3 Daily Checkout Monitor 26 27 System Flush 28 Final Position 29 3 10 Check the alarm limit settings The monitor alarm limits are automatically set to a default configuration when the SYSTEM POWER switch is turned on Check these settings and adjust them
163. tory Expiratory 1 Phase Time Ratio Use the I E ratio control knob to set the inspiratory expiratory I E phase time ratio The standard range is from 1 1 through 1 4 5 adjustable in increments of 0 5 An extended range of ratios is also possible for setting inverse I E ratios The specific extended range settings are 4 1 3 1 and 2 1 The extended ranges are set by pressing the EXTENDED RANGE switch while rotating the I E ratio control knob Rotating the control knob clockwise increases the I E ratio setting while counterclockwise rotation decreases the I E ratio setting WARNING Inverse LEE ratios introduce auto PEEP Setting the Inspiratory Flow Rate Use the inspiratory flow control knob to set the inspiratory flow in the 10 l min to 100 l min range This setting controls the gas flow rate into the bellows canister and the gas flow rate delivered to the patient Because of patient circuit variables such as lung compliance fresh gas flow airway resistance and equipment compliance the flow gauge is labeled with nominal zones The scale on the label is only a reference Adjust the flow setting to a point where the ventilator bellows is fully compressed but not deformed at the end of the inspiratory phase of the breathing cycle Use the inspiratory flow control to create an inspiratory plateau at the end of the inspiratory cycle and to affect the potential peak inspiratory pressure within the patient breathing system
164. uction 1 AVERTISSEMENT AVERTISSEMENT AVERTISSEMENT AVERTISSEMENT Ne pas utiliser de composants en provenance d autres fabricants avec l appareil d anesth sie le ventilateur ou le circuit d anesth sie moins qu ils n aient t approuv s au pr alable Contacter Dr gerService pour des informations compl mentaires Ne pas utiliser l appareil d anesth sie avec des anesth siques inflammables Pour viter tout risque d explosion ne pas utiliser d anesth siques inflammables tels que l ther et le cyclopropane Seuls les anesth siques conformes aux exigences relatives aux anesth siques ininflammables de la norme CEI ou toute norme nationale quivalente pourront tre utilis s avec cet appareil Lors du d placement de l appareil d anesth sie retirer l absorbeur et n utiliser que les poign es ou les barres de pouss e traction L appareil d anesth sie ne doit tre d plac que par des personnes suffisamment fortes pour en supporter le poids Draeger Medical recommande que deux personnes d placent l appareil d anesth sie afin de le manceuvrer plus facilement Veiller ce que l appareil ne bascule pas lors du d placement sur des plans inclin s dans des angles et au passage de seuils portes et ascenseurs par exemple Ne pas faire passer l appareil sur des tuyaux des fils lectriques ou d autres obstacles se trouvant sur le sol Utiliser seulement des pi ces de remplacement fournies par le man
165. ufacturier Des pi ces non approuv es peuvent causer des probl mes de fonctionnement des blessures ou la mort ATTENTION L appareil d anesth sie Narkomed MRI doit tre utilis uniquement en tant que syst me pour l imagerie r sonance magn tique L utilisateur ne doit pas pr sumer que chaque composant du syst me peut tre utilis seul pour ATTENTION Bien l IRM sans pr senter de risques que l appareil d anesth sie Narkomed MRI soit concu de mani re minimiser le parasitage lectromagn tique son fonctionnement peut tre affect par l utilisation de g n rateurs d lectrochirurgie ou d appareils de diathermie ondes courtes ou d appareils micro ondes se trouvant aux alentours ATTENTION Ne pas placer des objects sur l appareil Part Number 4113877 003 Rev F Narkomed MRI Operators Manual 1 9 Ag x NTENTS TAE NT i RETURI C RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS General Description Narkomed MRI Operator s Manual This section provides you with a general description of the Narkomed MRI anesthesia machine ioi ioi o eM MT 2 2 Gas Delivery Systemi isses conii prati oie HI nn Lore date cil Fx palici da 2 4 2 11 lj isa 2 12 Scavenger SNS IAE sand 2 14 AN OR OR cct 2 16 Main Switch Panel 2 17 Power Supply System nn 2 19 Montarino Systa ornini 2 22 Monitor Screen
166. ume Monitoring Overview Respiratory volume is measured using an ultrasonic flow sensor which is attached to the expiratory valve and mounted to the top of the absorber assembly as shown in Figure 12 1 The ultrasonic flow sensor has two transducers that measure the time of flight of ultrasonic pulses transmitted upstream and downstream in the respiratory flow path The difference in time of flight is used to determine the velocity and the flow rate of gas through the patient circuit The flow sensor output is converted into meaningful readings for minute volume tidal volume and respiratory rate displays Figure 12 1 Respiratory Volume System 12 2 CABLE TO ULTRASONIC BATTERY BOX TE FLOW SENSOR PERMANENTLY ATTACHED CONNECTOR HOSE EXPIRATORY VALVE EXPIRATORY HOSE TERMINAL OP00317 ABSORBER ASSEMBLY WARNING The ultrasonic flow sensor can be used with all normal anesthetic gases except oxygen helium heliox Incorrect flow measurements will result if heliox is used CAUTION Although the Narkomed MRI is designed to minimize the effects of ambient radio frequency interference the functioning of the respiratory volume monitor may be adversely affected by the operation of electrosurgical equipment or short wave or microwave diathermy equipment in the vicinity NOTE Sudden irregular expiratory flow may cause erratic tidal volume and respiratory rate displays To avo
167. us oxide cylinder supplies a Close the nitrous oxide cylinder valve and remove the cylinder from the yoke Verify that there is only one cylinder gasket and two index pins Verify that the cylinder matches the yoke label Replace the cylinder on the yoke Open the nitrous oxide flow control valve until the nitrous oxide pipeline and cylinder pressure gauges indicate zero pressure Open a nitrous oxide cylinder and check the cylinder pressure gauge A full nitrous oxide cylinder registers a pressure of about 745 psi Replace any cylinder with a pressure less than 600 psi To check for a high pressure leak close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure The following table shows the full and minimum pressures for E size gas cylinders at 70 21 C Part Number 4113877 003 Rev F Narkomed MRI Operator s Manual 3 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 3 Daily Checkout WARNING Use only nonmagnetic aluminum E cylinders with this machine Steel cylinders can cause serious injury or death if brought into an MRI scanning room Table 3 1 Nitrous Oxide Cylinder PSI Levels Pipeline Supply System Verification Low Pressure System Verification System Gas Circuit Verification Oxygen Monitor Calibration 3 4 GAS PSI FULL PSI MIN Nitrous Oxide 745 600 Oxygen 1900 1000 typical full load
168. wise including any liability based upon Draeger Medical s product warranty is subject to and limited to the exclusive terms of Draeger Medical s limited warranty whether based upon breach of warranty or any other cause of action Narkomed MRI Operators Manual Part Number 4113877 003 Rev F RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS Restriction Copyright Introduction 1 whatsoever regardless of any fault attributable to Draeger Medical and regardless of the form of action including without limitation breach of warranty negligence strict liability or otherwise Draeger Medical shall in no event be liable for any special incidental or consequential damages including loss of profits whether or not foreseeable and even if Draeger Medical has been advised of the possibility of such loss or damage Draeger Medical disclaims any liability arising from a combination of its product with products from another manufacturer if the combination has not been endorsed by Draeger Medical Buyer understands that the remedies noted in Draeger Medical s limited warranty are its sole and exclusive remedies Furthermore buyer acknowledges that the consideration for the products equipment and parts sold reflects the allocation of risk and the limitations of liability referenced herein Federal law restricts this device to sale by or on the order of a physician Copyright 2001 by Draeger Medical Inc
169. xpiratory Mounting ring nut size M33 x 1 Valve Hose 1 22 mm male Breathing Cn Pr 20 to 80 cmH 0 System Smallest scale division 2 cmH 0 Pressure Gauge Nominal 20 to 5 cmH 0 3 FS 5 to 55 cmH 0 2 FS 55 to 80 cmH 0 3 FS Mounting ring nut 1 1 1 8 x 18 APL Valve Nominal low flow resistance 2 cmH 0 at 8 l min Hose terminal isse vat eg eme er XA E RENE A 19 mm male Breathing sad aet P HET eb RICE tuer dune 22 mm male Bag Terminal Oxygen Monitoring qa TE E acis s 10 100 vol Resolution 22249 eg E e Ice Eo X Eo RR Hd 1 vol Os 3 vol When calibrated within 18 hours and constant temperature and pressure Response time rudes dard CR dote ee dg lt 25 sec T90 Hero CME RER RE dubbed ease lt 0 1 vol Oo month Span coon so lt 1 vol 5 8 hours Temperature lt 3 of reading 15 to 40 C Sensor service life gt 8 months at 25 C 50 relative humidity 50 Os gas mixture or 25000 hour Breathing Pressure Monitoring 15 4 Numeric display range 10 125 cm H30 9e 99 P UP
170. ygen even if the oxygen flow control valve is fully closed Part Number 4113877 003 Rev F Narkomed MRI Operators Manual 2 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 2 General Description Flow Control Valves Oxygen Flush Oxygen Ratio Controller ORC Fresh Gas Outlet 15 mm 2 8 A needle valve is located below the flowmeter tube for each gas This valve is used to adjust the flow of gas Turning the valve knob counterclockwise increases flow Turning the knob clockwise decreases flow A zero stop prevents damage to the flow control valve seats If necessary an authorized representative of Dr gerService can readjust the stop Each flow control knob is identified by its color code and chemical symbol The oxygen flow control valve is also touch coded with a deeply fluted knob CAUTION The flow of oxygen cannot be completely shut off see Minimum Oxygen Flow on page 2 7 Do not force the oxygen flow control knob to shut off the minimum flow Forcing the knob can damage the valve seat A manually operated self closing oxygen flush valve is located on the front of the machine A bezel is mounted around the pushbutton to prevent accidental engagement When actuated the valve delivers an unmetered oxygen flow of approximately 55 l min directly to the fresh gas common outlet The SYSTEM POWER switch does not have to be in the ON position to use the oxygen flush The ORC
171. ypad You use the left keypad to initiate system wide monitoring functions Figure 10 4 Left Keypad All Standby Silence Alarms Configure Part Number 4113877 003 Rev F PAIN S Config Alarms PAIN OP87007 When the ventilator is off turns off audible tones and message displays associated with the breathing pressure alarm and respiratory volume alarms until a valid breath is detected If the ventilator is on only the respiratory volume alarms are affected Silences all audible alarm tones for 2 minutes Displays the Configure screen where you can set system parameters such as the time date alarm volume and contrast You also enter the Alarm Log by way of the Configure screen These functions are described in detail later in this section Narkomed MRI Operator s Manual 10 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS 10 Monitoring System Right Keypad You use the right keypad to perform functions associated with a specific monitor These functions are described in the following sections Section 11 Oxygen Monitoring Section 12 Respiratory Volume Monitoring and Section 13 Breathing Pressure Monitoring Figure 10 5 Right Keypad Oxygen High Limit ow VLN Cal imit JA Breathing Br OP87008 10 6 Narkomed MRI Operator s Manual Part Number 4

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