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Maquet Servo 900c - Frank`s Hospital Workshop

1. Trig indication Yellow light 120 cm H20 W50 x D23 x H32 cm Approximately 19 kg e SV 900 is an intensive care anesthetic ventilator intended for adults pediacrics and neonates C The device if marked with the CE symbol including the number of the notified body shown to the left complies with the requirements of 0413 the Medical Device Directive 93 42 EEC Classification according to IEC 601 Class equipment Type B Continuous operation Symbols on the equipment Type B according 601 A Attention consult Operating Manual Alternating current On Power Connection to mains o Off Power Disconnection from mains A device to monitor the concentration of anesthetic agents in the inspiratory gas shall be used during anesthesia e All measured and set parameters are referenced to ATP Ambient Temperature and Pressure t Old non functioning cells must be returned to the plae of purchase or bd to a place where they can be disposed of properly cells must not be Ph disposed of with ordinary waste Servo Ventilator 900 C Operating Manual Order No 69 78 761 E313E Maquet Critical Care AB 1997 2001 All rights reserved No part of this publication may Printed in Sweden be reproduced strred in a retrival system or transmitted in any form or by any means electronic mechanical Price Group 0 photocopying recording or otherwise without the prior pe
2. 110 120 220 240 V 10 50 or 60 Hz Approximately 40 W Up to 120 cm H20 VOL CONTR Volume controlled VOL CONTR SIGH Volume controlled with sigh PRESS CONTR Pressure controlled PRESS SUPPORT Pressure support SIMV Synchronized Intermittent Mandatory Ventilation SIMV PRESS SUPPORT CPAP Continuous Positive Airway Pressure MAN Manual ventilation auxiliary equipment necessary 0 5 40 l min With sufficient working pressure Accuracy for momentary insp flow up to 1 6 1 5 10 or 0 2 l min Constant or accelerating 5 120 breaths minute 20 25 33 50 or 80 of the respiratory cycle 0 5 10 20 or 30 of the respiratory cycle 0 100 cm H20 0 50 cm 20 15 120 cm H20 20 0 cm H20 HIGH RATE 4 40 SIMV breaths min LOW RATE 0 4 4 SIMV breaths min Double tidal volume every hundredth breath 0 075 I Range 20 120 cm H20 Accuracy 5 or 2 cm H20 Expired minute volume Digital presentation Respiratory rate Oz concentration Inspired tidal Expired tidal volume Expired minute volume sssss Peak Pause Me
3. Values marked in green Set PRESET INSP MIN VOL at 10 l min Set UPPER PRESS LIMIT for AIRWAY PRESSURE at 80 cm H O Set the parameter selector at INSP TIDAL VOLUME Block the opening of the Y piece Servo Humidifier Note the reading on the INSP TIDAL VOLUME ml display Set the Servo Ventilator as desired for the patient including the desired minute volume for the patient and connect the patient See pages 7 4 to 7 10 Set the parameter selector at PAUSE PRESSURE and read actual pause pressure PRESET INSP when the patient is connected MIN VOL l min Calculate compensation l min for compressible volume read INSP TIDAL VOLUME ml according to item 8 above 1000 according to item 10 above min according 60 cm to item 9 above Set PRESET INSP MIN VOL desired minute volume for the patient compensation l min for compressible volume calculated in item Example 1 Servo Humidifer 11 above Read INSP TIDAL VOLUME item 8 54 ml at pause pressure 60 cm H O Desired minute volume for the patient 7 5 l min Set BREATHS min item 9 15 Read PAUSE PRESSURE item 10 22 cm H O Compensation for compressible volume item 11 54 x 22 x15 203 min 1000 60 PRESET INSP MIN VOL item 12 7 5 0 3 7 8 l min Example 2 Heater humidifier Read INSP TIDAL VOLUME item 8 88 ml at pause pressure 60 cm H O Desired minute volume
4. PAUSE TIME 96 The time in seconds for one SIMV cycle is calculated from the formula 60 preset SIMV freq The SIMV cycle is divided into SIMV period and spontaneous period The spontaneous period consists of spontaneous breathing time if the patient has triggered a mandatory breath during the previous SIMV period If the patient has insufficient spontaneous breathing the maximum time between two mandatory breaths is just over one SIMV cycle cp 1 to 2 in the picture above i SIMV cycle 10 s i H O 8 Hi SIMV period 4 s Spontaneous period 6 s SIMV period 4 s Spontaneous period 6 s During the SIMV period no breath has been triggered The next period begins with a mandatory breath After that spontaneous breathing To ensure adequate ventilation apnea alarm is activated if the time between two breaths exceeds approx 15 sec and the minute volume alarm is activated if any of the preset alarm limits is exceeded Either of these alarms is a command to take the necessary action e g clinical judgement of the patient increased SIMV frequency altered trig sensitivity The SIMV period is approx equal to one respiratory cycle The spontaneous period is calculated as SIMV cycle SIMV period Example BREATHS min 15 gt SIMV period 60 4 s 15 SIMV BREATHS min 6 gt SIMV cycle 60 10s 6 Spontaneous period 10 4 6 s A patient trig during the SIMV period initiates breath with
5. Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME Manual ventilation Set the values to be used after completed manual ventilation Set the WORKING PRESSURE Set the mode selector at MAN Set the mixer Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for O CONC 96 Set the parameter selector Make sure that the manual ventilation valve is in position MAN Set the PRESET INSP MIN VOL l min Set the value so that the breathing bag becomes satisfactorily filled Set the UPPER PRESS LIMIT for AIRWAY PRESSURE Set the PEEP level Q Manual ventilation valve in position MAN To protect the patient against high pressures always start from a low value Set the scale INFANTS ADULTS Connect the patient and check that the patient s chest rises and falls when manual ventilation is performed the tidal volumes on the digital display and the reading on the EXPIRED MINUTE VOLUME meter that the AIRWAY PRESSURE meter gives a reading during inspiration and that the reading falls to 0 cm or alternatively to PEEP level during expiration Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME Chapter 8 Clinical judgement and Troubleshooting Clinical judgement when an alarm indicates that preset ventilation can no longer be maintained If possible try to first eliminate technical faults by carrying out a check on functions In
6. TRIG SENSITIVITY Set the scale INFANTS ADULTS Connect the ventilator to the patient and check that the patient s chest rises and falls in time with the preset respiratory rate the tidal volumes on the digital display and the reading on the EXPIRED MINUTE VOLUME meter that the AIRWAY PRESSURE meter gives a reading during inspiration and that the reading falls to 0 cm H O or alternatively to PEEP level during expiration Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME If the VOL CONTR SIGH mode is selected it may be necessary to increase the UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME as well as the UPPER PRESS LIMIT for AIRWAY PRESSURE This is done in order to avoid activating the alarms when the sigh occurs PRESS CONTR MITITI M Connect the patient Set the WORKING PRESSURE Set the mode selector at PRESS CONTR Set the respiratory rate BREATHS min Set the INSP TIME 96 Set the PAUSE TIME Set the mixer Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for O CONC 96 Set the parameter selector Set the INSP PRESS LEVEL Set the PEEP level To protect the patient against high pressures always start from a low value Set the UPPER PRESS LIMIT for AIRWAY PRESSURE Set the TRIG SENSITIVITY Set the scale INFANTS ADULTS Connect the patient and adjust the INSP PRESS LEVEL so that the patient receives decided tidal
7. VOL ALARM GAS SUPPLY ALARM VOL CONTR VOL CONTR SIGH PRESS CONTR OPRESS SUPPORT VOL CONTR VOL CONTR SIGH PRESS CONTR OPRESS SUPPORT VOL CONTR VOL CONTR SIGH PRESS CONTR OPRESS SUPPORT VOL CONTR VOL CONTR SIGH PRESS CONTR OPRESS SUPPORT 3 Check for leakage Connect gases according to chapter 5 Set the following WORKING PRESSURE 60 cm H O PRESET INSP MIN VOL 7 5 I min BREATHS min 10 PAUSE TIME 30 constant flow and INSP TIME 25 Cover the Y piece Servo Humidifier and make sure that AIRWAY PRESSURE and the manometer WORKING PRESSURE show the same reading during inspiration and pause Press and hold the INSP PAUSE HOLD button and make sure that the AIRWAY PRESSURE reading does not drop more than 3 cm H O during 5 seconds Release INSP PAUSE HOLD and make sure that the AIRWAY PRESSURE reading falls to 0 during expiration If AIRWAY PRESSURE drops more than allowed block the outlet pipe on the insp side and repeat as described If the pressure drop is within the allowed limit the leakage is to be found in the breathing system or the exp channel 4 Check of manual ventilation accessory Applicable to manual ventilation accessory with motor Attach a test lung 2 Separate the valve and the motor units and make sure that alarm is activated 3 Set mode selector to MAN an
8. and on the connector agree Replace the rubber valve in the expiration channel Assemble the parts of the expiration channel Put a new pressure transducer tube and bacteria filter on the pipe of the expiration channel Connect the filter to the pressure transducer marked EXP Push the expiration channel into position Thread the silicone rubber bend onto its supporting pin Make sure that the expiration valve is not bent or twisted Make sure that the pressure transducer tube is not bent or pinched Connect the connector to the flow transducer Make sure that the serial numbers on the transducer and on the connector agree Connect manual ventilation accessory O FLUSH quick coupling if required and new patient tubes VOL CONTR Note on the log sheet that a complete cleaning has been carried out Calibrate the ventilator see chapter 13 Check Calibrate the O cell see chapter 12 Carry out a check on functions see chapter 6 After autoclaving in certain autoclaves the flow transducers may be somewhat damp and this may give rise to incorrrect readings on the EXPIRED MINUTE VOLUME meter The moisture is removed in the following Way Connect the ventilator to mains Connect a test lung to the Y piece Connect compressed air to the ventilator and let it run for about 15 minutes with a PRESET INSP MIN VOLUME of 7 5 l min Store the ventilator u
9. e Flow pattern T EUEL e A BREATHS min 10 breaths NSP PRESS LEVEL 0 em H O min O Concentration INSP TIME 96 25 LOWER ALARM LIMIT 20 96 PAUSE TIME 96 30 UPPER ALARM LIMIT mE 100 96 Expired minute volume Measuring range ADULTS LOWER ALARM LIMIT 0 l min UPPER ALARM LIMIT 40 l min Calibration 2 Check on mechanical zeroing of instruments During this check the ventilator must not be connected to mains or to a gas supply Check that the meters EXPIRED MINUTE VOLUME and AIRWAY PRESSURE read 0 If not adjust the meters 3 Balancing of flow transducers Open the lid on the pneumatic unit Open the lid above the trimmers variable resistors NOTE The adjustment of trimmers is very sensitive When adjusting turn the trimmers very slowly while watching the lamp List of trimmers Exp flow Gain Exp flow Lamp Insp flow Gain Insp flow Lamp Exp pressure Gain Exp pressure O setting Insp pressure Gain Insp pressure O setting O 96 10 O 0 volt Connect the ventilator to mains Set the mains switch on the rear of the ventilator to on Make sure that the green lamp POWER ON lights up when you switch on Let the ventilator run at least 15 minutes Then adjust a Flow transduce
10. min 7 s i If gas evacuation should be used Connect the gas evacuation accessory Setthe LOWER ALARM LIMIT to the value which is to be used during the treatment Remove the test lung disconnect Make sure that the LOWER ALARM LIMIT is activated Make sure that the EXPIRED MINUTE VOLUME meter reading is at least 2596 below the alarm limit setting If the alarm is not activated Set PEEP to 1 cm H O Check the alarm and meter reading as described above or Decrease the evacuation flow until the alarm is activated Also check the meter reading as described above Upper alarm limit Turn the knob UPPER ALARM LIMIT to 7 5 l min and make sure that the alarm is activated at 7 5 0 5 l min Turn the knob UPPER ALARM LIMIT to 40 l min amp UPPER PRESS LIMIT VOL CONTR MIN VOL ALARM 0 ALARM 8 O alarm Set the parameter selector at O CONC 95 Set the gas mixer at the lowest O concentration value air and make sure that the digital display shows 20 22 Set the gas mixer so that 40 is read on the digital display Lower alarm limit Turn LOWER ALARM LIMIT clockwise and make sure that alarm is activated when the knob setting corresponds to the digital display 1 scale division Turn LOWER ALARM LIMIT to 1896 Upper alarm limit Turn UPPER ALARM LIMIT counter cloc
11. of concentration despite adequate O supply indicates that the O cell is exhausted Upper pressure limit airway pressure The airway pressure exceeds the preset upper pressure limit When the alarm is activated inspiration and or pause in progress is immediately terminated and changed to expiration The alarm is given as a single audible signal and a visual flashing signal Alarm limit expired minute volume Upper or lower alarm limit has been exceeded There are two alarm limit settings UPPER ALARM LIMIT 3 43 l min adults 0 4 3 l min infants 0 37 l min adults 0 3 7 l min infants LOWER ALARM LIMIT Apnea alarm The APNEA ALARM is activated with audible signals and flashing light if the time between any two consecutive breaths spontaneous or mandatory or a combination of the two is greater than approximately 15 seconds 4 breaths per minute or less The APNEA ALARM is not intended to and will not monitor for disconnections The APNEA ALARM is operative in CPAP PRESS SUPPORT SIMV and SIMV PRESS SUPPORT Gas supply alarm This alarm is inoperative if the respiratory rate exceeds 80 breaths min with inspiration time 20 or 25 In the CPAP and PRESS SUPPORT modes a patient trig is required to activate the alarm Alarm schedule Alarm Visible Audible SET O ALARM Mains power failure APNEA ALARM The green lamp goes out The button must be depressed until the alar
12. out of scale the yellow lamp SET MIN VOL ALARM flashes The alarm limits are normally set at approx 2096 below and above the selected minute volume The upper limit may be set at approx 30 above the selected minute volume in the mode VOL CONTR SIGH The APNEA ALARM is activated with audible signals and flashing light if the time between any two consecutive breaths spontaneous or mandatory or a combination of the two is greater than approximately 15 seconds 4 breaths per minute or less The APNEA ALARM is not intended to and will not monitor for disconnections The APNEA ALARM is operative in CPAP PRESS SUPPORT SIMV and SIMV PRESS SUPPORT Failure of gas supply to the ventilator will result in visual and audible GAS SUPPLY ALARM signals The GAS SUPPLY ALARM is not operative at respiratory rates over 80 breaths min and INSP TIME 20 or 25 Special functions Under the small hood below the UPPER ALARM LIMIT knob are three pushbuttons for special functions Inspiratory pause hold When the pushbutton INSP PAUSE HOLD is depressed the valves close after inspiration and the pause is prolonged as long as the pushbutton is depressed This provides an exact measurement of the end inspiratory lung pressure It may also give time for an equilibration of the blood gas and alveolar pressures Expiratory pause hold The valves are closed after the expiration as e e e long as the pushbutton EXP PAUSE HOLD
13. the preset values A patient trig during the spontaneous period opens the inspiratory valve and the patient can breathe through the ventilator Supported and spontaneous ventilation 3 SIMV cycle 10 s o SIMV Spontaneous E period 4 s period 6 s o o i z il These settings determine a the SIMV period SI ra This setting determines the cx SIMV pressure support SIMV cycle The main difference between this mode and the SIMV mode is that the spontaneous triggered breaths are pressure supported The level of support is set with the control INSP PRESS LEVEL The level also includes PEEP SIMV cycle See also description of pressure support on page 2 13 SIMV period Spontaneous period INSP PRESS LEVEL Pressure OorPEEP level 71 TRIG SENSITIVITY Flow Mandatory breath Pressure supported Sponianapue breaths Spontaneous ventilation CPAP In this mode CPAP Continuous Positive Airway Pressure the patient breathes spontaneously PEEP through the ventilator at an elevated pressure level The positive pressure is set with the PEEP control The TRIG SENSITIVITY control must be set at a position which allows the patient to trigger the ventilator Upon triggering the inspiration valve opens and the patient can inspire through the ventilator and control the tidal volume and TRIG SENSITIVITY respiratory rate To avoid self triggering du
14. this chapter Clinical judgement 8 2 Technical troubleshooting 8 6 Clinical judgement Minute volume LOWER ALARM LIMIT for EXPIRED MINUTE VOLUME has activated an alarm Cause Symptoms and diagnostic Suggested treatment aids Leakage between the tracheal wall and tracheostomy tube or cannula An air leakage may be detected by palpation or auscultation over the trachea Correct cuff pressure If the leakage cannot be sealed increase the PRESET INSP MIN VOL so that expired minute volume settles at a suitable level Leakages mainly occur during the inspiration phase and the pause at the end of inspiration when the pressure in the trachea is high Prolonged inspiration time Temporary increase of lung volume Variations in measured expired minute voume spontaneous breaths or sigh Ventilation obstruction resulting in a pressure activated interruption of inspiration UPPER PRESS LIMIT for AIRWAY PRESSURE has also activated an alarm See UPPER PRESS LIMIT for AIRWAY PRESSURE Insufficient patient respiration during SIMV CPAP PRESS SUPPORT Variations in the measured expired minute volume Revert to normal ventilation or SIMV position which gives an increased controlled ventilation In SIMV increase the SIMV BREATHS min or the preset tidal volume In PRESS SUPPORT increase the INSP PRESS LEVEL if the tidal volume is too small but the
15. transducer on the expiration side measures the gas flow from the patient To prevent condensation the transducer is heated to approx 60 C The pressure transducer on the expiration side measures the airway pressure The expiration valve is closed during inspiration During the expiratory phase it is either fully open or regulating the PEEP level The flap valve prevents a back flow of exhaled gases It is also necessary for the trigg function Outputs for Equipotential socket On Off switch Fuse holders Mains inlet socket Control Recorder auxiliary terminal output equipment Rear of Control terminal Servo Ventilator 900 C To the right on the electronic unit are the mains inlet socket fuse holders On Off switch voltage rating equipotential socket and operating time meter To the left on the electronic unit are three 15 pole sockets for auxiliary equipment The 37 pole socket is used for recording of pressure and flow curves There are labels with the serial number of the apparatus on both the pneumatic unit and the electronic unit Under the secured lid there is a connector for external control of ventilation For details see separate Operating Manual Chapter 2 Control panel and ventilation modes In this chapter Panel design and symbols 2 2 Panel functions 2 3 Working pressure 2 3 Mode selection 2 3 Respirat
16. volumes and check the reading on the EXPIRED MINUTE VOLUME meter that the AIRWAY PRESSURE meter gives a reading during inspiration and that the reading falls to 0 cm H O or alternatively to PEEP level during expiration Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME Supported ventilation PRESS SUPPORT 1 Connect the patient Set the WORKING PRESSURE Set the mode selector at PRESS SUPPORT Set the respiratory rate BREATHS min determines the length of inspiration time Set the mixer Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for O CONC Set the parameter selector Set the INSP PRESS LEVEL Set the PEEP level To protect the patient against high pressures always start from a low value Set the UPPER PRESS LIMIT for AIRWAY PRESSURE Set the TRIG SENSITIVITY Set the scale INFANTS ADULTS Connect the patient and check that he can trigger the ventilator Adjust the INSP PRESS LEVEL so that the patient receives decided tidal volumes and check the reading on the EXPIRED MINUTE VOLUME meter that the AIRWAY PRESSURE meter gives a reading during inspiration and that the reading falls to 0 cm or alternatively to PEEP level during expiration Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME SIMV Connect the patient Set the WORKING PRESSURE Bor the mode selector at SIMV Set the
17. 13 Calibration Chapter 7 Connection to patient Be careful when moving the ventilator from the preparation room to the operating theatre If you bump into something it may be necessary to check the functions before connection to patient For detailed description of the functions see chapter 2 In this chapter Compressible volume and dead space 7 2 Controlled ventilation VOL CONTR or VOL CONTR SIGH 7 4 PRESS CONTR 5 Supported ventilation PRESS SUPPORT 7 6 7 7 SIMV PRESS SUPPORT 7 8 Spontaneous ventilation os nr 7 9 Compressible volume and dead space 10 4 20 28 10 Ps 2 80 VOL CONTR INSP TIDAL VOL Compensation for compressible volume Some of the preset minute volume does not reach the patient because it is needed for compression of gas in tubes and humidifier The compressible volume of the Servo Ventilator itself is negligible When setting the preset insp minute volume the compressible volume must be compensated for by adding a corresponding minute volume to the minute volume for the patient Compensation procedure Connect the complete breathing system with patient tubes and Servo Humidifier or heater humidifier to the Servo Ventilator Set WORKING PRESSURE at 60 cm H O Set the front panel values as shown
18. Gas and power supply Gas consumption Gas supply via high pressure inlet Electronic gas supply unit inlet pressure Other gas supply unit inlet pressure Gas supply via low pressure inlet Power SUDDIY eda een Power consumption sene Ventilation controls control ranges Working pressure ir Preset inspiratory minute volume Respiratory Tate iecit tenes Inspiration time essee Pause tlImie recette rires Inspiratory pressure above PEEP ids Upper pressure limit Trig sensitivity below PEEP SIMV rate NI E Compressible volume internal Special functions Inspiratory pause hold Expiratory pause hold Gas change Monitoring Analog presentation AirWay pressure enean te Loan Must fulfill specifications for medical gases Approximately equal to preset inspiratory minute volume or equal to flow meter setting From central gas supply compressor or gas cylinder 2 5 5 bar 250 500 kPa 2 5 7 bar 250 700 kPa From flowmeter s 100
19. M flash Connect gases Alternative 1 via O air mixer or via O N O mixer e Set the desired O concentration Alternative 2 via O N O O air mixer and vaporizer Connect a Halothane Enflurane or Isoflurane vaporizer Set the desired concentration Alternative 3 via low pressure flowmeters Connect air via low pressure flowmeters necessary pressures at least equal to WORKING PRESSURE Set the desired flow proportions of O and N O on the flowmeters so that the total gas flow exceeds PRESET INSP MIN VOL of the ventilator by 10 2096 The working pressure will be constant and the flow pattern unchanged in mode VOL CONTR In other ventilation modes only breaths with limited tidal volumes can be maintained The limitation is shown by falling WORKING PRESSURE Alternative 4 compressed air Connect compressed air Check on functions Carry out a check on functions according to chapter 6 Chapter 6 Check on functions A check on functions must always be carried out after cleaning and before connecting a patient Accessories Patient tubes Y piece test lung and manual ventilation accessory If any malfunction is detected during the check see chapter 8 Troubleshooting or chapter 13 Calibration In this chapter 1 Checks prior to connection of power 5 6 2 2 Start up 6 2 3 Check for leakages 6 3 4 Ch
20. MAQUET SERVO VENTILATOR 900 C OPERATING MANUAL GETINGE Important General information Servo Ventilator 900 C must be operated only by authorized personnel who are well trained in its use It must be operated according to the instructions in this Operating Manual After unpacking the ventilator must be checked and if necessary calibrated All data on pressures for Servo Ventilator 900 C are given in cm H O 1 kPa kilopascal 10 cm H O 100 kPa 1 bar 1 atm 1 kgf cm kp cm 100 kPa 15 psi Responsibility for the safe functioning of the equipment reverts to the owner or user in all cases in which service or repair has been done by a non professional or by persons who are not employed or authorized by MAQUET and when the equipment is used for other than its intended purpose A full technical description including circuit diagrams parts list and service data is contained in the service documentation copies of which are held by your supplier Connection When connected to a patient the ventilator must never be left unattended A check on functions must be done before a patient is connected to the ventilator When anaesthetic gas is metered via a flow meter on the low pressure inlet compressed air must not be connected at the same time To avoid explosion hazards flammable agents such as ether and cyclopropane must not be used in this machine Only agents which comply with the requirements
21. Pressure flow from gas source not enough Fault in gas supply Low pressure connection increase gas volume pressure High pressure connection check gas source mixer Large tidal volumes and short inspiration times set on ventilator Incorrectly adjusted inlet valve in gas supply unit Change respiratory pattern or gas volume To be dealt with by service technician WORKING PRESSURE reading is 0 but GAS SUPPLY ALARM not activated Tube connection is loose between the safety valve and the manometer for WORKING PRESSURE Connect tube connections WORKING PRESSURE reading is 0 GAS SUPPLY ALARM is activated Alarm is also activated for the LOWER ALARM LIMIT for EXPIRED MINUTE VOLUME Working pressure not set Insufficient gas supply Deformed valve arm on gas supply unit Set working pressure Check gas connections gas mixers flowmeters To be dealt with by service technician No airway pressure Malfunction Possible cause Action AIRWAY PRESSURE reading is 0 Loose tube between inspiration channel and pressure transducer Attach the tube UPPER PRESS LIMIT ALARM for AIRWAY PRESSURE has been activated Malfunction Possible cause Action Accumulation of secretion Suction of trachea Kink in tracheal tube Remove the kink or replace the tube Patient tries to breathe increased muscle tonus Clinical judgement The tracheal tube has slipp
22. RWAY PRESSURE has activated an alarm Combined with an interruption of inspiration in which case LOWER ALARM for EXPIRED MINUTE VOLUME may also have been activated Cause Symptoms and diagnostic Suggested treatment aids Airways obstructions In cases of substantial obstructions recordings of flow and airway pressure indicate increased airway resistance Increased elastic resistance low compliance may also occur at the same time When the UPPER PRESS LIMIT for AIRWAY PRESSURE is repeatedly exceeded and at the same time accompanied by interruptions of inspiration the expired minute volume falls and an alarm is activated a Accumulation of mucus in airways Auscultatory rales Rhoncal fremitus on parts of the chest Suction Expectorants Physiotherapy b Bronchospasm Bronchit Whistling or wheezing respiratory sounds during auscultation Bronchodilator drugs etc c Tracheostomy tube or cannula has slipped out of the trachea or has been kinked or twisted so that the opening is blocked The cuff protrudes over the opening of the tube or cannula Coagulate or dried mucus block the airway Often occurs suddenly and with variations Difficult to insert a suction catheter Resistance is felt when ventilating manually with a breathing bag Removal of kinks or correction of position Possibly a reduction of pressure in the cuff and possibly a replacement of tracheostomy tube o
23. Servo Ventilator 900 C Water trap Mobile cart 5 Y piece Mixer Bacteria filter Extra equipment Humidifier CO Analyzer 930 Nipple connector Lung Mechanics Calculator 940 Patient tubes Mingograf Recorder Muff angled Recorder Cable for Servo Ventilator 900 C Nipple Manual ventilation accessory Nipple Flex tube Angled connector Cup for water trap Anesthesia 1 Two proposals are given regarding the set up of Servo Ventilator 900 C in anesthesia applications This is only an example of a possible set up Some of the equipment shown is available in different versions e g for adults and children For details please see Products and Accessories catalogue and for patient tubing Assembling instructions with order form Basic equipment Servo Ventilator 900 C Mobile cart Mixer Vaporizer b Bacteria filter Nipple connector Manual ventilation accessory Tube joint Breathing bag Patient tubes 1 Y piece Servo Humidifier Nipple connector Flex tube 9 Angled connector Gas evacuation equipment Extra equipment CO Analyzer 930 Lung Mechanics Calculator 940 Mingograf Recorder Recorder Cable for Servo Ventilator 900 C Anesthesia 2 This is only an example of a possible set up For details please see Products and Some of the equipment shown is available in Accessories catalogue and for patient tubing different versions e g for adults and child
24. a service contract with MAQUET The 1000 hours overhaul shall be done after every 1000 operating hours or at the latest every six months In addition the ventilator shall undergo a technical safety check twice a year at six months intervals according to national regulations Service and repairs on the ventilator may be done only by MAQUET authorized personnel Only original parts from MAQUET must be used in the ventilator Equipment combinations Only MAQUET approved accessories and auxiliary equipment may be connected to the ventilator n order to maintain system safety and integrity only accessories complying with IEC 601 1 or the safety of which has been verified in another way must be connected to the signal outputs on the rear of the ventilator For details on connections and allowed voltages please see Circuit Diagram Product information program This Operating Manual is a part of a comprehensive information program for Servo Ventilator 900 C The program is planned to contain the following Promotional and Scientific Publications Brochure Servo Application Product Leaflet Reprints Ventilator Brochures Concept Intensive Care Anesthesia Transportation Operating and Service Instructions Brief Wall Diagram Service Manual Circuit Diagram Operating with Cleaning Instructions Instructions Product Training Material The Patient s ABSee Cards and Poster Training Advisory Slide Series
25. am breathing Instructions Booklet including through a for Instructors Textbook ventilator Film and Booklet Front Panel Panel Block Trainee s set Video programs Flip chart Video guide Video news Servo Ventilator 900 C Front 40 3n m eae aa v LOWER ma V upper 9 ALARM LIMIT ALARM LIMIT SENSITIVITY BELOW PEEP Itt e FIN 18 41 20 DULTS i imn E ta PEEP INSP PRESS L AhncNE PEEP J LOW ir 9i HIGH c s SIMY BREATHS min SRY PAESS SUPPORT VOL HGH PREES CONTA 4 qi surroer ul it INSP TIME PAUSE TIME 535 PEF pee 100 ag 100 LOWER ALARM LIMIT PP UPPER ALAFIM LIMIT NS TIDAL mi EXP TRIAL VOL mi i EXP VOL bria PALSE PRESS om rg 4 MEAN AIRMAN PRESS em Hac Operating instructions Servo Ventilator 900 C is simple to operate Operating instructions are found On the ventilator in the form of a panel and cleaning instructions on the lid of the pneumatic unit Normal settings are indicated in green on the front panel Settings indicated in red should be used with caution since these settings may involve a certain risk for the patient In the Brief Operating Instructions in the drawer under the ventilator A log sheet is available with the Brief Operating Instructions Aft
26. an airway pressure Alarms and indicators Push button PA TIRES TTL OD T Alarms M Gas supply Apnea alarm Expired minute volume eese concentration Upper pressure limit Power failure ADULTS range 0 40 l min Accuracy for momentary exp flow up to 1 6 1 5 5 or 0 5 l min INFANTS range 0 4 l min Accuracy for momentary exp flow up to 1 6 l s 5 or 0 2 l min Range 5 120 breaths min Accuracy in controlled ventilation 10 or 1 breath min Presented in by volume Range 20 100 Accuracy applying for the barometric pressure and working pressure at which the O2 cell is calibrated 5 of read value Range 0 1999 ml Accuracy for momentary insp flow up to 1 6 l s 10 or 0 2 l min resp rate Range 0 1999 ml Accuracy for momentary exp flow up to 1 6 1 5 5 or 0 2 l min resp rate ADULTS range 0 40 l min INFANTS range 0 4 l min Accuracy for momentary exp flow up to 1 6 I s 5 or 0 2 l min Range 0 120 cm H20 Accuracy 5 or 2 cm H20 Range 0 120 cm H2O Accuracy 5 or 2 cm H20 Range 0 120 cm H20 Accuracy 5 or 2 cm H20 Audible signals below marked muted for 2 minutes max Flashing red light audible signal Inoperative at respiratory rates hi
27. atient s own breathing efforts are insufficient When the patient triggers the ventilator an inspiration pressure support is given at a preset constant pressure The ventilator regulates the pressure during inspiration so that it corresponds to preset INSP PRESS LEVEL PEEP The pressure during expiration drops to 0 cm H O or alternatively to PEEP level The change from inspiration to expiration occurs when the flow decreases to 25 of the peak inspiratory flow There are also safety functions to control the change from inspiration to expiration for instance in the case of a leakage Expiration will then start when the step motor has closed the inspiratory valve and the airway pressure has increased to 3 cm H O above the preset INSP PRESS LEVEL PEEP or after 80 of the preset respiratory cycle Because of this safety function the respiratory rate should always be set with the knob BREATHS min SIMV cycle 105 Pressure Flow A patient trig during the SIMV period initiates mandatory breath After that spontaneous breathing SIMV SIMV Synchronized Intermittent Mandatory Ventilation means that a preset number of breaths are ventilator controlled mandatory breaths SIMV BREATHS min The patient may breathe spontaneously between those breaths Breathing pattern and tidal volume for the mandatory breaths are selected with the knobs PRESET INSP MIN VOL BREATHS min INSP TIME and
28. ation Example 2 Preset insp time 8096 80 inspiration Preset pause time 3096 0 pause 20 expiration The settings are independent of changes in the patient s compliance and resistance Inspiratory flow In mode VOL CONTR constant flow or SIMV the inspiratory flow is calculated by PRESET INSP MIN VOL l min INSP TIME 96 Example PRESET INSP MIN VOL l min 8 l min INSP TIME 96 25 Results in an inspiratory flow 8 100 25 32 l min Or Adjustment of INSP TIME use reverse value 20 1 5 5 25 1 1 4 33 4 3 50 1 2 67 21 5 1 5 80 4 25 1 25 x PRESET INSP MIN VOL inspiratory flow l min EXPIRED MINUTE VOLUME KLAAR LIMIT INFANTS e ADIRTS 0 40 i m n E kmid B caverns Expired minute volume EXPIRED MINUTE VOLUME is indicated on a meter which has dual scales 0 40 l min and 0 4 l min The scale 0 4 l min is intended for use when greater accuracy e g for infants is needed The knobs for LOWER ALARM LIMIT and UPPER ALARM LIMIT also have the same dual scales The end stop positions for the knobs do not coincide with the end positions on the scale This is correct and no attempt should be made to alter the range The desired scale is selected with the switch INFANTS ADULTS The alarm limits for expired minute volume must always be set If either of the knobs has been set in end position
29. d make sure that alarm is activated 4 Set the valve arm to MAN and attach the valve unit to the motor unit 5 Push O FLUSH and make sure that the breathing bag fills 6 Set VOL CONTR 7 Compress the breathing bag and make sure that there is no leakage the gas remains in the breathing bag 8 Set MAN 9 Compress the breathing bag with one hand to fill the test lung With the other hand immediately compress the test lung and make sure that the expiration valve opens 10 Let the breathing bag hang loose and be filled Then make sure that the EXPIRED MINUTE VOLUME meter drops to O Alarms 5 Upper pressure limit alarm T Set the mode selector at VOL CONTR r Block the Y piece Servo Humidifier Turn the knob UPPER PRESS LIMIT to 55 cm H O Make sure that inspiration is terminated and the alarm is activated Turn the knob back to 80 cm 6 Minute volume e NET ON Set the respiratory rate at 20 BREATHS min M 5 75 20 Connect a test lung T Te Set the parameter selector at EXP MIN VOL l min Make sure that the digital display and the meter EXPIRED MINUTE VOLUME read 7 5 0 5 l min after a few minutes 7 Minute volume alarm EXP MIN Lower alarm limit 3 5 VOL l min Turn the knob LOWER ALARM LIMIT to T 7 5 l min make sure that the alarm is activated at 7 5 0 5 l min Turn the knob LOWER ALARM LIMIT to E 0 l
30. e Action Leakage in the expiratory channel which causes spontaneous triggering when PEEP is used in the presence of leakages Chapter 9 Recording The ventilator can be connected to a recorder e g a Siemens Elema Mingograf In this chapter Connection Recorder output Connect the recorder cable to the 37 pin socket at the rear of the ventilator The cable has two connections to the Mingograf Recorder i e one for recording of pressure curves and one for recording of flow curves The output signals from the recorder cable are adapted to the inputs of Siemens Elema s Mingograf Recorders Calibration amp 0 II O Ojo 10 171 10 lo oo Rim VOL CONTR a Flow Adjust the O line on the recorder Set WORKING PRESSURE to 60 cm H O Set the UPPER PRESS LIMIT higher than the WORKING PRESSURE Select constant flow Set the respiratory rate to 10 BREATHS min Set the mode selector at VOL CONTR Calculate inspiratory flow as follows Insp flow 1 5 PRESET INSP MIN VOL l min is 60 s 100 INSP TIME A suitable calibration level for normal conditions is to allow 0 5 1 5 correspond to 1 cm deflection on the recorder paper 0 5 l s corresponds to a setting of 7 5 l min for PRESET INSP MIN VOL and 25 INSP TIME After this adjust the recorder to desired reading b Pressure Adjust the O line on the recorder Block the in
31. e are safety catches on the PEEP knob at 0 and at 20 cm H O In case of a leakage e g if a tracheal tube without cuff is being used the PEEP setting may cause self triggering To avoid this the TRIG SENSITIVITY should be set at a somewhat lower value The PEEP knob is prepared for NEEP Negative End Expiratory Pressure In order to use NEEP it is necessary to connect auxiliary equipment to the expiration outlet The NEEP range is from 0 to 10 cm H O TRIG SENSITIVITF BELO 1 PRESS LEVEL ass PEEP Trig sensitivity The knob TRIG SENSITIVITY is used to set the value of negative pressure that the patient must produce in order to trigger a breath The TRIG SENSITIVITY is relative to PEEP For instance PEEP 10 and TRIG SENSITIVITY 2 cm H O mean that the patient must produce a pressure of 2 cm H O relative to the setting to trigger a breath This corresponds to a pressure of 8 cm H O relative to atmospheric pressure in the patient s airways The airway pressure measured on the expiration side is compared with the preset TRIG SENSITIVITY PEEP If the airway pressure drops below TRIG SENSITIVITY PEEP a breath is triggered If it is desirable for the patient to be able to easily trigger the ventilator the knob is set at green value If it is undesirable for the patient to be able to trigger the ventilator the knob is set at 20 cm H O Trig sensitivity is connected in all modes e
32. e to leakage the trig level should be set at a low value Se ee at If CPAP PEEP 0 it will be possible to j check the patient s ability to breathe spontaneously without help from the ventilator The minute volume tidal volume and respiratory rate can be monitored Pressure Flow Manual ventilation W Motor valve unit Electronic unit Mode selector If the breathing bag becomes overfilled the expiratory valve in the ventilator may go to a locked position To unlock the valve Set UPPER PRESS LIMIT below 20 cm H O Squeeze the breathing bag and check that the pressure in the bag is lowered Set UPPER PRESS LIMIT back to the lowest possible value for normal operation If the breathing bag becomes overfilled with the manual ventilation valve in posotition AUT Manual ventilation The Manual Ventilation Accessory with Motor consists of two units e Electronic unit e Motor valve unit With this accessory switching between manual ventilation and other modes is done with the mode selector The valve is automatically set to the correct position by a motor The switch over time is about 5 seconds An alarm with audible signals and red light is activated if the positions of the valve and mode selector are not the same In position MAN the breathing bag is filled to a pressure of about 4 cm H O then the inspiratory valve closes When the breathin
33. eck manual ventilation 6 3 5 Upper pressure limit 767 6 4 6 Minute volume 6 4 7 Minute volume alarm 6 4 8 0 2 2 2 6 5 9 Apnea alarm 6 5 10 Digital display 6 6 11 Check on pressure levels 6 6 12 Mains supply failure 6 6 13 Log sheet 6 6 Prechecks If preparation and prechecks according to chapter 5 have been done start from para 3 0j eof oe ac 20 80 0201100 4 Checks prior to 14 connection of power and gas Connect patient tubes Y piece holder arm and humidifier Make sure that the meters for AIRWAY PRESSURE and EXPIRED MINUTE VOLUME give a zero reading Set the mode selector at VOL CONTR Set alarm limits to end positions according to the picture Set the scale range for ADULTS Set the TRIG SENSITIVITY to 20 cm H O Set the UPPER PRESS LIMIT to 80 cm H O Set PEEP and INSP PRESS LEVEL to 0 cm H O e e e e e 2 Start up Connect the ventilator to mains Set the mains switch on the rear of the ventilator to on Make sure that the green lamp lights up when you switch on Make sure that the meters for AIRWAY PRESSURE and EXPIRED MINUTE VOLUME still give a zero reading Make sure that GAS SUPPLY ALARM activates Make sure that SET MIN VOL ALARM and SET O ALARM flash e e e e i POWER ON OSET ALARM SET MIN
34. ect the patient by alerting ward personnel to any malfunctions Alarms are given with audible signals and flashing red lights An audible signal only is given as alarm for power failure and certain technical malfunctions Some audible alarms can be switched off for a period of approximately 2 minutes For details see the alarm schedule on page 3 4 In addition there are panel indicators with fixed or flashing yellow lights Examples are given in chapter 8 Troubleshooting regarding actions for various alarms The patient is protected against high pressure by an electronic limiter which is controlled by the knob UPPER PRESS LIMIT If the value set with this knob is too high or if the limiting function should fail the pressure is limited to the set WORKING PRESSURE The WORKING PRESSURE is prevented from exceeding the set value by a safety valve and cannot be set at values exceeding 120 cm H O As an extra patient safety protection against too high an airway pressure there is a HIGH PRESSURE PROTECTION circuit incorporated when either of the modes CPAP PRESS CONTR or PRESS SUPPORT is selected This protection circuit functions when the airway pressure in the inspiration channel for some reason e g coughing exceeds 30 cm H O above INSP PRESS LEVEL PEEP level Important The SV 900 is not designed to withstand severe negative pressures which if applied to the system may damage the internal pressure transducers re
35. ectronic unit The electronic unit contains a number of plug in PC boards with the circuits for regulation alarms and monitoring The unit effects the electronic control of the pneumatic unit Servicing of the ventilator is facilitated by the spare parts exchange system The faulty parts are replaced by factory trimmed exchange parts Service on the electronic unit must be done by MAQUET or by MAQUET authorized personnel only Pneumatic unit Gas connection The upper inlet not visible in the picture is used for low pressure gas and the lower inlet is used for high pressure gas For anaesthesia a gas supply unit with three inlets is available The gas supply is regulated by a valve so that a constant pressure is maintained in the bellows The O cell measures the O concentration in the gas The gas flows through a bacteria filter The respiratory gases are mixed and stored at a constant pressure in the bellows The working pressure is set with an adjustment screw A manometer shows the working pressure A safety valve opens if the bellows is overfilled or if the pressure exceeds approx 120 cm H O The flow transducer on the inspiration side measures the gas flow to the patient The inspiration valve regulates the inspiratory gas flow It is closed during the pause and expiratory parts of the respiratory cycle The pressure transducer on the inspiration side measures the airway pressure The flow
36. ed down into a bronchus Correct the tube position Spasms in respiratory airways Medicaments Change in patient s positioning e g on operation table Possible change of respiratory pattern Pneumothorax Suction drainage Sigh Set the UPPER PRESS LIMIT alarm somewhat higher 0o Technical trouble Minute volume LOWER ALARM LIMIT for EXPIRED MINUTE VOLUME has been activated Malfunction Possible cause Action Connection between patient and ventilator has loosened Reconnect the connections e g Y piece trach tube patient tube water trap Leakage in trach tube cannula cuff Adjust the cuff or change trach tube cannula cuff Changes in upper airway pressure so that the expiration valve opens at attained upper pressure limit Same action as for UPPER PRESS LIMIT alarm for airway pressure Insufficient patient respiration during SIMV SIMV PRESS SUPPORT PRESS SUPPORT or CPAP Change SIMV rate INSP PRESS LEVEL or change to controlled ventilation Working pressure too low lower than the airway pressure needed to provide preset ventilation Increase working pressure or change respiratory pattern Insufficient gas supply e g from flowmeters At low pressure increase gas flow At high pressure check gas source mixer Leakage due to poor assembling of parts of inspiration channel or expiration channel A
37. ed airway pressure When excess gas is being scavenged the scavenging System must meet the following requirements At the point at which the scavenging system is connected to the ventilator the sub atmospheric pressure must not exceed 0 5 cm H O or cause an induced flow from the breathing system greater than 0 5 l min With continuous air flows of 30 l min and 90 l min for not less than 5 seconds at the inlet of the anaesthetic gas scavenging system the resistance in the system shall not exceed 0 25 cm H O and 2 5 cm H O respectively The Servo Evac 180 basic evacuation unit meets these requirements If the ventilator is equipped with electronic gas supply unit the following applies When mains supply is switched off or in the case of power failure the gas supply is automatically blocked Cleaning The ventilator must not be gas sterilized The flow transducers must not be cleaned in a dish washing machine by ultrasonic methods or by using agents that contain aldehydes Agents used for cleaning must have a pH value between 4 8 5 Complete cleaning should be done after every 1000 hours of operation or at the latest after every six months Service The Servo Ventilator 900 C must be serviced at regular intervals by specially trained personnel Any maintenance must be noted in the log book provided for that purpose in accordance with national regulations We recommend that Service is done as a part of
38. er certain routines e g cleaning etc the person responsible for the work should complete and sign the log sheet The log sheet can then be filed On a separate wall poster with cleaning instructions In this Operating Manual The inside of the cover shows a picture of the ventilator This picture can be used as a foldout when reading the manual The following information is found in the corresponding chapters Technical specifications Contents uh Basic principles Control panel and ventilation modes Patient safety Set ups Preparations Check on functions Connection to patient Clinical judgement and troubleshooting O oj o Gc1 5 o6 n Recording 14 Technical specifications Chapter 1 Basic principles In this chapter General design 1 2 Pneumatic unit 1 3 Rear a o 1 4 General design Pneumatic unit The pneumatic unit comprises the gas conduction system pressure and flow transducers and control valves The control of flow and pressure is done by a feed back system The transducers continually measure the flow and pressures The information is compared with the panel settings and a difference between the actual and the preset values results in correction signals to the control valves For detailed description see chapter Basic principles in the Training Instructions Low pressure High pressure El
39. er than the highest airway pressure Mode selection The Servo Ventilator 900 C can be operated in 8 different modes which are selected by means of the mode selector The modes are described in special sections in this chapter Controlled ventilation Volume controlled ventilation VOL CONTR Volume controlled ventilation sigh VOL CONTR SIGH Pressure controlled ventilation PRESS CONTR Supported ventilation Pressure supported ventilation PRESS SUPPORT SIMV Synchronized Intermittent Mandatory Ventilation SIMV Pressure support SIMV PRESS SUPPORT Spontaneous ventilation CPAP Continuous Positive Airway Pressure Manual ventilation MAN Respiratory pattern Preset inspiratory minute volume The inspiratory minute volume is set with the knob PRESET INSP MIN VOL l min The knob has a locking button on the underside A suitable initial value can be calculated by for instance using a Radford nomogram The minute volume can be readjusted after indication from a CO Analyzer 930 which is auxiliary equipment for the Servo Ventilator The setting range is 0 4 40 l min The tidal volume PRESET INSP MIN VOL l min BREATHS min The tidal volume can be read on the digital display At extremely high flows it may be necessary to increase the working pressure in order to obtain the desired minute volume Flow pattern switch During VOL CONTR and VOL CONTR SIGH a constan
40. fference between the digital display and the meter EXPIRED MINUTE VOLUME must not be more than 0 5 l min Check that the lamp at trimmer 2 lights up at inspiration and pause If not repeat calibration according to 3B After 6 8 breaths make sure that the reading is stable 13 Volume alarms Lower alarm limit Turn the knob LOWER ALARM LIMIT to 7 5 l min and make sure that the alarm is activated at 7 5 0 5 l min Turn the knob LOWER ALARM LIMIT to 0 l min Upper alarm limit Turn the knob UPPER ALARM LIMIT to 7 5 l min and make sure that the alarm is activated at 7 5 0 5 l min Turn the knob UPPER ALARM LIMIT to 40 l min 14 O cell Set the parameter selector at O CONC 95 The digital display should read 20 9 with compressed air connected and WORKING PRESSURE 60 cm H O If not adjust with trimmer 9 Normally trimmer 10 needs not to be adjusted If necessary see chapter 12 Make sure that the UPPER ALARM LIMIT and LOWER ALARM LIMIT are functioning correctly 15 Log sheet Note on the log sheet that the ventilator has been calibrated Chapter 14 Technical specifications In this chapter Gas and power supply 14 2 Ventilation parameters and controls 14 2 Special functions 14 2 Monitoring 14 2 Alarm and indicators 14 3 General 14 4 Technical specifications
41. for the patient 9 0 l min Set BREATHS min item 9 zi Read PAUSE PRESSURE item 10 24 cm H O Compensation for compressible volume item 11 88 x 24 7 0 6 1000 60 PRESET INSP MIN VOL item 12 9 0 0 6 9 6 l min Compensation for dead space Servo Humidifier 151 35ml When setting PRESET INSP MINUTE VOLUME Servo Humidifier 152 55 ml dead space in the breathing system between the Servo Humidifier 153 incl flex tube 70ml and the patient should also be CO cuvette adult for 930 CM 130 5ml compensated for CO cuvette infant for CA 930 CM 130 2 5 ml Dead space for some accessories is shown in the table to the left Controlled ventilation VOL CONTR or VOL CONTR SIGH Connect the patient Set the WORKING PRESSURE Set the mode selector at VOL CONTR or VOL CONTR SIGH Set the desired minute volume e g by means of a Radford nomogram Select the curve shape for the inspiration flow Set the respiratory rate BREATHS min Set the INSP TIME 96 Set the PAUSE TIME Set the mixer Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for O CONC 95 Set the parameter selector Set the PEEP level miet rer Seifin S To protect the patient against high pressures always start from a low value Set the UPPER PRESS LIMIT for AIRWAY PRESSURE to approximately 10 cm H O above the patient s airway pressure Set the
42. fter about 24 hours make sure that the O cell gives a stable reading 20 996 with compressed air connected If the reading is not 20 996 calibrate as described above Log sheet Note on the log sheet that the O cell has been replaced and calibrated Calibration The calibration must be carried out after the 1000 hours overhaul and after complete cleaning In this ed f zeroing Dol 3 Balancing of flow transd cer S mauuanuuananauuzuuy 4 Electric zeroing 5 Gas supply and working p ess ire 6 Check of manometer and for internal leakage Pressure transducers 8 Upper pressure limit airway pressur 9 Triggering level 10 Flow inspiration side 11 Check for external 12 Flow expiration ES EE 13 Volume alarms 14 cell onec ceca 15 Log sheet cos 13 3 13 4 13 4 13 5 13 5 13 6 13 6 13 7 ET 13 8 13 8 13 Preparations Equipment e Calibration manometer e Screwdriver e 2 patient tubes e Y piece e Test lung DOME eee ee BOUC 1 Basic settings for calibration Set the following on the ventilator VOL CONTR Airway pressure Respiratory pattern duc SENSITIVITY on H0 PRESET INSP MIN VOLUME 7 5 l min UPPER PRESS LIMI Mrd
43. g bag is squeezed the gas flows to the patient via a non return valve Always set UPPER PRESS LIMIT at the lowest possible value for normal operation The APNEA alarm is inoperative during manual ventilation In the case of a power failure manual ventilation is not possible unless an external power pack is connected PEEP cannot be used in manual ventilation mode Set the mode selector to VOL CONTR immediately before connecting the ventilator to a patient The reason is to zero the gas flow reading At spontaneous breathing during manual ventilation the following readings will be incorrect the displayed values for BREATHS min EXP TIDAL VOLUME and EXP MINUTE VOLUME the alarm monitoring instrument EXPIRED MINUTE VOLUME The accuracy of the EXPIRED MINUTE VOLUME meter reading decreases After about 5 minutes the accuracy is about 2 l min To get a correct meter reading the breathing bag should be squeezed at least every 5 minutes For spontaneous breathing the PRESSURE SUPPORT mode is recommeded The INSP PRESS LEVEL should be set at zero or at a low value This Remove the breathing bag Exchange the manual ventilation valve enables continuous monitoring of pressure and volume Chapter 3 Patient safety In this chapter Protective devices 3 2 Alarm schedule 3 4 3 1 Protective devices Alarms There are a number of alarms on the ventilator which prot
44. gainst high pressures always start from a low value Set the INSP PRESS LEVEL Set the PEEP level Set the UPPER PRESS LIMIT for AIRWAY PRESSURE Set the TRIG SENSITIVITY Set the scale INFANTS ADULTS Connect the patient and check that he can trigger the ventilator Adjust the INSP PRESS LEVEL so that the patient receives the decided tidal volumes and check the reading on the EXPIRED MINUTE VOLUME meter that the AIRWAY PRESSURE meter gives a reading during inspiration and that the reading falls to 0 cm H O or alternatively to PEEP level during expiration Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME Spontaneous ventilation CPAP 10 Connect the patient Set the WORKING PRESSURE Set the mode selector at CPAP Set the mixer Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for O CONC Set the parameter selector Set the PEEP level Set the UPPER PRESS LIMIT for AIRWAY PRESSURE To protect the patient against high pressures always start from a low value Set the TRIG SENSITIVITY Set the scale INFANTS ADULTS Connect the patient and check that he can trigger the ventilator the tidal volumes on the digital display and the reading on the EXPIRED MINUTE VOLUME meter that the AIRWAY PRESSURE meter gives a reading during inspiration and that the reading falls to 0 cm H O or alternatively to PEEP level during expiration
45. gher than 80 breaths minute and INSP TIME 20 or 25 The APNEA ALARM is activated with audible signals and flashing light if the time between any two consecutive breaths spontaneous or mandatory or a combination of the two is greater than approximately 15 seconds 4 breaths min or less The APNEA ALARM is not intended to and will not monitor for disconnections The APNEA ALARM is operative in CPAP PRESS SUPPORT SIMV and SIMV PRESS SUPPORT Flashing red light audible signal 1 4 Flashing red light audible signal Red light audible signal Green light POWER ON goes out audible signal for approximately 5 minutes Indicators Set minute volume Set Pressure Support neni denies CGPAB LL eC a OPE ANON gt aR DAMES SIMV HIGH LOW RATE Expired minute volume INFANTS General Specified accuracies apply for medical air and imply that the ventilator is calibrated according to the Operating Manual For accuracies specified in more than one way the highest value applies Alarm limit unset Flashing yellow light Alarm limit unset Flashing yellow light Mode indication Yellow light Mode indication Yellow light Mode indication Yellow light Mode and range indication Two yellow lights Range indication Yellow light
46. ion are set with the knobs UPPER ALARM LIMIT and LOWER ALARM LIMIT The SET O ALARM flashes if the alarm limits have not been set The end stop positions for the knobs do not coincide with the end positions on the scale This is correct and no attempt should be made to alter the range The alarm limits are set as follows Set O concentration on the gas mixer flowmeters Set the parameter selector at O CONC and read the value Set the alarm limits at approx 6 by volume 3 scale divisions below and above the concentration reading on the digital display Visual and audible alarms are activated when any of the alarm limits is exceeded If the O cell is expended but still mounted in the ventilator the cell has to be disconnected If not the LOWER ALARM LIMIT will activate alarm If no O cell is mounted neither digital displays nor alarm is activated when the parameter selector is set at CONC 96 Parameter selection A digital display of the O concentration is given when the selector is set in position O CONC 95 Other displayable parameters are INSPIRED TIDAL VOLUME mi the volume provided by the ventilator at each breath EXPIRED TIDAL VOLUME mi the volume produced by the patient at each breath with no leakage in the patient circuit EXPIRED MINUTE VOLUME l min also indicated on the EXPIRED MINUTE VOLUME meter PEAK PRESSURE cm H O the pressure at the end of the inspiration pha
47. is depressed i e a prolonged expiratory pause INSP EXP GAS This provides an exact measurement of the end expiratory lung pressure PAUSE PAUSE CHANGE HOLD HOLD Gas Change The pushbutton GAS CHANGE is used for instance when it is desirable to rapidly alter the gas mixture to the patient The concentration setting on the vaporizer gas mixer flowmeters must be altered first The inspiration and expiration valves open so that the pressure in the patient circuit is max 20 cm H O During the gas changing time the EXPIRED MINUTE VOLUME meter is zeroed automatically UPPER PRESS LIMIT Airway Pressure Airway pressure meter The meter continually indicates the airway pressure reading Upper pressure limit The knob UPPER PRESS LIMIT is used to set the upper limit for airway pressure When this pressure limit has been reached inspiration is immediately discontinued and there is a change over to the expiratory phase Visual and audible alarms are activated Since the inspiration is discontinued the complete tidal volume will not be delivered and consequently the LOWER ALARM LIMIT for EXPIRED MINUTE VOLUME may be activated Upper pressure limit is connected in all modes There are safety catches on the knob at 80 and 100 cm H O PEEP PEEP is the setting of a Positive End Expiratory Pressure e g used to counteract the formation of atelectasis The PEEP range is from 0 to 50 cm H O Ther
48. kwise and make sure that alarm is activated when the knob setting corresponds to the digital display 1 scale division Turn UPPER ALARM LIMIT to 100 9 Apnea alarm Set TRIG SENSITIVITY at 10 Set the mode selector at PRESS SUPPORT Make sure that the APNEA ALARM is activated approx 15 s after the mode change Pressures pont PRESS CONTR 10 10 10 EXP 10 Digital display Set the parameter selector at BREATHS min Make sure that the value set with the BREATHS min knob corresponds to the BREATHS min value read on the digital display 11 Check on pressure levels Set the mode selector at PRESS CONTR Set BREATHS min to lowest value Set PEEP at 10 cm Set INSP PRESS LEVEL at 10 cm H O Make sure that the reading on the AIRWAY PRESSURE meter remains at 20 2 cm H O during inspiration Make sure that a PEEP level of 10 2 cm H O is maintained on the AIRWAY PRESSURE meter at the end of expiration Set PEEP and INSP PRESS LEVEL at 0 cm H O Set the mode selector at VOL CONTR 12 Mains supply failure alarm Switch off the ventilator with the mains switch on the rear Make sure that the green lamp POWER ON goes out and the audible alarm sounds 13 Log sheet Note on the log sheet that a check on functions has been carried out If any malfunctions are detected during the check see chapter 8 Troubleshooting or chapter
49. lie in a 70 ethyl alcohol solution for about one hour Ethyl alcohol If solutions other than ethyl alcohol are used rinse the solution from the flow transducer by carefully moving the transducer to and fro in a bowl containing distilled water Water Let the water run off the flow transducer after rinsing Make sure that the fine mesh net in the transducer is not blocked or damaged and that the disc in the small channel is in position Manual ventilation valve in position MAN 1 hour aren ai 20 Disinfectant f the manual ventilation valve should be cleaned do as follows Set the valve in the MAN position and let it lie in a 7096 ethyl alcohol solution for about one hour Let the other parts NOTE not the flow transducer and manual ventilation valve lie in a disinfectant for about one hour After this rinse the parts in water to remove the disinfectant Autoclave all parts including the flow transducer and manual ventilation valve at a maximum temperature of 150 C 300 Assembling Put a new bacteria filter with tube on the pressure transducer marked EXP Assemble the expiration channel Connect the tube from the pressure transducer on the expiration side to the metal pipe Make sure that the pressure transducer tube is not bent or pinched The tube should be placed below the silicone rubber muff Push the expiration channel down into posi
50. m stops EIL Mirua PODC Chapter 4 Set ups The Servo Ventilator 900 C is designed for several different applications It can be positioned in many different ways e g on a cart on an anesthesia table on a wall rail or in an ambulance or a helicopter In this chapter Intensive Care 4 2 Anesthesia 4 4 Patient transportation 4 6 Intensive care 1 Two proposals are given regarding the set up different versions e g for adults and children of Servo Ventilator 900 C in intensive care For details please see Products and This is only an example of a possible set up Accessories catalogue and for patient tubing Some of the equipment shown is available in Assembling instructions with order form Basic equipment Extra equipment Servo Ventilator 900 C CO Analyzer 930 Mobile cart ang Mechanics Calculator 940 Mixer Mingograf Recorder Recorder Cable for Servo Ventilator 900 C Clamp Manual ventilation accessory Support arm Bacteria filter Nipple connector Patient tubes Y piece Servo Humidifier Nipple connector Flex tube Angled connector Intensive care 2 This is only an example of a possible set up For details please see Products and Some of the equipment shown is available in Accessories catalogue and for patient tubing different versions e g for adults and children Assembling instructions with order form Basic equipment Exp water trap
51. more look for leakage Remove the calibration manometer Connect a patient tube from the inspiration outlet to the expiration inlet Keep the expiration valve closed The reading on the meter AIRWAY PRESSURE should not fall more than a few cm H O during the time the inspiration valve is closed If the reading falls more look for leakage in the expiration channel T Pressure transducers a Inspiration side Keep the expiration valve closed Check that the meter AIRWAY PRESSURE gives the same reading as the manometer WORKING PRESSURE 60 1 cm H O If not adjust with trimmer 7 b Expiration side Keep the expiration valve closed and depress the pushbutton Check that the meter AIRWAY PRESSURE gives the same reading as the manometer WORKING PRESSURE 60 1 cm H O f not adjust with trimmer 5 e of 6 3 TRIG SENSITIVITY 8 Upper pressure limit airway pressure Block the inspiration outlet Turn the knob UPPER PRESS LIMIT slowly counter clockwise from the position 80 cm H O until you reach the exact position where the alarm lamp for UPPER PRESS LIMIT flashes At this instant the readings for WORKING PRESSURE and AIRWAY PRESSURE should agree with the knob setting 3 cm If not the electronic unit is faulty and must be repaired by a service technician Turn the knob back to 80 cm H O 9 Triggering level Remove your hand from the inspiration ou
52. mpliance Adjustment of tube position d Pneumothorax Often occurs suddenly Reduced respiratory sounds and increased percussive tone over the affected side Sometimes followed by subcutaneous emphysema Roentgenologic changes Out suction of air in pleura TRIG SENSITIVITY lamp flashes Cause Symptoms and diagnostic aids Suggested treatment Patient triggers spontaneous breaths The airway pressure SIMV not used is usually negative or under preset PEEP level only at the start of inspiration Negative pressure or pressure under preset PEEP level during the whole inspiration indicates a considerable deviation between preset minute volume and the minute volume the patient needs SIMV treatment normally Patient triggering is more often acceptable and suitable Usually the patient requires a larger gas volume than that supplied by the controlled breaths In cases of unexpected patient triggering an increase of preset minute volume should be considered Technical trouble Power Ventilator does not start Possible cause Power cable not connected Blown fuse in ventilator On Off switch in the Off position Ventilator stops during operation Possible cause No mains supply Loose connection Technical trouble Pressures Fault in working pressure Malfunction Possible cause Action Working pressure varies
53. nd presettings 5 2 Connections 5 3 Prechecks and presettings ky Make sure that the ventilator has been cleaned Pm Urs see the log sheet of o fe al 20 20 100 e eR fT mis n cuba iun 1 Set the following on the ventilator e Mode selector at VOL CONTR e Alarm limits to end positions according to the picture e Scale range for ADULTS e TRIG SENSITIVITY to 20 cm H O e UPPER PRESS LIMIT to 80 cm H O e PEEP and INSP LEVEL to 0 cm H O Make sure that the meters for EXPIRED MINUTE VOLUME and AIRWAY PRESSURE give a zero reading If not see Calibration chapter 13 Connections Connect patient tubes holder arm humidifier test lung and if required manual ventilation accessory and gas evacuation accessory For details see previous chapter If required connect CO Analyzer 930 and Lung ntum Mechanics Calculator 940 Connect the ventilator to mains Set the mains switch on the rear of the ventilator to on The switch has to be pulled out before switching Make sure that the green lamp lights up when you switch on amp POWER ON Make sure that the meters for EXPIRED i8 GAS SUPPLY ALARM MINUTE VOLUME and AIRWAY PRESSURE 3 SET MIN VOL ALARM still give a zero reading If not see SET O ALARM Calibration chapter 13 Make sure that the GAS SUPPLY ALARM activates Make sure that the SET MIN VOL ALARM and SET O ALAR
54. nder a cover in normal room temperature and humidity Chapter 12 Replacement of O cell The O cell is an expendable item An indication of an expended O cell is a deterioration of the linearity and or a rapid drop in the O concentration readings on the digital display To avoid alarm when the O cell is exhausted the connector at the top of the O cell must be disconnected If the O cell is removed a plastic cover with an O ring has to be put in its place In this chapter Replacement 12 2 Calibration 12 2 Log sheet 12 2 12 Replacement and calibration rm a 5 Replacement Unpack the O cell at least 30 minutes before replacement calibration Disconnect mains supply and compressed air Disconnect the connector at the top of the O cell Remove the O cell by turning it counter clockwise Connect the ventilator to mains supply and let it run for about 15 minutes Set the parameter selector at CONC 96 Depress the pushbutton and adjust with trimmer 10 until the display reads 00 0 Put the new O cell in place by turning it clockwise Do not forget the O ring at the bottom of the O cell Connect the connector at the top of the O cell Calibration of O cell Connect compressed air Set WORKING PRESSURE to 60 cm H O The digital display should read 20 9 If not adjust with trimmer 9 A
55. ndering the unit inoperable Transducer pressure range SV 900 up to and including SIN 188499 are factory equipped with pressure transducers that will tolerate pressures down to 100 cm H20 mbar whereas units from S N 188500 are factory equipped with pressure transducers that will tolerate pressures ranging from 500 cm H20 mbar to 500 cm H20 mbar Earlier units may have been retrofitted with Transducer Upgrade 12102 featuring the same pressure tolerance as units with S N 2188500 Uppgraded units are identified with a label Upgrade EMO12 02 l attached to the inside of the pneumatic unit lid If closed system suctioning is applied the following must be considered A suctioning flow exceeding the flow delivered by the ventilator will result in a negative pressure affecting the patients airways as well as the ventilators breathing system Do not use the Pause hold function during the procedure Set minute volume alarm Indicates that the alarm limits for expired minute volume have not been set Mains power failure The green lamp for POWER ON goes out Slow audible signals which stop after 5 10 minutes Set O alarm Indicates that the alarm limits for O concentration have not been set Alarm limit O concentration Upper or lower alarm limit has been exceeded If no O cell is mounted neither digital displays nor alarm is given A deterioration in the linearity and or a rapid fall in the values
56. nections Disconnect the power cable Remove the patient tubes humidifier and manual ventilation accessory Also disconnect the O FLUSH quick coupling if used Wipe the outside of the ventilator with a cloth moistened in a disinfectant Open the lid on the pneumatic unit Open the lid over the bellows by releasing the locking pawls on the front edge of the lid Remove the bellows Discard the bellows Disconnect the connectors to the flow transducers Remove the bacteria filters from the pressure transducers marked INSP and EXP Lift the inspiration channel excluding the safety valve straight upwards Remove the safety valve Remove the bacteria filter of the manometer tube from the safety valve Luer lock adapter Discard the filter Lift the expiration channel straight upwards Dismantle the parts in the inspiration and expiration channels Discard the rubber valve in the inspiration and expiration channels Discard the tubes and bacteria filters for the pressure transducers Grasp the gas connection nipples and lift the gas supply unit straight upwards Unscrew the filter container with a hexagonal spanner 5 mm Discard the blue bacteria filter Remove the connector at the top of the O cell Remove the O cell by turning it counter clockwise Discard the O cell if it is exhausted Cleaning Let the flow transducers lie in a 70 ethyl alcoh
57. nt and the inspiration time is doubled The first sigh will occur at the second inspiration after setting the mode selector to VOL CONTR SIGH The UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME may have to be set somewhat higher in this mode Pressure controlled ventilation In the mode PRESS CONTR gas is delivered at a constant pressure during the set inspiration time The pressure is set with the knob INSP PRESS LEVEL The flow is decelerating in this mode The set inspiratory pressure respiratory rate and inspiration time determine the volume the patient will receive Servo Ventilator 900 C works with a constant pressure during the entire inspiration The minute volume can be read on the EXPIRED MINUTE VOLUME meter Tidal volume can be read on the digital display with the parameter selector in position INSP TIDAL VOLUME or EXP TIDAL VOLUME In case of leakage in the system e g due to the use of a tracheal tube without cuff a pause time of 0 is recommended to ensure that the measurement of the expired minute volume will be as correct as possible A patient trigg initiates a breath with the preset values Flow o Pressure Supported ventilation Rh Trig Pressure supported ventilation PRESS SUPPORT is a spontaneous breathing mode in which the patient must trigger breaths Some applications for PRESS SUPPORT are weaning patients suffering from asthma or in post operative use when the p
58. ol solution for about one hour Water If solutions other than ethyl alcohol are used rinse the solution from the flow transducers by carefully moving the transducer to and fro in a bowl containing distilled water Let the water run off the flow transducers after rinsing Make sure that the fine mesh nets in the transducers are not blocked or damaged and that the disc in the small channel is in Manual ventilation position N valve in position MAN Clean the manual ventilation valve Set the valve in the MAN position and let it lie in a 7096 ethyl alcohol solution for about one hour Clean the gas supply unit e Open the gas supply unit Put the lid gasket and screws ina disinfectant for about one hour Wipe the outside of the gas supply unit with a soft cloth moistened in a disinfectant e e Let the other parts lie in a disinfectant solution for about one hour NOTE Not the flow transducers manual ventilation valve O cell and gas supply unit e After cleaning and rinsing all parts not the O cell and gas supply unit can be autoclaved at a maximum temperature of 150 C 300 F aue MAX 150 C Assembling Insert a new blue filter in the filter container Ensure that the filter is positioned correctly i e with the indicating arrow in the flow direction Tighten the filter container Put if required a new O cell with O ring in place by
59. on non flammable agents in the IEC standard Particular requirements for electrical safety of anaesthetic machines are suitable in this machine As this machine is not suitable for use with flammable agents such as ether and cyclopropane the use of antistatic breathing tubes and face masks is not necessary The use of antistatic or electrically conductive breathing tubes when using high frequency electric surgery equipment may cause burns and is therefore not recommended in any application of this machine Never connect or disconnect auxiliary equipment to the outlet on the rear of the ventilator when the ventilator is connected to mains All gases must fulfill the specifications for medical grade gas The gases supplied must be dry and free from oil and dust Air lt 5 g m Oil lt 0 5 mg m H O lt 20 mg m H O 58 ppm Oxygen Nitrous oxide gaseous phase Operation The APNEA ALARM is not intended to and will not monitor for disconnections The APNEA ALARM is not functional in VOL CONTR VOL CONTR SIGH PRESS CONTR or MAN In the case of a power failure manual ventilation using a Servo Ventilator 900 C is possible only with the help of power supply from external battery A resuscitator should always be available however as an extra safety measure The SV 900 C is certified with regard to safety to be compatible with electromagnetic environments complying with IEC 601 1 2 It is the responsibility of the u
60. ory pattern 2 4 IE ratione 2 5 Expired minute volume 2 6 Special functions 2 7 Airway pressure 2 8 SST ee ee US 2 10 o 2 11 Parameter selection 2 11 Controlled ventilation 2 12 Supported ventilation 2 13 Spontaneous ventilation 2 15 Manual ventilation 2 16 Panel design and symbols For easy operation the panel is divided into The blue scale is always to be used when the fields Each field is described in this chapter low range is selected Normal settings are indicated in green on Power on is indicated by a green lamp the front panel Settings indicated in red should A yellow lamp is either an indication of a be used with caution since these settings may certain setting or a reminder to set an alarm involve a certain risk for the patient limit A number of knobs and the EXPIRED A red lamp always indicates an alarm MINUTE VOLUME meter have dual scales Working Pressure Mode Selection Respiratory Pattern Expired Minute Volume Special Functions Airway Pressure SIMV O Concentration Alarm Monitoring Panel functions 31M e PRESS SUPPORT Y f CONTR F md CPAF 5 TOL CONTA SIGH MAN D PALES CONTR C PRESS SUPPORT Working pressure The working pressure is set with an adjustment screw and is read on the manometer WORKING PRESSURE The working pressure must always be set at a value somewhat high
61. patient has adequate respiratory rate UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME has activated an alarm Cause Symptoms and diagnostic aids Suggested treatment Temporary decrease in lung volume Variations in measured expired minute volume spontaneous breaths compression of the lungs during thoracic surgery Increase in respiration rate A signal is also given by the yellow lamp below TRIG SENSITIVITY indicating that the patient triggers breaths at a faster rate than the preset basic rate of the ventilator However in volume controlled ventilation the patient can also be breathing at the same rate as the preset rate on the ventilator In assisted ventilation check the BREATHS min on the digital display In conjunction with suction of the trachea and other measures and also due to a number of other factors hypoxia rise in temperature pain restlessness physical activity physiotherapy etc increased ventilation may be necessary The patient can compensate for an increased demand on ventilation by using the patient triggering System if it is set at a suitable level If the necessity of increased ventilation is long term this indicates some action like increasing the ventilation volume but with increased oxygen supply reduction of oxygen consumption by sedatives analgesics and antipyretics 8 3 400 Clinical judgement Pressures UPPER PRESSURE LIMIT for AI
62. r cannula In case of an absolute blockage it may be necessary to withdraw the cannula or tube The blockage can often be located in the orifice of the tube Cause Symptoms and diagnostic aids Suggested treatment Reduced elasticity of the respiratory organs Recordings of flow and pressure indicate a high elastic resistance low compliance a Increased muscular tonus in the patient Coughing Sometimes caused by mucus often after suction The patient works against the ventilator Temporary increase of minute volume and BREATHS min Often more convenient for the patient if the inspiratory flow is increased by reducing INSP TIME until negative airway pressure caused by spontaneous breathing ceases Consider administering analgesics and sedatives Blood gas tests Adjustment of ventilator settings and alarm limits b Atelectasis pneumonia pulmonary edema Reduced respiratory sounds over affected sections of the lungs Possible rales during auscultation Roentgenologic changes Often accompanied by hypoxia Check of blood gases PEEP physiotherapeutic treatment change of patient s position postural drainage sigh function c Blockage of main bronchus The cause is often that the tracheal or the tracheostomy tube has slipped too far down Reduced respiratory sounds Roentgenologic changes Irregular movements of the thorax Hypoxia increased resistance and reduced co
63. r on insp side Adjust trimmer 4 until the lamp at trimmer 4 lights up b Flow transducer on exp side Adjust trimmer 2 until the lamp at trimmer 2 lights up 4 Electric zeroing a Airway pressure pressure transducer of insp side Check that the meter AIRWAY PRESSURE reads 0 If not adjust with trimmer 8 AIRES FRESEURE T b Airway pressure pressure transducer of exp side Keep the pushbutton depressed and at the same time check that the meter reads 0 f not adjust the reading with pushbutton depressed with trimmer 6 ANETE c Expired minute volume Set the parameter selector at EXP MIN VOL l min Check that the digital display and the meter EXPIRED MINUTE VOLUME read O If not the electronic unit is faulty and must be VOL l min repaired by a service technician 5 Gas supply and working pressure Connect compressed air Set the WORKING PRESSURE to 60 cm H O 6 Check of manometer and for internal leakage Connect a calibration manometer to the inspiration outlet pipe Block the calibration manometer Check that the manometer WORKING PRESSURE gives the same reading as the calibration manometer 60 2 cm HO If not replace the WORKING PRESSURE manometer The reading on the meter AIRWAY PRESSURE should not fall more than a few cm H O during the time the inspiration valve is closed If the reading falls
64. rate LOW RATE HIGH RATE Set the SIMV BREATHS min Set the PRESET INSP MIN VOL l min Set the respiratory rate BREATHS min Set the INSP TIME 95 M the PAUSE TIME 95 Set the mixer Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for O CONC To protect the patient against high pressures always start from a low value Set the parameter selector Set the PEEP level Set the UPPER PRESS LIMIT for AIRWAY PRESSURE Set the TRIG SENSITIVITY Set the scale INFANTS ADULTS Connect the patient and check that the patient can trigger the ventilator the tidal volumes on the digital display and the reading on the EXPIRED MINUTE VOLUME meter that the AIRWAY PRESSURE meter gives a reading during inspiration and that the reading falls to 0 cm or alternatively to PEEP level during expiration Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME SIMV PRESS SUPPORT Set the WORKING PRESSURE Set the mode selector at SIMV PRESS SUPPORT Set the rate LOW RATE HIGH RATE Set the SIMV BREATHS min Set the PRESET INSP MIN VOL l min Set the respiratory rate BREATHS min Set the INSP TIME 95 Set the PAUSE TIME Set the mixer Set the LOWER ALARM LIMIT and UPPER ALARM LIMIT for CONC 96 Set the parameter selector B EUM Nm i Wi m mum PE om Fili s To protect the patient a
65. ren Assembling instructions with order form Basic equipment Servo Humidifier Servo Ventilator 900 C Nipple connector Anesthesia table Flex tube Rotameter box Angled connector Mixer Gas evacuation equipment Bacteria filter Suction equipment Nipple connectors Extra equipment CO Analyzer 930 Lung Mechanics Calculator 940 Manual ventilation accessory Tube Tube joint Mingograf Recorder Breathing bag Recorder Cable for Servo Ventilator 900 C Patient tubes Y piece Patient transportation A proposal is given regarding the set up of Some of the equipment shown is available in Servo Ventilator 900 C during patient different versions e g for adults and children transportation within the hospital in an For details please see Products and ambulance or a helicopter accessories catalogue and for patient tubing This is only an example of a possible set up Assembling instructions with order form Basic equipment Servo Humidifer Servo Ventilator 900 C Nipple connector Mobile cart Flex tube Mixer Angled connector Vaporizer Bacteria filter Power pack Manual ventilation accessory Gas cylinders Tube Tube joint Breathing bag Extra equipment CO Analyzer 930 Lung Mechanics Calculator 940 Patient tubes Y piece Chapter 5 Preparations If any malfunction is detected during the preparations see chapter 8 Troubleshooting or chapter 13 Calibration In this chapter Prechecks a
66. rmission of the copyright owner in writing 0803 0 6 Subject to alterations without prior notice 9th English edition August 1997 Issued by Maquet Critical Care AB SE 171 95 SOLNA Sweden MAQUET SERVO VENTILATOR 900 C OPERATING MANUAL
67. rmula Resistance cm H O l s 60 T PRESET INSP MIN VOL l min P cm x x Insp 100 Volume controlled or pressure controlled ventilation in order to calculate compliance Compliance is indicated by a pressure drop during the expiration phase e Big drop in pressure P somp indicates low compliance i e poor elasticity in lungs and chest i e high elastic resistance Compliance is calculated according to the following formula Compliance ml cm PRESET INSP MIN VOL l min BREATHS min x 1000 P omp cm H20 Not valid if the flow has not reached zero when the next expiration starts or if the patient makes breathing efforts In this chapter Hygiene 10 72 PM d 1 Ds RECEN ing sussauuzuzzuuuuuuruu 4 10 n Hygiene The gas which passes the ventilator s inspiration system and is supplied to the patient is usually clean and dry It also passes a bacteria filter The dry environment gives unfavorable conditions for bacterial growth and bacteria spreading against the gas flow is considered virtually impossible Bacteria from the patient will on the other hand appear in the moist environment of the expiration side By attaching a disposable bacteria filter to the expiratory inlet of the ventilator the transmission of bacteria to the expiratory channel and out into the room is reduced This reduce
68. s the risks of infections being spread to the staff as well as cross infections between patients Exchange or cleaning of patient tubes and the parts of the expiratory channel and exchange of expiratory bacteria filter is recommended after each patient or according to the hospital routines The bacteria filter should be replaced according to manufacturer recommendations The gas conveying parts of the expiration system can be decontaminated and sterilized The parts of the inspiration system should be sterilized or replaced by clean parts after an operating time of 1000 hours or at the latest half yearly according to chapters 10 and 11 in this manual All personnel should be aware of the risk of parts being infected when disassembling and cleaning the ventilator Dismantling Remove gas connections Disconnect the power cable Remove patient tubes humidifier and manual ventilation accessory e Remove the O FLUSH quick coupling if used Wipe the outside of the ventilator with a cloth moistened in a disinfectant Open the lid on the pneumatic unit Disconnect the connector from the flow transducer on the expiration side Remove the bacteria filter from the pressure transducer marked EXP Lift the whole expiration channel upwards Dismantle the different parts Discard the tube and bacteria filter for the pressure transducer Cleaning 1 hour Let the flow transducer
69. se PAUSE PRESSURE cm H O the pressure at the end of the pause This pressure normally corresponds to the maximal alveolar pressure in the lungs MEAN AIRWAY PRESSURE cm H O the mean value in the patient circuit continually measured BREATHS min the respiratory rate of the patient In controlled ventilation this value equals the set respiratory rate plus eventual patient triggered breaths In the SIMV mode it is the sum of the spontaneous and the mandatory breaths In the CPAP and PRESSURE SUPPORT modes the value represents the spontaneous breaths min of the patient Pressure Flow Flow Pressure Flow amp Pressure Controlled ventilation Volume controlled ventilation Volume controlled ventilation VOL CONTR ensures that the patient receives a certain preset tidal volume Servo Ventilator 900 C delivers a specific tidal volume at a specific rate during a specific time preset values If the patient makes inspiratory efforts so that the airway pressure falls below the triggering level a preset tidal volume will be delivered earlier and the expired minute volume will increase A constant or an accelerating flow can be selected A patient trigg initiates a breath with the preset values Volume controlled ventilation sigh In this mode of operation the Servo Ventilator 900 C delivers a sigh every hundredth breath At sigh double tidal volume is delivered since the flow is consta
70. ser to take necessary measures in order to ascertain that the specified limits are not exceeded as this may impair the safety of the ventilator Such measures should include but are not limited to normal precautions with regard to relative humidity and conductive characteristics of clothing in order to minimize the build up of electrostatic charges avoiding the use of radio emitting devices in close proximity of the ventilator such as high frequency surgery apparatus or cordless mobile telephones resulting in a field level exceeding 3 V m IEC 601 1 2 Magnetic fields of MR equipment having flux densities above 20 mT may cause deactivation of the ventilator functions and may result in permanent damage to the Servo Ventilator To protect the patient against high pressures the WORKING PRESSURE and UPPER PRESS LIMIT must always be set at suitable values Do not forget to set the manual ventilation valve to position AUT after completed manual ventilation Otherwise the patient may be hypoventilated without any alarm from the ventilator Not applicable to manual ventilation accessory with motor When mains supply is switched off or in the case of a mains power failure the inspiratory and expiratory valves will automatically open This may also occur in the case of an internal electronic failure Thus if the WORKING PRESSURE is set too high and the gas supply through the gas supply unit continues this may result in increas
71. spiration outlet during the inspiration phase or connect the inspiration outlet to the expiration inlet with a patient tube A suitable calibration level for normal conditions is to allow 20 cm H O correspond to 1 cm deflection on the recorder paper The preset WORKING PRESSURE should then temporarily be set to 20 cm H O Adjust the recorder to desired reading Airway pressure Flow Airway pressure Flow Curves Constant Accelerating Decelerating flow Insp Pause Exp flow flow Pressure and flow curves If the flow curve is square shaped and an inspiratory pause is used it will be possible to calculate from the pressure curve airway resistance and the elasticity of the lungs and rib cage i e compliance It is possible to continuously follow changes in these values in patients with obstructive lung diseases and also when ventilating patients for prolonged periods For all measurements it is assumed that the patient makes no breathing attempts It is possible to read the effects from the changes in the ventilation e g optimal PEEP or broncho dilating agents which give a direct change in resistance Assessment of curves Volume controlled ventilation and constant flow in order to calculate resistance Resistance is indicated by a pressure drop that occurs during the pause Big amplitude of pressure drop indicates high airway resistance Resistance is calculated according to the fo
72. ssemble correctly Leakage in ventilator Safety valve out of position Put the valve in position Connection to one of the pressure transducers has loosened Reconnect Rubber valve defect on insp exp side Replace rubber valve UPPER ALARM LIMIT for EXPIRED MINUTE VOLUME has been activated Malfunction Possible cause Action Deeper breaths in VOL CONTR SIGH increase in expired minute volume every hundredth breath Set the UPPER ALARM LIMIT somewhat higher Patient breathes more than expected during SIMV SIMV PRESS SUPPORT CPAP PRESS SUPPORT Clinical judgement Condensation in exp flow transducer Empty water trap if necessary Protect exp inlet by an angled humidity trap or a bacteria filter Dry run the ventilator with a test lung if these actions are not enough Particles of medicines in exp flow transducer Replace exp flow transducer or try to clean the transducer according to chapter 10 Flow transducer is defective Replace exp flow transducer Technical trouble Others cell Malfunction Possible cause Action No digital display when O O cell not inserted CONC is selected Insert an O cell see chapter 12 Rapidly falling O CONC values LOWER ALARM LIMIT activates an alarm a Insufficient supply b O cell exhausted c O cell not properly inserted a Regulate O
73. supply b Replace O cell see chapter 12 c Insert properly UPPER ALARM LIMIT activates an alarm Insufficient air N O supply Regulate gas supply Leakage detected in ventilator during check on functions Malfunction Possible cause Action Connection between safety valve and manometer has loosened Reconnect Leakage at inlet valve of gas supply unit Replace gas supply unit Leakage in non return valve of gas supply unit Replace gas supply unit Leakage in bellows Replace bellows see chapter 11 Overfilling of bellows safety valve opens caused by deformed valve arm on gas supply unit Valve arm to be adjusted by service technician Leakage in bacteria filter Replace gas supply unit Bad connections in the inspiratory or expiratory channel Connect properly Incorrect values readings during check on functions Malfunction Possible cause Action Ventilator not calibrated Calibrate ventilator see chapter 13 Noises Malfunction Possible cause Action Rattle from step motor Must be dealt with by service technician as soon as possible Singing noise from springs under the bellows Springs hook into one another Not dangerous and does not interfere with function of ventilator Dealt with by service technician when convenient Trig sensitivity flashes without activity from the patient Malfunction Possible caus
74. t or an accelerating inspiratory flow can be selected Constant flow gives a lower peak pressure and is the pattern normally used A decelerating flow will be obtained in PRESS CONTR Breaths per minute The respiratory rate is steplessly adjustable within the range of 5 to 120 BREATHS min Inspiration time 96 There are 6 fixed inspiration times 20 25 33 50 67 and 80 of the breathing cycle Pause time 96 There are 5 fixed pause times 0 5 10 20 and 30 of the breathing cycle LE ratio Insp Pause ratio time time 20 1 3 10 20 33 o 33 33 i 20 33 Dv 50 33 1 7 1 50 2 3 1 67 10 3 4 1 80 4 1 Reduced to 1396 To the left is a conversion table for INSP TIME and PAUSE TIME to I E ratio for those who are more used to working with the latter On the basis of an E ratio i e the relation of inspiration time to expiration time the pause is allocated to inspiration time For example insp time 2596 and pause time 10 EE ratio 35 65 approx 1 1 9 If the ventilator has been set so that insp time pause time exceeds 80 then expiration automatically begins when 2096 of the respiratory cycle remains safety function The pause time is then reduced Example 1 Preset insp time 67 67 inspiration Preset pause time 2096 13 pause 20 expir
75. tion Make sure that the expiration valve is not bent or twisted Connect the connector to the flow transducer Make sure that the serial numbers on the transducer and on the connector agree Fit the manual ventilation accessory O FLUSH quick coupling if required and new patient tubes Note on the log sheet that routine cleaning has been carried out Carry out a check on functions after cleaning see chapter 6 After autoclaving in certain autoclaves the flow transducer may be somewhat damp and this may give rise to incorrect readings on the EXPIRED MINUTE VOLUME meter The moisture is removed in the following way Connect the power cable Connect a test lung to the Y piece Connect compressed air to the ventilator and VOL CONTR let it run for about 15 minutes with a PRESET INSP MIN VOLUME of 7 5 l min Store the ventilator under a cover in normal room temperature and humidity After every 1000 hours of operation or after every six months at t est overhaul should be carried out In this chapter curre perd C IIT 11 4 16 11 1 Dismantling E Disposable parts 3 bacteria filters 2 with tubes for pressure transducers 1 without tube for WORKING PRESSURE manometer 7 C 1 blue main flow bacteria filter for gas supply unit Bellows 2 rubber valves insp and exp Net for exp flow transducer Remove the gas con
76. tlet Set the TRIG SENSITIVITY to 10 cm Turn the PEEP knob and check that the TRIG lamp lights up when 10 2 cm H O is passed If not the electronic unit is faulty and must be repaired by a service technician e Reset TRIG SENSITIVITY to 20 cm and PEEP to 0 cm H O 10 Flow inspiration side Set BREATHS min to 5 Connect a calibration manometer to the inspiration outlet Let compressed air blow through the calibration manometer for a few minutes Check that the reading on the calibration manometer is 45 5 cm H O during inspiration f not adjust with trimmer 3 Check that the lamp at trimmer 4 lights up at pause and expiration If not repeat calibration according to 3a After 6 8 breaths make sure that the calibration manometer reading is stable 45 5 cm HO Remove the calibration manometer yo EXP MIN 25 VOL l min MIN VOL ALARM LIMITS 11 Check for leakage external Set BREATHS min to 10 Connect tubes and Y piece Block the Y piece Make sure that the AIRWAY PRESSURE does not fall more than a few cm during pause 12 Flow expiration side Set the respiratory rate at 20 BREATHS min and PAUSE TIME at 10 Connect a test lung Set the parameter selector at EXP MIN VOL l min Let the ventilator run for a few minutes Check that the digital display shows 7 5 0 1 l min If not adjust with trimmer 1 The di
77. turning it clockwise Connect the connector to the top of the O cell Place the gas supply unit in the ventilator Put a new bacteria filter on the manometer tube Connect the bacteria filter to the safety valve Mount the safety valve in position in the ventilator Putin a new bellows Make sure it is right side up i e upper side marked UP Push the bellows onto the connection tubes Make sure that the bellows is centered Shut the lid over the bellows and secure the locking pawls on the front edge of the lid i Replace the fine mesh net in the expiratory flow transducer as follows Loosen the screw Shake the flow transducer gently until the net loosens Insert and secure the new net Replace the rubber valve in the inspiration channel Assemble the parts of the inspiration channel Puta new pressure transducer tube and bacteria filter on the pipe of the inspiration channel see picture Push the inspiration channel down into position and thread the silicone rubber bend onto its supporting pin Make sure that the inspiration valve is correctly positioned and that it is not bent or twisted Connect the filter to the pressure transducer marked INSP Make sure that the pressure transducer tube is not bent or pinched Connect the connector to the flow transducer Make sure that the serial numbers on the transducer
78. xcept MAN For further details see description on different modes Inspiratory pressure level The knob INSP PRESS LEVEL is used to set the constant inspiratory pressure relative to PEEP when any of the following modes of ventilation are used PRESS CONTR PRESS SUPPORT SIMV PRESS SUPPORT A safety catch is located at 30 cm H O SIMV SIMV Synchronized Intermittent Mandatory Ventilation means that the patient gets mandatory breaths controlled by the ventilator and that he also has the possibility of breathing spontaneously The mandatory breaths are synchronized with the breaths of the patient so that he need not breathe against the ventilator SIMV rate SIMV BREATHS min is the rate of the mandatory breaths per minute The rate is set between 0 4 and 4 breaths per minute on the LOW RATE scale and between 4 and 40 breaths min on the HIGH RATE scale The desired rate is selected by means of a switch There are two indicating lamps one for each rate The tidal volume and the frequency can be read on the digital display C LN KATE 12 1 Ch SIGH RATE EET SAMY HREATES PRESS SUPPORT ee The SIMV cycle is divided into SIMV period and spontaneous period See page 2 14 IDAL EXP TIDAL YOL m EXP MIN VOL i min PEAK PRESS cm Hri PAUSE PRESS cm MEAN AIRWAY PRESS zm 420 BREATHS Smin O alarm Alarm limits for O concentrat

Maquet Servo 900c - Frank`s Hospital Workshop

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