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1. DEFAULT DOSE DEFAULT DRUG NAME RATE CONCENTRATION Fentanyl mL hr N A Fluconazole mL hr N A Flumazenil mL hr N A Fluorouracil mL hr N A Furosemide mL hr N A Gatifloxacin mL hr N A Gentamicin mL hr N A Heparin units kg hr units mL Hydromorphone mL hr N A Ifosfamide mL hr N A Insulin units hr units mL Labetalol mg min mg mL Lepirudin mg kg hr mg mL Leucovorin mL hr N A Levofloxacin mL hr N A Lidocaine mg min grams mL Lorazepam mL hr N A Magnesium grams hr grams mL Mannitol grams hr grams mL Mesna mL hr N A MethoHEXITAL mL hr N A MethoTREXATE mL hr N A Metoclopramide mL hr N A Metronidazole mL hr N A Midazolam mL hr N A Milrinone mcg kg min mg mL Morphine mg hr mg mL Nafcillin mL hr N A System Operating Manual 151 For Systems With Hospira MedNet Software DEFAULT DOSE DEFAULT DRUG NAME RATE CONCENTRATION NitroGLYCERIN mcg min mg mL Nitro PRUSSIDE mcg kg min mg mL Norepinephrine mcg min mg mL Ofloxacin mL hr N A Ondansetron mL hr N A Oxacillin mL hr N A Oxytocin mUn min units mL Paclitaxel mL hr N A Pantoprazole mg min mg mL Penicillin mL hr N A Pentobarbital mL hr N A Phenylephrine mcg min mg mL Piperacillin mL hr N A Potassium mEq hr mEq mL Procainamide mg min grams mL Propofol mcg kg min mg mL Ranitidine mL hr N A STREPTOkinase units hr units mL Theophylline mg kg hr mg
2. N182 Prox Occl B Proximal line Examine line B for kinks N188 Air obstructed line B closed clamps or air in N189 container disconnected cassette or obstructed Occlusion caused by empty container backprime into line B tubing or syringe N231 Prox Air B When proximal air Check for clamps or Backprime detected exceeds the empty container Correct limit for the line as necessary Backprime into line B tubing or syringe Malfunctions CORRECTIVE CODE MESSAGE POSSIBLE CAUSE ACTION E300 or Malfunction A failure has occurred Record Malfunction higher in the infuser s internal error code Pump must systems be turned OFF to clear malfunction If alarm malfunction repeats replace infuser 122 System Operating Manual Plum A Infusion Systems General Messages CORRECTIVE MESSAGE POSSIBLE CAUSE ACTION Cannot Standby in Selection of Select 4 Cancel Piggyback 4 Standby when Back Line B is in Piggyback Mode Cannot Standby with Selection of 4 Cancel Back Delay A Standby when Delay time was entered for program Changing CCA clears Displays when other N A program than last used Care Area is highlighted Change Conc clears entries A program delivery which has been stopped and drug amount value is selected This is displayed before any screen or field message User can enter new Concentration using keypad or press CLEAR then make new entry Ch
3. The Software will display and the user must press the CLEAR hard key and input a valid value System Operating Manual 127 For Systems With Hospira MedNet Software MESSAGE Minimum Rate X mL hr POSSIBLE CAUSE Attempt to start mL hr program with Rate less than lower hard Dose limit nn n CORRECTIVE ACTION Use number keypad to enter a value Maximum Rate X mL hr Attempt to start mL hr program with Rate greater than the upper Hard Limit or CCA Maximum Volumetric Rate n Attempt to input a Rate greater than the upper Hard Limit or CCA Maximum Volumetric Rate n The Software will display and the user must press the CLEAR hard key and input a valid value 128 System Operating Manual Plum A Infusion Systems SECTION 8 g Cleaning Maintenance and Storage The cleaning maintenance and storage of the Plum A are described in this section CLEANING AND SANITIZING For proper maintenance of the Plum A observe the following cleaning and sanitizing guidelines Establish a routine weekly schedule for cleaning the infuser To clean proceed as follows e Turn the Plum A off using the ON OFF switch e Disconnect from AC mains power The exposed surfaces of the Plum A may be cleaned with a lint free cloth dampened by one of the recommended cleaning solutions in the following list or mild nonabrasive soapy water Clean the cassett
4. POSSIBLE CAUSE ACTION N184 Prox Occl A Proximal line Examine line A for N190 Air obstructed line A kinks closed clamps N191 container disconnect or or air in cassette obstruction N232 Prox Air A When proximal air Check for clamps or Backprime detected exceeds the empty container limit for the line Correct as necessary Backprime into line B tubing or syringe 120 System Operating Manual Plum A Infusion Systems Line B Alarms CORRECTIVE CODE MEssAGE POSSIBLE CAUSE ACTION N104 Callback Alarm programmed by Press SILENCE Line B user Change in delivery for piggyback delivery Loading Dose to Maintenance Step or for any step in Multistep program provided the step is not the last step N160 Line B VTBI VTBI complete on line Program new VTBI complete B N183 Prox Occl B Proximal line Examine line B for kinks At Startup obstructed line B or closed clamps If there container or syringe disconnected or obstructed during non delivery startup are closed clamps open the clamps Then open and close door Continue programming Replace set if problem persists If clamps are not opened prior to completion of cassette test peak proximal occlusion may recur For syringe select 4 Backprime System Operating Manual 121 670 3 For Systems With Hospira MedNet Software MESSAGE POSSIBLE CAUSE CORRECTIVE ACTION
5. System Operating Manual 73 74 For Systems With Hospira MedNet Software Soft upper limit of 8 mcg kg min Hard upper limit of 12 mcg kg min NOTE The SOFT and HARD limits are not displayed However the limit is provided if a value is programmed outside the acceptable range Typically the pharmacy will set the limit The Select Therapy screen for Line A appears DOPamine Select 4 Choose to select Loading Dose Standard Program Dose Calc Mulustep and continue Select then Choose If selected drug has been Choose programmed with established a a dosing units and concentration skip to step 8 The Program Dose Calc screen appears mg min mL hr mg hr kg mii h NOTE Cursor defaults to package nalkgiin insert or hospital recommended meamin mmol min x mcg hr mmol hr dose units associated with the mg kg hr mEq hr selected drug Select then Choose Pie kab Choose Back p low Select 4 Choose to continue La lalala Or use to change the units to use in the delivery If desired select a Page Down to see more units of measure System Operating Manual Plum A Infusion Systems The Container Concentration Selection screen appears DOPamine whenever the selected Dose Drug Conc in Container Units are gram based e g meg mg grams mg mcg or ng ra otherwise this screen is ski ed Select then Choose pp Choose Back NOTE Cursor defaults to package A A insert o
6. When VTBI reaches zero infusion is competed VTBI maan may no longer be incremented then press STOP key To program the user must first Ts program was started under a select 4 Back then press the Bb an key Auto Programming Auto Programming is a new feature for the Hospira Plum A line of infusion pumps It can only be used if the feature has been installed in conjunction with your Hospital Information System HIS and Barcode Point Of Care BPOC Unit It works by scanning barcode labels for the patient pump and IV bag using a BPOC Unit such as a PDA This information is then transferred to the pump utilizing either it s wireless antenna or RJ 45 Ethernet connector with a shielded Ethernet cable The feature reduces the number of steps needed to program an infusion NOTE If the physician s order for an auto program therapy exceeds the capabilities of the pump or is above a hospital defined hard drug limit the infusion parameters for auto programming will be rejected and the order will need to be re checked System Operating Manual 111 For Systems With Hospira MedNet Software NOTE It is important that biomed personnel ensure that the barcode identification label affixed to each infuser corresponds to the correct Connectivity Engine Identification Number This way the correct order will be sent to the appropriate infuser NOTE The wireless icon will not appear if an Ethernet cable is used to connect to th
7. Alarms and Troubleshooting Turn infuser OFF then back ON If the self test alarm recurs remove the infuser from service and contact the local Hospira representative The infuser performs a suite of System Self Tests when power is applied to confirm readiness for use Failure during the Self Tests is reported as a Malfunction Condition DATA RETENTION Delivery program settings and programming option selections are retained in non volatile memory If the Plum A has been turned off for longer than four hours all delivery settings are cleared and programming option selections are restored to their default selections for next use System Operating Manual 49 For Systems With Hospira MedNet Software Power On 1 Press to Power On the 50 Plum A and the System Self 13 X Jan 31 2005 12 30 30 Tests Screen is displayed On System Self Test In Progress After self testing successfully completes the display will proceed to the next screen Programming the infuser may F 5creens SHOWN IN THIS MANUAL begin during the cassette ARE EXAMPLES ONLY AND DON T A NECESSARILY REFLECT ACTUAL check phase of the start up AA testing NOTE If battery is missing or defective a Battery not installed message with a Continue without battery prompt will appear AC power only CAUTION WHEN THE BATTERY IS REMOVED FROM THE PLUM A DO NOT OPERATE ON PATIENTS USE OF A PROPERLY MAINTAINED AND CHARGED BATTE
8. Mean System Operating Manual 141 For Systems With Hospira MedNet Software 25 ML HR O mm Hg DELIVERY HEAD 96 HOURS Typical 50 45 4 40 4 eng E 30 E 25 Aro ALAN 2 IND AAN J gt gt 2 20 4 om 154 10 5 0 T T T T T 0 10 20 30 40 50 Time minutes Actual Rate Programmed Rate 25 ML HR 0 mm Hg DELIVERY HEAD 96 HOURS Typical 15 0 o 10 0 5 5 0 a W 0 076 R 5 0 o A 10 0 15 0 0 5 10 15 20 25 30 Observation Interval minutes Max Min Mean 25 ML HR 0 mm Hg DELIVERY HEAD 96 HOURS Composite of 3 Pumps 15 0 10 0 pig X 505 ka e a 4 4 W 0 0 E 8 5 0 v a 10 0 15 0 0 5 10 15 20 25 30 Observation Interval minutes Max Min Mean 142 System Operating Manual Plum A Infusion Systems 1 ML HR O mm Hg DELIVERY HEAD START UP Typical 2 0 1 8 1 67 a 14 E 12 E LO mang PALA ay aan aa iei E Del PIPO Nan y PSA NAA a yF pas Dm 064 0 4 5 T 024 0 0 r r r r r 0 2 4 0 4 0 10 20 40 50 60 70 80 90 100 110 120 Time minutes Actual Rate Programmed Rate 1 ML HR O mm Hg DELIVERY HEAD START UP Typical 15 0 510 0 ES 5 50 Baa Ll 0 0
9. mL NOTE See Delivery Rate Range in mcg kg min Dose Paya Section 9 The ratio of concurrent rates has recommendations specified E in Section 1 A Vol Inf A A System Operating Manual Plum A Infusion Systems Loading Dose LOADING DOSE Allows programming of an initial infusion rate for a specific volume followed automatically by a maintenance rate from the same container e g a fluid challenge If Dose Calc is used the Loading Dose and Maintenance Dose are in the same unit of measure over the same period of time mcg min from the same container Clear ALL settings when changing patients or multiple programming parameters The Area Selection screen will appear if your system has been Any Hospital USA MM DD YY XXYYZZ 123456 programmed with the MedNet CT ena MedSurg Neo ICU OR accessory Cardio Urology OB GYN Use to select CCA and bring you to the Main Delivery Screen NOTE To change CCA while infusing see Changing CCA While Infusing in Section 6 1 Select 4 A or 4 B at the Main Delivery screen Rate mL hr Vol Inf 0 mL MedSurg Back a Prime Vol Inf A A System Operating Manual 85 For Systems With Hospira MedNet Software The selected Line A or B Programming screen appears 2 Select a Drug List The Drug List Screen appears mainly in alphabetical order NOTE Default entry is No Drug Selected This process will guide you through a
10. SS E pr a a 4 8 5 0 i RA 5 0 10 0 ae 15 0 o 5 10 15 20 25 30 Observation Interval minutes Max Min Mean 1 ML HR O mm Hg DELIVERY HEAD STARTUP Composite of 3 Pumps 15 0 SL 10 0 S 5 0 aga W 0 0 gt p H H 4 8 5 0 ce 2 10 0 PO 15 0 o 5 10 15 20 25 30 Observation Interval minutes Max Min Mean System Operating Manual 143 144 For Systems With Hospira MedNet Software 1 ML HR 0 mm Hg DELIVERY HEAD 96 HOURS Typical 2 0 184 164 144 127 E 1 04 maa CSA AN as 2 0 8 0 0 6 0 4 0 2 0 0 r 0 10 20 30 40 50 Time minutes Actual Rate Programmed Rate 1 ML HR O mm Hg DELIVERY HEAD 96 HOURS Typical 15 0 Se 10 0 5 5 0 gt 0 0 a Sor 8 a a Sa ri D 5 0 ae 2 10 0 15 0 0 5 10 15 20 25 30 Observation Interval minutes Max Min Mean 1 ML HR O mm Hg DELIVERY HEAD 96 HOURS Composite of 3 Pumps 15 0 o 10 096 o 5 0 aa E 00 z has E ARA Q 50 HA D da Q 10 0 15 0 0 5 10 15 20 25 30 Observation Interval minutes Max Min Mean System Operating Manual Plum A Infusion Systems SECTION 10 Supplies and Accessories Administration Fluids ADMINISTRATION FLUIDS All p
11. drug grams 7 Select 4 Choose to continue Or use to change the Container Concentration units to use in the delivery System Operating Manual 81 For Systems With Hospira MedNet Software The next page of the Program Program Dose Calc B Dose Calc screen appears to provide for entry of delivery a head me Mode Piggyback 0 mg min 0 mL program parameters Duration 00 00 hr min Rate 0 mL hr Enter value using keypad Program Cancel values Once entered use Fea e to highlight the next field Use keypad to enter desired NOTE If selected drug has established Rule Sets e g non blank concentration the Mode field will be highlighted upon entry to this screen To change the Piggyback Delivery Mode default scroll down to Mode using then select 4 Change Mode NOTE Delivery Mode Option is available on Line B its default is Piggyback and the Weight field is gone 10 Continue entering desired Program Dose Caie B 82 values using the keypad Use conc Planas 500 mL Mode Concurrent S to advance to the next field Dose VTBI Duration 16 40 hr min NOTE When entering the RATE id ma with a VTBI value entered the DOSE Pacers and DURATION fields are pa automatically updated To understand the Automatic Calculation feature see Examples of Automatic Calculation in Section 6 System Operating Manual 11 12 13 Plum A Infusion Systems NOTE The Durat
12. fluid challenge so No Drug Selected will be entered 3 Select 4 Enter to indicate selection and advance to the Program selection screen The Select Program screen for Line A or B appears NOTE This example shows line A being programmed 86 Ol mL hr O mL 00 00 hr min Rate VTBI Duration Enter Value using keypad Program Drug e Options List Back MedSurg No Drug Selected Albumin 5 25 grams 500 mL Aldesleukin 2 6 mg 50 mL Alfentanil 10 mg 250 mL Alteplase 50 mg 50 mL Alteplase 100 mg 100 mL Amikacin 100 mL Amiodarone 150 mg 100 mL Page Cancel Down Enten Back AAA Select then Enter Page Up A PROGRAM Standard Program Loading Dose Multistep Select then Choose Choose Back A A System Operating Manual Plum A Infusion Systems 4 Use to scroll down to Loading Dose Standard Program Loading Dose 5 Select 4 Choose to continue Multistep Select then Choose Choose Back A A The next page of the Program Loading Dose screen appears mg min mg hr 7 mcg kg min grams hr 6 Select a Choose to continue meatal nakgirin mcg hr mmol hr mg kg hr mEq hr Or use Bo change the units SE to use in the delivery 2 A A A If desired select a Page Down to see more units of measure me koading Dose Programming screen appears Rate VTBI Duration 7 The default field is Rate Since E Mm 0 0 00 00 a Fluid
13. or at wrong time resulting in an Invalid Key Warning 2 Input was properly related to a function resulting in a Valid Key Warning The Low Battery Warning is an exception using the Alarm Indication sound level Weight The Alternate Units Parameter whose value entry is required with Alternate Units for Dose that include kg 32 System Operating Manual Plum A Infusion Systems SECTION 3 Equipment Description Line A Flow Line B Flow Indicator Ped Indicator 6 Status Status Region rr Region NY Working Region Working Region Battery Charge Message Po ai Indicator Region Message Region Back Options Softkey Label Prime A B Vol int Numeric Softkey A A A A Keys Selector Up Left Start and MD 7 2 3 a Selection Stop Keys lt Key 4 5 6 sa Charging STOP Dawa Line 7 8 9 v aig Indicator onion 0 CLEAR SILENCE i SNOET aa ey Key Numeric Field Decimal Point Clear Key Key Front Panel Display and Keypad System Operating Manual 33 For Systems With Hospira MedNet Software Operating Keys NOTE For Plum A3 all three pumps act as individual Plum A infusers The ON OFF key is used to control the power of the Plum A NOTE All deliveries must be stopped in order to turn the power off NOTE To confirm proper shutdown of infuser do not unplug until double beep is heard approximately 5 seconds If double beep is not heard
14. system PROGRAMS e Standard Programming e Loading Dose e Multistep Programming LINE PROGRAMMING OPTIONS e Drug List e Nurse Call Back e Delayed Start Standby Setting e Concurrent delivery e Titration e Micro 0 1 99 9 mL hr in 0 1 mL increments flow rate range for both lines e Macro 100 999 mL hr in 1 mL increments flow rate range for both lines e Automated Secondary drug delivery Piggyback System Operating Manual 19 20 For Systems With Hospira MedNet Software PLUMSET CAPABILITIES e Anti Free Flow Protection e Direct Connection for syringe delivery AIR MANAGEMENT e Air Trap e Air Removal Backpriming e Air Detection Proximal e Air Detection Distal BATTERY NOTE The Plum A 3 utilizes three batteries e Battery Gauge e Less than 8 Hour Battery Recharge Time e Long battery life 3 hours for emergency backup and temporary portable operation BIOMEDICAL e Upgradability Field Single Channel Devices Only e Variable Rate Cap e Alarm History e Nurse Call Relay Connector OPTIONS e Volumes Infused A B Total Volume e KVO at dose end 1 mL hr or less depending on delivery rate or Continue Rate CR to continue at the current rate e Variable Distal Pressure Settings System Operating Manual Plum A Infusion Systems OTHER FEATURES e Nonpulsatile volumetric accuracy e Microprocessor control e Large liquid crystal display LCD screen e Panel back illumination on ma
15. the infuser will turn itself back ON sensing the AC power was lost and revert to battery back up power The START key is used to begin infusion It brings up the Confirmation screen If all information appears correct select 4 Yes to start program The STOP key is used to stop the current delivery on one line used in conjunction with soft keys to stop delivery on both lines 34 System Operating Manual Plum A Infusion Systems The SILENCE key is used to silence an audible alarm during actions to correct its cause I LE N C E The SELECT key or is used to move the highlighting cursor between the programming fields SELECT v The numeric keys are used to enter values for any highlighted field 1 requiring numeric data D Q highlighted numeric field to be cleared in preparation for data entry It is also used to clear the v displayed dashes that occur when entering values beyond the pre programmed hard CLEAR limits It WILL NOT clear the entire program 2 The CLEAR key will cause a 4 5 8 0 The DECIMAL POINT key is used to manually enter numbers other than whole numbers i e 1 2 mL System Operating Manual 35 For Systems With Hospira MedNet Software Softkeys are located at the bottom ST of the main display and serve a standoy Enter goce variety of functions What each key al ala al does is indicated by the text in the display above the actual soft
16. 6 Select 4 A at the Main Delivery Screen Rate mL hr Vol Inf 0 mL SCREENS SHOWN IN THIS MANUAL ARE EXAMPLES ONLY AND DON T NECESSARILY REFLECT CURRENT Back A Options Prime Vol Inf A A A ACTUAL PRACTICE System Operating Manual Plum A Infusion Systems The Line A Programming screen appears Rate O mL hr 2 Select 4 Drug List for Dose VIBI O mL Calculation programming Duration 00 00 hr min Enter Value using keypad Program Drug Pu Options List Back The Drug List Screen appears mainly in alphabetical order Albumin 5 25 grams 500 mL r Aldesleukin 2 6 mg 50 mL NOTE Default entry is No Drug Alfentanil 10 ma 250 E Alteplase 50 mg 50 mL Selected Alteplase 100 mg 100 mL Amikacin 100 mL Amiodarone 150 mg 100 mL Select then Enter Page Page Cancel Up Down Enter Back A A A A 3 Use 8 to highlight desired Antibiotic drug name DOBUTamine 250 mg 500 mL DOBUTamine 500 mg 500 mL D 100 mg 250 mL When list does not contain DOPamine e i 400 mg 250 desired generic drug name or mo nn Heparin 25 000 ay mg group name select Select then Enter 4 Page Down or 4 Page Page Page enter banat Up until it shows then use an ee a Co to highlight choice 4 Select 4 Enter to indicate selection and advance to the Therapy selection screen Based on this selection assume the hospital has set the following rules for the Med Surg Area
17. A or B Volume Infused use to highlight and press cea 6 Torestore the cleared quantity select 4 Cancel Back 7 Toreset all volumes use to highlight Total Vol then press Gien 8 To restore all quantities select 4 Cancel Back softkey System Operating Manual a oerons 8 DOPamine Dose Calculation Volumes Infused Line A Line B Total Vol 393 mL Press CLEAR to clear value Cancel Back Aj A Enter A orons 19 DOPamine Dose Calculation Volumes Infused Line A 0 mL Line B 0 mL Total Vol MO mi Press CLEAR to clear value Cancel Ent ee Back A A 105 For Systems With Hospira MedNet Software 9 When clearing of quantities is completed select 4 Enter to return to the Main Delivery screen 10 Select a Options Vol Inf from AT orrons TB the Main Delivery screen to O return to the Options screen Volumes Infused Lighting Contrast Any Hospital USA 1 1 Use to highlight the MM DD YY XXYYZZ 123456 Select then Choose Pressure Post Infusion Rate Change a Es CCA option 12 Select 4 Choose to continue NOTE Prior to changing Pressure Post Infusion Rate infuser must be stopped 13 Use to highlight Continue a options B Dose Calculation Rate or Distal Pressure Limit Pressure Post Infusion Rate field Continue Rate Distal Pressure Limit 6 psi Distal Pressure O psi 14 Continue Rate allows a choice y Change using KVO Rate when
18. HEALTHCARE PROFESSIONALS AND PATIENT RELATED 5 CONCURRENT FLOW 0 0 eee es 7 EPIDURAL ADMINISTRATION 0 a 8 BATTERY OPERATION 00000 cece eee eee eee eee ees 9 SETS AND ACCESSORIES 0000 cece eee eee eens 10 BACKPRIMING 0 0 c cece ee eee eee eee eee eee 10 GENERALc 0 0002 DEAN a wae an ee 11 GLEANING Stak AA AA ye e aet 11 BOLUS RELATED awuran aa wa i BEA das aid 12 ARTIFACTS am akan e a isc n 12 INTERCONNECTING OF MEDICAL EQUIPMENT 14 GUIDANCE ON EMC COMPATIBILITY 15 FCC INFORMATION 00000 e eee eee eee eee 16 US FCC FEDERAL COMMUNICATIONS COMMISSION STATEMENT En oA as ore KANG LALA ot a 16 FCC INTERFERENCE STATEMENT 00000 eee aae 16 RADIO FREQUENCY EXPOSURE STATEMENT 17 WIRELESS DEVICE PRECAUTION 222 17 Section 2 Principles of Operation 19 FEATURES Ha aa A ds DAAN ey dent 19 PROGRAMS 2 A a Bani hak 19 LINE PROGRAMMING OPTIONS 2 22 19 PLUMSET CAPABILITIES 0 220 20 AIR MANAGEMENT 2222 20 BATTERYA KNA AKALANG PAPA LAT PN CT A a PINK 20 BIOMEDICAL neo ag Beate GG anne eg cual Bedale 20 OPTIONS tara eds tes cy acacia te KO WYNN ain Fa 20 OTHER FEATURES incu cick Bare ade Kna Paes 21 COMMUNICATION 0 000 ccc cee 21 DEFINITIONS 200020 Seo al eee wate Mes eae etd 21 System Operating Manual iii For Systems With Hospira MedNet Software Section 3 Equipment Description 33 OPE
19. Line B is delayed for the time entered NOTE Delayed line drip indicator will appear solid not flashing It will begin flashing when pumping resumes Piggyback with Nurse Callback 1 100 After programming in desired values for both lines select 4 Program Options NOTE To set a nurse callback the infuser must be stopped This function can be selected either before or after entering the Piggyback delivery program Program Options B Delay Start for i 00 min Callback No Enter Value using keypad Standby Enter aa a 4A A Pa powen oreo a Rate 125 mL hr Vol Inf 350e MedSurg Vol Inf PROGRAM B LESTE Mode Piggyback Rate 200 mL hr VTBI mL Duration 00 30 hr min Enter value using keypad Program Drug Options List Back A System Operating Manual Plum A Infusion Systems The default screen for Program aano la Options appears Delay Start for 00 00 hr min Use to highlight Callback Callback Yes field and select a Yes No if necessary to obtain Yes then awan select MEA Cara 4 Enter Ajaja NOTE Callback default of Yes or No is a biomedical setting and must be configured using the Hospira MedNet accessory CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION 2 Press START to confirm P_rrocram B LEEMTE program setting and return to Mode Piggyback Main Delivery screen Rate 200 mL hr VTBI mL Duration
20. OFF key SERVICE All servicing or adjustments to the Plum A should be referred to qualified technical personnel A technical service manual may be ordered from the local Hospira sales office 132 System Operating Manual Plum A Infusion Systems SECTION 9 Specifications NOTE Specification information applies to both systems Plum A 8 Plum A 3 unless otherwise noted Physical Dimensions Plum A Approximately 8 X 8 X 6 excluding pole clamp protrusion and power cord storage Plum A 3 Approximately 19 X 15 X 14 including pole clamp barcode wand holder and power cord Weight Plum A Approximately 9 5 lbs with battery Plum A 3 Approximately 28 lbs with 3 batteries Casing High impact plastic Electrical Power Plum A 120 V 50 60 Hz 50 VA Meets UL Requirements 60601 1 Plum A 3 120 V 50 60 Hz 150 VA Fuses F1 F2 250V 0 5 A internal Power Cord Hospital grade AC cord 10 ft long with transparent plug and retainer plate Battery Plum A One sealed lead acid rechargeable 6 V battery internal to device Plum A 3 Three sealed lead acid rechargeable 6 V batteries internal to device System Operating Manual 133 For Systems With Hospira MedNet Software Battery Life Recharge Electrical Leakage NURSE CALL System Circuitry Ratings With a new fully charged battery the infuser operates for a minimum of three hours at 125 mL hr or less or de
21. eae OHA Standby mode Vistas o onr Rate b A NOTE This example screen shows a Dose Calculation Program with a Standby It looks similar to the Program Confirmation screen with the substitution of Put delivery in Standby replacing Confirm Program Selecting 4 Yes confirms both the Program and the Standby 5 Press to remove LA stanoBy sroPPED B DOPamine Standby and start the infusion Dose a 26 3 mL hr Vol Inf 0 mL 10 meakamin Options A Vol Inf A A System Operating Manual 103 For Systems With Hospira MedNet Software Select Option Volumes Infused Pressure Post Infusion Rate and Lighting Contrast 1 To select Options Screen A PUMPING STOPPED B select 4 Options Vol Inf Rate 5 5 mL hr 393 Vol Inf mL iim Options A Vol Inf A A 2 use 93 to highlight an option AL orons ls Release 13 x xx xx xx 3 Select A Choose to select the Pressure Post Infusion Rate Lighting Contrast Volumes Infused screen Any Hospital USA MM DD YY XXYYZZ 123456 Select then Choose Change Choose Back CCA A A A This will bring up the Volumes Fa options 15 Infused screen which defaults DOPamine Dose Calculation to Total Volume Volumes Infused Line A O mL Line B 0 mL A Use to scroll to Line A or B Payo ws Press CLEAR to clear value Cancel Ent aa Back A A 104 System Operating Manual Plum A Infusion Systems 5 To reset Line
22. highest degree of protection The C and US indicators Temperature adjacent to the CSA Mark Limitation signify that the product has c us been evaluated to the ULCGOE01 4 applicable CSA and ANSI UL CSA 601 1 Standards for use in Canada MCN 160992 and the U S respectively This Jra naicator inc uces products eligible to bear the i indicator NRTL i e National N one Recognized Testing na Laboratory is a designation Attention Sorsult granted by the U S D p i 9 Occupational Salo and Health 9CUMENIs ministration to i laboratories which have been This Way Up recognized to perform certification to U S Standards Complies with limits for WIFI enabled and HC Class B digital device Ko complies with IEEE established by FCC A 802 11 a b g Rules Part 15
23. information NOTE Nurse Callback enables an a Program Options alarm when a change in the delivery on a line occurs such as completing pee Step 1 and starting Step 2 Or on line Delay start for 00 min B a piggyback delivery is completed and line A is starting its delivery Callback No Enter Value using keypad Cancel Back AlATIA Standby Enter 14 Entera delay time less than 24 hours using the keypad Loading Dose i Delay Start for 00 05 hr min NOTE Not available if a delivery is taking place on the line Callback mes NOTE Nurse Callback cannot be Change using Yes No changed while a delivery is taking Yes No Enter Cancel place on the line ra a es 15 Select 4 Enter to accept the changes and return to the Program Loading Dose screen System Operating Manual 89 17 90 For Systems With Hospira MedNet Software NOTE 4 Cancel Back returns the fields to their original value and displays the previous screen 16 To start the delivery press START This will bring up the PROGRAM CONFIRMATION screen Delivery will be CAUTION VERIFY ALL VALUES Prug No Drug Selected BEFORE STARTING INFUSION Hate SON TATA VTBI 250 mL If Drug and Rate appear Contirm programy correct select 4 Yes to begin program The Main Delivery Screen appears Loading Dose appear in the upper left corner which have been selected Loading Dose 500 Rate NOTE The words DELA
24. keypad Enter value using keypad RHH Options List Back 5 Use to move down to the VTBI field 6 To enter VTBI amount use PROGRAM B keypad LESTE Mode Piggyback Rate 200 mL hr NOTE While the VTBI is being entered the duration is automatically Y mL computed If the computed value is Duration 00 30 hr min greater than 99 59 dashes Enter value using keypad appear in place of hours To a E understand the Automatic Calculation feature see Examples of Automatic Calculation in Section 6 System Operating Manual 59 For Systems With Hospira MedNet Software 7 Use to move down to the PROGRAM B DURATION field Mode Piggyback Rate 133 mL hr Optional Use keypad to VTBI 100 mL change duration Duration 0025 hr fi Enter value using keypad Pro gram Dru E When all parameters are EE displayed changing any one parameter will result in other parameters automatically being computed 8 Press START CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION Program Confirmation screen will appear If correct press 4 Yes to begin infusion NOTE If Line A has a Delay Start remaining or is stopped a message will appear warning of a possible non delivery see Section 6 Example of Main Delivery TA DELAYED PUMPING B Screen just after being programmed and started 55 Rate 159 A mL hr Vol Inf 20 L 0 1 m MedSurg mg Vol Inf 60 System Operating Manual Pl
25. mL Ticar clavulanate mL hr N A Tirofiban mcg kg min mg mL Tobramycin mL hr N A UROkinase mL hr N A Vancomycin mL hr N A Verapamil mL hr N A VinCRIStine mL hr N A 152 System Operating Manual Plum A Infusion Systems For customer service within the United States contact 1 877 9 HOSPIRA 1 877 946 7747 For technical assistance product return authorization and to order parts accessories or manuals within the United States contact Hospira Inc Technical Support Operations 1 800 241 4002 To order parts using the online eCatalog download technical publications technical training courses and additional services visit the website at www hospiraparts com Outside the U S contact your local Hospira Inc sales office System Operating Manual For Systems With Hospira MedNet Software CAUTION FEDERAL USA LAW RESTRICTS THIS INFUSER TO SALE BY OR ON THE ORDER OF A PHYSICIAN OR OTHER LICENSED PRACTITIONER WARNING POSSIBLE EXPLOSION HAZARD EXISTS IF THE INFUSER IS USED IN THE PRESENCE OF FLAMMABLE ANESTHETICS against electric shock Type CF Type CF Applied Parts are those parts suitable for direct cardiac application IPX1 Protection against vertically sag Keep Dry falling water drops e j i Class 1 Mains supply equipment using Compliant to IEC EN protective earth EN 2 60601 1 2 2001 Per IEC 60601 1 F Type Fragile Handle with Applied Part complying with the Care
26. of fluid delivered over a discrete period of time Cassette A Hospira standard Plum Macro Cassette that contains the actual pumping chamber with inlet and outlet valves It also contains access ports to diaphragms for proximal and distal line pressure sensing and chambers for air trapping and air quantity measurement Caution Contains information which could prevent hardware failure irreversible damage to equipment or loss of data Channel Distal Line output to the patient Cleared Program Same as Cleared Settings but restricted to the program delivery settings for an individual line Cleared Settings Programmed delivery settings for both lines and the general control parameters are at their default values Clinical Care Area CCA An area of the hospital for which authorized hospital staff has allowed use of up to 149 specific drugs plus No Drug Selected The clinician selects a CCA after turning on the Infuser The hospital may create from one to eighteen CCA s System Operating Manual 23 For Systems With Hospira MedNet Software TERM Concentration DEFINITION For Dose Calculation based Line A or B delivery programming of premixed drugs the concentration consists of Drug Amount in micrograms mcg milligrams mg grams milliequivalents mEq millimols mmols or units USP Units and Diluent Volume in milliliters mL Abbreviated on screen
27. per CDC guidelines or healthcare provider policy Discard after use Preparing the Secondary Line CAUTION CONSULT THE DRUG LABELING TO CONFIRM DRUG COMPATIBILITY CONCENTRATION DELIVERY RATES AND VOLUMES ARE ALL SUITABLE FOR CONCURRENT DELIVERY OR PIGGYBACK DELIVERY SECONDARY FOLLOWED AUTOMATICALLY BY PRIMARY MODES The Plum A features concurrent or piggyback delivery modes when program requires administering more than one fluid In addition to standard containers the Plum A can use syringes on the secondary port The secondary line can be prepared without removing or repriming the cassette Before preparing the secondary line observe the following guidelines e Review the backpriming function e Attach the secondary container using an 18 or 19 gauge 31 mm or shorter needle if the cassette secondary inlet port has a piercing reseal e Syringes must be larger than 3 cc Use syringe adapter List 11986 48 when using syringes smaller than 10 cc Some 10 cc syringes may require use of a syringe adapter Syringes larger than 10 cc may be attached directly to the secondary port of the System Operating Manual 43 44 For Systems With Hospira MedNet Software cassette Use of a syringe adapter may decrease the occurrence of proximal occlusion alarms When using a syringe adapter retract the plunger to draw approximately 1 mL of fluid into the syringe to clear air from the adapter filter To prepare the s
28. up to 10 steps fluid volumes and delivery rates may be programmed for each step The program may be entered based on Rate and Volume or Volume and Time If Dose Calc is used the delivery steps are in the same unit of measure over the same period of time from the same container Clear ALL settings when changing patients or multiple programming parameters The Area Selection screen will a appear if your system has been Any Hospital USA a MM DD YY XXYYZZ 123456 programmed with the MedNet CO Renal MedSurg Neo ICU OR accessory Cardio Urology OB GYN Use to select CCA and bring you to the Main Delivery Screen NOTE To change CCA while infusing see Changing CCA While Infusing in Section 6 1 Select 4 A at the Main TA STOPPED ST0PPED B Delivery screen Rate mL hr Vol Inf 0 mL MedSurg Back a Prime Vol Inf A A 92 System Operating Manual Plum A Infusion Systems The Line A Programming screen appears Rate ol mL hr 2 Select 4 Drug List VIBI O mL Duration 00 00 hr min Enter Value using keypad Program Drug Pus Options List Back The Dryg List Screen appears mainly in alphabetical order Albumin 5 25 grams 500 mL Aldesleukin 2 6 mg 50 mL NOTE Default entry is No Drug Alfentanil 10 ma 250 al dd Alteplase 50 mg 50 mL Selected Alteplase 100 mg 100 mL Amikacin 100 mL Amiodarone 150 a ml Select then Enter Page Page pT Up Dawn Enter A A A 3 Use bi
29. when powering down the The Installation may p f take up to an hour intuser Ensure AC power cord is plugged in z Install Now Emi 1 Select 4 Yes to begin the GR installation It may take up to R an hour NOTE When the clinician chooses A Yes the Library moves to the infuser side of the module When complete it powers OFF the unit signifying completion of the transfer process Example screen of Library Installing CT New Drug Library Or select A No to skip the The Installation may i take up to an hour installation and continue using E nsure AC power cord the current library i plugged NOTE When the clinician chooses 4 No the infuser completes the power down process without finishing the Library transfer When the infuser is next used or powered ON for any other reason the former Library remains IN EFFECT The New Library Drug Available screen will re appear when powering down and the same choices will be available System Operating Manual 69 70 For Systems With Hospira MedNet Software NOTES System Operating Manual Plum A Infusion Systems SECTION 5 Advanced Programs Dose Calculation Standard Allows programming Dose Rates in alternative units of measure Dose Calculation can be used in Program Simple Delivery Loading Dose and Multistep Allows programming of an initial infusion rate for a specific volume followed automatically by a maintenance rate from t
30. 00 30 hr min Enter value using keypad Program Drug A Options List Back At end of Piggyback delivery a with Callback enabled for the oa line Callback alarm is issued 5 5 Rate 999 mL hr A 0 3 Vol Inf 100 mL 3 Press to clear alarm N104 Callback Line B Options A Vol Inf A A System Operating Manual 101 For Systems With Hospira MedNet Software Possible Non Delivery Programmed NOTE Whenever a valid START key is pressed the device checks the PROGRAM B delivery program s for non delivery Attention Line A is stopped or conditions such as Line B Piggyback delayed Line B in piggyback mode gives no KVO or alarm at dose end without Line A or delayed start that could permit a period of non delivery Continue anyway If so the display presents this warning screen 1 Select a Yes to continue with delivery Or select a No to cancel Using the Standby Feature Standby is a feature that enables the clinician to DOPamine program the infuser up to 23 wm Gor Ur 59 minutes in advance of meatal Starting ey 1 Enter value using keypad If Line A is infusing select Program aS 4 A or a B to access a LE program screen of line to be placed on Standby 2 Select 4 Program Options 3 Select 4 Standby 102 System Operating Manual Plum A Infusion Systems 4 Confirm the information displayed is correct then select Delivery willbe 4 Yes to place program on Bee
31. 0678 04 CAUTION THIS DEVICE IS TO BE USED WITH AN IV POLE WITH A 6 WHEEL BASE AND A SHELF System Operating Manual 1 For Systems With Hospira MedNet Software The Plum A and Plum A 3 Volumetric Infusion Systems are designed to meet the fluid delivery requirements of today s evolving healthcare environments Both are cassette based multi function infusion systems The Plum A allows two lines in and one line out while the Plum A 3 allows six lines in and three lines out Each pump can be used for standard piggyback or concurrent delivery Delivery modes include e Standard Infusions e Loading Dose e Multistep Programming e Dose Calculation The Plum A and Plum A 3 are designed to deliver parenteral enteral or epidural infusions over a broad range of infusion rates from multiple fluid container types Both are designed to be used in most areas of patient care including but not limited to e General Floor e Labor Delivery e Burn Unit Post Partum e Medical Surgical e OR Anesthesia e Hemodialysis e CU CCU e Post Op Recovery Oncology e Pediatrics e Cardiac Cath Lab Mobile Intensive Care e Neonatology e Emergency e Nutritional Product Description Each system includes a pumping module hereafter called the infuser and an assortment of disposable IV sets hereafter called a set optional accessories and this operator s manual The Plum A host device contains a Connectivity Engine peripheral module that provid
32. A stopPeD stopPeD B NOTE This is an example using Rate 4 Stop All muthr 50 Vol Inf 20 4 CAUTION Veriry ALL VALUES mL BEFORE STARTING INFUSION MedSurg_ Back a Prime Vol Inf A A System Operating Manual 65 For Systems With Hospira MedNet Software 3 To resume infusion A STOPPED STOPPED B pessa mur 50 Vol Inf a 20 4 4 Select a Start A a Start B Kabi Or A Start All Choose line s to oe Start ae me Cancel All Or discontinue infusion ye le wal ae press ON OFR 5 Clamp secondary tubing if A connected To close Closed position slide clamp 6 Close all slide or CAIR clamps 7 Open cassette door remove af Y set and close door To close CAIR Closed position roller clamp Backpriming BACKPRIMING Removal of air or TA STOPPED STOPPED B fluid from the proximal line and cassette airtrap 55 Rate mL hr Vol Inf Bono 1 Toinitiate a backprime select 4 Back Prime MedSurg NOTE Backpriming is available only Prime E when all delivery is stopped A A Secondary container is necessary to receive the air 66 System Operating Manual Plum A Infusion Systems Select and hold TA BAcKPAMING 5 4 Back Prime until fluid a 7 55 Rate pumped from line A to line B Pa mL hr has expelled the air from Soe cassette air trap into WEEE Secondary container Release Backprime to Stop Back A Options NOTE Fluid flow is at maximum rate P t
33. Challenge is being performed in this example Enter value using keypad Program press to advance to the ara VTBI field System Operating Manual 87 8 9 For Systems With Hospira MedNet Software Enter value using keypad Use to highlight the next field 10 Enter Duration using keypad The Rate value is automatically calculated To understand the Automatic Calculation feature see Examples of Automatic Calculation in Section 6 11 After the values for loading 88 dose Step 1 are entered use S to highlight the maintenance dose Step 2 NOTE The Loading Dose program has two steps The first is the loading dose followed by the maintenance dose These words will appear on the main screen as each step is delivered Program Loading Dose VTBI Duration Enter value using keypad Program Cancel Options Back A A Program Loading Dose VTBI Duration Enter value using keypad Program Cancel Options Back Program Loading Dose VTBI Duration Enter value using keypad Program Options A System Operating Manual Plum A Infusion Systems 12 Enter the set of desired values for Step 2 of the program VTBI Duration hr min 13 Select 4 Program Options to 10 00 select a Delayed Start or Standby Enter value using keypad Options Tee NOTE At this point programming is A A complete unless 4 Program Options are desired See Section 6 Additional Features for more
34. Concurrent NOTE When Rate for Line A plus Rata mL hr Rate for Line B is greater than valid ae O lal rate ranges a Concurrency violation Duration 00 00 hr min message will explain why second line ESTE did not start See Section 9 for valid A E delivery rate ranges NOTE Concurrency violation may not be displayed if unit is displaying VTBI Complete The device will not start and an invalid keypress sound will occur when START is pressed Use to move down to the VTBI field To enter VTBI amount use PROGRAM B keypad MedSurg Mode Concurrent Rate 10 mL hr NOTE While the VTBI is being entered the duration is automatically 9 Da Hita computed If the computed value is Paraon be ae greater than 99 59 dashes Enter value using keypad appear in place of hours To ci nag A System Operating Manual Plum A Infusion Systems understand the Automatic Calculation feature see Examples of Automatic Calculation in Section 6 6 Use bit to move down to the DURATION field Optional Enter values for desired hours and minutes NOTE When Duration is entered Rate is automatically computed 7 Press START CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION Program Confirmation screen will appear If correct press 4 Yes to begin infusion Example of a concurrent TA PUMPING PUMPING B delivery Rate 5 5 mL hr Vol Inf 20 4 mi MedSurg Options A
35. FIRM PROPER OPERATION CAUTION IF THE LOW BATTERY ALARM SOUNDS CONNECT TO AC MAINS POWER IMMEDIATELY The Plum A is battery powered for emergency backup and temporary portable operation A fully charged new battery provides 3 hours of operation at 125 mL hr or delivers 250 mL total volume if pumping at a rate of 126 mL hr or greater whichever occurs first NOTE For optimum battery life the Plum A should be operated on battery power for three continuous hours at least System Operating Manual 131 For Systems With Hospira MedNet Software once every six months and then charged for a minimum of six hours The battery charges whenever connected to AC mains power If the infuser is switched OFF recharge takes approximately six hours Recharge takes longer if the infuser is turned ON As a general rule the more often the battery is partially discharged and recharged the sooner it will need to be replaced Consult a qualified biomedical technician for battery replacement if necessary To maintain maximum battery charge and to prolong battery life connect the infuser to AC mains power whenever possible When the infuser is used without wireless the operation times may be proportionally longer STORAGE To prolong the life of the Plum A observe the following storage precautions Store the away from excessive heat cold and humidity e Store connected to AC mains power e Switch the infuser OFF using the ON
36. Hospira MedNet Software Arrange tubing cords and cables to minimize the risk of patient strangulation or entanglement Before opening the door close clamp on the primary line or remove the secondary container from the secondary port to prevent mixing of primary and secondary fluids To prevent unrestricted flow close all slide or CAIR clamps before opening the cassette door Although unlikely failure of certain robust mechanical components such as the anti free flow mechanism or valve control springs could cause fluid delivery limited to the contents of the fluid container Single fault failure of certain electronic motor control components would result in no more than 5 mL of unexpected fluid delivery A small amount of fluid is expelled from the set less than 0 05 mL each time the door is opened or closed with a set installed If potent drugs are being used take appropriate action to guard against overmedication of the patient Before disconnecting a syringe from the cassette pull up the plunger slightly to avoid spilling the fluid For rigid containers close the upper slide clamp open the cassette door then remove and invert the cassette ports down Air bubbles may form distal to the cassette as the result of normal outgassing of dissolved air in the fluid in one or more of the following cases e Chilled solution is in use e Certain fluids known to routinely outgas are in use e The infuser is mounted significantly ab
37. IBLE PRODUCT DAMAGE OR HARDWARE FAILURE FAILURE TO OBSERVE A CAUTION COULD RESULT IN SERIOUS PATIENT OR USER INJURY NOTE A Note highlights information that helps explain a concept or procedure This symbol directs the user to consult accompanying NN documents When visible on the display this symbol informs the user to use CAUTION because the specified drug has NOT been programmed with specified safety limits NOTE Figures are rendered as graphic representations to approximate the actual product Therefore figures may not exactly reflect the product Precautions The Plum A has been designed and manufactured to be safe reliable and easy to use This section details precautions and possible hazards For safe operation of the Plum A observe the following precautions and hazards HEALTHCARE PROFESSIONALS AND PATIENT RELATED e In vitro studies have suggested that packed red blood cells with unusually high hematocrit be diluted with blood compatible fluids such as 0 9 sodium chloride injection to decrease hemolysis and increase flow rate e Setting the primary rate greater than the secondary rate will result in a more rapid infusion of any residual secondary drug remaining in the line and the cassette e Consult drug labeling to confirm drug compatibility concentration delivery rates and volumes are all suitable for secondary concurrent and piggyback delivery modes System Operating Manual 5 For Systems With
38. ION No Drug Selected mL hr N A Abciximab mcg kg min mg mL Acyclovir mL hr N A Albumin mL hr N A Aldesleukin mL hr N A Alfentanil meg kg min mcg mL Alteplase rt PA mg kg hr mg mL Amikacin mL hr N A Aminophylline mg hr mg mL Amiodarone mg min mg mL Amphotericin B mL hr N A Ampicillin mL hr N A Atracurium mL hr N A Azithromycin mL hr N A Bleomycin mL hr N A Blood Products mL hr N A Bretylium mg min mg mL Carboplatin mL hr N A System Operating Manual 149 For Systems With Hospira MedNet Software DEFAULT DOSE DEFAULT DRUG NAME RATE CONCENTRATION Cefazolin mL hr N A Cefepime mL hr N A CefoPERAZONE mL hr N A CefoTAXIME mL hr N A CefoTETAN mL hr N A CefoXITIN mL hr N A CeftAZIDime mL hr N A CeftIZOXime mL hr N A Ceftriaxone mL hr N A Cefuroxime mL hr N A Cimetidine mL hr N A Ciprofloxacin mL hr N A Cisplatin mL hr N A Clindamycin mL hr N A Cotrimoxazole mL hr N A Cytarabine mL hr N A Diltiazem mg hr mg mL DOBUTamine mcg kg min mg mL Docetaxel mL hr N A DOPamine mcg kg min mg mL DOXOrubicin mL hr N A Epinephrine mcg min mg mL Epoprostenol ng kg min mg mL Eptifibatide mcg kg min mg mL Erythromycin mL hr N A Esmolol mcg kg min mg mL Etoposide mL hr N A Famotidine mL hr N A 150 System Operating Manual Plum A Infusion Systems
39. L hr in 0 1 mL increments 100 999 mL hr in 1 mL increments Concurrent Delivery 0 5 mL hr minimum for each line PlumSet 500 mL hr cumulative A B maximum KVO 1 0 mL hr or the last primary delivery rate whichever is less Air in Line Alarm PlumSet Distal Bolus 0 1 mL or larger Cumulative 0 25 mL out of 4 9 mL PlumSet Bolus at 0 5 mL Total 1 0 mL Proximal System Operating Manual 135 For Systems With Hospira MedNet Software Occlusion Alarm and Limits 136 Distal Occlusion Proximal Occlusion Distal Pressure Limit without alarm Maximum Infusion Pressure The DISTAL OCCLUSION alarm sounds after the distal set tubing or set outlet fitting becomes occluded The PROXIMAL OCCLUSION alarm sounds if the tubing proximal to the cassette becomes occluded 1 to 15 psig The maximum pressure is user selectable Factory default setting is 6 psig 20 psig System Operating Manual Plum A Infusion Systems Time To Detect Downstream Occlusions OCCLUSION ALARM TYPICAL TIME MAXIMUM TIME PRESSURE TO ALARM TO ALARM SETTING MACRO Macro 25mL hr 6 psig 38 seconds 47 seconds 15 psig 98 seconds 106 seconds 1mL hr 6 psig 17 minutes 22 minutes 15 psig 45 minutes 49 minutes Baseline backpressure is 0 psig Bolus Volume Released After Downstream Occlusions Are Corrected OCCLUSION TYPICAL ALARM BOLUS PRESSURE VOLUME MAXIMUM BOLUS SETTING MACRO VOLUME MACRO 25mL hr 6
40. MedNet Main TA STOPPED STOPPED B Delivery Screen with cleared settings The selected area is Ga BO displayed at the bottom o Voli mL SCREENS SHOWN IN THIS MANUAL ARE EXAMPLES ONLY AND DON T MedSurg NECESSARILY REFLECT CURRENT ACTUAL PRACTICE Back _ Prime Vol Inf ala NOTE For clarity whole number font sizes will appear larger than fractional number font sizes numbers on the right side of the decimal To Program a delivery rate select 4 A To enter delivery rate use numeric keypad Rate Ol mL hr VTBI O mL Use to move down to the metn o a VTBI field Enter Value using keypad Program Drug Cancel Options List Back A A A To enter VTBI amount use A PROGRAM keypad MedSurg Rate 5 5 mL hr NOTE While the VTBI is being VTBI MIO mi entered the duration is automatically computed If the computed value is greater than 99 59 dashes Enter value using keypad appear in place of hours At ala En ama A A System Operating Manual Duration 00 00 hr min Plum A Infusion Systems B_ Use E to move down to the DURATION field If auto calculated Duration is acceptable skip to step 9 6 Use keypad to change enter A PROGRAM the hours part of duration if HfedSuga desired Rate 5 5 mL hr VTBI 0 5 mL NOTE When all parameters are Duration 0 05 I min displayed changing any one parameter will result in other Enter value using keypad A Progr
41. NG CORDS AND CABLES TO MINIMIZE THE RISK OF PATIENT STRANGULATION OR ENTANGLEMENT Use the aseptic technique to prepare the administration set for priming then proceed as follows 1 Make sure flow regulator is closed No 2 Insert piercing pin into container outlet with a twisting motion 3 Fill Drip chamber to about 1 2 full or to the md score mark Do not completely fill E gt lt NOTE To avoid getting Distal Air Alarms q E confirm the fluid bag is positioned higher than the infuser This should be set up prior to priming the cassette System Operating Manual 41 For Systems With Hospira MedNet Software Priming the Administration Set 1 Invert the cassette 2 Turn the flow regulator counter clockwise until a drop of fluid is seen in the pumping chamber 3 Turn the cassette upright then prime the p remainder of the administration set geo 3 A T ra LAN 4 Pushin the flow regulator to close Confirm Y there is no flow gt IND Loading the Cassette To load the primed cassette into the Plum A proceed as follows 1 Open the cassette door by lifting up the handle 42 System Operating Manual Plum A Infusion Systems 2 Insert cassette into door guides Close the cassette door Confirm there is no flow and no kinks appear in tubing NOTE If flow is observed close the tubing clamps and replace the administration set NOTE The administration set should be changed
42. NISTER ONLY ANESTHETICS ANALGESICS APPROVED FOR EPIDURAL ADMINISTRATION AS INDICATED OR ALLOWED BY THE DRUGS FDA APPROVED LABELING EPIDURAL ADMINISTRATION OF DRUGS OTHER THAN THOSE INDICATED FOR EPIDURAL USE COULD RESULT IN SERIOUS INJURY TO THE PATIENT System Operating Manual 3 For Systems With Hospira MedNet Software Conventions This section describes the conventions used throughout this manual as follows CONVENTION APPLICATION EXAMPLE Italic Reference to a See Figure 3 1 section figure or Priming Cassette table f Primary Only Function or mode Attach an empty specific instructions container BRACKETED Keys or buttons on START ALL CAPS the device are displayed in or BRACKETED ALL CAPS or with a graphic A Italic Softkey Options A Choose Initial Caps Screen displays and Program lowercase device labels as l appropriate Dose Calculation Bold Emphasis Sets are supplied Sterile and are for WARNINGS CAUTIONS AND NOTES Alert messages used throughout this manual are described below Pay particular attention to these messages WARNINNGOH_ A WARNING MESSAGE CONTAINS SPECIAL SAFETY EMPHASIS AND MUST BE OBSERVED AT ALL TIMES FAILURE TO OBSERVE A WARNING MESSAGE IS POTENTIALLY LIFE THREATENING 4 System Operating Manual Plum A Infusion Systems CAUTION A CAUTION USUALLY APPEARS IN FRONT OF A PROCEDURE OR STATEMENT IT CONTAINS INFORMATION THAT COULD PREVENT IRREVERS
43. NOTE IF DOOR OPEN ALARM OCCURS NOTE CASSETTE SHOULD BE IN UPRIGHT TURN PUMP OFF POSITION AND CLAMPS SHOULD BE OPEN System Operating Manual 45 For Systems With Hospira MedNet Software Discontinuing Fluid Administration O PRESS STOP gt STOP Gg 2 CLOSE ALL SLIDE OR CAIR ROLLER CLAMPS gt ZB OPEN DOOR REMOVE CASSETTE TO CLOSE CLOSED SLIDE CLAMP POSITION kea Roller Y i TO CLOSE CLOSED CAIR ROLLER POSITION CLAMP 5 DISCARD SET AND FLUID CONTAINER PER HOSPITAL PROCEDURE 46 System Operating Manual Plum A Infusion Systems SECTION 4 Basic Operation Getting Started UNPACKING CAUTION PRODUCT DAMAGE MAY OCCUR UNLESS PROPER CARE IS EXERCISED DURING UNPACKING AND INSTALLATION DO NOT USE THE PLUM A IF IT APPEARS DAMAGED IN ANY WAY THE BATTERY MAY NOT BE CHARGED UPON RECEIPT Inspect the Plum A packaging for possible shipping damage If damage is found contact the delivery company immediately Use care when unpacking the infuser Retain the packing slip and save all packing material in case the infuser is damaged or fails the infuser self test and has to be returned to Hospira Inspect thoroughly for damage CAUTION IF THE PLUM A APPEARS TO BE DAMAGED CONTACT HOSPIRA INC To set up connect the AC mains cord to a properly grounded receptacle unless temporary battery operation is desired NOTE Use AC mains power whenever possible Store the infuser conn
44. OTE If the lockout switch is put in the Locked position while the infuser is off the ON OFF key allows the unit to turn on The connector located below the lockout switch is the Nurse Call Relay Connector for providing remote notification of a nurse call event The Ethernet port is used with a shielded Ethernet cable to connect to a local area connection NOTE See pg 13 for more information on Ethernet cables The Reset Button only visible on Lists 20791 20792 04 77 8 single channel devices upgraded with Module List 20677 04 77 is located below the indicator lights It is used to reset the IP Address This button is only to be used by Field Service personnel See the Technical Service Manual for more information System Operating Manual 39 For Systems With Hospira MedNet Software Administration Sets The Plum A is compatible with a wide range of LifeCare Plum series administration sets Become familiar with the set components before preparing the administration set Convertible Piercing Pin Slide Clamp with Drip Chamber Primary Line Cassette Patient Line Secondary Inlet Port Cappea Finger Grip Flow Regulator Patient Line Pumping Chamber Air Trap Cassette 40 System Operating Manual Plum A Infusion Systems Preparing the Administration Set NOTE For detailed instructions see administration set packaging WARNINGH__ _ _ ARRANGE TUBI
45. PING PUMPING B the Main Delivery Screen 25 Rate 50 mL hr 41 Vol Inf 20 mL Options A B lim ajaja 54 System Operating Manual Plum A Infusion Systems 2 Enter the desired Rate using the keypad Rate mL hr NOTE When Rate is changed the VTBI 50 mL duration is automatically recomputed using the current VTBI To understand the Automatic Calculation iOS feature see Examples of Automatic ES a E Calculation in Section 6 3 Press START z E Delivery will be CAUTION VERIFY ALL VALUES Drug No Drug Selected BEFORE STARTING INFUSION Rate 15 mL hr VTBI 50 mL Program Confirmation screen Confirm Program will appear If correct press 4 Yes to begin infusion Duration 03 20 hr min NOTE During Titration infuser continues to deliver at previous parameters until new program is confirmed Example of Main Delivery Screen after being titrated Rate 50 NOTE Volume Infused is an mper A p A w 7 Vol Inf 20 incrementing value which is cleared mL in A Options Vol Inf LESTE The following 3 screens are examples of changed values System Operating Manual 55 56 For Systems With Hospira MedNet Software Example of changed rate From the Main Delivery Rate mL hr Screen select 4 A VTBI 50 mL Duration 03 20 hr min Use keypad to change the Enter Value using keypad Program Dr NOTE The display time is only accurate to one minute As shown in this exam
46. RATING KEYS 2 a pa ad ii PRA ANG NLANG 34 INDICATOR Saori iea tia ini ad 36 DISPLAY SYMBOLS seur rn 37 REAR CASE CONTROLS 00 cece eee nna 38 ADMINISTRATION SETS 22222 cece eee ee aes 40 PREPARING THE ADMINISTRATION SET 41 PRIMING THE ADMINISTRATION SET o o o o 42 LOADING THE CASSETTE 0000 cece eee eens 42 PREPARING THE SECONDARY LINE 43 DISCONTINUING ELECTRONIC FLOW CONTROL 8 SETTING GRAVITY FLOW 45 DISCONTINUING FLUID ADMINISTRATION 46 Section 4 Basic Operation 47 GETTING STARTED 22 0 c NA LG NG GA maa 47 UNPACKING 2 47 TANDEM CARRIER INSTRUCTIONS 0000 eevee 48 SYSTEM SELF TESTS 20 20w e eect e eens 48 DATA RETENTION 022220 49 POWER ON eos a NA rod e 50 SIMPLE DELIVERY ac a eh ate ood aes een Ba 52 TRATION a AKLAS Bam DL ART aati eine nance ea West 54 PIGGYBACK DELIVERY 222 2 58 CONCURRENT DELIVERY 2222555 aaa 61 STOP AND START WITH ONLY 1 LINE PUMPING 64 STOP AND START WITH BOTH LINES PUMPING 65 BACKPRIMING 5b rata sae UN LINK TAGA KA de eas 66 CLEARING SETTINGS 2222 a 67 UPDATING DRUG LIBRARY 0000000e scene 69 Section 5 Advanced Programs 71 DOSE CALC MCG KG MIN ON A uu aaa 72 DOSE CALC MG MIN ON B 2 22 79 LOADING DOSE 2 2223 cece eee haaa 85 MULTISTEP PROGRAMMING 2222m 92 Section 6 Additiona
47. RY HELPS CONFIRM PROPER OPERATION To set up the Plum A insert selected Plum Set and close cassette holder door lever Insert PLUM Set Close Lever NOTE If cassette is already inserted this screen is skipped If Infuser ID Entry screen appears consult your hospital s biomed personnel System Operating Manual Plum A Infusion Systems The Area Selection screen will appear if your system has been Any Hospital USA E K MM DD YY XXYYZZ 123456 programmed with the Hospira EU en OR OB GYN Cardio MedNet accessory Use to 5 choose If only one CCA has been entered it becomes the default and this screen is skipped NOTE To change the CCA while infusing see Changing CCA While Infusing in Section 6 If not using MedNet the display will go straight to the Clear Settings option Example of Clear Settings Screen ings 3 The on screen message Clear Clear Settings Settings may appear Select 4 Yes to clear all settings ESTA Clear ALL settings when E changing patients or multiple programming parameters NOTE This clears all delivery parameters such as Rate and VTBI on both lines as well as setting items such as the KVO and Nurse Callback options to their default values NOTE If no settings currently exist or all settings are zero this screen will be bypassed System Operating Manual 51 For Systems With Hospira MedNet Software Simple Delivery 52 Example of
48. System Operating Manual ws bh Hospira MedNet For use with List Numbers 20678 20679 20792 04 amp fE 11971 04 or 12391 04 with Module 20677 04 Options Vol Inf Hospira HOSPIRA INC 275 NORTH FIELD DRIVE LAKE FOREST IL 60045 USA 430 95597 005 C 2012 11 For Systems With Hospira MedNet Software Change History Title 430 95597 001 Rev 06 05 430 95597 002 Rev 02 06 430 95597 003 Rev 01 07 430 95597 004 Rev 02 07 430 95597 005 Rev 2012 11 Description of Changes Section First Release Second Release Third Release Fourth Release Replaced O with removed copyright and trademark statements updated regulatory symbols Added precaution to prevent unrestricted flow Rewrote air bubble precaution and air filter recommendation Added low flow rate range Updated alarm volume instructions Added administration set graphic and warning to prevent unrestricted flow Added instructions for closing clamps Updated air in line alarm distal and cumulative bolus amounts All All All All All 1 and 2 4 and 5 9 System Operating Manual Plum A Infusion Systems Contents Section 1 Descriptive Information 1 PRODUCT DESCRIPTION 2 2200 2 INDICATIONS FOR USE 2222220 3 USER QUALIFICATION 0 2 2000 3 CONVENTIONS 2222 4 WARNINGS CAUTIONS AND NOTES o ooooooooo 4 PRECAUTIONS 2 2 2 5
49. These limits are designed to provide reasonable protection against harmful interference in a typical medical installation The equipment generates uses and can radiate radio frequency energy and if not installed and used in accordance with the instructions may cause harmful interference to other devices in the vicinity However there is no guarantee that interference will not occur in a particular installation If this equipment does cause harmful interference with other devices which can be determined by turning the equipment off and on the user is encouraged to try to correct the interference by one or more of the following measures e Reorient or relocate the receiving device e Increase the separation between the equipment e Connect the equipment into an outlet on a circuit different from that to which the other device s is connected e Consult the manufacturer or field service technician for help System Operating Manual 13 For Systems With Hospira MedNet Software e Portable and mobile RF communications equipment such as cellular telephones 2 way radios Bluetooth devices microwave ovens in close proximity to this device may affect wireless and wired communications with the Infusion pump and or the operation of the Infusion pump Special precautions need to be exercised regarding EMC These include e Use of a shielded Ethernet cable CAT5 STP or better for plugging into the RJ45 Ethernet connector Using an unshi
50. VIRONMENT 52222 135 DELIVERY RATE RANGE 2 2 2200 00 135 AIR IN LINE ALARM 222200 135 OCCLUSION ALARM AND LIMITS 136 TIME TO DETECT DOWNSTREAM OCCLUSION Sica BS ha at NGA oe ie PA BAS 137 BOLUS VOLUME RELEASED AFTER DOWNSTREAM OCCLUSIONS ARE CORRECTED 137 DELIVERY ACCURACY 0 0 0 0 eee 138 ENTERAL amp HIGH VISCOSITY FLUIDS EFFECTS 138 System Operating Manual v For Systems With Hospira MedNet Software TRUMPET CURVES cos PADA HANDA 139 EXAMPLE aaa ai tt mh NANG 139 Section 10 Supplies and Accessories 145 ADMINISTRATION FLUIDS 22222250 145 ADMINISTRATION FLUIDS 022200 145 ENTERAL AND HIGH VISCOSITY FLUIDS 145 CONTAINERS 0 00 e eee eee eee 145 ACCESSORIES 0 00 aa eee eee 146 GENERAL ps cei ri ba ee a 146 NETWORKED APPLICATION 000 eee eee eee 146 Section 11 Warranty ooooooococoomo 147 Section 12 Default Drug Library DDL 149 All Rights Reserved Vi System Operating Manual Plum A Infusion Systems SECTION 1 Descriptive Information NOTE In this manual references to Plum A Infusion System apply to both the Plum A Infuser and Plum A 3 Infuser unless otherwise noted Plum A Infuser List 20679 20792 04 NOTE This operating manual may also be used with Device List 12391 04 8 11971 04 when used with Module List 20677 04 Plum A 3 Infuser List 2
51. VTBI is completed KVO cn Cancel Rate Back Select NR 4 KVO Rate e KVO The infuser will revert to a fixed KVO of 1 mL hr or the last programmed Rate whichever is less e Rate The infuser will continue at the Rate programmed NOTE Option will be for both line A and line B selections 15 To change Distal Pressure Limit when highlighted 106 System Operating Manual Plum A Infusion Systems enter value between 0 1 and 15 psi 16 Select 4 Enter to keep changes and return to the Main Delivery screen or 4 Cancel Back to restore original values and return to the Options screen NOTE Continue Rate default of KVO or Rate must be configured using the Hospira MedNet software 17 Select 4 Options Vol Inf from a options B the Main Delivery screen to O return to the Options screen Volumes Infused Pressure Post Infusion Rate Lighting Contrast Any Hospital USA 18 use E to highlight Lighting MM DD YY XXYYZZ 123456 Select then Choose 3 Contrast Option Change Gee ea CCA A A A 19 Select 4 Choose to continue 20 Press 8 to highlight Backlight AL oros 5 Intensity or Display Contrast Lighting Contrast ia MN Display Contrast MEI 21 While viewing display for desired effect select either 4 maa Increase Setting or a Decrease Increase Enter Cancel Setting Setting Back Decrease Setting to change level 22 Select 4 Enter to keep change s and ret
52. Vol Inf A A System Operating Manual 63 For Systems With Hospira MedNet Software Stop and Start with Only 1 Line Pumping 1 Press at the Main Delivery Screen NOTE If 4 A or 4 B is selected prior to pressing STOP the display will return to the programming screen Select 4 Cancel Back to return to the Main Delivery screen Example of stopped delivery 2 To resume infusion press Or to discontinue infusion press ON OFR 3 Clamp secondary tubing if connected 4 Close all slide or CAIR clamps 5 Open cassette door remove set and close door Ta puwna srorreo 5 Rate 100 mL hr Vol Inf ga al A MedSurg Back au Prime Vol Inf A A nee Rate 100 mL hr Vol Inf a KEN A MedSurg Back Options Prime A B he A A A A To close Closed position slide clamp ba BAN To close CAIR Closed position roller clamp 64 System Operating Manual Plum A Infusion Systems Stop and Start with Both Lines Pumping 1 Press STOP at the Main a rouenoTeumenoTe Delivery Screen Rate mL hr Vol Inf aai 20 4 50 MedSurg Select 4 Stop A 4 Stop B or 4 Stop All Rate 50 mL hr NOTE If 4 A or 4 B is selected Vol Inf 59 4 prior to STOP the display will show me the programming screen Select 4 DESTE Cancel Back to return to the Main Choose line s to stop Delivery screen pai S SP en A A A Example of stopped infusion T
53. YED and JA mene 0 Vol Inf mL These indicate the options MedSurg After the programmed delay period has expired the Plum aa A starts Pumping This is Ga Rate indicated where Delayed o Voli previously was displayed ml MedSurg nng Vol Inf System Operating Manual Plum A Infusion Systems eli A a RUE Sroorco a completed the Main Delivery Po Screen changes to the second 75 Rato step a 250 e i NOTE A flashing Callback Line A message and the audio alarm sound indicates activation of that option A Options Ol Ini A A 18 The user should acknowledge the Callback message and stop the audio alarm by pressing SILENCE Upon completion of delivery a v STOPPED 8 the screen shows a flashing Maintenance Dose Line A VTBI complete 4 Rate Un message and the audible alarm Haa 1000 e sounds mL NOTE The KVO rate will change to the rate of 1 mL hr or less depending A biga on delivery rate and Pumping mode A A changes to KVO If Continue Rate option was selected pumping continues at original rate 19 Press to stop alarm sound NOTE Warning message continues to flash and audio alarm will return after a two minute period of silence unless delivery is stopped or VTBI of last line is changed System Operating Manual 91 For Systems With Hospira MedNet Software Multistep Programming MULTISTEP Allows a sequential program to deliver
54. am Drug ee parameters automatically being Options List Back computed To understand the A Automatic Calculation feature see Examples of Automatic Calculation in Section 6 7 Use to move from hours to minutes NOTE The maximum hours allowed is 99 and the maximum minutes is 59 8 Use keypad to enter minutes 9 Press START Delivery will be CAUTION VERIFY ALL VALUES Drug No Drug Selected BEFORE STARTING INFUSION Rate 5 5 mL hr VTBI 0 5 mL Program Confirmation screen Genfirn Program will appear If correct press 4 Yes to begin infusion System Operating Manual 53 For Systems With Hospira MedNet Software Example of Main Delivery TA PUMPING STOPPED B Screen just after being programmed and started 65 Hab R a 0 1 Vol Inf NOTE The Line A Fluid Flow 3 mL Indicator also will flash to indicate pumping A Options NOTE VTBI volume to be infused Vol Inf values over 100 mL are displayed A A truncated This means that the number displayed rounds down to the last whole number e g 105 7 would be displayed as 105 An example would be the Programming or Pumping screens NOTE VI volume infused values over 100 mL are displayed rounded This means that the number displayed rounds off to the nearest number e g 105 7 would be displayed as 106 but 105 3 would be displayed as 105 An example would be the Program Options screen Titration 1 Select Line 4 A or 4 B at A PUM
55. ange units clears entries A program delivery which has been stopped and user highlights another concentration unit for the same line User can select 4 Back to exit or use SELECT arrows to highlight a new value Change Vol clears entries A program delivery which has been stopped and diluent value is User can enter new Concentration volume using keypad or press selected This is CLEAR then make displayed before any another entry screen or field message System Operating Manual 123 For Systems With Hospira MedNet Software MESSAGE Concurrency alert POSSIBLE CAUSE Attempt to start a multistep or loading dose delivery whose later steps would exceed concurrent delivery limit if delivery proceeds CORRECTIVE ACTION User can enter new values using number keypad or use SELECT arrows to move to another field to change the entry User can also press CLEAR Concurrency violation Attempt to start a second line with a delivery rate that would exceed concurrent delivery upper limit immediately Or concurrent delivery attempt and rate for the second line is less than concurrent delivery lower limit Takes precedence over Rate must be gt n mL hr message The combined delivery rate must fall within the range of 1 0 mL hr 500 mL hr or CCA specific Maximum Volumetric Rate with 0 5 mL hr minimum per line User can enter new values using number key
56. arenteral fluids Whole Blood Blood fractions ENTERAL AND HIGH VISCOSITY FLUIDS Dextrose 20 to 50 concentration Isomil Powder Similac Powder Ensure plus HN TwoCal HN Packed red cells CONTAINERS Dual Chamber Parenteral flexible container Nutrimix Large Volume Parenteral flexible plastic containers including premixed Large Volume Parenteral glass containers including premixed and nutritional Part Fill Parenteral flexible plastic containers including ADD Vantage Part Fill Parenteral glass containers Small Volume Parenterals Syringes may require special adapters Top Filled Enteral bags Ready to hang Enteral solution containers System Operating Manual 145 For Systems With Hospira MedNet Software Accessories GENERAL Syringe Adapter List 11986 48 Mini Pole List 12096 04 Secondary Container Support List 12095 03 Tandem Carrier List 12270 01 Plum A 3 IV Pole upright 12577 04 01 Plum A 3 IV Pole base 12576 04 01 NETWORKED APPLICATION Ko Hospira MedNet Medication Management Server Suite MMSS List 20676 04 Hospira MedNet Plug n Play Module List 20677 04 For use with Hospira Plum A Infusers Lists 11971 04 8 12391 04 NOTE Contact Technical Support Operations at 1 800 241 4002 for current listing of accessories 146 System Operating Manual Plum A Infusion Systems SECTION 11 Warranty Subject to the terms and conditions herein Hospira Inc h
57. asis clean all of the elements behind the cassette door using cotton tipped swabs saturated with cleaning solution The cassette door may be unlatched from the door handle to facilitate cleaning 130 System Operating Manual Plum A Infusion Systems To unlatch the cassette door from its handle tilt the device back open the cassette door then push the door release tab to open the door fully CAUTION To AVOID MECHANICAL OR ELECTRONIC DAMAGE DO NOT IMMERSE THE PLUM A IN ANY FLUIDS OR CLEANING SOLUTIONS CAUTION Do NOT SPRAY CLEANING SOLUTIONS TOWARD ANY OPENING IN THE INSTRUMENT CAUTION CERTAIN CLEANING AND SANITIZING SOLUTIONS MAY SLOWLY DEGRADE COMPONENTS MADE FROM SOME PLASTIC MATERIALS USING ABRASIVE CLEANERS OR CLEANING SOLUTIONS NOT RECOMMENDED BY HOSPIRA MAY RESULT IN PRODUCT DAMAGE Do NOT USE COMPOUNDS CONTAINING COMBINATIONS OF ISOPROPYL ALCOHOL AND DIMETHYL BENZYL AMMONIUM CHLORIDE CAUTION NEVER USE SHARP OBJECTS SUCH AS FINGERNAILS PAPER CLIPS OR NEEDLES TO CLEAN ANY PART OF THE INFUSER CAUTION DO NOT STERILIZE BY HEAT STEAM ETHYLENE OXIDE ETO OR RADIATION CAUTION TO AVOID INFUSER DAMAGE CLEANING SOLUTIONS SHOULD ONLY BE USED AS DIRECTED THE DISINFECTING PROPERTIES OF CLEANING SOLUTIONS VARY CONSULT THE MANUFACTURER FOR SPECIFIC INFORMATION BATTERY MAINTENANCE CAUTION DONOT OPERATE THE INFUSER ON PATIENTS WITH THE BATTERY REMOVED USE OF A PROPERLY MAINTAINED AND CHARGED BATTERY HELPS CON
58. bring up the VTBI 825 mL Confirmation screen Confirm Program CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION NOTE The Values are now updated TATPUMPING STOPPED B on the Main Delivery Screen CARS y Step 2 The infuser reverts to KVO 25 when last Step completes 658 Vol Inf mL The last step can be restarted by entering a new VTBI value Options A Vol Inf A A System Operating Manual Plum A Infusion Systems SECTION 6 Additional Features Simple Delivery Using Delayed Start 1 Before or after entering the CR a simple delivery program select 4 Program Options Mode Rate 5 mL hr VTBI 250 mL NOTE To program a Delayed Start using an advanced program i e Dose Calc you must first select Cnangetsing Change Mode which line you want A or B next eee Hoa es select 4 Drug List and then alala 4 Program Options If you program the Delayed Start first it will be cleared upon entry into Select Program mode The Default screen for aaa 1a Program Options appears Duration 50 00 hr min Delay Start for fg 00 min Callback No Enter Value using keypad Cancel Back Standby Enter AA A System Operating Manual 99 For Systems With Hospira MedNet Software Enter values for desired hours and or minutes Select 4 Enter to confirm delayed start CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION Press to confirm programming
59. confirm there is sufficient empty space to accept the backprimed fluid GENERAL Possible explosion hazard exists if used in the presence of flammable anesthetics Do not place Plum A in service if it fails the self test Do not operate the Plum A with the case opened Keep the cassette door securely closed while the infuser is not in use to avoid cassette door damage Values beyond a fields maximum hard limit will be displayed as dashes The user must clear these fields using the CLEAR key prior to entering new values The Plum A 3 is to be used with an IV pole with a 6 wheel base and a shelf CLEANING For more information on cleaning the infuser see Section 8 To avoid mechanical or electronic damage do not immerse the Plum A in any fluids or cleaning solutions Do not spray cleaning solutions toward any opening in the instrument Certain cleaning and sanitizing solutions may slowly degrade components made from some plastic materials Using abrasive cleaners or cleaning solutions not recommended by Hospira may result in product damage Do not use compounds containing combinations of isopropyl alcohol and dimethyl benzyl ammonium chloride Never use sharp objects such as fingernails paper clips or needles to clean any part of the infuser Do not sterilize by heat steam ethylene oxide ETO or radiation To avoid infuser damage cleaning solutions should only be used as directed The disinfecting prop
60. ctive and lockout is enabled N255 Soft lockout The use of the STOP Unlock lockout by Violation key during delivery or pressing the decimal opening the door while key followed by 9 6 amp lockout is enabled 3 on the keypad N256 Soft lockout Pressing of any key Unlock lockout by Enabled except STOP during pressing the decimal delivery while any alarm key followed by 9 6 amp is active and lockout is 3 on the keypad enabled 118 System Operating Manual Plum A Infusion Systems Line A Alarms CORRECTIVE A EOS POSSIBLE CAUSE ACTION N105 Callback Line A Alarm programmed by Press SILENCE user Change in delivery for Loading Dose to Maintenance Step or for any step in Multistep program provided the step is not the last step N161 Line A VTBI VTBI complete on line Program new VTBI complete A N185 Prox Occl A At Proximal line Examine line A for Startup obstructed line A container or syringe disconnected or obstructed during non delivery startup kinks or closed clamps If there are closed clamps open the clamps Then open and close door Continue programming Replace set if problem persists If clamps are not opened prior to completion of cassette test peak proximal occlusion may recur For syringe select A Backprime System Operating Manual 119 70 3 1 For Systems With Hospira MedNet Software MESSAGE CORRECTIVE
61. culation feature see Examples of Automatic Calculation in Section 6 Press START CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION Program Confirmation screen will appear If correct press 4 Yes to begin infusion System Operating Manual 57 For Systems With Hospira MedNet Software NOTE START accepts the change Delivery is changed to the new DURATION and RATE and the display brings up the Confirmation screen before returning to the Main Delivery Screen Piggyback Delivery PIGGYBACK DELIVERY Infusion will stop Line A and infuse Line B until VTBI completes Line A will automatically restart With Line A pumping to program a Piggyback delivery select 4 B The Delivery Mode field is highlighted NOTE If an entry was previously programmed RATE is highlighted If no previous entries MODE is highlighted If field reads Concurrent select 4 Change Mode to switch to Piggyback Ta Jromeno srorezo 8 Rate 5 5 mL hr Vol Inf 20 pi NE ENT ani Options A Vol ni A A PROGRAM B Mode arre Rate O mL hr VTBI O mt Duration 00 00 hr min Change using Change Mode Program Change Drug Cancel Options Mode List Back A A A A System Operating Manual Plum A Infusion Systems 3 Select H to highlight the PROGRAM e LESTE RATE field Mode Piggyback Rate mL hr A VTBI O mL 4 To enter delivery rate use le Duration 00 00 hr min numeric
62. d lt ose Calculation Gy lose Calculation also may appear regardless of Auto 063 Rate 30 Programming However in a wireless menr E 1 Vol Inf 0 1 network environment Auto ml Programming will not be successful if magaling DOS aan the icon is not visible during the Auto Program transfer If wireless Auto A Options Programming is desired and the icon is m not displayed on the Main Delivery Screen try relocating the pump towards the wireless access point until the icon is displayed The icon will not be displayed if the infuser is communicating via an ethernet connection Rear Case Controls NOTE For Plum A 3 each control applies to all three pumps The Audio Level Rotary Knob is located on the back of the pump Rotate the knob to achieve the desired alarm volume level The Toggle Switch located below the audio level control activates Locked the lockout function when the lever is placed in the up position disabling all front panel keys except STOP Password Protected Keypad Lock Unlocked may also be used It both locks and unlocks the keypad by pressing the decimal key followed by 9 6 8 3 9 6 3 38 System Operating Manual Plum A Infusion Systems NOTE For Plum A 3 keypad lock applies to individual pump in use NOTE Pressing of a key while lockout is active results in the display of the lockout enabled message This action is recommended to confirm each lockout activation N
63. displays as Conc Concurrent Delivery Simultaneous delivery of two fluids at independent flow rates Concurrent Mode The Line B control selection mode that allows either Line A or Line B or both of the Mechanism to be programmed for delivery that completes with KVO or CR Line A operation is unaffected by Line B delivery Connectivity Engine CE A component of the infuser that controls ethernet and wireless communication between the MMU and Infuser processor Continue Rate CR An option used to provide fluid delivery at the current fluid delivery rate when the VTBI becomes zero Default Drug Library DDL A drug list of 99 drug names default units and default concentrations plus No Drug Selected Does not contain Soft or Hard Limits The DDL is a subset of Plum A Version 11 3 drug list The Infuser functions initially with the DDL Deliver Together A Biomed Delivery option setting which selects default of Piggyback or Concurrent delivery mode Delivery Mode The normal operational mode for the Infuser either Concurrent or Piggyback during which fluid delivery may occur Delivery Rate The delivery rate as Volume Time assigned by the operator or calculated from other delivery parameters 24 System Operating Manual Plum A Infusion Systems TERM DEFINITION Device The Plum A IV Infusion Device Infuser not includi
64. e BPOC system Power On the pump as A STOPPED STOPPED B described in Section 4 n 0 mL hr After the CCA has been Wi aie selected the pump is ready for auto programming Back A Options Prime Vol Inf NOTE The Auto Program feature Alar A must begin on the Main Delivery Screen with the desired line STOPPED Following your hospital s procedure activate your BPOC Unit Scan the patient wristband to pull up the patient s task list on the BPOC Unit Scan the IV bag IV Task and documentation with Order Details is displayed on the BPOC Scan the barcode of the available pump channel that is not currently infusing A or B NOTE If the scanned medication does not exist in the Hospira MedNet Rx Rules medication library no medication will be System Operating Manual Plum A Infusion Systems displayed on the pump and No Drug Selected will be seen on the subsequent Confirmation and Main Delivery Screens T Programming screen is auto filled aan Na Weight 70 kg 10 meg kg min 8 Verify ALL parameters If pLa Har changes are desired the a a infusion parameters can be Eto valve using Keypad manually changed using the E keypad on the pump 10 Select 4 Yes to confirm programming and begin Delivery will be i i Dose 10 mcg kg min infusion Drug DOPamine Conc 400 mg 250 DIN Weight ki The BPOC will reconfirm that Ka the pump parameters match the order 11 Complete the transaction o
65. e and Drug 0 KA are displayed as well as the Dose mog ymin ESSE a mi Rate and Dose Units Ki Vol Inf System Operating Manual Plum A Infusion Systems Dose Calc mg min on B DOSE CALCULATION Allows programming Dose Rates in alternative units of measure Dose Calculation can be used in Simple Delivery Loading Dose and Multistep Clear ALL settings when changing patients or multiple programming parameters 1 Select 4 B at the Main A PUMPING STOPPED B Delivery Screen Dase eiela ian Rate 26 3 UG Vol Inf 0 mL 10 Dose mcg kg min VES ENMAY nira Vol Inf The Line B Programming To pRocRAM B screen appears MEET Mode 2 Select 4 Drug List Rate o mL hr VTBI Ome Duration 00 00 hr min Change using Change Mode Program Change Drug Options Mode List Back A A A System Operating Manual 79 For Systems With Hospira MedNet Software The Drug List Screen appears Medsug B mainly in alphabetical order Albumin 596 25 grams 500 mL Aldesleukii 2 6 mg 50 mL NOTE Default entry is No Drug Ar e ei Alteplase 50 mg 50 mL Selected Alteplase 100 mg 100 mL Amikacin 100 mL Amiodarone 150 a me Select then Enter Page Page Enter a Up Down A A A 3 use 89 to highlight desired Labetalol 200 mg 200 mL drug name Lepirudin 100 mg 250 mL Lidocaine 1 grams 250 mL a acano E aasisoa mel 2 grams 500 mL When list does not contain Lidocaine 4 grams 500 mL Lipo
66. e door with a soft lint free cloth dampened with one of the cleaning agents listed in the following table or a mild solution of soapy water Use a small non abrasive brush to aid in cleaning the infusion system housing and subsystem chassis components To thoroughly clean the cassette receptacle disengage the cassette door from the door latch by pressing the door release tab CAUTION DO NOT ALLOW CLEANING SOLUTIONS TO SATURATE THE AIR IN LINE DETECTORS OR ENTER THE DEVICE WHEN CLEANING THE AIR IN LINE DETECTORS System Operating Manual 129 For Systems With Hospira MedNet Software CLEANING SOLUTION MANUFACTURER PREPARATION Coverage HBV Steris Corporation A Per manufacturer s division of Calgon Vestal recommendation Laboratories Formula C Diversey Corporation Per manufacturer s recommendation Dispatch Caltech Industries Per manufacturer s recommendation Precise Caltech Industries Per manufacturer s recommendation Household bleach Various Per hospital procedures do not exceed one part bleach in ten parts water Manu Klenz Calgon Vestal Per manufacturer s Laboratories recommendation Sporicidin Sporicidin International Per manufacturer s recommendation Super Edisonite S M Edison Co Per manufacturer s recommendation The rubber pad on the Plum A 3 pole clamp as well as the IV poles for both instruments may be cleaned using isopropyl alcohol On a routine b
67. e manual concerning operating devices near RF sources System Operating Manual 15 For Systems With Hospira MedNet Software The wireless module 20677 20791 04 has been tested with Plum A infusion systems and has been found to comply with the international standard IEC 60601 1 2 Edition 2 Electromagnetic Compatibility EMC of Medical Electrical Equipment FCC Information KC US FCC FEDERAL COMMUNICATIONS COMMISSION STATEMENT 16 This device complies with Part 15C 15E of the FCC Rules Operation is subject to the following two conditions 1 This device may not cause interference and 2 This device must accept any interference including that may cause undesired operation of these devices FCC INTERFERENCE STATEMENT This equipment has been tested and found to comply with the limits for a Class B digital device pursuant to Part 15C 15E of the FCC Rules These limits are designed to provide reasonable protection against harmful interference in a residential installation This equipment generates uses and can radiate radio frequency energy If not installed and used in accordance with the instructions it may cause harmful interference to radio communications However there is no guarantee that interference will not occur in a particular installation If this equipment does cause harmful interference to radio or television reception which can be determined by turning the equipment off and on the user is encouraged to t
68. e of delivery for the lowest rate may be affected by no more than 0 5 When air is present in the bubble trap the absolute percentage of delivery for the lowest rate may be affected by up to 2 0 When variations in container height are present the absolute percentage of delivery for the lowest rate may be affected by up to 2 5 for up to 24 inches of container height differences Enteral amp High Viscosity Fluids Effects System delivery accuracy limits for each Enteral and High Viscosity Fluid such as those listed in the following table can be degraded by an additional maximum of 5 System accuracy for Enteral Fluids is defined only for rates of 1 to 200 mL hr with no 138 System Operating Manual Plum A Infusion Systems suspended air in the solution and using an Hospira Plum enteral set ENTERAL HIGH VISCOSITY FLUIDS Dextrose 20 to 50 concentration Isomil Powder Similac Powder Ensure Plus HN Twocal HN Jevity Trumpet Curves The Trumpet Curve Graphs following the Example show representative maximum and minimum percent flow rate deviation from the programmed rate over time This information was developed in accordance with IEC 60601 2 24 1998 Sub Clause 50 102 Refer to this standard for detailed information How to read a Trumpet Curve Graph Refer to example on the following page The graphs following the Example plot flow rates at 30 second intervals for the
69. econdary line use aseptic technique and proceed as follows With cassette door closed Loosen and remove white cap then discard Add secondary tubing or syringe Open all proximal clamps before pressing START Set up per operating instructions See Sections 4 6 of this manual Syringe Secure the container to the cassette door using the optional container support arm List 12095 03 lt A System Operating Manual Plum A Infusion Systems Discontinuing Electronic Flow Control amp Setting Gravity Flow If electronic flow needs to be stopped the precision flow regulator on the cassette can be used to manually set and maintain fluid flow in a gravity mode see the following graphics CAUTION BEFORE OPENING DOOR CLOSE CLAMP ON PRIMARY OR SECONDARY SET OR REMOVE SECONDARY CONTAINER FROM SECONDARY PORT TO PREVENT MIXING OF PRIMARY AND SECONDARY FLUIDS WARNINGQHYH TO PREVENT UNRESTRICTED FLOW CLOSE ALL SLIDE OR CAIR CLAMPS PRIOR TO OPENING THE CASSETTE DOOR O Press STOP Gro O CLOSE ALL SLIDE OR CAIR ROLLER CLAMPS P 3 OPEN DOOR amp REMOVE CASSETTE TO CLOSE CLOSED NOTE FLOW REGULATOR CLOSES SLIDE CLAMP POSITION AUTOMATICALLY WHEN DOOR IS OPENED TO PREVENT ACCIDENTAL FREE FLOW Roller Roller TO CLOSE CLOSED CAIR ROLLER POSITION CLAMP SET GRAVITY RATE BY TURNING FLOW REGULATOR COUNTER CLOCKWISE
70. ected to AC mains to confirm a fully charged battery for emergencies NOTE If the quality of the earth grounding source is in doubt use battery power CAUTION THE PLUM A SYSTEM IS DESIGNED TO OPERATE NORMALLY IN THE PRESENCE OF MOST ENCOUNTERED ELECTROMAGNETIC INTERFERENCE EMI CONDITIONS IN THE EVENT OF EXTREME LEVELS OF INTERFERENCE SUCH AS ENCOUNTERED NEXT TO AN ELECTROSURGICAL GENERATOR CELLULAR TELEPHONES OR 2 WAY RADIOS IT IS POSSIBLE THAT THE NORMAL OPERATION OF A SENSOR OR MICROCOMPUTER MIGHT BE DISRUPTED System Operating Manual 47 48 For Systems With Hospira MedNet Software OPERATION OF THE INFUSER UNDER THESE CONDITIONS SHOULD BE AVOIDED TANDEM CARRIER INSTRUCTIONS NOTE The Plum A 3 is NOT to be used with the tandem carrier It is only to be used with the Plum A and other single channel devices The Plum A may be safely and conveniently mounted on an IV stand or on a tandem carrier mounted on an IV stand Always mount the tandem carrier List 12270 01 to the pole before attaching the infuser s to the tandem carrier Make sure tandem carrier clamp is attached firmly to pole Make sure infusers are firmly attached to tandem carrier This section details the Plum A instrument setup procedures SYSTEM SELF TESTS The infuser performs a suite of System Self Tests when power is applied to confirm readiness for use Failure during the Self Tests is reported as a Malfunction Conditi
71. een enabled no Alarm is active and any key besides Stop is pressed Disable the Lockout switch located on the back of the device See Section 3 Illegal when Line Delivering Attempt to select program other than Dose Calculation while a Basic program is delivering on this line Select 4 Cancel Back or press CLEAR Pressing CLEAR invokes another message System Operating Manual 125 For Systems With Hospira MedNet Software MESSAGE Input digits 5 max allowed POSSIBLE CAUSE Attempt to input digit that would exceed the number of decimal places allowed for defined value except Dose and Rate CORRECTIVE ACTION Press CLEAR hardkey Input value gt max allowed Attempt to input number that would cause field to exceed its defined limit In the Drug amount Diluent amount VTBI Duration Patient Weight Distal pressure and Delayed Start time fields the Software shall display and the user must press the Clear hard key and input a Press CLEAR hardkey valid value Maximum value reached The display contrast User can select intensity has reached its 4 Enter or maximum value 4 Cancel Back Minimum value reached The display contrast User can select intensity has reached its Enter or minimum value 4 Cancel Back No delivery programmed Delivery attempt at Main Delivery Screen when A and B have both Rate and VTBI eq
72. ela possible AJLA Upon release of 4 Back Prime the cassette test is performed to confirm readiness for pumping Pressing will resume programmed delivery Clearing Settings 1 Press STOP at the Main a roueno srorreoTe Delivery Screen Rat 5 5 lar A Vol Inf Clear ALL settings when o changing patients or multiple programming parameters mm Options A Vol Inf A A System Operating Manual 67 For Systems With Hospira MedNet Software Select Line 4 A or B if active a storreo storrED 8 from the stopped Main Delivery Screen s5 n mL hr 8 9 Vol Inf mL NOTE If Line A or B is programmed with a Therapy i e Dose MedSurg Calculation Rate VTBI and Duration will not display values The Pano ES values to be cleared may be viewed Alar in applicable programming screen under 4 Drug List Select 4 Yes Clear ALL settings when changing patients or multiple programming parameters Clear Line A Settings Example screen of Cleared A PROGRAM Settings MedSurg Rate O mL hr Select 4 Cancel Back to VIBI O mL return to the Main Delivery Duration 00 00 hr min screen or program new Enter Value using keypad settings Program Drug Options List Back System Operating Manual Plum A Infusion Systems Updating Drug Library let reli available the New Drug Library N 5 4 lew Drug Library Install screen will be displayed Available
73. elded Ethernet cable may result in increased emissions Maintaining a minimum separation distance of 2 Ye ft between the Infusion pump system and portable mobile RF communications equipment e List Numbers 12391 and 11971 are compliant to IEC EN 60601 1 2 1993 List Numbers 20678 20679 8 20792 are compliant to IEC EN 60601 1 2 2001 and have been tested and found to comply with EMC limits for the Medical Device Directive 93 42 EEC EN 55011 Class B and EN 60601 1 2 2001 INTERCONNECTING OF MEDICAL EQUIPMENT e Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC Standards e g IEC 60950 for data processing equipment and IEC 60601 1 for Medical Equipment Furthermore all configurations shall comply with the system standard IEC 60601 1 1 Any person who connects additional equipment to the signal input or output part configures a medical system and is therefore responsible for ensuring that the system complies with the requirements of the system Standard IEC 60601 1 1 If in doubt consult the technical service department or your local representative System Operating Manual Plum A Infusion Systems Guidance on EMC Compatibility e There is a shared responsibility between manufacturers customers and users to ensure that Medical Equipment and Systems are designed and operated as intended Medical electrical equipment needs special precautions regarding elect
74. eps Enter value using keypad Program Prev ac Options Steps Back 15 To start the delivery press Deli i EES elivery will be START Drug VinCRIStine E H Rate 50 mL hr This will bring up the VTBI 50 mL Confirmation screen Confirm Program CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION 96 System Operating Manual Plum A Infusion Systems The Main Delivery Screen TATPUMPING STOPPED B displays Step 1 in the upper RESTO ep left corner 50 Rate mL hr 27 5 Vol Inf NOTE In units other than mL hr the g mL Dose rate and units also will be displayed Example of Multistep Screen Pumping on Step 2 100 ate 16 To change a program e52 Vol Inf parameter while pumping select 4 A Options B Vol Inf A NOTE The in a Step number field indicates the step is delivering or q indicates each completed step 17 Enter a value using the keypad Enter value using keypad Program More Cancel Options Steps Back A Aj A System Operating Manual 97 18 98 For Systems With Hospira MedNet Software If Rate value is changed the Duration will automatically VinCRIStine change Rate VIBL Duration mi 50 825 75 NOTE Only the current delivering step and future steps can be changed Enter value using keypad Program More Cancel Options Steps Back 50 A Aj A To start the delivery press Delivery will be Drug VinCRIStine Rate 125 mL hr This will
75. erein referred to as Hospira warrants that a the product shall conform to Hospira s standard specifications and be free from defects in material and workmanship under normal use and service for a period of one year after purchase and b the replaceable battery shall be free from defects in material and workmanship under normal use and service for a period of 90 days after purchase Hospira makes no other warranties express or implied as to merchantability fitness for a particular purpose or any other matter Purchaser s exclusive remedy shall be at Hospira s option the repair or replacement of the product In no event shall Hospira s liability arising out of any cause whatsoever whether such cause be based in contract negligence strict liability other tort or otherwise exceed the price of such product and in no event shall Hospira be liable for incidental consequential or special damages or losses or for lost business revenues or profits Warranty product returned to Hospira must be properly packaged and sent freight prepaid The foregoing warranty shall be void in the event the product has been misused damaged altered or used other than in accordance with product manuals so as in Hospira s judgment to affect its stability or reliability or in the event the serial number or lot number has been altered effaced or removed The foregoing warranty shall also be void in the event any person including the Purchaser perf
76. erties of cleaning System Operating Manual 11 For Systems With Hospira MedNet Software solutions vary consult the manufacturer for specific information BoLus RELATED Use the following procedure to avoid the administration of a bolus following a distal occlusion that is a closed distal clamp e If a secondary container is in use clamp proximal tubing before opening cassette door e To prevent unrestricted flow close all slide or CAIR clamps before opening the cassette door e Open cassette door and remove the cassette Open the flow regulator briefly to dissipate the pressure and then close it Eliminate the source of occlusion closed clamp Reinsert the cassette and close the cassette door e Open all clamps and resume infusion NOTE When troubleshooting an occlusion where all clamps are in the OPEN position use care to avoid delivery of a bolus by opening the flow regulator to release any built up pressure Close the clamp between the cassette and the patient before opening the flow regulator to relieve the pressure See Section 7 Alarms and Troubleshooting for more information ARTIFACTS e Nonhazardous low level electrical potentials are commonly observed when fluids are administered using infusion devices These potentials are well within accepted safety standards but may create artifacts on voltage sensing equipment such as ECG EMG and EEG machines These artifacts vary at a rate that is associated wi
77. es wired Ethernet and wireless 802 11 a b g local area networking capabilities This allows the Hospira Mednet networked application software to download drug libraries to the infuser and enable the auto programming feature 2 System Operating Manual Plum A Infusion Systems Accessory equipment connected to the analog and digital interfaces must be certified according to the respective IEC Standards e g IEC 60950 for data processing equipment and IEC 60601 1 for Medical Equipment Furthermore all configurations shall comply with the system standard IEC 60601 1 1 Any person who connects additional equipment to the signal input or output part configures a medical system and is therefore responsible for ensuring that the system complies with the requirements of the system Standard IEC 60601 1 1 If in doubt consult the technical service department or your local representative Indications for Use USER QUALIFICATION The Plum A is intended for use at the direction or under the supervision of licensed physicians or certified healthcare professionals who are trained in the use of the infuser and the administration of parenteral enteral and epidural fluids and drugs and whole blood or red blood cell components The training should emphasize preventing related IV complications including appropriate precautions to prevent accidental infusion of air The epidural route can be used to provide anesthesia or analgesia WARNING ADMI
78. first 2 hours and for the 96th hour of delivery The graph plots mean delivery rate error Average of 3 infusers for the 2nd hour and the 96th hour as a straight line The graph also presents maximum and minimum average delivery rate error for this interval plotted by averaging delivery errors over intervals of 2 5 11 19 and 31 minutes Trumpet Curve EXAMPLE From the Trumpet Curve Graph sample that follows find the 5 minute interval A at the horizontal axis and read the corresponding points B and C on the vertical axis The values are approximately 2 8 and 0 5 This means that at the rate of 25 mL hr the average maximum flow rate fluctuation for any 5 minute time interval during the 2nd hour of operation was within the limits of 2 8 and 0 5 from System Operating Manual 139 For Systems With Hospira MedNet Software the nominal rate The average delivery rate error over the entire 2nd hour was 1 6 D For other time intervals look at other points at the horizontal axis and determine corresponding limits as above 25 ML HR 0 mm Hg DELIVERY HEAD START UP A 15 096 9 o Max Positive Error over 5 g 00 Minute Interval 2 8 S 50 pa i FP 0 0 fi 5 0 a Max Negative Error over 5 O i Minute Interval 0 5 W 10 09 p Average Delivery Rate Error 1 6 15 0 H 0 5 10 15 20 25 30 Observation Interval minutes A trained professional can use the resulting graphs to selec
79. g or syringe N180 Distal Distal line kinked IV site Check distal tubing N181 Occlusion clotted or positional check IV site reset N186 pressure limit set too pressure limit low See page 1 10 for detailed instructions for avoiding a bolus following a distal occlusion N187 Neg Distal Pump too high above Lower infuser or Occlusion patient or defective set replace set N233 Distal Air When air is detected at Remove and reprime N234 the distal sensor and cassette using exceeds the limit standard technique System Operating Manual 117 For Systems With Hospira MedNet Software CODE MESSAGE POSSIBLE CAUSE CORRECTIVE ACTION N250 Door open Pump door opened Close door with while pumping while operating cassette inserted N251 Cassette Test Faulty cassette Check clamps Failure proximal or distal manually reprime set occlusion or air in close door Backprime cassette detected at into line B tubing or start up syringe if appropriate If alarm recurs on retest replace set If alarm repeats replace infuser N252 Depleted Too much time on Plug into AC mains Battery battery power power N253 Hard lockout The use of the STOP Unlock lockout switch Violation key during delivery or opening the door while lockout is enabled N254 Hard lockout Pressing of any key Unlock lockout switch Enabled except STOP during delivery while any alarm is a
80. he associated line B The drug and concentration in the auto program is different from a currently programmed drug and concentration Auto Program titration An auto program is considered a titration if the drug and concentration in the auto program match the currently programmed drug and concentration Non promotion titration programs include some subset of the following Rate Dose Duration Promotion titration programs include some subset of the following Rate Dose Duration Patient Weight Dosing Units Drug Amount Drug Units Diluent Amount Awake CE The CE is considered awake when the infuser is powered on with battery power and the battery is above the low battery threshold or is plugged into AC Backpressure Resistance to fluid flow on the Distal or output portion of the Administration Set usually expressed as PSIG Backprime Removal of air or fluid from the proximal tubing and Cassette air trap by rapid pumping of fluid from Line A to an output receptacle on Line B No fluid delivered distal to the cassette during a Backprime 22 System Operating Manual Plum A Infusion Systems TERM Basic Delivery DEFINITION A single step delivery specifying rate VTBI and duration only Drug name may or may not be specified Biomed Mode The name for the non delivery or service mode of Infuser operation Bolus A single uninterrupted discrete volume
81. he same container e g a fluid challenge If Dose Calc is used the Loading Dose and Maintenance Dose are in the same unit of measure over the same period of time mcg min from the same container Loading Dose Allows a sequential program to deliver up to 10 steps fluid volumes and delivery rates may be programmed for each step The program may be VURIGE entered based on Rate and Volume or Volume and Time If Dose Calc is used the delivery steps are in the same unit of measure over the same period of time from the same container NOTE During programming user must identify desired drug with softkey Drug List prior to setting program parameters Use drug manufacturer recommendations for IV administration when using the Plum A infuser System Operating Manual 71 For Systems With Hospira MedNet Software Dose Calc mcg kg min on A 72 DOSE CALCULATION Allows programming Dose Rates in alternative units of measure Dose Calculation can be used in Simple Delivery Loading Dose and Multistep Clear ALL settings when changing patients or multiple programming parameters The Area Selection screen will appear if your system has been Any Hospital USA s MM DD YY XXYYZZ 123456 programmed with the MedNet C UE Renal accessory Cardio Da Urology Use to select CCA and bring you to the Main Delivery Screen NOTE To change the CCA while infusing see Changing CCA While Infusing in Section
82. ins power e Lockout switch e Standard syringe use e Parenteral and nonparenteral enteral fluid delivery Blood and blood products delivery e Wide range of Standard and Specialty administration sets e Password protected keypad lock COMMUNICATION e Networked Communication Ethernet 4 Wireless e Autoprogramming e Drug Library Download Definitions TERM DEFINITION Administration Set The sterile disposable assembly with flexible tubing that connects to a source fluid container for input to the Cassette pumping chamber and to some output device for administration to the patient Alarm A condition requiring operator intervention that invokes both audible and visible alarm indicators Confirmation of the condition usually is required Alert While entering a program a visual warning that informs the clinician of the violation of a hospital defined rule set e g a dose limit for a specific drug System Operating Manual 21 For Systems With Hospira MedNet Software TERM DEFINITION Alternate Units Dose Rate units that may be selected Alternate Units are any units other than mL hr Alternate Units Parameters Drug Amount Diluent Patient Weight if applicable and Dose Rate Auto Program A physician order sent to the infuser Auto Program new An auto program is considered new if either of the following conditions are met A There is no program on t
83. ion field temporarily changes to dashes when the computed value is larger than what can be displayed Continue entering the RATE value if desired NOTE As Rate is entered the Duration and Dose are automatically adjusted as individual numbers are entered NOTE If the Duration value is changed the Rate and Dose are automatically adjusted NOTE At this point programming is complete unless 4 Program Options are desired See Section 6 Additional Features for more information CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION To start the delivery press Program Dose Calc B Delivery will be START 2 mg min Lidocaine 2 grams 500 mL 70 kg This will bring up the PROGRAM A CONFIRMATION screen Confirm Program If Dose Drug Conc Weight amp Rate appear correct select 4 Yes to begin program NOTE If the selected drug has been pre programmed with dosing units and concentration the concentration drug amount or diluent volume cannot be changed whether delivering or stopped The only way to change to a different concentration is to clear the program However if selected drug has not been pre programmed or still operating with the DDL the concentration can be changed for a program System Operating Manual 83 84 For Systems With Hospira MedNet Software Upon START the Main Delivery AIsrorreo ruwenc B Screen shows delivery status aaa for both A and B lines A mL hr 4 Vol Inf 0 1
84. key Indicators The Charge Line Indicator is illuminated to indicate the battery is currently charging NOTE If the device is plugged into AC power with a battery installed and the Charge Indicator is not illuminated contact technical support The fluid drop symbol when flashing indicates an active infusion on Line A and or Line B 36 System Operating Manual Plum A Infusion Systems Display Symbols Battery Capacity Symbol located on right side of message region on display indicates relative charge with number of white boxes from TITI left to right Cautionary Symbol is displayed to alert the user that the infuser is being operated without rule sets soft or hard limits Read the drug package insert for information on proper usage Soft Limit Override Symbol Ea indicates the programmed soft limits upper up arrow or lower down arrow have been E overridden NOTE The infuser will display the rule set icon from the first step in a situation where a 2 step process is completed and the infuser is stopped after going to KVO The Wireless Connection Available icon is displayed when the device is receiving a wireless o signal The infuser will connect to the network if a wireless network access point is recognized System Operating Manual 37 For Systems With Hospira MedNet Software It may appear on any Main Delivery STOPPED PUMPING 8 Screen whether pumping or stoppe
85. l Features 99 SIMPLE DELIVERY USING DELAYED START 99 PIGGYBACK WITH NURSE CALLBACK o 100 POSSIBLE NON DELIVERY PROGRAMMED 102 iv System Operating Manual Plum A Infusion Systems USING THE STANDBY FEATURE 102 SELECT OPTION VOLUMES INFUSED PRESSURE POST INFUSION RATE AND LIGHTING CONTRAST 104 VARIABLE RATE CAP 0 2200 108 EXAMPLES OF AUTOMATIC CALCULATION 108 AT STARTUPS ga nana DA IA AA 108 WHILE RUNNING TITRATION 2 2 a 108 TALA SA AA PRA 109 CHANGING CCA WHILE INFUSING 110 AUTO PROGRAMMING 222 111 Section 7 Alarms and Troubleshooting 115 WARNING MESSAGES 0 0220 115 RESPONSE TO ALARMS 022220000 116 GENERAL ALARMS 2 0220 117 LINE A ALARMS 002220 119 LINE B ALARMS 0 2222 121 MALFUNCTIONS 2 222 cece eee eee 122 GENERAL MESSAGES 0 000 0000 eee 123 Section 8 Cleaning Maintenance and Storage 129 CLEANING AND SANITIZING 0 0 00000 c ee eee eens 129 BATTERY MAINTENANCE 00000 c cece eee ee eee 131 STORAGE xc sey DANGAN dos de ald 132 SERVICES CA actly Ca NE ga e a 132 Section 9 Specifications 133 PHYSICAL uo Bayag as ead aide iat a hd waded ANN laid de de 133 ELECTRICAL a5 as sient Rd va arose D 133 WIRELESS LAN UPGRADE MODULE 134 VTBERANGE popping tame ees hal DD Maange NG buenos 135 EN
86. livers 250 mL if gt 126 mL hr Time is measured from initial pumping to Depleted Battery Alarm The battery charges whenever the infuser is connected to AC power The recharge time is approximately six hours with the device operating at 125 mL hr on one line Meets IEC 60601 1 standard Medical Electronic Equipment Part 1 General Requirements for Safety NURSE CALL alarm is factory set for Normally Open NO Contact the Technical Services Center to make an internal adjustment to change the device from Normally Open NO to Normally Closed NC system Voltage 30 VDC Max Current 0 25 Amps Max Contact Rating 3 Watts Max Wireless LAN Upgrade Module 134 Device Name Standards Transmit Power Antenna Certifications This Device Contains Hospira MedNet 802 11 a b g Wireless Upgrade Module IEEE802 11a b g 802 11 b g 17 dBm 802 11 a 16 dBm Integrated surface mount antenna FCC Part 15 247 15 407 IC RSS 210 RSS 102 FCC ID STJ80411396001 IC 5627A 80411396 Model CUSTOM DWL AG132 System Operating Manual Plum A Infusion Systems VTBI Range VTBI Range 0 1 to 99 9 mL in 0 1 mL increments 100 to 9999 mL in 1 mL increments Environment Operating 5 to 40 C Temperature Storage 20 to 60 C Temperature Atmospheric 0 10 000 feet 0 3 000m or equivalent Pressure pressure Relative Humidity 10 90 40 C Max Delivery Rate Range Lines A and B 0 1 99 9 m
87. livery Infusion will stop Line A and infuse Line B until VTBI completes 28 System Operating Manual Plum A Infusion Systems TERM Piggyback Mode DEFINITION The Line B control selection mode that requires Line A delivery suspension while Line B delivers and then its resumption when Line B VTBI completes If Line A is not programmed and started Line B delivery just stops when its VTBI completes Line A operation is delayed for duration of its interruption by Line B Plunger Park Position The position of the pumping plunger that allows the cassette to be withdrawn from the Infuser without restriction with an opened Door POST Power On Self Tests Startup initialization and test of critical hardware modules and software functions to determine Infuser readiness for its Intended Use Power On When the power is first applied to the Infuser processor It occurs when Infuser is in the off condition and the AC power is applied or during battery operation when the ON OFF key is pressed Pressure The measured fluid pressure for Proximal Line A Proximal Line B or the Distal line when a fully primed administration set is loaded into a Mechanism with the Cassette Door closed Programs A Concentration based extension to basic Volume Rate delivery for Dose Rate applications Softkey selected types are 1 Standard Program for single rate delivery 2 Loading Dose fo
88. ly for side effects in a fully equipped and staffed environment for at least 24 hours following completion of drug administration by the epidural route DELAYED RESPIRATORY DEPRESSION FOLLOWING CONTINUOUS EPIDURAL ADMINISTRATION OF PRESERVATIVE FREE MORPHINE SULFATE HAS BEEN REPORTED e The epidural space has 58 openings through which fluid can exit Pressure buildup during administration is transient However if a large volume of fluid is administered over a short time period the pressure will take longer to return to normal If overdelivery occurs during administration observe the patient closely for signs of spinal cord compression disorientation headache transient neuralgias and drug overdose BATTERY OPERATION When the battery is removed from the Plum A do not operate on patients Use of a properly maintained and charged battery helps confirm proper operation e The battery may not be fully charged upon receipt Connect the infuser to AC power for at least six hours System Operating Manual 9 10 For Systems With Hospira MedNet Software Use AC power whenever possible Connect to AC power during storage to ensure a fully charged battery for emergencies If the quality of the earth grounding source is in doubt use battery power If the low battery alarm sounds connect the infuser to AC power immediately SETS AND ACCESSORIES Only compatible LifeCare PlumSets can be used with the Plum A See individual se
89. macodynamics of any critical drug before administration This information is presented to inform clinicians of a rare situation that could be misinterpreted if they are unfamiliar with this phenomenon EPIDURAL ADMINISTRATION Recommended use of the epidural route is to provide anesthesia or analgesia for periods up to 96 hours e This device can be used to administer only those anesthetics analgesics approved for epidural administration as indicated 8 System Operating Manual Plum A Infusion Systems or allowed by the drugs FDA approved labeling Epidural administration of drugs other than those indicated for epidural use could result in serious injury to the patient e For epidural administration the use of Hospira catheters Plum sets without Y sites and epidural stickers indicating ongoing epidural administration are recommended e Administration of drugs via the epidural route should be limited to personnel familiar with associated techniques and patient management problems Proper epidural placement of the catheter is essential since catheter migration could result in intravascular or intrathecal administration Facilities practicing epidural administration must be equipped with resuscitative equipment oxygen naloxone and other resuscitative drugs Adequate monitoring equipment e g Oximetry is recommended for continuous monitoring of the patient during epidural administration Patients must be observed frequent
90. me or Volume and Time If Dose Calc is used the delivery steps are in the same unit of measure over the same period of time from the same container System Operating Manual 27 For Systems With Hospira MedNet Software TERM DEFINITION MMS Medication Management Suite a product suite that will be used to support safe and efficient caregiver administration of intravenous medications MMU Medication Management Unit the MMU is a product of the MMS and provides external communications with infusers and other systems supporting medication management lt supports drug library downloads and status log updates to the infusers MMU also delivers a variety of pre built and custom reports related to the infuser activities Network Enabled Module The hardware that facilitates communication between the infuser and the network Note A Note explains something new gives tips on performing an activity or provides a reminder of necessary preparations Override The clinician acknowledges an Alert confirms and proceeds with a program containing a parameter that falls outside the hospital defined Soft Limits Parenteral Delivery via other than an intestinal route such as intravenous IV injection Patient Weight The Alternate Units Parameter whose value entry is required with Dose rates quantity time having the third parameter of weight such as mcg kg min Piggyback De
91. ming see Basic Delivery 30 System Operating Manual Plum A Infusion Systems TERM DEFINITION Standby A delivery program state that resembles a delayed start for a line in all respects but status display of STANDBY instead of DELAYED A press of the START key and a Start Softkey if necessary will begin the programmed delivery System The Plum A Infuser system with its associated accessories and Administration Sets Tall Man Lettering Tall Man lettering uses upper case letters in combination with lower case letters to help clinicians differentiate among sound alike or look alike drug names Certain Hospira Default Library drug names are displayed in Tall Man lettering Truncate To round down to the last whole number e g 103 7 would be 103 Units A Drug Amount without a quantity of mass referent adopted as the United States Pharmacopoeia USP standard of measure for use in a Concentration VI Volume Infused VTBI Volume To Be Infused The volume of fluid or IV solution remaining for delivery by a program or Therapy step from a Line System Operating Manual 31 For Systems With Hospira MedNet Software TERM DEFINITION Warning Audible indication at the defined Warning sound level often accompanied by a brief message to advise operator that 1 Input was attempt to use a function in wrong sequence with wrong values
92. n the BPOC Unit or document the process per hospital procedure System Operating Manual 113 For Systems With Hospira MedNet Software NOTES 114 System Operating Manual SECTION 7 Plum A Infusion Systems Alarms and Troubleshooting Warning Messages MESSAGE Stop delivery then turn off POSSIBLE CAUSE Attempting to turn the infuser off while a delivery is in progress CORRECTIVE ACTION Stop all lines then turn infuser off Warning Replace Battery The battery current charge is greater than 200 mA hr The battery voltage is less than the depleted threshold and charge level is higher than the low charge threshold Replace battery Warning Charger Service The charging circuitry is not behaving as expected charge voltage is not changing and can reduce battery life Silence key is pressed Warning Low Battery Pump not plugged in to AC power Plug into AC power only about 30 minutes of battery life remains NOTE Other error and warning messages will occur when appropriate for the current selection context For instance when a change to a required parameter would result in clearing some delivery settings the warning message will appear when that field is selected When an input error has just been made the three quick beeps of an Invalid Key Warning will sound and an appropriate warning message will be shown to explain the System Ope
93. n invalid key press resulting from an operator attempt to make an input that is not valid for the current operational context Not a Malfunction Filling Head Height FHH The gravity induced Proximal Line pressure due to fluid height in source container above the Distal Line output level Flow Rate The resulting rate of fluid flow See Rate and Dose Fluid Delivery Begin The time required measured from the initial start of a keypad press for a digit in the third decimal place of a scale measuring grams to change when pumping water the delivery tube is fluid filled and the end of the delivery tube is immersed Hard Limit The dosing amount upper and or lower amount that when assigned to a drug cannot be overridden Defined by the hospital for each drug in its Drug Library The hard limits for a particular drug may vary across different CCAs Infuser A Plum A device not including the disposable administration set Initialized Position The plunger is in the Plunger Park Position and each valve is in the Valve Home Position Key Any of the marked locations on the front panels intended for user input via a pressing action KVO Keep Vein Open Internally selected minimal delivery rate the lesser of 1 0 mL Hr or actual Rate intended to provide sufficient fluid flow to decrease the potential for clotting at the IV infusion site 26 System Operating Ma
94. ng the disposable administration sets Diluent Volume The volume of fluid used with the Diluent Unit e g 250 mL which dilutes the drug to be infused Distal Downstream output from the Cassette portion of the Administration Set Door The lever operated bottom hinged Cassette holder on the front of the Mechanism Dose Rate Delivery rate times drug concentration Dose Calculation Allows programming Dose Rates in alternative units of measure Dose Calculation can be used in Simple Delivery Loading Dose and Multistep Drug Amount The mass or quantity of the drug premixed with a Diluent to express the Concentration for the Line being programmed Drug Library Drug names available for use with the Infuser in the selected CCA and each drug s concentration units of measure and dose limits as determined by authorized hospital staff The Drug Library is based on hospital defined best practices The Drug Library is customized and downloaded into the Infuser by authorized hospital personnel using Hospira MedNet Networked software Duration The time period used to deliver a VTBI at an existing Delivery Rate or as set by the operator Enteral Delivery via an intestinal route System Operating Manual 25 For Systems With Hospira MedNet Software TERM DEFINITION Error A condition resulting in an audible warning and often an accompanying message such as a
95. nual Plum A Infusion Systems TERM DEFINITION Line A Inlet tubing on the top center of Cassette when viewed after it has been loaded in Mechanism Door Line B Inlet connector on the top right of Cassette when viewed after it has been loaded in Mechanism Door Loading Dose Allows programming of an initial infusion rate for a specific volume followed automatically by a maintenance rate from the same container e g a fluid challenge If Dose Calc is used the Loading Dose and Maintenance Dose are in the same unit of measure over the same period of time mcg min from the same container Macro Cassette The Plum Cassette as part of an Administration Set whose attainable delivery performance is for general purpose uses Malfunction One of a number of conditions that indicate a failure of the Infuser These conditions usually require a repair action Mechanism The provider of the physical activities of 1 valve control for Line selection and inlet to or outlet from the Cassette 2 Plunger extension and retraction for changing fluid volume of the Cassette pumping chamber MedNet software Networked application software used to define and download the custom drug library to the Infuser Multistep Allows a sequential program to deliver up to 10 steps fluid volumes and delivery rates may be programmed for each step The program may be entered based on Rate and Volu
96. nue If desired select a Page Down to see more units of measure System Operating Manual Plum A Infusion Systems The Multistep Programming LA Program Multistep screen appears VinCRIStine Duration 9 Rate is the default field Enter value using keypad Enter value using keypad Program More Cancel Options Steps Back A Al A maa 10 Use ts to highlight the Duration or VTBI field Burton i min KY 00 NOTE The VTBI value is automatically computed when the Duration value is entered If VTBI is e maa entered the Duration value is Program EE a automatically computed Opens Sieps E Ban 11 Use to drop down to Step AL h oatamMuttister _ VinCRIStine 2 Rate field Duration 12 Enter the set of desired values for Step 2 of the program T Continue process for each Program More Na nga Options Steps Back additional Step System Operating Manual 95 For Systems With Hospira MedNet Software NOTE When Step 4 is programmed Program Multistep using SELECT to advance will A Program Mutistep highlight another item on this screen Duration 13 When Step 4 is programmed select Ba 4 More Steps to program up HE to 10 Steps Options Steps Back A A A NOTE Using SELECT will not advance you to the additional steps 14 To set up Steps 5 through 10 enter desired values as E pa ate uration performed for Steps 1 miu through 4 To see the previous steps select A Prev St
97. on CAUTION Do NOT PLACE THE PLUM A IN SERVICE IF IT FAILS THE SYSTEM SELF TESTS Connect the AC power mains cord to an AC power receptacle then confirm that the Charging Line indicator illuminates above the ON OFF key on the front panel A systematic self testing of the processing delivery and safety systems is performed whenever the Plum A is turned on to verify readiness for operation System Operating Manual Plum A Infusion Systems NOTE If the quality of the earth grounding source is in doubt use battery power Press the ON OFF key to turn the power on Check screen display and listen for a beep to indicate the audio is working Wait for the self tests to complete If successful put a fully primed macro cassette into the cassette door and close the door See Loading Cassette in Section 3 for details of correct procedure When the Charging Line indicator is off and the battery symbol on the display is flashing this indicates that the Plum A is operating on low battery power and should be recharged CAUTION WHEN THE BATTERY IS REMOVED FROM THE PLUM A DO NOT OPERATE ON PATIENTS USE OF A PROPERLY MAINTAINED AND CHARGED BATTERY HELPS CONFIRM PROPER OPERATION To confirm battery is fully charged connect the Plum A to AC mains power for a minimum of six hours while in the OFF mode If an alarm occurs during the power on self test identify the alarm message then take corrective action see Section 7
98. orms or attempts to perform any major repair or other service on the product without having been trained by an authorized representative of Hospira and using Hospira documentation and approved spare parts For purposes of the preceding sentence major repair or other service means any repair or service other than the System Operating Manual 147 For Systems With Hospira MedNet Software replacement of accessory items such as batteries and detachable mains power cords In providing any parts for repair or service of the product Hospira shall have no responsibility or liability for the actions or inactions of the person performing such repair or service regardless of whether such person has been trained to perform such repair or service It is understood and acknowledged that any person other than an Hospira representative performing repair or service is not an authorized agent of Hospira 148 System Operating Manual Plum A Infusion Systems SECTION 12 Default Drug Library DDL NOTE This list is only accurate if no custom drug library has been developed using the Hospira MedNet accessory Once a custom drug library has been developed this list will no longer be accessible Only Hospira personnel can re install the DDL Use drug manufacturer recommendations for IV administration when using the Plum A infusion infuser DEFAULT DOSE DEFAULT DRUG NAME RATE CONCENTRAT
99. ove the patient e The infuser is infusing at very low rates between 0 1 5 mL hr In these cases an air eliminating filter may be used when clinically appropriate Repeated opening and closing of the door may defeat the proximal air in line alarm and may cause a distal air in line alarm requiring repriming The screen displays the VTBI volume to be infused in integers when value is above 99 9 Any fraction of a milliliter delivered is not displayed but is retained in memory System Operating Manual Plum A Infusion Systems e For Plum A 3 users be aware that changing the weight on one device does NOT change the weight on the other two devices Patient weight must be changed on each device when delivering weight based therapy dependent on medication requirements CONCURRENT FLOW GUIDELINES When delivering short half life critical drugs see Critical Drugs this section using the Plum A in the Concurrent mode the following delivery rate guidelines should be observed e If the critical drug with half life less than 6 minutes is to be infused at less than 2 mL hr the other infusion should be no faster than 5 times the critical drug s rate Dopamine for example delivered at 1 5 mL hr should not be accompanied by an infusion programmed any faster than 7 5 mL hr e If the critical drug with half life less than 6 minutes is to be infused at 2 5 mL hr the other infusion should be no faster than ten times the critical drug s
100. pad or use SELECT arrows to move to another field to change the entry User can also press CLEAR Decimal point not allowed Attempt to input Decimal point when either not used in field or a three digit whole number already input Press CLEAR Hardkey 124 System Operating Manual MESSAGE Dose gt X xx Override Plum A Infusion Systems POSSIBLE CAUSE Attempt to start program with parameter that has caused the Dose or Rate if mL hr program to be greater than the upper soft limit uuuuuuuu for the CORRECTIVE ACTION May be overridden by selecting 4 Yes Cleared by pressing of NUMERIC KEYS SELECT CLEAR or STOP hard keys or 4 Yes No softkeys Also selected drug and CCA cleared by the ON OFF Also includes placing key when the line is programin Standby and stopped re starting a stopped program Dose lt X xx Override Attempt to start program May be overridden by with parameter that has selecting 4 Yes caused the Dose or Cleared by pressing of Rate if mL hr program to be less than the lower soft limit 1111111 for the selected drug and CCA Also includes placing program in Standby and re starting a stopped program NUMERIC KEYS SELECT CLEAR or STOP hard keys or 4 Yes No softkeys Also cleared by the ON OFF key when the line is stopped Hard Lockout Enabled The Lockout Switch has b
101. ple the delivery shows 3 hours and 20 minutes not 3 minutes and 20 seconds Press START Program Confirmation screen will appear If correct press 4 Yes to begin infusion NOTE START accepts the change Delivery is changed to the new RATE and DURATION and display returns to Main Delivery Screen Example of Changed VTBI value Rate 15 mL hr VTBI E m Use 8 to highlight the VTBI m field Duration 06 40 hr min Enter Value using keypad Program Drug Cancel Use the keypad to change the kak ra VTBI value NOTE When the VTBI is changed the Duration is recomputed with respect to the current Rate To understand the Automatic System Operating Manual 10 11 Plum A Infusion Systems Calculation feature see Examples of Automatic Calculation in Section 6 Press START Program Confirmation screen will appear If correct press 4 Yes to begin infusion NOTE START accepts the change Delivery is changed to the new VTBI and DURATION and the display brings up the Confirmation screen before returning to the Main Delivery Screen Example of changed PROGRAM DURATION field ESTA Rate 150 mL hr VTBI 100 mL Use to highlight the Duration field then use the keypad to change its value aereas hepa Program Drug ee Options List Back Duration 001 hr NOTE When DURATION is changed RATE is automatically recomputed using the current VTBI value To understand the Automatic Cal
102. psig 0 23 mL 0 28 mL 15 psig 0 55 mL 0 63 mL 1mL hr 6 psig 0 24 mL 0 30 mL 15 psig 0 59 mL 0 70 mL Baseline backpressure is 0 psig System Operating Manual 137 For Systems With Hospira MedNet Software Delivery Accuracy The Plum A Infuser was designed and manufactured to maintain a volumetric delivery rate error of the total fluid delivered of less than or equal to 5 over the course of 48 hours at a programmed rate of 1 to 999 mL hr during normal operating conditions For use of the device at rates below 1 mL hr the delivery rate error is less than or equal to 10 Backpressure Effect Positive backpressure on the distal line may affect delivery accuracy by no more than 0 5 per psig 2 per psig for rates between 0 1 and 0 9 mL hr for backpressures up to 15 psig A typical deviation under these conditions is 0 3 Negative backpressure may affect delivery accuracy no more than 2 for pressures up to 2 psig 56 inches of water A typical deviation under these conditions is 0 3 Filling Head Effect Variations in filling head such as container height may affect delivery accuracy by no more than 2 for variations in the range 15 to 28 inches A typical deviation under these conditions is 0 5 Concurrent Delivery Effect When both lines A amp B are delivering the ratio of delivery for the fluid with the lowest rate may be affected by as much as 5 for ratios up to 9 to 1 For higher ratios the absolute percentag
103. r hospital recommended concentration units associated with the selected drug 7 Select 4 Choose to continue Or use to change the Container Concentration units to use in the delivery The next page of the Program Dose Calc screen appears to pmm provide for entry of delivery Tana o program parameters o da The Concentration and Volume tt om fields are filled in per drug aaa selection Program Cancel Options Back A A 8 Use keypad to enter desired values Once each value is entered use Co to highlight the next programming field NOTE The Concentration elements and weight value must be entered before the SELECT key allows access to remaining fields System Operating Manual 75 For Systems With Hospira MedNet Software 9 Continue to enter values using the keypad and advancing to GO 250m Weight 70 kg the next field using D Hao Duration 00 00 hr min Rate 26 3 mL hr NOTE As the Dose value is entered Pat the Rate is automatically calculated Piera To understand the Automatic igan Ha Calculation feature see Examples of NA A Automatic Calculation on page 6 10 10 Use to scroll down to the VTBI field ane m e 250 mL 10 mcg kg min 20 hr min 11 Enter a value for VTBI using nl E the keypad Enter value using keypad Program Cancel i po Back or changes Duration is automatically updated NOTE As the VTBI value is entered NOTE Atthis point programming i
104. r up to two steps of delivery at differing rates 3 Multistep for up to ten steps of delivery at differing rates Loading Dose and Multistep include the basic Delivery Rate option System Operating Manual 29 For Systems With Hospira MedNet Software TERM Protocol DEFINITION In the medical field hospital approved procedures For devices with an electronic communications interface the format and content of messages being exchanged Proximal Upstream input as Line A and or B with respect to the Cassette portion of the Administration Set Rate See Delivery Rate Rounding To round off to the closest whole number e g 25 5 would round to 26 but 25 4 would round to 25 Rule Sets The compilation of Soft and Hard Limits associated with a drug entry Screen That active portion of the LCD assigned to a delivery or other user interactive display operation Softkey A front panel key whose function label is on the bottom portion of the display screen just above its location so that label may be changed to indicate differing key functions within the operational context of the defined screens Soft Limit The dosing amount upper and or lower amount that when assigned to a drug can be overridden based on confirmation Defined by the hospital for each drug in its Drug Library The soft limits for a particular drug entry may vary across CCAs Standard Program
105. rate Dopamine for example delivered at 3 5 mL hr should not be accompanied by an infusion programmed any faster than 35 mL hr e If the critical drug with half life less than 6 minutes is to be infused at 5 1 mL hr or greater the other infusion can be programmed at any desired rate NOTE The total of the primary rate plus the secondary rate cannot exceed 500 mL hr These guidelines apply only when infusing short half life critical drugs in Concurrent mode Individual patient responses may vary requiring adjustment of delivery rates System Operating Manual 7 For Systems With Hospira MedNet Software DELIVERY RATE GUIDELINES SHORT HALF LIFE LESS THAN 6 MINUTES CRITICAL DRUG MAXIMUM RATE OF INFUSION RATE ACCOMPANYING INFUSION 0 5 1 9 mL hr 5 Times the Critical Drug Rate 2 5 mL hr 10 Times the Critical Drug Rate 5 1 or Greater Any Desired Ratio CRITICAL DRUGS Examples of drugs with a short half life approximately 6 minutes or less when given IV include Dobutamine Esmolol Nitroprusside Dopamine Isoproterenol Norepinephrine Epinephrine Lidocaine Oxytocin Epoprostenol Nitroglycerin Procainamide For these drugs the concurrent flow guidelines should be followed when the infusion rate of the drug will be 5 mL hr or less NOTE This list of critical drugs is not intended to be all inclusive of critical drugs or drugs with a short half life The clinician should become familiar with the phar
106. rating Manual 115 For Systems With Hospira MedNet Software problem All such messages will be cleared or replaced by another message upon the next valid input key press Response to Alarms 1 a A W N Disable Lockout by confirming back switch is in the down position or press the decimal key followed by 9 6 4 3 on the keypad Press SILENCE key Identify Observe Alarm condition Correct Alarm condition see following tables Press START to resume infusion NOTE Alarm messages begin with an alphanumeric code for tracking purposes only If troubleshooting does not correct the problem record the code number and contact technical support 116 System Operating Manual Plum A Infusion Systems General Alarms CORRECTIVE A E O POSSIBLE CAUSE ACTION N100 Unrecognized Attempting to use Turn off or insert cassette unrecognized cassette recognized cassette N101 No Action Pump programming Press START or Alarm incomplete continue programming N102 Infuser Idle 2 Pump is ON without Begin programming or Minutes operator input turn infuser OFF Standby time has Re enter all elapsed programmed data N103 Memory Failure The infuser did not Re enter all accept the previous programmed data programmed data N230 Prox Air When the total proximal Check for clamps or Backprime air detected exceeds the empty containers on limit line A or B Correct as necessary Backprime into line B tubin
107. romagnetic compatibility and needs to be installed and used according to the electromagnetic compatibility information provided in this manual e The device is suitable for use in all establishments including domestic establishments If extended operation during power mains interruption is needed use battery power e Always manage the electromagnetic environment e The guidance included in this manual provides information needed to e Determine the device s suitability for use in the intended environment e Manage the electromagnetic environment to permit the device to perform as intended without disturbing other equipment e Separate the device from all other electronic equipment If the device must be used near other electrical equipment monitor the equipment to ensure there is no electromagnetic interference e Devices should not be used adjacent to or stacked with other equipment If the device must be used adjacent to or stacked with other equipment monitor the devices to verify normal operation e USE ONLY components specifically labeled for use with the Plum A Infusion System to help ensure the device operates as intended e If you suspect external RF sources or other equipment are influencing device operation contact the biomedical engineering department for additional guidelines concerning electromagnetic immunity Contact the biomedical engineering department for additional information in the technical servic
108. ry and correct the interference by one or more of the following measures e Reorient or relocate the receiving antenna e Increase the distance between the equipment and the receiver e Connect the equipment to an outlet on a circuit different from that to which the receiver is connected System Operating Manual Plum A Infusion Systems e Consult the dealer or an experienced radio TV technician for help e Changes or modifications not expressly approved by Hospira could void the user s authority to operate the equipment RADIO FREQUENCY EXPOSURE STATEMENT e The Wireless LAN radio device in the Connectivity Engine peripheral board with this infusion device has been evaluated and found compliant to the requirements of the following Radio Frequency exposure standards e Federal Communications Commission OET Bulletin 65 Edition 97 01 Supplement C Edition 01 01 Evaluating Compliance with FCC Guidelines for Human Exposure to Radio frequency Electromagnetic Fields July 2001 e Industry Canada Evaluation Procedure for Mobile and Portable Radio Transmitters with respect to Health Canada s Safety Code 6 for Exposure of Humans to Radio Frequency Fields Radio Standards Specification RSS 102 Issue 1 Provisional September 1999 e The radiated output power of this Wireless LAN device is far below the FCC radio frequency exposure limits The Wireless LAN device for both Plum A and Plum A 3 has been evaluated with 0 2 inches
109. s complete unless A Program Options are desired See Section 6 Additional Features for more information 12 Press START CAUTION VERIFY ALL VALUES BEFORE STARTING INFUSION 76 System Operating Manual Plum A Infusion Systems Because the Dose falls outside the soft limits the infuser DOPamine beeps three times Invalid Key weon ma Uo Warning and generates the mcgfkgfmin error message bit Da haa Dose gt 8 Override Dose gt 8 Override Yes 13 Select 4 Yes A NOTE A SOFT limit override will be recorded in the History Events Log This will bring up the PROGRAM CONFIRMATION screen MedSur Delivery will be Dose 10 mcg kg min Drug DOPamine 14 if Dose Drug Conc Weight amp Core 400 mg 250m Rate appear correct select 4 baga Yes to begin program NOTE If the selected drug has been pre programmed with dosing units and concentration the concentration drug amount or diluent volume cannot be changed whether delivering or stopped The only way to change to a different concentration is to clear the program However if selected drug has not been pre programmed or still operating with the DDL the concentration can be changed for a program System Operating Manual 77 78 For Systems With Hospira MedNet Software The Main Delivery screen TA PUMPING STOPPED B appears displaying the DOPamine Dose Calculation information just entered R 26 gee NOTE The Program Typ
110. separation of human body from the antenna and found to be compliant with FCC RF exposure limits WIRELESS DEVICE PRECAUTION e The wireless 801 11a b g device usage in the 5150 5250 MHz band is limited to indoor use to reduce potential for harmful interference to co channel mobile satellite systems e Inthe 5250 5350 MHz and 5650 5850 MHz frequency bands high power radars are allocated as primary users and these radars could cause interference and or damage to LE LAN devices System Operating Manual 17 18 For Systems With Hospira MedNet Software e Operation is subject to the following two conditions 1 the wireless device may not cause interference and 2 the wireless device must accept any interference including interference that may cause undesired operation of the wireless device System Operating Manual Plum A Infusion Systems SECTION 2 Principles of Operation Features The Plum A is a dual line volumetric infusion system designed to meet the growing demand for hospital wide as well as alternate site and home healthcare standardization With its primary line secondary line and piggyback fluid delivery capability the Plum A is suited for a wide range of medical surgical and critical care applications Full compatibility with LifeCare Plum Series administration sets and accessories and the LifeShield and CLAVE needleless protection systems makes the Plum A a convenient and cost effective infusion
111. syn 10 100 mL desired generic drug name or f Liposyn 20 500 mL Milrinone 200 mcg 1 a mL group name select Select then Enter 4 Page Down or Page Page Emer 4 Page Up until it shows then use to highlight choice 4 Select 4 Enter to indicate selection and advance to the Program Selection screen The Select Program screen for PROGRAM B Line B appears 5 Select 4 Choose to continue Loading Dose Multistep Select then Choose Choose Back A A 80 System Operating Manual Plum A Infusion Systems If selected drug has been programmed with established dosing units and concentration skip to step 8 The Program Dose Calc Program Dose Calc 8 screen appears mL hr NOTE Cursor defaults to package UG one oan insert or hospital recommended ae Su dose units associated with the mg kg hr mEg hr selected drug Select then Choose PE ob Choose Back p own 6 Select a Choose to continue fa a Or use to change the units to use in the delivery If desired select a Page Down to see more units of measure The Container Concentration Program Dose Cale B Selection screen appears whenever the selected Dose Drug Conc in Container Units are gram based e g mog mg grams mg mcg or ng otherwise this screen is ski pped i Select then Choose Choose Back NOTE Cursor defaults to package A Ka insert recommended concentration units associated with the selected
112. t a infuser with the appropriate startup and flow characteristics to suit the clinical application NOTE As an example of how the trumpet curves can be used consider the maximum and minimum deviations at the 5 minute average interval The upper curve provides the maximum expected delivery rate error over a 5 minute interval the lower curve provides the minimum expected delivery rate error over a 5 minute interval An example would be Dopamine administered at 5 ugm kg min At 5 minutes the average drug delivery error would be within the range of 2 8 and 0 5 of the expected nominal rate 140 System Operating Manual Plum A Infusion Systems 25 ML HR 0 mm Hg DELIVERY HEAD START UP Typical 25 MAMANA AMA pl YAA a ara lA Aa air A A Rate ml hr 8 0 10 20 30 40 50 60 70 80 90 100 110 120 Time minutes Actual Rate Programmed Rate 25 ML HR 0 mm Hg DELIVERY HEAD START UP Typical 15 0 10 09 5 0 0 0 5 0 Percent Error 10 0 15 0 0 5 10 15 20 25 30 Observation Interval minutes Max Min Mean 25 ML HR 0 mm Hg DELIVERY HEAD START UP Composite of 3 Pumps 15 0 10 0 5 0 nh a 0 0 mr 5 0 Percent Error 96 10 0 15 0 0 5 10 15 20 25 30 Observation Interval minutes Max Min
113. t instructions for additional information Administration sets should be changed per CDC guidelines or healthcare provider policy Discard after use LifeCare IV infusion sets with integral nonblood filters are not for use in the administration of blood blood products emulsions suspensions or any medications not totally soluble in the solution being administered These medications may be administered through the lower Y injection site below the filter When infusing at low delivery rates 5 mL hr or less the use of thick walled microbore PlumSets is recommended This will reduce the amount of the fluid bolus that may be delivered when a distal line occlusion is released Syringes must be larger than 3 cc Use syringe adapter List 11986 48 when using syringes smaller than 10 cc Some 10 cc syringes may require use of a syringe adapter Syringes larger than 10 cc may be attached directly to the secondary port of the cassette Use of a syringe adapter may decrease the occurrence of proximal occlusion alarms Use a 19 gauge or larger needle or catheter at the venipuncture site for viscous fluids if operating at rates greater than 500 mL hr See Section 10 for information on sets and accessories BACKPRIMING Backpriming is not recommended for reconstituting secondary containers containing dry powders System Operating Manual Plum A Infusion Systems To avoid pressurization when backpriming into a syringe the user must
114. tes RATE based on previous VTBI and new DURATION AT KVO Audible KVO alarm will sound clinician will need to re set the appropriate settings 1st Action 2nd Action AUTOCALC enter VTBI keep RATE DURATION enter DURATION keep RATE VTBI change RATE enter VTBI DURATION enter DURATION enter VTBI DURATION enter VTBI enter DURATION RATE change RATE change DURATION VTBI System Operating Manual 109 For Systems With Hospira MedNet Software Changing CCA While Infusing 1 Select a Options Vol Inf from aTrumeina storreo 8 the Main Delivery screen Rate 26 3 PAWA Vol Inf ma ea LS 10 meg kg min HI _ Vol Inf 2 Select 4 Change CCA Release 13 x xx xx xx Volumes Infused Pressure Post Infusion Rate Lighting Contrast Any Hospital USA MM DD YY XXYYZZ 123456 Select then Choose i z Change CCA Choose Back A 3 Press to highlight desired Any Hospital USA MM DD YY XXYYZZ 123456 CCA then select 4 Enter to ena confirm the change OR so OBIGYN Urology The delivery continues until VTBI equals zero or you stop the program and clear the settings 110 System Operating Manual Plum A Infusion Systems The message bar informs the TA PUMPING STOPPED B user of the changed CCA DOPamino Dose Calculation Rate 26 3 TURO Vol Inf mL 10 Dose meg kg min TOUS Line A using prior CCA Options A Vol Inf A A
115. th the infusion rate If the monitoring machine is not operating correctly or has loose or defective connections to its sensing electrodes these artifacts may be accentuated so as to simulate actual physiological signals To determine if the abnormality in the monitoring equipment is caused by the infusion device instead of some other source in the environment set the System Operating Manual Plum A Infusion Systems infusion device so that it is temporarily not delivering fluid Disappearance of the abnormality indicates that it was probably caused by the electronic noise generated by the infusion device Proper setup and maintenance of the monitoring equipment should eliminate the artifact Refer to the appropriate monitoring equipment system documentation for setup and maintenance instructions e The Plum A Infusion system is designed to operate normally in the presence of most encountered electromagnetic interference EMI conditions In the event of extreme levels of interference such as encountered next to an electrosurgical generator it is possible that the normal operation of a sensor or microcomputer might be disrupted Even in this event the outcome would likely be a false alarm or detected system malfunction and would not result in a hazard to patient or operator e This equipment has been tested and found to comply with the EMC limits for the Medical Device Directive 93 42 EEC EN 55011 Class B and IEC EN 60601 1 2 2001
116. to highlight desired Tirofiban 5 mg 100 mL drug name Tobramycin 40 mg 50 mL Tobramycin 80 mg 100 mL Vancomycin 500 mg 100mL When list does not contain VinCRIStine 100 mL desired drug name or drug A sii class name select Select then Enter 4 Page Down or 4 Page Page Page enter bawat Up until it shows then use aa a Co to highlight choice 4 Select 4 Enter to indicate selection and advance to the Program Selection screen System Operating Manual 93 94 For Systems With Hospira MedNet Software The Select Program screen for Line A or B appears VinCRIStine A z Standard Program NOTE This example shows line A being programmed Loading Dose Multistep Select then Choose Choose Back A A Use to scroll down to VinCRIStine Multistep Standard Program Loading Dose Select 4 Choose to continue If selected drug has been Select then Choose programmed with established Choose Back dosing units and concentration ala skip to step 9 The Program Multistep screen TA Program Multistep appears VinCRIStine mg min mgihr NOTE Cursor defaults to package megkomin grams hr 3 mcg kg hr ng kg min insert recommended dose units meg min mmol min a a mcg hr mmol hr associated with the selected drug mg kg hr mEq hr Select then Choose Use ke to highlight the ub bow Cree Back y to nigniig aaa Ez units to use in the delivery Select 4 Choose to conti
117. ual to zero no delivery programmed Select a line to program or A Options or 4 Backprime Rate must be gt 0 mL hr Delivery attempt when VTBI is non zero but rate is zero Use number keypad to enter a value 126 System Operating Manual MESSAGE Plum A Infusion Systems POSSIBLE CAUSE CORRECTIVE ACTION Soft Lockout Enabled While the Soft Lockout is enabled and no Alarm is active either 1 any key besides Stop is pressed during delivery or 2 any key is pressed while stopped Disable the Soft Lockout See Section 3 VTBI must be gt 0 Delivery attempt when rate is non zero but VTBI is zero Use number keypad to enter a value Value is too high Attempt to move cursor from field whose input value is too high Use number keypad to enter a value Value is too low Attempt to move cursor from field requiring a non default value Use number keypad to enter a value Weight change affects Line A B Selecting the weight field on line while a weight based program is entered on other line Use number keypad to enter a value Minimum Dose X xx Attempt to start program with Dose less than lower hard Dose limit n nn Use number keypad to enter a value Maximum Dose X xx Attempt to start program with Dose greater than upper hard Dose limit n nn Attempt to input a Dose greater than the upper Hard Limit
118. um A Infusion Systems Concurrent Delivery CONCURRENT DELIVERY Simultaneous delivery of two fluids at Ta Jromeno srorezo 8 independent flow rates Rate mL hr CAUTION CONSULT DRUG LABELING TO CONFIRM DRUG COMPATIBILITY CONCENTRATION DELIVERY RATES AND VOLUME ARE ALL SUITABLE FOR CONCURRENT AND orien PIGGYBACK DELIVERY MODES SEE Vol Int SECTION 1 FOR INFORMATION ON Nang CONCURRENT FLOW SEE SECTION 9 FOR DELIVERY RATE RANGES MedSurg NOTE In concurrent mode with certain alarm conditions one line may stop while the other line may continue to deliver 1 With pumping started on line A to program a Concurrent delivery rate select 4 B The Delivery Mode field is T PROGRAM B highlighted MedSurg Mode NOTE If an entry was previously Rate o mL hr programmed RATE is highlighted If VIBI O mL no previous entries MODE is Duration 00 00 hr min highlighted Change using Change Mode Program Change Drug a If field reads Piggyback e ngo x Ka select 4 Change Mode to switch to Concurrent System Operating Manual 61 62 For Systems With Hospira MedNet Software Verify change to Concurrent PROGRAM B mode Mode Rate O mL hr Use to highlight Rate field VTBI O ml Duration 00 00 hr min Change using Change Mode Program Change Drug E Options Mode List Bac A A A cel k To enter delivery rate use PROGRAM B numeric keypad al Mode
119. urn to the Main Delivery screen or 4 Cancel Back to restore previous settings and return to the Options screen System Operating Manual 107 For Systems With Hospira MedNet Software Variable Rate Cap NOTE Variable Rate Cap is used to set the maximum rate values to be accepted by the device The clinician cannot change it once it has been programmed It must be configured using the Hospira MedNet software Examples of Automatic Calculation AT STARTUP Initial programming allows the clinician to enter two of the three programming parameters Rate VTBI or Duration and the third is automatically calculated Refer to table below 1st Action 2nd Action AUTOCALC enter RATE enter VTBI DURATION enter VTBI enter DURATION RATE enter RATE enter DURATION VTBI WHILE RUNNING TITRATION Changing two parameters after startup of the infusion will allow for the re calculation of the third parameter 108 System Operating Manual Plum A Infusion Systems NOTE VTBI will not be re calculated if the Rate and Duration are changed VTBI must be cleared and then the new VTBI re entered The new VTBI will automatically calculate a new Rate 1st Action 2nd Action AUTOCALC change RATE keep VTBI DURATION change RATE change VTBI DURATION change VTBI keep RATE DURATION change DURATION keep VTBI RATE change VTBI change DURATION RATE change RATE change DURATION Recalcula

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