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Synchrony Clinical Manual

1. 2 Press the UP or DOWN key to toggle the Lockout command between YES and NO OPTIONS Modem PEV YES Lockout YE STEP 3 Press the ENTER key to implement the Lockout command OPTIONS 2 3 Modem PEV YES PLockout YES The Lockout command change does not take effect until you exit the Options menu 7 2 7 UNLOCKING THE After the unit is set to Lockout you may access the Setup screen by simultaneously pressing and holding the RAMP and ENTER keys for ACCESS LEVEL one second Synchrony Provider Manual 7 2 8 CHANGING THE LANGUAGE YOUR ACTION RESULT STEP 1 From the Options menu press the DOWN key until the Language command is selected then press the ENTER key OPTIONS 3 3 Language ENGLISH Alarm LOUD EXIT OPTIONS 3 3 Language ENGLISH Alarm LOUD amp oss EXIT STEP2 Press the UPor DOWN key to scroll through OPTIONS 3 3 the available languages then press the ENTER Language 54 key to implement the language change Alarm LOUD 9 fa Fo p S a r EAR OPTIONS 3 3 Langue FRANCAIS Volume Alarm HAUT SORTIE BiPAP Synchronj Provider Manual 7 12 7 2 9 CHANGING THE ALARM VOLUME YOUR ACTION STEP 1 From the Options menu press the DOWN key until the Alarm command is selected then press
2. Synchronj Provider Manual 8 4 CHANGING THE APNEA ALARM If you disable the apnea alarm the system will not produce an audible alarm A record of the apnea will not appear in the Synchrony alarm log However a record will appear in the Encore Encore Pro alarm log YOUR ACTION RESULT STEP 1 From the Monitoring screen press the DOWN key until the Alarms command is selected ES 15 cm 5 209 Ey WR 25 SETUP 4 4 e Parameters Alarms 4 Options 12 79 2 Press the ENTER key to display Alarms screen press the DOWN key to select the Apnea parameter then press the ENTER key to activate ALARMS 1 2 Disconnect OFF Apnea OFF gt STEP 3 Press the UP or DOWN key to change the The settings are OFF 10 20 30 40 seconds parameter then press the ENTER key to implement the change ALARMS 1 2 Disconnect 15 sec Apnea OFF EXIT p ALARMS 1 2 Disconnect 15 sec Apnea 20 sec STEP 4 Press the DOWN key twice then press the LARMS 2 2 ENTER key to exit the Alarms screen LowMinVent 25 L MIN EXIT SETUP Parameters Alarms ode BiPAP Synchrony Provider Manual 8 5 CHANGING THE Low MINUTE VENTILATION ALARM YOUR ACTION RESULT STEP 1 From the Monitoring screen press the DOWN key until the Alarms command is selected SETUP e Parameters
3. RESPIRONICS J STEP 2 Press the ENTER key to activate the Time at P SIME ORT US reset screen then press the UP key to select the 25 l i hours CLEAR command CLEAR EXIT TIME AT P 25 1 hours CLEAR EXIT STEP Press the ENTER key to reset the Time at Pressure hours OPTIONS 1 3 Time at P Ohrs System Codes Pt Alarm Histor BiPAP Synchrony Provider Manual 7 3 7 2 2 SYSTEM CODES The Synchrony stores the system error codes in the system alarm log These codes can be used by authorized service representatives to troubleshoot the ventilator The Synchrony can store five pages of 10 codes per page Appendix B lists the error codes The Error Code Screen also allows you to clear all the currently stored codes YOUR ACTION RESULT STEP 1 From the Options menu press the DOWN key until the System Codes command is selected then press the ENTER key to display the System Codes screen OPTIONS 1 3 Time at P 50hrs System Codes Pt Alarm History 9 us 25 ES SYSTEM CODES 1 1 8 6 067 011 009 d E FE STEP 2 Press the ENTER key to Exit the screen If there are more than one page of codes press the DOWN key to scroll through the screens The final screen will display the EXIT command To exit the system codes press ENTER To clear the system codes when the CLEAR command is displayed press the UP
4. Enter Key Ramp Silence Key 3 1 3 INDICATORS AC Power Indicator DC Power Indicator The Synchrony control panel has five membrane type switches that perform different functions depending on the screen selected alarm status and access level Starts and stops the Synchrony The key must be pressed and released Navigates between screens or increases the value of a selected parameter by one increment Navigates between screens or decreases the value of a selected parameter by one increment Switches the function of the Up and Down keys between screen navigation and parameter adjustment and implements changes Activates ventilation ramp and silences the audible alarm signal The Synchrony uses four LED indicators on the control panel for alarm indications and power indications It also uses five indicators on the display screen Green LED that illuminates when the Synchrony is connected to AC power See Figure 3 2 Green qB Figure 3 2 AC Power Indicator Green LED that illuminates when the Synchrony is connected to DC power See Figure 3 3 Green Figure 3 3 DC Power Indicator Synchrony Provider Manual 3 3 Red Alarm Indicator When flashing indicates a new high priority alarm has occurred When on continuously indicates a loss of power or silenced high priority alarm Yellow Alarm Indicator When flashing indicates a new medium priority alarm When on continuously indicates
5. modem must be Hayes compatible and recognize the AT command set ATZ CR command will reset the modem where CR represents a carriage return ASCII 13 ATHO CR command will hang up the modem e The escape code sequence is a one second guard time where no data is sent to the modem followed by the command The Synchrony software uses the DTR line on the RS 232 port to aid in hanging up the modem It is strongly recommended that the external modem be configured to monitor the DTR line Normally this is the default operation for the modem If it is not you should add the amp D2 option in the modem initialization string The Synchrony software requires that modem commands and modem result codes are echoed back to the Synchrony Normally this is the default operation for the modem If not you should add the E1 X4 AND 00 options in the modem initialization string BiPAP Synchrony Provider Manual A 2 A 3 Example Initialization Strings The Synchrony software handles both numerical short form and verbose long form result codes However it will only recognize the verbose result codes that contain the following words in English OK ERROR CONNECT RING NO CARRIER NO DIALTONE NO DIAL TONE BUSY NO ANSWER Normally the default option for the modem verbose result codes which is typically configured with the V1 option If not the V0 option specifies numerical result codes In either case it is r
6. 2 2 3 S T Example IPAP 14 cm HO EPAP 6 cm H O Rate 10 BPM PS 8 H O 2 2 4 PRESSURE CONTROL 2 2 5 TIMED MODE The Spontaneous Timed S T mode of the Synchrony is similar to the S mode except that it also can deliver a machine triggered breath if the patient does not spontaneously breath within a set time The S T mode ensures that patients will receive a minimum number of breaths per minute based on the Rate setting If the patient fails to initiate an inspiration within the interval determined by the Rate control the unit triggers a timed or machine triggered breath resulting in a pressure control pressure limited time cycled breath at the set IPAP level The rate of timed breaths is adjustable The duration of each timed breath is controlled by an Inspiratory Time control See Figure 2 4 for an example of patient triggered and machine triggered breaths Time Interval Exceeds Rate Setting approx 6 sec 20 P Cem H20 a _ gt of 1 1 2 1 0 2 T TI p T try ry T T 7 1 1 1 12 18 21 sec 15007 Vol m 1000 4 5001 1 1 2 1 0 T T 7 7 7 I rer rT 1 6 12 18 21 5 1 Spontaneously triggered pressure support breaths 2 Time triggered pressure limited time cycled breath Figure 2 4 Example of Patient Triggered and Machine Triggered Breaths The Pressure Control PC mode is similar to the S T mode except t
7. NOTE Items within the dashed line must be at least six feet away from the patient NOTE See Appendix for external modem requirements STEP 2 From the Monitoring Screen press the DOWN key to display the Patient Controls BiPAP Synchrony 1 4 1 48 12 cm H20 05 52 20 K 0 RR 18 BPM o E ou STEP Press the DOWN key to select the Dial Provider command then press ENTER to dial the caregiver and send the report 2 RESULT Telephone 1 To 1926 Outlet Power Source Modem Telephone Connector 6 ft RS232 Cable External Modem Connection CONTROLS hRise Time 3 Dial Provider SENDING REPORT STATUS Dialing gt ABORT The STATUS changes from Dialing to Connected to Complete under normal circumstances If you press ENTER when ABORT is displayed in the Call screen the call will stop and the screen will go to STATUS Complete BiPAP Synchrony Provider Manual 4 9 To send a report before therapy is started PATIENT ACTION STEP 1 With the Synchrony not running press the STANDBY key STEP 2 When the self test screen appears press the UP key STEP 3 Press the UP or DOWN key to select the Dial Provider Command then press ENTER 4 5 3 Data TRANSMISSION ERRORS RESULT The start up screen is displayed followed by the self test screen The Dial Provider screen is displayed The STATUS changes fro
8. BiPAP systems are the subject of one or more of U S Patents 5148802 5239995 531937 5433193 Canadian Patent 2 024 477 European Patent EP0425092 German Patent 69021681 5 08 and other pending U S and foreign patents BiPAP is a registered trademark of Respironics Inc 2002 Respironics Inc All Rights Reserved Table of Contents Chapter 1 Warnings and Cautions eee e eere eee eee eere enne e eee ee eea 1 1 1 1 RAIN ERIT E TO T 1 1 1 2 e i RTT EEEE AEE EIEE AEE EE 1 3 1 3 OG Errem 1 4 1 4 Contraindications RT DR 1 4 1 5 Patient 5 1 4 1 6 Communication Statements for Optional Modem 2 4 2 4 1 5 buco deiude 1 5 TELEPHONE 2 SUE SES EE EIE Eee EVE TEE A E HESSE 1 5 PROBLEMS ARISE cccccesesessssssssececescscscscseseececeseececesevensusueususususesessusssseseseessecesesesseessuscsceaususessusessssesesseeceseseeesseseseseeees 1 5 1 7 Industry Canada Notice scu ER RENTE UE 1 6 Chapter 2 Introduction Pc 2 1 2 1 Synchrony Overview ss ssssssssesssocssooecosscooessoocsscocsooscoosesoesssoessooscosecoss
9. 152 25 YSVEMUCODES searre Pe yer ere LIEU 7 3 7 2 3 IBATIENT ADARM HISTORY coe E uere EE EE Ple dn 7 4 7 2 4 MODEM SETEINGS Perte gh UE Ce Pe CE Ee ee ve Beber te Peau eve Ce eo ERREUR ERE 7 5 DE 7 9 7 2 6 CHANGING THE ACCESS LEVEL cccsssecseecsssseesecesessnaeececesenseaeececesseaesecceeseaeeesesesenseececesesseecececesseaeecececsseaeeseeenenea 7 10 7 2 7 UNLOCKING THE ACCESS LEVEL s ccccscsssssececesessnssececessnaececceceuseaesescsessaesecesesneeececesenssasececesusaeececeessaeseceeesesaeees 7 10 7 2 8 CHANGING THE LANGUAGE 5 5 iran ri reet eee eee YES aeu Read dud 7 11 7 2 9 CHANGING THE ALARM VOLUME ccssccccccsssssesececessnssecececesusseceecsessaesenceesnesecesesenaeececesesseaeececesseaeseceeeseaeeetecesensaeees 7 12 7 2 10 EXITING THE OPTIONS MENU ccsssscceccsssestececessnaeceececssascesenceessaesecesessaesececesenaeecececessnaeececeeseaeseseseseseetecesensaeees 7 12 Synchrony Provider Manual Chapter 5 eo Ra 8 1 8 1 Alarm Introducti n M 8 1 8 2 Setting Alarm rms UUHU SENE ERU EURO Key OIN EUR ERRANT UNELSE V OH EN EUN UR EUR 8 2 8 2 1 ALARM P
10. 41 4 SUPPLYING POWER THE SYNCHRONY WARNING The Synchrony can operate on AC or DC power The DC power option is not intended as a battery backup during use of AC power CAUTION When DC power is obtained from a vehicle battery the Synchrony should not be used while the engine of the vehicle is running Damage to the vehicle may occur AC OPERATION Plug the electrical cord into the AC inlet in the back of the Synchrony then plug the electrical cord into an outlet that is not controlled by a wall switch NOTE Use the AC cord retainer to provide strain relief for the AC power cord Figure 4 4 Plugging in the AC Cord DC OPERATION STEP Plug the DC cord connector into the rear of the Synchrony STEP 2 Leaving a small amount of slack in the cord press the cord into the DC cord retainer STEP Connect the DC cord to the appropriate DC source Refer to the DC cord instruction sheet for recommended DC power sources CAUTION Only use a Respironics supplied DC cord DC Cord Retainer Figure 4 5 Plugging in the DC Cord Synchrony Provider Manual 4 5 4 1 5 OPTIONAL INTERNAL optional internal modem is set up as shown in Chapter 7 MODEM 4 1 6 PERFORMANCE When the initial setup is complete perform the performance verification as VERIFICATION described in Chapter 13 4 2 Setting Up the Synchrony Before using the Synchrony on a patient set the prescription To change the mode
11. Bi Flex In the Continuous Positive Airway Pressure CPAP mode the Synchrony delivers a continuous pressure support ventilation at one pressure level The Spontaneous S mode of the Synchrony delivers bi level pressure support The unit triggers to Inspiratory Positive Airway Pressure IPAP in response to spontaneous inspiratory effort and cycles to Expiratory Positive Airway Pressure EPAP during exhalation Figure 2 2 illustrates the trigger and cycle concepts Cycle Inspiration irati Expration IPAP t SSS EPAP Rise Time 5 l Inspiratory Time Figure 2 2 Triggering and Cycling in S Mode The level of pressure support PS delivered is determined by the difference between the IPAP and EPAP settings PS IPAP EPAP The Synchrony Lab System provides the Bi Flex feature in S mode The Bi Flex attribute adjusts therapy by inserting a small amount of pressure relief during the latter stages of inspiration and during active exhalation the beginning part of exhalation In the following diagram the bold lines represent Bi Flex in comparison to the dashed line representing normal BiPAP therapy Bi Flex levels of 1 2 or 3 progressively reflect increased pressure relief that will take place at the end of inspiration and at the beginning of expiration EPAP Bi Flex Time Figure 2 3 Bi Flex in Comparison to Traditional Bi level Therapy Synchrony Provider Manual 2 3
12. CPAP PARAMETERS CPAP 10 10 cm H20 VentRamp OFF EXIT Increment Parameter of Change CPAP 4 to 20 cm H O lcm H O Ventilation Ramp Disabled 0 5 1 0 2 0 3 0 cm H O per breath Discrete values as listed 5 22 S S PARAMETERS 1 2 S PARAMETERS 19 19 20 VentRamp OFF EPAP 5 5 cm H20 Bi Flex OFF Rise Time 3 Screen Increment Number Parameter of Change Screen 1 of 2 IPAP 4 to 30 cm H O 1 cm H O EPAP 4 to 25 H O 1 H O Rise Time 1to6 1 Screen 2 of 2 Ramp Disabled 0 5 1 0 2 0 3 0 cm H O per breath Discrete values as listed Bi Flex OFF 1 2 3 Discrete values as listed IPAP cannot be set lower than EPAP When Bi Flex is enabled Rise Time is set to 3 0 3 seconds When Bi Flex is enabled then IPAP and EPAP are limited to 20 cm The Rise Time of 1 to 6 corresponds to tenths of a second e g a setting of 4 equals 0 4 second rise time Synchrony Provider Manual 5 3 5 2 3 PC AND S T XX PARAME XX PARAMETERS 2 3 XX PARAMETERS 3 3 IPAP 19 Timed Insp 1 0 sec VentRamp OFF 5 Rise Time 3 Rate 20 Screen Increment Number Parameter of Change Screen 1 of 3 IPAP 4 to 30 cm H O 1 H O 4to 25 H O 1 H O Rate 0 to 30 BPM PC and S T 1 BPM 4 to 30 BPM T BPM Screen 2 of 3 Timed Inspiration 0 5 to 3 0 sec 0 1 sec Rise Time l
13. Chapter 4 Setting up and Starting the Synchrony 4 1 Preparing the Synchrony 4 1 1 Summary or SETUP OPERATIONS Step 1 Install the inlet air filters See Section 4 1 2 Step 2 Assemble and attach the patient circuit See Section 4 1 3 Step 3 Provide power and set up the patient See Sections 4 1 4 to 4 1 6 Step 4 Setup the patient parameters using the control panel See Section 4 2 Synchronj Provider Manual 4 2 4 1 2 INSTALLING THE AIR Synchrony uses one or two removable filters at the air inlet You must FILTERS install the gray foam filter before operating the Synchrony The gray foam filter is washable and reusable The disposable white ultra fine filter is optional CAUTION properly installed undamaged gray foam inlet filter is required for proper operation STEP 1 Place the gray foam filter on top of the ultra fine filter if using the ultra fine filter Step 2 Slide the filters into the air inlet at the rear of the Synchrony and push them down into the recess as shown in Figure 4 1 Reusable Gray Foam Filter Air Filter Cover STEP 3 Place the bottom of the air filter cover into the bottom of the air inlet opening making sure that the catches engage the lip of the opening Disposable Ultra fine Filter STEP 4 Swing the top of the cover into place and press down on the cover to engage the catches in the air inlet opening See Figure 4 2 See Ch
14. reducing the effectiveness of treatment 1 4 Contraindications The use of the Synchrony is contraindicated on patients without a spontaneous respiratory drive The use of the Synchrony for noninvasive positive pressure therapy may be contraindicated on patients unable to maintain a patent airway or adequately clear secretions at risk for aspiration of gastric contents with acute sinusitis or otitis media with a history of allergy or hypersensitivity to the mask materials where the risk from allergic reaction outweighs the benefit of ventilatory assistance with epistaxis causing pulmonary aspiration of blood or with hypotension When assessing the relative risks and benefits the health care professional should understand that the Synchrony can be set to deliver pressures up to 30 cm Also in the unlikely event of certain fault conditions a maximum static pressure of 40 cm is possible 1 5 Patient Precautions Advise the patient to immediately report any unusual chest discomfort shortness of breath or severe headache If skin irritation or breakdown develops from the use of the mask refer to the mask instructions for appropriate action The following are potential side effects of noninvasive positive pressure therapy ear discomfort conjunctivitis 5 abrasions due to noninvasive interfaces gastric distention aerophagia BiPAP Synchrony Provider Manual 1 5 1
15. the ENTER key o 9 Step 2 Press the UP or DOWN key to toggle between LOUD and SOFT then Press the ENTER key to implement the Alarm volume change 7 2 10 EXITING THE OPTIONS MENU YOUR ACTION STEP 1 Press the UP or DOWN key to return to Options screen 3 3 STEP2 Press the UP or DOWN key to select EXIT then press the ENTER key 2 RESULT OPTIONS 3 3 Language ENGLISH Alarm LOUD EXIT OPTIONS 3 3 Language ENGLISH Alarm 10004 EXIT OPTIONS 3 3 Language ENGLISH Alarm 5 EXIT OPTIONS 3 3 Language ENGLISH Alarm SOFT EXIT RESULT OPTIONS 3 3 Language ENGLISH Alarm LOUD EXIT OPTIONS 3 3 Language ENGLISH Alarm LOUD EXIT Synchrony Provider Manual 8 1 Chapter 8 Alarms 8 1 Alarm Introduction This chapter describes the Synchrony alarms describes how to set them and lists corrective actions for the alarm conditions The Synchrony provides three alarm levels high medium and low priority High priority alarms require immediate operator response The alarm signal consists of a red LED and a high priority sound The display has the message ALARM at the top of the screen Medium priority alarms require prompt operator response The alarm signal consists of a yellow LED and a medium priority sound The display has the message WARNING at the to
16. 6 1 Change Mode Setup Screens 6 2 Change Parameters Operations 5 1 Index Change Parameters Screens 5 2 Changing Access Level 7 10 Alarm Volume 7 12 Language 7 11 Mode 6 3 Parameters 5 4 Circuit Configurations Patient 12 1 Cleaning Filters 11 1 Synchrony 11 1 Codes System 7 3 Commands Modem A 1 Communication Statements 1 5 Communications 9 1 Encore Software 9 1 Optional Modem 9 1 Port 3 8 Concentrations of Oxygen 10 3 Connecting the Patient 4 5 Connections AC Inlet 3 8 Communications Port 3 8 DC Inlet 3 8 Patient Circuit 3 7 RS232 Port 3 8 Telephone Jack 3 8 Contraindications 1 4 Control Keys 3 2 Down Key 3 2 Enter Key 3 2 Ramp Silence Key 3 2 Standby Key 3 2 Up Key 3 2 Control Panel 3 1 Controls and Displays 3 1 AC Power Indicator 3 2 Attention or Activity Indicator 3 3 Control Keys 3 2 Control Panel 3 1 DC Power Indicator 3 2 Display Data 3 6 Display Screen 3 1 Down Key 3 2 Enter Key 3 2 Indicators 3 2 Navigation Indicator 3 4 Progress Indicator 3 5 Ramp Silence Key 3 2 Rear Panel 3 8 Synchronj Provider Manual I 2 Selection Indicator 3 4 Standby Key 3 2 Up Key 3 2 Ventilation Ramp Indicator 3 4 CPAP Defined 2 10 Mode 2 2 Mode Parameter Screen 5 2 Mode Setup Screen 6 2 Cycle Defined 2 10 Cycle to EPAP 2 7 D Data Transmission Errors 4 9 DC Inlet 3 8 DC Operation 4 4 DC Power Cord Retainer 3 8 DC Power Indicator 3 2 Definitions 2 10 Alarm 8 12 Bi Flex 2 9 BiPAP 2 1
17. 8 Name 7 8 R Ramp Defined 2 10 Ramp Silence Key 3 2 Rear Panel 3 8 AC Inlet 3 8 Air Filter Cover 3 8 Communications Port 3 8 DC Inlet 3 8 DC Power Cord Retainer 3 8 Telephone Jack 3 8 Requirements Modem A 1 Respiratory Rate 3 6 Rise Time Setting 4 7 S S Mode 2 2 Parameters Screens 5 3 Setup Screens 6 2 Verification 13 1 S T Mode 2 2 Parameter Screens 5 3 Setup Screens 6 2 Verification 13 2 Screen Navigation 3 5 Screens Change Parameters 5 2 Selection Indicator 3 4 Sensitivity 2 5 Serial Cable External Modem A 1 Serial Number 7 8 Service 2 9 Setting Modem Dial 7 6 BiPAP Synchronj Provider Manual I4 Modem Initialization Strings 7 7 Modem Type 7 5 PEV Option 7 9 Provider Name 7 8 Setting Alarm Parameters 8 2 Setting the Rise Time 4 7 Setting Up 4 1 Setting up the Modem 7 5 Setup Operations 4 1 Setup Screens Change Mode 6 2 CPAP Mode 6 2 S Mode 6 2 T PC S T Modes 6 2 Shape Signal 2 6 Software 12 2 Sounds Alarm 8 6 Specifications 14 1 Accuracy 14 2 Electrical 14 1 Environmental 14 1 Physical 14 1 Pressure 14 1 Spontaneous Expiratory Threshold 2 7 Spontaneous Trigger to IPAP 2 7 Standby Key 3 2 Start Up Screen 4 5 Starting 4 1 Summary Change Mode Operations 6 1 Change Parameters Operation 5 1 Options Operations 7 1 Setup Operations 4 1 Summary of Alarm Behavior 8 6 Supplemental Oxygen 10 1 Support 2 10 Symbol Key 2 9 Synchrony Setup 4 5 Synchrony Overview 2 1 System Codes 7 3 Syste
18. 9 1 Communicating via Optional Modem esssesssecssocssoosssocssscessocesocesoosssoesssecssocssoosssosssossssee 9 1 9 2 Communicating with Encore 9 1 Chapter 10 Adding Supplemental 10 1 10 1 Adding Supplemental Oxygen e ssesssecssecssocescoescocessccssecesocesoossscesssecssocesccssoosssocsssesssecesosess 10 1 10 2 Supplemental Oxygen Concentrations esssesssccssecssocescoessocesscessccesocesocsssoesssecssecesocsscosess 10 3 Chapter 11 Cleaning and Maintenance csccccssssssssccccsssssssccsscsssssssccsssees 11 1 11 1 Cleaning the Synchrony 11 1 11 2 Cleaning or Replacing the Inlet Filters esssecssocssoossoosssocssscessocesocesoossoccssseessocssocsscossss 11 1 11 3 Maintenance 11 2 Chapter 12 Circuits and Accessories 12 1 12 1 Circuit Configurations NOR 12 1 12 2 Circuits 12 2 12 3 Masks Exhalation Ports and Related Accessories 0 22 ee eee eee eere nenne 12 2 12 4 Humidifiers PE 12 2 12 5 12 2 Chapter 13 Operational Verification 0 eene eene 13
19. Alarms ode BiPAP Synchrony STEP 2 Press the ENTER key to display the Alarms screen press the DOWN key twice to select the LowMinVent parameter then press the ENTER key to activate ALARMS 2 2 p LowMinVent OFF The settings are OFF 1 to 99 L MIN STEP3 Press the UP or DOWN key to change the parameter then press the ENTER key to LARMS 2 2 implement the change LowMinVent 20 L MIN EXIT D LARMS 2 2 LowMinVent 25 L MIN EXIT STEP 4 Press the ENTER key to exit the Alarms screen SETUP Parameters Alarms ode BiPAP Synchronj Provider Manual 8 6 8 3 Summary of Alarm Behavior 8 3 1 ALARM SOUNDS BEHAVIOR Alarm conditions are signaled by the Synchrony in three ways a sound an LED and a display message Each signal type behaves differently depending on the type of alarm High Priority Sounds High Priority The sound repeats a pattern of three beeps followed by two beeps until the RAMP SILENCE key is pressed The silence period is one minute This pattern is indicated in Section 8 5 by eee Loss of Power The sound is continuous for two minutes without user intervention If the user presses the STANDBY key the sound will termi nate There is no silence period for this sound This pattern is indicated in Section 8 5 by Synchrony Failure In the event of a Synchrony failure the alarm sounds in single beeps until power
20. Respironics mask with separate exhalation device Accessories disposable headgear reusable headgear chin strap Comfort Flap mask accessory 12 4 Humidifiers Respironics Pass over humidifier Respironics H2 Heated Humidifier 12 5 Software Respironics Encore and Encore Pro Data Management Software for reading compliance data BiPAP Synchronj Provider Manual 13 1 Chapter 13 Operational Verification WARNING Ifthe Synchrony system fails to perform within the stated specifications of Chapter 14 have the system serviced by a qualified Respironics approved service facility This procedure does not verify performance of the optional Oxygen Valve If this valve is installed and a performance verification is required refer to the Synchrony Service Manual NOTE If the indicator does not move when you are simulating breaths press the RAMP key to exit flow limit control 13 1 S Mode Verification The operational verification allows the home care provider to verify that the Synchrony is functioning properly Operational verification should be com pleted before each new patient setup STEP 1 STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 Connect the patient circuit to the Synchrony as described in Chapter 4 of this manual Connect a water column or digital manometer to a mask port Connect the AC inlet to the Synchrony and connect the AC line to the appropriate power source The AC power LED should be
21. a low priority alarm or silenced medium priority alarm Figure 3 4 Alarm Indicators Attention or Activity Indicator Used in several screens to indicate pressure level machine triggered breaths or 9 alarm messages When appears next to EPAP or IPAP on the display it indicates the current pressure phase See Figure 3 5 When appears next to an alarm message it indicates that the alarm is active See Figure 3 6 When appears next to RR on the display it indicates that the current pressure phase was device triggered See Figure 3 7 Figure 3 5 EPAP Indicator ALARM 0 Patient A 1 1 v Disconnect Figure 3 6 Alarm Indicator Figure 3 7 Device Triggered Breath Indicator BiPAP Synchronj Provider Manual 3 4 Selection Indicator Navigation Indicator 7 Ventilation Ramp Indicator 7 appears next to the item that can be selected with the ENTER key as shown in Figure 3 8 The indicator is moved by pressing the UP or DOWN key S PARAMETERS 1 2 IPAP 125 cm 20 P EPAP 9 cm H20 Rise Time 3 Figure 3 8 Selection Indicator Pressing the ENTER Key will Select EPAP for Adjustment appears next to a page number display to indicate that the UP and DOWN keys can be used to change pages as shown in Figure 3 9 If it appears next to a value it flashes and indicates that the UP and
22. e _ underscore e period e sign l enter NOTE The patient ID text will appear on the start up screen See Section 4 3 RESULT MOD 5 AT amp FVOE1QO ETTINGS IT 25 MOD mPa MR EM S tien BiPAP Synchronj Provider Manual t ID ITH ETTINGS 7 7 YOUR ACTION The maximum number of characters is 20 When you have entered the desired initialization string move one character to the right scroll to the J symbol and press the ENTER key The screen scrolls to page 5 of 6 Provider STEP 12 The Provider screen is used to identify your company to the patient It is shown in place of Provider in the Call Provider screen The navigation of the ID string and the character set are the same as for the Patient ID of Step 10 The maximum number of characters is 20 When you have entered the desired initialization string move one character to the right scroll to the 1 symbol and press the ENTER key then press the DOWN key The screen scrolls to page 6 of 6 Serial Number Step 13 The Serial Number is the serial number of the Synchrony It is factory set and cannot be changed You may use the number for tracking purposes Press the ENTER key to exit the Modem Setting screens and return to the Options menu RESULT MODEM SETTINGS 5 6 Provider HEALTH CARE MODEM SETTING
23. electrical shock always unplug the Synchrony power cord before cleaning the Synchrony CAUTION Do not immerse the Synchrony in liquid or allow any liquid to enter the enclosure inlet filter or any openings Unplug the Synchrony and clean the front panel and exterior of the enclosure as needed using a cloth dampened with water and a mild detergent Allow the Synchrony to dry completely before plugging in the power cord The mask and tubing should be cleaned daily For details on cleaning your mask and accessories refer to the cleaning instructions packaged with the accessories CAUTION Dirty inlet filters may cause high operating temperatures that may affect Synchrony performance Regularly examine the inlet filters as needed for integrity and cleanliness 11 2 Cleaning or Replacing the Inlet Filters The Synchrony uses two removable filters at the air inlet The gray foam filter is washable and reusable The optional white ultra fine filter is disposable The gray foam filer should be cleaned at least once every two weeks under normal usage and should be replaced with a new one every six months STEP 1 Ifthe Synchrony is operating stop the Synchrony by pressing the STANDBY key Disconnect the Synchrony from the power source STEP 2 Remove the filter cover by pressing down on the top of the cover to release the tabs then swinging the cover out from the Synchrony s body STEP 3 Remove the filters from the enclosure The
24. failure Red Solid Power was lost while the device was providing therapy Press 5 to silence restore power High Pressure Red Flash Red Flash Red Flash Red Flash Red Flash Optional Invalid Prescription Call Provider Low Pressure Patient Disconnect Apnea event occurred during therapy Malfunctioning device The prescription data is corrupted Excessive leak or blockage Patient circuit is disconnected or has a large leak BiPAP Synchronj Provider Manual Report alarm to your home care provider None If alarm continues call your home care provider Do not use the device call your home care provider Check for the following dirty inlet filters blocked air intake excessive leak in patient circuit If alarm continues call your home care provider Reconnect the patient circuit or correct the leak NOTE If therapy does not resume after you start breathing 1 silence the alarm using the RAMP key 2 clear the alarm using the ENTER key and 3 press the RAMP key again to resume therapy If the alarm continues contact your home care provider Verify patient status Replace device Re enter prescription data or replace the device Replace the device Reconnect the patient circuit or fix the leak If the alarm continues replace the device 8 10 LED Audible Display Synchrony Possible Patient Provider
25. illuminated Press the Standby key to start the Synchrony Set the parameters to the following Mode 5 Bi Flex OFF IPAP 20cm H O EPAP 4 cm H O IPAP Rise Time 1 e Patient Disconnect Alarm Delay OFF Apnea OFF LowMinVent OFF Simulate a breathing pattern by occluding and opening the patient outlet e Verify that the indicator appears next to the IPAP display during the inspiratory phase and appears next to the EPAP display during the expiratory phase Verify the IPAP and EPAP pressures displayed on the Synchrony screen agree with the pressures indicated on the manometer If you wish to verify the performance of the patient alarms see Section 13 3 Synchronj Provider Manual 13 2 13 2 S T Mode STEP 1 Verification STEP 2 STEP 3 STEP 4 STEP 5 STEP 6 STEP 7 STEP 8 Connect the patient circuit to the Synchrony as described in Chapter 4 of this manual Connect a water column or digital manometer to a mask port Connect the AC inlet to the Synchrony and connect the AC line to the appropriate power source The AC power LED should be illuminated Press the Standby key to start the Synchrony Set the parameters to the following Mode S T IPAP 20 H O EPAP 4cm H O e Rate 6 BPM e Timed Inspiration 1 5 sec PAP Rise Time 1 e Patient Disconnect Alarm Delay OFF Apnea OFF LowMinVent OFF Simulate a breath
26. in a mode that supports machine triggered breaths this display will be the total breathing rate spontaneous machine The display value is updated at the end of each expiration Va Estimated Exhaled Tidal Volume Displays an estimated exhaled tidal volume measurement for the previous breath The display 15 updated at the end of each breath The estimated exhaled tidal volume is obtained by integration of patient flow e MinVent Estimated Exhaled Minute Ventilation Displays the estimated exhaled minute ventilation based on an average of the previous six breaths The display is updated at the end of each breath e Leak Displays the average leak value calculated during the previous breath cycle The display value is updated after each breath Table 3 1 summarizes the displayed parameters BOTH FULL ALL Fu Table 3 1 Displayed Parameters Different display screens are available based on the access level Full Access Screen 1 4 Monitoring Screen Page 1 Screen 2 4 Monitoring Screen Page 2 Screen 3 4 Patient Controls Screen 4 4 Caregiver Menu Lockout Screen 1 2 Monitoring Screen Page 1 Screen 2 2 Patient Controls See Section 4 4 for illustrations of these screens Synchrony Provider Manual 3 7 3 4 Patient Circuit Connection 3 5 Optional Oxygen Valve The patient circuit is connected to the patient interface port shown in Figure 3 15 T
27. of operation see Chapter 6 To change the parameters see Chapter 5 To view or change the options see Chapter 7 Set the necessary alarms see Section 8 2 BOR 4 3 Connecting the Patient STEP 1 Press and release the Standby key SYNCHRONY 5 MR SMITH The start up screen is displayed then the Synchrony initiates a self C 2002 Respironics test Both alarm LED indicators light momentarily the audible alarm beeps twice to verify that the audible alarm is functioning NOTE If your device is a system The start up screen is then displayed followed by the self test for home use S or S T screen If the indicators do not light or the audible alarm does not will appear on the startup beep twice the Synchrony requires service screen depending on the model Step 2 Ifa Plateau Exhalation Valve PEV is used enable the PEV option If your device is a Lab see Section 7 2 5 System LAB will appear before S or S T on the STEP 3 If oxygen is being used turn on the oxygen flow Always turn the startup screen Synchrony on before turning on the oxygen and always turn the oxygen off before turning off the Synchrony STEP 4 Place the mask on the patient If you have entered patient ID for the device TEP 5 see Section 7 2 4 that text 5 will also appear on the startup screen When the setup is complete place the Synchrony in Lockout see Section 7 2 6 See Chapter 8 for alarm i
28. top filter is the reusable gray foam filter The bottom filter is the optional disposable white ultra fine filter STEP 4 Examine the filters regularly for cleanliness and integrity STEP 5 If needed wash the gray foam filter in warm water with a mild detergent Rinse thoroughly to remove all detergent residue Allow the filter to completely dry before reinstalling it If the foam filter is torn replace it Only Respironics supplied filters should be used as replacement filters Reusable Pollen Filter Disposable Ultra fine x Filter BiPAP Synchrony Provider Manual STEP 6 If the ultra fine filter is dirty or torn replace it STEP 7 Reinstall the filters with the ultra fine filter on the bottom Slide the filters into the air inlet at the rear of the Synchrony and push them down into the recess CAUTION Never install a wet filter into the Synchrony We recommend that you clean the used filter in the morning and alternate use of the two pollen filters provided with the system This will allow enough drying time for the cleaned filter STEPS Reinstall the filter cover 11 3 Maintenance See the Synchrony Service Manual for recommended periodic maintenance BiPAP Synchronj Provider Manual 12 1 Chapter 12 Circuits and Accessories This chapter details the Respironics approved breathing circuits and accessories 12 1 Circuit Configurations WARNING The Synchrony requires an intentiona
29. u a 1 3 2 1 0 0 20 40 60 80 100 120 140 160 180 Flow LPM Maximum Pressure Drop for Patient Disconnect Alarm The Patient Disconnect alarm relies on a fixed relationship between the patient pressure settings and the open circuit flow of the patient circuit The alarm should work properly if your circuit is less restrictive than the circuit parameters shown below Most Restrictive Circuit for Patient Disconnect 180 00 160 00 140 00 120 00 100 00 80 00 60 00 40 00 20 00 0 00 Flow 007 005 009 007 00 8 006 0041 007 oo TL 00 SL 0091 0071 e e Pressure NOTE You must verify that the Patient Disconnect Alarm operates properly with the prescribed patient pressures and circuit BiPAP Synchrony Provider Manual Synchronj Provider Manual 1 Appendix External Modem Requirements This chapter explains requirements for using an external modem with the Synchrony A 1 Serial Cable The Synchrony is equipped with a 9 pin RS 232 port The serial cable for connecting the external modem to the Synchrony must be a DTE to DCE cable i e straight through cable This is the serial cable that normally comes with a modem however a diagram is shown in Figure A 1 for verification OMAN DOA A ON 1 2 3 4 5 6 7 8 9 Figure A 1 Serial Cable Requirements A 2 Modem Commands The Synchrony makes the following assumptions regarding modem commands
30. 0 CPAP 2 10 Cycle 2 10 EPAP 2 10 High Priority Alarm 2 10 IPAP 2 10 Low Priority Alarm 2 10 Medium Priority Alarm 2 10 OSA 2 10 Ramp 2 10 Trigger 2 10 Description Alarms 8 1 Design Flow Analysis 2 8 Maximum IPAP Time 2 7 Sensitivity 2 5 Shape Signal 2 6 Spontaneous Expiratory Threshold 2 7 Volume Trigger 2 6 Dialing the Provider 4 8 Display Alarm 8 6 Display Data 3 6 Down Key 3 2 E Electrical AC Operation 4 4 DC Operation 4 4 Electrical Specifications 14 1 Encore 2 1 9 1 Enter Key 3 2 Environmental Specifications 14 1 EPAP Defined 2 10 Errors Data Transmission 4 9 Estimated Exhaled Minute Ventilation 3 6 Estimated Exhaled Tidal Volume 3 6 Example Initialization Strings Modem A 2 Expiratory Flow Rate Adjustment 2 4 External Modem Requirements A 1 F Filters Replacing Cleaning 11 1 Flow Analysis 2 8 Flow Reversal 2 7 Full Access 2 8 H High Priority Alarms Actions 8 9 Defined 2 10 Humidifiers 12 2 I Indicators 3 2 AC Power Indicator 3 2 Alarm Enabled Indicator 3 5 Attention or Activity Indicator 3 3 DC Power Indicator 3 2 Navigation Indicator 3 4 Progress Indicator 3 5 Selection Indicator 3 4 Ventilation Ramp Indicator 3 4 Industry of Canada Notice 1 6 Initialization Strings Modem A 2 Installing the Air Filters 4 2 Intended Use 1 4 Introduction 2 1 IPAP Defined 2 10 L Lab System 2 1 2 2 4 5 5 1 6 1 Language 7 11 Leak 3 6 Leak Tolerance 2 4 LEDs Alarm 8 7 Lockout 2
31. 1 Chapter 1 Warnings and Cautions WARNING Indicates the possibility of injury to the patient or the operator CAUTION Indicates the possibility of damage to the device CAUTION US federal law restricts this device to sale by or on the order of a physician NOTE Places emphasis on an operating characteristic 1 1 Warnings This manual serves as a reference The instructions in this manual are not intended to supersede the health care professional s instructions regarding the use of the Synchrony The operator should read and understand this entire manual before using the Synchrony The Synchrony provides positive pressure ventilation and is indicated for assisted ventilation The Synchrony does not provide ventilation with guaranteed tidal volume delivery Patients requiring ventilation at predetermined tidal volumes are not candidates for pressure support ventilation The Synchrony should be used only with masks and connectors recommended by Respironics or with those recommended by the health care professional or respiratory therapist See Chapter 12 for approved patient circuits A mask should not be used unless the Synchrony is turned on and operating properly The exhalation port s associated with the mask should never be blocked Explanation of the Warning The Synchrony is intended to be used with special masks or connectors that have exhalation ports to allow continuous flow of air out of the mask When the Sync
32. 1 131 gt 555 ERU SFr t FERE VEN ERA 13 1 13 2 S T Mode Verification i ier EYEPHO SENA PEE HN ERE PR PITE EE PNE E Qua Pr dn USVERRI CH 13 2 13 3 Alarm Verification mM 13 3 Chapter 14 Specifications eesssssecoccssoooecesessooeccessssooecsssooecoeessossccecssssoeessssssossee 14 1 Appendix A External Modem Requirements seoeecssosoocessssosecsssssccccessssseseeessoo A 1 Serial AMO tee c E A 1 AZ Modem Commands 42 55 1 Example Initialization Strings A 2 Appendix B Error Codes M c B 1 1 BiPAP Synchronj Provider Manual iii BiPAP Synchronj Provider Manual Package Contents e BiPAP Synchrony e power cord e flexible tubing 1 8 m x 2 mm I D e filter cap e pollen filters e ultra fine filter e optional modem cable 4 27 m e User Guide BiPAP Synchrony Power Cord Filter Flexible Tubing Ultra fine Filter Pollen Filters Optional Modem Cable Nec BiPAP Synchrony User Guide User Guide Not included with all models Synchronj Provider Manual BiPAP Synchronj Provider Manual 1
33. 5 2 2 for parameter ranges and increments 6 2 3 T PC S T Monks SETUP SCREENS SETUP MODE X 1 3 SETUP MODE X 2 3 SETUP MODE X 3 3 IPAP 12 cm H20 Timed Insp 1 0 sec VentRamp OFF EPAP 6 cm H20 Rise Time 3 Rate 10 BPM START ABORT See Section 5 2 3 for parameter ranges and increments BiPAP Synchrony Provider Manual 6 3 6 3 Changing the Synchrony Mode This section details the steps required to change the operating mode For this example the Synchrony is operating in the CPAP mode and will be changed to the S mode YOUR ACTION RESULT STEP 1 From the CPAP monitoring screen press the DOWN key until the Mode command is selected in the Setup screen SETUP Parameters Alarms Mode STEP 2 Press the ENTER key twice to activate the Change Mode screen and the New Mode command STEP Press the UP key once to select S then press the ENTER key to implement the change SETUP MODE S 1 2 IPAP 12 cm H20 EPAP 6 cm H20 Rise Time 3 Synchronj Provider Manual 6 4 YOUR ACTION STEP 4 Press the ENTER key to activate the IPAP parameter for change b Press the UP or DOWN key to change the IPAP value Each key press changes the value by one increment see Section 5 3 c Press the ENTER KEY to implement the change 2 2404 STEP 5 Continue changing parameters press the UP or DOWN key to selec
34. 6 Communication Statements for Optional Modem An optional internal modem is available in models of the Synchrony sold in the United States and Canada If your model does not have this feature you can connect the Synchrony to an external modem The following statements apply to use of the Synchrony with a modem through U S telephone lines TYPES OF SERVICE Synchrony optional internal modem is designed to be used on standard device telephone lines It connects to the telephone line by means of a standard jack called the USOC RJ 11C or USOC 455 Connection to telephone company provided coin service central office implemented systems is prohibited Connection to party lines service is subject to state tariffs TELEPHONE COMPANY goal of the telephone company is to provide you with the best service it PROCEDURES In order to do this it may occasionally be necessary for them to make changes in their equipment operations or procedures If these changes might affect your service or the operation of your equipment the telephone company will give you notice in writing to allow you to make any changes necessary to maintain uninterrupted service In certain circumstances it may be necessary for the telephone company to request information from you concerning the equipment that you have connected to your telephone line Upon request of the telephone company provide the FCC registration number and the ringer equivalence nu
35. 8 Low Priority Alarms Actions 8 11 Defined 2 10 M Maintenance 11 1 Masks Exhalation Ports 12 2 Maximum IPAP Time 2 7 BiPAP Synchrony Provider Manual I 3 Medium Priority Alarms Actions 8 10 Defined 2 10 Menu Options 7 2 Minute Ventilation 3 6 Mode Changing 6 3 Modem Commands 1 Communications 9 1 Dial 7 6 Initialization Strings 7 7 A 2 Requirements A 1 Serial Cable A 1 Settings 7 5 Type 7 5 Modes 2 1 CPAP 2 2 Pressure Control 2 3 S 2 2 S T 2 2 Summary 2 3 N Navigating the Screens 3 5 Navigation Indicator 3 4 O Operating the System 4 6 Patient Instructions 4 7 Operational Verification 13 1 Options Menu 7 2 Options Operations 7 1 OSA Defined 2 10 Overview Synchrony 2 1 Oxygen Adding 10 1 Concentrations 10 3 Valve 3 7 P Parameters Changing 5 4 Parameters Screens T PC S T Modes 5 3 Patient Alarm History 7 4 Patient Circuit 4 3 Patient Circuit Connection 3 7 Patient Connection 4 5 Patient Disconnect Alarm Delay 8 3 Patient Operating Instructions 4 7 Patient Precautions 1 4 PC Mode Parameter Screens 5 3 Setup Screens 6 2 PEV Setting 7 9 Physical Specifications 14 1 Pressure Control Mode 2 3 Pressure Specifications 14 1 Principles of Operation Flow Analysis 2 8 Flow Reversal 2 7 Leak Tolerance 2 4 Maximum IPAP Time 2 7 Sensitivity 2 5 Shape Signal 2 6 Spontaneous Expiratory Threshold 2 7 Volume Trigger 2 6 Product Support 2 10 Progress Indicator 3 5 Provider Dialing 4
36. A FAILURE BLOWER DEFAULT ERRI BLOWER OFF CURRENT HIGH UNRECOGNIZED CAL VERSION BY SW UNIT TYPE FAILURE TLOG WRITE QUEUE BAD DATA UNEXPECTED WATCHDOG RESET VALVE DEFAULT ERRI RIFT DEFAULT ERRI I HIGH PRIORITY ALARM TEST I 2 HIGH PRIORITY ALARM TEST I MEDIUM PRIORITY ALARM TEST I 2 MEDIUM PRIORITY ALARM TEST I LOW PRIORITY ALARM TEST I2 LOW PRIORITY ALARM TEST LOW PRESSURE SUPPORT ALARM INVALID DRIFT INDEX AT CAL INVALID TCAL AT CAL INVALID MODE IN CURRENT MODEL UNSUPPORTED FEATURE SET LOW TIDAL VOLUME ALARM VTE TARGET SETPOINT ZERO ERR BRMODEL MAX AMPLITUDE ERR RAMP DEFAULTI INVALID ALARM CODE BiPAP Synchronj Provider Manual I 1 A Abbreviations 2 10 AC Inlet 3 8 AC Operation 4 4 AC Power Indicator 3 2 Access Levels 2 8 Changing 7 10 Unlocking 7 10 Accessories 12 2 Accuracy Specifications 14 2 Acronyms 2 10 Air Filters Cover 3 8 Installation 4 2 Alarm Actions During 8 8 Defintions 8 12 Description 8 1 Display 8 6 High Priority 8 9 History 7 4 LEDs 8 7 Low Priority 8 11 Medium Priority 8 10 Sounds 8 6 Tables 8 9 Alarm Enabled Indicator 3 5 Alarm Parameters Apnea 8 4 Changing 8 3 Patient Disconnect Alarm Delay 8 3 Setting 8 2 Alarm Volume 7 12 Apnea Alarm 8 4 Changing 8 5 Assembling the Patient Circuit 4 3 Attention or Activity Indicator 3 3 Auto Trak Sensitivity 2 4 B backlight 3 1 Bi Flex 2 2 BiPAP Defined 2 10 C Cable A 1 Cautions 1 3 Change Mode Operations
37. ARAMETER OPERATION SUMMARY cscscssssscscecscceseeccceccececesecensssescseusususcscsceceeseececesesecesesesseseesneauseseseeeees 8 2 8 2 2 CHANGING THE ALARM PARAMETERS 21 n e assess assis e eese sete eret terne anna nnns 8 3 8 3 Summary of Alarm Behavior oe ions cit CHEER ERN CUR ERR N ERREUR RM NEAN SER 8 6 8 3 1 AEARM SOUNDS BEHAVIOR 8 6 8 3 2 ALARM LED BEHAVIOR eene eene n Innen tettetett testets nsns na e ases sese ses sese 8 7 58 3 3 DISPLAY BEHAVIOR teer t EST eue ECL Eee CU Piece rise 8 7 8 4 Summary of User Actions During Alarm 8 8 8 5 Alarm Tables RN RR 8 9 8 5 1 HIGH PRIORITY ALARMS 8 9 8 32 MEDIUM PRIORITY ALARMS 8 10 8 5 3 Low PRIORITY ALARMS ccccccccccccscecesesesesscscseaceususcecscceseseceesesceccesesecscsscesescseucsscssececeseeeseseseeeecesenecesesstesanees 8 11 5 54 ALARM DEBINITIONS 15 sete co ues vivas e dee 8 12 Chapter 9 Communications M 9 1
38. ARZMETEHST increment Press the ENTER key to select the IPAP 19 154 next parameter EPAP 5 5 cm Rise Time 3 P S PARAMETERS Pe P ata p IPAP 15 15 cm 5 5 d Rise Time 3 STEP 4 Continue changing parameters press UP or NOTE move from one screen to another press the DOWN key to select a parameter press the DOWN key when the selection indicator is at ENTER key to activate the parameter for the last selectable item on the screen or press change use the UP or DOWN key to change the UP key when the selection indicator is at the the value and press the ENTER key to retain first item the change When you reach the last parameter on a page press the DOWN key to scroll to the next page BiPAP Synchrony Provider Manual 5 5 RESULT S PARAMETERS 2 2 VentRamp OFF Bi Flex OFF STEP 5 Scroll to page 2 of the S Parameters screens Select the EXIT command and press the ENTER key to return to the Setup screen EXIT SETUP Parameters Alarms ode BiPAP Synchronj Provider Manual BiPAP Synchronj Provider Manual 6 1 Chapter 6 Changing Modes 6 1 Summary of Change Mode Operations Full Access Only BiPAP Synchrony BiPAP Synchrony HODE 8 exit 9 amp Select using UP or DOWN key IRONICS The X shown in the hand mea
39. DOWN key until the Modem command is selected then press the ENTER key to activate the Modem Settings screen m OPTIONS 2 3 Modem p PEV 0 Lockout NO e MODEM SETTINGS 1 6 Type Ext 19200 6 Dial e ATDT 70 4125551212 STEP 2 Press the ENTER key to activate the Type for change MODEM SETTINGS 1 6 Type Ext 192004 Dial ATDT 70 4125551212 STEP 3 Press the UP DOWN key to toggle the The choices are modem types e nternal External 9600 External 57600 External 2400 e External 38400 e None e External 19200 NOTE For all screens you can hold in the UP or DOWN key to quickly scroll through the choices STEP 4 Press the ENTER key when your modem type is displayed If your Synchrony was purchased with the optional internal modem select Internal MODEM SETTINGS 1 6 Type Ext 19200 Dial ATDT 70 4125551212 Synchronj Provider Manual In the remainder of the modem setup steps you can select a character in the text string selections If you press the ENTER key when the is displayed all characters to the right of the 4 are deleted all characters to the left of the l are accepted YOUR ACTION RESULT STEP 5 Press the ENTER key to activate the Dial parameters for change MODEM SETTINGS 1 6 Type Ext 19200 Dial ATDT 70 4125551212 STEP 6 The first parameter unde
40. DOWN keys can be used to adjust the value as shown in Figure 3 10 Figure 3 9 Page Indicator S PARAMETERS 13472 IPAP 15 cm H20 EPAP 9 cm H20 Rise Time 3 Figure 3 10 Value Adjust Indicator IPAP can be adjusted with the UP or DOWN key 2 appears at the top of the display when ventilation ramp has been initiated See Figure 3 11 Figure 3 11 Ventilation Ramp Indicator Synchrony Provider Manual 3 5 Progress Indicator m The imi consists of seven segments that empty from top to bottom to indicate the progress of certain operations See Figure 3 12 The four indicators work simultaneously mmSYSTEM SELF VER X XX XXXXX X HRS XXX XXX XXX XXX XXX XXX XXX XXX XXX XXX Figure 3 12 Progress Indicators Alarm Enabled Indicator EX The B appears in the Monitoring screen if any of the patient alarms Patient Disconnect Apnea or Low Minute Ventilation is enabled see Chapter 8 Indicates a Patient Alarm is Enabled ODE S T 1 48 IPAP LD cm H20 EPAP 9 cm H20 RR 20 BPM Figure 3 13 Monitoring Screen with Alarm Enabled Indicator 32 Navi gating the When the screen indicates that there are multiple pages 1 3 2 4 etc appear in the upper right corner you can scroll through the pages by pressing either the Screens DOWN arrow key when the last item on the screen is sele
41. IONAL INTERNAL MODEM cs uei t HEU ver EE EHE REESE EU VE ted EE EE 4 5 4 1 6 PERFORMANCE VERIFICATION ccssccccccsssssecececesssssecccecesuesecceceesseseeceeseeseseseseaaeececeseausaeccecesaaaececceessaeeeseeesenseeeecesenses 4 5 4 2 Setting Up the Synchrony eei a 4 3 Connecting the Patient c 420 4 4 Operating the 4 5 Patient Operating 0 5255 4531 SETTING THE RISE D IME iis ertet AE SERERE TR RE cence 4 7 4 5 2 DIALING THE PROVIDER cccecesssseccecsesscececesescecececensaseecececesuececccesseseecsesaeeesesenesaeeeeceseaueaeccecesusaececcsensaeeeeeseneaecs 4 8 45 3 DATA TRANSMISSION ERRORS reti iore Eee oed i Pieter 4 9 4 5 4 USING THE RAMP FUNCTION c ccccccessssesecesesscssececenssasceccecesaececeeceessececesessseeeeeceaaeeeececesuesecesceeeseseeceeneaeeeeeeeneas 4 10 Chapter 5 Changing 2 2 D L 5 1 Summary of Change Parameters Operations e sesessosssosssscessecssocssoosssoessoecesocesocesoossssesssee 9 1 5 2 Change Parameters Screens eesseessoosscoessocessecss
42. Message Action Cause Action Action Red Flash Low Pressure Operates Device Call your home Replace the Support is malfunctioning care provider device Red Flash Low Minute Operates Device sensed minute Report alarm Verify patient Ventilation ventilation below to your home status alarm setpoint provider Red Flash Ventilator Shuts down Internal device Remove power Replace the Inoperative failure from the device Synchrony Displays Codes Call your home care provider Red Flash Ventilator Shuts down Battery is Remove DC power Replace the Inoperative discharged source from the battery Battery Failure Synchrony replace the battery restore power to the Synchrony or seek reliable AC power source Optional The error codes can be viewed upon start up of the Synchrony on the self test screen The codes can also be viewed by displaying the System Codes screen as described in Section 7 2 2 Appendix B lists the error codes and their descriptions 8 5 2 MEDIUM PRIORITY ALARMS Display Synchrony Possible Patient Provider LED Audible Message Action Cause Action Action Yellow Battery Voltage Operates Wrong or Remove DC power Replace the Flash Too High malfunctioning from the device battery battery or charger use on AC or call home care provider Yellow ee e Low Battery Operates Battery nearly If on battery replace Replace the discharged battery if on AC battery exchange the battery and c
43. RE BUZZER SOUND FAILURE LCD CUST CHAR FAILURE RED ALARM LED FAILURE YELLOW ALARM LED FAILURE GREEN DC POWER LED FAILURE GREEN AC POWER LED FAILURE RTC NOT TICKING FAILURE RTC BATTERY LOW FAILURE RTC DATA CORRUPT FAILURE WATCHDOG FAILURE GET THERAPY LOG DATA ERRI BREAKPOINT EXCEPTION FAILURE BUS ERROR EXCEPTION FAILURE SOFTWARE INTERRUPT FAILURE ILLEGAL INSTRUCT EXCEPT FAILURE DIVIDE BY ZERO EXCEPTION FAILURE UNUSED INTERRUPT FAILURE UNINIT INTERRUPT FAILURE SPURIOUS INT EXCEPTION FAILURE HIGH PRIORITY THREAD INACTIVE LOW PRIORITY THREAD INACTIVE BACKGROUND THREAD INACTIVE FRONT PANEL TEST NO KEY FAILURE FRONT PANEL TEST UP KEY FAILURE FRONT PANEL TEST DOWN KEY FAILURE FRONT PANEL TEST ENTER KEY FAILURE FRONT PANEL TEST RAMP KEY FAILURE FRONT PANEL TEST SECRET KEY FAILURE LCD DISPLAY CTRL TIMEOUT LCD DISPLAY DATA TIMEOUT LCD DISPLAY READ TIMEOUT ADC CONVERSION FAILURE SYS DATA BAD RANGE FAILURE LOSS AC OPER DC POWER MOMENTARY LOSS OF POWER BATTERY IN USE ALARM LOW BATTERY ALARM DEFINITION BATTERY FAILURE ALARM HIGH BATTERY ALARM LOW MIN VENT ALARM EXHALATION PORT ALARM ALARM PATIENT DISCONNECT ALARM HIGH PRESSURE ALARM LOW PRESSURE ALARM PROX LINE ALARM WAIT FOR TRIG ERRI COMPUTE MINVENT ERRI COMPUTE PERCENT TI ERRI COMPUTE BPM ERRI COMPUTE PAT TRIG BREATHS ERRI COMPUTE TIME AT P ERRI COMPUTE TIME AT P ERR2 GET CALC PARAM ERRI ROM CRC FAILURE VREF 12000 FAIL
44. S 6 6 Serial Number 012345 EXIT OPTIONS 2 3 Modem PEV NO Lockout NO Synchrony Provider Manual 7 9 7 2 5 PEV SETTING The PEV parameter is provided to compensate for the different leak characteristics when using a Respironics Plateau Exhalation Valve PEV The PEV setting is stored in memory and must be changed if you are changing from or to a PEV after restarting the Synchrony YOUR ACTION RESULT STEP 1 From the Options menu press the DOWN key until the PEV parameter is selected then press the ENTER key OPTIONS Modem Pye A PEV NOS Lockout i OPTIONS 1 3 J time 25 hrs f_ 9 System Codes K Pt Alarm History 2 Press the UP or DOWN key to toggle the value of the PEV parameter OPTIONS 2 3 Modem PEV YES Lockout NO STEP3 Press the Enter key to accept the change to the PEV parameter OPTIONS 2059 Modem PEV YES Lockout NO Synchronj Provider Manual 7 10 7 2 6 CHANGING THE ACCESS LEVEL YOUR ACTION RESULT STEP 1 From the Options menu press the DOWN key until the Lockout command is selected then press the ENTER key 5 OPTIONS 2 3 Modem 2 PEV YES E dep Eod Lockout Pt Alarm History j 8 OPTIONS 2 3 Modem B ron J PEV YES Mun Lockout
45. URE AUDIBLE ALARM VCAP FAILURE FRONT PANEL TEST STANDBY KEY FAILURE UI ALARM QUEUE FULL FAILURE CAL DATA CRC FAILURE AIR STREAM OVER TEMP AIR STREAM UNDER TEMP AUDIBLE ALARM VOLTAGE FAILURE MOTOR FAILURE DEFAULT SWITCH MODEM HANGUP DEFAULT SWITCH MODEM INIT EXECUTION SEQUENCE FAILURE DEFAULT SWITCH MODEM REGAINCONTROL RESICALC UNIT ID DEFAULT SWITCH MODEM ESCAPE SEQ CORRUPT KNOWN LEAK DATA DEFAULT SWITCH MODEM PROCESS CMD BARO PRESSURE FAILURE BAD RESISTANCE TABLE DRIFT TOO HIGH DRIFT HIGH DRIFT FAILURE MAX RESETS OVER TIME CORRUPT ACCESS KEY DATA FAILURE CORRUPT TLOG STORAGE DATA FAILURE INVALID TEST CALL UNRECOGNIZED BOARD REVISION BY SW BLOWER ERROR SIGNAL FAILED BLOWER CURRENT FAILED HIGH BLOWER CURRENT FAILED LOW BLOWER RPM FAILED HIGH BLOWER RPM FAILED LOW VALVE ENABLE FAILURE VREF 1250 FAILURE COMPUTE AVG LEAK ERRI BACKGROUND THREAD DEFAULT SWITCH COPY FLASH FUNCTIONS FAILURE UI EVENT QUEUE FULL FAILURE RISE RATE RANGE FAILURE PRESSURE RANGE FAILURE IRFLOW STUCK SENSOR BiPAP Synchronj Provider Manual DEFINITION STUCK SENSOR PP STUCK SENSOR STUCK SENSOR PV2 STUCK SENSOR ERASE SECTOR FAIL WRITE FLASH FAIL UNRECOGNIZED ACCESS KEY VERSION PV1 PV2 SENSOR FAILURE DATA LOGGING ERRI SCAN EVENTS ERR LOG INITIAL VALUES ERRI LOG EVENT ERRI DATA FLASH ERR SYS PT ALARM LOG CHECKSUM ERR CORRUPT SYS ALARM LOG DATA FAILURE CORRUPT PT ALARM LOG DAT
46. against electric shock Degree of protection against harmful ingress of water Modes of Operation Electromagnetic Compatibility Fuses PRESSURE Output Operating Storage 41 F to 95 F 4 F to 140 F 15 to 95 Relative 15 to 95 Relative non condensing non condensing Atmospheric Pressure 83 to 102 kPa 50 kPa to 106 kPa 5600 feet to sea level 20000 feet to sea level 12 Lx7 Wx6 H Approximately 6 Ib 100 to 240 V 50 60 Hz 12 V 1 25 A maximum 5 5 A maximum Class II Type BF Applied Part Ordinary Equipment IPXO Continuous The BiPAP Synchrony Ventilatory Support System meets the requirements of EN 60601 1 2 There are no user replaceable fuses 4 to 30 cm H O BiPAP Synchrony Provider Manual 14 2 Specifications CONTROL ACCURACY CPAP io 3 on HO Timed Inspiration 0 5 to 3 0 sec 0 1 0 10 of setting sec Ventilation Ramp Disabled 0 5 1 0 2 0 3 0 cm H O per breath 0 1 0 25 of setting cm H O breath Measured over the full duration of the 2 2 Breath Rate 0 to 30 BPM PA and S T Greater of 1 BPM or 10 of setting when 4 to 30 BPM T measured over a four minute period programmed ramp Measured at the patient end of circuit with a Whisper Swivel II exhalation port and no patient flow Dynamic pressure accuracy is 5 cm H O measured at the patient end of the circuit with a Whisper Swivel and varying flow conditions The range of va
47. amination a low resistance main flow bacteria filter may be placed in line between the Synchrony and the patient The Synchrony does not have an alarm to detect occlusion of the exhalation port Before each use inspect the patient circuit to verify that the port is not occluded Occlusion or partial occlusion can reduce airflow and result in rebreathing of exhaled air Do not use antistatic or electrically conductive hoses or tubing with the Synchrony When the Synchrony is used with a humidifier position the humidifier such that the water level in the humidifier is lower than the patient and the humidifier is on the same level or lower than the Synchrony If you detect any unexplained changes in the performance of the Synchrony if the Synchrony is dropped or mishandled if water is spilled into the enclosure or if the enclosure is broken seek the assistance of Respironics or an authorized service center Repairs and adjustments must be performed by Respironics or an authorized service center Service done by inexperienced or unqualified personnel or installation of unauthorized parts could cause injury invalidate the warranty or result in costly damage Electrical cords and cables should be periodically inspected for damage or signs of wear To avoid electrical shock unplug the Synchrony before cleaning it Verify the operation of the patient disconnect alarm with any changes in the patient circuit BiPAP Synchrony Provid
48. apter 11 to clean or replace the filters Figure 4 1 Installing the Air Filters Figure 4 2 Replacing the Air Filter Cover Synchrony Provider Manual 4 3 4 1 3 ASSEMBLING THE PATIENT CIRCUIT The exhalation device e g the Whisper Swivel II or exhalation port on masks with integrated exhalation port is designed to exhaust CO from the patient circuit Do not block or seal the ports on the exhalation device WARNING The oxygen valve must be installed and used if oxygen is to be titrated to the patient circuit See Chapter 10 for complete details STEP 1 Assemble the patient circuit according to the configurations presented in Chapter 12 STEP 2 If required connect a bacteria filter to the patient interface port shown in Figure 4 3 and connect the patient tubing to the outlet of the bacteria filter e Ifthe bacteria filter is not required connect the patient tubing directly to the patient interface port e If oxygen is to be used connect it according to Chapter 10 e Ifa humidifier is to be used connect the inlet to the bacteria filter outlet or to the patient interface port A completed assembly is shown in Figure 4 3 Patient Interface cl a Typical 4 Exhalation Port Typical Circuit Valve Optional Bacteria Patient Filter Interface Optional Port Figure 4 3 An example of a Respironics approved circuit Synchronj Provider Manual 4 4
49. arantee the equipment will operate to the user s satisfaction Before installing this equipment users should make sure that it is permissible to be connected to the facilities of the local telecommunications company The equipment must also be installed using an acceptable method of connection The customer should be aware that compliance with the above conditions may not prevent degradation of service in some situations Repairs to certified equipment should be coordinated by a representative designated by the supplier Any repairs or alterations made by the user to this equipment or equipment malfunctions may give the telecommunications company cause to request the user to disconnect the equipment Users should ensure for their own protection that the electrical ground connections of the power utility telephone lines and internal metallic water pipe system if present are connected together The precaution may be particularly important in rural areas CAUTION Users should not attempt to make such connections themselves but should contact the appropriate electric inspection authority or electrician as appropriate Ringer Equivalence Number REN The REN assigned to each terminal device provides an indication of the maxi mum number of terminals allowed to be connected to a telephone interface The termination on an interface may consist of any combination of devices subject only to the requirement that the sum of the Ringer Equivalence Num
50. arm detects the cessation of spontaneous breathing The high pressure alarm limits pressure to the patient The low pressure alarm detects when the patient is not receiving adequate pressure therapy The patient disconnect alarm detects when the patient is no longer connected to the Synchrony The low pressure support alarm detects when the patient is not receiving adequate pressure therapy The low minute ventilation alarm detects when the user 15 not receiving a specified volume of air on a per minute basis Alarm is detected when the time between spontaneous breaths exceeds the Apnea alarm time setting The alarm is not detected during Flow Limit Control FLC Alarm is detected when the pressure exceeds the IPAP setpoint by 5 cm H O for a continuous 0 5 second Alarm is detected when the pressure is below 5 cm H O for 60 continuous seconds Alarm is detected when the Synchrony is in FLC and the Patient Disconnect Alarm is enabled There is a 10 second delay between the time the Synchrony enters FLC and the alarm 15 generated Alarm is detected when R PS MeasPS gt PSmin cm H O for 60 continuous seconds Alarm is detected when the calculated minute ventilation lt the alarm setting The alarm is not detected during FLC Synchrony waits 6 breaths after machine is started or after exiting FLC before detection The Synchrony shuts down if the pressure exceeds IPAP by 5 cm H O for 10 se
51. bers of all the devices does not exceed 5 BiPAP Synchrony Provider Manual 2 1 Chapter 2 Introduction 2 4 Synchrony Overview WARNING The Synchrony can operate on AC or DC power The DC power option is not intended as a battery backup during use of AC power CAUTION When DC power is obtained from a vehicle battery the Synchrony should not be used while the engine of the vehicle is running Damage to the vehicle may occur The Synchrony is available in two models The BiPAP Synchrony Lab System is for use by clinicians in a sleep lab setting The Synchrony Ventilatory Support System is for use in a hospital or home setting Throughout this manual references to Synchrony will apply to both the Lab System and the Ventilatory Support System unless otherwise noted NOTE Throughout this manual references to Bi Flex apply only to the Synchrony Lab System The Synchrony shown in Figure 2 1 is a low pressure electrically driven ventilator system with electronic pressure control The Synchrony s pressure controls are adjusted to deliver pressure support for patient ventilatory assistance The Synchrony is intended to augment patient breathing by supplying pressurized air through a patient circuit It senses the patient s breathing effort by monitoring airflow in the patient circuit and adjusts its output to assist in inhalation and exhalation This assistance is provided by the administration of two levels of po
52. combustion Oxygen should not be used while smoking or in the presence of an open flame Synchrony Provider Manual 1 2 Warnings continued When administering fixed flow supplemental oxygen the oxygen concentration may not be constant The inspired oxygen concentration will vary depending on the IPAP and EPAP settings patient breathing pattern and the leak rate Substantial leaks around the mask may reduce the inspired oxygen concentration to less than the expected concentrations shown in Chapter 10 Appropriate patient monitoring should be used Operation of the Synchrony may be adversely affected by electromagnetic fields exceeding the level of 10 V m in the test conditions of EN 60601 1 2 the operation of high frequency diathermy equipment defibrillators or short wave therapy equipment tradiation e g x ray magnetic fields e g MRD The Synchrony is not suitable for use in the presence of flammable mixtures such as gases anesthetics and liquids Do not use the Synchrony at room temperatures above 35 C If the Synchrony is used at room temperatures above 35 C the temperature of the airflow may exceed 41 C which could cause thermal irritation or injury to the patient s airway Do not operate the Synchrony in direct sunlight or near a heating appliance because these conditions can increase the temperature of the airflow delivered to the patient To reduce the risk of cont
53. conds The alarm 1s terminated when two consecutive spontaneous breaths occur within the Apnea alarm time setting The alarm is terminated when the pressure is within 5 cm H O of the IPAP setpoint for a continuous 0 5 second The alarm 1s terminated when the pressure is within 5 cm H5O for a continuous 0 5 second The alarm is terminated when the Synchrony is no longer in FLC Alarm is terminated when R PS MeasPS lt PSmin cm H O for 5 continuous seconds Alarm is terminated when the calculated minute ventilation the alarm setting MeasPS Measured Pressure Support Attained IPAP Attained EPAP R PS Prescription Pressure Support PSmin R PS 2 cm H O 3 The following conditions must be satisfied for the Synchrony to be examined for a Low Pressure Support condition R PS gt 3 cm H O and R PS lt 10 cm H O The Synchrony is not performing the Ramp function The Synchrony is not in FLC The respiratory rate is non zero Synchrony Provider Manual 9 1 Chapter 9 Communications This chapter describes the ability of the Synchrony to communicate with the caregiver using the optional modem 9 1 Communicating Via Optional Modem The modem setup is described in Chapter 7 Section 4 5 2 provides instructions to connect the Synchrony to a phone line and dial the provider 9 2 Communicating With Encore or Encore Pro Data Management Software The Encore or Encore Pro soft
54. cribes the procedure to set the access level BiPAP Synchrony Provider Manual 2 5 Symbol Key The following symbols are used on the Synchrony Symbol Meaning AC Power Indicator DC Power Indicator Alarm Indicator Type BF Applied Part Class Il for Protection Against Electric Shock Attention consult accompanying documents dE C q A 9 Standby Key Start Stop Up Key Down Key Enter Key Ramp Start Alarm Silence Key BiPAP Synchrony Provider Manual 2 0 2 6 Definitions Acronyms and Abbreviations 2 7 Service The following terms are used in this manual Bi Flex A therapy feature that establishes a level of pressure relief taking place at the end of inhalation and at the start of exhalation BiPAP Bi level Positive Airway Pressure CPAP Continuous Positive Airway Pressure Cycle The transition from inspiration to expiration EPAP Expiratory Positive Airway Pressure High Priority Alarm Alarm signal indicating a condition that requires immediate attention IPAP Inspiratory Positive Airway Pressure Low Priority Alarm Signal indicating an information message Medium Priority Alarm Alarm signal indicating a condition that requires operator awareness OSA Obstructive Sleep Apnea Ramp A feature that may increase patient comfort when therapy is started The Synchrony IPAP starts at the EPAP level and is increased gradually breath by breath over several breaths unt
55. ct OFF LowMinVent OFF Apnea OFF BiPAP Synchrony Provider Manual 8 3 82 2 CHANGING THE The Patient Disconnect Alarm Delay the Apnea Alarm and the Low Minute ALARM PARAMETERS Ventilation Alarm are adjustable on the Synchrony When any of these alarms are enabled an inverse A appears at the top of the Monitoring screen See CHANGING THE PATIENT DISCONNECT ALARM DELAY YOUR ACTION STEP 1 From the Monitoring screen press the DOWN key until the Alarms command is selected BiPAP Synchrony STEP 2 Press the ENTER key to activate Alarms screen then press the ENTER key again to activate the Disconnect parameter for change 5 0 STEP Press the UP or DOWN key to change the parameter then press the ENTER key to implement the change 9 4 Press the DOWN key twice the press the ENTER key to exit the Alarms screen 2 4 Chapter 3 for details RESULT SETUP Alarms ode 4 4 Parameters Options ALARMS Disconnect Apnea OFF ALARMS Disconnect Apnea OFF 1 7 2 The settings are OFF 15 seconds and 60 seconds A LARMS Disconnect Apnea OFF 15 sec ALARMS Disconnect OFF 15 sec pi LARMS LowMinVent 2 2 25 L MIN EXIT S ETUP Parameters Alarms ode
56. cted or by pressing the UP arrow key when the first item is selected Total Number Page of Pages Indicator NEW MODE S T 2 3 Timed Insp 1 0 sec Rise Time 3 Figure 3 14 Example of Page Indicator on Screen In the example of Figure 3 14 if you press the UP key the Synchrony displays page 1 of 3 if you press the DOWN key twice the Synchrony displays page 3 of 3 Synchronj Provider Manual 3 6 3 3 Display Data NOTE The Estimated Exhaled Tidal Volume and the Estimated Exhaled Minute Ventilation displays represent estimates There are some circum stances such as low tidal volumes erratic breathing or rapidly changing leak where the accuracy of the estimates will vary greatly The Estimated Exhaled Tidal Volume and the Estimated Exhaled Minute Ventilation displays will flash during some transient conditions The display screen is used to display measured parameters in the Monitoring screens The data changes depending on the access level and the mode of operation The Synchrony is capable of displaying e CPAP IPAP and EPAP These displays are estimates of measure ments at the patient connection Displays are updated as follows CPAP is updated at the end of inspiration IPAP is updated at the end of IPAP and EPAP is updated at the end of EPAP Respiratory Rate The breathing rate is a running average from the six previous breaths If the Synchrony is operating
57. e Flashing yellow LED indicates a new medium priority alarm The LED changes to continuous when the alarm sound is silenced or the alarm condition is corrected The LED will resume flashing during the silence period if a new medium priority alarm occurs The LED goes off when the alarm message is cleared e Continuous yellow LED indicates a low priority alarm or a silenced medium priority alarm 8 3 3 DISPLAY BEHAVIOR The indicator is displayed next to an alarm message to indicate an active alarm condition When the condition is corrected the indicator is cleared For High Priority Alarms the displays shows ALARM and the name of the alarm For Medium Priority Alarms the display shows WARNING and the name of the alarm For Low Priority Alarms the display shows INFO and the name of the alarm The display can contain multiple pages of alarms The page number in the upper right of the display will indicate the page you are on and the total pages e g 1 3 To access the other pages press the UP or DOWN key BiPAP Synchronj Provider Manual 8 8 8 4 Summary of User Actions During Alarm The following steps apply to most alarm conditions The patient or operator should follow this sequence unless otherwise directed by the alarm table in Section 8 5 STEP 1 Look at the alarm indicators and listen to the alarm sound Note color and whether LED is flashing or solid STEP 2 Look at the display for
58. ecommended that you specify this option in the initialization string The Synchrony software currently does not handle the answering of incoming calls Therefore you should configure the modem by setting the 50 register to zero 1 80 0 in the initialization string The Synchrony requires that you specify two initialization strings The follow ing recommendations work with U S Robotics modems and should work with others Init String 1 AT amp FX4V1E1Q0D2 Init String 2 ATSO 0 To turn off the modem s speaker add the option The initialization strings would appear as follows Init String 1 amp 4 1 100 2 Init String 2 ATM0S0 0 BiPAP Synchronj Provider Manual B 1 Appendix B Error Codes This appendix lists the definitions for the displayed error codes see Section 7 2 2 DEFINITION SOFTWARE CPU FAILURE STACK OVERFLOW FAILURE STACK UNDERFLOW FAILURE STACK RESERVE FAILURE RAM FAILURE STUCK KEY FAILURE CORRUPT RX MODE FAILURE CORRUPT RX PARM IN MODE FAILURE CORRUPT RX PARM OUT MODE FAILURE CORRUPT ALARM PARM FAILURE CORRUPT SYSTEM DATA FAILURE CORRUPT MODEM PARM FAILURE CORRUPT USAGE LOG DATA FAILURE CORRUPT SW VERSION DATA FAILURE SOFTWARE CHANGE FAILURE DATA FLASH ERASE FAILURE DATA FLASH WRITE FAILURE DATA FLASH OVERLAP PAGE 1 FAILURE DATA FLASH OVERLAP PAGE 2 FAILURE DATA FLASH OVERLAP PAGE 3 FAILURE DATA FLASH OVERLAP PAGE 4 FAILU
59. equential damages which may be claimed to arise from any sale or use of this product Some states do not allow the exclusion or limitation of incidental or consequential damages so the above limitation or exclusion may not apply to you This warranty is given in lieu of all other express warranties In addition any implied warran ties including any warranty of merchantability or fitness for the particular purpose are limited to one year Some states do not allow limitations on how long an implied warranty lasts so the above limitation may not apply to you This warranty gives you specific legal rights and you may also have other rights which vary from state to state To exercise your rights under this warranty contact your local authorized Respironics Inc dealer or contact Respironics Inc at 1001 Murry Ridge Lane Murrysville Pennsylvania 15668 8550 1 412 387 4000 BiPAP Synchronj Provider Manual RESPIRONICS 1001 Murry Ridge Lane Murrysville Pennsylvania 15668 8550 U S A 1010709 LG 5 3 02
60. er Manual 1 3 Warnings continued e Verify that the Patient Disconnect alarm is active if required for medical reasons 1 2 Cautions Synchrony may only be operated at temperatures between 5 C and 35 C Do not immerse the Synchrony or allow any liquid to enter the enclosure or the inlet filter e Condensation may damage the Synchrony Always allow the Synchrony to reach ambient temperature before use e Use the AC cable retainer to keep the AC power cord from falling out Additional Warnings Cautions and Notes are located throughout this manual Synchronj Provider Manual 1 4 1 3 Intended Use The Synchrony is intended to provide noninvasive ventilation in adult patients gt 30 kg for the treatment of respiratory insufficiency a condition in which the patient can continue without ventilation for some period such as overnight or obstructive sleep apnea The Synchrony may be used in the hospital or home The Synchrony is intended for use with nasal masks and full face masks as recommended by Respironics WARNING Do not connect any equipment to the Synchrony unless recommended by Respironics or the health care professional Verify that an exhalation port is present to exhaust CO from the circuit If circuit accesso ries other than those recommended by Respironics are connected to the Synchrony then pressures must be verified Use of these accessories may alter the pressure received
61. esoessocosssossosscosssssesssso 2 1 2 2 2 2 CRAP eee rese urere LC 2 2 222 MINI OID Screen este cece ev LT 2 2 S W INI IDE 2 3 2 2 4 PRESSURE CONTROL MODE ccccsecseceeesesecececesesssecececessuaeececeessaesecceesenesecesesenseececesesseaeceecesnaaesecceeseaeeeseeeseneeeeecenes 2 3 22552 MED MODE m 2 3 22226 MODE SUMMARY 2 4 2 3 Digital Auto Trak Sensitivity IM 2 4 TOLERANCE o etri rete reet Dt e ene e UD REM 2 4 2 3 2 SENSITIVITY erosie rE 2 4 2 4 Eve abad c M 2 7 25 Symbol Key Sf 2 8 2 6 Definitions Acronyms and Abbreviations 2 1 21 eene 2 9 2 7 OS YEE ESENS T E E EE EET 2 9 Chapter 3 Controls and Displays ccsccccsssssssscscssscssssccesssssssssccsssssssssscsessesees 3 1 3 1 e gu B ulMe 3 1 3 1 1 DISPLAY SCREEN ccccccccecsssscccecesssaeceececesseceseecsesecececesesneeececesaseececece
62. gnal from the actual patient flow by 15 L min and delaying it for a 300 msec period This intentional delay causes the shape signal to be slightly behind the patient s flow rate A sudden change in patient flow will cross the shape signal causing the pressure level to change IPAP PRESSURE EPAP Cycle to EPAP 2 Crossover 9 Point Estimated FLOW Patient Flow Trigger to IPAP Crossover Point Figure 2 5 Shape Signal Tracking the patient s flow pattern with the Shape Signal provides a sensitive mechanism to trigger to IPAP or cycle to EPAP in response to changing breathing patterns and circuit leaks BiPAP Synchrony Provider Manual 2 6 Spontaneous Expiratory Threshold IPAP to EPAP Maximum IPAP Time IPAP to EPAP Flow Reversal IPAP to EPAP A second method used to cycle off IPAP during spontaneous breathing in the S S T and PC modes is called Spontaneous Expiratory Threshold SET The SET rises in proportion to the inspiratory flow rate on each breath When the Spontaneous Expiratory Threshold SET and actual patient flow value are equal the unit cycles to EPAP IPAP PRESSURE EPAP Spontaneous Expiratory Threshold FLOW Figure 2 5 Spontaneous Expiratory Threshold A maximum IPAP time of 3 0 seconds acts as a safety mechanism to limit the time spent at the IPAP level during spontaneous breathing in the S S T and PC modes Once the time limit is reached the unit automa
63. harge Synchronj Provider Manual 8 5 3 Low Priority ALARMS Display Synchrony Possible Patient Provider LED Audible Message Action Cause Action Action Yellow Solid ui Call for Service Codes are displayed Momentary Loss of Power Power Failure Battery in Use Operates Operates Operates On start up information message that battery 15 being used to provide power Minor internal error Power was lost for less than two minutes while the Synchrony was providing therapy Line AC power was lost the device 15 now operating on battery DC power Press amp to confirm that you wish to operate on battery power Record the error code or message replace the unit Continue to use write down error code call your home care provider Press to clear the information message Check AC power seek reliable power source The error codes can be viewed upon start up of the Synchrony on the self test screen The codes can also be viewed by displaying the System Codes screen as described in Section 7 2 2 Appendix B lists the error codes and their descriptions BiPAP Synchronj Provider Manual 8 12 8 5 4 ALARM DEFINITIONS The following table lists each patient alarm with its purpose detection parameters and termination parameters High Pressure Low Pressure Patient Disconnect Low Pressure Support Low Minute Ventilation The apnea al
64. hat all breaths are machine cycled The PC mode is a pressure limited machine or patient triggered time cycled mode Therefore the inspiratory pressure may be triggered by the patient or by the Synchrony but IPAP will be pressure limited with a set cycle time determined by the Inspiratory Time control The Timed T mode provides mandatory pressure assist with bi level pressures All breaths are machine triggered and machine cycled the patient s breathing rate has no effect on the machine rate or pressure levels The trigger to IPAP is determined by the Rate control and the cycle time is determined by the Inspiratory Time control BiPAP Synchrony Provider Manual 2 4 2 2 6 SUMMARY 2 3 Digital Auto Trak Sensitivity 2 3 1 LEAK TOLERANCE 2 3 2 SENSITIVITY Table 2 1 summarizes the initiation of triggers and cycles for each bi level mode Trigger Limit Cycle Patient Pressure Patient or Device Patient or Machine Pressure Patient or Device Patient or Machine Pressure Device Machine Pressure Device Table 2 1 Initiation of Triggers and Cycles for Synchrony Modes An important characteristic of the Synchrony is its ability to recognize and compensate for unintentional leaks in the system and to automatically adjust its trigger and cycle algorithms to maintain optimum performance in the presence of leaks This feature is known as Digital Auto Trak Sensitivity The following sections examine this function in de
65. he patient interface port accepts a bacteria filter or a tubing connector for reusable or disposable tubing Patient Interface Port NS Oxygen Valve Optional Figure 3 15 Synchrony Patient Interface Port and Optional Oxygen Valve The Synchrony optional oxygen valve is mounted under one side of the Synchrony as shown in Figure 3 15 The valve must be used if oxygen is to be titrated into the breathing circuit See Chapter 10 for instructions BiPAP Synchronj Provider Manual 3 8 3 6 Rear Panel Figure 3 16 shows the rear panel of the Synchrony Telephone NC DC Cord Jack Communications Retainer Optional internal Connector modem only AC Inlet DC Inlet Filter amp AC Filter Cap Cord Retainer Figure 3 16 The Synchrony Rear Panel The rear panel contains e AC inlet that accepts the AC power cord e the DC inlet that accepts the DC power cord the filter cap that is removed to inspect the inlet air filters see Chapter 11 e RS 232 communications connector that accepts the Respironics Communications Cable for computer and external modem communi cation e the RJ 11 telephone jack provided with Synchrony devices having optional internal modem for remote data readings DC power cord retainer that provides strain relief for the DC power cord e AC cord retainer that provides strain relief for the AC power cord Synchrony Provider Manual 4 1
66. hrony is turned on and functioning properly new air from the Synchrony flushes the exhaled air out through the mask exhalation port However when the Synchrony is not operating enough fresh air will not be provided through the mask and exhaled air may be rebreathed Rebreathing of exhaled air for longer than several minutes can in some circumstances lead to suffocation In the event of a power or device failure audible and visual alarm signals will activate The Synchrony must be disconnected from the patient immediately As is the case with most ventilators with passive exhalation ports when power is lost sufficient air will not be provided through the circuit and exhaled air may be rebreathed At low EPAP pressures the flow through the exhalation port may be inadequate to clear all exhaled gas from the tubing Some rebreathing may occur If supplemental oxygen is added to the breathing circuit the optional oxygen valve must be installed and used as shown in Chapter 10 The valve automatically stops the flow of oxygen when the blower is off If oxygen is used with the Synchrony the oxygen flow must be turned off when the Synchrony is not operating Explanation of the Warning When the Synchrony is not in operation and the oxygen flow is left on oxygen delivered into the ventilator tubing may accumulate within the Synchrony s enclosure Oxygen accumulated in the ventilator enclosure will create a risk of fire Oxygen supports
67. il the IPAP prescription pressure is reached RR Respiratory Rate Trigger The transition from expiration to inspiration If you need product support call Respironics Customer Service Department 1 800 345 6443 USA or Canada only or 1 724 387 4000 BiPAP Synchrony Provider Manual Synchrony Provider Manual 3 1 Chapter 3 Controls and Displays This chapter describes the control panel and displays the patient circuit connections and the rear panel connections 3 1 Control Panel Display Screen BiPAP Synchrony Red Alarm Indicator AC Power Indicator Yellow 1 Alarm Indicator DC Power Indicator Down Key p Standby Up Ramp Key Alarm Silence Key Figure 3 1 The Synchrony Control Panel Figure 3 1 illustrates the Synchrony control panel The control panel includes e display screen control keys e alarm indicators e power indicators 3 1 1 DISPLAY SCREEN The display screen is used to display operating parameters instructions and messages A backlight is activated when the or key is pressed and remains on until there are no keystrokes for one minute If the backlight is off the first press of any of these keys will only turn the backlight on the normal key action is suppressed until the key is pressed a second time Synchronj Provider Manual 3 2 3 1 2 CONTROL KEYS Standby Key Down Key
68. ime procedures assume Parame ters I a the backlight is already on BiPAP Synchrony SETUP 4 4 Alarms Options 2 9 CB orcs OPTIONS 1 3 OPTIONS 2 3 OPTIONS 34 3 Time at P 100hrs Modem Language ENGLISH System Codes PEV NO Alarm LOUD Pt Alarm History Lockout NO EXIT Synchronj Provider Manual 7 2 7 2 Synchrony Options Menu The Options menu allows you to e view and reset the Time at P Time at Pressure e view and clear the System Codes and the Pt Alarm History Patient Alarm History e view and change the Modem settings adjust leak determination for the Plateau Exhalation Valve PEV e change the access level modify the language modify the alarm volume 7 2 1 TIME AT PRESSURE The Time at P display shows the time in hours that the Synchrony has run at the prescribed pressure The time is accumulated for bi level modes when the IPAP pressure is within 2 cm H O of the set pressure for the CPAP mode time is accumulated when a breath is triggered The time can be cleared To view or clear the Time at P display YOUR ACTION RESULT STEP 1 From the Options menu press the UP or DOWN key to select the Time at P display x 173 OPTIONS at 25hrs I o EA system codes Time at P 25hrs Pt Alarm History System Codes Pt Alarm History
69. ime parameter is adjustable so that the patient can find the most TIME comfortable setting To change the Rise Time PATIENT ACTION RESULT STEP 1 From the Monitoring Screen press the DOWN key to display the Patient Controls NOTE If the backlight is off the first press of the or key will only turn the backlight on All procedures assume the backlight is already on CONTROLS 3 4 m Rise Time 3 6 Dial Provider Sow STEP 2 Press the ENTER key to activate the Rise Time control CONTROLS 3 4 Rise Time 34 Dial Provider STEP Press the DOWN or UP key to adjust the Rise Time 8 CONTROLS 3 4 Rise Time 34 Dial Provider STEP 4 Allow the machine to cycle several times to see if it feels better Press ENTER to return to the control selection screen CONTROLS 3 4 Rise Time 4 Dial Provider Synchronj Provider Manual 4 8 4 5 2 DIALING THE When instructed to do so the patient can upload data from the Synchrony with PROVIDER the modem The instructions to program the modem are in Section 7 2 4 The Synchrony can be in use by the patient while downloading data PATIENT ACTION STEP 1 If you are using an external modem attach the RS 232 cable from the Synchrony to the modem If you are connecting an external modem through a telephone line plug a telephone line from the rear of the Synchrony to a convenient telephone outlet
70. ing pattern by occluding and opening the patient outlet Verify that the indicator appears next to the IPAP display during the inspiratory phase and appears next to the display during the expiratory phase When you have established an IPAP EPAP pattern occlude the patient circuit Wait for the Synchrony to establish a breathing pattern according to the settings of Step 5 Verify that the indicator appears next to the Rate display when the Synchrony initiates a breath Verify the IPAP and EPAP pressures displayed on the Synchrony screen agree with the pressures indicated on the manometer If you wish to verify the performance of the patient alarms see Section 13 3 Synchrony Provider Manual 13 3 13 3 Alarm Verification STEP 1 STEP 2 STEP 3 STEP 4 Keep the patient circuit and parameter setups as used in the S or S T verification Set the Patient Disconnect Alarm Delay to 15 sec Exit to the Monitoring screen Open the patient circuit to atmosphere Verify that the Patient Disconnect Alarm occurs in 15 seconds Press the RAMP key to silence the alarm Then clear the alarm screen using the ENTER key Next simulate a breathing pattern by occluding and opening the patient outlet to correct the alarm condition The red high priority alarm indicator light will appear solid when the alarm condition has subsided It will take several breaths to correct the alarm conditi
71. is removed from the Synchrony It cannot be silenced except by removing power This pattern is indicated in Section 8 5 Medium Priority Sound The sound repeats a pattern of three beeps every 20 seconds until the RAMP SILENCE key is pressed The silence period is one minute The pattern is indicated in Section 8 5 by Low Priority Sound The alarm repeats a pattern of two beeps every 30 seconds until the RAMP SILENCE is pressed The audible alarm will not reoccur The pattern is indicated in Section 8 5 by e e Silence Period The alarm silence period when applicable is one minute When the alarm sound is silenced a flashing LED becomes continuous see 8 3 2 If the alarm condition is not corrected by the end of the silence period the alarm sound is repeated the LED is not affected If a new high or medium priority alarm condition occurs during this time the appropriate LED will flash New low priority alarms will not cause the LED to flash Synchrony Provider Manual 8 7 8 3 2 ALARM LED Red LED BEHAVIOR e Flashing red LED indicates a new high priority alarm The LED changes to continuous when the alarm sound is silenced or the alarm condition is corrected The LED will resume flashing during the silence period if a new alarm occurs The LED goes off when the alarm message is cleared Continuous red LED indicates a loss of power or a silenced high priority alarm Yellow LED
72. key then the Enter key OPTIONS 1 3 Time at P 50hrs System Codes Pt Alarm History Synchronj Provider Manual 7 4 7 2 3 STEP 1 STEP 2 OPTIONS 1 3 o J erime at P 25hrs of System Codes a Pt Alarm History e B orcs PATIENT ALARM The Synchrony stores the patient alarms such that the most recent alarm appears first in the patient alarm log The Synchrony can store 20 pages with History two alarm messages per page YOUR ACTION RESULT From the Options menu press the DOWN key until the Patient Alarm History command is selected then press the ENTER key to activate OPTIONS 173 Time at P 25hrs System Codes Pt Alarm History PT ALARMS 1 1 Apnea CLEAR EXIT P Press the ENTER key to Exit the screen If there are more than one page of history press the DOWN key to move to the Exit screen then press ENTER To clear the alarm history when the CLEAR command is displayed press the UP key then the Enter key OPTIONS 1 3 Time at P 25hrs System Codes Alarm History Synchrony Provider Manual 7 5 7 2 4 MODEM SETTINGS The Modem Settings screens display and allow you to change the modem type external or internal modem speed phone number to be dialed and the modem initialization string See Appendix A for external modem considerations YOUR ACTION RESULT STEP 1 From the Options menu press the
73. l leak port either built into the mask or on a separate exhalation device e g Whisper Swivel II Plateau Exhalation Valve PEV or Disposable Exhalation Valve to remove exhaled air from the circuit Therefore specific masks and circuits using an intentional leak port are required for normal operation The pressurized air from the Synchrony causes a continuous flow of air to exhaust from the leak port to flush the exhaled air from the circuit The Synchrony should be turned on and the intentional leak port should be checked before using the Synchrony The Synchrony is intended for use with Respironics approved patient circuits Typical components are e bacteria filter optional e 22mm reusable circuit tubing e exhalation device Respironics patient interface e g mask e humidifier optional Additional accessories may be added to the circuit to meet specific needs BiPAP Synchrony Provider Manual 12 2 12 2 Circuits and Accessories Reusable or Disposable Circuit Reusable smooth inner lumen circuit tubing exhalation port Disposable smooth inner lumen circuit tubing exhalation port Circuit Accessories 6 disposable circuit tubing 18 disposable circuit tubing 72 disposable circuit tubing O enrichment attachment bacteria filter Synchrony Accessories oxygen valve DC power cord 12 3 Masks Exhalation Ports and Related Accessories Masks Respironics mask with built in exhalation port or
74. lues correspond to hundreds of milliseconds e g a setting of 4 indicates a Rise Time of 4 seconds Limited to 4 to 20 cm H O for IPAP EPAP when Bi Flex is enabled TRIGGER Spontaneous Trigger Shape Trigger Volume 6 cc above Mun Spontaneous Cycle Spontaneous Expiratory Threshold SET Shape Cycle IPAP maximum of 3 0 sec Flow Reversal A flow reversal event causes the machine to cycle to EPAP ACCURACY OF MEASURED AND CALCULATED PARAMETERS PARAMETER ACCURACY Respiratory Rate Greater of 1 BPM or 10 of reading when measured over a four minute period Exhaled Tidal Volume 25 0 15 of reading ml Exhaled Minute Ventilation 1 0 15 of reading L min 5 0 15 of reading L min CONNECTOR The patient interface port is 22 mm tapered connector BiPAP Synchronj Provider Manual 14 3 Pressure Drop Versus Flow for Patient Circuits The Synchrony automatically compensates for pressure drops associated with a 6 foot smooth bore tube Additional pressure drop will occur when restrictive elements are added to the patient circuit The following graph shows the additional pressure drop when adding 1 a bacteria filter 2 a bacteria filter and a Respironics pass over humidifier Note Always use a manometer to verify patient mask pressure Pressure Drop VersusFlow for Patient Circuits Bacteria Filter Bacterial Filter and Oasis Humidifier 10 9 8 7 86 E g 5 54
75. m Dialing to Connected to Complete under normal circumstances If you press ENTER when ABORT is displayed in the Call screen the call will stop and the screen will go to STATUS Complete STATUS Possible Message Cause What to Do No Modem Modem is not installed Call your home care provider properly or not connected correctly No Dial Tone A phone is off the hook Press to exit check the telephone line connection Lift the receiver of or telephone line is your telephone to make sure that you have a dial tone not working several times before stopping Line Busy The provider s line is The Synchrony will try to make the connection again after a slight delay in use Press Q if you wish to stop the redialing You should set the modem to try Send Failed 1 If occurs shortly after 1 Press to exit Provide a phone number first try the Synchrony does not have a phone number entered into it 2 If occurs after many 2 Press to exit try again later Line Busy and Retry messages the Synchrony tried too many times with the line busy BiPAP Synchronj Provider Manual 4 10 4 5 4 Usinc THE RAMP The Synchrony is equipped with a ramp function that starts the IPAP pressure FUNCTION at the EPAP level The IPAP pressure is increased at each breath until the full prescription level is reached You set the increment per breath and enable or disable the ramp as shown in Section 5 2 Figure 4 6 illu
76. m Operation 4 6 T T Mode Parameter Screens 5 3 Setup Screens 6 2 T PC and S T Modes Parameters Screens 5 3 T PC and S T Modes Setup Screens 6 2 Telephone Jack 3 8 Tidal Volume 3 6 Tidal Volume Adjustment 2 5 Time at Pressure 7 2 Timed Mode 2 3 Trigger Defined 2 10 Trigger Sensitivity 14 2 Triggering Auto Trak Sensitivity 2 4 Leak Tolerance 2 4 U Unlocking the Access Level 7 10 Up Key 3 2 User Actions During Alarm 8 8 Using Ventilation Ramp 4 10 V Ventilation Ramp 4 10 Ventilation Ramp Indicator 3 4 Verification 13 1 S Mode 13 1 S T Mode 13 2 Volume Trigger 2 6 W Warnings 1 1 Synchrony Provider Manual Limited Warranty Respironics Inc warrants that the Synchrony System shall be free from defects of work manship and materials and will perform in accordance with the product specifications for a period of two 2 years from the date of sale by Respironics Inc to the dealer If the product fails to perform in accordance with the product specifications Respironics Inc will repair or replace at its option the defective material or part Respironics Inc will pay customary freight charges from Respironics Inc to the dealer location only This warranty does not cover damage caused by accident misuse abuse alteration and other defects not related to material or workmanship Respironics Inc disclaims all liability for economic loss loss of profits overhead or cons
77. mber REN both of these items are listed on the equipment label The sum of all the RENs on your telephone lines should be less than five in order to assure proper service from the telephone company In some cases a sum of five may not be usable on a given line Ir PROBLEMS ARISE If any of your telephone equipment is not operating properly you should immediately remove it from your telephone line as it may cause harm to the telephone network If the telephone company notes a problem they may temporarily discontinue service When practical they will notify you in advance of the disconnection If advance notice is not feasible you will be notified as soon as possible When you are notified you will be given the opportunity to correct the problem and informed of your right to file a complaint with the FCC Contact your telephone company if you have questions about your phone line In the event repairs are ever needed on the Synchrony they should be performed by Respironics or an authorized representative of Respironics For information contact Respironics See page 2 9 Synchronj Provider Manual 1 6 1 7 Industry Canada Notice NOTICE The Industry Canada Label identifies certified equipment This certification means that the equipment meets telecommunications network protective operational and safety requirements as prescribed in the appropriate Terminal Equipment Technical Requirements documents The Department does not gu
78. nchrony continuously tracks patient breathing patterns and automatically adjusts sensitivity thresholds to ensure optimum sensitivity as breathing patterns change or as circuit leaks change The algorithms used to ensure optimum sensitivity are the Volume Trigger Shape Signal and the Spontaneous Expiratory Threshold SET Synchrony Provider Manual 2 5 Volume Trigger EPAP to IPAP Shape Trigger Shape Cycle EPAP to IPAP IPAP to EPAP The volume trigger is one method used to trigger IPAP during spontaneous breathing in the S S T and PC modes The volume trigger threshold is 6 cc of accumulated patient inspiratory volume When patient effort generates inspiratory flow causing 6 cc of volume IPAP is triggered The shape trigger cycle is another method used to trigger IPAP and or cycle from IPAP to EPAP during spontaneous breathing in the S S T and PC modes This method continuously tracks patient inspiratory and expiratory flow and adjusts the spontaneous trigger and cycle thresholds for optimum sensitivity The Shape Signal appears as a shadow image of the patient s actual flow The shape signal functions as a sensitivity threshold at either inspiration or expiration When the patient s flow rate crosses the shape signal the unit changes pressure levels Figure 2 5 illustrates how the shape signal is superimposed onto the actual waveform to trigger and cycle off IPAP The shape signal is created by offsetting the si
79. necessary WARNING Oxygen supports combustion Oxygen should not be used while the patient is smoking or in the presence of an open flame WARNING When administering fixed flow supplemental oxygen the oxygen concentration may not be constant The inspired oxygen concentration will vary depending on the IPAP and EPAP settings patient breathing pattern and the leak rate Substantial leaks around the mask may reduce the inspired oxygen concentration to less than the expected concentrations shown in Section 10 2 Appropriate patient monitoring should be implemented WARNING When you are using oxygen with this system the oxygen supply must comply with the local regulations for medical oxygen WARNING If oxygen is used with the Synchrony the oxygen flow must be turned off when the Synchrony is not operating Explanation of the Warning When the ventilator is not in operation and the oxygen flow is left on oxygen delivered into the ventilator tubing may accumulated within the ventilator enclosure Oxygen accumulated in the ventilator enclosure will create a risk of fire This warning applies to most types of bi level devices WARNING Oxygen accelerates fires Keep the Synchrony and the oxygen container away from heat open flames any oily substance or other sources of ignition DO NOT smoke in the area near the Synchrony or the oxygen WARNING If supplemental oxygen is added to the breathing circuit the optional oxygen valve must be ins
80. nformation See Chapter 10 if you are administering oxygen to the patient NOTE Before placing the patient on the Synchrony check the integrity of the patient circuit the exhalation port and the alarms Synchronj Provider Manual 4 6 4 4 Operating the System During operation the screen shows Monitoring Screen 1 see Section 3 3 To change patient controls go to the Patient Controls screen To change parameters go to the Caregiver Menu screen The display returns to Monitoring Screen 1 if no keys are pressed for one minute Full Access Lockout AP Synchrony E t 9 Monitoring uix Monitoring Screen 1 Screen IRONICS E HODES 5 PEN 2 44 f Patient Monitoring Controls o Screen 2 Bs rone PIRONICS Patient Controls orcs NOTE If the backlight is off the first press of the or key will only turn the backlight on All procedures assume the backlight is already on t Provider Menu IRONICS BiPAP Synchrony Provider Manual 4 7 4 5 Patient Operating Instructions With the Synchrony in Lockout the patient is restricted to viewing only the pressure levels and the respiratory rate The patient may change the Rise Time dial the provider with the modem and initiate the ventilation ramp 4 5 1 SETTING THE RISE The Rise T
81. ns that multiple presses X Brons are required to attain the next screen shown EXIT RESPIRONICS S Mode CPAP Mode SETUP MODE S 1 2 SETUP MODE CPAP IPAP 12 cm H20 CPAP 10 cm H20 em EPAP 6 cm H20 VentRamp OFF Rise Time 3 START ABORT SETUP MODE S 2 2 VentRamp OFF Bi Flex OFF T PC S T Modes m START ABORT o 0 SETUP MODE X 1 3 N 12 cm H20 RESPIRONICS EPAP 6 cm H20 Rate 10 BPM SETUP MODE X 2 3 Timed Insp 1 0 sec Rise Time 3 RESPIRONICS Y If the backlight is off the first press of the or SETUP MODE X 3 3 key will only turn the backlight on the normal VentRamp OFF key action is suppressed until the key is pressed a y PP dat START ABORT second time All procedures assume the backlight is already on BiPAP Synchronj Provider Manual 6 2 6 2 Change Mode Setup Screens 6 2 1 CPAP SETUP SCREEN SETUP MODE CPAP CPAP 10 cm H20 VentRamp OFF START ABORT See Section 5 2 1 for parameter ranges and increments 6 2 8 SETUP SCREENS SETUP MODE S 1 2 SETUP MODE S 2 2 IPAP 12 cm H20 VentRamp OFF EPAP 6 cm H20 Bi Flex OFF Rise Time 3 START ABORT See Section
82. ocesocesooessoeessecssocssoossoosssoesssocesocesoossssesssesssse D 2 CPAP MOD aeee eer 5 2 a e a E DM 5 3 29 T PO au S dn adde GR D LE 5 3 5 3 Changing Synchrony Parameters 9 4 Chapter 6 Changing Modes sssssesssosoccessssoceccesosoccecsssooeecesssoooeessssssoeesesssseseessss L 6 1 Summary of Change Mode Operations esseesssesssecssocesoosscocessecesocesooesoossscseessecssocssoosessssss 6 1 6 2 Change Mode Setup Screens Ono 6 2 1 CPAP MODE SETUP SCREEN EUER ERRAT REESE 6 2 6 2 2 S MODE SETUP SCREENS cscssccececssssceeceesescecesesenseececesescaeececesauececcecssaeseceeceeeaececesensseseeecessaueeeececesaeseceeesensaeees 6 2 6 2 3 T PC ANDS T MODES SETUP SCREENS reete teret tette ene ru ed 6 2 6 3 Changing the Synchrony eere eee eee en sese eese sees sesso sesso sees 0 3 Chapter 7 Options e ral 7 1 Summary of Options Operations eere ee eere eee sees so 7 1 7 2 Synchrony Options Menu ssessseessoosscosssoesssecssocesoossooessocessecssocssoosscosesocessocesocesoossssssssesssse 7 2 7221 TIME AD PRESSURE EEE E AE A S 7 2
83. on The light will remain solid until the alarm has been cleared STEP 5 STEP 6 STEP 7 Step 8 STEP 9 Step 10 Step 11 STEP 12 Set the following alarms Patient Disconnect Alarm OFF Apnea 10 sec Exit to the Monitoring screen To ensure that Flow Limit Control is not active simulate a breathing pattern until the IPAP EPAP activity indicator 6 moves then occlude the patient outlet Verify that the Apnea Alarm occurs in 10 seconds Clear the alarm set the following alarms Apnea OFF LowMinVent 20 L min Exit to Monitoring screen 2 to display Minute Ventilation Simulate 6 breaths by alternately occluding and opening the patient outlet After 6 breaths alter the breathing pattern to lower the minute ventilation below the alarm setpoint of 20 L min Verify that the LowMinVent alarm occurs Clear the alarm While the Synchrony is still operating disconnect the power cord from the Synchrony Verify that a continuous alarm sounds for at least two minutes Adjust the Synchrony to the appropriate patient settings after the Performance Verification and before patient use Synchronj Provider Manual BiPAP Synchronj Provider Manual 14 1 Chapter 14 Specifications ENVIRONMENTAL Temperature Humidity PHYSICAL Dimensions Weight ELECTRICAL AC Voltage DC Voltage AC Current DC Current Protection against electric shock Degree of protection
84. ony Provider Manual YOUR ACTION STEP 9 If you have the internal modem installed the modem initialization strings are automatically entered and cannot be changed Press the DOWN twice and skip to Step 11 For external modems see Appendix A for recommended initialization strings Press the ENTER key to activate the Initialization String 1 for change The navigation of the string works the same as for the phone number entry of Step 7 except the character set is AtoZ e equal e 009 e plus e amp ampersand e minus percent e backslash e pound sign e l enter The maximum number of characters is 20 When you have entered the desired initialization string move one character to the right scroll to the symbol and press the ENTER key then press the DOWN key The screen scrolls to Page 3 of 6 Init 2 Step 10 Enter the Init 2 string as shown in Appendix A The navigation and change operation is the same as in Step 9 The maximum number of characters is 20 When you have entered the desired initialization string move one character to the right scroll to the J symbol and press the ENTER key The screen scrolls to page 4 of 6 Patient ID Step 11 The Patient ID screen is used to identify the patient for your records The navigation of the ID string works the same as for the phone number in Step 7 except the character set is AtoZ space 009 e minus
85. p of the screen Low priority alarms require operator awareness The alarm signal consists of a yellow LED and a low priority sound The display has the message INFO at the top of the screen Some audible indicators are self cancellable This means that the alarm sound will stop when the cause of the alarm is corrected See Section 8 3 for detailed descriptions of the alarm LEDs and sounds Figure 8 1 identifies the alarm LED locations on the control panel BiPAP Synchrony High Priority Alarm LED Low Medium Priority Alarm LED RESPIRONICS Figure 8 1 Synchrony Alarm Indicators Synchronj Provider Manual 8 2 8 2 Setting Alarm Parameters 8 2 1 ALARM PARAMETER OPERATION SUMMARY BiPAP Synchrony The X shown in the hand o gel 008 174 means that multiple presses IPAP 15 cm H20 A o Foul 6 cm H20 are required to attain the RR 20 BPM next screen shown If the backlight is off the RESPIRONICS first press of the or A er key will only turn the backlight on the normal Y key action is suppressed until the key is pressed a second time All proce SETUP 4 4 ede Mode Options dures assume the backlight is already on 0 BiPAP Synchrony SETUP 4 4 Parameters 4 o Alarms Q o Mode Options Y ALARMS 1 2 ALARMS 2 2 Disconne
86. r Dial sets the type of line service the patient will be using Press the UP or DOWN key to scroll through the options e for tone dialing e ATDP for pulse dialing e dto leave the phone number blank MODEM SETTINGS 1 6 Type Ext 19200 Dial ATDT 0 4125551212 Press the ENTER key when the desired setting is dis played The Navigation Indicator moves one character to the right STEP 7 The remaining characters are selected one at a time and NOTE The comma is used to place a pause between are used to set the number to dial This includes any inputs such as after 70 the is used to access prefixes such as 70 Use the UP or DOWN arrow keys to special phone options such as disabling call scroll through waiting No dashes are used in the phone number The maximum number of characters e 1009 e asterisk is 15 e e enter Press the ENTER key when the desired character is MODEM SETTINGS 1 6 displayed the Navigation Indicator moves one character to Type Ext 19200 the right Dial ATDT 7 4125551212 STEP 8 At the final digit of the phone number press the ENTER MODEM SETTINGS 1 6 key to move one character to the right scroll to the Type Ext 19200 symbol Dial ATDI 70 4125551212 MODEM SE INIT 1 AT amp FVO I Press the ENTER key then the DOWN key The Modem Settings screen scrolls to page 2 of 6 BiPAP Synchr
87. sitive pressure During exhalation pressure is variably positive or near ambient During inspiration pressure is variably positive and always higher than the expiratory level Figure 2 1 Synchrony The Synchrony responds reliably to patient flow rates that indicate movement to inhalation or exhalation even in the presence of most normal leaks in the patient circuit Automatic adjustment of this trigger threshold in the presence of leaks makes the system ideal for mask applied ventilation assistance The patient controllable Rise Time may enhance patient ventilator synchrony and patient comfort If the patient interface is disconnected the Synchrony automatically reduces the output flow to a low level When the interface is replaced therapy will typically resume when the patient starts to breathe If therapy does not resume when the patient starts to breathe the patient should press the RAMP ALARM SILENCE button to resume therapy A modem allows the patient to provide compliance data to the home care provider with a few simple key presses A communications port provides communication to the Respironics Encore or Encore Pro Data Management Software The Synchrony operates in the following modes e Continuous Positive Airway Pressure CPAP e Spontaneous S e Spontaneous Timed S T Timed T e Pressure Control PC Synchrony Provider Manual 2 2 2 20 Modes of Operation 2 2 1 CPAP 2 2 2 S MODE
88. ssaseececeessaeseeceeseseseceseseseesecesenesaeeeeceneaaeeeeeeees 3 1 3 1 2 CONTROL KEYS nce te lace E TUE e 3 2 3 13 INDICATORS tote ertet ure t eee ee ee ERE Ye egeo Fe evi ese eb EE sues HAVE 3 2 3 2 Navigating the 4 559 E ap EVE CREE ENR RU ERU RR N NR ERREUR CRY ross 3 5 3 3 Display Data rnm 3 6 3 4 Patient Circuit Connection aicidssccsrcssicssnecsscsoncencsdveraascdesnuviedexeenncdeeceascdvensancdverseucdaceasentancensei 3 7 3 5 Optional Oxygen Valve ee 3 7 3 6 hocce 3 8 BiPAP Synchronj Provider Manual ii Chapter 4 Setting up and Starting the Synchrony eere 4 1 4 1 Preparing the Synchrony sseessecessoessocessecssocesooeccocecocessccesocesooesooessoecssecesocescosssseesseesseeesssss L 4 1 1 SUMMARY OF SETUP OPERATIONS E 4 1 4 1 2 INSTALLING THE AIR FILTERS c ccccccccssssceceseseseececesesececcecesaeseceecsensaeseseseneeeececeseseeeececesuaaeceeceensaeeecceesenseeeeeesenaes 4 2 4 1 3 ASSEMBLING THE PATIENT CIRCUIT cz REPE EE UFEH V 4 3 4 1 4 SUPPLYING POWER TO THE SYNCHRONY 2 4 4 4 1 5 OPT
89. strates the ramp function IPAP LEVEL EPAP ap al Increment Set by Home Care Provider 1 Breath Figure 4 6 The Synchrony Ramp Function To start the Ramp feature press 6 The Ramp indicator will be shown at the top of the display BiPAP Synchrony Provider Manual Chapter 5 Changing Parameters 5 1 Summary of Change Parameters Operations Full Access Only BiPAP Synchrony aue uere o BiPAP Synchrony OE We Mode Options S Mode CPAP Mode S PARAMETERS 1 2 CPAP PARAMETERS IPAP 19 19 cm H20 CPAP 10 10 cm H20 EPAP 5 5 cm H20 VentRamp OFF Rise Time 3 EXIT S PARAMETERS 2 2 eVentRamp OFF Bi Flex OFF EXIT If the backlight is off the first press of the amp key will only turn the backlight on the normal key action is suppressed until the key is pressed a second time All procedures assume the backlight is already on The X shown in the hand means that multiple presses are required to attain the next screen shown T PC S T Modes XX PARAMETERS 1 3 IPAP 19 19 cm H20 EPAP 5 5 cm H20 Rate 20 20 BPM XX PARAMETERS 2 3 Timed Insp 1 0 sec Rise Time 3 XX PARAMETERS 3 3 VentRamp OFF EXIT Synchronj Provider Manual 5 1 5 2 5 2 Change Parameters Screens 5 2 1 CPAP
90. t a parameter press the ENTER key to activate the parameter for change use the UP or DOWN key to change the value and press the ENTER key to imple ment the change STEP 6 Scroll to page 2 of 2 and press the DOWN key to select the START command NOTE To exit the setup mode without initiating a new mode press the DOWN to select the ABORT command then press the ENTER key STEP 7 Press the ENTER key to implement the S mode at the selected settings RESULT SETUP MODE S 1 2 IPAP 11 cm H20 EPAP 6 cm H20 Rise Time 3 NOTE To move from one screen to another press the DOWN key when the selection indicator is at the last selectable item on the screen or press the UP key when the selection indicator is at the first item SETUP MODE S VentRamp OFF Bi Flex OFF 5 MODE S 1 44 IPAP I5 cm HZO EPAP 5 cm H20 Synchrony Provider Manual 7 1 Chapter 7 Options 7 1 Summary of Options Operations BiPAP Synchrony MODE S 1 4 v o de 15 em 20 S EPAP 6 cm H20 o o RR 20 BPM The X shown in the hand means that multiple shown presses are required to attain the next screen Tf the backlight is off the first press of the BiPAP Synchrony or amp key will only turn the backlight on the normal key action is suppressed until the key is 741 pressed a second t
91. tail by describing the leak tolerance function and sensitivity A microprocessor monitors the total flow of the patient circuit and calculates patient flow values 1 Leak Estimation A verage and Parabolic The Synchrony uses two leak estimation algorithms A conservation of mass algorithm is used to compute the average leak for a given pressure support relationship This average leak is used when large leak variations are present in the system Average leak is a high estimate during EPAP pressure and a low estimate during IPAP pressure A better leak estimate enabled by the digital system is the parabolic leak algorithm Parabolic leak is proportional to the square of the patient pressure therefore the leak estimate is correlated to the changing patient pressure Both algorithms include unintentional circuit leak and are averaged over several breaths 2 Patient Flow The total circuit flow is comprised of the circuit leak and the patient flow The calculated patient flow is the total flow minus the circuit leak Patient flow is a primary input into the triggering and cycling mechanisms An essential feature of the Synchrony while operating in the S S T and PC modes is its ability to effectively sense spontaneous breathing efforts which causes the ventilator to trigger to IPAP and cycle to EPAP Because no preset sensitivity threshold can assure patient and machine synchrony with changing breathing efforts and circuit leaks the Sy
92. talled and used as shown in Figure 10 1 10 1 Adding Supplemental Oxygen The delivered oxygen concentration varies with changes in flow in the circuit The following may have an impact on oxygen concentration Pressure settings e Patient Tidal Volume e Peak Inspiratory Flow WARNING If supplemental LE Ratio oxygen is added to the breathing Respiratory rate circuit the optional oxygen valve e Circuit leak rate must be installed and used as e Oxygen flow rate shown in Figure 10 1 e Site where oxygen is added to the circuit To add oxygen to the circuit the oxygen supply must comply with the local regulations for medical oxygen The oxygen flow into the oxygen valve cannot exceed 15 L min and the pressure cannot exceed 50 psi BiPAP Synchrony Provider Manual 10 2 Step 1 Step 2 Step 3 Step 4 Circuit Tubing From Oxygen Oxygen Valve 2 Enrichment Valve Adaptor P Oxygen Pd Source As shown in Figure 10 1 attach oxygen tubing from the oxygen source to the In port on the oxygen valve Connect a section of oxygen tubing to the valve port then to one of the ports on the mask if so equipped or to an O enrichment adaptor positioned in the patient circuit Turn the Synchrony on Set the oxygen flow to the desired value y Oxygen Tubing Figure 10 1 Methods of Adding Oxygen to the Patient Circuit BiPAP Synchrony Provider Manual 10 3 10 2 Supplemental Ox
93. text ALARM 1 1 Apnea If more than one alarm is listed the indicator shows which alarm is still active STEP 3 Press the RAMP SILENCE key D ALARM 1 1 Alarm CLEAR Screen is displayed gt CLEAR Alarm LED is solid STEP 4 Press the Enter key to clear the alarm ALARM 1 1 indicator is off Apnea p Alarm LED is CLEAR solid For High and Medium Priority Alarms the 6 indicator will go off when the alarm condition is corrected STEP 5 Look up the alarm in the alarm tables and perform the Patient Action Alarm is reset IPAP 15 cm H20 Display returns to screen that was showing at time of alarm Synchrony Provider Manual 8 0 8 5 Alarm Tables Sections 8 5 1 to 8 5 3 detail the alarms display messages Synchrony actions possible causes and patient and provider actions The tables are arranged alphabetically by priority Note that the LED and Audible columns represent the conditions when the alarm is activated all LEDs will be on and the audible will be silenced after you press the RAMP SILENCE key Section 8 5 4 provides definitions for the alarms 8 5 1 HicH PRIORITY ALARMS Provider Action Possible Cause Patient Action Synchrony Action Display Message Blank Screen Blank Screen Cannot be silenced remove power from the device and contact home care provider Replace the device Red Flash Device
94. tically cycles off IPAP to the EPAP level As flow begins to decrease during IPAP a flow reversal can occur due to a large leak around the mask or because the patient s mouth is open When the Synchrony unit senses this flow reversal the unit automatically cycles to the EPAP level The sensitivity criteria for spontaneous breathing in the S S T and PC modes can be summarized as follows Spontaneous Trigger to IPAP A transition from EPAP to IPAP will occur when one of the following conditions is met Patient flow exceeds the shape signal 6 cc inspired patient volume Cycle to EPAP The transition from IPAP to EPAP will occur when one of the following conditions is met Patient flow is less than the shape signal Spontaneous Expiratory Threshold SET is achieved 3 0 second maximum IPAP time has occurred safety feature Flow reversal occurs during IPAP safety feature BiPAP Synchrony Provider Manual 2 7 2 4 Access Levels The Synchrony can be set to a Lockout mode so that certain settings and displays cannot be accessed In the Lockout mode the IPAP Rise Time can be adjusted if Bi Flex is not enabled If Bi Flex is enabled then it is adjustable in Lockout Mode Rise Time cannot be adjusted in Lockout mode when Bi Flex is enabled Only the IPAP EPAP and Respiratory Rate are displayed in Lockout Mode In the Full Access level all ventilator functions and displays are accessible Section 7 2 6 des
95. to 6 1 Screen 3 of 3 Ramp Disabled 0 5 1 0 2 0 3 0 cm H O per breath Discrete values as listed IPAP cannot be set lower than EPAP The Rate and Timed Inspiration controls are linked so that the inspiratory time is never longer than the expiratory time If the Rate or Timed Inspiration are set to values that would cause the I E ratio to exceed 1 1 the Timed Inspiration is automatically reduced to maintain a 1 1 I E ratio The Rise Time of to 6 corresponds to tenths of a second e g a setting of 4 equals 0 4 seconds rise time Synchronj Provider Manual 5 4 5 3 Changing Synchrony Parameters This section details the steps required to change parameters while in a given operating mode For this example the Synchrony is operating in the S mode YOUR ACTION RESULT STEP 1 From the Monitoring screen press the DOWN key until the Setup screen is displayed LPAP Synchrony MODE S 1 44 L4 EIS 15 cm H20 at SETUP E eee 6 cm H20 P Parameters RR 20 BPM Alarms 8 ode BB rons Step 2 Press the ENTER key to activate the Change S PARAMETERS 1 2 Parameters screen then press the ENTER key IPAP 1 9 19 cm H20 to activate IPAP parameter for change EPAP 5 5 cm H20 Rise Time 3 S PARAMETERS 1 2 25 IPAP 19 196m H20 EPAP 5 5 cm H20 Rise Time 3 STEP 3 Press the UP or DOWN key change the value Each key press changes the value by one 5 B
96. ware can extract compliance data from the Synchrony Use the Respironics supplied RS 232 cable to connect the Synchrony to an IEC950 EN60950 or UL1950 approved device or computer with the Encore or Encore Pro software loaded Figure 9 1 shows a typical setup See the Encore or Encore Pro software help files for information on running the software RS 232 Communication Connector m ds a Figure 9 1 Typical Configuration for connecting a Synchrony to a Computer BiPAP Synchronj Provider Manual Synchronj Provider Manual 10 1 Chapter 10 Adding Supplemental Oxygen You may add oxygen to the patient circuit using the optional oxygen valve This chapter describes the method of oxygen delivery and shows the oxygen concentrations attained at various IPAP and EPAP settings and oxygen flow rates Oxygen should be administered only on the order of a physician Supplemental oxygen should not be added to the breathing circuit by placing the source where the gas will be entrained through the inlet filter on the rear of the device Never attach oxygen tubing or any positive pressure source to the Pressure Line Port on the front panel of the Synchrony ventilator Continuous patient monitoring is recommended while administering oxygen Patient monitoring should consist of at a minimum patient observation and pulse oximetry Arterial blood gas measurements should be used when
97. ygen Concentrations Figures 10 2 and 10 3 illustrate the potential range of oxygen concentration available to the patient at a given tidal volume supplemental oxygen flow and pressure setting These figures represent bench test results without inadvertent mask leaks when oxygen is administered at the mask Substantial leaks around the mask may reduce the expected oxygen concentration to below the levels shown in Figures 10 2 and 10 3 This guideline may be used as a starting point for initiating oxygen therapy Oxygen flow should be gradually adjusted until the patient s oxygen needs are adequately met Supplemental O Flows e 2 L min A 10 L min 15 L min 100 90 80 pcc NN 70 8 60 H DUK ec Psor 5 40 F 30 77 20 10 H 0 10 5 20 5 30 5 IPAP EPAP Settings 600 cc Tidal Volume Respiratory Rate 20 BPM Figure 10 2 Oxygen Concentration for 600cc Tidal Volume Supplemental Flows 9 2 L min A 10 L min 9 15 L min 100 90 80 F 70 Oxygen Concentration 20 10 10 5 20 5 30 5 IPAP EPAP Settings 1000 cc Tidal Volume Respiratory Rate 20 BPM Figure 10 3 Oxygen Concentration for 1000cc Tidal Volume BiPAP Synchrony Provider Manual Synchronj Provider Manual Chapter 11 Cleaning and Maintenance 11 1 Cleaning the Synchrony WARNING To avoid

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