User`s Manual, Digital Spirometer, IQmark
Contents
1. Auta bnberpeet ston btemeetston Loge ats Loge 1951 Prmary Care Practiicne PCP Made EVC Geta Minimum FVE Test Length e 8 sec The Measurements tab Meaasements allows vanous calculated values to be included on the report It is possible to add or AT delete items based on your facility s procedures or the consulting provider s request default values are recommended for most situations standard items to include on report When selected reminds The Calibration tab user that calibration is due allows vanous M huii Fi Caliboahesy ow Caibahyn Remade calibration settings Recommended frequency to be controlled f Caldnation Expeation internal fj 1 30 dap for performing calibrations Dielault Syringe Vokas ff mseou the ATC recommends Multi flow calibration works daily calibrations your with Calibration Pump O Barein Perre facility may have a different Window reqiured if C Ua Delil Baomatie Prernns requirement used for OSHA testing Delat Batometne Perse fo 500 760 ment C Caoiye Barometnc Preaoure From Aude If local barometric pressure oA Mexesbweleledt jo WAN is unknown click here e If known enter a typical barometric pressure from a daily weather report and enter the approximate elevation of your facility here Figure 24 Settings tabs third row PUB 116 Rev B doc 26 User s Manual Digital Spirometer IQmark 1 2 Particulars of the AFHCAN2. PUB 116 Rev B doc 7 User s Manual Digital Spirometer IQmark This manual focuses on the most common spirometry test the FVC or forced vital capacity Although the FVC test is the primary focus of this manual a basic familiarity with the nature of the other tests available will be helpful if those tests are requested Forced Vital Capacity Test A single FVC test will produce two graphs Figure 7 e flow volume curve flow rate in liters per second vs total volume expelled e volume time curve cumulative volume exhaled vs time in seconds 164 ere Oey rit IS ValL Best Pre Bronchodilator ams Bosi Post Bronchodilator Figure 7 The basic FVC curve The horizontal dotted line in the second curve is the predicted value of the forced vital capacity FVC which is the maximum amount of air that can be expelled by the lungs In Figure 7 the patient exceeded the predicted value Recording Inhalation If the patient inhales through the mouthpiece after the FVC test inhalation data will be added to the graph as shown in Figure 8 This information called the flow volume loop is shown in the negative part of the flow volume curve and is automatically recorded PUB 116 Rev B doc 8 User s Manual Digital Spirometer lQmark Hti Fre Bronchodilatar ames Osi Post Bronchodilator _ Time 3 Figure 8 Data showing flow volume loop Comparing Multiple Tests A number of FVC tests as well as other types of
3. temperature e ee k b H ee and change Eie mn the color Blow all the leaves off the trees and see ihe monkeys Provider can stop test any time Blow out all the birthday candles Info to support coaching Figure 13 Patient incentive displays Patient Feedback Messages If the patient inhales through the mouthpiece the inhalation will be recorded and the test will end automatically If all that is required is the FVC test then the operator can stop the test when it is obvious the patient has emptied his or her lungs To stop the test press the Stop button on the patient incentive display On completion of the test a message providing feedback on the patient s performance will be displayed The goal is to obtain the Good test message shown in Figure 14 Also shown is an example offering advice on how to improve performance Details on all the possible messages can be found in the Midmark Operation Service Manual PUB 116 Rev B doc 15 User s Manual Digital Spirometer lQmark Siprlincerree tir yy Ga wel ce lier The goal is to have this message come up but this is not always easy Good test Accept this teat m yee The software automatically marks a Good test for acceptance Afeenpas Accepted 0 Matches Click on Yes to proceed Ferid another test Press Enter or click on Yes immediately into another trial This is advice on what the patient can do to improve his o
4. Installation The AFHCAN software serves as a host program for the Midmark software This means the AFHCAN software calls up the Midmark software on an as needed basis and works with the Midmark software to provide full functionality Functions such as filing and archiving reports for example are handled by the AFHCAN software so the corresponding features in the Midmark software have been disabled Because of technical requirements in the software various other features described in the Midmark Operation Service Manual are not available in the AFHCAN installation None of the disabled features compromise the intended functionality Buttons text entry boxes or other items are typically grayed out 1f they are not available The AFHCAN software provides some information that is required by the Midmark software in order to work e g patient gender age Integration with the AFHCAN Cart and software means there is no setup or installation required 1 2 1 Version Compatibility When sending a case spirometry reports are not backwards compatible with older versions of the AFHCAN software This means a report created using AFHCAN Client software Version 4 cannot be sent to providers using the earlier Version 3 4 The AFHCAN software will notify the sender 1f this situation occurs and will prevent the case from being sent Itis always possible to print out the spirometry report scan it into a new case and send that case 1 3 Warnings and
5. report Note If the data is not active in other words if the case has been sent and the data has been frozen as part of a permanent medical record these buttons and other features will be grayed out 6 To print the spirometry report click on the Print button Note Various items in the Settings dialog box give the user some control the format and content of the printed reports 7 To close the report and return to the previous screen click Exit PUB 116 Rev B doc 33 User s Manual Digital Spirometer lQmark PUB 116 Rev B doc 34 Section 3 Clinical Considerations These pointers are to be used as a supplement to your clinical experience 3 1 Guidelines for Clinical Success coaching the patient in how to make a best effort is important demonstrate yourself how to do the test have the patient sit up straight it is important for the patient to give a good effort always use nose clips to help the patient achieve a good seal goal is three good tests no more than eight attempts Common Mistakes lips not making a tight seal patient coughs during test spirometer not calibrated recently calibrate once a day not required for every patient Tips and Tricks help the patient relax by describing the first attempt as practice do not attempt spirometry on a patient who is uncomfortable acutely ill or uncooperative stop the test of the patient becomes tired or uncomfortable if a good curve cannot be obtained
6. temperature and dry air conditions can be entered or selected The bronchodilator can also be selected from the data display screen The parameters entered will appear on a report printout if one is generated Pressing the Settings button opens up a nine tab dialog box Details on settings are provided in Section 1 1 5 5 The data display screen can access the settings dialog box with the alternative form of the settings button shown at the right Parameters set in the Settings dialog box persist in the memory and become Settings the default settings for future sessions 13 User s Manual Digital Spirometer lQmark Button Screens Function Pressing the Help button brings up the Midmark help pages ADC Not all features described are available in the AFHCAN installation Pressing the Exit button exits from the current screen and ADC l i returns to a previous screen in the sequence When one or more tests have been performed this button replaces the Exit button on the data acquisition screen Pressing this button saves the report and returns to the Spirometer screen The File button appears when viewing an existing report Pressing the File button brings up a grayed out menu for archiving or emailing the report These functions are handled by the AFHCAN software The Print button prints a spirometry report The print format DC can be modified in the Settings popup window see Settings Print below This button
7. the AFHCAN Spirometer screen Clicking on the thumbnail brings up the Midmark data display screen described later Only accepted tests will be available for display on the data display screen However from the data display screen it is possible to reopen the data acquisition screen If Delete Rejected Tests has not been selected any previously rejected reports are still available and can be displayed on the data acquisition screen The test s status can also be changed to Accepted making it available for display on the data display screen On the other hand if Delete Rejected Tests has been selected as indicated by a checkmark rejected tests will be deleted when the report is saved and cannot be recovered Once a case has been sent it is no longer possible to open the data acquisition screen from the data display screen which means rejected tests can no longer be viewed or recovered regardless of whether this item was selected or not Note The screen function buttons in Table 3 may be disabled or replaced with other buttons from time to time depending on what the program is doing When a button s function is not available the button is grayed out Table 3 Midmark screen function buttons and applicable screens Button PUB 116 Rev B doc Screens AC Function Brings up the Midmark calibration screen Brings up a dialog box where the medical indication bronchodilator used barometric pressure ambient
8. the case 10 To uncheck any reports that you wish to discard click on the green checkmark next to those reports The green checkmark will disappear and that report will not be saved to the case Click the box again to bring the checkmark back 11 If this case has been set up to record only calibration results click Save to save the reports and return to the Case screen process the case as desired e g send to archives Otherwise proceed with obtaining a spirometry report PUB 116 Rev B doc 30 User s Manual Digital Spirometer lQmark 2 1 3 Obtaining a Spirometry Report 2 1 3 1 Patient Preparation and Coaching The quality of the spirometry report is directly related to the patient s level of effort Being clear about how to perform the test and conveying enthusiasm to the patient are very helpful in ensuring the best effort is obtained Proceed as follows l 2 Pit o a 8 Explain that the goal is to inhale deeply and to exhale forcefully quickly and fully Using your own clean mouthpiece demonstrate how to perform the test Explain that teeth and lips go outside the mouthpiece Give the patient a clean mouthpiece and let him or her blow through it handle not attached Loosen or remove any tight clothing Remove any foreign objects or dentures from the patient s mouth Let the patient know he or she can stop the test if feeling dizzy ill or uncomfortable If pre and post bronchodilator tests will be per
9. Cautions Refer to the Midmark Operation Service Manual provided with the device for warnings and cautions In additional please observe the following points e any automatic analyses provided by software must be confirmed or revised by a qualified physician e do not use the spirometer with patients who are nauseated or in situations where liquids can enter the mouthpiece and flow into the pressure ports e be aware of the patient and discontinue the test if any abnormality is observed such as hyperventilation e discard the disposable mouthpiece after each use e use a Separate mouthpiece for calibration PUB 116 Rev B doc 27 User s Manual Digital Spirometer lQmark PUB 116 Rev B doc 28 Section 2 Operation 2 1 Basic Operating Procedures Refer to Section for descriptions and illustrations of the controls indicators screens and other items referenced in these procedures 2 1 1 Starting the Spirometer Proceed as follows 1 Plug the USB connector into an available USB port on the Cart or computer 2 From the Add To Case screen press the Patient button to identify the patient search add or edit patient information as necessary 3 From the Add To Case screen press the Spirometer button to begin a spirometry session This brings up the Spirometer screen 2 1 2 Calibration With the Midmark Digital Spirometer calibration is more of a functional checkout than an actual adjustment to the instrument The freq
10. E 30 List of Tables Title Page Spirometer screen buttons and their functions essssssseoeesssssssseerrsssssssserrsssssssserrsessssseee 6 Items in the test selection and control pannel ccceeccccccccsssseseeeecececeeeaeeeseeeeeeeeeeaaeeseeees 11 Midmark screen function buttons and applicable screens enesssseoeenssssssseeerssssssssseeeee 13 Data display screen items that are active when a spirometry session is open 18 Troubleshooune ouide lIMeS Aerni a a a 37 PUB 116 Rev B doc iV User s Manual Digital Spirometer IQmark Preface About this Document This document is part of the set of user manuals provided with the AFHCAN Cart These user manuals covering various topics are normally assembled into a binder delivered with each Cart This modular design has the following advantages e the set of manuals provided with your cart includes documents for the specific peripheral devices installed e each document is a stand alone publication so as new devices or features are added to the Cart new manuals can be added to the existing binder e user information that is common to all items of equipment does not need to be repeated in each module but can be covered in separate modules and referenced as needed Related Documents This document assumes you have read the introductory hardware and software manuals included in this binder The original manuals provided with the equipment were inclu
11. The Midmark software and the AFHCAN software work together The Midmark software controls the digital spirometer and captures and displays the data The AFHCAN software activates the Midmark software provides some patient information and associates the spirometry data with a case Once the Midmark data is in a case it becomes a permanent record which can be sent to another provider for review printed out for the patient s records and eventually archived electronically It has been shown that good results depend on the patients making their best possible effort Patients must be cooperative comfortable and very clear on how to perform the maneuver NIOSH Spirometry Training Guide December 12 2003 www cdc gov niosh docs 2004 154c pdts 2004 154c ch2 pdf PUB 116 Rev B doc 1 User s Manual Digital Spirometer lQmark The Midmark software can generate a tentative diagnosis based on how the spirogram compares with the predicted norms for the patient The automatic diagnosis is a general guide that must be confirmed or modified by the physician responsible for the patient Please read and understand the following statement which is from the Midmark Operation Service Manual Physician s Responsibility The I Qmark Digital Spirometer can provide test interpretations if the user enables the Auto Interpretation feature These interpretations are for the exclusive use of licensed physicians or personnel under their direct supervision The sugges
12. Uri ANANN 4 1 1 4 1 How the AFHCAN Software Works with Midmark Software cccceeeeeeeeeees 4 Liki 2S PiTOMMell y Sccela tenet iviae ae AU Oia aba slaat snd tessa tia oistiiaddiscm eit aliel 5 1 1 5 Features of the Midmark Spirometry Software 00 0 0 cccccccccccssssssseseseseeeeceeeeeeeeeeeaaaas 7 1 1 5 1 Introduction to Available Spirometry Tests 0 cccccccccccsscssssssssesseseeeeeeeeeeeeees 7 ELS Obtainine Sproei Wat Ae ss chsh hcoestn a N tie tacthalet 11 KESS Vienne opromme iy Dila ee e E a A 16 LESA Cairano SCEN ee a E a a 19 LES CLUES Didot DB OX iad ta alerted n A E Seademnateat 23 1 2 Particulars of the AFHCAN Installation 200 0 cccccccnssesssseeecccesneeesssecceceseneeesseeeceeees 2 D2 ell Vie tStOT COMPACT eaa a a dane edeinaWadaws E O ZT VY GE UAT SATS ONS sch tates es cat hac caste eats dec ase ta eed E anne dace iatuenlie 21 Secon 2 CPSP AUON enn a R 29 Dele Basie Operaune Procede S st ctetivasich fue daluss odio a e N 29 2AE Stare DeSeT E nee ttamer oases 29 2A CAHD ON oe A N N 29 2 1 3 Obtamine a Spiromety Report aisc6 ces sacwancaaianticectayennaa tactend waa tancnanarminedanienast aacsinswestaane 31 21 31 Patient Preparation and COac Aine ear bce csawidacerechaaeusnbeas 31 2 Ned 2 Condones the TCS ia25 it ss sa seid Seca ial tans atk as veel E va seas 22s aes vse Stee Dak use 31 2 13 REVIEWING and Selecting Tests 5 2 cashes sil baseline aa a atta holens 32 2 1 3 5 Saving the Spirometry Repo
13. User s Manual Digital Spirometer lQmark Document ID PUB 116 Revision B User s Manual Digital Spirometer Qmark The names of any providers and patients used in illustrations or examples in this document are fictitious Every effort has been made to ensure this manual is accurate complete and useful Please let us know if you have any suggestions for improvement using one of the following means of contact AFHCAN Training Department 4000 Ambassador Drive Anchorage AK 99508 Phone 877 885 5672 Fax 907 729 2269 Email customersupport afhcan org Copyright 2006 Alaska Native Tribal Health Consortium ANTHC All rights reserved No part of this publication may be reproduced stored in a retrieval system or transmitted in any form or by any means including photocopying electronic mechanical recording or otherwise without the prior written permission of Alaska Native Tribal Health Consortium PUB 116 Rev B doc User s Manual Digital Spirometer IQmark Table of Contents Section Title Page RA E E E E T E E L E E L A I E L E E L E L ER OE E ETEA v APUN S DOCUMEN eere a V Related Docume mts a3 cass satel coea nes sire a a a S e E R ee V For More Iniormad oien a a esaaiseteinncd a saadaeeheanncd eins aguaadan ete V SCHON k Mirodenii aaa Ea 1 hel Introduction 0 Me Spron eine E I E re Ueeecues l kit Foncuonal LIES CT ULOMNS ers aa austin Neudosahensea l ke Mae OMONE Di ee N 2 AeA ELC Au OPW aber e a
14. VV button on data acquisition screen image 11 MVV test description 10 results curve image 10 New Cal button function and use 14 general reference 29 on calibration screen image 21 Next button function and use 12 on data acquisition screen image 11 nose clip general reference 2 image 3 procedure 31 35 Patient button general reference 29 patient feedback message window image 16 patient incentive display image 15 Perform Post BD button function and use 18 PUB 116 Rev B doc general reference 33 on data display screen image 17 Perform Pre BD button function and use 18 general reference 33 on data display screen image 17 Performed By data entry field on calibration screen image 21 Post button function and use 12 on data acquisition screen image 11 power requirements supplied by USB port 37 Pre button function and use 12 on data acquisition screen image 11 Pressure data entry field on calibration screen image 21 Prev button function and use 12 on data acquisition screen image 11 Print button function and use 14 general reference 33 on calibration screen image 21 on data display screen image 17 Reject radio button function and use 12 on data acquisition screen image 11 Reports tab image 24 Review Date data entry field function and use 19 Reviewed By data entry field function and use 19 Save button 7 general reference 32 33 o
15. added but the case has not been closed and sent it is possible to open a spirometry report from the Case screen and add data to it You can tell whether a spirometry report is still active or not by looking at the Midmark data display screen Table 4 describes the features of the Midmark data display screen which are available when a spirometry session is open but which are unavailable after the data has been sent Table 4 Data display screen items that are active when a spirometry session is open Item Description Clicking on this button brings up the Midmark data acquisition Perform Pre BD screen with Pre already selected New pre bronchodilator spirometry tests can be added to the report Clicking on this button brings up the Midmark data acquisition Perform Fost BD screen with Post already selected New post bronchodilator tests can be added to the report Bronchodilator When this area is active it is possible to identify or change the Albuteral bronchodilator used in the test Brings up the nine tab settings dialog box Settings Functional equivalent of the Settings function button PUB 116 Rev B doc 18 User s Manual Digital Spirometer lQmark Item Description Normally this field is left blank by the originating provider In the Midmark software the Reviewed By field would be used by __ the healthcare provider responsible for reviewing the case and Reviewed By affirming or modifying t
16. allows a quick check of the calibration to be done It C only requires one pump of the calibration syringe If you are uncertain whether this is adequate for your purposes perform a full calibration C Initiates the sequence for performing a full calibration and activates the Start Cal button This button brings up the calibration pump window which C prompts the user to pump the calibration syringe and provides a pump rate guidance graphic which helps the user gauge the rate at which the syringe is pumped _ Start Cal_ Note 1 the Screens column indicates which screens the button can appear on as follows A data acquisition screen D data display screen C calibration screen Patient Incentive Displays When the Start New Test button is pushed on the data acquisition screen the Midmark software brings up a patient incentive display which is designed to help patients make their best efforts There are five patient incentive displays that can be selected via the Settings Dialog Box Incentives Miscellaneous tab see 1 1 5 5 for information Patient incentive displays respond to the patient s level of effort as if the patient is blowing on the display directly blowing out candles for example Three of the five available displays are shown in Figure 13 PUB 116 Rev B doc 14 User s Manual Digital Spirometer lQmark Screens at start of test Screens with test underway Raisethe wc CAAA FVC Test
17. as been saved to the case but if the report is opened again before the case is sent data from more tests can be added It is a good practice to describe the quality of the patient s efforts Were they 100 cooperative and making their best effort Were there distractions that could have affected performance On the Case screen press the Add Comment button to enter this kind of descriptive information into the case If possible try to correlate the descriptions with individual tests Once the case is sent the data in the spirometry report becomes part of a permanent medical record and cannot be changed New spirometry reports could be added to the case however 2 1 4 Viewing Spirometry Reports Proceed as follows 1 From the Spirometer screen or from the Case screen click on the thumbnail for a spirometry report This will open the Midmark data display screen 2 On first opening the data display screen the Summary tab will be active and numerical results will be displayed Scroll up or down and left or right to bring data into view 3 To see graphics of the patients performance click on the FVC Graphs tab If other types of spirometry tests were done click on the applicable tab 4 To display various combinations of graphs click on the Display Tests pull down window 5 Ifthe data is active you can press the Perform Pre BD button or the Perform Post BD button in the upper right corner of the screen and add more tests to the
18. ay screen image 17 Cal button function and use 13 general reference 29 on data acquisition screen image 11 Calibrate button 6 general reference 19 29 on Spirometer screen image 5 calibration changes in elevation 21 expiration interval 19 function 19 29 quick verification 14 recommended frequency 6 19 29 results out of tolerance 37 calibration screen 7 calibration syringe adapter 19 function 4 general reference 2 35 image 3 performing calibration image 30 procedure 14 21 type and capacity 19 Calibration tab image 26 cleaning 37 PUB 116 Rev B doc Index Configuration tab image 24 Continue Report button 6 general reference 6 31 on Spirometer screen image 6 Cover Page Settings tab image 24 data acquisition screen 7 image 11 data display screen 7 numerical data image 17 performance curve image 17 Delete Rejected Tests selection box function and use 13 on data acquisition screen image 11 digital spirometer functional description 1 main components 2 disposable pneumotach mouthpiece See mouthpiece DPM See disposable pneumotach mouthpiece Ethnic Adjustments tab image 25 Exit button function and use 14 on calibration screen image 21 on data display screen image 17 File button function and use 14 on data display screen image 17 flow volume loop curve example image 9 forced vital capacity test See FVC test functional descript
19. be changed for various ethnic groups Figure 23 Settings tabs second row PUB 116 Rev B doc Digital Spirometer IQmark jreartiveMiacelaneous Incentive Display Type Select the patient incentive a STS display that works best for you and your patient It Poat BD Test Timeout Interval Exceeded Than Since post BD tests are usually done a short time after administration these user convenience features are of limited value On Warn The pasa C Preen Operator From Perficoning Poat 20 Tests Poot BO Test Timecud interval fi pi i Prous e Trending Woke Pamelen Left aan Fenat Selection Mearunemerds Piedced E Sade By Side FA Loopa T I Ovela FAV Loops Delsu FA Dimpilay sma C Samsa E veiy Fight Sadi Panai C None Son oe i Percent ii Total Selected 3 HE ee It is best to simply FF Use Dani singa leave this checked Adi Sethinge Padane Saling E x Alcan gt m fe Afocan menc ani S s Aan E amp E Ts mandan E r Amannan Asian E E n F Black Black oS Hispanic Hispanic 25 User s Manual Digital Spirometer IQmark The Interpretation tab Interpretation allows selection of Fieleronce Equali reference equations Primy Adut Fleteeance E quater Ce used in predicting performance and Secondary Adul Reletence Equatona Krudeon interpreting results Prinmy Pediabic Fielarence Equations Erain Peda Seconday Pedace Aeference Equator Kudin Pedan
20. ce in mouth with teeth and lips over outside and lips making a good seal c blow out as fast hard and long as possible at least 6 seconds but not more than 15 seconds d inhale deeply optional for full flow volume loop If step 0 d is not required or not done press Stop on the incentive display to end the test A Spirometry Guidelines window will come up providing feedback on the test and guidance on what the patient can do to obtain a Good Test message If anything but the Good Test message appears a the test will automatically be marked No for accepting the test you have the option to select Yes which means the results for this attempt will be saved in the data included in this report b use the information displayed to coach the patient on how to improve performance Note The Good Test message is fairly difficult to obtain Let the patient know this and encourage them to keep up the good effort The Spirometry Guidelines window allows you to select whether to perform another test of the same type or not Note A minimum of three tests should be done but no more than eight tests a if you select Yes repeat steps 9 14 b if you select No the Midmark software returns to the data acquisition screen which still allows you to initiate further testing On completion of the testing click on the Save Review button to close the Midmark software and return to the AFHCAN Spirometer screen 2 1 3 3 Reviewing and Se
21. cted these buttons sequence p E through the tests to display them in the live data display areas The information area at the top of the test selection and control panel indicates which type of test is underway or is being viewed The second line indicates which test in a sequence of tests is underway or being viewed and the total number of tests of the indicated type that have been taken thus far These selectable items allow the user to choose whether a given test is to be accepted or rejected The software evaluates the quality of a patient s effort and will display a message indicating either that the effort was a good one or advising how it can be improved Any test that rates less than Good test will be rejected automatically by the software In the review of one or more test results the user has the option to manually select whether a given test will be accepted or rejected C Accept C Reject The software automatically selects one of the tests as the best available effort In reviewing a sequence of tests the user may Best overrule the software s choice and designate a different trial as the patient s best effort It is the best efforts of pre and post bronchodilator trials that are compared side by side PUB 116 Rev B doc 12 User s Manual Item M Delete Repected Tests Digital Spirometer IQmark Description Saving a set of tests creates a spirometry report A thumbnail of the spirometry report is displayed on
22. ction and control panel Item Description These three buttons select the type of test FVC is the default and FVC ve TEF is the most common spirometry test The selected test is shown iiil with a bold face button label The selected test is also indicated in the upper right corner of the data acquisition screen PUB 116 Rev B doc 11 User s Manual Digital Spirometer lQmark Item Description Before a test is undertaken these buttons allow the user to identify the test as pre bronchodilator or post bronchodilator The best attempts from each type of test can then be compared side by side Pre Post The selected condition is shown with a bold face button label After some tests have been collected these buttons select which type of tests can be reviewed in the live data display areas by using the Prev and Next buttons described below This button begins the selected test The patient and spirometer must both be ready When the button is pushed a message will appear saying Zeroing sensor please wait f the sensor is moving or there are any air currents in the vicinity a message may Start New Test appear saying Cannot zero spirometry sensor Hold spirometer still and away from any air currents usually just to the side of the patient s mouth Once the sensor has been zeroed a screen displaying a patient incentive graphic will come up whereupon the patient can begin the test Next A After some tests have been colle
23. ded in a set of materials delivered with the AFHCAN Cart Those manuals can be used to supplement the information provided in this document Be aware however that items installed on an AFHCAN Cart may have been modified slightly so the features as described in the original product manuals may not apply For More Information This document describes the equipment to a level of detail that will meet most user s needs in the context of clinical use of the AFHCAN Cart For more information contact AFHCAN Customer Support AFHCAN Customer Support Phone 888 449 4435 Fax 907 729 2269 email customersupport afhcan org User manuals specifications brochures and other information that may be helpful can be obtained at Midmark s website www midmark com PUB 116 Rev B doc V User s Manual Digital Spirometer lQmark PUB 116 Rev B doc vi Section 1 Introduction 1 1 Introduction to the Digital Spirometer 1 1 1 Functional Description Spirometry measures the patient s ability to move air into and out of the lungs Spirometry is a medical screen test that measures various aspects of breathing and lung function It is performed by using a spirometer a special device that registers the amount of air a subject inhales or exhales and the rate at which the air is moved into or out of the lungs Spirograms are tracings or recordings of the information obtained from the test The most common spirometric tests require that the subject ex
24. e 16 Select how available tests are displayed _ Technician is the user logged in when test was taken Click on Summary tab to return to numerical data diaplay Various combinations of tests can be displayed and Figure 16 Midmark data display screen graphical data PUB 116 Rev B doc 17 User s Manual Digital Spirometer lQmark Viewing Active Data and Viewing Fixed Data The Midmark data display screen can be called up in two different situations e during the process of adding a new spirometry report in a case data is active e when viewing an existing report after a case has been sent data is fixed When a new spirometry report is being added to a case it opens up what can be called a spirometry session The session remains open until the case is closed and sent this includes placing the case on hold At the beginning of the session supplemental patient information must be added before any spirometry tests can be performed As long as the session is open the following points apply e the supplemental patient information entered at the beginning remains available to the Midmark spirometry software e one or more separate spirometry reports can be created e one or more trials can be added to a given report These points hold true even after a spirometry report has been saved to a case If the spirometry session is still open in other words new spirometry data has been
25. ect will be displayed and the software will return to the Spirometer screen Returns to the Add To Case screen If there are spirometry thumbnails in the left bar area when the Back button is pressed a message will advise that data will be lost 1 1 5 Features of the Midmark Spirometry Software The Midmark software has three principal screens Figure 6 e data acquisition screen e data display screen e calibration screen ee a A all f i ae Pe om SS s j Pa en oe rl SSE 2 8 Data acquisition screen Data display screen Calibration screen Figure 6 Introduction to three principal screens in Midmark software The following functions are provided by or are accessible in the Midmark software e analyzing and capturing one or more spirometry reports e printing a spirometry report e reviewing a spirometry report works with AFHCAN software to provide this feature e selecting various display and print formats e changing some system settings e g date format English metric 1 1 5 1 Introduction to Available Spirometry Tests The Midmark Digital Spirometer can perform a variety of tests and gather various items of data Details on the use of different types of spirometry tests and data is beyond the scope of this manual More information can be found in the Midmark Operation Maintenance Manual in the NIOSH Spirometry Training Guide http www cdc gov niosh docs 2004 154c or in other medical references
26. eeeeeeeseeeseeeeees 7 THE ASIC TE VCC VC rsa seisise aan shtace E a N 8 Data showin Tow VO MING OOD sg scacsn cect etadecceentencaie lace E E acaasaedeeess 9 Compare a seres OL PY C eS tS mut oreo Meath alee Neath ae 9 Example Of VC Test TESU MSs acolo ea sae Scena a A ives 10 Example OF IVI VES EBC SUN OS rsh oh artnet A 10 Midmark data acquisition SCLCOMN cccssessseccccceeeeeseseccecccesaeeesseeceesessaeeeeeecesseesaaaeseeeeess 11 Patient mMeenmive display Sooner E ae 15 Examples oF patient Teed back messa ESen A 16 Midmark data display screen numerical data cccceccccccssseeseececeeeceeeeeseeeceeeeeaaaeeeeeees 17 Midmark data display screen graphical data ccccccccccccsssssseeccececeeeeseseeceeeeeeaeaaeseeeees 17 Midmark calibration screen first Calibration cccccccccssseseecececeeeeseseecceseeesaeeeseseeeees 20 Midmark calibration screen subsequent Calibrations ccccceccccessseeseeeeeeeeeeaaeeeeeeees 21 Calibration pump window single TOW sic ccsscsseevenesdcadersavvordscedsarensceereedecdes ela tekaintivase 22 Calibration pump window multiflow test underway sseeeeeeeesesssssssssssssssererersssssssse 22 Available Tabs msetines dialo t DOXA E E 29 SENES TAS TSt LOW aeii a a a a a a aaa 24 Senes TADS SOCOM TOW aa a r a 23 SEE D A O a as Stic cnntauetan te eatean nant an heanaorateniet at ecuanactes seacte 26 Double teaming the calibration Syringe riccii E a
27. erformed One option is to create a fictitious patient named Spirometry Calibration and to save and archive all calibrations to test cases associated with that patient name That way there is a permanent record of calibrations that anyone can easily access Alternatively a calibration can be saved into a real case along with the patient s spirometry data or your facility can print and file calibration reports The Midmark software allows the user to specify the calibration expiration interval Using the Settings dialog box intervals from 1 to 30 days can be entered Each time spirometry is done the software will compare the date of the last calibration against the calibration expiration interval If the calibration has expired the user will be notified and invited to perform a calibration before proceeding The most common way to initiate calibration is by pressing the Calibrate button on the AFHCAN Spirometer screen Doing so brings up the screen shown in Figure 17 PUB 116 Rev B doc 19 User s Manual Sensor S N located on spirometer under mouthpiece Last name of person doing the calibration Enter volume of 3000 On bottom of syringe Based on local Ciki ig Pereme By i a A a F Digital Spirometer S 1 Tere Si i Temperature Accepted Pumps rere ij Fai lQmark Pree Career Prapa mmHg Tarpe ate cae iy Woke lary Lope altitude see Settings r men e aT ie iT r
28. figuration tab is for some general SF ia eid Information entered here configuration items will appear at the tops of printed reports A serial COM port is not applicable to USB type spirometers The Reports tab Reports allows you to select items to appear on EF Cover Page printed reports FVE Graphie Reports MY Graphie Reports Ad Pre BD PVC M Be 3 PreBD MW FF Bei 3PreBD FVC T Bea 3 Pont BD MW AE Post BD FVE R Pre And Post BO MVV Best 2 Pow 6D FE ve Graphic s Best 3 Poot BOYE Pre And Post BOVE Fat Viol ene Precdeted Curve RE Fowo Predicted Curve E Print Tesi Qualiy Statements Print Calibration Repol fe Use ATS iagh Seales Print Using Color Help The Cover Page tab Cover Page Settings allows you to select items to appear on Table And Graphs Single Page Repo the cover page of C Tabie Ory printed reports Pre And Post BO Table Format Pre Oe Post BO Table Fost Best Pre And Pow BD Ben Pee Or Post BO Best 3 Pre And 3 Poet B0 Ben 3 Pre Or 3 Pos 6D fF Port Smokung History RE Print COPD Riik A Pret Lung Age Figure 22 Settings tabs first row PUB 116 Rev B doc 24 User s Manual The Incentive Miscellaneous tab allows selection of patient incentive displays and Post BD waming and timout The Trending tab applies to trending reports which is not available in the AFHCAWN installation The Ethnic Adjustments tab allows factors used in calculating predicted performance to
29. formance alter the default display and print formats and select system preferences Figure 21 shows the basic plan of the window Click on tabs at the top of the window to select an individual tab page If any settings are changed click on Apply at the bottom of the window to activate the setting Click on OK to save all settings and exit Selections will be saved in memory and will become the default settings for subsequent spirometry reports Click on Cancel to cancel any changes not yet applied and exit Figures 22 through 24 show more detailed images of selected tab pages as well as typical settings for items on that page For more information on items not covered in this manual refer to the Midmark Operation Service Manual Spirometry Settings ge ebeg Interpretation Measurements Calibration individual Incentive Miscellaneous Trending Ethnic Adjustments tab pages Configuration Reports Cover Page Settings Ere hp leer i Le Boe ET oehr a BWE mgin Teme bimi ae T Per Ha E F o TE Pe lie dg Pan i E r in mani Ay ka ita E A ha phj Pe imi hE ba igna l on gt P l Buttons apply j to all tab pages lt simultaneously Click Apply to activate Click OK to activate and save all current all current selections selections and close Settings dialog box Figure 21 Available tabs in settings dialog box PUB 116 Rev B doc 23 User s Manual Digital Spirometer lQmark The Con
30. formed have the medication handy 2 1 3 2 Conducting the Test Proceed as follows l 2 SE Sia On the Spirometer screen click on the Start New Report button If this is the first test of the session enter the required fields for supplemental patient data race height weight smoking history and medications and click Continue Report From the Midmark data acquisition screen click Test Data to enter information about symptoms and the bronchodilator used if desired Ensure the type of test selected is FVC Note Because VC and MVV are not normally done in the settings where the AFHCAN Cart is deployed the FVC test is assumed If this is a pre bronchodilator test ensure that Pre is selected the selected button is shown in bold letters If you have already performed the pre bronchodilator tests and this is a post bronchodilator test select Post and enter the bronchodilator used in the pull down list in the upper right area of the Spirometer screen Place the patient s mouthpiece on the handle ensuring it is fully seated in the slot Place a disposable nose clip on the patient s nose highly recommended Have the patient hold the mouthpiece still beside his or her cheek Press the Start New Test button An incentive display will come up PUB 116 Rev B doc 31 User s Manual Digital Spirometer lQmark 10 11 12 13 14 15 Tell the patient a inhale as deeply as possible b place mouthpie
31. hale as forcefully as possible after taking in a full deep breath The subjects effort is called the forced expiratory maneuver The IQmark Digital Spirometer working with Midmark software measures the flow rate of air exhaled through a disposable mouthpiece attached to a hand held sensor device The Midmark software tracks the flow rate over time and calculates total volume of air expelled The data obtained is displayed both graphically and numerically The most common spirometric test is the forced vital capacity FVC test As described above the patient inhales as deeply and fully as possible and exhales through the mouthpiece as vigorously and completely as possible Although the FVC test is most common additional types of tests can be performed refer to Midmark s Operation Service Manual supplied with the device for details In addition to recording flow rates and volumes for exhalations the digital spirometer can record the same data for inhalations Normal flow rates and volumes have been established scientifically Most healthy patients can expel 70 to 80 percent of their lung capacity in the first second The Midmark software obtains predicted performance criteria based on the patient s age height weight gender and race and then compares the patient s actual performance against these criteria In addition the Midmark software gauges the quality of the patient s effort and provides messages on how to improve performance
32. has to be entered only once while a case is open Once added it is automatically incorporated into all the reports created in that session On completion of the data entry pressing Continue Report proceeds directly to the spirometry test screen in the Midmark software Table 1 shows the buttons that appear on the Spirometer screen and their functions Table 1 Spirometer screen buttons and their functions Button Function If supplemental patient information has not yet been added in this session the Start New Report button brings up the data entry screen for supplemental patient information If supplemental patient information has already been added in this session pressing the Start New Report button brings up the Midmark spirometry software This button replaces the Start New Report button when the data entry screen for supplemental patient information is displayed Pressing Continue Report stores the supplemental information and opens the Midmark spirometry software Brings up the Midmark calibration screen It is good practice to calibrate ona regular basis to verify equipment operation Daily calibration is recommended by the American Thoracic Society PUB 116 Rev B doc 6 User s Manual Digital Spirometer IQmark Button Function Saves all spirometry data with a green checkmark into the case and returns to the Case screen If no spirometry data has been obtained when the Save button is pushed a message to that eff
33. he diagnosis Once the case is sent however this field is locked The reviewing provider would normally enter a diagnosis or instructions in a case comment not in the spirometry report itself This field is not directly accessible by the user The Review _ e Date field works in conjunction with the Reviewed By field If Review Date for some reason there is information is entered in the Reviewed By field then the date the information was entered would be displayed here by the Midmark software 1 1 5 4 Calibration Screen With the Midmark Digital Spirometer calibration confirms that the instrument is operating properly Calibration is done using the Midmark 3 liter calibration syringe A mouthpiece preferably one reserved for calibration is placed on the spirometer handle and then it is fitted into a rubber adapter on the syringe Following directions on the screen the user pumps the syringe a number of times until a calibration result is displayed Use a helper to hold the spirometer in place If the result is accepted the calibration data is stored in a thumbnail and is available for inclusion in a case The calibration results will be stored and used by the Midmark software until the next time calibration is performed The American Thoracic Society recommends that calibration be performed once each day assuming of course that the device is being utilized that day Itis a good practice to maintain records of when calibration was p
34. in 8 attempts allow the patient to try on another day when calibrating the spirometer have the patient or another helper pump the calibration syringe for you give the patient a chance to empty his or her bladder before the test to reduce the risk of leaking urine if the patient coughs most children of age seven and some younger can be given a spirometry test PUB 116 Rev B doc 35 User s Manual Digital Spirometer lQmark PUB 116 Rev B doc 36 Section 4 Routine Maintenance 4 1 Care and Cleaning Since the mouthpiece is the single use disposable type cleaning is limited to a general wipe down of the handle and cable with cloth dampened with a mild detergent Do not get any moisture on the pressure ports at the top of the handle 4 2 Replacement Items The USB version does not require batteries The battery compartment may have been glued shut Box of 25 Disposable Pneumotach Mouthpieces Midmark part number 2 100 1200 4 3 Elementary Troubleshooting Table 5 shows offers some troubleshooting guidelines Additional troubleshooting information can be found in the Midmark manual or on their website Table 5 Troubleshooting guidelines Problem Possible Solutions Midmark software indicates e ensure the USB connector is connected to a suitable USB the sensor is not ready or port on the Cart or computer cannot be found e try exiting the Midmark software and coming back into it from the Spirometer screen calibration res
35. ion See device functional description FVC button function and use 11 on data acquisition screen image 11 FVC test description 1 displaying results 17 33 general reference 8 15 31 typical results curve image 8 viewing multiple results 9 handle See spirometer handle Help button function and use 14 on calibration screen image 21 on data acquisition screen image 11 on data display screen image 17 Incentive Miscellaneous tab image 25 Interpretation tab image 26 laminar flow element function 3 image 3 39 User s Manual Digital Spirometer lQmark LED indicator image 2 showing green significance 3 maximum voluntary ventilation test See MVV test Measurements tab image 26 Midmark Digital Spirometer See digital spirometer Midmark software automatic diagnosis 2 calibration data 19 calibration screen image 20 21 data acquisition screen image 11 data display mage 17 description of on screen buttons 13 descriptions on screen buttons 11 elevation and pressure 20 functions 7 general reference 1 4 6 22 27 interaction with AFHCAN software 1 4 patient incentive display 14 patient incentive displays image 15 three major screens image 7 mouthpiece calibration 19 21 described 3 details mage 3 general reference 2 37 installed image 2 laminar flow element See laminar flow element orientation 4 part number 37 precautions 27 proper use 31 M
36. ip eyes supplied separately Plunger Adapter Mouthpiece fits inside smaller end liter calibration syringe Figure 3 Calibration syringe and adapter The spirometer handle is small lightweight and easily manipulated by the patient At the top is a slot which receives the mouthpiece and secures it in place On the back of the handle is an LED which illuminates green when the device is communicating with the computer The mouthpiece is a low cost single use disposable item Inside the mouthpiece there is a laminar flow element the corrugations in the middle of the mouthpiece and two pressure ports one on either side of the laminar flow element The laminar flow element performs three functions e it offers a small amount of resistance to air flow and this resistance to air flow creates a small difference in air pressure between the upstream port and the downstream port e it smoothes or stabilizes the air flow through the mouthpiece so good pressure readings can be obtained e it allows air to be exhaled with virtually no perceived resistance as far as the patient is concerned The spirometer handle actually measures the difference in air pressure between the upstream port and the downstream port The amount of pressure difference is related to the amount of air being forced through the mouthpiece at any given time The air upstream of the laminar flow element will be at a slightly higher pressure tha
37. l full deep breaths as quickly as possible for about 12 seconds This is a demanding test and can lead to hyperventilation An example of MVV test results is shown in Figure 11 The MVV test is not normally required in the clinical situations where the AFHCAN Cart is usually installed Additional details on performing this test are included in the Midmark Operation Service Manual GST FP re Brancho dilatar ames Osi Post Bronchodilator Time Figure 11 Example of MVV test results PUB 116 Rev B doc 10 User s Manual Digital Spirometer lQmark 1 1 5 2 Obtaining Spirometry Data Once all the required patient data has been added pressing Start New Report or Continue Report from the Spirometer screen brings up the Midmark data acquisition screen Figure 12 Patient name Type of test selected Calculated numerical results SSN p rome fot Jach Widens 809 0009 Live data display area for volume time curve Test selection and control panel Live data display area for flow volume H curve 4 Screen function 4 buttons 5 Tally of tests included in Spirometer this report Status indicator Figure 12 Midmark data acquisition screen Table 2 describes the items included in the test selection and control panel Table 3 provides a comprehensive list of the screen function buttons for all Midmark screens encountered in the software Table 2 Items in the test sele
38. ld archived or discarded During the session one or more spirometry reports can be created Furthermore an individual spirometry report can be accessed from the Case screen and more spirometry tests can be added to that report A typical sequence will involve pressing the Start New Report button The AFHCAN software automatically provides the Midmark software with patient identification information and some of the information needed for predicting performance However additional information must be supplied Because the information such as weight height and smoking habits can change the information must be entered each time a spirometry session is initiated in other words each time the Spirometer button is pushed on the Add To Case screen When the Start New Report button is pressed the screen shown in Figure 5 comes up PUB 116 Rev B doc 5 User s Manual Digital Spirometer lQmark E Bewell May Mya F Pig i abe Eo fie ee a m Patient information Lasi Hnnm s from existing _ patient record eae not editable here ei Kata of Bath mmddyy ATE Supplemental information needed race for performance High predictions must be ae entered in sequence wieght lf these boxes are i D Simeon checked _ 5 these fields aut become required Medic ations Information on medications may be entered here Figure 5 Data entry screen for supplemental patient information Supplemental patient information
39. lecting Tests The Midmark data acquisition screen allows you to review a series of tests decide which to keep and to manually identify the patients best effort This is done using the test selection and control panel in the middle of the screen Proceed as follows l To review the newly generated tests click on Prev or Next The software will display each test of the given type in sequence To switch the type of test being reviewed select Pre or Post for pre bronchodilator tests and post bronchodilator tests As each test is displayed you can select whether to Accept or Reject the test or you can indicate that the test being displayed was Best the patient s best effort PUB 116 Rev B doc 32 User s Manual Digital Spirometer IQmark Note Rejected tests can be recovered as long as the current session remains open but are lost once the case itself has been saved 4 To take additional tests click on Start New Test 5 On completion of the testing and review click on the Save Review button to close the Midmark software and return to the Spirometer screen The spirometry report just completed will now appear as a thumbnail in the left bar area The green checkmark will automatically appear in the box to the right indicating that this report will be saved to the case 2 1 3 5 Saving the Spirometry Report to a Case From the Spirometer screen click the Save button This returns to the Case screen At this point the data h
40. n Spirometer screen image 5 Save Review button function and use 14 general reference 33 Sensor SN data entry field on calibration screen image 20 Settings button function and use 13 18 on calibration screen image 21 on data acquisition screen image 11 on data display screen image 17 settings dialog box available pages image 23 description 23 spirometer See digital spirometer Spirometer button 5 general reference 5 29 spirometer handle cleaning 37 description 3 40 User s Manual Digital Spirometer function 3 general reference 2 19 31 image 2 Spirometer screen activating Midmark software 11 description of on screen buttons 6 general reference 33 image 5 initiating calibration 19 29 report thumbnails 13 returning to 14 30 supplemental patient information image 6 viewing thumbnail 16 spirometry available tests 7 defined 1 Start Cal button function and use 14 general reference 21 29 on calibration screen image 21 Start New Report button function 6 general reference 5 11 31 on Spirometer screen image 5 Start New Test button function and use 12 general reference 14 31 on data acquisition screen image 11 Stop button general reference 15 Syringe S N data entry field on calibration screen image 21 Syringe Volume data entry field on calibration screen image 21 Test Data button function and use 13 on data acquisi
41. n the air downstream from it By monitoring the pressure PUB 116 Rev B doc 3 User s Manual Digital Spirometer IQmark difference and tracking it over time the Midmark software can compute flow rates and flow volumes The Midmark calibration syringe is used to verify instrument performance The mouthpiece includes a locating pin next to the upstream pressure port which ensures that the mouthpiece can only be installed one way Ridges on the sides of the mouthpiece fit between the retaining tabs on the spirometer to ensure correct alignment and complete insertion into the pressure ports Arrows on the tabs indicate the direction that exhaled air will travel 1 1 4 AFHCAN Software Features 1 1 4 1 How the AFHCAN Software Works with Midmark Software The AFHCAN software interacts with the Midmark software in three ways e activates the Midmark software when creating a spirometry report and adding it to a case when viewing a spirometry report already saved into a case e feeds information from a case to the Midmark software e configures the Midmark software so that some features are active and some are disabled The AFHCAN software provides the following information to the Midmark software e patient s first name middle initial and last name e patient s social security number e patient s date of birth e patient s gender e provider s last name and first name the user currently logged into AFHCAN software Midmark desig
42. ned its software to be interactive with other software packages such as the AFHCAN software and therefore gave programmers the ability to activate or deactivate certain features of their software A number of screens and features described in Midmark s Operation Service Manual do not apply because the AFHCAN software handles those functions for example archiving a case In addition some features are disabled to ensure that the data in a case which is an official medical record is not accidentally altered or deleted at a later time The AFHCAN software enables and disables features in the Midmark software as needed to ensure the integrity and security of medical records PUB 116 Rev B doc 4 User s Manual Digital Spirometer lQmark 1 1 4 2 Spirometer Screen Pressing the Spirometer button on the Add To Case screen brings up the Spirometer screen Figure 4 Thumbnails of one or i a ye more reports will kaem Pam Cini Md appear here after reports are obtained Checkmark indicates data to be saved click to add or remove Spirometry Brief synopsis of procedure for doing spirometry the full procedure is provided in this manual and in your training simplified example of spirogram for FEM maneuver Figure 4 Spirometer screen Accessing the Spirometer screen can be thought of as opening a spirometry session The session remains open as long as the case is open The case remains open until it is sent placed on ho
43. o have the performance bar stay even with the moving pointer It takes a little practice to get used to it There is no harm in doing several calibrations in arow Only the most recent one is saved in the Midmark software Practice calibration reports can be unchecked so they are not saved in a case Note It is important to draw the plunger out slowly If itis drawn out too fast it will bounce a little bit when it reaches its limit of travel The spirometer is sensitive enough to detect the bounce as forward flow whereupon it begins moving the needle to the right If you are not actually ready to begin pushing yet it can be hard to catch up so the performance bar stays even with the pointer If needed simply restart the test Figure 19 shows the calibration window that comes up when Multiflow calibration testing has not been selected Figure 20 shows how the calibration pump window looks when Multiflow calibration testing has been selected with a calibration test underway Adjust pumping speed to keep performance bar even with blue pointer Blue line shows actual oli Target time for pushing performance C a rs C lt 4 Plunger all the way in The three second portion of test is underway Figure 20 Calibration pump window multiflow test underway PUB 116 Rev B doc 22 User s Manual Digital Spirometer IQmark 1 1 5 5 Settings Dialog Box The Settings dialog box allows the user to control the spirometer s per
44. oe Existing calibration results if any will be displayed here Instructions fo begin Calivabon cich on Nan Evia fw dala ke Perona By iina Vole Eyinge Pressure and aaa Sa Then prear Star i begin cmibraime E Screen function buttons Figure 17 Midmark calibration screen first calibration Figure 17 shows how the screen appears the very first time a spirometry report is created at an AFHCAN Cart The blank fields must be filled in The callouts on the illustration show where to obtain the desired information The Pressure entry requires a little more explanation The following are options for entering or obtaining an appropriate value e if you happen to have a reading of local atmospheric pressure say from a daily weather report and the units of pressure are in millimeters of mercury mm Hg then you can enter that number directly e if the elevation of your location is within a few hundred feet of sea level you can enter the value for standard atmospheric pressure of 760 mm Hg e if you know the elevation of your location in feet above sea level then you can allow the Midmark software to computer a standard reference pressure for that elevation as follows go to the Settings dialog box select the Calibration tab select Calculate Barometric Pressure from Altitude enter the elevation of your facility in the Altitude Above Sea Level text box When the Midmark software calcula
45. r her results For anything less than a Good test the software automatically selects No but the user can change this here or in 2 Anwenpaia 1 Accepted Matches the Test Selection and Control Panel Fado another test Prete Enter or cick on wies _ Figure 14 Examples of patient feedback messages When all desired trials and tests have been obtained click on No in the feedback window then Save Review in the data acquisition screen A thumbnail of the spirometry report will now appear in the left bar area of the Spirometer screen 1 1 5 3 Viewing Spirometry Data Clicking on a spirometry thumbnail in the Spirometer screen or in the Case screen brings up the Midmark data display screen Initially the screen display is in the data format which is the first tab selection Summary as shown in Figure 15 PUB 116 Rev B doc 16 User s Manual Digital Spirometer lQmark Click on FVC Graphs tab to bring up graphs of FVC test The Reviewed By field is usually left blank Numerical results select items from Settings Dialog Box Patient details a Pre BO one Ts ampled 3 acicopted A test statistics ag gS eae egia 3 acceptad 3 matches Automatic diagnosis n must be confirmed ip Normal guromeiry Post bronchodila sor Screen function buttons Figure 15 Midmark data display screen numerical data Clicking on the FVC Graphs tab brings up a graphical display of the spirometry results Figur
46. rt toa C as uac siop annie E E aa iE 33 214 VIEWING Spirometry REPOMS sersan oies a a 33 Section 3 Clinical Considerations sciiccsccsicccsecsdsacssccsccsccsecsssedessecsdssacecdesedecesecsecdsedessecedscacacsededes 35 Jl Guide hnes Tor Clinical SUCCESS S a E 35 PEON a E a A nto oes acaeanatelen 35 Jo Lipe and TEk Saia Oe eee er ree cn Me Ce nC nny en ere creer nn roe ee aren ame 35 Section 4 Routine Mamtenane vaissiccssesiccscnedeicsssed cetenessccusesiccsenedeicsssedicetedadsacesecssecsanedeccseseasce 37 As Ue Care and Cenin Tesa a ealys Sea aes wd Sevens Rand esa tales Saale a 37 4 2 Replacement Te mS ersi hb ate debccea tech babi a Riahiel seuss R 37 4 5 elementary PrOUDIES MO OUI nren san vecaceoasdecaesueraaed cosuetand a sdace ours iapduesesed casgstauseereeset 37 PUB 116 Rev B doc jii User s Manual Digital Spirometer IQmark Figure Se Oowonwnony nN Nn BW NO NO NO N NN NN N KF KF KF KF Kr Fr m nA A U Ne OO WNADN NK A WW WN Table nN A U N List of Illustrations Title Page DTS ifs prone ei ea a A E e teats 2 Disposable mouthpiece and nose chp ssssseeessssssssoerrsssssssssserrressssseceresssssseceersssssseeeresess 3 Calibration SVMine Gand adapte asah r E E A 3 SPO O gol E A Neen Ee Ey Ente En NR renee esesy 5 Data entry screen for supplemental patient information ccccceccceceeceeeeeeaeeeeeeeeeeeeees 6 Introduction to three principal screens in Midmark sSoftware ccccessseessecc
47. ted interpretation and the numerical and graphical results should be examined with respect to the patient s overall clinical condition Final analysis should always be determined and verified by a physician Spirometry is an effort dependent test Proper administration of the test is the physician s responsibility as is making a diagnosis obtaining expert opinions on the results and implementing the correct treatment if indicated 1 1 2 Main Components The spirometer consists of the following components Figures through 3 e spirometer handle with sensing electronics and computer cable e mouthpiece called the disposable pneumotach mouthpiece or DPM by Midmark e disposable nose clip optional but highly recommended for good results e calibration syringe with adapter oor Direction of exhalation Serial USS connecor shown on retaining tab number Port Disposable Locating mouthpiece hole Port gt Spirometer handle Digital Spirometer USB type LED indicator Back view sealed shut on USB models 3 P _ Battery compartment may be Bottom view Figure 1 Digital spirometer Midmark Diagnostics Group IQmark Digital Spirometer Operation Service Manual Version 7 0 p iii PUB 116 Rev B doc 2 User s Manual Digital Spirometer Qmark Laminar flow element Laminar flow Downstream port Upstream port element Disposable Locating pin nose clip Figure 2 Disposable mouthpiece and nose cl
48. ter while you pump the plunger as shown in Figure 25 This is an excellent way to involve the patient in the process Figure 25 Double teaming the calibration syringe 6 Follow the instructions displayed in the window As soon as the spirometer detects forward flow plunger moving in it will start moving both the pointer and the performance bar Adjust pumping speed as needed to keep the performance bar even with the pointer Note When pulling the plunger out do so slowly and gently If pulled out too quickly the plunger may bounce a little on reaching the limit of travel This bounce may be enough to trigger the performance bar If you are not ready it may be hard to catch up to the pointer At worst this may mean the system asks you to repeat the attempt 7 Pump as many times as requested each time matching the speed of the pointer Follow any instructions that may appear The system will reject any unsatisfactory attempts inform you of why and will ask you to repeat the trial 8 After a sufficient number of satisfactory attempts have been made usually 4 or 5 the screen will display the Verification Pump window If the indicated results are within the ranges listed click Yes to accept the calibration 9 Click Exit to return to the Spirometer screen Each calibration report generated will appear as a thumbnail in the left bar area A green checkmark will appear automatically indicating that these reports will be saved to
49. tes a reference pressure that revised pressure will appear in the Pressure text box in the calibration screen The accuracy of the Midmark Digital Spirometer is not affected significantly by daily fluctuations in atmospheric pressure However if the device is moved to a new location and the difference in PUB 116 Rev B doc 20 User s Manual Digital Spirometer IQmark elevation is significant say 1 000 feet or more then a new reference pressure should be obtained and a new calibration should be performed Once the instrument has been calibrated one time the Midmark calibration screen will come up with the fields already filled in as shown in Figure 18 Update this field bprenrirp Laisimi with your name Data Tee oss eM Sens D ena Preous Catbranon Puronas Bey Tent vx Senger SH fang Cade tse After the first Steps Wolves mT mi Temper ahure E dg F Presture man m calibration the Synge S nominees i Tinei oy dag F information on pa m i AE AMIE _ peel eae tS bes this screen marcas S Se a is filled in a LE OTH Weare Wy ima EN Homiy automatically These flow curves are typical when Multiflow Calibration is selected in the Settings _ dialog box i i F i i Figure 18 Midmark calibration screen subsequent calibrations Calibration Pump Window Pressing New Cal in the calibration screen begins the process of creating a new calibration report At this point you can update
50. tests can be added to a given spirometry report Each spirometry report is stored as a separate thumbnail in an AFHCAN case Multiple tests can be viewed on the same graph as shown in Figure 9 If desired the software allows tests to be identified as Pre Bronchodilator or Post Bronchodilator Ehr vol L Gest Pre Bronchodilator ames Qes Post Bronchodilator Figure 9 Comparing a series of FVC tests Vital Capacity Test The vital capacity VC test measures the full capacity of the lungs measured at slower rates of inhalation and exhalation The test begins with the patient taking a full breath exhaling into the mouthpiece a few tidal breaths normal breaths and finally a full inhalation and full exhalation The final inhalation and exhalation should not be done too slowly but neither should it be forced If the test is completed in about 25 seconds or less all the breaths will be displayed on the graph as shown in Figure 10 PUB 116 Rev B doc 9 User s Manual Digital Spirometer Qmark The VC test is not normally required in the clinical situations where the AFHCAN Cart is usually installed Additional details on performing this test are included in the Midmark Operation Service Manual Vel L ame Besi Pre Gronchodilator aes ST Post Bronchodilator Time S Figure 10 Example of VC test results Maximum Voluntary Ventilation Test The maximum voluntary ventilation MVV test requires the patient to take severa
51. the various fields on the screen Note The name displayed in the Performed By field comes from the previous calibration report not from the name of the current User the person logged into the AFHCAN software The person actually doing the calibration should enter his or her last name in the Performed By field When the data is satisfactory place an unused mouthpiece on the spirometer place the adapter on the calibration syringe ensure the plunger has been pushed all the way in and press the Start Cal button Pressing the Start Cal button will bring up the calibration pump window Figure19 PUB 116 Rev B doc 21 User s Manual Digital Spirometer IQmark Rs 7 ioe pull the plunger ea the wey oat Puah lt Instructions the mninga plunger following the speed of Shee bhre aia Red line shows goal of 1 5 liters per second for a total of 3 liters test completes in 2 seconds Pumping data and evaluation Last Pump will appear here ba a k a Flow rate target and Plunger speed target live performance curve and performance gauge Figure 19 Calibration pump window single flow Follow the instructions on the calibration pump window and slowly draw the pump handle out all the way As soon as the pump handle begins to push back in the display will go live On the left side a trace of the flow rate will appear On the right side the blue pointer will start moving and a performance bar will appear The goal is t
52. tion screen image 11 Trending tab image 25 troubleshooting 37 VC button on data acquisition screen image 11 VC test description 9 results curve image 10 Verify button function and use 14 on calibration screen image 21 vital capacity test See VC test PUB 116 Rev B doc 41 lQmark Date Printed 8 13 09 User s Manual Digital Spirometer lQmark PUB 116 Rev B doc 42
53. uency with which you perform calibration depends on your facility s policies and requirements The American Thoracic Society recommends daily calibration A reminder interval for doing calibrations can be entered under the Calibration tab in the Settings dialog box To maintain a consistent and readily accessible record of calibrations consider creating a test case with a patient named Calibration Reports or something similar All cases for this patient would then contain the calibration reports The cases can be archived and then can be easily searched As an alternative you can include the calibration report along with the spirometry reports for a real patient Proceed as follows 1 From the Spirometer screen press the Calibrate button This brings up the Spirometry Calibration screen After a moment the previous calibration results will be displayed and the sensor status will be indicated at the right of the screen Note The Spirometry Calibration screen can also be accessed from the data acquisition screen by pressing the Cal button 2 Press the New Cal button 3 Confirm or enter the necessary data in the data entry fields at the top of the screen if you are doing the calibration enter your last name in the Performed By field 4 Press the Start Cal button The Calibration pump window will come up PUB 116 Rev B doc 29 User s Manual Digital Spirometer lQmark 5 Have someone assist by holding the spirometer in the adap
54. ults not within e may indicate a problem with the instrument a satisfactory range e in general the pressure ports on the handle are not designed for user cleaning or maintenance however it does no harm to inspect the openings to be sure no foreign objects or material is present cannot zero the spirometer e the spirometer is very sensitive if any air movement is detected the spirometer cannot zero e while zeroing is underway keep instrument still and away from any miscellaneous air currents in the environment other problems e check the Midmark Operation Service Manual e contact AFHCAN Customer Support at 888 449 4435 e check the Midmark online help pages by clicking Help on their screens PUB 116 Rev B doc 37 User s Manual Digital Spirometer lQmark PUB 116 Rev B doc 38 Accept radio button function and use 12 on data acquisition screen image 11 adapter for calibration syringe image 3 general reference 19 21 in position image 30 Add Comment button 33 Add To Case screen 5 AFHCAN software data sharing 4 5 21 27 function 14 27 interaction with Midmark software 1 4 limits on backwards compatibility 27 automatic diagnosis responsibility to confirm 2 Back button 7 on Spirometer screen image 5 battery compartment image 2 not used on USB models 37 Best selection box function and use 12 on data acquisition screen image 11 Bronchodilator pull down menu function and use 18 on data displ
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