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1. Slides on Clicks into place Remove Remove nsert Press latch release Slides off Push in and pull sensor out Do not twist Do not twist NICO Sensor WARNI NG The Disposable NICO Sensor is intended for SINGLE PATIENT USE ONLY Re use including disassembly cleaning disinfecting sterilizing and other efforts made in an attempt to re use a NICO Sensor may compromise system performance and may cause a potential patient hazard Performance is not guaranteed if reused Before use verify the sensor is physically intact with no broken or damaged parts Do not use a broken or damaged sensor or one with wet contaminated or corroded connectors Do not allow the NICO Sensor to remain in the ventilator circuit when not connected to the NICO monitor A ventilator circuit leak will occur CAUTION Connect only a Novametrix NICO Sensor Catalog Number 8950 00 8951 00 or 8952 00 to the NICO monitor Do not connect any other sensor in place of a NICO Sensor NICO User s Manual 59 Disposable NICO Sensors NICO Sensor and CAPNOSTAT Elbow Other devices HME filter etc Disposable automatic Patient rebreathing valve connection Patient circuit Y CAPNOSTAT CO gt Sensor CO gt Flow Sensor VA e NICO Loop KET adjustable N rebreathing AKU volume Anesthesia machine ventilator circuit connection Choosing a NICO Choose
2. TURN PUSH hr TREND T 28 Rebreathing Curves Screen LAST COMPLETED CYCLE YCOD 159 m L z m CO0O f 5 3 3 min CYCLE IN PROGRESS PUSH LAST COMPLETED CYCLE CO SpO Screen No Options Flow Pressure Screen No Options Numerics Screen No Options Rev 05 NICO User s Manual 11 KNOB selectable Monitoring Screens KNOB Selectable Respiratory Screens TURN 12 NICO User s Manual The following Respiratory Screens are available in the monitoring mode only when activated Press the MENU key and select RESP SCREENS from the SELECT A SCREEN menu by turning and then pressing the KNOB From the ADD RESPIRATORY SCREENS menu highlight and then select which screens will appear in the base monitoring mode by turning and then pressing the KNOB When enabled selected screens can be displayed by turning the KNOB while viewing any monitoring screen Respiratory Numerics Flow Volume Loop and Pressure Volume Loop N Vtalw NE A T Single Breath CO Waveform VdW 38 VCO gt MValv Trend Rev 05 MENU key Screen Displays Rev 05 MENU key Screen Displays Press the MENU key to activate the SELECT A SCREEN menu and illuminate the key s green icon Press the key again to return to the previously displayed screen From the SELECT A SCREEN menu turn the KNOB to highlight the screen you wish to display Press the MENU key or the KNOB to display that selected s
3. The displayed pulse rate value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed respiration rate value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed SpO value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The wrong part number CAPNOSTAT is connected to the NI CO monitor Use only a CAPNOSTAT with part number 9567 00 this can be distinguished from other CAPNOSTAT part numbers by the yellow part number label on the CAPNOSTAT s electrical connector The wrong flow sensor is connected to the NICO monitor Use only a NICO Sensor part numbers 8950 00 8951 00 or 8952 00 the correct flow sensor is an integral part of the NICO Sensor where xx is a numeric value with units of mmHg kPa or Yo At least 3 mmHg 0 1 or 0 1 kPa of CO has been detected during inspiration other than during rebreathing for at least ten continuous seconds The displayed cardiac output value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed ETCO value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings
4. 2 Connect the CAPNOSTAT CO Sensor to the monitor O20 seme nG See CAPNOSTAT CO2 Sensor on page 65 m gg 3 Select an appropriate size CO Flow sensor T i Connect a CO5 Flow Sensor to the monitor and attach a 8 CAPNOSTAT See CO2 Flow Sensors on page 62 32 NI CO User s Manual Rev 05 Preparing for Use 5 Connect the CAPNOSTAT CO sensor to the CO5 Flow sensor Pediatric Neonatal Combined CO flow sensor Combined CO flow sensor added deadspace 4 cc added deadspace 1 cc CAPNOSTAT N CO sensor Pediatric adult CAPNOSTAT CAPNOSTAT Combined CO Flow sensor CO sensor CO sensor added deadspace 8 5 cc 6 For optimal results place the CO gt Flow sensor in the ventilator circuit between the endotracheal tube and the ventilator circuit wye Place the sensor proximal to the patient if using other devices in the circuit Place the sensor so that the tubing lines exit from the top of the sensor to help keep them clear and dry Keep the sensor clear of accumulations by proper circuit maintenance 7 Connect the combined CO gt Flow sensor to the patient breathing circuit To ventilator To ventilator To patient Adult CO Flow sensor with CAPNOSTAT CO with CAPNOSTAT CO sensor attached sensor attached To patient To patient Neonatal CO Flow sensor with CAPNOSTAT CO sensor attached Rev 05 NICO User s Manual 33 Begin Respiratory Moni
5. The displayed pulse rate value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings Alert Class Rev 05 Message Areas Cardiac Output mode General Message Area LOW RESP RATE Message Alert Description Class The displayed respiration rate value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings M The displayed SpO value is below the set alert limit in the MONITOR INOPERABLE AIRWAY ZERO ERROR MONITOR INOPERABLE BARO PRESS ERROR MONITOR INOPERABLE SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The NICO monitor detected a problem with its pneumatic flow and pressure sub system Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its internal barometric pressure sensor Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its internal CLOCK FAILURE MONITOR INOPERABLE clock Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its flow FLOW ZERO ERROR MONITOR INOPERABLE zeroing sub system or related pneumatic components Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its internal NICO
6. Before monitoring take a few moments to inspect the NICO monitor and its sensors Check that all items are clean dry and physically intact with no broken or damaged components Turn the NICO monitor on 1 Press the Operate Standby key to turn the monitor on f and off NICO can operate from its internal battery or from the AC Mains See AC Battery Operation on page 4 for details A 2 The monitor performs a quick self test An audible tone sounds the key indicators illuminate and a SELF TEST IN PROGRESS message is briefly displayed 3 The message PRESS KNOB TO ERASE STORED TRENDS is displayed for 5 seconds To erase the contents of the monitor s trend memory press the knob TRENDS ERASED is briefly displayed Toretain the contents of the monitor s trend memory do not press the knob Wait the 5 seconds and TRENDS RETAINED is displayed Note If the internal battery becomes fully discharged the message CHECK DATE TI ME MENU gt SETUP will appear before the PRESS KNOB TO ERASE STORED TRENDS message See Setup Screen on page 45 for details 4 The power up sequence is completed and a monitoring screen is displayed NICO displays the screen that was displayed when the monitor was last turned off If the monitor is in Respiratory Mechanics mode connecting a
7. CARDIAC OUTPUT Non Invasive Cardiac Output Monitor Model 7300 February 1 2001 Catalog No 9226 23 05 Copyright 2001 Novametrix Medical Systems Inc 0086 5 Technology Drive Wallingford Connecticut U S A 06492 All rights reserved Rev 05 Thank you Thank you for purchasing the NICO Non Invasive Cardiac Output monitor from Novametrix NICO measures cardiac output through respiratory gas analysis based on the well accepted Fick Principle providing continuous and accurate display of cardiac output The monitor also operates in Respiratory Mechanics only mode providing the clinician with a respiratory profile of the patient through a combination of capnography airway flow and pressure and pulse oximetry We expect that you will find the application and use of NICO extremely simple making it easy to adopt this exciting technology into your clinical practice NICO can provide accurate cardiac output values without the need for invasive procedures benefitting the patient the clinician and the health care system in general We appreciate your patronage and look forward to developing a long term relationship with you and your institution Sincerely NOVAMETRIX MEDICAL SYSTEMS INC USA TOLL FREE 1 800 243 3444 PHONE 205 265 7701 FAX 205 284 0753 WORLD WIDE WEB http www novametrix com E MAIL Customer Service sales novametrix com Technical Service techline novametrix com NICO User
8. Construction Durable high performance plastic ultra flexible cable Shock Resistant Sensor will withstand a 6 foot drop to a tile floor End Tidal CO e Range 0 150 mmHg 0 20 kPa or 96 at Pb 760 mmHg Accuracy 2 mmHg for 0 40 mmHg 5 of reading for 41 70 mmHg 8 of reading for 71 150 mmHg Respiratory Rate Range 2 150 breaths min Accuracy 1 breath min Flow Range L min at Pb 760 mmHg room air 35 C e Adult 2 to 180 Pediatric 5 to 100 Neonatal 25 to 25 Flow Accuracy Greater of 3 reading or e Adult 5 L min Pediatric 25 L min Neonatal 125 L min Tidal Volume Range ml e Adult 200 to 3000 Pediatric 30 400 Rev 05 S pO Monitor S pecifications RS232 Communications Rev 05 Neonatal 1 100 Airway Pressure Range cmH5O 120 e Accuracy greater of 0 5 cmH50O or 2 reading Oxygen Saturation e Range 0 100 e Accuracy 2 for 80 100 for 1 standard deviation or approximately 68 of readings unspecified for 0 79 e Averaging Time 2 seconds Pulse Rate e Range 30 250 beats per minute e Accuracy 1 of full scale for 1 standard deviation or approximately 68 of readings e Averaging Time 8 seconds Classification IEC601 1 Class l internal power source type BF continuous operating mode enclosure protection rating I PXO Operating Environment 50 95 F 10 35 C 0 90 relative humidity non condensing Size Height 6 5 in Widt
9. Mark ABG Time or Default ABG screen 6 Turn KNOB to adjust value e ABG Time is required for PaCO and PaO e Ensure that the NICO clock is synchronized to the clock used to determine the draw time f Press the KNOB to accept the value and return to the ABG DATA ENTRY screen Updated Vd Vt and Vdalv values are displayed C O Averaging The Cardiac Output Confidence Bar or CObar is an indicator of the system s confidence in the currently displayed cardiac output value The CObar indicator is located above the cardiac output value and can contain up to five segments The degree of confidence more segments for higher confidence fewer segments for lower confidence is based on multiple factors including ventilatory pattern sizing of the NICO Loop tidal volume entry of patient data and breathing circuit integrity At higher confidence levels the system can more quickly resolve changes in C O and is therefore able to display those changes more quickly At lower confidence levels the system must work harder at resolving C O changes thereby delaying how quickly that information can be displayed The delay from detection to display of changes in C O can range from e 5 segments 1 5 2 minutes 4 segments 3 7 minutes e 3 segments 5 9 5 minutes 2 segments 7 9 5 minutes segment 8 5 9 5 minutes A lower number of segments indicates that the displayed cardiac output reading is being averaged more wi
10. Warranty for NICO Monitor and CAPNOSTAT CO Sensor is 2 years NICO Sensor 10 per box Small size for tidal volumes of 200 500 mL NICO Sensor 10 per box Standard size for tidal volumes of 400 1000 mL NICO Sensor 10 per box Large size for tidal volumes of 750 1500 mL CAPNOSTAT CO Sensor NICO Cable Management Straps for use with the CAPNOSTAT CO Sensor Organizes and holds multiple cables and tubings package of 5 CAPNOSTAT CO Sensor Cable Holding Clips 50 per box SuperBright Finger Sensor 10 ft sensor cable 1 yr warranty SuperBright Y Sensor 10 ft sensor cable 90 day warranty NICO CO5 Flow Sensors 10 per box Neonatal size NICO CO Flow Sensors 10 per box Pediatric size NICO CO Flow Sensors 10 per box Adult size Single Patient Use Airway Adapter 1 piece Adult size Single Patient Use SpO Sensor 10 per box Pediatric Adult Single Patient Use SpO Sensor 25 per box Pediatric Adult Single Patient Use SpO Sensor 10 per box Neonatal Pediatric Single Patient Use SpO Sensor 25 per box Neonatal Pediatric Saturation Sensor Extension Cable 4 feet Saturation Sensor Extension Cable 6 feet Saturation Sensor Extension Cable 10 feet Saturation Sensor Extension Cable 25 feet Saturation Sensor Extension Cable 50 feet 20mm Wrap Style Y Strip Taping System 100 per box Neon
11. additional consideration such as more frequent site checks may be appropriate Periodically check sensors and tubing for excessive moisture or secretion build up Although NICO automatically purges the lines excessive moisture or secretions may still remain While using the sensors a system leak such as that caused by uncuffed endotracheal tubes or a damaged sensor may significantly affect flow related readings These include flow volume pressure deadspace CO production and other respiratory mechanics parameters Do not position sensor cables or tubing in any manner that may cause entanglement or strangulation The NICO monitor is not intended to be used as an apnea monitor The NICO monitor has no protection against the ingress of water CAUTI ON N Indicates a condition that may lead to equipment damage or malfunction Use only Novametrix approved sensors and accessories with the NICO monitor Do not operate the NICO monitor when it is wet due to spills or condensation Do not operate the product if it appears to have been dropped or damaged Never sterilize or immerse the monitor in liquids Do not sterilize or immerse sensors except as directed in this manual No tension should be applied to any sensor cable or tubing To avoid the effects of excessive moisture in the NICO Sensor insert it in the ventilator circuit with the pneumatic tubes upright Excessive moisture in the NICO Sensor may affect the accurac
12. s Manual iii About this manual NICO Monitor Technical Description Manufacturing Quality amp Safety Declaration of Conformity with European Union Directive Trademarks and Patents Manual Revision History 0086 IV NICO User s Manual Introduction This manual is written for clinical personnel using the Novametrix NI CO Non Invasive Cardiac Output Monitor Model 7300 and the sensors and accessories intended for use with the monitor This document contains information which is proprietary and the property of Novametrix Medical Systems Inc and may not be reproduced stored in a retrieval system translated transcribed or transmitted in any form or by any means without the prior explicit written permission of Novametrix Medical Systems Inc Novametrix reserves the right to change specifications without notice Per requirements of IEC 601 1 the NICO monitor is classified as class equipment internally powered with type BF applied part and an enclosure protection rating of IPXO The NICO monitor is Year 2000 compliant Transport Storage 10 to 55 C 14 131 F 10 95 R H non condensing Operating Conditions 10 to 40 C 50 to 104 F 10 90 R H non condensing The NICO monitor Model 7300 contains no user serviceable parts Refer servicing to qualified service personnel A technical Service Manual is available for use by technical personnel The Novametrix Medical Systems Inc ma
13. 05 NI CO User s Manual 85 Analog Output Output to a Serial Printer Output files for use on a PC Setup 86 NICO User s Manual For output to a serial printer such a strip chart recorder or the Seiko DPU 414 printer configure your serial printer to 9600 bps no parity 8 data bits 1 stop bit An output sample is shown below 2000 Els Z4 MV When configured to ASCII OUTPUT 2 NICO will output a text file that can be imported into a spreadsheet program such as Microsoft Excel Configure your serial device to 19200 bps no parity 8 data bits 1 stop bit Data is output once every breath An output sample is shown below 10 40 04 PR 75 SPO2 97 RR 20 C 0 0 0 C 0 f 0 0 CI 20 0 SV 0 VCO2 429 ETCO2 39 PECO2 32 MV 12 2 MVALV 11 0 Vti 916 Vte 907 Vtalv 546 VdAW 63 PIP 45 MAP 22 PEEP 9 Cdyn 27 Raw 13 Analog Output NICO directly supports interface to analog devices The NICO monitor must be set to the appropriate interface 1 Oo 01 5 CO Press the Operate Standby key to turn the monitor on f and off NICO can operate from its internal battery or from the AC Mains See AC Battery Operation on page 4 for details A Press the MENU key to activate SELECT A SCREEN The key s green icon illuminates Press the key again to return to the previously displayed screen MENU Highlight and then select SETUP by turning and then pressi
14. Agilent Technologies VueLink Interface The NI CO interface to the Agilent Technologies VueLink module provides a pathway for NICO data to be viewed on the Agilent Technologies Patient Monitoring System The data from NICO is available for display in conjunction with the other parameters configured for display on the Agilent Technologies Patient Monitor Preparing for Use To setup and connect the NICO monitor to the Agilent VueLink module you will need the following NICO monitor with software revision 3 1 or greater Agilent Patient Monitor with software revision C 9 xx or higher Agilent VueLink module Auxiliary Plus B with Open Interface product number M1032 option A05 Agilent 4 meter VueLink Interface Cable part number K6B 25 pin female to 9 pin male null modem crossover cable NOTE The Agilent Patient Monitor VueLink Module and Agilent interface cable are supplied by Agilent Component Setup 1 Connect the CAPNOSTAT CO sensor flow sensor pulse f oximeter probe and AC power cord to the NI CO monitor 2 Connect the 25 pin male connector on the VueLink Interface Cable to the 25 pin female connector on the null modem cable then connect the 9 pin male connector to the rear panel of the O20 NICO Tighten screws Bj 3 Connect the other end of the VueLink cable to the VueLink module by grasping the end of the
15. Description Percent of oxygen in the inspired gas Must be entered in order for NICO to accurately calculate parameters Percent of anesthetic agent in the inspired gas Must enter percent delivered in order for NICO to accurately calculate parameters N gt He or N20 Must select the correct balance in the inspired gas in order for NICO to accurately calculate parameters Enter patient height Enter patient weight for respiratory mechanics calculations Partial pressure of carbon dioxide in arterial blood Enter this value for calculation of Vd alv alveolar deadspace Vd Vt deadspace to tidal volume ratio and Vd phys physiologic deadspace Partial pressure of oxygen in arterial blood Enter a value for this parameter if desired does not affect CO gt flow calculations Concentration of hemoglobin or hematocrit in the blood Enter a value for parameter if desired does not affect CO gt flow calculations Enter time ABG is drawn Only accepts time since ETCO gt was first detected Resets blood gas settings to default values 35 NI CO User s Manual Entering ABG Data Entering Patient Data To enter or view patient data 1 Press the DATA ENTRY key to activate DATA ENTRY The key s green icon illuminates e Press the key again to return to the previously displayed screen Highlight the desired data by turning the KNOB Select the highlighted data by pressing the KNOB Turn the KNOB to adj
16. Mechanics mode AC Mains Power Indicator This icon illuminates green to indicate AC Mains power is applied to the monitor To illuminate the icon the monitor must be plugged into the AC outlet and the monitor s rear panel power switch must be on OPERATE STANDBY key Press this key to turn the monitor on If connected to the AC outlet the monitor uses AC power otherwise it powers up using its internal battery provided the battery is charged Press the OPERATE STANDBY key again to put the monitor into Standby mode if using AC power or to turn it off if using battery power Kickstand front and rear The NICO monitor can be positioned for better viewing from above or below by extending the kickstand at the front or rear of the monitor Rear Panel The NICO monitor s rear panel includes an AC Mains power input module three RS232 serial communications ports an analog input output port equipotential connector fan and ventilation slots and the monitor s serial number label These are explained below Rev 05 Symbols 16 17 18 19 20 21 22 SERIAL NUMBER VOLTS Hz TUSE i 138 1234 120 60 2 NOVAMETRIX MEDICAL SYSTEMS IN Wallingford Connecticut U S A 06492 LZ Ko WY 100 120 200 240 VAC 1A S B 2 100 120V NOVAMETRIX Cc 50 60 Hz 70VA JAN T500mA 2 200 240V MEDICAL SYSTEMS INC WALLINGFORD CT U S A G
17. NICO Sensor will cause the monitor to automatically switch to Cardiac Output mode The monitor is in a READY state and the parameters will be dashed and alerts will not be active until parameters are calculated and displayed Parameters will display and their alerts will become active as they are calculated Connect the sensors to the monitor ventilator circuit and patient r ar 1 Connect the SpO sensor to the monitor and apply it to the o patient See Pulse Oximetry Sensors on page 67 zm 2 Connect the CAPNOSTAT CO Sensor to the monitor O20 mer GO See CAPNOSTAT CO2 Sensor on page 65 3 Select a NICO Sensor see Choosing a NICO Sensor size on i page 60 d 4 Connect the NICO Sensor to the monitor and attach a CAPNOSTAT See NICO Sensor on page 59 5 Use the Initial Adjustment Template as a guide and adjust the NICO Loop to match the ventilator s tidal volume setting then discard the template See Instructions on the NICO template Rev 05 Begin NICO monitoring 6 For optimal results place the NICO Sensor into the ventilator circuit between the endotracheal tube and the ventilator circuit wye Place other devices HME filters etc between NICO Sensor and the patient connection e The NICO Sensor increases airway deadspace by 35 cc minimum At low tidal volumes compensatory changes to ventilation protocol should be considered e Pl
18. a NICO Sensor size based on the tidal volume ranges listed below Sensor size Sensor Size Tidal Volume Range Part Number Small For use with ventilator set tidal volumes of 200 500 ml 8950 00 Standard For use with ventilator set tidal volumes of 400 1000 ml 8951 00 Large For use with ventilator set tidal volumes of 750 1500 ml 8952 00 WARNI NG The NICO Sensor is not for pediatric use The NICO Sensor increases airway deadspace by 35 cc minimum At low tidal volumes compensatory changes to ventilation protocol should be considered Connecting a To connect a NICO Sensor into the ventilator circuit TM NICO Sensor 1 Remove a new NICO Sensor and loop adjustment template from its package Open and inspect the sensor Do not use if damaged 2 Using the Initial Adjustment Template as a guide adjust the NICO Loop to match the ventilator s tidal volume setting Discard the template A 60 NICO User s Manual Rev 05 Disposable NICO Sensors Status Messages Rev 05 3 Insert the connector on the NICO Sensor into NICO monitor s front panel Verify a NICO SENSOR IDENTIFIED message is briefly displayed 4 Attach the CAPNOSTAT to the NICO Sensor and connect the NI CO Sensor to ventilator circuit For optimal results place the NICO Sensor into the ventilator circuit between the endotracheal tube and the ventilator circuit wye Place other d
19. baseline in less than 30 seconds The Fick equation using CO as an indicator states that cardiac output is equal to CO elimination divided by the venous arterial difference in the CO content VCO5 CvCO5 CaCO The partial rebreathing method yields a differential form of the Fick equation eliminating the need to measure mixed venous CO assumed constant during the rebreathing period and therefore cancels out of the equation This indirect Fick method is then corrected for shunt Rev 05 Principles of Operation Carbon Dioxide CO gt Flow and Pressure Carbon Dioxide Elimination VCO Oxygen Saturation SpO gt amp Pulse Rate Rev 05 based on the Nunn s iso shunt curves using SpO or entered PaO and a user entered value for FiO INSP O gt NICO uses the CAPNOSTAT CO Sensor to measure CO by using the infrared absorption technique The principle is based on the fact that CO molecules absorb infrared IR light energy of specific wavelengths with the amount of energy absorbed being directly related to the CO concentration When an IR beam is passed through a gas sample containing CO the electronic signal from the photodetector which measures the remaining light energy can be obtained This signal is then compared to the energy of the IR source and calibrated to accurately reflect CO concentration in the sample To calibrate the photodetector s response to a known concentration of CO is stored at the fa
20. be enabled or disabled for each individual high and low limit setting Limits cannot be adjusted to provide less than a 5 digit separation between the high and low limit values Violating the 5 digit minimum separation constraint may cause previously set alerts to reset or turn off NOTE The message ALERTS OFF will appear if the monitor is powered up with all alert limits and audible alerts set to OFF To cancel the ALERTS OFF message adjust any individual limit value and activate the audible alert 1 Both the alert limit and audible alert must be activated View Alert Settings To view the existing alert settings 1 Press the MENU key The SELECT A SCREEN menu appears 2 Highlight and then select SET ALERTS by turning and then pressing the knob 3 The SET ALERTS screen is displayed Adjust Alert Limits To adjust LOW or HIGH alert limit values 1 Display the SET ALERTS screen Press MENU then select SET ALERTS 2 Highlight and then select the LOW or HIGH limit you wish to adjust PIP is HIGH only 3 Turn the knob to adjust the limit then press the knob to accept the displayed value 4 If desired enable the audio for the alerts which have been enabled See below Enable Disable To enable or disable the audible alert tone s for a particular alert Audible Alerts 1 Display the SET ALERTS screen Press MENU then select SET ALERTS 2 Highlight the bell icon for the alert you wish to adjust 3 Press the knob to s
21. connector and pushing it into i the receptacle on the VueLink module 4 Plug the VueLink Module into an available slot in the Agilent monitoring system module rack e The VueLink module may be stored in the rack when not in use Rear panel VueLink Interface Cable 25 pin connector fc a dr WS oe L OL 9 pin connector l Agilent Technologies was formerly Hewlett Packard The information above also applies to existing HP products Rev 05 NI CO User s Manual 83 Agilent Technologies VueLink Interface Transmitted Parameters 84 NICO User s Manual 1 Press the Operate Standby key to turn the monitor on and off NICO can operate from its internal battery or from the AC Mains See AC Battery Operation on page 4 for details 2 Press the MENU key to activate SELECT A SCREEN The key s green icon illuminates f Press the key again to return to the previously displayed screen Oo OF KB CO The SETUP screen is displayed Turn and press the KNOB to select INPUT OUTPUT Turn and press the KNOB to select RS232 2 or RS232 3 Turn and press the KNOB to select VUELINK Highlight and then select SETUP by turning and then pressing the KNOB NOTE If you need detailed installation and operating instructions for the Agilent V
22. data 1 Press the DATA ENTRY key to activate DATA ENTRY The key s green icon illuminates Press the key again to return to the previously displayed screen Highlight the desired data by turning the KNOB Select the highlighted data by pressing the KNOB Turn the KNOB to adjust the value as desired Press the KNOB to accept the value o oo fF c N Repeat these steps for the other settings ABG DATA ENTRY DATA ENTRY WEIGHT ENTER F iE INSP AGENT FB ALAMNCEI EB m CLE are in TURN PUSH TO ADJUST TO ACCEPT Entering ABG Data To enter ABG data 1 Draw blood sample during the normal phase of the EL DIM NICO cycle not during the rebreathing phase The cardiac output message will display how much time before the next rebreathing phase occurs Rev 05 NI CO User s Manual 20 Entering ABG Data 2 Press the DATA ENTRY key to activate DATA ENTRY The key s green icon illuminates e Press the key again to return to the previously displayed screen 3 Highlight ABG DATA ENTRY by turning the KNOB 4 Select ABG DATA ENTRY by pressing the KNOB ABG DATA ENTRY 1 T L Fal Ay 7 P DATA ENTRY vdr YL PUSH i dl ri l ki DEFAULT ABGSs Anc E gar mmrmnd FN LT L pius T GO EN TIME TURN PUSH TO SELECT TO ACCEPT 30 NICO User s Manual Rev 05 C O Averaging CObar Confidence Indicator C O Fast Mode Rev 05 5 Turn and press the KNOB to select the PaCO PaO Hb Hct
23. for VCO ETCO and pulse rate Additionally CO f C O fast mode unaveraged is reported for the last completed cycle PROGRESS LF NG omes How NI CO User s Manual 39 Cardiac Output mode Whe hs B ufa The Rebreathing Curves Screens can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting REBREATH CURVES To switch between the two curves push the KNOB Data is plotted from left oldest data to right newest data e Points on the trend plotted or blank represent the VCO or ETCO value for each breath The curves are automatically scaled to fit the display area Two one pixel wide dashed vertical lines are used to divide the curve into its baseline rebreathing and stabilization phases e ETCO and SpO values will flash if an alert limit is exceeded CO and SpO The CO and SpO gt z Waveform Screen plots the capnogram and plethysmogram signals as well as Waveform Screen wi The C0 Sp0 screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting C0 5p0 Information is updated in real time and reflects current patient status The capnogram and plethysmogram are automatically scaled The capnogram sweep speed is selectable in the SETUP menu e ETCO RR SpO and pulse rate values will flash if an alert limit is exceeded Flow and Pressure The Flow and Pressure Waveform
24. gas by pressing the DATA ENTRY key See Entering Patient Data on page 28 3 If available enter the patient s PaCO5 PaO hemoglobin and hematocrit in the ABG DATA ENTRY screens then mark the ABG time before exiting See Entering Patient Data on page 28 Rev 05 NI CO User s Manual 25 Begin NICO monitoring NOTE Vd Vt Phy Vd Phy and Vd alv are calculated based on the PaCO value last entered and are not updated until the next time the PaCO value is entered or changed 4 As you begin monitoring with NICO please note the following Reliance on Cardiac Output parameters NICO SV amp Cl should be taken in context with other monitoring parameters and the physiologic condition of the patient e Entry of patient height and weight is required to calculate and display Cardiac Index Pulse oximetry is required to calculate and display Stroke Volume SV Accuracy of cardiac output and related parameters will be affected by the following e Significant fluctuations in mixed venous CO content or metabolic CO production during any three minute measurement period e Sudden release of CO into the bloodstream such as when releasing a cross clamp e The presence of excessive moisture or secretions in the NICO sensor Entry of blood gas information e Due to the periodic rebreathing for NICO measurements the patient s effective ventilation will be reduced by typically 10 1596 depending on the rebreathing volume
25. given pressure Note that if the ventilator is set for an inspiratory pause that is detected by NICO Cdyn becomes Cstat C O divided by body surface area Maximum CO plateau value at the end of the breath reflects alveolar CO gt Maximum CO value observed during the baseline portion of the Inspiratory phase of the breath baseline shift above zero point Mean average pressure in the airway throughout the breath Volume in liters of gas delivered to the patient per minute MV less deadspace wasted ventilation Portion of the cardiac output that is effective in gas exchange Volume weighted average CO in the breath Pressure in the lungs at the end of expiration Highest absolute flow rate during expiration Highest absolute flow rate during inspiration Peak highest pressure in the airway during inspiration Screen Display All Last Completed Cycle rebreathing curve amp Tabular Data Last Completed Cycle rebreathing curve amp Tabular Data Numerics amp Tabular Data All Numerics Respiratory Numerics CO2 SpO SBCO Tabular Data amp rebreathing curves General Message Area if above 3 mmHg for 10 sec 0 4 96 or kPa Numerics amp Tabular Data Numerics Respiratory Numerics amp Tabular Data Numerics Respiratory Numerics amp Tabular Data 3 min Cycle in Progress rebreathing curve amp Tabular Data Respiratory Numerics amp Tabular Data Numeric
26. it If the problem persists contact qualified service personnel REBREATHI NG OFF PRESS y KEY TO CONTI NUE REBREATHING PAUSED WAITI NG FOR ETCO lt XX REBREATHING PAUSED Rebreathing and therefore C O measurements are currently disabled and can be enabled by pressing the STOP CONTINUE REBREATHING key Rebreathing and therefore C O measurements have been temporarily paused automatically by the monitor and will resume automatically once the indicated parameter is within the stated range here XX 85 mmHg 11 5 kPa 11 5 96 Rebreathing and therefore C O measurements have WAITING FOR ETCO gt gt XX REBREATHING PAUSED been temporarily paused automatically by the monitor and will resume automatically once the indicated parameter is within the stated range here XX 15 mmHg 2 0 kPa 2 0 96 Rebreathing and therefore C O measurements have WAITING FOR RR 60 br m been temporarily paused automatically by the monitor and will resume automatically once the indicated parameter is within the stated range Rev 05 NI CO User s Manual Uf Message Areas Respiratory Mechanics mode C O Message Alert Message Area Description Class REBREATHI NG PAUSED Rebreathing and therefore C O measurements have L WAITING FOR been temporarily paused automatically by the monitor RR 5 3 br m and will resume automatically once the indicated parameter is within the stated range REBREATHI NG PAUSED Rebreathi
27. patient Rev 05 Y Sensor BE SZ 7 IS Using Foam Wraps To use the foam wraps 8836 00 Non Adhesive Foam Wrap Large Adult pediatric or neonatal use 8943 00 Non Adhesive Foam Wrap Small Neonatal or appropriately sized pediatric patient use 8831 00 20mm Finger Style Y Strip Tape blue Appropriately sized pediatric or adult fingers 8832 00 25mm Finger Style Y Strip Tape green Adult fingers 8828 00 Wrap Style Tapes 20mm blue Neonatal foot hand pediatric toe finger Catalog No 8829 25mm green Neonatal foot hand Size refers to the distance between the holes in the tape 6131 00 Ear Clip Adult or pediatric use Head 1 Press each sensor button through the blue side of the foam N wrap LN i e Place the head with the red LED closest to the edge and the other in either remaining hole removing the Y Sensor s center strip as required Blue 2 If using an adhesive foam tape remove both sides of the paper liner e You can also remove the liners prior to buttoning the sensor into the foam wrap if desired 3 With the blue foam towards the patient wrap around the site Ensure the sensor heads are opposite each other through the tissue Secure in place with the white plastic tab Rev 05 NICO User s Manual 69 Y Sensor e The tab on the Small foam wrap is removable allowing shortening for a better fit Reapp
28. qe Ro ere UC Db S REA LABEL ALAK penne 1 PROM ANGE AA E R A E A A ER 1 nl aree EEEE EE EREI EEE AA E 2 ws AP AA 3 AC Ballery OPeraliOn 3 1 3 229 mund MAMANG DA Ron aa nr us CE MAAGA EPEE NEEDE 4 NICO Parameter List 0 0 Re 5 Principles of Operation 2 0 0c ee en een mn 8 Navigating in Cardiac Output mode 10 Areas of the Display 0 0 a 10 Navigating the Display System ce ene tenn eee 10 KNOB selectable Monitoring Screens 20 eee 11 MENU key Screen Displays 2 13 DATA ENTRY key Screen Displays 0 0 0c ccc eee nee eee 14 Navigating in Respiratory Mechanics mode 16 Areas of the Display ccc nee Ih 16 Navigating the Display System 2 0 0 0 ccc cee eee nee eee 16 KNOB selectable Monitoring Screens 0 eee 17 MENU key Screen Displays ccc ee ee eee tenn eens 18 DATA ENTRY key Screen Displays nananana cece eee 19 Safety reece TT ETTT bo baehneed oe ce oneunauoeorseees 14udenaeneeesaenas 21 Monitoring Cardiac Output 24 Prepanng Tor USE MREMEEREMTIIT 24 Begin NICO monitoring 0 ccc aanne e 25 Entering Patient Dald 442 Re emet E RERO OR UXOR REDE SOEUR ENNA 28 AN Ab Data suueaduuissud nemi quas ERU ERE EARREREKEDISARRS Wa RE 29 erem uice AA 31 Respiratory
29. screen plots the airway flow and pressure signals over time as Waveform Screen well as providing numeric displays of Vte Vti PIP and PEEP PEEP 40 NICO User s Manual Rev 05 Respiratory Screens Optional Numerics Screen Rev 05 The FLOW PRESSURE screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting FLOW PRESSURE e Information is updated in real time e The airway flow and pressure waveforms are automatically scaled The waveform sweep speed is selectable in the SETUP menu The NUMERICS screen display presents several monitored parameters together in one place PI The NUMERICS screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting NUMERICS e Information is updated in real time e The PEEP label is replaced with AUTO if Auto PEEP Intrinsic PEEP is detected e ETCO RR SpO and pulse rate values will flash if an alert limit is exceeded Respiratory Screens Optional NI CO offers four optional respiratory screens displaying Respiratory Numerics Flow Volume and Pressure Volume Loops a Single Breath CO Waveform and the VCO5 MValv Trend Press the MENU key and select RESP SCREENS from the SELECT A SCREEN menu by turning and then pressing the KNOB From the ADD RESPIRATORY SCREENS menu highlight and then select which screens will appear in the base monitoring mode
30. sensor was disconnected from the mon itor after it was powered up Acknowledge by pressing the Silence key The CAPNOSTAT CO sensor is not at proper operating temperature yet Alert Class H NI CO User s Manual 81 GE Medical Systems Solar Interface External Devices GE Medical Systems Solar Interface The Solar monitor from GE Medical Systems Information Technolgies GEMS IT connects to the NICO via an Octanet and a DIDCA interface adapter Solar interface software is compatible with NICO release 2 1 or above If your NICO software is updated please complete and fax the software notification found in your GEMS IT service manual so they can confirm continued compatibility Preparing for Use To setup and connect the NICO monitor to the GEMS IT Solar monitor you will need the following NOTE NICO monitor with software revision 3 1 or greater GEMS IT Solar monitor Model 7000 or 8000 with software version V6A or higher or GEMS IT Solar monitor Model 8000M with software version V1A or higher GEMS IT Octanet module PN OCTANET A DIDCA interface adapter PN 420915 058 GEMS IT Octanet cable PN 418335 00x Cables come in various lengths and are available from GEMS IT GEMS IT Solar monitor cable PN 409752 00x or 700520 00x Optional GEMS IT TRAM Net Hub PN 410217 001 and TRAM Net cable PN 409752 00x Instructions for use of the TRAM Net are detailed within Octane
31. than 1000 ml The NICO monitor is suggesting a different sized sensor with a smaller loop to correct the condition Resizing the NICO Loop was not effective because the L ventilator set tidal volume is greater than 1000 ml The NICO monitor is suggesting a different sized sensor with a larger loop to correct the condition The NICO Loop expandable rebreathing volume on L the NICO Sensor needs to be expanded Expand the loop by approximately 3 6 inches or until the message is removed Note that the message is displayed only during the rebreathing phase of the NICO cycle If the loop is not appropriately sized by the end of the rebreathing phase the message will be removed and displayed again during the next rebreathing phase If this message persists with maximal expansion of the NICO Loop the tidal volume may be too large for the ventilatory conditions for NICO to report accurate results There are x xx minutes seconds until the beginning of S the next rebreathing period provided as an indicator as to the current state of the NICO cycle The NICO Sensor has not been connected to the S monitor since it was last turned on Rev 05 Message Areas Cardiac Output mode C O Message Area O REBREATHI NG REBREATHING OFF Message Description The patient is currently rebreathing a portion of his her tidal volume in order for NICO to calculate cardiac output provided as an indicator of the cu
32. time Waveform Screen The FLOW PRESSURE screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting FLOW PRESSURE e Information is updated in real time e The airway flow and pressure waveforms are automatically scaled The waveform sweep speed is selectable in the SETUP menu Flow Volume and The Flow Volume and Pressure Volume Loops screen displays a flow versus volume loop and a Pressure Volume volume versus peak airway pressure loop Loops screen The FLOW PRES VOL screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting FLOW PRES VOL The flow volume loop is plotted in a clockwise direction comparing flow versus volume for a single patient breath and providing information regarding the condition of the airways The pressure volume loop is plotted in a counter clockwise direction the slope from the beginning of inspiration to the end of inspiration depicts compliance while the width of the loop references resistance The curve is automatically scaled to fit the display area Rev 05 NI CO User s Manual 47 Respiratory Mechanics mode Set Overlay The Set Overlay function freezes a single breath on the FLOW PRES VOL screen as a template Subsequent loops will be drawn over that breath e Press the KNOB to highlight SET OVERLAY and again to select the breath e Press the K
33. to when the overlay was set The VC02 MVALV TREND screen displays trends for alveolar minute ventilation and CO elimination Monitoring spontaneous versus mechanical alveolar ventilation along with CO elimination provides information on continued success or impending failure when weaning a patient off a ventilator While viewing the VCO2 MV ALV TREND screen each push of the knob will advance through the available 30 minute and 2 4 8 and 12 hour trend displays Data is plotted from left oldest data to right newest data Once the display is filled data shifts left so that the oldest data point on the left is pushed out to make room for the newest point entering from the right NI CO User s Manual 43 Respiratory Screens Optional Each bar on the trend represents the average MValv or VCO value over a time period The time periods are 1 minute average for the 30 minute trend 4 minute average for the 2 hour trend 8 minutes for the 4 hour trend 16 minutes for the 8 hour trend and 24 minutes for the 12 hour trend Systemic Vascular The SVR CALCULATION screen displays the Systemic Vascular Resistance formula and allows for Resistance SVR entering the MBP CVP and C O values for calculating the SVR value The screen also displays Calculation the current time and last SVR value To calculate the SVR value EN 1 Press the MENU key The SELECT A SCREEN menu appears o 2 Highlight and then select SVR CALCULATION b
34. 1 12 11 13 11 14 Time Column With the TIME column selected flashing turn the KNOB to display NICO parameters collected since the beginning of the monitoring session the most recent records are at the bottom of the table Three arrows WV will display at the bottom of the column when more records are available The SET ALERTS screen displays the current patient values as well as the LOW and HIGH alert limit settings for various parameters PIP is HIGH only This screen also allows adjustment of alert limits audible alert volume and of the No Respiration alert See Alerts on page 56 for details y P ih HO RESP Tm L4 Rev 05 Respiratory Mechanics mode The SET ALERTS screen can only be displayed by pressing the MENU key and selecting SET ALERTS e CURRENT the current patient value for a parameter shown in real time NOTE The CURRENT value will flash when a high or low alert limit is exceeded e LOW and HIGH the values below and above which an alert will be generated k Bell with slash the audible alert is disabled for this limit a Bell the audible alert is enabled for this limit e AUDIO set the audible alert volume level e AUTO LIMITS have the NICO monitor bracket alerts around current patient values e NO RESP set the No Respiration alert delay timer Setup Screen The SETUP screen allows the user to perform certain functions such as a CO Zero erase trend d
35. CO Tabular Data Tabular Data Respiratory Numerics Flow Pressure amp SBCO Tabular Data Tabular Data Rev 05 NICO Parameter List Respiratory Mechanics mode Label Parameter Cdyn Dynamic Compliance ETCO End Tidal Carbon Dioxide I E I E Ratio MAP Mean Airway Pressure MV Minute Volume MV alv Alveolar Minute Volume NI P Negative Inspiratory Pressure PeCO gt Mixed expired CO FeCO gt PEEP Positive End Expiratory Pressure PEF Peak Expiratory Flow PIF Peak Inspiratory Flow PIP Peak Inspiratory Pressure Pulse Rate Airway Resistance RR Respiration Rate RSBI Rapid Shallow Breathing Index SpO gt Oxygen Saturation Rev 05 Range Units 0 500 ml cmH5O 0 150 mmHg 0 20 0 96 0 20 0 kPa 1 9 90r4 1 0 100 cmH5O 0 4 40 L min adult 0 06 30 L min pedi 0 01 5 L min neonatal 0 16 L min adult 0 8 L min pediatric 0 4 L min neonatal 0 to 120 cmH O 0 100 mmHg 0 13 2 kPa or 96 0 99 cmH5O 2 180 L min adult 0 5 100 L min pedi 0 25 25 L min neo 2 180 L min adult 0 5 100 L min pedi 0 25 25 L min neo 0 120 cmH5O 30 250 bpm 0 100 cmH5O L sec adult pediatric 0 500 cmH 0 L sec neonatal 2 120 br min adult 2 150 br min pedi 10 150 br min neo 0 1000 br min L adult only 0 100 96 The NICO monitor displays the parameters described in this table Description Volume the lungs expand for a given pressure Maximum CO plateau value at the end of
36. CO Sensor Oxygen saturation SpO gt is used by the NICO monitor to calculate the shunt correction of the NICO calculation and the pulse rate is used to calculate stroke volume SpO is determined using sensors containing red and infrared light emitting diodes LEDs The light from each LED is beamed through a pulsating vascular bed such as the patient s finger or toe The remaining light not absorbed by the tissue reaches a photodiode light receptor in the sensor Oxygen saturated blood absorbs different amounts of light at each wavelength as compared to unsaturated blood Therefore the amount of light absorbed by the blood in each pulse can be used to calculate oxygen saturation NICO is calibrated to display functional saturation This differs from the fractional saturation value displayed by most co oximeters Functional saturation represents the amount of oxyhemoglobin as a percentage of the hemoglobin that can be oxygenated Dysfunctional hemoglobins COHb and METHb are not included in the measurement of functional saturation e Functional Saturation HbO5 100 COHb METHb HbO is fractional hemoglobin COHb is carboxyhemoglobin and METHb is methemoglobin Pulse Rate derived from the pulse oximetery sensor is calculated by measuring the time interval between the peaks of the infrared light waveform The inverse of this measurement is displayed as pulse rate NI CO User s Manual 9 Areas of the Display Naviga
37. D US PATENTS 4 859 858 4 859 859 4 914 720 T 5 146 092 5 153 436 5 190 038 5 206 511 5 251 121 CAUTION FEDERAL U S A LAW RESTRICTS 5 347 843 5 369 277 5 379 650 5 398 680 5 616 923 THIS DEVICE TO SALE DISTRIBUTION OR EEE Eas Ue aN Ue sb le USE BY OR ON THE ORDER OF A LICENSED ED MEDICAL PRACTITIONER du Qu e Pier 4 C Pb MEDICAL Yea s CAUTION EQUIPMENT MUST BE GROUNDED AT ALL TIMES TO AVOID DANGEROUS ELECTRICAL SHOCK HAZARD p 4371773 EE I NREFER TO USER S MANUAL PRIOR TO USE GENE eum Model 7300 Made in U S A d AC Mains Power Cord Connection Connect only approved hospital grade line cords to this connector AC Mains Power Switch This switch controls the flow of AC current into the NICO monitor Press the portion of the switch to supply the monitor with AC power or the O portion of the switch to interrupt the flow of AC power If supplied with AC power the monitor illuminates the front panel AC Mains Power Indicator energizes the fan and recharges the internal battery RS232 Communications Ports Three 9 pin serial communications ports provide for digital communications with the NICO monitor See RS232 Communications Fan The fan draws air in through the monitor Do not block the fan s air intake slots Serial Number Label The NICO monitor s serial number is shown here Refer servicing to qualified personnel Power cord retaining clip If desired remove the
38. Default CO UNITS mmHg 96 kPa Select the desired units for the mmHg capnogram PeCO5 ETCO and PaCO values ETCO AVG 10 sec 20 sec Select the interval from which the 10 sec 1 Breath displayed value of end tidal CO ETCO gt is calculated Select the averaging time for the 1 min displayed value of CO elimination VCO gt VCO gt AVG 10 min 7 min 5 min 3 min 1 min 8 Breath ALLOW AUDIO OFF N A When the ALLOW AUDIO OFF setting is Yes set to YES the audible alert tone may be silenced permanently by pressing and holding the SILENCE key If the ALLOW AUDIO OFF is set to NO the audible alert tone may not be silenced for more than 2 minutes LANGUAGE Select the desired language English Reference Handbooks For a discussion on waveform interpretations refer to the Novametrix Reference Handbooks on capnography respiratory mechanics and pulse oximetry Contact Novametrix Customer Service or your local sales representative for more information NICO User s Manual 55 NICO Alert Priorities Alerts This section describes NICO monitor alerts NICO Alert Priorities The NICO monitor prioritizes alert notifications This prioritization allows an alert condition for which an immediate user response is required to take precedence over a lesser alert for which a less urgent response is acceptable Alert notifications may include on screen display messages and audible tones and may result from violations o
39. Monitoring Llseeeseeeee 32 iceo u hom cmT X 32 Begin Respiratory Monitoring 0 a 34 Entering Patient Data 2 2 2 lt desccceweeadesesd dou es eR ee ead E Rm Pee eee ees 34 Enternmnd ABG Wald AA AA AA 36 Monitoring and Setup Screens 39 Cardiac Output mode ssssseseeleese rn 39 Respiratory Screens Optional 0 0 0c eese 41 Respiratory Mechanics mode a 46 NICO User s Manual V Vi NICO User s Manual Notes on Patient Monitoring 53 Aid on yas ooh gk ow eee ee ee eee eee we ee 53 Manual ale AA AA AY 53 Intra Aortic Balloon Pump 2 2 2 2 eee III 54 Configuration Menu 0 cee hse 55 Reference Handbooks 0 a 55 iij coe hha Hee habe ooh eee hes dete Bok oe Shee cenesehetst ou ber dh eneess 56 NICO Alert Priorities ouuu cece RR 56 Responding to Alert Audio AA AA 56 Parameter Limit Alerts lille 57 No Respiration Alert ccc eee eee In 58 NICO Sensor MU 59 Disposable NICO Sensors ee ern 59 CO Flow Sensors 22 teen eens 62 Choosing a COS FIOW SENSON duasseri dex diera rire obere hende PERPE Pd 63 Connecting a GOs FIOW Sensor uds ig eiie a d dd ccdui Es Ea eria cca eon 63 CAPNOSTAT CO Sensor ll a 65 The CAPNOSTAT CO2 Sensor sss c
40. NOB to highlight CLEAR OVERLAY and again to erase the selected breath The time stamp above the template waveform corresponds to when the overlay was set VCO MValv Trend The VC02 MVALV Trend screen displays trends for alveolar minute ventilation and CO elimination Screen Monitoring spontaneous versus mechanical alveolar ventilation along with CO elimination provides information on continued success or impending failure when weaning a patient off a ventilator While viewing the VCO2 MVALV Trend screen each push of the knob will advance through the available 30 minute and 2 4 8 and 12 hour trend displays Data is plotted from left oldest data to right newest data Once the display is filled data shifts left so that the oldest data point on the left is pushed out to make room for the newest point entering from the right e Each bar on the trend represents the average MValv or VCO value over a time period The time periods are 1 minute average for the 30 minute trend 4 minute average for the 2 hour trend 8 minutes for the 4 hour trend 16 minutes for the 8 hour trend and 24 minutes for the 12 hour trend Vt Vd Trend Screen The Vt Vd TREND screen displays trends for mechanical and spontaneous airway deadspace and alveolar tidal volume Monitoring spontaneous versus mechanical deadspace along with expired tidal volume provides information on continued success or impending failure when weaning a patient off a ventilat
41. Pediatric Foam Wrap Style Neonatal or appropriately sized pediatric patients CAUTI ON should not be used across multiple patients Single Patient Use sensors should not be Single Patient Use SpO sensors can be reapplied to a single patient as needed but cleaned or disinfected System performance may be compromised as a result Replace sensor instead 1 Select the appropriate size sensor based on the patient type 2 With the blue foam towards the patient wrap around the site Ensure the sensor heads are opposite each other through the tissue Secure in place with the white plastic tab Double sided adhesive dots included with the sensor can be applied over the LED and detector components to help hold the sensor to the site Rev 05 NI CO User s Manual 71 Single Patient Use Sensors The tab on the Neonatal Pediatric sensor is removable allowing shortening for a better fit Reapply the tab to secure the sensor in place Neonatal Pediatric ZA 2 Cut 3 Z Adult Pediatric Finger EN Pediatric Toe I Neonatal hand Neonatal foot 72 NICO User s Manual Rev 05 Message Areas Cardiac Output mode General Message Area Rev 05 Messages Message Areas Cardiac Output mode For Respiratory Mechanics messages see page 78 In Cardiac Output mode the monitor uses two screen locations the General PULSE SEARCH Message Area and the C O Message Area to convey information
42. VALVE ZERO ERR MONITOR INOPERABLE rebreathing valve control circuitry or related pneumatic components Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its pulse SpO gt HDW ERROR NO RESP xx Xx PULSE SEARCH oximetry sub system Contact qualified personnel for monitor repair or exchange The time selected in the SET ALERTS screen for the NO RESP no respiration alert was exceeded since the end of the last detected breath press MENU key then select SET ALERTS to view the alert limit settings The pulse oximeter is not detecting a sufficient pulse This could be due to e SpO sensor is off of the patient nsufficient perfusion at the site Tissue at the site is too thick or too thin The pulse oximeter sensor is faulty Replace the sensor SpO PROBE FAILURE SpO gt PROBE WARMUP and contact qualified service personnel The pulse oximeter sensor was not connected to the NICO monitor when it was powered up e Flashing SpO sensor was disconnected from the mon itor after it was powered up Acknowledge by pressing the Silence key The CAPNOSTAT CO sensor is not at proper operating temperature yet Rev 05 NI CO User s Manual 75 Message Areas Cardiac Output mode C O Message Area contain a message The C O Message Area is dedicated to cardiac output related information and may be blank or The C O Message Area messages
43. acement of a sidestream gas analyzer sampling port between the NICO Sensor and the patient connection may reduce NICO accuracy at low tidal volumes e Sidestream or mainstream gas analyzers placed between the NICO Sensor and the patient circuit Y may be inaccurate during the rebreathing phase of the NICO cycle e Place the sensor so that the triple lumen tubing lines exit from the top of the sensor to help keep them clear and dry Keep the sensor clear of accumulations by proper circuit maintenance NI CO Sensor and CAPNOSTAT Elbow Other devices HME filter etc Patient connection Disposable automatic rebreathing valve x v SP uc NG A es adjustable rebreathing volume NIN PN Anesthesia machine ventilator circuit connection Begin NICO monitoring After the NICO monitor is turned on and the sensors are properly connected and applied cardiac output monitoring can begin 1 Press the STOP CONTINUE REBREATHING key to p initiate monitoring Subsequent presses will Stop Continue the rebreathing process e An icon J identifies rebreathing status e Illuminated Rebreathing is DISABLED Not illuminated Rebreathing is ENABLED CONT OP NU SE EBREATHINGS C2 2 Enter the patient s height and weight for cardiac index calculations and the delivered oxygen anesthetic agent and balance
44. arantee are limited to repairs or at Novametrix option replacement of any defective parts of our equipment except fuses batteries and calibration gasses without charge if said defects occur during normal service Claims for damages during shipment must be filed promptly with the transportation company All correspondence concerning the equipment must specify both the model name and number and the serial number as it appears on the equipment Improper use mishandling tampering with or operation of the equipment without following specific operating instructions will void this guarantee and release Novametrix from any further guarantee obligations Service Department For factory repair service Call toll free 1 800 243 3444 To Call Direct 203 265 7701 Facsimile 203 284 0753 http www novametrix com techline novametrix com Caution Federal U S A law restricts this device to sale distribution or use by or on the order of a licensed medical practitioner Copyright 2001 Novametrix Medical Systems Inc 5 Technology Drive Wallingford Connecticut 06492 All rights reserved Rev 05
45. are listed below in alphabetical order Alert Class H High Priority M Medium Priority L Low Priority S Status Message See NICO Alert Priorities on page 56 for details C O Message Area BLOOD GASES HAVE BEEN RESET CO gt UNSTABLE CO STABILI ZING CONSIDER USING SMALL NI CO SENSOR CONSIDER USING STANDARD NICO SENSOR CONSIDER USING LARGE NICO SENSOR EXPAND LOOP NEXT amp xx xx NICO SENSOR 76 NICO User s Manual Alert Class Message Description A NICO cycle has started after 20 minutes of a no S respiration timeout Data not available when no breaths are detected 20 minutes after the last detected breath The NICO monitor was not able to calculate a cardiac L output value This can be due to e Spontaneous breaths or efforts e Surgeon moving the lungs e Ventilator adjustments Resizing the NICO Loop was not effective because the L ventilator set tidal volume is less than 300 ml The NICO monitor is suggesting a different sized sensor with smaller loop to correct the condition If a small NICO Sensor is currently in use L Resizing the NICO Loop was not effective because the ventilator set tidal volume is greater than 500 ml The NICO monitor is suggesting a different sized sensor with a larger loop to correct the condition If a large NICO Sensor is currently in use Resizing the NICO Loop was not effective because the ventilator set tidal volume is less
46. ata change items like the waveform trace sweep speed and to set the time and date Once set the NICO monitor will use these settings until again changed by the user To display the SETUP screen VENY 1 Press the MENU key to activate SELECT A SCREEN The key s green icon illuminates e Press the key again to return to the previously displayed screen 2 Highlight and then select SETUP by turning and then pressing the KNOB COz ZERO HOW l URGE HOW 3 The SETUP screen is displayed TABP MODE OFI 4 Again turn the KNOB ERASE TRENDS to highlight an item and THPUT OUTPUT push the KNOB to select it Items within the SETUP screen are described below Label Settings Range Description CO ZERO NOW Start or Cancel Displays the CO ZERO NOW screen Place the CAPNOSTAT CO Sensor default Start onto a clean and dry adapter Place the adapter in room air and away from all sources of CO Select START to begin a CO Zero or CANCEL to exit the selection and return to the SETUP menu PURGE NOW n a The system immediately purges the CO gt Flow Sensor tubing No messages are displayed The Purge takes approximately 8 seconds The flow and pressure waveform traces will return to zero during this period IABP ON or OFF Displays the SET SpO IABP MODE screen Turn the KNOB to select OFF Intra Aorta default setting or ON to turn off the validator algorithm so that all Balloon Pump pulsatile data including the normally rejected a
47. atal foot and hand pediatric toe or finger color coded blue 25mm Wrap Style Y Strip Taping System 100 per box Neonatal foot and hand color coded green 20mm Finger Style Taping System 100 per box Use on pediatric finger or on small adult finger color coded blue 25mm Finger Style Taping System 100 per box Use on adult finger color coded green Adhesive Foam Wraps Large 25 per box Adhesive Foam Wraps Small 25 per box Non Adhesive Foam Wraps Large 25 per box Non Adhesive Foam Wraps Small 25 per box Ear Clips 5 per box Ear Clips 25 per box Adhesive Dots 200 per box Rev 05 Rev 05 Catalog No 9861 00 601012 600026 9226 23 9226 90 Description Flow Connector Cap 3 port 25 per bag NICO 9 pin to 9 pin null modem crossover cable Power Cord included with monitor NICO User Manual NICO Service Manual NICO User s Manual 93 94 NICO User s Manual Warranty Equipment manufactured or distributed by Novametrix Medical Systems Inc is fully guaranteed covering materials and workmanship for a period of one year from the date of shipment except for certain disposable products and products with stated guarantees other than one year Novametrix reserves the right to perform guarantee service s at its factory at an authorized repair station or at the customer s installation Novametrix obligations under this gu
48. ations Push the KNOB to accept your selection and return to the SETUP menu ERASE TRENDS Yes or No Displays the ERASE STORED TRENDS screen Turn the KNOB to select NO default No the default setting or YES Push the KNOB to accept your selection and return to the SETUP menu INPUT OUTPUT ANALOG OUT 1 4 Turn the KNOB to select ANALOG OUT 1 through ANALOG OUT 4 ANALOG ANALOG CAL CAL RS232 2 or R232 3 Push the KNOB to accept your selection and RS232 2 RS232 3 assign it the desired output parameter PULSE BEEP OFF and 1 10 Displays the SET PULSE BEEP screen Turn the KNOB to select a volume default OFF 1 10 and OFF for the audible tone to accompany each detected pulse beat Push the KNOB to accept your selection and return to the SETUP menu SWEEP Slow Medium Fast Displays the SET SWEEP SPEED screen Turn the KNOB to select how default Medium quickly the CO Flow and Pressure waveforms sweep across the display Plethysmogram is unaffected Push the KNOB to accept your selection and return to the SETUP menu C O MODE AVERAGE or FAST Displays the SET C 0 MODE screen Turn the KNOB to select AVERAGE CO a CObar displayed FAST CO f CObar not displayed Push the KNOB to accept your selection and return to the SETUP menu SET SPON 0 50 cmH50 Displays the SET SPONTANEOUS THRESHOLD screen The spontaneous THRESHOLD threshold is the airway pressure chosen to differentiate between a spontaneous patient initiated breath and a m
49. become elevated 3 5 mmHg typical and mixed venous CO remains unchanged NOTE The rebreathing period will typically induce an increase in PaCO gt by 3 5 mmHg An ABG blood sample drawn during this period REBREATHING displayed or during the first twenty seconds of the stabilization period where NEXT is displayed may cause PaCO values to reflect higher than normal levels Stabilization After completion of rebreathing a 70 second stabilization period begins during which time VCO PaCO and ETCO return to their baseline values NICO updates the displayed C O value following the completion of each three minute NICO cycle The CObar cardiac output confidence bar provides an indication of the system s confidence in the displayed value See CObar Confidence Indicator on page 31 Rebreathing On Off The user can interrupt or resume the rebreathing cycle at any time by pressing the STOP or Paused CONTINUE REBREATHING key The NICO monitor will not automatically restart the rebreathing cycle that must be initiated by the user pressing the STOP CONTINUE REBREATHING key Note that once rebreathing is initiated by the user the monitor will under certain conditions pause rebreathing until a specified condition see below is corrected at which time the monitor will restart the rebreathing Rebreathing can be Off On or Paused as indicated below Rebreathing OFF disabled e The NICO monitor starts in
50. by turning and then pressing the KNOB screen choices are dimmed until selected When enabled selected screens can be displayed by turning the KNOB while viewing any monitoring screen See KNOB Selectable Respiratory Screens on page 12 TURN PUSH TO SELECT TO ACCEPT NI CO User s Manual 41 Respiratory Screens Optional Respiratory Numerics The RESPIRATORY NUMERICS screen presents several monitored parameters together in one place The RESPIRATORY NUMERICS screen can be displayed when enabled by turning the KNOB while viewing any monitoring screen e Information is updated in real time ETCO value will flash if an alert limit is exceeded Flow Volume and The Flow Volume and Pressure Volume Loops screen displays a flow versus volume loop and a Pressure Volume volume versus peak airway pressure loop Loops The Flow Volume and Pressure Volume Loops screen can be displayed when enabled by turning the KNOB while viewing any monitoring screen The flow volume loop is plotted in a clockwise direction comparing flow versus volume for a single patient breath and providing information regarding the condition of the airways The pressure volume loop is plotted in a counter clockwise direction the slope from the beginning of inspiration to the end of inspiration depicts compliance while the width of the loop references resistance The curve is automatically scaled to fit the display area Set Overlay The Set O
51. creen RESP SCREENS TABULAR DATA SET ra 5 P 0 I PRESSURE ALERTS m L LI w Fa LOW PRESS HOHE RESP SCREEHS CALCULAT L up H L C me Hi TI E r 1 1 13 NI CO User s Manual DATA ENTRY key Screen Displays DATA ENTRY key Screen Displays Press the DATA ENTRY key to activate the DATA ENTRY screen and illuminate the key s green icon Press the key again to return to the previously displayed screen From the DATA ENTRY screen you can enter patient information including height weight and respiratory gas mixture and access the ABG DATA ENTRY screen See Entering Patient Data on page 28 for details DATA ENTRY GATA ENTRY Oo PUSH HEIGHT WEIGHT TURN PUSH TO ADJUST TO ACCEPT 14 NICO User s Manual Rev 05 DATA ENTRY key Screen Displays ABG Data Entry From the DATA ENTRY screen select ABG DATA ENTRY Turn and press the KNOB to enter PaCO Screens PaO5 and Hemoglobin entry screens See Entering Patient Data on page 28 for details PUSH PUSH TURN PUSH TO SELECT TO ACCEPT Rev 05 NICO User s Manual 15 Areas of the Display 16 NICO User s Manual Navigating in Respiratory Mechanics mode Areas of the Display The major sections of the Respiratory Mechanics mode screen are identified below Respiratory data including end tidal Parameters change CO respiration rate saturation and depending on selected pulse rate is displayed i
52. ctory in the monitor s memory A reference channel accounts for optical changes in the sensor allowing the system to remain in calibration without user intervention Flow and pressure measurements in the NICO monitor are made by a fixed orifice differential pressure pneumotachometer Respired gas flowing through the flow sensor causes a small pressure drop across the two tubes connected to the sensor This pressure drop is transmitted through the tubing to a differential pressure transducer located inside the monitor and is correlated to flow according to the factory stored calibration User calibration is not required due to the ability of the plastic injection mold to repeatedly produce precision flow sensors The pressure transducer is automatically zeroed to correct for changes in ambient temperature and electronics The NICO monitor system software compensations allow accurate flow and volume measurements in the presence of high oxygen concentrations anesthetic gases and helium oxygen mixtures When compensated gas density and viscosity effects do not cause significant errors in flow measurement Carbon dioxide elimination VCO5 is a key measurement for NICO calculations It is calculated based on a mathematical integration of the measured flow and CO signals These signals are obtained from practically the same point at the patient s airway thereby insuring optimal accuracy Both the flow and CO sensors are integral components of the NI
53. d 0 0 99 5 96 11 0 gm dL Hb 5 0 20 0 gm dL 6 8 mmol L Hb 3 1 12 4 mmol L 33 96 Hct 0 60 96 displayed until an initial value is entered Current Time hh mm hours minutes PaCO5 5 mmHg 0 7 kPa or 96 above the measured ETCO value PaO Based on barometric pressure and INSP O value Hb 11 0 gm dL a 40mmHg 5 4 kPa or 96 if ETCO is not available 28 NICO User s Manual Description Percent of oxygen in the inspired gas Must be entered in order for NICO to accurately calculate parameters Percent of anesthetic agent in the inspired gas Must enter percent delivered in order for NICO to accurately calculate parameters N 5 He or N5O Must select the correct balance in the inspired gas in order for NICO to accurately calculate parameters Enter patient height for Cl calculations Enter patient weight for CI calculations Partial pressure of carbon dioxide in arterial blood Entering this value can enhance the accuracy of NICO parameters Partial pressure of oxygen in arterial blood Entering this value can enhance the accuracy of NICO parameters Concentration of hemoglobin or hematocrit in the blood Entering this value can enhance the accuracy of NICO parameters Enter time ABG is drawn Only accepts time since ETCO was first detected Resets blood gas settings to default values Rev 05 Entering ABG Data Entering Patient Data To enter or view patient
54. e The NICO monitor detected a problem with its internal clock Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its flow zeroing sub system or related pneumatic components Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its pulse oximetry sub system Contact qualified personnel for monitor repair or exchange A neonatal size CO5 Flow sensor was just connected to the NI CO monitor Alert Class M Rev 05 Message Areas Respiratory Mechanics mode General Message Area NO RESP xx Xx PEDIATRIC CO5 FLOW SENSOR IDENTIFIED PULSE SEARCH SpO PROBE FAILURE SpO gt PROBE WARMUP Rev 05 Message Description The time selected in the SET ALERTS screen for the NO RESP no respiration alert was exceeded since the end of the last detected breath press MENU key then select SET ALERTS to view the alert limit settings A pediatric size CO5 Flow sensor was just connected to the NICO monitor The pulse oximeter is not detecting a sufficient pulse This could be due to e SpO sensor is off of the patient e Insufficient perfusion at the site Tissue at the site is too thick or too thin The pulse oximeter sensor is faulty Replace the sensor and contact qualified service personnel The pulse oximeter sensor was not connected to the NI CO monitor when it was powered up e Flashing SpO
55. e NICO Loop with one hand and the automatic rebreathing valve with the other hand so as not to disturb disconnect the breathing circuit while adjusting the loop 2 Expand or retract the NICO Loop 3 6 inches t may take 2 3 additional breaths before the icon changes Note that if the loop is still not appropriately sized by the end of the rebreathing period the message will be removed and may be displayed again during the next rebreathing period Sensor Size Message If the EXPAND or RETRACT LOOP message appears for more than three rebreathing cycles and resizing the NICO Loop was not effective the NICO monitor will suggest a different sized sensor to correct the condition See Status Messages on page 61 26 NI CO User s Manual Rev 05 Begin NICO monitoring The NICO Cycle Once rebreathing is enabled the NICO monitor automatically repeats a three minute cardiac output measurement cycle This NICO cycle has three phases Baseline During the 60 seconds baseline period the rebreathing valve inside the NICO Sensor is turned off and the rebreathing volume of the NICO Loop is bypassed During this time VCO5 PaCO and ETCO will be at baseline values Rebreathing The 50 second rebreathing period starts when the monitor turns on the rebreathing valve inside the NICO Sensor causing the rebreathing volume of the NICO Loop to be added into the circuit During rebreathing VCO is reduced PaCO and ETCO
56. e ratio Cardiac Output Mode only CO a Average Cardiac Output L min CO f Fast mode Cardiac Output L min CI Cardiac Index L min m PCBF Pulmonary Capillary Blood Flow L min SV Stroke Volume ml SVR Systemic Vascular Resistance dynes sec cm CO parameters are reported in either mmHg kPa or 96 depending upon the CO units currently selected for the NICO monitor Transmitted A total of five waveform are transmitted to the Agilent Patient Monitor a maximum of two may Waveforms viewed at one time Label Waveform Units AWV Volume ml ASCII Output The NICO monitor must be set to the appropriate interface 1 Press the Operate Standby key to turn the monitor on f and off NICO can operate from its internal battery or from the AC Mains See AC Battery Operation on page 4 for details o 2 Press the MENU key to activate SELECT A SCREEN The key s green icon illuminates e Press the key again to return to the previously displayed screen WENY Highlight and then select SETUP by turning and then pressing the KNOB 0 The SETUP screen is displayed Turn and press the KNOB to select NPUT OUTPUT Turn and press the KNOB to select RS232 2 or RS232 3 Oo 0 A OW Turn and press the KNOB to select e ASCII OUTPUT to a serial printer e ASCII OUTPUT 2 for data collection using a PC 8 Connect the device to the appropriate rear panel connector Rev
57. ece cece eee eee 65 CAPNOSTAT Adapter Zero 00 cece cece cence eee eee 66 Pulse Oximetry Sensors 2 2 ccc cnn es 67 S Tuae e A cn nese cece an eneteenr ee eee eases Opes canasen gates 67 AGA aucun can es d rura den rui equ EE dur AA 68 TOM OTN P 68 Single Patient Use Sensors 0 71 Messages a 73 Message Areas Cardiac Output mode eee 73 Message Areas Respiratory Mechanics mode 2000000 eae 78 External Devices 2 2 a 82 GE Medical Systems Solar Interface ls sese 82 Agilent Technologies VueLink Interface 0 0 eee 83 ASCOCIOUDUT AA AA AA nls att 85 Analog OUUU 25 e 123 0E E ador nord oer brani DEI CENE 86 Alerts and Messages 0 ccc eee n eee rn 87 Maintenance een nee e ens 88 Cleaning and Sterilization illii 88 Monitor Maintenance Schedules 0 0 ccc llle 89 Battery Maintenance 0 2 2 2 hr 89 Specifications 6 nnn rn 90 NICO Accessories ccccccccececeecucteecuvetecnnteeees 92 Warranty MRRERRERTRRERCPRETTCPPP 94 Rev 05 General Description Indications Contraindications Rev 05 Welcome to NICO General Description NICO a Non Invasive Cardiac Output monitor from Novametrix Medical Systems Inc non invasively measures and displays cardiac output C O T
58. echanical ventilator breath Turn the KNOB to adjust the setting indicated by a dashed line For optimal setting of the spontaneous threshold the dashed line should be above any spontaneous breaths and below the mechanical breaths Push the KNOB to accept your selection and return to the SETUP menu SET TIME amp DATE hh mm Displays the SET TIME DATE screen Turn the KNOB to highlight the dd mmm yyyy portion of the time date to change Push the KNOB to select that item it begins to flash Turn the KNOB to adjust the flashing item and when correctly set push the KNOB again to accept the value Repeat for the other time date entries Finally turn the KNOB to highlight EXIT and push the KNOB to return to the SETUP menu Respiratory Mechanics mode This section provides an overview of the various monitoring and setup screens in Respiratory Mechanics mode CO and SpO The CO and SpO Waveform Screen plots the capnogram and plethysmogram signals Waveform Screen 46 NICO User s Manual Rev 05 Respiratory Mechanics mode The C05 5Sp05 screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting CO gt Sp05 e Information is updated in real time e The capnogram and plethysmogram are automatically scaled e The capnogram sweep speed is selectable in the 5ETUP menu Flow and Pressure The Flow and Pressure Waveform screen plots the airway flow and pressure signals over
59. ed Tidal Volumes to be higher than set volumes If reported values are higher or lower than expected and water is seen in the line or sensor body purge the lines If purging does not clear the water remove the sensor from the circuit and remove the water by shaking the sensor or by flowing oxygen or compressed air through the tubing or sensor until the water is removed Do not use high pressure for water removal To minimize the effects of aerosolized medications on the CO5 Flow sensor it is rec ommended that the CO gt Flow sensor be removed from the ventilator circuit prior to the delivery of the medication The decision to remove or not remove the CO Flow sensor is the responsibility of the clinician During the purge cycle the pump will be heard Water will condense in the pressure sense lines at a faster rate when used in cooler ambient temperatures Always keep the CO5 Flow sensor tubing pointed in an upward position to minimize pooling of water and secretions at the pressure sense line openings The automatic purge mode may not be disabled During a very low battery condition automatic and manual purging is not allowed Entering Patient Data Respiratory monitoring can be enhanced by the entry of key patient specific data including respired gas composition anesthetic agent balance gas and inspired O Patient data should be updated in the DATA ENTRY screen whenever possible The screen may be accessed at any time b
60. ers by the yellow part number label on the CAPNOSTAT s electrical connector The wrong flow sensor is connected to the NICO monitor Use only a NICO CO j Flow sensor part number 9765 00 9766 00 or 9767 00 If message persists a hardware error is may exist Contact qualified personnel for monitor repair or exchange where xx is a numeric value with units of mmHg kPa or Yo At least 3 mmHg 0 1 or 0 1 kPa of CO has been detected during inspiration other than during rebreathing for at least ten continuous seconds The displayed ETCO value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed pulse rate value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed respiration rate value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed SpO value is below the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The NICO monitor detected a problem with its pneumatic flow and pressure sub system Contact qualified personnel for monitor repair or exchange The NICO monitor detected a problem with its internal barometric pressure sensor Contact qualified personnel for monitor repair or exchang
61. es with a xenon light source or direct sunlight Excessive patient movement Venous pulsations Electrosurgical interference e Use of an IABP NICO measurements will occur provided the following conditions are met e The NICO Sensor assembly is properly installed in the patient s breathing circuit e Valid flow and CO signals are detected with no significant signal artifact e VCO is greater than 20 mL min e ETCO is between 15 and 85 mmHg 2 0 11 5 kPa or 96 during baseline e ETCO is between 15 and 100 mmHg 2 0 13 5 kPa or during rebreathing The tidal volume is greater than 200ml small and standard sizes The tidal volume is greater than 400 ml large size The respiratory rate is between 3 and 60 br min e The STOP CONTINUE REBREATHING key is not illuminated NICO is not paused by the monitor for any other reason displayed in the C O message area e When a new CAPNOSTAT CO sensor is attached to the monitor or is moved from one monitor to another it must be zeroed before use After the life cycle of the equipment and accessories has been met disposal should be accomplished following national and local requirements Rev 05 NI CO User s Manual 23 Preparing for Use Inspect Turn on the monitor Connect and apply the sensors 24 NICO User s Manual Monitoring Cardiac Output This section details the steps needed to begin patient monitoring with the NICO monitor Preparing for Use
62. etup screens in Cardiac Output mode The Cardiac Output Trend Screen plots cardiac output over time TREND The C 0 TREND screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting C O TREND While viewing the C 0 TREND screen each push of the KNOB will advance through the available 2 4 8 and 12 hour trend displays Data is plotted from left oldest data to right newest data Once the display is filled data shifts left so that the oldest data point on the left is pushed out to make room for the newest point entering from the right The current time is shown in the lower right corner of the display and represents time at the right edge of the screen See Setup Screen on page 45 to set the time Each point on the trend plotted or blank represents the average C O value over a time period The time periods are 1 minute average for the 2 hour trend 2 minutes for the 4 hour trend 4 minutes for the 8 hour trend and 6 minutes for the 12 hour trend C O trends are automatically scaled to fit 0 5 0 10 0 15 and 0 20 L min scales A two pixel wide dashed vertical line in the trend is used to denote a power cycle where the NICO monitor was turned off and back on There are two Rebreathing Curves Screens one displays the last completed NICO cycle and the other shows the current cycle Both plot VCO5 and ETCO values over time and also provide numeric displays
63. evices HME filters etc between NICO Sensor and the patient connection Placement of a sidestream gas analyzer sampling port between the NICO Sensor and the patient connection may reduce NICO accuracy at low tidal volumes e Sidestream or mainstream gas analyzers placed between the NICO Sensor and the patient circuit Y may report diluted readings during the rebreathing phase of the NI CO cycle Place the sensor so that the triple lumen tubing lines exit from the top of the sensor to help keep them clear and dry Keep the sensor clear of accumulations by proper circuit maintenance 5 To begin monitoring press the STOP CONTINUE REBREATHING key To enhance accuracy enter the respiratory gas composition and the arterial blood gas values whenever possible by pressing the DATA ENTRY key While monitoring if the EXPAND or RETRACT LOOP message appears adjust the loop 3 6 inches 8 15 cm or until the message is removed If the EXPAND or RETRACT LOOP message appears for more than three consecutive rebreathing cycles and resizing the NICO Loop was not effective the NICO monitor will suggest a different sized sensor with a larger or smaller loop to correct the condition e Small NICO Sensor the monitor displays CONSIDER USING A STANDARD NICO SENSOR when ventilator set tidal volume is greater than 500 ml e Standard NICO Sensor the monitor displa
64. ey indicators illuminate and a SELF TEST IN PROGRESS message is briefly displayed 3 The message PRESS KNOB TO ERASE STORED TRENDS is displayed for 5 seconds To erase the contents of the monitor s trend memory press the knob TRENDS ERASED is briefly displayed To retain the contents of the monitor s trend memory do not press the knob Wait the 5 seconds and TRENDS RETAINED is displayed Note If the internal battery becomes fully discharged the message CHECK DATE TI ME MENU gt SETUP will appear before the PRESS KNOB TO ERASE STORED TRENDS message See Setup Screen on page 45 for details 4 The power up sequence is completed and a monitoring screen is displayed NICO displays the screen that was displayed when the monitor was last turned off e f the monitor is in Cardiac Output mode connecting a CO2 Flow sensor will cause the monitor to automatically switch to Respiratory Mechanics mode The monitor is in a READY state and the parameters will be dashed and alerts will not be active until parameters are calculated and displayed Parameters will display and their alerts will become active as they are calculated Connect and apply Connect the sensors to the monitor ventilator circuit and patient r c the sensors 1 Connect the SpO sensor to the monitor and apply it to the P 2 patient See Pulse Oximetry Sensors on page 67 cms
65. f parameter limit settings or from monitor or sensor related error conditions High Priority Alert Medium Priority Alert e Action Immediate user response Action Prompt user response Audible 3 consecutive tones repeated Audible 2 consecutive tones repeated every 5 seconds if enabled every 10 seconds if enabled Visual the SILENCE key Visual Screen message SILENCE indicator flashes red and a Example HIGH RESP screen message is displayed Example LOW C O Low priority Alert Status Messages Action User awareness Action Informational no urgency Audible a single tone repeated every 15 Audible none seconds if enabled Visual Screen message Visual Screen message Example ALERTS OFF Example EXPAND LOOP Responding to Alert Audio The SILENCE key is used to mute prevent audible alerts It also visually SILENCE indicates the presence of a High Priority Alert The Silence feature operates in two modes a temporary 2 Minute Silence mode and an Audio Disabled mode 2 Minute Silence Press and release to activate or deactivate the two minute silence The key s icon illuminates amber when active and audible alerts will be muted for two minutes after which the icon turns off and any active audible alert will sound Audio Disabled Press and hold for two seconds to prevent or allow any audible alerts The key s icon illuminates and flashes amber to indicate that all aud
66. ged parts Do not use a broken or damaged sensor or one with wet contaminated or corroded connectors NICO User s Manual 65 CAPNOSTAT Adapter Zero Adapter Zero 66 NICO User s Manual CAPNOSTAT Adapter Zero An Adapter Zero a quick 15 second process that lets the NICO monitor learn the special characteristics of a particular CAPNOSTAT is necessary only when the NICO monitor requests an Adapter Zero Such a request may occur the first time a particular CAPNOSTAT is connected to a particular NICO monitor as is the case the first time you power up your NICO monitor and CAPNOSTAT or if the monitor detects some change in the CAPNOSTAT Once an Adapter Zero is performed NICO can be turned on and off and the CAPNOSTAT can be unplugged and reconnected without having to calibrate or Adapter Zero CO ZERO REQUIRED MENU sy ED sensor However if a second CAPNOSTAT is connected in place of the first the Adapter Zero process must be performed on the new sensor and if at a later time the first CAPNOSTAT is reconnected it too will then have to be put through the Adapter Zero process To perform an Adapter Zero 1 Press the MENU key Highlight and then select SETUP by rotating and then pressing the knob 2 3 Highlight and then select C02 ZERO NOW 4 Place the CAPNOSTAT onto a clean and dry NICO Sensor or CO gt Flow sensor adapter that is exposed to room air and away fro
67. ging This action anticipates increased moisture migration into the sensor tubing due to the increase in circuit pressure The automatic purge cycle used in the neonatal or pediatric mode is fixed at every 3 minutes regardless of circuit pressure Only one side of the sensor tubing will be purged during each purge cycle The purge will only occur during the exhalation portion of the ventilator cycle regardless of exhalation time Unlike the adult purge mode the neonatal or pediatric purge mode does not use the full force of the internal pump but rather pressurizes an internal reservoir which is used for the purge This minimizes the pressure delivered to the ventilator circuit but does deliver a sufficient pressure to purge the sensor tubing Manual Purging Occasionally purging may be required in between the automatic purge cycle The manual purge may be used as often as needed and may be used at all times except when a very low battery condition exists During very low battery conditions automatic and manual purging is not allowed To manually purge 1 Press the MENU key 1 Turn and press the KNOB to select SETUP 1 Turn and press the KNOB to select PURGE NOW 2 The purge cycle will begin In adult mode the system will purge both sides of the line one at a time during each purge cycle In pediatric and neonatal modes only one side of the sensor tubing will be purged during each purge cycle The purge is synchronized to the e
68. h 10 75 in Depth 9 5 in Weight 9 Ibs 6 oz Power 100 240 VAC 50 60 Hz 70VA Fuse Rating 100 240 VAC 0 5 A 250 V Slo Blo x2 200 240 VAC T 250 mA 250 V x2 Battery Internal Sealed lead acid gel cell 45 minute life on full charge on screen life indicator 12 hours recharge time Display 4 625 x 3 5 inch EL 320x240 pixels Electromagnetic Emissions Conforms to EMC Directive 89 336 EEC CISPR Class A Tested to EN55011 1991 and CISPR11 1990 Electromagnetic Immunity Conforms to EMC Directive 89 336 EEC EN50082 1 1992 Tested to IEC801 3 1984 Radiated Immunity Conforms to Medical Device Directive 93 42 EEC EN60601 1 1992 Tested to IEC801 2 1991 ESD IEC801 4 1988 EFT and IEC1000 4 5 1995 Surge Immunity RS232 Communications Ports Pin X RS232 1 RS232 2 RS232 3 2 Rx Rx Rx 3 Tx Tx Tx 5 Ground Ground Ground 7 n a RTSB n a 8 n a CTSB n a 9 n a Power n a NICO User s Manual 91 92 NICO User s Manual Catalog No 9226 00 8950 00 8951 00 8952 00 9567 00 6934 00 8751 00 8776 00 8791 00 9765 00 9766 00 9767 00 6063 01 6455 00 6455 25 6480 00 6480 25 4941 00 4942 00 4943 00 5266 00 6147 00 8828 00 8829 00 8831 00 8832 00 6929 00 6968 00 8836 00 8943 00 6131 50 6131 25 8700 00 NICO Accessories Description NICO Non Invasive Cardiac Output Monitor Model 7300 Includes Monitor CAPNOSTAT CO Sensor SpO Sensor Power Cord and User s Manual
69. he NICO monitor Model 7300 also displays cardiac index and stroke volume as well as various respiratory monitoring parameters including CO elimination VCO and alveolar minute ventilation In Respiratory Mechanics mode NICO can be used as a respiratory profile monitor without cardiac output displayed In either mode NICO provides the clinician with important information to aid in precise and efficient patient management The NICO monitor is indicated for use by technically skilled clinical personnel In Cardiac Output mode the monitor is used for the monitoring of cardiac output and various respiratory parameters of adult patients receiving mechanical ventilation In Respiratory Mechanics mode the NICO monitor is used for monitoring the respiratory parameters of adult pediatric and neonatal patients NICO is not intended for any other purpose In Cardiac Output mode use of the NICO monitor is contraindicated in patients in whom a small rise 3 5 mmHg 0 4 0 67 kPa in their PaCO level cannot be tolerated Front Panel The NICO monitor s front panel includes a display screen sensor input connectors a control knob and operational push button keys and indicators that are explained below E CQ 1c MENU SILENCE op CONTIN SUEBREATHINGS NOVAMETRIX NICO User s Manual 1 Rear Panel 2 NICO User s Manual 10 11 12 13 Display Screen The screen displays NICO data respirato
70. he screen you wish to display Press the MENU key or the KNOB to display that selected screen SI LENCE key The SILENCE key is used to mute prevent audible alerts It also visually indicates the presence of a High Priority Alert The Silence feature operates in two modes a temporary 2 Minute Silence mode and an Audio Disabled mode 2 Minute Silence Press and release to activate or deactivate the two minute silence The key s icon illuminates amber when active and audible alerts will be muted for two minutes after which the icon turns off and any audible alert will sound Audio Disabled Press and hold for one second to prevent or allow any audible alerts The key s icon illuminates and flashes amber to indicate that all audible alerts are being suppressed High Priority Alerts See NICO Alert Priorities on page 56 The SILENCE key s icon illuminates and flashes red to indicate High Priority Alert is active The icon alternately flashes red and amber if the audio is disabled and a High Priority Alert is active STOP CONTI NUE REBREATHI NG key Press to start NICO monitoring and the automatic rebreathing process Subsequent presses will stop amber indicator illuminated or continue amber indicator off the rebreathing process Press and hold for two seconds to reset the NICO algorithm the C O value and averaging filter will be cleared The STOP CONTINUE REBREATHING key will be amber and inactive in Respiratory
71. ible alerts are being suppressed High Priority Alerts The SILENCE key s icon illuminates and flashes red to indicate High Priority Alert is active The icon alternately flashes red and amber if the audio is disabled and a High Priority Alert is active 56 NI CO User s Manual Rev 05 Parameter Limit Alerts Parameter Limit Alerts The NICO monitor allows for the establishment of high and low limit alerts for Cardiac Output C O Cardiac Output mode only Positive Inspiratory Pressure PIP Respiratory Mechanics mode only End Tidal Carbon Dioxide ETCO gt Oxygen Saturation SpO gt Respiratory Rate RR and Pulse Rate LJ These alerts provide a visual and audible if desired indication to the user that a parameter has violated the limit settings Cardiac Output mode Respiratory Mechanics mode Parameter Range Units Parameter Range Units C O OFF 0 1 19 9 L m PIP OFF 5 120 cmH5O ETCO gt OFF 1 150 mmHg ETCO gt OFF 1 150 mmHg OFF 0 1 19 9 kPa OFF 0 1 19 9 kPa OFF 0 1 19 9 96 OFF 0 1 19 9 96 SpO OFF 50 100 96 SpO gt OFF 50 100 96 RR OFF 3 150 br min RR OFF 3 150 br min Pulse Rate OFF 31 249 bpm Ly Pulse Rate OFF 31 249 bpm All alert limit values are retained each time the monitor is turned off e The user can select individual limit values or have the monitor automatically assign limit values based on current patient values with the AUTO LIMITS feature e Audible alarms can
72. ilizing and other efforts made in an attempt to re use a CO gt Flow sensor may compromise system performance and may cause a potential patient hazard Performance is not guaranteed if reused Before use verify the sensor is physically intact with no broken or damaged parts Do not use a broken or damaged sensor or one with wet contaminated or corroded connectors Do not allow the CO gt Flow sensor to remain in the ventilator circuit when not connected to the NICO monitor A ventilator circuit leak will occur Rev 05 Choosing a CO2 Flow Sensor CAUTION Connect only Novametrix NICO CO gt Flow sensors Catalog Number 9765 00 9766 00 or 9767 00 to the NICO monitor Do not connect any other sensor in place of a NICO CO gt Flow sensor Choosing a CO Flow Sensor Select the appropriate combined CO gt Flow sensor based on endotracheal tube size ETT volume and flow rate Ranges for each sensor are listed in the chart below Range Sensor ETT mm Volume ml Flow Deadspace Neonatal 2 5 4 0 1 100 0 25 25 LPM Less than 1 ml 4 417 ml sec Catalog No 9765 00 Pediatric 3 5 6 0 30 400 0 5 100 LPM Less than 4 ml 8 1600 ml sec Adult gt 5 5 200 3000 2 0 180 LPM Less than 8 5 ml i 33 3000 ml sec Catalog No 9767 00 Connecting a CO gt Flow Sensor To connect a combined CO gt Flow sensor 1 Remove a new CO Flow sensor from its package Open and inspect the sensor Do not use if damaged 2 I
73. ins Power indicator turns off 2 Press the front panel Operate Standby key to turn the monitor on and off 4 NICO User s Manual Rev 05 NICO Parameter List NICO Parameter List Cardiac Output mode The NICO monitor displays the parameters described in this table Label C O CO a CO f Cdyn CI ETCO Insp CO MAP MV MV alv PCBF PeCO FeCO PEEP PEF PIF PIP Rev 05 Parameter Cardiac Output Average Cardiac Output Fast mode Cardiac Output Dynamic Compliance Cardiac Index End Tidal Carbon Dioxide Inspired Carbon Dioxide Mean Airway Pressure Minute Volume Alveolar Minute Volume Pulmonary Capillary Blood Flow Mixed expired CO Positive End Expiratory Pressure Peak Expiratory Flow Peak Inspiratory Flow Peak Inspiratory Pressure Range Units 0 5 19 9 L min 0 5 19 9 L min 0 5 19 9 L min 0 500 ml cmH5O 0 9 9 L min m2 0 150 mmHg 0 20 0 0 20 0 kPa 3 50 mmHg 0 4 6 7 0 4 6 7 kPa 0 100 cmH5O 2 40 L min Adult 0 05 16 L min 0 5 19 9 L min 0 100 mmHg 0 13 2 kPa or 0 99 cmH 0 2 180 L min 2 180 L min 0 120 cmH z0 Description Volume of blood pumped by the heart each minute C O averaged value displayed when the fast mode cardiac output mode is chosen for large display C O unaveraged value displayed when the average cardiac output mode is chosen for large display Volume the lungs expand for a
74. just the setting indicated by a dashed line For optimal setting of the spontaneous threshold the dashed line should be above any spontaneous breaths and below the mechanical breaths Push the KNOB to accept your selection and return to the SETUP menu SET TIME amp DATE hh mm Displays the SET TIME DATE screen Turn the KNOB to highlight the dd mmm yyyy portion of the time date to change Push the KNOB to select that item it begins to flash Turn the KNOB to adjust the flashing item and when correctly set push the KNOB again to accept the value Repeat for the other time date entries Finally turn the KNOB to highlight EXIT and push the KNOB to return to the SETUP menu 52 NICO User s Manual Rev 05 Automatic Purging Adult mode Neonatal and Pediatric modes Rev 05 Notes on Patient Monitoring Automatic Purging A double lumen connecting line tubing connects the NICO Flow and CO3 Flow sensors to the NICO monitor The NICO monitor includes an automatic and manual purge feature which provides a flow rate of room air to keep the sensor tubing free from water condensation and patient secretions This feature is available for the adult pediatric and neonatal modes The system automatically purges the sensor tubing every 10 minutes or less depending on system conditions In adult mode the system will purge both sides of the line one at a time during each purge cycle The higher the pressure the more frequent the pur
75. ly the tab to secure the wrap in place Adult Finger Pediatric Toe C Neonatal hand Neonatal pediatric foot Using Y Strip Tapes To use the Y Strip Tapes 1 Remove the release liner with the holes m BED Center Strip Head 2 Press each sensor button through the adhesive side of 7 a the tape Remove the Y Sensor s center strip if Button GEA required N A 3 Remove the remaining release liner Apply the sensor s tape to the patient Ensure the sensor heads are Adhesive opposite each other Adult Pediatric Finger Pediatric Toe Removed 70 NICO User s Manual Rev 05 Single Patient Use Sensors Using the Ear Clip To use the ear clip 1 Remove the center strip from the Y Sensor 2 Slide each Y Sensor head into an Ear Clip receptacle with the blue button facing outwards 3 Open the clip by squeezing its ends and apply it to the ear e It may be necessary to rub the ear with your fingers in order to increase circulation prior to applying the sensor Adhesive Dots 8700 00 are included with the ear clip to help hold the clip to the ear mn Strip removed Blue ___ Sensor Button y Head Squeeze to apply P Single Patient Use Sensors These Single Patient Use Sensors are for use on appropriately sized patients 6455 00 Pediatric Adult Foam Wrap Style Adult or appropriately sized pediatric patients 6480 00 Neonatal
76. m all sources of CO Alternatively a Single Patient Use Adult Airway Adapter Cat No 6063 01 provided with the CAPNOSTAT can be used for the zero procedure 5 Highlight and then select START ADAPTER ZERO IN PROGRESS PLEASE WAIT is displayed during the 10 seconds needed to complete the process Upon completion ADAPTER ZERO SUCCESSFUL is briefly displayed before the monitor automatically returns to the SETUP screen 6 Highlight and then select EXIT to return to the previous monitoring screen Rev 05 Oximetry Sensors Pulse Oximetry Sensors This section details the various pulse oximetry sensors and accessories that can be used with the NICO monitor This section also explains how to connect a sensor to the monitor and how to apply the sensor to the patient NICO uses the pulse oximeter portion of the monitor to enhance shunt corrections as well as to monitor patient oxygenation levels Oximetry Sensors NICO is compatible with a variety of Novametrix pulse oximetry sensors including reusable Finger and Y Sensors and Single Patient Use sensors Uy 4 Press latch release and pull sensor out Do not twist Sensors may be connected and removed with the monitor off or on Insert Push in Do not twist CAUTI ON Connect only Novametrix SuperBright SpO sensors extension cables and acce
77. merics SBCO5 amp ABG Data Entry Numerics SBCO amp Tabular Data All except Flow Pressure amp Loops Tabular Data Tabular Data All except Flow Pressure amp Loops Tabular Data Tabular Data Non Invasive Cardiac Output NICO 8 NICO User s Manual 1 100 ml neonatal Principles of Operation NICO calculates cardiac output C O non invasively based on respiratory gas analysis using a technique known as differential Fick partial rebreathing The key to this technique is a NICO Sensor consisting of a rebreathing valve and a combined CO 5 Flow sensor placed in the breathing circuit The NICO Sensor is placed into the ventilator circuit between the patient elbow and ventilator wye The rebreathing valve is automatically controlled by the monitor When the valve is activated the flow of the inspired and expired gas is diverted through a rebreathing NICO Loop When the valve is deactivated this additional rebreathing volume is bypassed and normal ventilation resumes Every three minutes a baseline rebreathing and stabilization phase occurs See The NI COG Cycle on page 27 A non invasive cardiac output calculation is made following the end of each three minute cycle The calculation is based on the changes induced in CO elimination and end tidal CO in response to the rebreathing volume The increase in end tidal CO5 which reflects the increase in PaCO is usually 3 5 mmHg 0 4 0 67 kPa and returns to
78. moglobin as a percentage of total hemoglobin less dysfunctional hemoglobin Volume of blood pumped by the heart each beat Stroke volume divided by body surface area Resistance exerted by the blood vessels on blood flow and is an indicator of left ventricular afterload SVR normalized to body surface area Volume of CO eliminated through the breath each minute Includes added mechanical deadspace proximal to the flow sensor PaCQ gt PeCO gt PaCO gt Difference between physiologic and airway deadspace Tidal volume less airway deadspace Volume of gas exhaled per breath Volume of mechanically exhaled gas per breath Volume of spontaneously exhaled gas per breath Volume of gas inhaled per breath Volume of mechanically inhaled gas per breath Volume of spontaneously inhaled gas per breath Screen Display Numerics CO2 SpO5 amp Tabular Data Numerics amp Tabular Data Numerics CO2 SpO5 amp Tabular Data Respiratory Numerics amp Tabular Data Numerics CO5 SpO Tabular Data amp rebreathing curves All Tabular Data SVR Calculation amp Tabular Data Tabular Data Numerics Respiratory Numerics SBCO Tabular Data amp rebreathing curves Respiratory Numerics SBCO Tabular Data Respiratory Numerics amp ABG Data Entry Respiratory Numerics amp ABG Data Entry Respiratory Numerics SBCO amp Tabular Data Respiratory Numerics Flow Pressure amp SB
79. n all views screen A General Message area for status alert and error information is displayed in all views A battery icon also appears if on battery power The lower half of the display presents trend waveform respiratory and numeric data to the user Various data entry setup and alert menus are also presented here Use the KNOB and the MENU and DATA ENTRY keys to select the various displays Navigating the Display System Use the KNOB MENU and DATA ENTRY keys to navigate the NICO display system as outlined in the following sections MENU PATA ENTRY DS Rev 05 KNOB selectable Monitoring Screens Rev 05 TURN KNOB selectable Monitoring Screens The KNOB is used to page through monitoring screens scroll through menus and make selections and to change or enter values The KNOB is generally turned to access different monitoring screens and to highlight menu options and pressed to accept or change selections CO5 SpO Screen Flow Pressure Screen Flow Volume Loop and Pressure Volume Loop OOHO ANN ulullll ONI VCO7 MValv Trend en CT TIN Vtalv Vdaw Trend Single Breath CO Screen Respiratory Numerics Screen NI CO User s Manual 17 MENU key Screen Displays MENU key Screen Displays Press the MENU key to activate the SELECT A SCREEN menu and illuminate the key s green icon Press the key again to return to the previously displayed screen From the SELECT A SCREEN menu t
80. ng and therefore C O measurements have L WAITI NG FOR been temporarily paused automatically by the monitor VCO gt 20 mL min and will resume automatically once the indicated parameter is within the stated range REBREATHI NG PAUSED Rebreathing and therefore C O measurements have L WAITING FOR been temporarily paused automatically by the monitor Vt 5 200 mL and will resume automatically once the indicated parameter is within the stated range RETRACT LOOP The NICO Loop expandable rebreathing volume on L the NICO Sensor needs to be retracted made smaller Retract the loop by approximately 3 6 inches or until the message is removed Note that the message is displayed only during the rebreathing phase of the NICO cycle If the loop is not appropriately sized by the end of the rebreathing phase the message will be removed and displayed again during the next rebreathing phase If this message persists with the NICO Loop at its minimal size the tidal volume may be too small for the ventilatory conditions for NICO to report accurate results Message Areas Respiratory Mechanics mode For Cardiac Output messages see page 73 In Respiratory Mechanics mode the General Message Area monitor uses one General Message Area to convey information to the user General Message The General Message Area in Respiratory Mechanics mode Area displays all messages including system status alert and error conditions It may be bla
81. ng the KNOB 0 The SETUP screen is displayed Turn and press the KNOB to select NPUT OUTPUT Turn and press the KNOB to select ANALOG OUT 1 4 Turn and press the KNOB to select the parameters you want from ANALOG OUT 1 4 maximum of 1 per to be transmitted to an analog device like a strip chart recorder etc CO Cl SV PCBF ETCO SpO resp rate and pulse rate value outputs are available as well as CO plethysmogram flow and airway pressure waveform data Calibrate the recorder to the correct voltage levels using the ANALOG CAL setting Press ZERO HALF and FULL to set the analog outputs e ZERO O volts e HALF 0 50 volts FULL 1 00 volts Rev 05 Alerts and Messages Ranges and Units Rev 05 e Analog Input Output Port selectable O to 1 volt range C O Cardiac Output 0 20 L m 50mV L m Cl Cardiac Index 0 20 L m 50mV L m SV Stroke Volume 0 20 L m 50mV L m PCBF 0 20 L m 50 mV L m ETCO 0 150 mmHg 0 20 kPa or 96 6 67mV mmHg SpO gt 0 100956 10mV 96 Resp Rate 0 150 br min 6 67mV br min Pulse Rate 0 250 bpm 4mV bpm CO Waveform 0 150 mmHg 0 20 kPa or 96 6 67mV mmdHg Pleth Waveform auto scaled Flow Waveform 125 to 125 L m 4mV L m Airway Pressure Waveform 20 to 105 cmH 0 8mV cmH5O Pin Description Pin Description 1 Ground 9 Ground 2 Channel 1 input not enabled 10 Ground 3 Channel 2 input not enabled 11 Channel 1 output 4 Cha
82. nitor Maintenance Schedules Ear Clip Rev 05 Clean with a cloth dampened with 70 isopropyl alcohol After cleaning thoroughly wipe the ear clip with a clean water dampened cloth Monitor Maintenance Schedules The NICO monitor performs a diagnostic self test at powerup that checks the internal electronics If this self test fails the normal monitoring display will not appear Remove the NICO monitor from use and contact qualified service personnel The NICO monitor should undergo inspection and safety checks on a regular basis or according to institutional protocol A Service Manual Catalog No 9226 90 containing information to assist qualified service personnel is available Battery Maintenance The monitor may not power up on battery power if the battery is not sufficiently charged If the NICO monitor has not been used or powered by the AC Mains for an extended time 3 months or more allow the battery to charge for 12 hours before use The internal battery may slowly discharge over long periods of non use To charge the battery connect the line cord to an AC source and set the rear panel power switch ON Check that the AC Mains Power Indicator on the front panel is illuminated green Allow the battery to charge for 12 hours Refer battery replacement to qualified service personnel NICO User s Manual 89 General Cardiac Output CO Flow 90 NICO User s Manual Specifications Specifica
83. nk or e contain 1 2 or 3 single line messages e contain 1 multi line message e contain 1 multi line message and 1 single line message The General Message Area messages are listed below in alphabetical order 78 NICO User s Manual Rev 05 Message Areas Respiratory Mechanics mode Alert Class H High Priority M Medium Priority L Low Priority S Status Message See NICO Alert Priorities on page 56 for details General Message Area ADAPTER DISCONNECT REMOVE FROM CIRCUIT ADULT CO5 FLOW SENSOR IDENTIFIED ALERTS OFF AMBIENT LIGHT COVER SpO PROBE CHECK CHANGE AIRWAY ADAPTER CO SENSOR FAILURE REPLACE SENSOR CO SENSOR CO ZERO REQUIRED MENU gt SETUP DEMO MODE ETCO gt XX mmHg FLOW SENSOR HIGH ETCO HIGH PIP Rev 05 Message Description The CO Flow sensor is not connected to the NICO monitor The CO5 Flow sensor should be removed from the breathing circuit in order to avoid leaking breathing circuit gas through the sensor s connector NOTE If a two line message will not fit in the General Message Area because other higher priority messages are present the message FLOW SENSOR will be used for the same condition An adult size CO5 Flow sensor was just connected to the NI CO monitor Displayed as a reminder that the default for all user selectable alerts is OFF To cancel the message adjust any individual limit value and activate the audible alert Both
84. nnel 3 input not enabled 12 Channel 2 output 5 Channel 4 input not enabled 13 Channel 3 output 6 Ground 14 Channel 4 output 7 Ground 15 Input Output Sense 8 Ground Alerts and Messages Alarms and messages are not transmitted from the NICO monitor to the Agilent VueLink module most alarms and messages are not transmitted from the NICO monitor to the GEMS IT Solar monitor All alarms and messages should be viewed directly from the NICO monitor NICO User s Manual 87 Cleaning and Sterilization Single Patient Use NICO Sensor CO Flow Sensors CAPNOSTAT CO Sensor NICO Monitor SpO Finger Sensor SpO Y Sensor SpO gt Tapes and Foam Wraps 88 NICO User s Manual Maintenance This section details routine maintenance procedures for the NICO monitor its sensors and accessories Cleaning and Sterilization To clean and or sterilize the monitor and its accessories Treat the NICO Sensor in accordance with hospital protocol for single patient use items Treat CO5 Flow sensors in accordance with hospital protocol for single patient use items Do not immerse the sensor Do not sterilize the sensor The sensor can be cleaned and disinfected by wiping with solutions such as a 7096 isopropyl alcohol 296 gluteraldehyde or 1096 bleach solution Then wipe down with a water dampened clean cloth to rinse Dry before use Make certain that the sensor windows are clean and dry before re
85. nsert the connector on the CO7 Flow sensor into NICO monitor s front panel Verify a C02 FLOW SENSOR IDENTIFIED message is briefly displayed 3 Attach the CAPNOSTAT to the CO gt Flow sensor The sensor will click when properly seated When a CO 7 Flow sensor is replaced the message CHECK CHANGE AIRWAY ADAPTER may appear this means a CO zero is required to help the NICO monitor learn the specific optical characteristics of the CO gt Flow sensor in use Rev 05 NICO User s Manual 63 Connecting a CO2 Flow Sensor To perform an Adapter Zero 1 2 3 4 64 NICO User s Manual Press the MENU key Highlight and then select SETUP by rotating and then pressing the knob Highlight and then select 02 ZERO NOW Place the CAPNOSTAT onto a clean and dry CO gt Flow sensor adapter that is exposed to room air and away from all sources of CO Alternatively the CO adapter provided with the CAPNOSTAT can be used for the zero procedure Highlight and then select START e ADAPTER ZERO IN PROGRESS PLEASE WAIT is displayed during the 10 seconds needed to complete the process Upon completion ADAPTER ZERO SUCCESSFUL is briefly displayed before the monitor automatically returns to the SETUP screen Highlight and then select EXIT to return to the previous monitoring screen CAUTI ON Position the airway adapter with its windows in a vertical and NOT a horizontal position this helps keep patient secretions from
86. nt Data NICO monitoring can be enhanced by the entry of key patient specific data including respired gas composition anesthetic agent balance gas and inspired O5 patient height and weight and arterial blood gas data PaCO PaO Hb or Hct Inclusion of ABG data is especially important when gas exchange impairment is expected i e high shunt or deadspace ABG samples should not be obtained during the rebreathing phase of the 3 minute NI CO cycle Patient data should be updated in the DATA ENTRY screen whenever possible The screen may be accessed at any time by pressing the DATA ENTRY key DATA ENTRY settings The following table lists the parameters and ranges accessible in the DATA ENTRY screens Label I NSP O5 INSP AGENT BALANCE HEIGHT WEIGHT Parameter Inspired Oxygen Inspired Anesthetic Agent Gas Balance Patient Height Patient Weight ABG DATA ENTRY Screen PaCO PaO Hb MARK ABG TIME DEFAULT ABGs Arterial Carbon Dioxide Arterial Oxygen Hemoglobin Concentration or Hematocrit Time when ABG blood sample is drawn Blood gas values Default Range Units 7096 21 100 96 096 0 20 96 N2 N gt He or NO 35 91 in 90 230 cm 55 551 Ib 25 250 kg 40 mmHg 0 250 mmHg 5 4 kPa or 0 0 20 0 kPa 0 0 20 0 displayed until an initial value is entered FiO Pb 47 mmHg 0 750 mmHg displayed until an 0 0 99 5 kPa initial value is entere
87. nt waveforms will be drawn over that breath YoalLlyv T x E B r Lue e E E UT m Lit I CLEAR OVERLAT e Press the KNOB to highlight SET OVERLAY and again to select the breath e Press the KNOB to highlight CLEAR OVERLAY and again to erase the selected breath The time stamp above the template wave corresponds to when the overlay was set NICO User s Manual 49 Respiratory Mechanics mode Numerics Screen Tabular Data Screen Set Alerts Screen 50 NICO User s Manual The NUMERICS screen display presents several monitored parameters together in one place FI Vd t Vitaly The NUMERICS screen can be displayed by turning the KNOB while viewing any monitoring screen or by pressing the MENU key and selecting NUMERICS e Information is updated in real time e The PEEP label is replaced with AUTO if Auto PEEP Intrinsic PEEP is detected The TABULAR DATA screen displays the data collected for all NICO parameters in one minute increments in a table format Cardiac output related parameters will not be displayed and will remain dashed and inactive in Respiratory Mechanics mode The parameter displayed in each column will vary depending on the setting chosen by the user 1 Highlight and select the desired column by turning then pressing the KNOB 2 Turn the KNOB to advance through all available NICO parameters 3 Press the KNOB to accept the displayed parameter turn to select the next column 1
88. nufacturing facility is certified to both ISO 9001 and EN46001 MDD93 42 EEC Annex II Novametrix products bear the CE 0086 mark The product is certified by Underwriter s Laboratories UL to bear the UL mark and tested by TUV Rheinland to I EC 601 1 EN60601 1 The Authorized Representative for Novametrix equipment is D R M Green European Compliance Services Limited Oakdene House Oak Road Watchfield Swindon Wilts SN6 8TD United Kingdom CAPNOSTAT CO Sensor and NICO are registered trademarks NICO and the stylized NICO with CO shadow NICO Sensor NICO Loop and CObar cardiac output confidence bar SuperBright and Y Sensor are trademarks of Novametrix Medical Systems Inc Other trademarks and registered trademarks are the property of their respective owners NICO and its sensors and accessories are covered by the following USA patents 4 859 858 4 859 859 4 914 720 5 146 092 5 153 436 5 190 058 5 206 511 5 251 121 5 347 843 5 369 277 5 379 650 5 398 680 5 535 633 5 616 923 5 693 944 5 789 660 5 793 044 5 820 550 5 891 026 5 999 834 6 098 622 6 126 610 D424 193 6 179 784 Other patents pending 11 Mar 99 Release at Rev 00 23 Mar 99 Revision 01 05 Oct 99 Revision 02 R N677 20 Mar 00 Revision 03 R N741 19 Oct 00 Revision 04 R N807 01 Feb 01 Revision 05 R N850 Rev 05 Rev 05 Table of Contents Welcome to NICO uuu General DESCIIPION 7 us a ioca ht m
89. oper monitoring of oxygenation and ventilation The use of pulse oximetry is recommended during NICO monitoring e Setting of ETCO and SpO alert limits is recommended e A NO RESPIRATION alert is not generated when both the CAPNOSTAT CO sensor and the NICO Sensor or CO3 Flow sensor are disconnected from the NICO monitor Becertain that the monitor is not in Demo mode while monitoring Demo mode can be identified by the flashing DEMO MODE label in the General Message area of the display To exit Demo mode and return to normal monitoring mode turn the power off and back on e The NICO monitor contains no user serviceable parts Refer servicing to qualified service personnel A technical Service Manual is available for use by technical personnel Do not attach an SpO sensor distal to a blood pressure cuff Valid data cannot be processed when the cuff is inflated Attach the sensor to the limb opposite to the site used for the blood pressure cuff This product and its accessories which have patient contact are free of latex The NICO monitor is Year 2000 compliant e Data Validity Inaccurate SpO and Pulse Rate values may be caused by ncorrect application or use of a sensor e Significant levels of dysfunctional hemoglobin carboxyhemoglobin or methemoglobin e Significant levels of indocyanine green methylene blue or other intravascular dyes Exposure to excessive illumination such as surgical lamps especially on
90. or EEIE ET ET ET 48 NICO User s Manual Rev 05 Respiratory Mechanics mode Single Breath CO Screen Rev 05 e While viewing the Vt Vd TREND screen each push of the knob will advance through the available 30 minute and 2 4 8 and 12 hour trend displays Data is plotted from left oldest data to right newest data Once the display is filled data shifts left so that the oldest data point on the left is pushed out to make room for the newest point entering from the right Each bar on the trend represents the average Vtalv or Vdaw value over a time period The time periods are 1 minute average for the 30 minute trend 4 minute average for the 2 hour trend 8 minutes for the 4 hour trend 16 minutes for the 8 hour trend and 24 minutes for the 12 hour trend The SINGLE BREATH C02 screen displays the CO waveform for a single patient breath as well as providing numeric displays of Vd Vt Vtalv Vdaw PeCO and Vdalv Vda Ydalv 196 SBCO presents the exhaled concentration of CO versus tidal volume during a single expiration useful for understanding the ventilation perfusion relationship It allows the clinician to detect relative changes in CO production deadspace and effective ventilation by observing the shape of the graph The curve is automatically scaled to fit the display area Set Overlay The Set Overlay function freezes a breath on the SINGLE BREATH CO2 screen as a template Subseque
91. ows 444 will display at the bottom of the column when more records are available 44 NICO User s Manual Rev 05 Respiratory Screens Optional Set Alerts Screen The SET ALERTS screen displays the current patient values as well as the LOW and HIGH alert limit settings for various parameters This screen also allows adjustment of alert limits audible alert volume and of the No Respiration alert See Alerts on page 56 for details OFF OFF OFF OFF RESP The SET ALERTS screen can only be displayed by pressing the MENU key and selecting SET ALERTS e CURRENT the current patient value for a parameter shown in real time NOTE The CURRENT value will flash when a high or low alert limit is exceeded e LOW and HIGH the values below and above which an alert will be generated I Bell with slash the audible alert is disabled for this limit fi Bell the audible alert is enabled for this limit e AUDIO set the audible alert volume level e AUTO LIMITS have the NICO monitor bracket alerts around current patient values e NO RESP set the No Respiration alert delay timer Setup Screen The SETUP screen allows the user to perform certain functions such as a CO Zero erase trend data change items like the waveform trace sweep speed and to set the time and date Once set the NICO monitor will use these settings until again changed by the user To display the SETUP screen VENY 1 Press the MENU key to acti
92. pooling on the windows To prevent rain out and moisture from draining into the airway adapter do NOT place the airway adapter in a gravity dependent position Periodically check the CO Flow sensor and tubing for excessive moisture or secretion build up Rev 05 The CAPNOSTAT Connecting the CAPNOSTAT Rev 05 CAPNOSTAT CO Sensor This section provides information regarding the CAPNOSTAT CO Sensor and its use with NICO Sensors and the NICO monitor The CAPNOSTAT The CAPNOSTAT CO Sensor is a rugged solid state mainstream sensor It is factory calibrated and does not require further calibration during use The CAPNOSTAT may be connected to and removed from the NICO monitor while the monitor is turned off or on Connect Slides on Clicks into place CAPNOSTAT Remove CO Sensor Slides off f Pediatric adult Pediatric or neonatal CO Flow sensor CO Flow sensor 4 2 g NOVAMETRIX sie a S Insert Push in Do not twist Remove Pull out Do not twist CAUTION Connect only a Novametrix CAPNOSTAT CO Sensor Catalog Number 9567 00 to the NICO monitor Do not use other CAPNOSTAT types or other CO sensors WARNING Before use verify the sensor is physically intact with no broken frayed wires or dama
93. r small standard or large NICO Sensor or neonatal pediatric or adult CO5 Flow sensor when it is connected If a sensor identification message is not displayed when a sensor is first connected DO NOT use the sensor If the condition persists refer the monitor to qualified service personnel Do not use the NICO monitor if it is unable to properly identify a CO2 Flow sensor or a NICO Sensor If the condition persists refer the monitor to qualified service personnel e Inthe event the message NICO SENSOR FAILURE is displayed remove the NICO Sensor from the patient circuit The CO gt Flow or NICO Sensor connector should be properly inserted into the front panel receptacle prior to connecting a sensor to the breathing circuit in order to avoid a circuit leak or occlusion of sensor tubing e NICO Sensors increases airway deadspace by 35 cc minimum At low tidal volumes compensatory changes to ventilation protocol should be considered e NICO Sensors are not for pediatric use Rev 05 NI CO User s Manual 21 Cautions 22 NICO User s Manual Patient Safety Care should be exercised to assure continued peripheral perfusion distal to the SpO sensor site after application e Inspect the SpO sensor site for adequate circulation at least once every four hours e When applying sensors take note of patient s physiological condition For example burn patients may exhibit more sensitivity to heat and pressure and therefore
94. required This can be offset by increasing the minute ventilation before NICO monitoring begins Rebreathing Bar The Rebreathing Bar visually indicates the level of patient rebreathing Under normal monitoring conditions the O REBREATHING icon and Rebreathing Bar appear in the message center each time the automatic rebreathing cycle begins The Rebreathing Bar represents the total possible range of rebreathing from 0 10096 e The highlighted area within the bar represents the target rebreathing range 5096 9096 for optimal NICO performance A vertical pointer within the Rebreathing Bar indicates the current rebreathing percentage The pointer will appear within the highlighted area of the Rebreathing Bar when the NICO Loop is properly sized and providing an acceptable percentage of rebreathing Note The word OK will disappear when the pointer falls within that area of the highlighted bar The Rebreathing Bar is not displayed when the ratio of spontaneous to mechanical breaths is greater than or equal to 2 1 Expand Retract NICO e If the NICO Loop is not sufficiently expanded and Loop the Rebreathing Bar pointer falls below 5096 the message EXPAND LOOP is displayed during the rebreathing period f the NICO Loop is over expanded and the Rebreathing Bar pointer is above 9096 the message RETRACT LOOP is displayed during the rebreathing period To expand or retract the NICO Loop 1 Grasp th
95. rred e Press the SILENCE key to cancel the alert The alert message audio and flashing SILENCE key is automatically cancelled after ten minutes WARNING The NICO monitor is not intended to be used as an apnea monitor Adjust the No Resp To adjust the No Respiration Alert Limit Alert Limit 1 Display the SET ALERTS screen Press MENU then select SET ALERTS 2 Highlight and then select NO RESP by turning and then pressing the knob 3 Turn the knob to adjust the limit setting The limit timer is selectable from 10 60 seconds 4 Press the knob to accept the displayed value 58 NI CO User s Manual Rev 05 Disposable NICO Sensors Rev 05 NICO Sensor This section provides information regarding Disposable NICO Sensors and their use with the CAPNOSTAT CO Sensor and the NICO monitor Disposable NICO Sensors A NICO Sensor incorporates a rebreathing valve NICO Loop an adjustable rebreathing volume and an adult CO gt Flow Sensor It is disposable and intended for Single Patient Use only The NICO Sensor is not for pediatric use A NICO Sensor may be connected to and removed from the NICO monitor while the monitor is turned off or on ff NICO Sensor shown with NICO Loop adjustment template C CAPNOSTAT Lp Connect
96. rrent state of the NICO cycle The rebreathing phase of the NICO Cycle lasts for 50 seconds Alert Class S Rebreathing and therefore C O measurements are REBREATHING OFF ADAPTER DISCONNECT REMOVE FROM CIRCUIT REBREATHING OFF LARGE NICO SENSOR IDENTIFIED REBREATHING OFF SMALL NI CO SENSOR IDENTIFIED REBREATHING OFF STANDARD NI CO SENSOR IDENTIFIED REBREATHING OFF currently disabled The STOP CONTINUE REBREATHING key is illuminated amber while rebreathing is off and can be pressed to enable rebreathing and C O measurements Rebreathing is off when e The monitor is first turned on until the STOP CONTINUE REBREATHING key is pressed e The STOP CONTINUE REBREATHING key is pressed while C O measurements are enabled The monitor detected a system fault or condition which warrants automatic disabling of C O measure ments The NICO Sensor was disconnected from the monitor after C O measurements had been made since the last power up The NICO Sensor should be removed from the breathing circuit in order to avoid leaking breathing circuit gas through the NICO Sensor s connector A large size NICO Sensor was just connected to the NICO monitor A small size NICO Sensor was just connected to the NICO monitor A standard size NICO Sensor was just connected to the NICO monitor A problem with the NICO Sensor was detected by the NICO SENSOR FAILURE monitor Discard the sensor and replace
97. rt limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed PIP value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings Alert Class NI CO User s Manual 79 Message Areas Respiratory Mechanics mode General Message Area HIGH PULSE HIGH RESP RATE INCOMPATIBLE CO SENSOR NCOMPATIBLE FLOW SENSOR INSP CO3 xx LOW ETCO LOW PULSE LOW RESP RATE MONITOR INOPERABLE AIRWAY ZERO ERROR MONITOR INOPERABLE BARO PRESS ERROR MONITOR INOPERABLE CLOCK FAILURE MONITOR INOPERABLE FLOW ZERO ERROR MONITOR INOPERABLE SpO HDW ERROR NEONATAL CO7 FLOW SENSOR IDENTIFIED 80 NICO User s Manual Message Description The displayed pulse rate value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed respiration rate value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed SpO value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The wrong part number CAPNOSTAT is connected to the NI CO monitor Use only a CAPNOSTAT with part number 9567 00 this can be distinguished from other CAPNOSTAT part numb
98. rtifact generated by the IABP are allowed to influence the SpO and Pulse Rate calculations Push the KNOB to accept your selection and return to the SETUP menu ERASE TRENDS Yes or No Displays the ERASE STORED TRENDS screen Turn the KNOB to select NO default No the default setting or YES Push the KNOB to accept your selection and return to the SETUP menu INPUT OUTPUT ANALOG OUT 1 4 Turn the KNOB to select ANALOG OUT 1 through ANALOG OUT 4 ANALOG ANALOG CAL CAL RS232 2 or R232 3 Push the KNOB to accept your selection and RS232 2 RS232 3 assign it the desired output parameter Rev 05 NI CO User s Manual 51 Respiratory Mechanics mode Label Settings Range Description PULSE BEEP OFF and 1 10 Displays the SET PULSE BEEP screen Turn the KNOB to select a volume default OFF 1 10 and OFF for the audible tone to accompany each detected pulse beat Push the KNOB to accept your selection and return to the SETUP menu SWEEP Slow Medium Fast Displays the SET SWEEP SPEED screen Turn the KNOB to select how default Medium quickly the CO gt 5 Flow and Pressure waveforms sweep across the display Plethysmogram is unaffected Push the KNOB to accept your selection and return to the SETUP menu SET SPON 0 50 cmH 0 Displays the SET SPONTANEOUS THRESHOLD screen The spontaneous THRESHOLD threshold is the airway pressure chosen to help NICO differentiate between a spontaneous breath and a mechanical breath Turn the KNOB to ad
99. ry mechanics trends waveforms and messages along with setup and configuration data CAPNOSTAT CO Sensor Input Connector Connect only a Novametrix CAPNOSTAT CO Sensor Catalog Number 9567 00 here Connector Isolation Icon Identifies the connector to either side of this icon as a type BF patient isolation connection Pulse Oximetry Sensor Input Connector Connect only Novametrix pulse oximetry sensors and extension cables approved for use with the NICO monitor NICO Sensor Input Connector Connect only Novametrix NICO Sensors Catalog Number 8950 00 8951 00 and 8952 00 or Novametrix CO Flow sensors Catalog Number 9765 00 9766 00 and 9767 00 KNOB The KNOB is used to select monitoring screens scroll through menus and to change or enter values The KNOB is generally turned to access different monitoring screens and to highlight menu options and pressed to accept or change those selections DATA ENTRY key Press to activate the DATA ENTRY screen and illuminate the key s green icon Press the key again to return to the previously displayed screen From the DATA ENTRY screen you can enter patient information including height weight and respiratory gas mixture and access the ABG DATA ENTRY screen MENU key Press to activate the SELECT A SCREEN menu and illuminate the key s green icon Press the key again to return to the previously displayed screen From the SELECT A SCREEN menu you can by turning the knob highlight t
100. s Flow Pressure amp Tabular Data Tabular Data Tabular Data Numerics Flow Pressure amp Tabular Data NI CO User s Manual 5 NICO Parameter List Label Raw RR RSBI SpO 5 SV SVI SVR SVRI VCO Vd Aw Vd Vt Vd alv Vt alv Vte Vte m Vte s Vti Vti m Vti s Parameter Pulse Rate Airway Resistance Respiration Rate Rapid Shallow Breathing Index Oxygen Saturation Stroke Volume Stroke Volume Index Systemic Vascular Resistance Systemic Vascular Resistance Index Carbon Dioxide Elimination Airway deadspace Deadspace to tidal volume ratio Alveolar deadspace Alveolar tidal volume Expired Tidal Volume Expired Tidal Volume mechanical Expired Tidal Volume spontaneous Inspired Tidal Volume Inspired Tidal Volume mechanical Inspired Tidal Volume spontaneous 6 NICO User s Manual Range Units 30 250 bpm 0 100 cmH gt 0 L sec 2 120 br min 0 1000 br min L 0 100 0 250 ml 0 125 ml 0 5000 dynes sec cm 0 5000 dynes sec cm 0 3000 ml min 0 500 ml 0 1 00 ml 0 500 ml 0 2400 ml 200 3000 ml 200 3000 ml 200 3000 ml 200 3000 ml 200 3000 ml 200 3000 ml Description Number of pulse beats per minute Pressure required to cause gas flow at a given rate Number of breaths per minute Respiratory rate divided by average spontaneous tidal volume only calculated when RR lt 57 Oxyhe
101. sage Area CO SENSOR FAILURE REPLACE SENSOR CO SENSOR CO ZERO REQUIRED MENU SETUP DEMO MODE ETCO XX mmHg HIGH C O HIGH ETCO HIGH PULSE HIGH RESP RATE INCOMPATIBLE CO SENSOR INCOMPATIBLE FLOW SENSOR INSP CO3 xx LOW C O LOW ETCO LOW PULSE 74 NICO User s Manual Message Description A problem with the CAPNOSTAT CO sensor has been identified Replace the CAPNOSTAT and return it to Novametrix for exchange or repair The CAPNOSTAT CO sensor is not connected to the NICO monitor The CAPNOSTAT CO sensor needs to be zeroed Press the MENU key then select SETUP then C02 ZERO NOW and follow the instructions on the screen NOTE the CO adapter provided with the CAPNOSTAT can be used for the CO zero procedure rather than a new NICO Sensor The monitor is in demonstration mode and is not displaying patient data all data is simulated To exit demo mode turn the monitor off then back on End tidal CO is greater than 60 mmHg or exceeds the high alert limit Appears in the general message area to supplement screens that do not display the ETCO value The displayed cardiac output value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings The displayed ETCO value is above the set alert limit in the SET ALERTS screen press MENU key then select SET ALERTS to view the alert limit settings
102. screw slip the cord through the clip and insert and tighten the screw Use only the supplied screw to secure the clip Equipotentiality Connection to the monitor s chassis earth ground system Analog I nput Output Port This 15 pin connector provides analog signal output capability for the NICO monitor Input reserved for future use Ventilation Slots Do not block the air ventilation slots S ymbols These symbols may be found on the NICO monitor its sensors accessories and documentation Attention Patient I solation N Consult manual for detailed Identifies the patient isolation information connection as type BF Single Patient Use AC Mains Power Switch Treat in accordance with protocol ON connection to mains Rev 05 for single patient use items Q O OFF disconnection from mains NI CO User s Manual 3 AC Battery Operation IN Mains Fuse Rating y Equipotentiality Mains rating for replacement fuses Connection to monitor s chassis 250v Separate collection Heavy Metal Content 4 Take appropriate steps to ensure Pb Indicates heavy metal content that spent batteries are collected specifically lead This symbol is separately when disposed of This found on the internal battery and symbol is found on the internal the monitor enclosure battery and the monitor enclosure OXY Recyclable item m This symbol is found on the internal battery and the monitor enclosure AC Ba
103. splayed A YES to BOTH 1 and 2 indicates the sensor is operational Apply the sensor to the patient as instructed Note that the Quick Check tag on the sensor may refer to the message Probe Off Patient This message does not apply to the NICO monitor PULSE SEARCH does Finger Sensor The reusable Finger Sensor is intended for adult and appropriately sized pediatric fingers and is not intended for neonatal applications To apply Squeeze the grips Position the fingertip as shown and release the grips To remove Squeeze the grips Slide the sensor from the finger and release the grips Caution Overstretching can damage the sensor and affect oximetry readings Do not force the sensor onto large objects such as bedrails Cable exits above finger TM Y Sensor The reusable Y Sensor is designed for use on all patients from adults to neonates The Y Sensor s center strip may be carefully cut away if the distance between the sensor heads needs to be reduced to less than 25mm The flexible and versatile Y Sensor is applied to the patient using a variety of adhesive and non adhesive applicators Treat applicators except ear clip in accordance with hospital protocol for single patient use Refer to instructions packaged with the various applicators 6929 00 Adhesive Foam Wraps Large Adult pediatric or neonatal use 6968 00 Adhesive Foam Wraps Small Neonatal or appropriately sized pediatric
104. ssories with the NICO monitor Do not use other SpO sensors or accessories Overstretching the pulse oximeter finger sensor can damage the sensor and potentially affect pulse oximeter readings Do not stretch the finger sensor open beyond the limit for which it was designed Overstretching can be prevented avoid opening the sensor by any means other than squeezing the grips DO NOT force the sensor onto large objects such as a bedrail WARNI NG Before applying to the patient verify the sensor is physically intact with no broken frayed wires or damaged parts Do not use a broken or damaged sensor or one with wet contaminated or corroded connectors After applying to the patient inspect the site often for adequate circulation at least once every four hours Do not wrap so tightly that circulation is restricted Note the patient s physiological condition For example burn patients may be more sensitive to heat and pressure and require more frequent site checks Rev 05 NICO User s Manual 67 Finger Sensor Sensor Quick Check Y Sensor configuration Y Sensor applicators 68 NICO User s Manual A quick functional check of basic sensor operation 1 With the sensor connected to the monitor but not applied to the patient position the sensor heads so they face each other red light shines on the detector Is PULSE SEARCH displayed Apply the sensor to your finger Are reasonable SpO gt and pulse rate values di
105. t and other service documents provided by GEMS IT All GEMS IT parts are supplied by GEMS IT Component Setup Refer to the following steps for correct cable connections 1 Connect the DIDCA interface adapter to the connector labeled RS232 1 on the back of the NICO The interface adapter is programmed specifically to work with a NICO monitor 2 Connect the Octanet cable between the interface adapter and one of the eight Octanet serial ports 3 Connect the Solar monitor cable PN 409752 00x for Models 7000 and 8000 PN 700752 00x for model 8000M from the Octanet to the Solar monitor Complete the communication cabling by referring to the power up instructions found in the Octanet Connectivity Device Service Manual PN 418264 003 4 Ensure Octanet serial port LED is steady green Transmitted The following parameters are transmitted from the NICO monitor to the Solar monitor Parameters The CO CI SV CO confidence level and PCBF values will be displayed in the NICO 82 NICO User s Manual parameter block Four of the following sub parameters can be displayed in the RM parameter block PEF MV MVs MVm TV TVs TVm PIP MAWP PEEP RR RRs RRm I E CYDN RAWe Rev 05 Agilent Technologies VueLink Interface e The CO inspired CO expired and respiration rate RR values will be displayed in the CO parameter block e The SPO value and pulse rate RATE value will be displayed in the SPO parameter block
106. th readings from previous NICO rebreathing cycles If there is no confidence in the signals the C O value is not displayed and no segments are displayed in the CObar The CObar is displayed when the C 0 MODE is set to AVERAGE in the SETUP screen When the C 0 MODE is set to FAST the monitor will display the unfiltered C O value CO f rather than the averaged value The text FAST MODE will replace the CObar graphic The stroke volume and cardiac index will be calculated from this value rather than the averaged value The averaged C O value can still be viewed as CO a under the VCO value in the LAST COMPLETED CYCLE screen The C 0 MODE option is set in the SETUP screen NI CO User s Manual 31 Preparing for Use Respiratory Monitoring This section details the steps needed to begin patient respiratory mechanics monitoring with the NICO monitor Preparing for Use Inspect Before monitoring take a few moments to inspect the NICO monitor and its sensors Check that all items are clean dry and physically intact with no broken or damaged components Turn on the monitor Turn the NICO monitor on 1 Press the Operate Standby key to turn the monitor on f and off NICO can operate from its internal battery or from the AC Mains See AC Battery Operation on page 4 for details A 2 The monitor performs a quick self test An audible tone sounds the k
107. the alert limit and audible alert must be activated The monitor detects interference on the SpO sensor from ambient light This can be corrected by covering the SpO sensor or possibly by changing the sensor site A change in the CO adapter portion of the CO gt Flow sensor is detected Possible causes e CAPNOSTAT CO sensor off adapter High level of moisture and or secretions in the adapter Replace if needed A problem with the CAPNOSTAT CO sensor has been identified Replace the CAPNOSTAT and return it to Novametrix for exchange or repair The CAPNOSTAT CO sensor is not connected to the NICO monitor The CAPNOSTAT CO sensor needs to be zeroed Press the MENU key then select SETUP then C02 ZERO NOW and follow the instructions on the screen NOTE the CO adapter provided with the CAPNOSTAT can be used for the CO zero procedure rather than a new sensor The monitor is in demonstration mode and is not displaying patient data all data is simulated To exit demo mode turn the monitor off then back on End tidal CO is greater than 60 mmHg or exceeds the high alert limit Appears in the general message area to supplement screens that do not display the ETCO value The CO Flow sensor is disconnected NOTE This message may also be used in place of ADAPTER DISCONNECT REMOVE FROM CIRCUIT when a two line message will not fit in the General Message Area The displayed ETCO value is above the set ale
108. the breath reflects alveolar CO gt Ratio of inspiratory time ti to expiratory time te Mean average pressure in the airway throughout the breath Volume in liters of gas delivered to the patient per minute MV less deadspace wasted ventilation Maximum negative pressure during inspiratory cycle Volume weighted average CO in the breath Pressure in the lungs at the end of expiration Highest absolute flow rate during expiration Highest absolute flow rate during inspiration Peak highest pressure in the airway during inspiration Number of pulse beats per minute Pressure required to cause gas flow at a given rate Number of breaths per minute Respiratory rate divided by average spontaneous tidal volume only calculated when RR 57 Oxyhemoglobin as a percentage of total hemoglobin less dysfunctional hemoglobin Screen Display Numerics amp Tabular Data All Flow Pressure Numerics amp Tabular Data All except Flow Pressure amp Loops Numerics amp Tabular Data Loops Numerics SBCO amp Tabular Data Numerics Flow Pressure amp Tabular Data Loops amp Tabular Data Loops amp Tabular Data Numerics Flow Pressure amp Tabular Data All Numerics amp Tabular Data All Loops All NICO User s Manual Principles of Operation Label Parameter VCO Carbon Dioxide Elimination Vd Aw Airway deadspace Vd Vt Deadspace to tidal vol
109. this state upon power up Rees D KEY To The STOP CONTINUE REBREATHING key is illuminated while in this state The NICO rebreathing cycle can be placed into this state at any time by pressing the STOP CONTINUE REBREATHING key rebreathing is immediately disabled e The NICO rebreathing cycle is automatically turned off for certain monitor sensor conditions See Alert Class H High Priority M Medium Priority L Low Priority S Status Message See NICO Alert Priorities on page 56 for details on page 79 Noted in the cardiac output message area as REBREATHING OFF Rebreathing ON enabled e When the monitor is initially turned on this state is entered only after pressing the STOP CONTINUE REBREATHING key The STOP CONTINUE REBREATHING key is not illuminated while in this state The cardiac output is calculated and updated while in this state Noted in the cardiac output message area as REBREATHING or NEXT D Rebreathing Paused e The NICO monitor automatically pauses the CEUWATTIMG FoR rebreathing cycle and generates a display message under any of these conditions e ETCO is less than 15 mmHg 2 0 kPa or 96 or greater than 85 mmHg 11 5 kPa or 96 Respiration rate is less than 3 or greater than 60 br min e VCO is less than 20 mL min The rebreathing cycle automatically restarts when the condition is corrected Rev 05 NI CO User s Manual 27 Entering Patient Data Entering Patie
110. ting in Cardiac Output mode Areas of the Display The major sections of the Cardiac Output mode screen are identified below Stroke Volume SV and Cardiac Index Cardiac Output C O value is displayed CI are displayed in all views A battery in all views The CObar confidence icon also appears if on battery power indicator is replaced by FAST MODE when NI in fast mode A General Message area for status alert and error information Displayed in all views here shown blank A Cardiac Output Message area for C O information is displayed in all views The Rebreathing Bar is displayed during the rebreathing portion of the cycle hr TRENO The lower half of the display presents trend waveform respiratory and numeric data to the user Various data entry setup and alert menus are also presented here Use the KNOB and the MENU and DATA ENTRY keys to select the various displays Navigating the Display System Use the KNOB MENU and DATA ENTRY keys to navigate the NICO display system as outlined in the following sections MENY Q DATA ENTRy 10 NICO User s Manual Rev 05 KNOB selectable Monitoring Screens The KNOB is used to page through monitoring screens scroll through menus and make selections and to change or enter values The KNOB is generally turned to access different monitoring screens and to highlight menu options and pressed to accept or change selections C O Trend Screen
111. tions for the Novametrix NICO Monitor Model 7300 are listed for informational purposes only and are subject to change without notice Measurement Frequency Rebreathing cardiac output measurement made every three minutes rebreathing period is 50 seconds Cardiac Output Range 0 5 19 9 liters minute Cardiac Output Resolution 0 1 liters minute Pulmonary Capillary Blood Flow PCBF Range 0 5 19 9 L min Resolution 0 1 L min Cardiac Index Range 0 9 9 L min meter Resolution 0 1 L min meter Stroke Volume Range 0 250 ml Resolution 1 ml Rebreathing Valve sensor Valve type dual diaphragm pneumatically controlled Return spring automatically returns valve to normal position e Resistance 3 cmH50O L min maximum Rebreathed volume normal position 35 ml rebreathing position 150 450 ml std e CO flow sensor integrated into valve assembly Parameter limits for NICO measurements e VCO5 520 ml min e RR 53 60 e Vt 2200 small and standard 5400 large e ETCO 515 85 mmHg 100 mmHg during rebreathing 52 0 11 5 kPa or 13 5 kPa or during rebreathing Principle of Operation Non Dispersive Infrared NDIR absorption dual wavelength ratiometric single beam optics mainstream sensor Response Time Less than 60 ms Gas composition effects Operator selectable CAPNOSTAT CO Sensor Weight Less than 18 g without cable e Sensor Size 1 3 x 1 67 x 85 inches 3 3 x 4 2 x 2 2 cm 8 foot cable 2 44 m
112. to the user General Message Area C O Message Area The General Message Area in Cardiac Output mode displays system status alert and error conditions It may be blank or e contain 1 single line message e contain 2 single line messages e contain 1 multi line message The General Message Area messages are listed below in alphabetical order Alert Class H High Priority M Medium Priority L Low Priority S Status Message See NICO Alert Priorities on page 56 for details General Message Alert Message Area Description Class ALERTS OFF Displayed as a reminder that the default for all user S selectable alerts is OFF To cancel the message adjust any individual limit value and activate the audible alert Both the alert limit and audible alert must be activated AMBIENT LIGHT The monitor detects interference on the SpO sensor from S COVER SpO PROBE ambient light This can be corrected by covering the SpO sensor or possibly by changing the sensor site CHECK CHANGE A change in the CO adapter portion of the NICO Sensor S AIRWAY ADAPTER is detected Possible causes e CAPNOSTAT CO sensor off adapter High level of moisture and or secretions in the adapter The moisture can be drained from the NICO Sensor and re inserted in the circuit Facing the pneumatic tub ing upward as it exits the NICO Sensor can minimize this NI CO User s Manual 13 Message Areas Cardiac Output mode General Mes
113. toring Do NOT place the CO7 Flow sensor between the ET tube and the elbow pediatric adult circuit as this may allow patient secretions to block the adapter windows Position the CO5 Flow sensor with its windows in a vertical and NOT a horizontal position this helps keep patient secretions from pooling on the windows e To prevent rain out and moisture from draining into the CO gt Flow sensor do NOT place the CO gt Flow sensor in a gravity dependent position Periodically check the CO 5 Flow sensor and tubing for excessive moisture or secretion build up For routine performance of airway care separate the system between the ET tube and the airway adapter neonatal circuit or between the ET tube and elbow pediatric adult circuit Lavage and suctioning of the airway can then be performed without fluids and mucous accumulating on the CO gt Flow sensor windows Begin Respiratory Monitoring After the NICO monitor is turned on and the sensors are properly connected and applied Respiratory Mechanics monitoring can begin 1 Enter the delivered oxygen and balance gas or f anesthetic agent if present by pressing the DATA ENTRY key See Entering Patient Data on page 34 GATA ENTRY Ce 2 As you begin monitoring with NI COS please note Sus the following Water that accumulates in the CO 5 Flow sensor or the sensor tubing may cause the report
114. ttery Operation The NICO monitor is designed to be operated from AC Mains power An internal battery provides uninterrupted monitoring and trending capability for short periods no more than 45 minutes if the AC power is removed AC Mains Operation To operate NICO from AC Mains power 1 Plug the line cord into the rear panel connector and the AC Mains power outlet 2 Set the rear panel power switch to the On position The front panel AC Mains Power indicator illuminates The monitor s fan turns on The internal battery starts to recharge Operate Standby I 3 Press the front panel Operate Standby key to turn the monitor on and off Battery Operation The NICO monitor automatically switches to battery power from AC Mains power if the AC source is removed A fully Battery icon shows capacity charged battery will power the monitor for up to 45 minutes While on battery power NICO displays a battery icon that u il drains as power is consumed half depleted The battery icon starts to flash when approximately 5 minutes of battery power remain An audible alert tone also sounds Reconnect to AC Mains power or the monitor will automatically shut off A depleted battery may require 12 16 hours to fully recharge To operate NICO on battery power 1 Unplug the line cord or set the rear panel power switch to the Off O position The front panel AC Ma
115. ueLink Module and the Agilent Patient Monitor refer to the Agilent Operator s Manual A total of twenty four parameters are transmitted to the Agilent Patient Monitor The parameter selection varies depending upon whether you are in Cardiac Output mode or Respiratory Mechanics mode Seventeen of these parameters will display in the Agilent Main Screen a maximum of six at a time Seven parameters display in the Task Window only Label AWRR Cdyn RAW e PIP PEEP Pmean Pulse SpO gt ETCO gt PECO gt PEF TVin TVex MV t MV s MV m VCO gt VD aw Respiratory Mechanics Mode only RAW VT alvt Parameter Respiratory Rate Dynamic Compliance Expired Airway Resistance Dynamic Peak Inspiratory Pressure Positive End Expiratory Pressure Mean Airway Pressure Pulse Rate SpOz ETCO Mixed Expired CO Peak Expiratory Flow Inspired Tidal Volume Expired Tidal Volume Total Minute Volume Spontaneous Minute Volume Mechanical Minute Volume CO Elimination Airway Deadspace Inspired Airway Resistance Dynamic Total Alveolar Tidal Volume Units rpm ml cmH5O cmH50 L S cmH5O cmH5O cmH5O bpm mmHg kPa mmHg kPa L min ml ml L L L ml min ml cmH gt 0 L S ml Rev 05 ASCII Output VT alv s Spontaneous Alveolar Tidal Volume ml VT alv m Mechanical Alveolar Tidal Volume ml MV alv Alveolar Minute Volume Total L VdVtPh Physiologic deadspace to tidal volum
116. ulsatile signal can be massively distorted without affecting the patient s SpO In order to accommodate these IABP procedures without compromising the monitor s superior artifact rejection algorithm IABP MODE is available IABP MODE allows the 54 NI CO User s Manual Rev 05 Configuration Menu Rev 05 user to turn off the validator algorithm so that all pulsatile data are allowed to influence the SpO and Pulse Rate calculations NOTE With IABP MODE turned ON the clinician must exercise prudence in assessing the validity of the SpO and Pulse Rate displays because any motion or other artifact not just that associated with the IABP can have a significant affect on the SpO and Pulse Rate calculations While in IABP MODE the displayed Pulse Rate reflects true pulsatile signal heart rate plus the IABP ratio e g 1 heart rate 2120 bpm IABP ratio 1 1 then displayed Pulse Rate should be 120 120 1 240 beats min e g 2 heart rate 120 bpm IABP 1 3 then displayed Pulse Rate should be 120 120 3 180 beats min When in IABP MODE the Pulse Rate can be affected by motion or other artifact the accuracy of the Pulse Rate can usually be used as an indicator of the quality of the SpO display Configuration Menu Simultaneously press and hold the MENU and DATA ENTRY keys for 3 seconds to access the Configuration Menu Turn and press the KNOB to adjust and accept settings i e Factory Range Units Description
117. ume ratio Vd alv Alveolar deadspace Vt alv Alveolar tidal volume Vte Expired Tidal Volume Vte m Expired Tidal Volume mechanical Vte s Expired Tidal Volume spontaneous Vti Inspired Tidal Volume Vti m Inspired Tidal Volume mechanical Vti s Inspired Tidal Volume spontaneous Range Units 1 3000 ml min adult pediatric 0 300 ml min neonatal 0 500 ml 0 1 00 ml 0 500 ml 0 2400 ml adult 0 1200 ml pediatric 0 160 ml neonatal 200 3000 ml adult 30 400 ml pediatric 1 100 ml neonatal 200 3000 ml adult 30 400 ml pediatric 1 100 ml neonatal 200 3000 ml adult 30 400 ml pediatric 1 100 ml neonatal 200 3000 ml adult 30 400 ml pediatric 1 100 ml neonatal 200 3000 ml adult 30 400 ml pediatric 1 100 ml neonatal 200 3000 ml adult 30 400 ml pediatric Description Volume of CO eliminated through the breath each minute Includes added mechanical deadspace proximal to the flow sensor PaCO5 PeCO PaCO Difference between physiologic and airway deadspace Tidal volume less airway deadspace Volume of gas exhaled per breath Volume of mechanically exhaled gas per breath Volume of spontaneously exhaled gas per breath Volume of gas inhaled per breath Volume of mechanically inhaled gas per breath Volume of spontaneously inhaled gas per breath Screen Display All except Flow Pressure amp Loops Numerics SBCO Tabular Data Numerics SBCO 8 ABG Data Entry Nu
118. ument in such an environment may present an explosion hazard e Electrical Shock Hazard Always turn the NICO monitor off before cleaning it Do not use with a damaged external power source Refer servicing to qualified service personnel Connect the AC Mains power cord to a properly grounded hospital grade outlet The NICO monitor should be connected to the same electrical circuit as other equipment in use on the patient Outlets of the same circuit can be identified by members of the hospital s engineering department Failure of Operation If the monitor fails to respond as described do not use it until the situation has been corrected by qualified personnel e Reuse disassembly cleaning disinfecting resterilizing etc of the CO5 CO Flow and NICO Sensors may compromise device functionality and system performance and cause a potential patient hazard Performance is not guaranteed if a sensor is reused Inspect the CO CO Flow SpO and NICO Sensors prior to use Do not use if they appear to be damaged or broken Do not attempt to rotate the NICO Sensor in the breathing circuit by grasping the pneumatic tubes exiting the flow sensor Do not apply excessive tension to any cable or pneumatic tubing e Periodically inspect sensor tubing lines for kinks e Replace the CO5 CO Flow or NICO Sensor if excessive moisture or secretions are observed in the tubing e NICO automatically identifies the type of senso
119. urn the KNOB to highlight the screen you wish to display Press the MENU key or the KNOB to display that selected screen YCOo MValy 7 PEN J ro 3 LI T1 E 1 1 18 NI CO User s Manual Rev 05 DATA ENTRY key Screen Displays DATA ENTRY key Screen Displays Press the DATA ENTRY key to activate the DATA ENTRY screen and illuminate the key s green icon Press the key again to return to the previously displayed screen From the DATA ENTRY screen you can enter patient information including height weight and respiratory gas mixture and access the ABG DATA ENTRY screen See Entering Patient Data on page 28 for details DATA ENTRY GATA ENTRY Oo PUSH HEIGHT WEIGHT TURN PUSH TO ADJUST TO ACCEPT Rev 05 NI CO User s Manual 19 DATA ENTRY key Screen Displays ABG Data Entry From the DATA ENTRY screen select ABG DATA ENTRY Turn and press the KNOB to enter PaCO Screens PaO5 and Hemoglobin entry screens See Entering Patient Data on page 28 for details E NEN FUEL Ty di ud Y L AC Lun u E T TURN PUSH TO SELECT TO ACCEPT 20 NICO User s Manual Rev 05 Safety For maximum patient and operator safety observe the following warnings cautions and notes Warnings WARNING Indicates a potentially harmful condition that can lead to personal injury e Explosion Hazard Do not use the NICO monitor in the presence of flammable anesthetics Use of this instr
120. use Do not immerse the monitor Do not sterilize the monitor Turn the monitor off and unplug from the AC power source before cleaning The monitor can be cleaned and disinfected by wiping with solutions such as a 70 isopropyl alcohol 2 gluteraldehyde or 10 bleach solution Then wipe down with a water dampened clean cloth to rinse Dry before use Do not immerse the finger sensor Do not sterilize the finger sensor The sensor can be cleaned and disinfected by wiping with solutions such as a 70 isopropyl alcohol 2 gluteraldehyde or 10 bleach solution Then wipe down with a water dampened clean cloth to rinse Dry before use Make certain that the finger sensor windows are clean and dry before reuse After cleaning the finger sensor perform a Quick Check to verify the sensor is functional See Sensor Quick Check on page 68 The Y Sensor may be immersed up to but not including the connector in a 2 gluteraldehyde solution or 10 bleach solution Refer to manufacturer s instructions and standard hospital protocols to determine recommended times for disinfection and sterilization Rinse thoroughly with water and dry before use Do not rinse the connector After cleaning or sterilizing the Y Sensor perform a Quick Check to verify the sensor is functional See Sensor Quick Check on page 68 Treat tapes and foam wraps in accordance with hospital protocol for single patient use items Rev 05 Mo
121. ust the value as desired Press the KNOB to accept the value O 01 A C N Repeat these steps for the other settings DATA EHTRY GATA ENTRY IHZP BALAHCE TURN PUSH TO ADJUST TO ACCEPT Entering ABG Data To enter ABG data 1 Press the DATA ENTRY key to activate DATA ENTRY The key s green icon illuminates Press the key again to return to the previously displayed screen 2 Highlight ABG DATA ENTRY by turning the KNOB 36 NI CO User s Manual Rev 05 Entering ABG Data 3 Select ABG DATA ENTRY by pressing the KNOB GATA ENTRY PUSH dals zu ERI fe is TI Lu JR PUSH TURN PUSH TO SELECT TO ACCEPT Rev 05 NI CO User s Manual 37 Entering ABG Data 4 Turn and press the KNOB to select the PaCO PaO Hb Hct Mark ABG Time or Default ABG screen NOTE PaO and Hb selections are dimmed in Respiratory Mechanics mode to denote that although they are available for data input the data will not affect parameter calulations 5 Turn KNOB to adjust value e ABG Time is required for PaCO Ensure that the NICO clock is synchronized to the clock used to determine the draw time 6 Press the KNOB to accept the value Updated Vd Vt and Vdalv values are displayed 38 NI CO User s Manual Rev 05 Cardiac Output mode C O Trend Screen Rebreathing Curves Screens Rev 05 Monitoring and Setup Screens Cardiac Output mode This section provides an overview of monitoring and s
122. vate SELECT A SCREEN The key s green icon illuminates 0 e Press the key again to return to the previously displayed screen 2 Highlight and then select SETUP by turning SETUP and then pressing the KNOB ee eee PULSE BEEP OFF PURGE HOW SWEEP MEDIUM 3 The SETUP screen is displayed IABP MODE OFF C 0 MODE AVERAGE 4 Again turn the KNOB ERE ados to highlight an item and IMPUT OUTPUT push the KNOB to select it Items within the SETUP screen are described below Label Settings Range Description CO ZERO NOW Start or Cancel Displays the CO ZERO NOW screen Place the CAPNOSTAT CO Sensor default Start onto a clean and dry adapter Place the adapter in room air and away from all sources of CO Select START to begin a CO Zero or CANCEL to exit the selection and return to the SETUP menu PURGE NOW n a The system immediately purges the NICO Sensor tubing No messages are displayed The Purge takes approximately 8 seconds The flow and pressure waveform traces will return to zero during this period Rev 05 NICO User s Manual 45 Respiratory Mechanics mode Label Settings Range Description IABP ON or OFF Displays the SET SpO IABP MODE screen Turn the KNOB to select OFF Intra Aorta default setting or ON to turn off the validator algorithm so that all Balloon Pump pulsatile data including the normally rejected artifact generated by the IABP are allowed to influence the SpO gt and Pulse Rate calcul
123. verlay function freezes a single breath on the FLOW PRES VOL screen as a template Subsequent loops will be drawn over that breath CLEAR OVERLAT e Press the KNOB to highlight SET OVERLAY and again to select the breath e Press the KNOB to highlight CLEAR OVERLAY and again to erase the selected breath e The time stamp above the template wave corresponds to when the overlay was set 42 NICO User s Manual Rev 05 Respiratory Screens Optional Single Breath CO VCO gt MValv Trend Rev 05 The SINGLE BREATH C02 screen displays the CO waveform for a single patient breath as well as providing numeric displays of VCO Vte ETCO Vtalv Vti and VdAw SBCO presents the exhaled concentration of CO versus tidal volume during a single expiration useful for understanding the ventilation perfusion relationship It allows the clinician to detect relative changes in CO production deadspace and effective ventilation by observing the shape of the graph The curve is automatically scaled to fit the display area Set Overlay The Set Overlay function freezes a breath on the SINGLE BREATH CO2 screen as a template Subsequent waveforms will be drawn over that breath for comparison ADA A dra P s L LE ee Press the KNOB to highlight SET OVERLAY and again to select the breath Press the KNOB to highlight CLEAR OVERLAY and again to erase the selected breath The time stamp above the template wave corresponds
124. witch between audio enabled fi l settings Rev 05 NI CO User s Manual 57 No Respiration Alert Adjust Alert Audio To adjust the Alert Audio Volume MENY Volume 1 Display the SET ALERTS screen Press MENU then select SET ALERTS 2 Highlight and then select AUDIO by turning and then pressing the knob 3 Turn the knob to adjust the volume setting e Volume ranges from 1 to 10 loudest e A representative tone sounds at each setting 4 Press the knob to accept the displayed value NOTE Make sure that the audible alert volume is not set too low to be heard over ambient noise levels Auto Alerts Alert limits for LOW and HIGH C O PIP HIGH only ETCO SpO RR and Pulse rate can be set automatically for alerts which have been enabled Alert limits are bracketed about the current patient values Auto Alerts do not affect the status of the audible alert bell icon No Respiration Alert The NICO monitor incorporates a No Respiration Alert NO RESP Once the monitor detects respiration any loss of that signal starts the No Resp timer A visual and audible if desired alert occurs if the monitor does not detect a respiratory rate signal before the timer reaches its user set limit 20 seconds by default If a No Respiration alert occurs e The message NO RESP x xx is displayed unless a higher priority alert is in progress e The counter shows the elapsed time minutes seconds since the alert occu
125. xhalation phase of the ventilator cycle and will not exceed exhalation time NI CO User s Manual 53 Intra Aortic Balloon Pump A purge can also be initiated upon request if the flow waveform appears as though the lines are partially occluded see example below and the purge did not initiate automatically To initiate a purge see Manual Purging above Normal Occluded NOTE If the purge does not sufficiently clear the flow tubing lines the flow sensor should be changed Below is an example of a waveform that exhibits a small leak in the breathing circuit Replace the sensor if problem persists refer monitor to qualified service personnel Small leak in flow tubing Intra Aortic Balloon Pump NICO uses advanced signal processing algorithms to distinguish valid pulsatile signals from signals generated by motion or other artifact Motion artifact very common in all but heavily sedated patients can swamp the true pulsatile signal or distort it enough to produce significant errors in the SpO and Pulse Rate calculations The validator algorithms reject distorted plethysmographic signals or those that lack a regular rhythmic pattern therefore only valid pulsatile signals are allowed to affect the monitor s SpO and Pulse Rate calculations Rare conditions exists where the pulsatile waveform truly is distorted and lacks a fixed rhythm specifically during use of an Intra Aortic Pump IABP During IABP procedures the p
126. y of the measurements To avoid the effects of excessive moisture in the measurement circuit insert the CO Flow sensor in the ventilator circuit with the tubes upright Improper placement may result in erroneous data Excessive moisture in the CO Flow sensor tubing may affect the accuracy of the measurements It is recommended that CO5 Flow or NICO Sensors be removed from the circuit whenever an aerosolized medication is delivered This is due to the increased viscosity of the medications which may contaminate the sensor windows causing the sensor to fail prematurely Operate the monitor at temperatures between 10 to 40 C 50 to 104 F 10 9596 R H non condensing Avoid storing the monitor at temperatures less than 10 C or greater than 55 C lt 14 F or gt 131 F 10 95 R H non condensing Observe precautions for electrostatic discharge ESD and electromagnetic interference EMI to and from other equipment Where electromagnetic devices i e electrocautery are used patient monitoring may be interrupted due to electromagnetic interference Electromagnetic fields up to 3 V m will not adversely affect system performance Caution Federal U S A law restricts this device to sale distribution or use by or on the order of a licensed medical practitioner Rev 05 Notes NOTE A point of particular interest or emphasis intended to provide more efficient or convenient operation n order to ensure pr
127. y pressing the DATA ENTRY key 34 NI CO User s Manual Rev 05 Entering Patient Data DATA ENTRY settings The following table lists the parameters and ranges accessible in the DATA ENTRY screens Label INSP O5 INSP AGENT BALANCE HEIGHT WEIGHT Parameter Inspired Oxygen Inspired Anesthetic Agent Gas Balance Patient Height Patient Weight ABG DATA ENTRY Screen PaCO PaO Hb MARK ABG TIME DEFAULT ABGs a 40mmHg 5 4 kPa or if ETCO is not available Rev 05 Arterial Carbon Dioxide Arterial Oxygen Hemoglobin Concentration or Hematocrit Time when ABG blood sample is drawn Blood gas values Default 70 0 40 mmHg 5 4 kPa or displayed until an Initial value is entered FiO Pb 47 mmHg displayed until an initial value is entered 11 0 gm dL 6 8 mmol L 33 96 displayed until an initial value is entered Current Time PaCO gt 5 mmHg 0 7kPa or 96 above the measured ETCO value PaO gt Based on barometric pressure and INSP O value Hb 11 0 gm dL Range Units 21 100 96 0 20 Yo N gt He or N50 35 91 in 90 230 cm Neonatal 0 22 44 09 Ib 0 10 20 00 kg Pediatric 0 2 220 2 Ib 0 1 99 9 kg Adult 55 551 Ib 25 250 kg 0 250 mmHg 0 0 20 0 kPa 0 0 20 0 Yo 0 750 mmHg 0 0 99 5 kPa 0 0 99 5 Yo Hb 5 0 20 0 gm dL Hb 3 1 12 4 mmol L Hct 0 60 hh mm hours minutes
128. y turning and then pressing the knob The SVR CALCULATION screen is displayed Press then turn the KNOB to adjust the setting e MBP Mean Blood Pressure 25 to 300 mmHg e CVP Central Venous Pressure 9 to 25 mmHg e C O Cardiac Output 0 5 to 19 9 L m This value will correspond to the displayed value AVERAGED or MBP CVP X 80 CO SVR FAST and its value can be manually changed If uds dyn sec cm manually changed the value will not be updated to reflect the displayed value e SVR Systemic Vascular Resistance 0 to 5000 dynes sec cm Appears as until the MBP value is entered e 80 A constant factor used to convert from Wood to VRU units 5 Press the KNOB to accept the displayed value turn to select the next setting Tabular Data Screen The TABULAR DATA screen displays the data collected for all NICO parameters in three minute increments in a table format The parameter displayed in each column will vary depending on the setting chosen by the user 1 Highlight and select the desired column by turning then pressing the KNOB 2 Turn the KNOB to advance through all available NICO parameters 3 Press the KNOB to accept the displayed parameter turn to select the next column Time Column With the TIME column selected flashing turn the KNOB to display NICO parameters collected since the beginning of the monitoring session the most recent records are at the bottom of the table Three arr
129. ys CONSIDER USING A SMALL NICO SENSOR when ventilator set tidal volume is less than 300 ml e Standard NICO Sensor the monitor displays CONSIDER USING A LARGE NICO SENSOR when ventilator set tidal volume is greater than 1000 ml e Large NICO Sensor the monitor displays CONSIDER USING A STANDARD NICO SENSOR when ventilator set tidal volume is less than 1000 ml NI CO User s Manual 61 62 NICO User s Manual CQ Flow Sensors This section details the use of combined CO Flow sensors with the NICO monitor This section also explains how to connect a sensor to the monitor and how to apply the sensor to the patient NICO automatically operates in Respiratory Mechanics mode whenever a CO gt Flow sensor is connected to the monitor Cardiac output and associated parameters are no longer available Only NICO CO5 Flow sensors are compatible with the NICO monitor Sensors may be connected and removed with the monitor off or on ff OV V i Remove nsert Press latch release CO Flow sensor Push in and pull sensor out Connect Do not twist Do not twist Slides on Clicks into place Remove Slides off WARNING The Disposable CO gt Flow sensor is intended for SINGLE PATIENT USE ONLY Re use including disassembly cleaning disinfecting ster

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