Stimuplex® HNS 11 - Erfaringsregistrering
Contents
1. ers a wide range of skin and needle impedance This is especially important when using stimulation needles with an extremely small conductive area pin point electrode tip such as Stimuplex D and Contiplex D needles 12 Battery The battery must be regularly checked for correct charge by press ing the BAT button While the button is pressed the existing battery voltage appears on the LCD display The battery should be replaced under 7 volts as soon as the BAT symbol appears When the battery voltage drops below 6 V the nerve stimulator stops operating Four horizontal lines and the BAT symbol appear in the LCD display Change the battery When the Stimuplex HNS 11 nerve stimulator is not used for a long period of time the battery must be removed to prevent leak age Changing the battery The battery compartment is in the base of the nerve stimulator Open the compartment by lightly pressing the OPEN symbol At the same time slide the cover in the direction of the arrow Change the battery ensuring correct polarity After fitting the bat tery slide the cover of the battery compartment back on again right up to the limit stop Use only 9 V alkaline manganese batteries e g VARTA 4022 DURACELL MN 1604 These will provide you with a greatly extended operating time and thus considerably more reliable function Warning If the battery is leaking the Stimuplex HNS 11 should no longer be operated for safety rea2. 0 03 0 80 mA 0 03 1 00 mA 0 03 Patient current 0 00 mA 0 50 mA 1 00 mA 1 50 mA 2 00 mA 3 00 mA 4 00 mA 5 00 mA Measurement display 0 00 mA 0 50 mA 0 1 1 00 mA 0 1 1 50 mA 0 1 2 00 mA 0 1 3 00 mA 0 1 4 00 mA 0 1 5 00 mA 0 1 24 Controller display 0 00 mA 0 50 mA 0 1 1 00 mA 0 1 1 50 mA 0 1 2 00 mA 0 1 3 00 mA 0 1 4 00 mA 0 1 5 00 mA 0 1 nnna C1 Conversion table Amplitude mA and pulse width ms to charge nano Coulomb nC Amplitude mA Pulse width Charge Pulse wid ms nc ms th Charge nc 0 3 30 Pulse width Charge ms nc 1 0 100 0 3 60 0 3 90 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 0 3 25 Appendix C Stimuplex HNS 11 Nerve Stimulator Operating range 60 Max stimulation voltage V 50 40 30 20 10 gt Battery voltage V 12 Stimuplex HNS 11 Nerve Stimulator Max stimulation current as a function of tissue resistance 5 00 10 KQ Max stimulation current mA 4 00 15 KQ 3 00 20 KQ 25 KQ 2 00 50 KQ 1 00 0 0 5 6 7 8 9 10 11 12 Battery voltage V Appendix D Bare and insulated needles 10 Stimulation current 9 T T mA sd Ba
3. 00 203 10 Peripheral electrical nerve stimulation Principles By simplifying the accurate location of peripheral nerves periph eral electrical nerve stimulation PNS facilitates the performance of nerve and plexus blocks increasing their safety and reliability The old rule no paraesthesia no anaesthesia 1 loses its valid ity because information from the patient concerning paraesthesia is eliminated and the danger of a mechanical nerve lesion 8 is largely excluded The principle consists of triggering depolariza tions with electrical pulses at but not within the nerve causing muscular contractions at the effector muscle or sensitive sensa tions in the distribution area Paraesthesia due to direct contact of injection needles and nerve is consciously avoided PNS does not replace the anatomical knowledge required for re gional anaesthesia rather it assumes accurate knowledge of the topography and the nerve distribution area The various types of nerve fibre differ in regard to their sensitivity to electrical stimulation The A alpha motor fibres have the short est chronaxia 50 100 us The fibres of pain sensation A delta and C fibres require a longer pulse 150 and 400 us respectively at minimum current Mixed peripheral nerves can be localized with short pulses 0 1 ms without triggering pain sensations For pure sensory nerves a longer pulse 0 3 or 1 0 ms is recommended When using unipolar needle
4. 200 25 Product discription Canula Code number Sales unit x length Stimuplex A needles 30 bevel A 25 24Gx1 0 55x 25mm 4894251 25 A 25 22Gx1 0 70 x 25mm 4894539 25 A 50 22 Gx 2 0 70 x 50mm 4894502 25 A 50 21G x 2 0 80 x 50mm 4894375 25 A 100 21 G x 4 0 80 x 100 mm 4894260 25 A 150 20 G x 6 0 90 x 150 mm 4894278 25 Contiplex D needles 15 bevel D 28 055 C 18 G x 2 1 3x 55mm 4894219 25 D 28 110 C 18 G x 4 1 3 x 110 mm 4894294 25 Contiplex D needles 30 bevel D 18 055 C 18 G x 2 1 3 x 55 mm 4894227 25 Contiplex D Catheter Set with polyamide catheter 0 45 x 0 85 x 400 mm needle D 28 055 C 18 G 15 bevel 1 3 x 55 mm 4894235 10 needle D 18 055 C 18 G 30 bevel 1 3 x 55 mm 4894243 10 with polyamide catheter 0 45 x 0 85 x 1000 mm needle D 28 110 C 18 G 15 bevel 1 3 x 55 mm 4894391 10 Contiplex A needles 30 bevel A 45 C 18 G x 13 1 3 x 45 mm 4893611 25 A 55 C 18 G x 2 1 3 x 55 mm 4893643 25 Contiplex A Catheter Set with polyamide catheter 0 45 x 0 85 x 400 mm needle A 45 C 18 G 30 bevel 1 3 x 45 mm 4893603 10 needle A 55 C 18 G 30 bevel 1 3 x 55 mm 4893638 10 Alphaplex Catheter Set with catheter 0 9 m x 1 25 m x 330 mm guide wire and Contiplex D D 28 055 C 15 and 30 bevel Basic Set 15 bevel 1 3 x 55 mm U 1800 210 10 Super Set 15 bevel 1 3 x 55 mm U 1800 200 10 Basic Set 30 bevel 1 3 x 55 mm U 1800 201 10 Super Set 30 bevel 1 3 x 55 mm U 18
5. Stimuplex HNS 11 Nerve Stimulator for Regional Anaesthesia Regional Analgesia Neurology User manual B BRAUN Manufacturer Stockert GmbH B tzinger StraBe 72 D 79111 Freiburg Germany Distributor B Braun Melsungen AG P O Box 11 20 D 34209 Melsungen Tel 056 61 71 0 Fax 05661 71 38 11 Contents Page Checks before Start up ooo eoe ee 4 TEChMical desenption nee 6 Operating the nerve stimulator 7 Switching ot SwItehlng OTEs s idi ma tem nd ania pe oon ade 7 Selecting the pulse frequency ittm iler enter tdg kii enia 7 Seleetingsthepulse width en nunmehr 7 Selecting the c rrent range uscire Teiln Len T ER 8 Checking thebattery voltage s moienn n A Ear retentis ir cepe rn 8 Selecting the current display mode sinisiin 8 The LED displays 9 CUM EIS play moe eee mi eR pair ee eet rtu abr Essa Eten 9 Current adjustment ra g iain theta dria ea 9 Pulse width 9 MSc 9 Pulse LED display naninira meta topped ANA NNA NANAREN TAINA 10 TREILCD ASHIaV ee ae 10 THE One ee einen 1 Initial set up maintenance and general advice 11 Testing the Stimuplex HNS 11 before an application sssi 11 Speciaktechnical features aminn ian u a A a a 12 Technical datai anioia a Eur 12 Battle adea tasta in Rene RD nin Hbi ie REDE Berta ue RR eR BERTA NATAS EITHER es 13 Cleaning and disinfecting the Stimuplex HNS 11 sssrinin 14 Maintenance and Safety CHECKS cct iet tacet dite flt d d
6. al value display is selected the LCD display additionally shows a in front of the current displayed Exceptions 1 Pressing the BAT button displays the battery voltage 2 Equipment related error functions produce the corresponding error code in the display see p 17 3 The BAT symbol in the display indicates that the battery must be exchanged soon 4 When the battery voltage drops to approx 6 volts or appears on the display The stimulator switches off automatically when these signs appear Display The BAT symbol indicates that the battery voltage is too low Refer to the Battery section p 13 10 1 T LI Ju a ra as Ga gt m a gt p The tone Each generated pulse produces a tick When a stimulation current flows to the electrodes greater than 2 of the maximum stimula tion adjustable the tick becomes louder If the stimulation current flowing exceeds the current set then taking into account the measuring tolerance see page 12 Techni cal data Measuring tolerance the Stimuplex HNS 11 institutes an error message consisting of several tone groups of rapid frequency approx 6 Hz The device is no longer operational Each time a button is pressed a short tone is produced of a differ ent frequency as audible confirmation A click confirms that the instrument has been switched on Initial set up maintenance and general advice Test
7. ents may cause direct contact of the needle with the nerve resulting in the danger of a me chanical nerve lesion If needles from other manufacturers are used the threshold currents may be much higher You would have to work out these yourself After clearly visible muscular contractions are seen using the desired threshold current inject local anaesthetic The response to the electrical stimulation will reduce or disap pear within a few seconds after an injection of 2 3 ml If this effect is not definite do not continue to search for the nerve at the same location For safety reasons a more peripheral site should be used 22 Literature Literature 1 Moore DC 1965 Regional block A handbook for use in the clinical practice of medicine and surgery Thomas Springfield II 4th ed Ford DJ Pither CE Raj PP 1984 Electrical characteristics of peripheral nerve stimulators Implications for nerve localizati on Reg Anesth 9 73 Ford DJ Pither CE Raj PP 1984 Comparsion of insulated and uninsulated needles for locating peripheral nerves with a peri pheral nerve stimulator Anesth analg 63 925 Kaiser H Niesel HC Klimpel L 1988 Einfluss der Reizstrom st rke der Nervestimulation auf Latenz und Erfolg der hinteren Ischiasdiskusblockade Regional Anaesthesie 11 92 Kaiser H Niesel HC Hans V 1990 Grundlagen und Anforde rungen der peripheren elektrischen Nervenstimulation Regio nal Anaesthe
8. h to actual current flowing value indicator mA 4 and check that the actual value corresponds to the set value see p 12 Technical data measuring tolerance If the two values coincide the total resistance is acceptable impedance test and the electric circuit is satisfactory If the actual value is less than the set value this indicates that the electrical resistance in the external circuit is too high The cause must be found e g adhesive electrode too dry skin resistance too high broken cable After the impedance test leave in the mA position current flowing at the tip of the needle indicated and a sign in front of the current displayed until the block is successful Set an actual current of approx 1 to 2 mA and advance the needle further until the first muscles supplied by contractions occur in the nerve sought Then while reducing the current advance the needle to the nerve until the recommanded thres hold current For values see for example literature references 4 7 The threshold current to be achieved depends on the pulse width and the geometry of the conductive tip of the needle Warning When using Stimuplex or Contiplex needles it must be noted that muscular contractions with a current of 0 2 to 0 5 mA and a stimulus duration of 0 1 ms with a current of 0 05 to 0 2 mA and a stimulus duration of 1 0 ms indicate satisfactory proximity to the nerve sought Any further reduc tion in the threshold curr
9. his button does not affect the Stimu plex HNS 11 functions All settings remain unchanged Selecting the current display mode During operation of the nerve stimulator the stimulation current is shown on the LCD display Pressing the mA button selects the cur rent display mode the stimulation current set mA displays set current or the current actually flowing in the tissue mA dis plays actual current In addition a appears in front of the cur rent on the LCD display in the case of the actual current display If a current display mode is set check this by switching to operat ing mode 7 in the operating mode mA actual current and 0 00 appears in the display then the possible source of the error could be the electrode cable is not connected to the device the adhesive electrode is defective possible too dry the tissue resistance is very high the connecting cables are defective The measuring mode selected is displayed and is stored until the mA button is pressed again The LED displays All LEDs directly assigned to the buttons are used to monitor the selected operating mode Since LEDs require relatively high power the Stimuplex HNS 11 switches them off after 8 seconds see p 6 Section 7 The individual displays have the following significance Current display mode The LCD display shows the stimulation current set 7 The LCD display shows the stimulation current actual
10. ing the Stimuplex HNS 11 before an application Switch on the Stimuplex HNS 11 nerve stimulator by turning the control knob clockwise from position O A short click confirms that switching on has taken place When the self test has been com pleted the unit changes over immediately to the normal operating mode You can now select the frequency pulse width and current range according to the application required see Section Operat ing the nerve stimulator p 7 With the set current indication mA 7 do not connect both elec trodes check both current ranges 1 mA max and 5 mA max up to maximum Switch to actual current indication mA both mA ranges give a should reading of 0 00 mA independet from the set current Connect the two electrodes clip and plug together check the mA value in each case up to the maximum All mA values have a sign in front of the display As soon as current flows the LED above the display flashes in time with the stimulation current The symbol appears next to the A and the tick becomes louder Set an actual current of approx 0 30 mA and switch to set current mA 7 the two values should be the same see Page 12 Techni cal data Measuring tolerance If all adjustments have been found to be correct your Stimuplex HNS 11 is ready for application o p Fa Dc e a Special technical features The configuration of the electrode connection provides protection again
11. ion is faulty F2 Error in the program F3 Reference error in the analogue data acquisition system Instruments and accessories The Stimuplex HNS 11 nerve stimulator should only be operated with the accessories and instruments mentioned on page 13 14 18 and 19 of this user manual Check the accessories and instruments for serviceable condition before every occasion of use and comply with the care and disin fection instructions supplied p 14 Stimuplex HNS 11 and Accessories Stimuplex and Contiplex needles 18 Product discription Canula Code number Sales unit x length Stimuplex HNS 11 nerve stimulator 4892097 1 with electrode cable for Stimuplex D Stimuplex A and Contiplex D needles Knob for sterile handling 4892283 1 Electrode cable for Stimuplex D 4892070 1 Stimuplex A and Contiplex D needles Connection cable for Contiplex A needles 4892925 1 Stimuplex D needles 15 bevel D 25 035 25 G x 11 0 5x 35mm 4894103 25 D 25 055 25 G x 2 0 5x 55mm 4894111 25 D 26 040 23 G x 11 0 6x 40mm 4894120 25 D 26 070 23 G x 2 0 6x 70mm 4894138 25 D 27 050 22 G x 2 0 7 x 50mm 4894146 25 D 27 080 22 G x 3 0 7 x 80mm 4894154 25 D 27 120 22 G x 43 0 7 x 120 mm 4894162 25 D 29 150 20 G x 6 0 9 x 150 mm 4894170 25 Stimuplex D needles 30 bevel D 17 040 22 G x 1 0 7 x 40mm 4894189 25 D 17 050 22 G x 2 0 7x 50mm 4894197 25 D 17 080 22 G x 3 J 0 7 x 80 mm 4894
12. ly flowing A In addition a appears in front of the current displayed Current adjustment range Setting range from 0 00 to 5 00 mA Use the controller to dial a stimulation current up to 5 mA The current is displayed in 0 02 mA digits Setting range from 0 00 to 1 00 mA Use the controller to dial a stimulation current up to 5 mA The current is displayed in 0 01 mA digits Pulse width Pulse width 1 0 ms duration of stimulation pulse is 1 0 ms Pulse width 0 3 ms duration of stimulation pulse is 0 3 ms Pulse width 0 1 ms duration of stimulation pulse is 0 1 ms Pulse frequency Pulse frequency 2 Hz two pulses per second Pulse frequency 1 Hz one pulse per second o m te V j fos Cea os i Pulse LED display The small orange LED above the LCD display flashes according to the pulse frequency set 1 Hz once per second 2 Hz twice per second when current is flowing through the electrodes At the same time a louder tick can be heard The LCD display According to the display mode selected the LCD display shows the setting for or the actually flowing stimulation current The display is in mA The A symbol indicates the stimulation frequence At the same time there is a ticking sound in the same stimulation frequence A A symbol appears next to the symbol in the same stimulation frequence when the stimulation current is flowing and the ticking sound gets louder When the actu
13. n appropriate medical specialist Possible interference with the implanted devices by the stimulation current could represent a danger to the patient The adhesive electrodes must not be applied in the area of injuries The Stimuplex HNS 11 nerve stimulator must not be used in areas where there is an explosion hazard The Stimuplex HNS 11 nerve stimulator must not be used close to microwave therapy equipment The possible pick up of radio frequency currents by the stimulation electrode could damage the nerves The patient current should not drop below a specific value please refer to p 21 points 8 and 9 If the battery has leaked the Stimuplex HNS 11 must not continue to be operated for safety reasons It must be returned to the manufacturer for correct cleaning The same applies if any liquid soaks through In the event of warning tone sequences tone groups of approx 6 Hz the Stimuplex HNS 11 must be switched off and returned to the manufacturer or distributor for repair Error messages When the Stimuplex HNS 11 nerve stimulator is switched on it automatically carries out a self test If this detects a faulty function the fault is shown on the corresponding error code on the LCD display The Stimuplex HNS 11 is then no longer operational It must be returned to the manufacturer for repair You should state the error code in the repair order The following error codes are possible F1 Analogue data acquisit
14. ng mode The LEDs on the button te d panel indicate the operating conditions selected To conserve Vr power these extinguish after 8 seconds If no display appears when the Stimuplex HNS 11 is switched on change the battery immediately Refer to the Battery section p 13 If the self test detects a defective function the corresponding error code will appear in the LCD display and the instrument will then be inoperative Refer to the Error messages section When the LEDs are switched off they can be reactivated by press ing any button This does not change the existing operating mode The operating mode can only be changed when the LEDs are lit 2 Carry out a visual inspection of the electrode cable Damaged cables must not be used Connect the electrode cable to the front of the nerve stimula L N tor The plug connector configuration prevents wrong polarity connection In the operating mode the LCD display shows the preselected stimulation current set on the controller between 0 00 and approx 1 00 mA in the 1 mA range or from 0 00 to approx 5 00 in the 5 mA range In the operating mode the Stimu plex HNS 11 shows the stimulation current actually flowing via the stimulation electrodes through the tissue A sign on the LCD display signals this setting The operating mode is switched by pressing the mA button Select operating mode 4 Set the controller to 5 mA max and try
15. ou should replace the 9 volt block battery as soon as the battery volt age drops to 6 5 volts To switch off the nerve stimulator turn the control knob anti clockwise to position O To conserve the battery always switch off the Stimuplex HNS 11 after use If you do not use it for a long period of time remove the battery to prevent battery leakage BAT Technical description 6 Refer to the Safety information section before using the Stimu plex HNS 11 on a patient Any instrument behaving abnormally must not be put into operation Contact customer service Electromedical equipment may only be repaired by the manu facturer or by an organization expressly authorized by the manu facturer The Stimuplex HNS 11 nerve stimulator is designed for reliable identification and location of nerves for local anaesthesia It generates consistent square pulses with selectable frequency selectable pulse width and continuously adjustable stimulation current The range of adjustment of the pulse current from O to 5 mA peak to peak can be reduced to 0 to 1 mA with the mA max button This 1 mA range allows precise adjustments for extremely thin and technically sophisticated needles The stimulation frequency and the pulse width can be varied for different applications The Stimuplex HNS 11 nerve stimulator offers the facility for selecting a frequency of either 1 Hz or 2 Hz can be chosen together with p
16. ps 14 Safety checks local lawerestricts a tpi aaa 15 SUELO ise Ot CO sertim vette aa eria av certc rtc Rer rus 16 Safety information et tetto oci ld ER RD en E ER ae EEE 17 Error messages Instrumernts andsactesso Mes E 18 Stimuplex HNS 11 and Accessories Stimuplex and Contiplex needles 18 Peripheral electrical nerve stimulation 20 Performing PNS with the Stimuplex HNS 11 and the Stimuplex needles 21 Literature ooo Eo ORE EUER ee 23 Appendices A to D Cerere determi em eade ern 24 Checks before start up 4 The Stimuplex HNS 11 is a class lla medical device according to Council Directive 93 42 EEC An item of medical equipment may only be put into operation after the supplier has subjected the equipment to a function test on site and has instructed the person responsible for operating the equipment in the use of the equipment with the aid of the user manual Before putting the Stimuplex HNS 11 into operation carry out the following tests 1 Turn the control knob clockwise out of the O position to switch on the Stimuplex HNS 11 A brief click signals that this has taken place At this instant the devices automatically starts a self test This includes switching UIS i 3 ZZ P on all segments of the LCD display as a visual check e L When the self test is completed the stimulator immediately 1 switches to its normal operati
17. re 4 i i lt uncoated gt 7 r i needles 4 arth i 1 i s 5 l t 45 7 3 Coated 2 i needles i 1 bevel uncoated gt 1 i Stimuplex A i Contiplex A 0 10 0 10 Distance from the nerve mm Stimuplex D and Contiplex D needles DP DE 3919666 Only 0 2 or 0 05 mA stimulation current required 1 D 5 1 1 1 4 i i i Stimulation 4 i current 3 i 4 mA gt i J 1 i I I 1 1 dle i 10 0 10 Distance from the nerve mm Threshold currents down to minimum 0 05 mA with 1 and minimum 0 2 mA with 0 1 ms allow reliable location of nerves Fully insulated Current density 26 Stainless steel needle blunt 30 needle with bare tip Stimuplex D Contiplex D 0 ms pulse width pulse width Plastic insulation pointed 15 B BRAUN Caution i B Braun Melsungen AG Federal U S A law restricts h o spit al care P O Box 1120 g this device to sale by or on the order of physicians D 34209 Melsungen Tel 056 61 71 0 Fax 05661 71 3811 W 01 08 01 7 Nr 6043895 www bbraun com
18. s needles with an insulated needle shaft and a conductive tip the current necessary to trigger mus cular contractions pulse amplitude correlates with the distance of the tip of the needle from the nerve the lower the threshold current the more accurately is the nerve localized and the shorter the onset and more reliable the success of the block 4 The short er the electrical pulse pulse width the faster is the rise in cur rent to the nerve and the clearer the discrimination as to whether the needle tip is sufficiently close to the nerve 2 5 The stimula tion needle should always be connected to the negative pole be cause higher currents are required if the polarity is reversed nee dle positive 6 The geometry of the electrical current field is dependent on the geometry of the conductive tip of the stimulation needle The small er the emission site of the electrons at the tip of the needle the higher is the current density at this point and the lower the thresh old current when the nerve is exactly localized The Stimuplex HNS 11 stimulator has been designed according to the most modern aspects and the requirements which originate from the theory and practice of peripheral electrical nerve stimu lation 3 6 It is provided with alarm systems necessary for the early detection of technical faults which could endanger the patient and place the success of the anaesthesia in jeopardy Performing PNS with the Stimuple
19. sie 13 143 Kaiser H Niesel HC Hans V Klimpel L 1990 Untersuchungen zur Funktion peripherer Nervenstimulation f r die Durchf h rung von Nerven und Plexusblockaden Regional Anaesthesie 13 172 Marz P 1990 Kann bei der elektrischen Nervenstimulation aus der Intensitat der Muskelkontraktion auf den Abstand zum Nerven geschlossen werden Regional Anaesthesie 13 179 Selander D Edshage S Wolff T 1979 Paraesthesiae or no pa raesthesiae nerve lesions after axillary block Acta anaesthesiol scand 23 27 Further literature Kaiser H Die periphere Nervenstimulation In Niesel HC dir Regionalan sthesie Lokalan sthesie Regionale Schmerztherapie Thieme Verlag Stuttgart New York 1994 186 207 Prithvi Raj P Editor Clinical practice of regional anaesthesia Churchill Livingstone New York 1991 Pinncock CA Fischer HBJ Jones RP Peripheral nerve blockade Churchill Livingstone New York 1996 Scott DB Introduction to regional anaesthesia Mediglobe Fribourg 1989 Appendix A Stimulation current display in the mA range Patient current 0 00 mA 0 05 mA 0 10 mA 0 20 mA 0 30 mA 0 40 mA 0 60 mA 0 80 mA 1 00 mA Appendix B Measurement display 0 00 mA 0 05 mA 0 02 0 10 mA 0 02 0 20 mA 0 02 0 30 mA 0 02 0 40 mA 0 02 0 60 mA 0 02 0 80 mA 0 02 1 00 mA 0 02 Controller display 0 00 mA 0 05 mA 0 03 0 10 mA 0 03 0 20 mA 0 03 0 30 mA 0 03 0 40 mA 0 03 0 60 mA
20. sons Acid penetrating the inside of the instrument can damage or impair essential circuitry It must be returned to the manufacturer for correct cleaning and a safety check Cleaning and disinfecting the Stimuplex HNS 11 Use only soft damp cloths to clean and disinfect the Stimuplex HNS 11 and the electrode cable Water soap or white spirits are especially suitable for this Ensure that no moisture penetrates the Stimuplex HNS 11 Use only wet disinfection no spray disinfection Avoid condensation White spirit or commercially available methanol free disinfectant in an ethyl alcohol base can be used for disinfection Caution The following substances must not be used trichloroethylene acetone methyl ethyl ketone benzene metha nol cellulose thinner 1 propanol and 2 propanol Maintenance and safety checks Check the serviceable condition of the Stimuplex HNS 11 and ac cessories on each occasion before use A defective instrument must not be used Electromedical equipment may only be repaired by the manufac turer or by an organization expressly authorized by the manufac turer An order for repairs must be accompanied by a detailed description of the fault acc separate Technical Service Manual 14 For usage of HNS 11 please refer to the individual local law restricts eg maintaining a logbook etc In case of conducting safety checks on the device please refer to the enclosed inspection sheet Ca
21. st a wrong polarity connection of the electrode cable This new type of plug connection system ensures correct polarity of the electrodes at all times A high stimulation voltage is associated with an unusually wide range of adjustment with extremely small stimulation electrodes The Stimuplex HNS 11 generates a negative current stabilized square pulse In contrast to conventional instruments of this type the pulse is shaped at both slopes by extremely fast active pulse drivers An output amplifier specially designed for this application has an extraordinarily wide dynamic range and produces repro ducible settings even below 0 1 mA Use of the latest microcomputer technology has made it possible to integrate performance characteristics which until now could only be provided in large systems For example selection of cur rent display mode set and actual value display display of battery charge error messages An internal quartz time base ensures precise pulse widths and frequencies Technical data Type Stimuplex HNS 11 nerve stimulator Power consumption Stimulation current max 5 mApp 0 Q 12 kQ Stimulation voltage max 65 Vpp Stimulation frequency 1 Hz 2 Hz Measuring tolerance Adjustment control display 3 set point Flowing current display 2 actual value based on set mA max values 5 mA or 1 mA Due to its high maximum output voltage the nerve stimulator cov
22. to get a connection with the insulated black 2 mm male plug with a part of the red clamp Compare by briefly switching to operating mode the measured value with the set value ac tual value and set value These two values must be the same with shorted cables Reset to 1 mA max and compare these two values see Measuring Accuracy in Appendix A if neccessary A symbol appears next to the A symbol in the LCD display Display and the pulsed LED display orange light emitting di ode blinks according to the stimulation frequence A sign appears in front of each measurement displayed When a current is set at O the orange LED starts to blink at 0 02 mA when 1 mA max is set and at 0 10 mA when 5 mA max is set When the stimulation cable is disconnected when 4 is set 0 00 appears in the display and the symbol disappears The pulsed LED display is no longer lit If the BAT symbol appears in the display then the battery voltage is getting too low Current application can be complet ed without a problem but exchanging the battery afterwards should be considered Press the BAT button to display the re maining battery voltage in volts When the battery voltage is approx 6 volts three horizontal dashes preceded by the sign or four dashes appear in the display in addition to the BAT symbol In this case the stimu lator shuts off automatically To avoid having to abort a stimulator treatment y
23. trol knob anticlockwise to position O Selecting the pulse frequency The selected setting is displayed and stored You can change the setting by pressing the Hz button when the LED display is lit The Stimuplex HNS 11 nerve stimulator offers the facility of selecting a frequency of 1 Hz or 2 Hz one or two pulses per second Selecting the pulse width The pulse width can be set by pressing the ms button It is possible to set a stimulation of 0 1 ms 0 3 ms or 1 0 ms The selected setting is displayed and stored Setting can be changed by pressing the ms button when the LED display is lit Selecting the current range The maximum current available can be selected by pressing the mA max button The Stimuplex HNS 11 nerve stimulator offers a choice between a range up to 5 mA max or up to 1 mA max Values between 0 00 mA and 1 00 mA can be selected in the 1 mA range with the on off control knob This also allows precise adjust ments to be made for extremely thin and technically sophisticated needles For safety reasons while a patient current is flowing it is not possible to switch from the 1 mA range to the 5 mA range If this is required turn the control to 0 00 mA and then switch over The selected current range is displayed and is stored until the mA max button is pressed again Checking the battery voltage Pressing the BAT button will display the existing battery voltage on the LCD display Pressing t
24. ulse widths of 0 1 ms 0 3 ms or 1 0 ms When the Stimuplex HNS 11 is switched off all set parameters remain stored As a visual and audible check the A symbol and a tick occur in time with the stimulation Stimulation current flowing through the electrodes is signalled by the symbol next to the A and a sign in front of the value for current in the display in operating mode To conserve battery power the LEDs on the button panel for the operating modes are switched off after approx 8 seconds They are reactivated by pressing any button This does not change the operating mode setting which can only be changed when the LEDs are lit Operating the nerve stimulator Switching on switching off Turn the control knob clockwise out of the O position to switch on the Stimuplex HNS 11 A brief click signals that this has taken place At this instant the device automatically starts a self test This includes switching on all segments of the LCD display as a visual check When the self test is completed the nerve stimulator immediately switches to its normal operating mode The LEDs on the button panel indicate the operating conditions selected see below To conserve power these extinguish after 8 seconds They light up again immediately when a button is pressed but this does not change the operating mode The operating mode can only be changed when the displays are lit To switch off the nerve stimulator turn the con
25. ution Electromagnetic fields may interfere with the function of the nerve stimulator Do not use the stimulator in the proximity of equip ment which produces strong electromagnetic fields such as HF high frequency surgical equipment micro wave equipment or cord less phones Notice The cables of the nerve stimulator Stimuplex HNS 11 should be positioned in such a way that they do not contact either the patient or other cables All accessories have to be visually inspected at regular time inter vals The insulation of the cables must not exhibit any damage Only original accessories from B Braun labelled with the CE sign should be used Regarding the disposal of the nerve stimulator and its accessories you should refer to the corresponding regulations in your country Storage and shipping conditions 0 50 C up to 90 relative humidity non condensation Warranty Stimuplex HNS 11 is guaranteed for two years against defects in material and workmanship if the device is used in accordance with the operationg instructions Wear and tear parts such as electrode cables batteries etc are not covered by this warranty In addition relevant sections of our General Sales Conditions Allgemeine Verkaufsbedingungen apply particularly in chapter IV No 8 16 Safety information The nerve stimulator should not be used on patients with implanted electrical devices e g cardiac pacemakers without prior consultation with a
26. x HNS 11 and the Stimuplex or Contiplex needles 1 Check the Stimuplex HNS 11 2 Check the skin electrode ECG adhesive electrode the conduc tive gel must not have dried and apply it to a degreased area of skin which is not in the distribution area of the nerve to be blocked 3 Carry out patient positioning skin disinfection and if neces sary local infiltration of the needle puncture site 4 Connect the electrode cables to the stimulation needle nega tive and skin electrode positive switch on the Stimuplex HNS 11 and set the mA controller current mA to zero After the automatic self test of the stimulator the A symbol appears in the display in time with the stimulation pulse to indicate that it is ready to operate Caution A change to the stored parameters can only be made when the LEDs are lit By pressing any button the LEDs will light up and indicate the value stored To change press the appropriate button Select pulse width 0 1 ms 0 3 ms or 1 0 ms Select pulse frequency 1 Hz or 2 Hz Select amplitude range 1 mA max or 5 mA max o NMN Oo Ci Advance the Stimuplex or Contiplex needle through the skin and the subcutaneous tissue towards the nerve to be blocked Set a current of approx 0 30 mA set value mA the orange LED above the display flashes in time with the stimulation the display shows a next to the A and a tick signals that current is flowing in the tissue Then switc
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