Home

Life Pulse High Frequency Ventilator In

1. Menlo Introduction or onni gt HOW TO USE THIS MANUAL large bold capitol letters Objectives Understand how to use this manual 2 Know how to navigate to the information you need t Text that lists sequential procedures 1 Is numbered Each chapter includes 9 Like this objectives for the reader Otherwise lists will be e Bulleted EJ e Likethis ED UB an us Text that instructs you to press a button will highlight the button s font like this press MENU A am cS GER enl uml ams STANDBY Text will appear in the right column pe Graphics and instruction boxes will appear in the INSTRUCTION BOXES Boxes containing instructions and summaries of procedures will appear in lightly shaded boxes and will look like this E bunnell mS Objectives Chapter 1 OVERVIEW 1 Know the 5 subsystems of the Life Pulse and their purposes 2 Understand the relationship between the Life Pulse and the conventional ventilator 3 Know the structure and function of the LifePort adapter The Life Pulse High Frequency Ventilator is a microprocessor controlled infant ventilator capable of delivering and monitoring between 240 and 660 heated humidified breaths per minute MONITOR ALARMS CONTROLS PATIENT BOX HUMIDIFIER INDICATOR LED MODEL 203 MODEL 203A STANDBY Red Yellow TEST Red Yellow JET VALVE OFF Red Yellow READY Red Green WAIT Red Y
2. GENERAL GUIDELLINES FOR WEANING rurvorvnvovevorrerrvvevevervrversvsevevervesersrvevesrvrsersrsevevsrvesersrrevenssvrversssevenne 45 GENERAL GUIDELINES FOR WEANING esee nennen nennen rennen eene E E tree EEE EENET NEEE CHAPTER 10 VENTILATOR ALARNMS eese esee esee en entente sns ata tnn tnos esent soto tota tatnen enean sn sn spans sss ene nen enean nt READY LIGHT ON 5 ertet e piede E enka saksen EUIS 48 ALARM LIMITS rire th eee tee hi er e E bete e De dte i dieere dnd 49 JET VALVE FAULT ueteri elfenben 50 VENTILATOR FAULT HFV CONTINUES RUNNING rrvvorororverrvvnvevervvsersrvevevsrvrsersvsevevsrvesersrreversvsrversesevenn 51 VENTILATOR FAULT HFV STOPS RUNNING essent nnne trennen terere nennen teens 52 VENTILATOR FAULT CODE 10 etinio e De UHR ROI Eea E E e E eoe e Ree EG 53 LOW GAS PRESSURE eerte ie spese brute qeu oer EDAD Seperate leet e peste peto 54 eese EET 55 LOSS OF EEE EEE 56 HIGH PI E M 57 CHAPTER 11 INTERPRETING VENTILATOR ALARMS eerererevevevvvresvevevnerenenenenenenenenevnveunenenenenenenensnsnevennvnenenensnenenese ALARM DISPLAY dite heise in REQUE HIER nats HIE AEn qe avaiable Gardai 58 LOOK AT THE PATIENT iiir tertie rr tritt aee e ERR Heer PRA HL snd Eia 59 USE COMMON SENSE rire EE Hace rt EUER E ere reae qt eH PE BR TRE g 60 KNOW THE LIFE PULSE Vie iae treten Hee Giss Ur e Phe E
3. Excess humidification exhibits a collection of water pooling continuously in the clear portion of the circuit tubing between the cartridge and the Patient Box The water may even begin to march into the patient s endotracheal tube This condition can be alleviated by lowering the set CARTRIDGE temperature by 1 20 C Insufficient humidification will be indicated by the green circuit tubing being dry Examples of proper over and under humidification are illustrated on the left It is important to see condensation in the green portion of the circuit between the Patient Box and the LifePort adapter This condensation is an indication that the gas has reached 100 relative humidity 25 Objectives 1 high frequency ventilation Attach to pressure monitoring port on Patient Box Attach CV circuit blood gases while using less pressure Bc Chapter 6 START UP Learn how to determine initial settings for high frequency ventilation Learn to balance the conventional and high frequency ventilators to achieve better Understand the changes in monitored PEEP level that can occur when initiating The following procedures describe how to prepare the Life Pulse for start up 1 Secure the caps on the LifePort adapter Replace the endotracheal tube adapter with the LifePort adapter once a successful test sequence has been completed and while the Life Pulse is still in the Standby mode Reattach the pa
4. Objectives TEST PROCEDURE Be able to attach the Life Pulse circuit to the LifePort adapter Understand the ON STANDBY ALARM SILENCE TEST and ENTER buttons Know how to perform a Life Pulse systems test and know the meaning of VENTILATOR FAULT alarms 02 03 and 04 Be able to enter NEW settings and convert them to NOW settings SILENCE f B c m 2 m lt TEST CI STANDBY POWER ON This section discusses how to manipulate the CONTROLS and perform a systems test When the ON button is pressed the Life Pulse activates into the Standby mode with an audible alarm sounding The Standby mode is indicated by a small light in the corner of the STANDBY button and an audible alarm every 30 seconds The alarm may be silenced by pushing the SILENCE button Once the 60 second alarm silence time has expired the audible alarm will sound 6 beeps every 30 seconds to remind you that the Life Pulse is in the Standby mode and not operating The Life Pulse can monitor conventional ventilator and other high frequency ventilator pressures in the Standby mode This information will be displayed in the MONITOR section 10 E bunnell THE CONTROLS SECTION PIP RATE on JET VALVE TIME on off NOW CONTROLS NEW e v ENTER sacer TEST There are only three setting parameters in the CONTROLS section PIP Peak Inspiratory Pressure RATE and JET VALVE ON Time which is nearly synonymous with
5. e regulates PEEP e provides supplementary IMV when needed and e provides periodic dilation of airways when needed The purpose of the supplementary IMV is to provide background breaths sufficient to recruit atelectatic alveoli The purpose of the PEEP provided by the conventional ventilator is to maintain the inflation of alveoli with adequate FRC Using IMV periodically to dilate airways without interrupting the Life Pulse affords opportunities to ventilate areas downstream from airway restrictions LifePort Adapter The LifePort adapter allows both the conventional ventilator and the Life Pulse to be connected to a patient The LifePort has three main features e 15 mm Port provides the standard connection to the conventional ventilator e Jet Port the entrance for the high frequency pulses provided by the Life Pulse e Pressure Monitoring Tube allows the Life Pulse to display approximations of distal tip airway pressures Accurate pressure measurements through the LifePort are fed back to the ventilator and provide the Life Pulse with information necessary to control peak inspiratory pressure PIP For example if the measured PIP is higher than the set PIP the Life Pulse stops pulsing If the PIP suddenly reaches automatically set criteria the Life Pulse dumps the stored Servo 15 mm port ieii daa Jet Pressure to insure that the Life Pulse will not bon org port deliver excess gas to the p
6. Operation Gas from the GAS OUT connector on the front panel of the ventilator flows into the humidifier cartridge via the green gas inlet tube The shorter clear tube is the water inlet tube and contains a check valve that prevents gas from leaking out when the water supply bag is disconnected Water is pumped into the cartridge against the cartridge pressure Once the water inlet tubing is securely closed in the pump housing water and air cannot be forced back into the water supply bag 18 E bunnell GAS FLOW THROUGH HUMIDIFIER Gas inlet tubing Green Temperature thermistor Baffles Water level sensing pins Heating plate To Patient The gas flows from the Life Pulse to the patient as follows The gas enters the cartridge through the green gas inlet tube The gas flows down below the water level then back up through a venturi mechanism which atomizes some of the heated water The gas then flows over the heated reservoir of water and past a series of baffles which knock out water droplets The humidified gas passes over the cartridge thermistor which measures the temperature The microprocessor uses this temperature to regulate the amount of heat delivered to the cartridge through the metal heating plate This feedback control system uses the CARTRIDGE temperature setting on the humidifier front panel as its set point and controls the humidification of gas be
7. PERFORMING A TEST ccccccccccccccccccccccccecccccccccecccececccescecsecscesesesescauscecsesecessacesscuusceceeeuscasecesecasacasess 12 A FAILED ES 13 CHAPTER 4 PRESSURE MONITORING i ccccccssscccccssssssssssccccscssssssssccccscsssesscsccccscescesssescccscescesecescssscsscesecesscsscesees MONITOR DISPLAYS ssrrrrrrrrnnmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmemmemmemmemmemmemmemememmememeeee 15 PRESSING ENTER BUTTON tn tpe bee Si res 16 PURGE PAUSES sswrrrrrrrrnnmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmemmemmememeeee 17 CHAPTER 5 HUMIDIFIER iiisesecssccicsdccsacecscssscandessecstscseassnd eaessesssessobecesaaseav oasanessacsscaseadaesecssaasnseancsavasecasdesessecegeseesuesesassccea GAS FLOW THROUGH HUMIDIFIER 0 ccccccccccecececececscscecececssssecsesesesssssssssesesssesesssssssssssssesseees 19 STARTING THE HUMIDIFIER eene emn nem een nnne em mene e ene ne ese ne senes esr esee e esee esee en 21 CHANGING THE CIRCUIT eeeeseee I eene rrr der kr dr rr epp P ppp ppp pR anana RR PR Rl d 22 CIRCUIT CHANGE PREPARATIONS 1 n ener errore a dele Sue tedvocnevesiesdoctvdvodeetecheveotveeeencde CHECKICIST at FRONT PANEL DUTIES eR Neiden PATIENT BOX DUTIES t E ERE Fe Ee ren POSTE CIRCUIT CHANGE tete e EE exero tee co SEEN Ve eret vede fe trs AETER JENTER BUTTEON IS PRESSED rer E Fe ER Ee eR Ee e Ere e ree e e RE IMPORTANT ss TO COMPLETE A CIRCUIT
8. Position new circuit Press WAIT button Clamp H20 transfer tube Disconnect H20 transfer tube from old circuit e Reconnect H20 transfer tube to new circuit e Disconnect Purge tube from the front of the Life Pulse e Unlatch and open cartridge door and e Disconnect purge tube from Patient Box FRONT PANEL DUTIES e Press STANDBY button Disconnect green gas inlet tube Open pump door Remove used cartridge Insert new cartridge Connect green gas inlet tube Install new water inlet tube into pump housing Open clamp on H20 transfer tube e Press ENTER button When replacing the circuit place the humidifier in its WAIT mode to turn off the circuit and cartridge heaters until the replacement circuit is installed This procedure is best performed with 2 people Both people should perform their tasks simultaneously The actual changing of the circuit should be performed with the Life Pulse in the Standby mode but many steps can be taken to prepare for the actual circuit change as long as the Life Pulse is in the READY condition These steps are as follows 1 Lay the new circuit next to the circuit in use 2 With the ventilator still running press the humidifier WAIT button 3 Clamp off the water transfer tube connecting the water supply with the water inlet tube 4 Disconnect the water transfer tube from the old cartridge and attach it to the water inlet tube of the new cartridge 5 Disconnect
9. are a to place the Life Pulse in Standby mode and suction normally b toleave the Life Pulse running instill normal saline down the Jet port of the LifePort adapter and apply suction in both directions while introducing and withdrawing the suction catheter c tousea closed suction system d Allofthe above 4 If the Life Pulse is placed in Standby mode for suctioning the patient will not require manual resuscitation or increased support from the conventional ventilator TO FU 5 With the Life Pulse running if suction is not applied while introducing the suction catheter the jet pulses will interrupt and a HIGH PIP alarm may occur dumping the Servo Pressure safely to atmosphere TU FU 6 Ifthe READY light is on while suctioning is performed with the Life Pulse running the Servo Pressure is designed to lock at or near its baseline operating level and continue to ventilate the patient as requested TO FU 83 Appendix A POST TEST QUESTIONS Section 9 WEANING 1 Which of the following statements regarding weaning is false a Ifthe Life Pulse is not needed for another patient a baby may be weaned from high frequency ventilation down to CPAP Weaning too quickly is a vital concern and should be avoided c Ifa separate blender is being used to supply mixed gas to the Life Pulse both blenders should be adjusted to wean FiOz d Conventional pressures and or breaths may need to be increased gradually whe
10. lung volume recruitment and raising PEEP maintains recruitment Once oxygenation improves alveoli are open and stable wean the IMV rate as tolerated Clinical trials have shown that changing high frequency On Time has little clinical value except possibly at slow ventilator rates while weaning and trying to maintain a desired I E ratio 95 So Appendix B POST TEST ANSWERS Section 8 SUCTIONING THE PATIENT 1 True 2 INCREASE 3 d all of the above 4 False 5 True 6 True 96 So 35 Appendix B POST TEST ANSWERS Section 9 WEANING l e 2 True 3 True 4 True 5 True 6 False 7 True 8 True 97 1 True 2 d ande 3 1 5 20 4 True 5 False 6 False 7 False 8 True 9 True 10 a andc Appendix B POST TEST ANSWERS Section 10 VENTILATOR ALARMS The Servo and Mean Airway Pressure alarm limits may be manually adjusted to suit the patient s needs The pinch valve will continue cycling but may be out of synch with the Life Pulse A test should only be performed with the Life Pulse connected to a test ung 11 1 c and f 2 a and e 3 b and d 4 g and h 98 Appendix B POST TEST ANSWERS Section 11 INTERPRETING VENTILATOR ALARMS 1 Patient baby 2 True 3 Therapist Nurse Doctor 4 e 5 True Increasing Servo Pressure may be an early warning indication of compliance improving pneumothoraces leaks in the
11. 2 The STANDBY button stops jet ventilation from being delivered to the patient TU FU 3 The STANDBY button a should be pressed each time a parameter is changed in the CONTROLS section b puts the Life Pulse through a systems test c creates a brief audible alarm every 30 seconds d none of the above 4 systems TEST may be performed only with the Life Pulse in the Standby mode and should never be performed while the Life Pulse is attached to the patient TU FU 5 It is important to observe the front panel of the Life Pulse during the TEST procedure to assure all LEDs and displays are functional TU FU 6 Match each item in the first column with the single most accurate statement in the second column 1 ENTER button a Never pressed while the Life Pulse is attached to the patient 2 NOW settings b Stops the audible alarm for 60 seconds 3 TEST button _ c Awakens the Life Pulse into the Standby mode with an audible alarm 4 ON button NEUE d Transfers NEW settings to NOW settings 5 NEW settings e Disconnected purge tubing 6 SILENCE button f The current or active PIP RATE and ON Time 7 STANDBY button _ g Problem with connection at GAS OUT hose barb or with one of the Servo Pressure control valves 8 VENTILATOR I h Similar to Inspiratory Time FAULT 02 9 VENTILATOR _ i Proposed PIP RATE and ON Time FAULT 03 10 JET VALVE _ j Stops high frequency ventilation delivery ON TIME 77 123 Appendix
12. A POST TEST QUESTIONS Section 4 PRESSURE MONITORING 1 What pressure is displayed in the MONITOR section when the Life Pulse is in the Standby mode and not attached to a patient a Servo Pressure b MAP c proposed PIP d Zeros will be displayed e a b and c 2 Once the pressure monitoring tube of the LifePort adapter has been connected to the Patient Box the Life Pulse in its Standby mode will begin to monitor the pressures being delivered by the conventional ventilator These pressures are measured every 2 milliseconds averaged over seconds and updated on the display every seconds 3 Match one MONITOR feature in the first column with its definition in the second column 1 MAP a The internal driving or working pressure required to ventilate the patient at the NOW settings 2 AP b Average of peak pressures measured in the LifePort 3 PEEP c PIP minus PEEP 4 PIP d Average of pressures measured over the total area of the pressure waveform 5 SERVO e Average of minimum airway pressure 4 Bigger patients or patients with more compliant lungs require MORE LESS Servo Pressure 5 The Purge system maintains the patency of which tube a Jet port b Main port of the endotracheal tube c Pressure monitoring tube 78 Appendix A POST TEST QUESTIONS Section 5 HUMIDIFIER 1 Lowering the cartridge temperature will reduce the amount of humidity in the gas but will not affect the temperature of the gas th
13. ALARMS section but the READY condition is mentioned here because the monitoring specifications change after the READY light 1s on the display is updated every 2 seconds The JET VALVE ON OFF lights turn on and off in conjunction with the pinch valve that 1s located in the Patient Box ON means the valve is open OFF means the valve is closed These lights serve as a visual check on the status of high frequency ventilation in general and on the extent to which the patient or the conventional ventilator may be causing interruptions of the Jet pulses The Life Pulse will sense a high pressure and will pause whenever the monitored PIP exceeds the NOW PIP Ventilation resumes when the PIP drops below the set level Monitor such interruptions visually by watching the ON OFF lights 16 PURGE PAUSES The Life Pulse may pause periodically and briefly during operation for no apparent reason Such pauses can occur during clinical use or when you are operating on a test lung These brief pauses are usually a result of the purge of the pressure monitoring tube that takes place once every 15 seconds Extended pauses of the Green Jet Valve ON light indicate an The Purge valve is located next to the interruption of jet pulses pressure transducer inside the Patient Box When the valve opens it allows a pulse of dry f air to flush the pressure monitoring tube PIP JET VALVE pe eR On rare occasions the purge may cause high MONITOR A
14. HEEL EE Hie eher ER 61 COMMON THINGS HAPPEN COMMONLY eeseeeeeeeeerneneneene enne nene nnn entrent nennen 62 USE AVAILABLE RESOURGES hinne eir ette race et EE PRA EE RES Eee Bases qe mic de eere een 63 CHAPTER 12 HUMIDIFIER ALARMS ssesrevererenvevnvnvnvveneesenesenenenenenenenennnenennesenenensnsnenenenenennessnenenenenenensnnnenennvsenensnsnenenese HUMIDIFIER OPERATION bed ons ati arts ette ede ee doo pertenece Goa cete Prodi 65 CIRCUIT FAULT LEVEL ALARM n o regt ec ecoute e pa oa a nee rep en ape bind 66 WATER LEVEL SENSING seer es rep En eee Se iubet ope S 67 CIRCUIT TEMPERATURE rei Pet Pepe feteste ep ia eo pe cheatin 68 TEMPERATURE CONTROLS wits 3 1 5 ith eek ete Gassen rege era eee Nee do etu d 69 SETTING CARTRIDGE TEMPERATURE essere a 70 CONDENSATION PROBLEMS 1 5 2 bibel tren Petites epu Ruled eg orba ien ee edict hee ae 71 MANUALLY PURGING crt coe edocet sa greater Super assailed a spise 72 HIGH LOW WATER LEVEL petet Pert re Stend RUA ari Gre sd 73 HIGH LOW TEMPERATURE amrseredeiniperesnstonsasdinioniamnnnatinsintnnndsgietdauiseshie 74 APPENDIX A POST TEST QUESTIONS eeseeeevsvnvnenevrenenenenenenenenenennnenenensenenenensneneneneneneneusvennsnenenenenenennnenenevneneneneneneneneser APPENDIX B POST TEST ANSWERS nenooeoeovevnvnvneneererenenenenerenenenennnenevensvnenenensnsneneneneneneunuennenenenenenensnsnenevennvnvnsneneneneneser ii So 1 Each chapter begins with a chapter
15. Life Pulse for correct operation knowing baseline operating levels and observing trends All of the above po pp wm 5 IfServo Pressure exhibits an upward trend the patient s compliance may be improving or there may be an air leak either in the patient or the cartridge circuit TU FU 6 Knowing the ventilator is an important principle for understanding how to troubleshoot the Life Pulse TU FU 7 A majority of alarms are caused by kinked disconnected or obstructed tubes TU FU 8 One of the most important resources available to clinicians using the Life Pulse is the trained customer service representative answering the Bunnell 24 hour Hotline TU FU 9 The Operator s Manual is a valuable resource for understanding the Life Pulse since it details information not covered in the In Service Manual TU FU 87 Appendix A POST TEST QUESTIONS Section 12 INTERPRETING HUMIDIFIER ALARMS 1 A humidifier CIRCUIT FAULT alarm may be caused by a broken cartridge or circuit wires impaired contact between electrical connections e g cartridge door open c water in the cartridge not reaching the appropriate level within the allotted fill time d All of the above 2 The Circuit temperature is best left at 40 C because the gas temperature drops 3 from where it is last heated to where it enters the patient TUO FO 3 Match the following Circuit temperature a Primarily controls humidity of delivered gas Cartr
16. and e Press ENTER button again if necessary PATIENT BOX DUTIES The person at the Patient Box disconnects the Jet port of the old Life Pulse circuit from the side of the LifePort adapter Remove the old pinch tube from the jaws of the pinch valve in the Patient Box and install the pinch tube of the new circuit Attach the new circuit to the Jet port of the LifePort adapter FRONT PANEL DUTIES The person at the ventilator can disconnect the gas inlet tube and remove the cartridge from its holder Place the new cartridge into the cartridge door and latch it Connect the green GAS OUT tube and purge tube to their ports Install the water inlet tube into the pump housing and latch the door securely with the pump door latched open the clamp on the water transfer tube Press the ENTER button to reestablish high frequency ventilation and clear a LOSS OF PIP alarm that may result from tubing disconnections 23 IMPORTANT To complete a circuit change e Observe water filling cartridge e Observe water pump stopping when cartridge fills to proper level and e Observe humidity appearing in the green portion of the circuit CHANGING THE CIRCUIT cont 6 After the ventilator is running make sure the purge tube is attached at both the ventilator and Patient Box barbed connectors 7 If necessary adjust the conventional ventilator settings back to their previous settings Lower the peak pressure first t
17. average values are displayed so give the Life Pulse 20 seconds between adjustments to indicate the true PEEP value Be aware of significant changes in Servo and mean airway pressure MAP that may occur when manipulating the conventional ventilator settings For example a pressure change of 2 cm H20 in the PEEP setting will cause a change of about 2 cm H20 in the MAP 6 If changing PEEP produces a MAP or SERVO PRESS alarm press the RESET button to accommodate the change Or the limits may be changed manually Pressing the RESET button allows the limits around SERVO PRESS and MAP to be recalculated and new alarm limits to be set The READY light will turn off when the RESET button is pressed As soon as monitored values have been stable for 20 seconds new limits will be set and the READY light will illuminate Always wait until the READY light is ON before leaving the patient s bedside 31 Chapter 7 PATIENT MANAGEMENT Objectives 1 Understand the advantages for patient management of using a conventional ventilator in tandem with the high frequency ventilator 2 Understand the techniques for improving oxygenation and ventilation 3 Comprehend the relationship between AP and tidal volume Managing patients on high frequency ventilation is similar to managing patients on a conventional ventilator CLINICAL OBJECTIVES The main distinction with the Life Pulse is Oxygenation Conventional that typi
18. bunnell 2 Use Common Sense USE COMMON SENSE Second USE COMMON SENSE There is no substitute for a skilled and alert therapist nurse or doctor who takes a logical approach to alarm interpretation e The Life Pulse s rhythmic sounds will become familiar to you Learn to recognize when the sounds have changed e The displayed and monitored values should remain at consistent levels Watch for changes in these levels and learn to understand what the changes mean For example the Servo Pressure value reflects the gas flow and pressure required by the Life Pulse to produce the NOW settings on a patient If the Servo Pressure changes either suddenly or gradually it may be that e Lung compliance is changing e A pneumothorax has occurred e Tension is developing on a pneumothorax e Aright mainstem intubation has occurred e The patient needs suctioning e There is a leak in the tubing Not all alarms require emergency corrective actions Use common sense If the Life Pulse alarms are saying one thing and clinical observation says another react accordingly For example if the humidifier displays a TEMP LOW alarm and the circuit and cartridge feels hot to the touch place the humidifier into WAIT and replace the cartridge circuit 60 KNOW THE LIFE PULSE Third KNOW THE LIFE PULSE Interpreting alarms is difficult if not impossible without a good working knowledge of the ventilator how the feedback cont
19. cartridge circuit 6 True 7 True 8 True The Hotline number is 1 800 800 4358 9 True 99 Appendix B POST TEST ANSWERS Section 12 INTERPRETING HUMIDIFIER ALARMS 1l d All of the above 2 True 9 Circuit b Cartridge a 4 e VENTILATOR FAULT 5 True In this condition despite fluctuating PIP and PEEP displays the Servo Pressure locks at or near its baseline operating level and the patient continues to be ventilated appropriately 6 e Any time there is a question about the Life Pulse or its alarms call the Hotline Under the conditions described the circuit may be faulty and need to be replaced 100
20. e The green portion of the Life Pulse circuit between the Patient Box and the LifePort adapter will be dry Over humidification Under humidification Good humidification E bunnell Purge pressure monitoring tubing with air from a syringe if condensation is partially obstructing the tube Lower Cartridge Temperature if water collects in the circuit MANUALLY PURGING PRESSURE TUBE The pressure monitoring tubing is purged automatically every 15 seconds If the Life Pulse monitoring senses that the pressure monitoring tube may be obstructed the purge fires once per second until the obstruction 1s cleared However if displayed pressures are erratic the fluctuating pressures may be a result of excess condensation or mucus partially obstructing the pressure monitoring tubing You may find that manually purging the pressure monitoring tubing followed by suctioning of the ET tube may alleviate the problem e Manually purge the pressure monitoring tube of the LifePort adapter by flushing 2 3 cc of air from a needless syringe before manipulating the temperature settings e Ifthe clear portion of the Life Pulse circuit collects water that migrates into the patient lower the CARTRIDGE temperature e If condensation enters the endotracheal tube it may be necessary to suction the patient However most of the water will be evacuated out of the ET tube into the conventiona
21. plugged into a standard electrical outlet or an uninterruptible power supply TU FU 2 Oxygen and compressed air must be blended before entering the Life Pulse TO FQ 3 At least 30 psi 206 85 kPa of gas pressure must be supplied for the Life Pulse to operate TO FQ 4 Analyzing FiO is best performed by measuring directly from the air oxygen blender TO FQ 5 The Life Pulse alarm volume level is not adjustable TO FQ FRONT PANEL 6 The disposable humidifier cartridge circuit consists of which of the following a Electrical sensors b Heating elements c Purge tubing d Humidification cartridge e All of the above T The pinch valve is located in the Patient Box TO FQ 8 Either sterile water or normal saline may be used in the humidifier cartridge TO FQ 9 Once the humidifier cartridge circuit has been installed three tubes will need to be connected to the front panel of the Life Pulse Attach the small clear tube to the barbed connector labeled PURGE attach the green gas inlet tube to the barbed connector labeled GAS OUT and latch the clear water inlet tube into the pump housing TO FQ 10 The pinch tube portion of the humidifier cartridge circuit is the only tube that should be between the jaws of the pinch valve TO FQ 76 Appendix A POST TEST QUESTIONS Section 3 VENTILATOR CONTROLS AND TEST PROCEDURE 1 Animmediate audible alarm after the Life Pulse is turned on means the ventilator is defective TO FU
22. times every thirty seconds to inform you that it is not ventilating 4 True The TEST button should only be pushed with the ventilator attached to a test lung Pressing the TEST button will not initiate the systems test when the Life Pulse is running 5 True 6 1 d 2 f 3 a 4 c 5 i 6 b 7 j 8 e 9 g 10 h 91 Sor Appendix B POST TEST ANSWERS Section 4 PRESSURE MONITORING l d zero pressure All displays will be zero 2 80 10 However during operation all pressures are averaged over a 10 second period and the display is updated every 2 seconds This approach helps to produces more stable readings 3 1 d 2 c 3 e 4 b and 5 a 4 MORE 5 C Pressure monitoring tube 92 1 True 2 True 3 a b c d e 4 True 5 b and c only 6 d 7 True 8 True Appendix B POST TEST ANSWERS Section 5 HUMIDIFIER The cartridge temperature may be reduced to minimize condensation however the heated wire circuit will assure that the temperature of the gas remains stable Temperature in the cartridge and in the circuit tubing are controlled separately All of these are complications of improperly regulated humidification with high frequency ventilation and conventional ventilation Condensation is controlled by adjusting the Cartridge temperature The Circuit temperature should normally remain at 40 C If the humidifier is placed in the WAIT mode manually indicat
23. to raise or lower the patient s core temperature do not adjust the Circuit temperature to any value other than 40 C 68 TEMPERATURE CONTROLS CIRCUIT TEMPERATURE amp CARTRIDGE MA HUMIDIFIER scx CIRCUIT TEMP Pressing the SET button repeated will scroll through the Circuit Cartridge and Circuit Temp LEDs We recommend that the set CIRCUIT temperature remain at its default setting of 40 C Adjust the Circuit Temperature only if the patient s temperature is not within an expected range and if there 1s a reason to believe the temperature of the delivered gas may be contributing to the problem Adjusting the Circuit temperature may affect humidification in the circuit tubing Be ready to change the Cartridge Temperature to provide appropriate levels of humidification The temperature in the cartridge and the circuit tubing are set and controlled independently Pressing the SET button repeatedly causes the LED to alternate between CIRCUIT CARTRIDGE and CIRCUIT TEMP readings e Ared or yellow light indicates a set temperature e A green light indicates an actual temperature 69 NY SETTING CARTRIDGE TEMPERATURE TEMPERATURE CIRCUIT CARTRIDGE nnam dU ba amp CIRCUIT TEMP Press the SET button twice then press the up or down arrows to change the Cartridge Temperature The humidity levels of the gas delivered to the patient may be increased or decreased by raising or lower
24. AIT button and SILENCE button LIFE PULSE HIGH FREQUENCY VENTILATOR TEMPERATURE amp CIRCUIT age CIRCUIT CIRCUIT FAULT TEMP The humidifier alarms are on the right side of the humidifier control panel Humidifier alarms will appear as red LEDs accompanied by an audible alarm The alarm can be silenced for 60 seconds by pressing the SILENCE button The humidifier alarm system detects high or low water levels and high and low temperature for both the circuit and cartridge The system also has an alarm for disrupted electrical connections between the humidifier and the cartridge 64 So 1 HUMIDIFIER OPERATION Installation of a new humidifier cartridge circuit includes observing the cartridge function for a few minutes After you press the ENTER button e The humidifier begins operating Gas inlet Baffles Temperature tubing Green thermistor e The pump fills the cartridge with water EE e Water in the cartridge is heated by the hot plate behind the cartridge To Patient e The red circuit heater wire begins heating e The cartridge fills with water up to the Heating Water level point where the water contacts the first plate sensing pins two level sensing pins e The pump stops pumping 65 CIRCUIT FAULT LEVEL Alarm The humidifier microprocessor knows that T ALARMS the pump should be able to fill the cartridge CARTRIDGE within eighty six secon
25. CHANGE e ERE PE ER Ete e n Ee ends atdet IDENTIFYING PROPER HUMIDIFICATION rsrrrrrrrrrrrmmmmmmmmmmmmmmmmmmmmmmmmememmemmemmemmememeeee 25 CHAPTER 6 START UD eeeesseesesveezeos ca vacua enean eee oe a Roe aor ou eoe pe vel Nea eoa ade CORE GA Peas eas a Ca eroe were dove pe E Foe ade CUP De RESI Red DN MEASURING amp DISPLAYING PRESSURES eere mener er eren enter nr sss s erri rrr nr sr reser tren ass 27 CHOOSING STARTING VALUES 0 Ier eme ennonn rro annann rno eser nets ss serere ate Sannn nann rens 28 6 STEPS TO START HFV eeeeeeeee eee emer rere rr rere rrr p p p ppp spp psp pps SOPOP OPOPO P Pe se pR PE PP ERR 29 CHAPTER 7 PATIENT MANAGEMENT ee eren ee ee eene een ones es eate ta sn asses e haee sn asses e teen ses see tee a snae ses e tee e ense ses e topo CLINICAL OBJECTIVES ccc cccccscccccccceccceccccccccccaucccueccuuscsesccscecsensecausecsescsuscsuseescenecaueceuessseseseseceseeanscanss 32 OXYGENATION 0oooooooccccccccccccccccccccscscscssscsssssssssessssscsssssssesssesesesssesetstesstssesesesessessssssesssesssssssssssssssssssssssssssesesees 33 OXYGENATION OVEREXPANDED LUNGS cece cccccccccccccccecccccuccccecceesccuscecscecucceuscesescsesesesecnseanseanss 35 FINDING OPTIMAL PEE ssrrrrrrrrrrrnmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmee 36 VENTILATION ooo ooccccccccccccccccccccccccccccccscccccececececececececececececececececececececececececececececececec
26. DS If necessary adjust PEEP setting e g higher to improve atelectasis and oxygenation lower if FiO2 is lower than 30 and oxygenation is appropriate After settings stabilize if a MAP alarm occurs press the RESET button to enable the Life Pulse to recalculate correct alarm limits around the NEW settings Initiation of high frequency ventilation involves six steps 1 Select Starting PIP Value 1 Once the monitored pressures are stable select a starting PIP specific to the patient s pathophysiology Input the chosen value by using the increase or decrease arrow next to the NEW PIP display in the CONTROLS section 2 Press ENTER 2 After selecting the NEW settings press the ENTER button to begin high frequency ventilation As the Life Pulse begins to operate note that the monitored values return to zero and new average values accumulate based on the new conditions 29 124 3 Lower Conventional PIP 4 Lower Conventional Rate 6 STEPS TO START HFV cont The Life Pulse may pause every time the conventional ventilator delivers a breath These interruptions may be heard or seen by observing the JET VALVE ON OFF lights The interruptions in the Jet pulses are caused by the delivery of conventional breaths at pressures higher than the PIP that has been requested by the operator and entered as the NOW PIP Except in cases of extremely poor lung compliance it is usually best to allow the high freq
27. IST Fault Code Numbers 02 Purge tube disconnect or pressure transducer failure 03 Green gas inlet tube disconnect pinch tube incorrectly installed or stuck Servo Pressure control valve 04 Electrical component failure A FAILED TEST If an internal fault is detected the test sequence will stop VENTILATOR FAULT will be displayed in the ALARMS area and a code number 02 03 or 04 will appear in the ON OFF window of the CONTROLS section A VENTILATOR FAULT code may or may not mean the Life Pulse has a serious problem For example if the purge tube is disconnected during the Test either at the Patient Box or the front panel a VENTILATOR FAULT 02 will be displayed e VENTILATOR FAULT 02 check the purge tube for a disconnect at the front panel or the Patient Box This fault will also occur if the pressure transducer in the Patient Box has failed e VENTILATOR FAULT 03 check the green gas inlet tube for a disconnect at the GAS OUT connector This fault may also occur if one of the Servo Pressure control valves 1s not working properly e VENTILATOR FAULT 04 You may observe the Life Pulse performing this check by watching the code display area closely As the test is performed the display momentarily flashes 04 If the test is passed the 04 disappears If it fails the 04 stays lit a VENTILATOR FAULT code appears and an audible alarm sounds Once it has successfully passed the test and after operating prop
28. Inspiratory Time These settings may be changed by pressing the up and down arrow buttons next to their respective displays 1 Press the ENTER button to transfer the NEW settings into the NOW settings the settings the patient will receive 2 Press the STANDBY button to place the Life Pulse into the Standby mode The Life Pulse stops producing high frequency jet ventilation and only the NEW settings are displayed A systems test should be performed to insure that the Life Pulse is in good operating condition before connecting the system to a patient A test lung must be attached to the patient end of a standard endotracheal tube and LifePort adapter prior to performing the Test The test lung can be as simple as the one pictured a finger cot or the finger of a rubber glove taped lightly to the tip of the ET tube 11 ATTITUDES PERFORMING A TEST The Life Pulse s systems test will ensure that the ventilator is operating according to specifications To perform the test follow these steps Press TEST button to begin systems test on JET VALVE TIME on off seconds son i All possible alarms will be illuminated briefly during the systems test ALARMS SILENCE JET VALVE FAULT VENTILATOR FAULT LOW GAS PRESS CANNOT MEET PIP LOSS OF PIP HIGH PIP 1 Attach a LifePort adapter to an ET tube and test lung In the Standby mode connect the patient end of the Life Pulse circuit coming
29. K Ararredt F o Power Circuit Gas dump cord breaker port Life Pulse Model 203 A REAR PANEL CONNECTIONS 1 Plugin the power cord to a standard 110 volt outlet or preferably an uninterruptible power supply 2 Connect a high pressure oxygen hose from a low flow air oxygen blender 0 30 L min or the output from the low flow port 2 100 L min of a standard blender to the Mixed Gas Input fitting minimum pressure of 30 psi is required to operate the Life Pulse 3 Attach an oxygen analyzer to the Oxygen Sensor in order to monitor FiO not applicable to serial number 2414 or higher or monitor FiOs from the air oxygen blender output 4 With Model 203 plug in one of a variety of recording devices to the Analog Output to monitor airway pressure graphically Optional 5 Connect the Patient Box to the ventilator by its electrical cable attached to the multi pinned connector 6 Adjust the volume of the audible alarms using the Alarm Volume dial CHECKLIST Rear Panel Connections Power cord Gas in from blender O2 Sensor Only SN s 2413 and lower Patient Box Alarm volume Soo 0 J FRONT PANEL CONNECTIONS 1 Insert the Humidifier Cartridge into the 2 1 3 cartridge door Latch the door shut to Green gas inlet Cartridge Purge tube ke all el men b tube to Gas Out in door make all e ectrica connections etween the cartridge and the Life Pulse vr 2 Connect the green gas inlet tube to th
30. LOAD button with one finger 5 Slide the pinch tubing into the pinch valve assembly until you feel it snap into place The illustrations on the left show a proper pinch tubing placement The entire width of the pinch tube should be within the pinch valve jaws 6 Connect the small purge tube to the barbed connector labeled FROM PURGE The disposable humidifier cartridge and circuit are now ready for operation and the Life Pulse is ready to be turned on SETUP CAUTIONS Two cautions should be noted about the Set Up procedure First patients are often placed on the Life Pulse on an emergency basis You can save time if the ventilator is stored clean and partially set up ready for use Do NOT install the pinch tube in the pinch valve prior to actual patient set up The disposable cartridge circuit water transfer tube and a test lung can be placed with the Life Pulse If using the Bunnell Cart everything necessary to begin high frequency jet ventilation can be wheeled to the patient s bedside Second notice that the installation description includes only cartridge circuit tubing supplied by Bunnell Incorporated Do NOT make modifications to the supplies or the set up procedure Pressures cannot be monitored accurately and the Life Pulse will not work properly if other equipment is teed into the pressure monitoring tube or if leaks are present in the circuit E bunnell Chapter 3 VENTILATOR CONTROLS amp
31. Life Pulse High Frequency Ventilator In Service Manual 01513 07 12 4 bunnell Phone 801 467 0800 ee eee Hotline 800 800 4358 436 Lawndale Drive Fax 801 467 0867 Salt Lake City UT 84115 Website www bunl com 01801 07 12 In service Manual HOW TO USE THIS MANUAL oossssridieisessdeekesvedeesdegsededeseegdekenndersddvddenebedsrdnngsdadseskeasdseddsddanssensssenesesdoesdadndankesnasdosdenaededesaedde CHAPTER T OVERBVIEW d ecsesevec eeczeeceevz soscvkYcoe rop bee eco dc Peer eni Po ae SE CE Koskov vbs eV ve eara Ce sk t ne een dor s rel dc V aa eae ec e ervY TETTE Ne daa HEV WITH CV 000 o o oc cc coco cece cece cc cccccccccccececccecececececececececececesecececeseaececesecesusesesessssssseseseauseauacauseauaeauauassusuaeaeseanauanees 3 LIFEPORT ADAPTER RR 4 CHAPTER SETUP LE REAR PANEL CONNECTIONS onic cccccccccccccccccccccccccecececccccecccccecececccccececececcccceccceccccccecccecececcescececececececececesececevecs 6 FRONT PANEL CONNECTIONS sssrrrnmnmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmmes 7 PATIENT BOX CONNECT ITONG c ccccccccssecssscerccecccscccccsccecssssscccsecsscacsescacscacacacacaeaeauasasacasasasanananaes 8 SELIUPGAUTIONS Arr Se E 9 CHAPTER 3 VENTILATOR CONTROLS amp TEST PROCEDURE sessssvvvveesessvsnsvsvseesensnnnssnvsssnessnsnnsssnsssensnnnnsnnsssnennnse THE CONTROLS SECTION oiccccccccccccccccccccscccecccececececececececececscececececeescecscecececsceescecececscecscecscecececseccscccsecesesencess 11
32. Newsletters Website www bunl com 24 Hour Hotline Fifth USE AVAILABLE RESOURCES Bunnell Incorporated offers an Operator s Manual newsletters research articles and a 24 hour Hotline 1 800 800 4358 When using the Hotline make sure to gather as much information about the alarm condition as possible The more facts you have about the situation the better the assistance a clinical specialist can provide on the Hotline If an alarm condition cannot be corrected easily perform a systems Test The systems Test can help isolate the source of the alarm If the Life Pulse passes the Test on the test lung the cause of the alarm has to be in the ET tube or the patient Also run an operational test on a test lung to verify the Life Pulse s operation Remember to call as soon as possible after determining the alarm condition cannot be corrected Do not hesitate to call if there are any question or concern It is much better to call and have a good experience than not call and have a bad experience 63 Chapter 12 HUMIDIFIER ALARMS Objectives 1 Recognize and correct the conditions that will produce humidifier cartridge circuit alarms Understand the purpose and methods of controlling gas temperature in the cartridge and circuit Understand how cartridge temperature is linked with humidification and when and how to change this temperature Understand the importance of the CIRCUIT TEMP CARTRIDGE TEMP W
33. OFF display window of the CONTROLS section to let the operator or service rep know where the fault occurred If the Life Pulse continues to run with the VENTILATOR FAULT message possible causes are een e One of the ends of the purge tube has a become disconnected either at the VENTILATOR FAULT PURGE connector on the front panel or y at the FROM PURGE connector on the Patient Box e The purge tube is kinked or obstructed In any case with the Life Pulse in its Ready condition the Life Pulse will continue operating because the purge function 1s not critical for supporting the patient 51 1a VENTILATOR FAULT HFV STOPS RUNNING If the VENTILATOR FAULT places the Life Pulse into Standby mode and a code number appears in the ON OFF window take the ES following steps to determine if the alarm is true amp 1 Disconnect the patient from the Life Pulse p VENTILATOR FAULT gt lt 2 Provide ventilatory support to the patient e using the conventional ventilator g 3 Turn off the power to the Life Pulse for at least three minutes 4 Turn on the power attach a test lung to a Life Pulse circuit and perform an internal on JETVALVE TIME on off test by pressing the TEST button V1 L5 5 Perform an operational check of the Life ES ES E Pulse on a test lung with the 15 mm LifePort connector open to the room seconds 6 Ifthe Life Pulse reaches the set pressure the READY light illumi
34. P SERVO pressure to be measured by the transducer em Ho PRESS that in turn makes the Life Pulse skip a beat PEEB m in conjunction with its built in response to cm Ho cm HO high pressures Do not be concerned if the Life Pulse appears to hiccup every once in a while If you time the pauses you will find that they occur at some multiple of 15 seconds This pause usually will only occur on rates of 550 bpm or greater 17 p Objectives Chapter 5 HUMIDIFIER 1 Describe the flow of gas from the ventilator through the entire length of the Humidifier Cartridge Circuit Understand the purpose of humidification and how it is produced and regulated Learn to adjust the temperature manually in the cartridge and the circuit Understand the function of the pinch tube portion of the circuit Gas inlet tube Cartridge thermistor Purge tube DO Circuit G Cartridge Water supply tube E Circuit thermistor 2 pe t Heating Wire Purge tube Pinch Tube Gas to patient The Life Pulse humidifier uses a one piece disposable cartridge and tubing set called the humidifier cartridge circuit This item is often referred to as the cartridge the circuit or the patient breathing circuit All are terms that refer to all or part of the humidifier cartridge circuit It is pre assembled and contains the heating wire thermistors and all connections needed for
35. Pulse must generate to meet the settings requested Servo Pressure changes above or below the established operating level for a particular patient may be a result of changes in lung compliance airway resistance or lung volume Servo Pressure changes give an early indication that the patient s condition may be improving or worsening 15 PRESSING ENTER BUTTON on JET VALVE TIME on off SECONDS Press ENTER button begin ventilation dc iau to READY light ON ALARMS READY Jet Valve ON OFF lights flash Z PIP JET VALVE cm H 0 ON OFF MONITOR SEVO ar PRESS PSI 0 145kPa PEEP MAP cm HO cm HO When the ENTER button 1s pressed the microprocessor will begin increasing the Servo Pressure from zero to whatever value will produce the NOW PIP at the end of the NOW ON TIME at the NOW RATE Although it will typically take a short time for the actual PIP to reach the NOW PIP the displayed PIP will equilibrate slower because of the averaging characteristics of the display Thus it may take longer typically within a minute for the monitored PIP to reach the NOW PIP When the monitored NOW PIP is stable for 20 seconds the READY light will illuminate The READY light indicates the Life Pulse is providing ventilation at the settings you have requested and alarm conditions that are set automatically have been established The specific criteria which produce the READY condition are discussed in the
36. T button TU FU 2 The displayed values which have manually adjustable upper and lower alarm limits are check all that apply PIP AP PEEP Servo Pressure MAP ogpococmp 3 The READY condition is met when the monitored PIP has come to within cm H20 of the set NOW PIP and has stabilized there for seconds 4 Itisimportant to never walk away from the Life Pulse until the READY light is illuminated TU FU 5 The Servo and Mean Airway Pressure alarm limits are set automatically and are not manually adjustable TU FU 6 AJET VALVE FAULT alarm may indicate that the electronics controlling the pinch valve have failed TU FU 7 The patient should be left attached to the Life Pulse when pressing the TEST button to perform a systems test in the Standby mode TU FU 8 Ifthe Life Pulse continues to run with the VENTILATOR FAULT message chances are one of the ends of the purge tube has become disconnected TU FO 9 Ifa VENTILATOR FAULT 10 alarm occurs the Life Pulse will resume operating when the ENTER button is pressed TU FO 85 123 10 11 Appendix A POST TEST QUESTIONS Section 10 VENTILATOR ALARMS cont If the exhalation tubing of the conventional ventilator circuit becomes kinked the Life Pulse choose two a b E d initiates a HIGH PIP alarm initiates a LOW GAS PRESSURE alarm dumps the Servo Pressure to reduce the PIP locks the Servo Pressure at the current val
37. VALVE FAULT alarm implies that the pinch valve is out of synchrony with the electrical drive signal A JET VALVE FAULT alarm will appear in the ALARMS section and the Life Pulse and Patient Box will continue running This alarm is extremely rare if it occurs call the Bunnell Hotline at 1 800 800 4358 for troubleshooting support The JET VALVE FAULT alarm only applies to electrical failures If the pinch valve fails mechanically it will stop cycling The following precautions should be followed if the WhisperJet Patient Box Cat 312 pinch valve stops cycling while on a patient In the Non READY condition 1 A Loss of PIP alarm will be activated verify pinch valve is cycling 2 Donot press the Enter or Reset buttons 3 If pinch valve is cycling do normal troubleshooting for a Loss of PIP alarm see Operator s Manual 4 If pinch valve is NOT CYCLING press the STANDBY button to dump Servo Pressure and change out WhisperJet Patient Box 5 Call Bunnell Hotline to report stoppage get RA and send WhisperJet Patient Box to Bunnell for service 50 VENTILATOR FAULT HFV CONTINUES RUNNING A VENTILATOR FAULT message may or may not be serious If the Life Pulse has a VENTILATOR FAULT serious Ventilator Fault it will automatically put itself in the STANDBY mode with the audible alarm sounding Ventilator Fault alarms that place the Life Pulse in Standby will display a code number in the ON
38. al possibilities for increasing mean airway pressure are available but they have not been studied in prospective clinical trials Increasing high frequency rate by 50 or 60 breaths per minute at a time has been helpful in some cases especially in smaller infants If the high frequency rate is increased be sure to watch the PEEP level Inadvertent PEEP may develop as the I E ratio is shortened 34 p EXCEPTION Overexpanded Lungs OXYGENATION Overexpanded Lungs There is one major exception to this strategy This exception arises when the patient on conventional ventilation has grossly overexpanded lungs If overexpansion is observed on X ray the lungs will need to deflate considerably before any improvements in oxygenation will result To accomplish this deflation set the conventional ventilator rate near zero when starting the Life Pulse In most cases DO NOT DECREASE PEEP Overexpanded lungs are usually a result of gas trapping not excessive PEEP Decreasing CV support Rate PIP and I Time is usually a more effective strategy PEEP must be maintained or even increased when the CV rate is very low to prevent atelectasis and maintain oxygenation However beware that if the patient initially responds well to this strategy poor oxygenation may result some time later due to atelectasis You must be ready to treat that condition as outlined above A strategy for identifying optimal PEEP is demon
39. arm limits vary according to size of patient 3 MAP alarms set 1 5 cm H O The Life Pulse alarm system alerts the operator both audibly and visually to changes in the ventilator or the patient The alarm statements are not visible until they are lit The ALARMS area has three key features e upper and lower alarm limits for Servo and Mean Airway Pressure MAP e alarm messages for various potentially hazardous conditions and e an alarm SILENCE button Both the upper and lower alarm limits are set automatically and can be adjusted manually After the ENTER button has been pressed the Servo Pressure rises to bring the monitored PIP up to the NOW PIP setting The alarm limits are set automatically when the READY light comes on indicating that the monitored PIP has come to within 1 5 cm H20 of the NOW PIP and has stabilized there for at least 20 seconds The instant the READY light comes on the limits around the current Servo Pressure are set and vary according to the size of the patient wider limits are set for larger patients and tighter limits for smaller patients VENTILATOR ALARMS 48 een SILENCE JET VALVE FAULT VENTILATOR FAULT LOW GAS PRESSURE CANNOT MEET PIP LOSS OF PIP HIGH PIP ALARM LIMITS The limits around the current mean airway pressure MAP are set at 1 5 cm H20 Press the various limit buttons any time after the READY light is lit to observe where the limits h
40. at is delivered to the patient TQ FQ 2 There are two separate temperature controls for the humidifier cartridge circuit TQ FQ 3 Improper regulation of the humidity and temperature of the gas delivered to the patient may choose all that apply contribute to dehydration contribute to fluid overload raise the patient s body temperature lower the patient s body temperature contribute to mucus plugging poem mm 4 Itisimportant to check for proper humidification misty or condensation in the green portion of the Life Pulse circuit between the Patient Box and the LifePort TO FQ 5 The humidity of the gas delivered to the patient is a primarily controlled by the Circuit temperature b determined by the Cartridge temperature c controlled in response to measurements taken by the Cartridge thermistor 6 The temperature regulation in the Patient Circuit tubing a primarily controls the temperature of the gas going to the patient b is used to control condensation in the Circuit tubing c iscontrolled in response to measurements taken by the thermistor in the circuit just before the Patient Box d a ande only 7 The Circuit temperature stays at 40 C and the Cartridge temperature is adjusted as necessary to control condensation and rainout TQ FQ 8 Ifa small red light on the Humidifiers WAIT button is flashing the Humidifier has been placed in its WAIT mode manually and the button must be pressed
41. atient Pressure monitoring tube gt Conventional endotracheal tube lt lt Main port Jet inlet port gt Jet port cap amp ebunnell am Chapter 2 SETUP Objectives 1 Understand the connections to the electrical power air oxygen and water necessary for the Life Pulse to function Know how to install the humidifier cartridge and circuit The Life Pulse should be positioned so that the displays are easy to read and its controls and the conventional ventilator controls are within easy reach The cart is on 5 inch lockable casters for easy portability and stability The Bunnell ventilator cart is designed to carry most of the patient s cardiopulmonary equipment For example oxygen analyzers and other monitors can be placed on the top shelf The Life Pulse is typically placed on the second shelf the conventional ventilator on the third and an uninterruptable power supply on the bottom Setup procedures for the Life Pulse include making connections in three places e the Rear Panel e the Front Panel and e the Patient Box Mixed Alarm Patient Box gas volume connector input ALARM VOLUME DO NOT BLOCK VENT HOLES e e MIXED GAS INPUT a 30 60 PSI e c kor RE e gt i O Power Circuit Gas dump cord breaker port Life Pulse Model 203 Mixed Alarm Patient Box gas 7 connector input I O uke 5 ERI
42. ave been set If the READY light is not lit then the limits have not yet been set and the SERVO PRESS and MAP displays will not change when you press one of the limit buttons To change the limits and make them tighter or wider in any combination press the button for the particular limit hold it down and press either the increase or decrease button next to it The other alarms that are available with the Life Pulse are illuminated only to indicate changing or potentially threatening conditions While in the Standby mode press the TEST button to observe a display of these alarms Do NOT perform the Test while a patient is connected to the Life Pulse Alarm messages include e JET VALVE FAULT e VENTILATOR FAULT e LOW GAS PRESSURE e CANNOT MEET PIP e LOSS OF PIP e HIGH PIP 49 E bunnell JET VALVE FAULT S za JET VALVE FAULT In the READY condition 1 A Loss of PIP alarm will be activated check for chest vibration 2 Do not press the Enter or Reset buttons 3 If chest is vibrating do normal troubleshooting for Loss of PIP alarm see Operator s Manual 4 If chest is not vibrating check the pinch valve 5 If pinch valve is NOT CYCLING press the STANDBY button to dump the Servo Pressure and change out the WhisperJet Patient Box 6 Call Bunnell Hotline to report stoppage get RA and send WhisperJet Patient Box to Bunnell for service JET VALVE FAULT A JET
43. by the operator to return the humidifier to normal operation TQ FQ 79 Appendix A POST TEST QUESTIONS Section 6 START UP 1 To begin high frequency Jet ventilation attach the Life Pulse to the patient monitor conventional ventilator pressures with the Life Pulse in Standby mode and determine the initial Life Pulse settings TU FU 2 Inthe Standby mode the pressures displayed in the MONITOR section are 80 second running averages updated every 10 seconds During operation the displayed pressures are 10 second running averages updated every 2 seconds TU FU 3 If air leak is the primary concern select a PIP approximately 90 100 of the monitored conventional ventilator PIP If the primary concern is RDS select a PIP 100 110 of the monitored conventional ventilator PIP TU FU 4 Number the following Start up steps according to the order in which they occur Adjust PEEP if necessary Select starting PIP Lower conventional ventilator Rate Lower conventional ventilator PIP if interrupting jet pulses Press ENTER button Press RESET button to establish new alarm limits if necessary mo aoop 5 A 10 drop in PIP with the Life Pulse typically results in a 20 to 25 drop in MAP a reduction that may be too great in the RDS patient TU FU 6 After making a change in the conventional ventilator settings it may be necessary to a make the same changes on the Life Pulse b press the RESET button to allow the L
44. cally less pressure and much Concerns Ventilator smaller tidal volumes are used to manage the patient Ventilation amp Life Pulse High Pressure Ventilator The conventional ventilator settings will be Concerns manipulated most often when oxygenation of the patient 1s of primary concern The Life Pulse settings will be manipulated most often when ventilation CO2 removal and or the consequences of using high airway pressures e g pulmonary air leaks are of greatest concern 32 E bunnell 1 Increase PEEP 2 Increase CV Rate 2 Increase CV Rate OXYGENATION The main choices for improving oxygenation require increasing mean airway pressure by elevating the e CV PEEP e CV RATE e CVPIP e CVI Time High frequency PIP and rate would be secondary considerations Raising high frequency On Time has rarely been shown to be effective in clinical trials The choices for improving oxygenation due to atelectasis are e Increases in PEEP are meant to stabilize alveoli PEEP changes are made with the conventional ventilator since the Life Pulse has no PEEP control However the PEEP adjustment will be displayed on the Life Pulse in the MONITOR PEEP display e Increase background rate from the conventional ventilator Do not exceed 10 bpm on the background rate If more CV breaths are needed to oxygenate it may be an indication that the PEEP is too low Always optimize PEEP before increasing CV Rat
45. ds If the level EB EVER sensing pins do not detect water within this e orcu CIRCUIT FAULT period the water pump will shut off and a CIRCUIT FAULT LEVEL alarm will appear in the humidifier ALARMS window The alarm may be silenced for 60 seconds by pressing the humidifier alarm SILENCE button The CIRCUIT FAULT LEVEL alarm indicates it is necessary to check the progress of the cartridge filling If the water has reached the appropriate level as described above the cartridge may need to be replaced If a CIRCUIT FAULT LEVEL alarm sounds and the water has not reached it proper level look for one of the following possible causes e The water supply and or water transfer tubing may not be connected properly e The water transfer tubing may be clamped shut e The water supply may be empty If the CIRCUIT FAULT alarm sounds immediately after the ENTER button is pressed e The humidifier door may not be closed properly e The cartridge circuit may be faulty If none of these conditions exists call the Bunnell Hotline at 1 800 800 4358 66 So 1j Water level sensing pins Proper water level is at 2nd level sensing pin WATER LEVEL SENSING While observing the delivery of water to the cartridge ensure that it does not overfill The pump stops pumping when the water level reaches the second water level sensing pin The cartridge has a third level sensing pin to detect high water level and prev
46. e large barbed connector labeled GAS OUT 3 Connect the small diameter purge tube to the barbed connector labeled PURGE 4 Locate the water inlet tube a clear tube running from the lower right corner of the Transfer tube to Water Water inlet cartridge with a check valve and a Leur water supply Pump tube fitting on the end 6 5 4 5 Install the water inlet tube by placing the CHECKLIST clear tube into the pump housing closing the pump door securely to pinch the water inlet tube inside and connect the water Cartridge in and door latched transfer tube to the Luer connector on the end of the water inlet tube Front Panel Connections Green gas inlet tube Purge tube 6 Tap the sterile water bag with the other end of the water transfer tube and open Water inlet tube the tubing clamp Water pum BUMP Use only sterile water for the cartridge Water supply bag water supply PATIENT BOX CONNECTIONS Purge Tube Push To Load button To Patient Pinch Valve End view CHECKLIST Patient Box Connections Pinch tubing in pinch valve Purge tube connect Locate the soft pinch tubing portion of the circuit just beyond where the red and white wires inside the circuit terminate 2 Place the pinch tubing in line with the pinch valve assembly 3 Hold the pinch tubing on each side of the pinch valve assembly 4 Press the PUSH TO
47. e For example The Ballard Neonatal Elbow system can be use with the Life Pulse the Ballard Neonatal Y system cannot e if the suction catheter is straight for the first few inches at its tip A straight tip on the in line suction catheter ensures a straight shot into the endotracheal tube A curved suction catheter may dead end against the inner wall of the LifePort adapter making it difficult to advance the catheter down the ET tube Once a compatible inline suction system has been selected it can be used according to the procedures outlined in procedures 1 and 2 described earlier in this section 44 Chapter 9 WEANING Objectives 1 Recognize the indications for weaning from the Life Pulse 2 Know the various options for weaning and the advantages of each As the patient improves he will eventually need to be weaned from the Life Pulse The goal in most cases will be to wean the patient back to conventional ventilation at much less support than the patient was on before beginning high frequency ventilation However the Life Pulse may be left on the patient while he is weaned directly to CPAP a nasal cannula or an oxygen hood Below is a brief summary of weaning guidelines GENERAL GUIDELINES FOR WEANING Decrease Minute Ventilation and MAP slowly by lowering PIP on the Life Pulse and the conventional ventilator Lower F Q2 gradually to around 30 Continue decreasing PIP a
48. e PIP or I time e Increase the PIP delivered with the background conventional breaths Increases in CV PIP are meant to reach the critical opening pressure required to inflate collapsed alveoli Adequate PEEP levels are essential for avoiding derecruitment between conventional breaths 33 4 Increase CV I Time OXYGENATION cont e Increase I Time in combination with adequate levels of PEEP and PIP to improve atelectasis Consider carefully the combined effect of PIP and I Time increases Increasing I Time when CV PIP is set at high levels increases the risks of causing lung injury e If other approaches to oxygenation have failed or are contrary to the patient s pathophysiology increase the Life Pulse PIP by 2 cm H20 at a time until the desired response has been achieved Increasing HFV PIP too high may result in hyperventilation and hypocarbia which in preterm infants may increase the risk of cerebral injuries Concomitant increases in PEEP may help maintain an appropriate tidal volume and reduce this risk e If necessary the conventional ventilator PIP can be increased along with the Life Pulse peak pressure except in severe cases of air leak However the CV PIP should not be raised if it is at an adequate level to reach the critical opening pressure of the alveoli Remember to keep the conventional PIP below the Life Pulse s peak pressure to avoid interrupting the high frequency pulses Addition
49. ecececececececececececececcesecececeecece 37 UNDERSTANDING SERVO PRESSURE cc ccccccccccsscscccccceceesecsececececeesenssaccceccesserseacscccesesesecuaceceeseeneaaes 39 CHAPTER 8 SUCTIONING THE PATIENT 01 c ccccccccsssssssccocscssssssssccccsssssesscsccecscessesssescesscsssssscccsecscessesscessccecesees SUCTION PROCEDURE 1 oooio cocccccccccccccccccccccccccccccscccececececscececececcesceceeecececscecececececscecececscecscecscecscecseceseceecess 41 In service Manual TABLE OF CONTENTS SUCTION PROCEDURE 312 tecti eei t eine ete Pe e iet pe ee Ti i kaien 42 READY LIGHT MUST BEON un ped Ee HEU tret e dd elicit dente aa INSTILL INTO JET PORT THEN RECONNECT LIFE PULSE CIRCUIT ONE PERSON DISCONNECT CV CIRCUIT FROM LIFEPORT eee SECOND PERSON APPLIES SUCTION GOING INTO AND OUT OF THE ET TUBE SUCTION PROCEDURE 313 eR HE ee Lt e E EE Ede ie ee ee eere Rte UE HR EER 44 SELECT AN IN LINE SUCTION SYSTEM COMPATIBLE WITH THE LIFEPORT ADAPTER M M SELECT AN IN LINE SUCTION SYSTEM WITH A CATHETER THAT IS STRAIGHT FOR THE FIRST FEW INGELES eret trente te ape tuere rata rostro ie E ipee Tete deut bartendere Signa et SUCTION ACCORDING TO PROCEDURE 1 OR 2 DESCRIBED EARLIER IN THIS SECTION p CHAPTER 9 imllc
50. echanics change Resistance Decreases ig Resistance Increases SERVO Ke ee SERVO PRESSURE f W PRESSURE INCREASES i DECREASES Volume Increases Volume Decreases Servo Pressure changes early warning of changes in patient condition SERVO PRESSURE INCREASES WITH SERVO PRESSURE DECREASES WITH e Improving compliance or resistance e Worsening compliance or resistance e Leak around ETT e Obstructed ETT e Tubing leak e Tension Pneumothorax e Right mainstem intubation e Patient needs suctioning Charting Servo Pressure simplifies patient management decisions 39 Chapter 8 SUCTIONING THE PATIENT Objectives 1 Learn three methods of suctioning a patient while on high frequency ventilation which technique is preferred and when to use which alternative Be ready for problems that may possibly be encountered when using each suctioning method SUCTIONING 3 Techniques 1 Suction with Life Pulse in Standby mode 2 Suction with Life Pulse running 3 Suction with in line suction system High frequency ventilation may mobilize and help remove secretions Be prepared to suction soon after starting the Life Pulse on a patient Suctioning may need to be performed more frequently in the first 4 to 6 hours Suctioning frequency may then subside Suctioning the patient s airway may be accomplished by either of three methods e with the Life Pulse in the Standby mode e with the Life Pulse running e usi
51. ed by a flashing WAIT button it must be restarted manually 93 Sor GS Appendix B POST TEST ANSWERS Section 6 START UP 1 True 2 True 3 True However these starting criteria may vary depending on the patient s pathophysiology 4 8 5 b 1 c 4 d 3 e 2 f 6 5 True 6 b 94 1 True 2 d 3 True 4 d 5 EITHER 6 True 7 True 8 a 9 b d g 10 a c e f 11 True Appendix B POST TEST ANSWERS Section 7 PATIENT MANAGEMENT Delta P can be increased by raising the Life Pulse PIP or by decreasing the PEEP Delta P is PIP minus PEEP Raising PEEP might decreases Tidal Volume and may result in CO retention if despite raising PEEP alveoli remain unstable at the end of expiration However if by raising PEEP the alveoli are stabilized at the end of expiration CO may decrease MAP and PEEP have a 1 to 1 ratio meaning that raising the PEEP by 1cm H20 raises the MAP by 1 cm H20 Concern for pulmonary airleaks means limiting tidal volume form IMV breaths but increasing minute ventilation using HFJV Increasing HFJV PIP is more effective than increasing HFJV Rate for lowering PCOs Decreasing PEEP will increase delta pressure thus tidal volume and may help lower PCO Concern for oxygenation would lead to actions that recruit and maintain lung volume Except for increasing FiO gt all options involve increasing Mean Airway Pressure Using more IMV breaths improves
52. ellow CIRCUIT Red Yellow CARTRIDGE Red Yellow The Life Pulse is composed if 5 subsystems MONITOR Displays patient and machine pressures ALARMS Indicates various conditions that may require attention CONTROLS Regulates the On Time Peak Inspiratory Pressure and Rate of the HFV breaths HUMIDIFIER Monitors and controls the temperature and humidification of gas flowing through the disposable humidifier circuit to the patient PATIENT BOX Contains the pinch valve that breaks the flow of pressurized gas into tiny jet pulses and sends pressure information back to the ventilator s microprocessor Together these elements form a system that offers a variety of options for managing patients and the potential for improving blood gases using less pressure NOTE Graphics that display illuminated indicator lamps LEDs in this manual reflect Life Pulse model 203 For model 203A please refer to the table at right Sr 7 VENTILATOR FUNCTIONS LIFE PULSE e High frequency breaths e Airway pressure monitoring e Humidification e Alarms CONVENTIONAL VENTILATOR e Regulate PEEP e Fresh gas for spontaneous breathing e Supplementary IMV e Airway dilation Life Pulse Conventional Ventilator HFV with CV The Life Pulse is used in conjunction with a conventional infant ventilator The conventional ventilator has 4 functions e provides fresh gas for the patient s spontaneous breathing
53. ent overfill into the circuit The water pump is stopped automatically if the water level reaches the third pin If the all level sensing pins are defective the water level 1sn t sensed properly and a set fill time limit 86 seconds is designed to turn off the pump in time to prevent overfill Whenever installing a new cartridge circuit observe the cartridge fill until the pump stops As the cartridge fills the water and gas inside are heated by the hot plate behind the cartridge The temperature is regulated by the white cartridge thermistor wire located near where the circuit tubing attaches to the cartridge 67 E bunnell CIRCUIT TEMPERATURE The actual temperature of the gas is measured in the circuit just before the Patient Box and is displayed in the humidifier monitor section as CIRCUIT TEMP with a green light TEMPERATURE CIRCUIT As this temperature adjusts it will approach UO HUMIDIFIER Yn W a m 40 C may overshoot slightly and then settle in NEM O Aor right at or near 40 C TEMP There is approximately a 3 C drop in gas The actual Circuit Temperature will be 40 C and temperature from where it is last measured to will be indicated by a green LED where it enters the patient s trachea If the set circuit temperature is 40 C the actual temperature of the gas as it enters the patient will be 37 C body temperature The lungs are very effective heat exchangers Unless there is a reason for wanting
54. eria may be met with a relatively large patient on the Life Pulse or if large leaks are present somewhere in the system This condition can be simulated by using a test lung with a large air leak In either case the Life Pulse does not give up trying to meet the Ready condition This alarm is simply informing you that the Life Pulse is taking longer than usual to meet the Ready condition If necessary call the Bunnell Hotline at 1 800 800 4358 55 E bunnell LOSS OF PIP ea ET LOSS OF PIP LOSS OF PIP Causes 2596 drop in monitored PIP Monitored PIP lt 3 cm H O Monitored PIP and PEEP within 2 cm H O If necessary call the Bunnell Hotline at 1 800 800 4358 LOSS OF PIP The LOSS OF PIP alarm implies an extubation or a disconnected obstructed or kinked tube The alarm is initiated by one of the following criteria e The monitored PIP drops below 25 of the NOW PIP e The monitored PIP is less than 3 cm H20 e The monitored PIP and PEEP are within 2 cm H20 of each other The Life Pulse responds to a LOSS OF PIP alarm in the Non READY condition as follows e The Servo valves close e The Servo Pressure and PIP will drop to or near zero e The patient will not be receiving adequate ventilation This response is designed to stop gas flow into the patient circuit during start up or when changing settings if inadequate PIP is detected It also prevents pressure spikes when the Li
55. erly on a test lung the Life Pulse is ready for clinical use If the Life Pulse is unable to achieve the desired settings on a test lung or the cause of a VENTILATOR FAULT cannot be determined or an 04 stays displayed at the end of the test call the Bunnell Hotline 1 800 800 4358 13 Chapter 4 PRESSURE MONITORING Objectives Appreciate the advantages of the LifePort Adapter and the purpose of each of its 3 ports Understand the parameters displayed in the MONITOR section and where they are measured Understand Servo Pressure and its clinical relevance Understand the function of the PURGE The MONITOR displays reflect the pressures at the tip of the endotracheal tube and the RIE er internal Servo or drive pressure of the Life MONITOR Pulse If the Life Pulse is in Standby and AP SERVO there is no patient connected to the Patient s Bd Box the displays will all read zero PEER Ls Once the pressure monitoring tube of the LifePort adapter has been connected to the Patient Box the Life Pulse even in its Standby mode will begin to monitor the pressures being delivered by the conventional ventilator These pressures are updated in the MONITOR displays every 10 seconds The Life Pulse monitors e PIP Peak Inspiratory Pressure e PEEP Positive End Expiratory Pressure e MAP Mean Airway Pressure e AP PIP minus PEEP roughly equivalent to tidal volume and e SERVO PRESSURE internal driving
56. ess and the conventional rate has been increased to about 15 20 bpm the patient s chest rise will be much more a result of the conventional breaths than the high frequency pulses e Attempt CV Trial Place the Life Pulse into the Standby mode to begin a trial of conventional ventilation only The CV PIP should not have to be raised above 20 cm H5O If this is necessary the trial has failed Return to HFV e Ifthe patient is stable on conventional ventilation disconnect and cap the Jet port and the pressure monitoring tube of the LifePort adapter e Weaning to Nasal CPAP If the patient is stable on low Life Pulse and background CV settings and the patient is breathing on his own try the patient on CPAP If tolerated you may want to extubate the patient to nasal CPAP e Remove the Life Pulse for cleaning and preparation for the next patient 47 E bunnell Chapter 10 Objectives 1 Understand how the High and Low alarm limits are set for the Servo Pressure and Mean Airway Pressure Learn how and when to change the High and Low alarm limits Know the possible causes of the six types of alarm messages and how to troubleshoot and correct them Alarm Silence button me sursis n ALARM MESSAGES h 4 WILL BE DISPLAYED i HERE W MAP limit adjustment buttons Servo Pressure limit adjustment buttons READY Light ON Monitored PIP 1 5 cm H O of set NOW PIP for 20 Seconds SERVO PRESSURE al
57. fe Pulse circuit is disconnected or kinked then reconnected or unkinked while the READY light is off Gas flow is easily restarted by pressing the ENTER button If the LOSS OF PIP alarm occurs in the Ready condition the Servo valves are designed to lock and allow the Life Pulse to continue to ventilate the patient with nearly constant tidal volumes You should NOT press the ENTER button if the Servo Pressure display is locked at or near the established operating level and the patient s level of ventilation is adequate Eliminating the cause of LOSS OF PIP will eliminate the alarm condition 56 E bunnell 0 HIGH PIP ES HIGH PIP HIGH PIP Causes 1 Pressure 5 cm gt NOW PIP for 1 sec 2 PIP 10 cm gt NOW PIP for each breath over a 30 second period 3 Monitored PIP gt NOW PIP by 30 cm for each breath during a 0 75 sec period 4 Instantaneous airway pressure gt 65 cm H20 HIGH PIP The HIGH PIP alarm indicates one of the following conditions e the monitored pressure has exceeded the set NOW PIP by at least 5 cm H20 for 1 second e the PIP has consistently exceeded the NOW PIP by 10 cm H20 for all high frequency breaths for the past 30 seconds or e the monitored PIP for each breath during a 0 75 second period exceeds the set point by 30 cm H20 or e Instantaneous airway pressure gt 65 cm H20 This alarm may be observed by pinching off the exhalation limb of the conventiona
58. from the pinch valve to the Jet port on the side of the LifePort adapter Connect the clear pressure monitoring tube of the LifePort adapter to the Patient Box barbed connector labeled MONITORING LUMEN Press the TEST button An automatic test begins which determines the integrity of all the ventilator s electronics and valves Observe the front panel to assure all LEDs and displays are functional and listen to make sure the audible alarm is functioning properly If no problems are detected all the ventilator displays will illuminate 1 through 9 in sequence and all the alarm messages will be displayed The Test procedure will end with the Life Pulse in the Standby mode and an audible alarm sounding 6 10 Silence the audible alarm by pressing the SILENCE button The audible alarm stops for 60 seconds Once the internal Test passes perform an operational test using the test lung A conventional ventilator is not needed and the LifePort adapter 15mm connector is left open to the room Press the ENTER button to activate the default control settings 20 420 0 02 Once the PIP is stable the Ready light will activate Make sure the pressures are stable and the PEEP is reading 0 0 1 cm H20 If the PEEP is gt 1 cm H O switch out the Patient Box and repeat the operational test 12 E bunnell ener SILENCE VENTILATOR FAULT on JET VALVE TIME on off seconds GES sli ii CHECKL
59. idge temperature b Primarily controls temperature of delivered gas 4 Which of the following alarms is not found in the Humidifier Section a LEVEL LOW b TEMP HIGH c LEVEL HIGH d TEMP LOW e VENTILATOR FAULT 5 Excessive rainout in the clear portion of the circuit may enter the ET tube and impede pressure monitoring causing a LOSS OF PIP alarm TU FU 6 Ifthe cartridge door is closed and secured if all tubing and electrical connections have been made if water is in the water supply bag and if the water transfer tubing is patent and the humidifier appears to be working normally a TEMP HIGH or LOW or a LEVEL HIGH or LOW alarm usually means the operator should press the WAIT button and continue delivering high frequency Jet ventilation adjust the Cartridge and Circuit temperature settings probably replace the Humidifier Cartridge Circuit call the Bunnell Hotline for additional troubleshooting ideas c and d only D pop ES 88 Appendix B POST TEST ANSWERS Section 1 OVERVIEW 1 CONTROLS MONITOR ALARMS HUMIDIFIER AND the Patient Box 2 MONITOR 3 CONTROL 4 True 5 False The Life Pulse is always used in tandem with a conventional ventilator 6 True The conventional ventilator and the Life Pulse work synergistically to improve the patient s blood gases using less pressure in most cases T a Conventional only b Life Pulse and some Conventional c Conventional only d Life Pul
60. ient at close to 37 C normal body temperature 20 Press ENTER button to initially start humidifier Press WAIT button to stop and start humidification HUMIDIFIER ENTER Abunnell PURGE A STARTING THE HUMIDIFIER The Life Pulse Humidifier requires little operator intervention The temperature of the gas is regulated by feedback control from the point where it enters the cartridge to the point where it enters the Patient Box When the Life Pulse is first turned on the ventilator comes up in its Standby mode and the humidifier is in its WAIT mode The two modes are equivalent there is no ventilation and no humidification or heating being done in these modes When the ENTER button is pressed the light in the corner of the WAIT button goes off and the humidifier automatically begins functioning The pump has 86 seconds to fill the cartridge to the proper level When the STANDBY button is pressed the light in the corner of the WAIT button is lit and the humidifier assumes its WAIT mode The humidifier WAIT mode may also be entered independently by pressing the WAIT button In this case the light in the corner of the WAIT button begins blinking on and off Press the WAIT button again to bring the humidifier back into operation and reset the 86 second timer for the water pump 21 CHANGING THE CIRCUIT CIRCUIT CHANGE PREPARATIONS Checklist With Life Pulse Operating
61. ife Pulse to recalculate alarm limits around the Servo and Mean Airway Pressures lower the RATE on the Life Pulse Both a and c e None of the above ap 80 123 Appendix A POST TEST QUESTIONS Section 7 PATIENT MANAGEMENT The thought processes and rationale for managing patients on the Life Pulse as compared with a conventional ventilator are very similar TU FU Which of the following statements regarding patient management is are true Circle all that apply a Most setting changes to manage PCO will be performed on the Life Pulse b Most setting changes to manage PO will be performed on the conventional ventilator c The Life Pulse is used in tandem with the conventional ventilator to provide better blood gases while using less airway pressure d All of the above e a andb only The best approach for dealing with a high PCO is to increase delta P AP TU FU Because CO elimination is proportional to Tidal Volume squared V during high frequency ventilation small changes in which of the following parameters may produce significant changes in PCO Circle all that apply a PIP b PEEP c Delta P d All of the above PCO would most likely INCREASE DECREASE if PEEP is increased to improve PO Increasing high frequency PIP is a more effective means of eliminating PCO than increasing high frequency Rate TU FU The best approach for controlling PO is to adjust Mean A
62. ife Pulse troubleshooting Most of the necessary troubleshooting will be in response to alarms Ventilator alarms alert the operator to changes in the patient or the Life Pulse It is recommended that when a patient is on the Life Pulse the operator e pays particular attention to ventilator alarms and e sets the alarm volume loud enough to present a sense of urgency when it sounds There are at least five basic troubleshooting principles that if followed will help make working with patients on the Life Pulse easier 58 Hi T 7 1 Look At The Patient LOOK AT THE PATIENT First as with any ventilator observe the patient Whenever an alarm occurs LOOK AT THE PATIENT FIRST e Is the patient s chest rise adequate e How is the patient s color e How is the patient s external monitoring e Is there an obvious disconnected tube near the patient e Has the Servo Pressure locked at or near its operating level With the most common Life Pulse alarm LOSS OF PIP the Servo Pressure will lock and the patient will continue to receive a constant level of ventilation The cause of the alarm may then be determined without increasing conventional ventilator support or providing manual ventilation However some alarm conditions may require the conventional ventilator settings to be increased to provide ventilation while an alarm condition is corrected or the patient may need to be hand bagged 59 E
63. ilation is proportional to the tidal volume squared V Tidal volume on the Life Pulse is roughly proportional to delta P AP the arithmetic difference between PIP and PEEP Thus small changes in PIP or PEEP can produce significant changes in a patient s PCO The main choices for improving ventilation require increasing minute ventilation by changing e HFV PIP e PEEP e HFV Rate e Ifthe patient s PO is acceptable but his PCO is too high increase high frequency PIP by 1 to 2 cm H20 at a time e Ifthe patient s POz and PCOs are both unacceptable increasing PIP may address both problems at once When PEEP is increased oxygenation may improve However increasing PEEP without a corresponding increase in HFV PIP reduces tidal volume and may result in some degree of CO retention The PIP must be increased by an equal amount in order to keep the delta P AP the same and maintain tidal volume and adequate ventilation 37 124 2 Decrease PEEP 3 Increase HFV Rate 4 Hyperventilation VENTILATION cont e Ifthe primary concern is air leaks or cardiac compromise and oxygenation 1s acceptable lower PEEP 1n order to increase AP i e tidal volume and increase ventilation Be careful not to compromise oxygenation when lowering PEEP e Increase the high frequency rate by 40 to 80 breaths per minute at a time to improve ventilation without further increasing PIP Increasing high frequenc
64. ing delivered to the patient not the temperature Heated and humidified gas leaves the cartridge and enters the circuit tubing with the red and white wires inside The temperature thermistor at the tip of the white circuit wire measures the actual temperature of the humidified gas in the circuit just before the Patient Box The value is displayed as CIRCUIT TEMP in the humidifier display section The red wire is a heating element that is turned on and off according to feedback from the circuit temperature 19 GAS FLOW THROUGH HUMIDIFIER Pinch Tube Pinch Valve cont e Using the CIRCUIT temperature setting on the humidifier front panel as its set point the microprocessor controls the temperature of the gas being delivered to the patient The heating wire also minimizes the amount of condensation in the tubing to control rainout e The heated and humidified gas flows into the pinch tube section of the circuit where the pinch valve breaks the flow into breaths e The gas begins to cool as it leaves the pinch valve and condensation occurs as a result of the cooling The temperature of the gas that enters the LifePort adapter will be approximately 3 C less than when it was last measured by the circuit thermistor Therefore the CIRCUIT temperature is automatically set at 40 C on the front panel by the microprocessor The intention 1s to deliver the gas to the pat
65. ing the set CARTRIDGE temperature as follows e press the SET button twice to light the red or yellow LED next to CARTRIDGE and e adjust the temperature up or down by using the adjustment buttons The humidifier has no ENTER button Wherever you leave the setting will be the temperature at which the heater will maintain the humidified gas in the cartridge The humidifier will switch the temperature display back automatically to continuous CIRCUIT TEMP monitoring ten seconds after a button is pressed Remember that changes to the CARTRIDGE temperature affect humidification not the temperature of the gas delivered to the patient 70 E bunnell CONDENSATION PROBLEMS If the preset Cartridge Temperature is CARTRIDGE TEMP too high too high for a particular patient e Excess condensation will develop in the A LOSS OF PIP alarm with the oe eae of ars dr pue READY light on will lock the etween the cartri gean the Patien Servo Pressure Box e The MONITOR section of the Life Pulse ona ES ma will display fluctuating pressures E e A LOSS OF PIP alarm may occur gt e s long as the Life Pulse is in the READY mode the Servo Pressure will lock at or The patient will continue to near its operating level and the Life be ventilated appropriately Pulse will continue to ventilate the patient appropriately during a LOSS OF PIP alarm so OE If the Cartridge temperature is set too CARTRIDGE TEMP too low low
66. ional circuit from the 15 mm connection of the LifePort while a second person prepares to introduce the suction catheter 7 Introduce the catheter with suction applied This procedure allows the Life Pulse to continue ventilating the patient with fewer interruptions If suction is not applied while advancing the suction catheter the catheter creates an obstruction and the Life Pulse will pause to protect the patient the Life Pulse will not deliver gas if the exhalation path is obstructed by the suction catheter Suctioning all the way into the ET tube and all the way back out allows the patient to receive some jet ventilation throughout the suction procedure 42 E bunnell SUCTION PROCEDURE 2 If suctioning with the Life Pulse Running MAKE SURE THE READY LIGHT IS ON LOSS OF PIP If a LOSS OF PIP alarm occurs with the READY light on the Servo Pressure locks to protect the patient cont A LOSS OF PIP alarm usually occurs when suctioning with the Life Pulse running As long as the Life Pulse is in the READY condition the Servo Pressure will lock at or near its operating level and the patient will continue to receive appropriate ventilation even though the displayed PIP and PEEP may fluctuate 8 Reconnect the conventional ventilator when finished 9 Provide a few manual breaths with the conventional ventilator to help the patient recover from the procedure 10 Press the SILENCE button to sto
67. irway Pressure MAP TU FO 81 Appendix A POST TEST QUESTIONS Section 7 PATIENT MANAGEMENT Cont Which of the following strategies may be the most effective for increasing MAP and oxygenation Increasing PEEP Increasing conventional IMV Increasing conventional inspiratory time Increasing high frequency On time Increasing high frequency PIP verse In the following two scenarios match the most appropriate ventilator strategy with the patient s specific pathophysiology 9 10 11 A near term infant with a Increase FiO2 a spontaneous pneumothorax and pneumomediastinum b Set initial conventional IMV rates 0 to 3 bpm minimal oxygenation concerns but excessively high PCO c Set initial conventional IMV rates 3 to 5 bpm d Increase high frequency PIP by 1 to 2 cm H20 e Increase PEEP A premature infant with RDS requiring high pressures f Increase conventional IMV rate to 10 bpm worsening oxygenation g Decrease PEEP Changing the high frequency On Time has not been proven an effective means of improving oxygenation TU FU 82 Appendix A POST TEST QUESTIONS Section 8 SUCTIONING THE PATIENT 1 There are three methods of suctioning a patient while on the Life Pulse TO FU 2 Secretions and suctioning frequency may INCREASE DECREASE during the first 4 to 6 hours of high frequency ventilation 3 The technique s for suctioning during high frequency ventilation is
68. l circuit Note that the Life Pulse Servo Pressure is dumped in this condition Although it has no way of alleviating a condition caused by the conventional ventilator the Life Pulse does ensure that it will not further aggravate the problem All of the alarm conditions described in this section are accompanied by an audible alarm While the cause of the alarm is being evaluated the beeping may be silenced by pressing the Alarm SILENCE button It may be necessary to review this section several times before becoming familiar with the conditions that trigger each alarm Remember all alarms are important and should be responded to by the operator If necessary call the Bunnell Hotline at 1 800 800 4358 24 bunnell Chapter 11 INTERPRETING VENTILATOR ALARMS Objectives 1 Understand the usefulness of ventilator alarms 2 Know the Five Principles of ventilator troubleshooting ener SILENCE Oy JET VALVE FAULT VENTILATOR FAULT v LOW GAS PRESSURE A CANNOT MEET PIP LOSS OF PIP y HIGH PIP ALARM DISPLAY This section discusses interpreting and correcting the ventilator alarms It is beyond the scope of this manual to list all possible problems and their solutions Many ventilator problems and corrective actions have already been covered A more comprehensive review is offered in the Operator s and Service manuals There are however a few general principles that can simplify L
69. l ventilator circuit because of the Life Pulse s expiratory flow pattern 72 E bunnell HIGH LOW WATER LEVEL CIRCUIT CARTRIDGE CIRCUIT TEMP CIRCUIT CARTRIDGE CIRCUIT TEMP ALARMS m LEVEL LOW ALARMS HIGH The humidifier alarm system detects high or low water levels for the cartridge A LEVEL LOW alarm may indicate that the humidifier water supply has been exhausted The humidifier alarm SILENCE button can be pressed while a new water supply 1s connected as follows 1 Close the clamp on the water transfer tube and disconnect the empty water supply bag 2 Connect a new water supply 3 Open the clamp on the transfer tube to allow water to flow to the cartridge 4 Press the WAIT button twice 1 e off on to give the pump time 86 seconds to fill the humidifier cartridge Once the cartridge is filled and the pump has stopped the pump is limited to 5 seconds of operation every minute This restriction serves as a precaution against overfilling the cartridge during normal Life Pulse operation A LEVEL HIGH alarm rarely occurs but may be caused by a faulty humidifier cartridge Replacing the cartridge circuit usually eliminates this alarm A LEVEL HIGH alarm may occur when the water supply is hung above the Life Pulse and the water supply tubing is not properly installed in the Life Pulse s water pump For this reason the water supply bag should always be located bel
70. lines the blender or a failure in the hospital s gas supply system or e The gas pressure switch in the Life Pulse B is faulty The Life Pulse will otherwise function properly but will display a continuous LOW GAS PRESS alarm cea ET If necessary call the Bunnell Hotline at LOW GAS PRESSURE 1 800 800 4358 54 E bunnell CANNOT MEET PIP cea EZ AR gt CANNOT MEET PIP CANNOT MEET PIP Causes 1 Ready condition not met within 3 minutes 2 Servo Pressure reaches 20 psi 137 90 kPa before the Ready condition is met CANNOT MEET PIP A CANNOT MEET PIP alarm means one of two things e the Life Pulse has been unable to meet the Ready condition within 3 minutes of pressing the RESET or ENTER button or e the Servo Pressure has risen to 20 psi 137 90 kPa and the Ready condition has not been met The first criteria would be met if conditions keep changing after the RESET or ENTER button is pressed An unstable monitored PIP makes it difficult for the Life Pulse to meet the criteria necessary to enter the Ready condition For example a patient who is taking vigorous spontaneous breaths may initiate this alarm The alarm may be alerting you that the patient needs comforting attention or possibly sedation This condition can be simulated with a test lung by periodically creating leaks after pressing the ENTER button The CANNOT MEET PIP alarm will occur after 3 minutes The second crit
71. lse displays approximations of distal pressures We recommend that start up decisions be based on the pressures displayed in the Life Pulse s MONITOR section 27 CHOOSING STARTING VALUES The PIP setting chosen for initiation of high frequency ventilation will depend on the PIP currently being monitored by the Life Pulse in its Standby mode The other initial high frequency settings are usually left at the default values of a RATE of 420 breaths per minute and an ON Time of 0 02 seconds For larger patients the rate may need to be lowered to avoid gas trapping and inadvertent PEEP 240 360 bpm Generally the more pulmonary airleaks are a concern the lower you will set the background CV rate PIP and I Time on the conventional ventilator PEEP isa better way to control oxygenation in patients with airleaks The more atelectasis is a concern the higher the background CV Rate PEEP and I Time can be set Backgrounds CV rates greater than 10 bpm are almost never indicated For more detailed information on choosing starting values see the next few pages 28 6 STEPS TO START HFV SUMMARY OF SIX STEPS TO START UP Select the starting HFV PIP value Press the ENTER button to start the Life Pulse If necessary lower PIP on the conventional ventilator to prevent interruption of high frequency pulses Lower the conventional ventilator rate to CPAP to 3 breaths for air leak syndromes 3 to 10 breaths for R
72. lses when these brief interruptions begin to occur Adjust PEEP The PEEP may be adjusted as necessary to maintain adequate POs alveolar inflation and MAP which may decrease as PIP is weaned Do not worry about lowering PEEP until FiOz is 30 or less Lower FiO Begin more aggressive weaning of F1O when you are comfortable with the patient s MAP Remember to adjust both blenders so the settings remain equal 46 Resume Lowering HFV PIP Allow Jet Pulse Interruptions Begin CV Trial by Placing Life Pulse in STANDBY Add CV Support as Necessary Weaning Directly to CPAP or Nasal CPAP WEANING cont e Resume weaning PIP Do so as tolerated If the patient begins to deteriorate with further reductions in PIP the pressure may be near a mean airway pressure threshold In this case cease weaning and consider raising PEEP to stabilize the lungs Resume weaning when the patient is ready as determined by blood gases and clinical observation If possible you may continue weaning FiO during the interim e Allow Jet Pulse Interruptions When the high frequency PIP has been lowered into the mid teens allow the conventional ventilator breaths to interrupt the high frequency pulses i e don t lower CV PIP further e Add CV Support provide more CV support by increasing the conventional ventilator s IMV rate as high frequency PIP is weaned Once the high frequency PIP is down to approximately 15 cm H O or l
73. n the Life Pulse pressures have been decreased into the teens e The Life Pulse Rate should always be lowered to its minimum setting of 240 bpm before returning the patient to conventional ventilation 2 The Servo Pressure may indicate when a patient s compliance is improving TU FU 9 Generally as PCO decreases high frequency PIP is lowered in increments of 1 to 2 bpm as PO improves the FiOz or the parameters that produce MAP are lowered TU FU 4 When a patient begins to respond negatively to further decreases in pressure it may indicate that the patient has reached a pressure threshold and further decreases are ill advised until the patient has acclimated to the changes TU FU 5 FiO should be reduced to 40 or less before weaning PEEP TU FU 6 Interruptions in the jet pulses should never be allowed during any stage of the weaning procedure TU FU 7 The conventional ventilator rate and PIP usually need to be increased as Life Pulse PIP is weaned into the mid teens TU FU 8 When the patient is stable and most of the chest rise is being provided by the conventional ventilator breaths a trial of conventional ventilation alone may be attempted by pressing the STANDBY button on the Life Pulse TU FO 84 Appendix A POST TEST QUESTIONS Section 10 VENTILATOR ALARMS 1 The four components of the ALARMS section are upper and lower alarm limits alarm messages the SILENCE button and the RESE
74. nates and a VENT FAULT alarm doesn t occur it is safe to resume ventilation 7 Ifthe Test procedure fails call the Bunnell Hotline at 1 800 800 4358 52 12a VENTILATOR FAULT Code 10 lt d ED exes SILENCE VENTILATOR FAULT JET VALVE TIME on off 071 LI ENTER Ll TEST N VENTILATOR FAULT CODE 10 There is one Ventilator Fault that may cause the Life Pulse to revert to the STANDBY mode but is immediately recoverable If the Servo Pressure rises 3 4 psi 23 44 kPa above the level necessary to have met the READY condition the Life Pulse will revert to STANDBY mode with a VENTILATOR FAULT and a code 10 displayed in the ON OFF ratio display in the CONTROL section After the condition that caused the alarm e g a kinked pressure monitoring tube is corrected press the ENTER button and the Life Pulse will resume normal operation If the VENTILATOR FAULT 10 was caused by a problem not immediately correctable e g a faulty Servo Pressure control valve the Life Pulse after the ENTER button is pressed will immediately enter the STANDBY mode and display another VENTILATOR FAULT 10 If necessary call the Bunnell Hotline at 1 800 800 4358 53 Sn LOW GAS PRESSURE A LOW GAS PRESS alarm indicates that the gas supply to the Life Pulse has fallen LOW GAS PRESSURE to a pressure less than 30 psi 206 85 kPa This alarm could indicate that e You have a leak in one of the gas supply
75. ng an in line suction catheter system 40 E bunnell SUCTION PROCEDURE 1 The first technique for suctioning the patient Suctioning in the Life Pulse s is the easiest to learn because the procedure is STANDBY Mode similar to suctioning during conventional ventilation 1 Place the Life Pulse into the Standby mode 2 Suction as usual 2 Press the ENTER button after reattaching the conventional ventilator circuit when the suction procedure is complete 41 SUCTION PROCEDURE 2 Suctioning with the Life Pulse Running SUCTIONING CHECKLIST READY light must be on Instill into Jet port then reconnect Life Pulse circuit One person disconnect CV circuit from LifePort Second person applies suction going into and out of the ET Tube Reconnect CV circuit to LifePort Press SILENCE button if necessary The second technique requires that suction be applied in the endotracheal tube throughout the introduction and withdrawal of the suction catheter 1 First make sure the Life Pulse s READY light is ON before beginning the suction procedure 2 Press the alarm SILENCE buttons on both ventilators 3 With the Life Pulse running disconnect the Life Pulse circuit from the Jet port of the LifePort adapter 4 Instill irrigation fluid into the Jet port 5 Reattach the Life Pulse circuit to the Jet port to jet the fluid into the patient s airways 6 One person may disconnect the convent
76. o eliminate any unintentional interruptions of the jet pulses then lower the CV rate back to where it was before the circuit change 8 Bring the humidifier out of its Wait mode by pressing the WAIT button after the Life Pulse has been restarted with the new cartridge circuit otherwise the patient will receive relatively cold and dry gas There are no alarms for low temperature or low water level when the humidifier is in the Wait mode The circuit change is not complete until the water fills the cartridge the water pump shuts off and humidity appears in green portion of the circuit between the Patient Box and the LifePort On rare occasions a defective cartridge might not fill might over fill or might not heat properly It will then need to be replaced 24 e bunnell IDENTIFYING PROPER HUMIDIFICATION Proper Humidification Fine mist in green portion of circuit tubing Water pooling Over Humidification Water continuously pooling in clear portion of circuit tubing Tube is dry Under Humidification Green portion of circuit tubing dry It is important to identify proper humidification of the gas through the circuit You can do this by observing the degree of mist in the green portion of the circuit tubing between the Patient Box and the LifePort adapter Proper humidification looks similar to the mist you would see when breathing on a mirror or against a car window on a cold winter day
77. ow the level of the humidifier so that a LEVEL LOW alarm will occur when the water supply tubing is not properly installed 73 e bunnell HIGH LOW TEMPERATURE The humidifier alarm system detects high and low temperature for both the circuit and cartridge A high or low temperature is indicated by an audible alarm and a TEMP HIGH or e CIRCUIT ALARMS TEMP LOW message in the alarm display CARTRIDGE TEMP HIGH EB CS The TEMP HIGH alarm is activated if CIRCUIT TEMP e the monitored temperature strays 3 above the set temperature for more than 1 minute in the circuit or e the monitored temperature strays 3 vum WENNS above the set temperature for more than e CARTRIDGE xus 10 minutes in the cartridge en e The TEMP LOW alarm is activated if TEMP e the monitored temperature strays 3 below the set temperature for more than 3 minutes in the circuit or e the monitored temperature strays 3 below the set temperature for more than 30 minutes in the cartridge Such alarms may be caused by a faulty circuit relaying false information to the microprocessor For example if the circuit is quite warm to the touch when the humidifier is indicating that it 1s too cold it could result in overheating The humidifier circuit might need to be replaced in such conditions Call the Bunnell Hotline at 800 800 4358 before changing the circuit 74 Appendix A POST TEST QUESTIONS Section 1 OVERVIEW 1 The fi
78. p audible alarm 11 If necessary press the ENTER button to clear all alarms and reestablish appropriate ventilation and new alarm settings If pressure fluctuations continue after the suctioning procedure it may be necessary to press the ENTER button again This action will activate the Jet s purge system to clear the pressure monitoring tubing of fluids If problems persist with pressure fluctuations and the CANNOT MEET PIP alarm is displayed it may be necessary to suction again to remove secretions from the distal tip of the ET tube 43 E bunnell SUCTION PROCEDURE 3 Suctioning with an In Line Suction System SUCTIONING CHECKLIST e Select an in line suction system compatible with the LifePort adapter e Select an in line suction system with a catheter that is straight for the first few inches e Suction according to procedure 1 or 2 described earlier in this section e Call the Bunnell Hotline for more information or assistance The third technique may be used in conjunction with techniques 1 and 2 The key to success using this procedure is to choose a compatible in line suction system The two most important factors in choosing an in line system are e how the system connects to the LifePort adapter An in line suction system that uses a special adapter which replaces the conventional ET tube adapter cannot be used with the Life Pulse The Life Pulse requires the LifePort adapter in order to operat
79. pressure always 0 0 in Standby mode 14 PIP PEEP MAP AP i e Vz SERVO PRESSURE SERVO PRESSURE Improved compliance and or resistance Air leak Disconnected tube SERVO PRESSURE Worsening compliance and or resistance ET tube obstruction Tension pneumothorax Patient needs suctioning Right mainstem intubation MONITOR DISPLAYS e PIP the average of maximum airway pressures measured during a set time period e PEEP the average minimum airway pressure e MAP is an average of pressures measured from the total pressure waveform It includes pressures produced by high frequency ventilation conventional ventilation or spontaneous breathing e AP Delta P simply the arithmetic difference between PIP and PEEP AP is roughly proportional to Tidal Volume and its importance in clinical decision making will become more apparent in the discussion of patient management e SERVO PRESSURE the internal drive pressure of the Life Pulse indicates how much gas flow must be produced to meet the NOW PIP Rate and On Time requested by the operator Servo Pressure is regulated by the ventilator s microprocessor and is outside the control of the operator Bigger patients or those with more compliant lungs will require higher Servo Pressures whereas those infants with smaller and or less compliant lungs will require lower Servo Pressures Servo Pressure is an indication of how much gas flow the Life
80. rol mechanisms function and what the various alarms mean 3 Know The Life Pulse e What conditions can cause an alarm e How does the Life Pulse respond to an alarm e What should the clinical response be Review this manual and study the Operator s Manual which among other information contains a comprehensive troubleshooting section Interpreting alarm conditions is made easier when you know for example the HIGH PIP alarm means that the Life Pulse has sensed PIPs 10 cm H20 greater than the set PIP for every breath during the last 30 seconds or a sustained PIP 5 cm H20 greater for 1 second 61 COMMON THINGS HAPPEN COMMONLY 4 Common Things Happen Commonly Fourth common things are the most likely cause of the majority of alarms COMMON THINGS HAPPEN COMMONLY e Perhaps ninety five percent of alarms occur due to kinked disconnected or obstructed tubes Knowing this information will help greatly in troubleshooting The solutions to these problems are equally as common e Unkink the tubes reconnect the tubes or clear the obstruction Again if the Servo Pressure has locked at or near its last operating level the tubing problem can be corrected without manual ventilation or changing conventional ventilator settings 62 USE AVAILABLE RESOURCES 5 Use Available Resources Examples of Available Resources e In service Manual e Operator s Manual e Service Manual e Clinical Updates e
81. s blood gases allow weaning slowly 1 2 cm H20 of PIP unless hyperventilation is occurring in which case PIP should be weaned faster As the PIP is lowered into the teens begin to allow the conventional ventilator breaths to interrupt the high frequency pulses As the high frequency PIP continues to be decreased increase the conventional rate as needed to achieve good blood gases Place the Life Pulse into the Standby mode 45 Wean SLOWLY Find Optimal MAP Lower HFV PIP Adjust PEEP if necessary Lower FiO WEANING cont Wean slowly The fundamental rule in weaning is to WEAN SLOWLY to wean as slowly as the patient allows The Life Pulse is a very gentle form of ventilation much more so than conventional ventilation Therefore weaning a patient back to conventional ventilation too soon is ill advised Find Optimal MAP During patient management the MAP should be kept as low as the patient s pathophysiology allows without compromising oxygenation As the patient s condition improves blood gases will indicate that pressures can be weaned Lower Life Pulse PIP As weaning begins in earnest reduce PIP in increments of only 1 to 2 cm H20 unless PCO is below 35 torr Small changes in tidal volume have very dramatic results during high frequency ventilation whether you are increasing or decreasing support Lower the conventional PIP just enough to avoid interruptions of the high frequency pu
82. se only e Conventional only f Both g Conventional Unless the conventional ventilator has a low flow external output a separate oxygen blender provides mixed gas to the Life Pulse 8 True The LifePort adapter replaces the standard ET tube adapter and obviates the need to reintubate the patient 89 10 True True True True False True False True True Appendix B POST TEST ANSWERS Section 2 SET UP However the uninterruptible power source is more desirable The Life Pulse does not have an internal blender Pressures under 30 psi 206 85 kPa will cause a LOW GAS PRESS alarm The alarm volume knob is located on the rear panel of the Life Pulse All of the above Only sterile water should be used to properly humidify the gas and assure normal function of the cartridge Once the cartridge is placed in the cartridge door and the door is closed the tubes must be attached to the Life Pulse The pinch tube is the only circuit section flexible enough to function in the pinch valve 90 Appendix B POST TEST ANSWERS Section 3 VENTILATOR CONTROLS AND TEST PROCEDURE 1 False When the Life Pulse is powered up it always awakens in the Standby mode with the alarm sounding 2 True Pressing STANDBY is the accepted method of stopping high frequency ventilation while still allowing the Life Pulse monitoring to be active 3 c In the Standby mode the Life Pulse beeps six
83. strated in the flow chart on the next page Itis always important to optimize PEEP regardless of what pathophysiology is being treated 35 FINDING OPTIMAL PEEP Finding Optimal PEEP during HFV Switch to HFV from CV at same MAP by adjusting PEEP Reduce IMV Rate to 5 bpm Note current SaO on pulse oximeter m Switch CV to CPAP mode Does SaO drop EN Wait 1 5 min Si PEEP is high enough for the moment Use IMV 0 3 bpm with PEEP is too low IMV PIP 20 50 HFV PIP Switch back to IMV Increase PEEP by 1 2 I Wait for SaO to return Keep PEEP at this level to acceptable value until FiO lt 0 30 It may take 30 min hours later Does FiO needs to be increased Don t be shocked if optimal PEEP 8 12 cm H O when switching from CV to HFV Warnings Lowering PEEP may improve SaOs in some cases Optimal PEEP may be lower in patients with active air leaks or hemodynamic problems Using IMV with high PEEP is hazardous Do not assume high PEEP causes over expansion 3 bunnell 1 800 800 4358 www bunl com INSPIRED INFANT CARE 36 p 1 Increase HFV PIP VENTILATION Manipulating the patient s arterial PCO 2 is one of the easier tasks when using the Life Pulse Studies have shown that ventilation CO elimination during high frequency vent
84. the Purge tube 6 Open the cartridge door The Life Pulse continues to ventilate even with the cartridge door open because pressure remains in the cartridge and circuit and the actual pulsing is done in the Patient Box which is still connected Alarms can be silenced as necessary FRONT PANEL DUTIES 1 The person attending the Patient Box can disconnect the purge tube from the Purge barbed connector and attach the purge tube from the new circuit 2 When both operators are ready press the STANDBY button to stop the Life Pulse 22 CHANGING THE CIRCUIT cont Once the Life Pulse has been placed in the Standby mode manually ventilate the patient or adjust the conventional ventilator settings to provide the patient with adequate ventilatory support while the Life Pulse is not running With two people one at the ventilator and one at the Patient Box the circuit change can be performed more quickly PATIENT BOX DUTIES e Disconnect Life Pulse circuit at ET tube connections e Remove pinch tube from pinch valve e Insert new pinch tube into pinch valve e Connect new Life Pulse circuit at ET tube connections and e Press ENTER button to resume ventilation POST CIRCUIT CHANGE After ENTER button is pressed e Close and latch cartridge door e Reconnect purge tube at Life Pulse front panel e Reconnect purge tube at Patient Box e Make sure Humidifier is not in WAIT mode e Recheck all connections
85. tient to the conventional ventilator by connecting the conventional circuit to the 15 mm opening of the 2 LifePort Once the patient has been stabilized on the conventional ventilator make the LifePort adapter connections to the Patient Box and Life Pulse circuit while the Life Pulse is in the Standby mode Connect the pressure monitoring tube of the LifePort adapter to the Patient Box and connect the Life Pulse circuit to the Jet port on the side of the LifePort Attach Life Pulse Circuit adapter 26 p MEASURING amp DISPLAYING PRESSURES 279 80 sec 10 sec display 15 80 sec display Once the pressure monitoring tube of the LifePort adapter has been connected to the Patient Box the Life Pulse in its Standby mode will begin to monitor the pressures being delivered by the conventional ventilator or other high frequency ventilator and update them in the MONITOR section every 10 seconds It will take about a minute and a half for the MONITOR to display an accurate PIP PEEP and MAP being delivered by the conventional ventilator or HFOV In the Standby mode the Life Pulse monitors and displays the airway pressures as if measured at the distal tip of the ET tube These pressures may or may not be different from the pressures displayed on the conventional ventilator Remember that the conventional ventilator displays pressures measured proximally while the Life Pu
86. ue Match the alarms in the first column with the descriptions in the second column 1 LOW GAS PRESSURE CANNOT MEET PIP LOSS OF PIP HIGH PIP a Unable to meet READY condition within 3 minutes of pressing ENTER button Monitored PIP and PEEP come to within 2 cm H20 of each other Gas supply drops below 30 psi 206 85 kPa If occurs in Non READY condition Servo value drops to or near zero May occur on a patient who is too large to be ventilated by Life Pulse Leak in oxygen or compressed air hose Monitored PIP exceeds NEW setting by at least 5 cm H20 continuously for 1 second Servo Pressure is exhausted safely through dump valve to atmosphere 86 Appendix A POST TEST QUESTIONS Section 11 INTERPRETING VENTILATOR ALARMS 1 Many alarms can be prevented by learning how the Life Pulse is designed understanding its operation and performing careful and thorough ventilator checks However when an alarm occurs the first thing to do is look at the 2 Some alarm conditions may require manual ventilation or increased conventional ventilator support while adjustments are made to the Life Pulse TU FU 3 There is no substitute for a skilled and alert or 4 Careful observation is one aspect of using common sense when troubleshooting An example of this skill 1s watching for appropriate chest rise looking for proper condensation in the circuit listening to the sounds of the
87. uency pulses to continue uninter rupted by lowering the conventional PIP 3 If desired lower the conventional PIP by slowly turning down the PIP knob to just below the threshold of interruptions it may need to be lowered even more when treating infants with pulmonary airleaks 4 Lower the rate of the conventional ventilator to 0 5 breaths per minute once the conventional PIP 1s set properly A conventional ventilator rate of zero CPAP to 4 breaths per minute may be used in cases of pulmonary air leak If oxygenation 1s still a concern after optimizing PEEP provide ample opportunity for the recruitment of collapsed alveoli by adjusting CV PIP I TIME or by providing up to 10 conventional breaths per minute Lower the CV support e g lower the rate to 1 3 bpm once collapsed alveoli are recruited and stabilize them with adequate PEEP If both problems are of equal concern after PEEP has been optimized start with the lowest number of CV breaths possible and modest CV PIP and I TIME settings 30 E bunnell 5 Readjust PEEP 6 Press RESET 6 STEPS TO START HFV cont Once high frequency ventilation is initiated the displayed PEEP may be slightly different than what is desired Although PEEP is controlled by the conventional ventilator high frequency ventilation may cause it to rise or fall 5 Adjust the conventional ventilator PEEP knob and or flow rate to bring it to the level desired Remember that
88. ve subsystems of the Life Pulse are and Pressures measured in the patient are displayed in the section To make ventilator changes in high frequency Rate PIP and On Time use the buttons and displays in the section 4 The Patient Box is where blended gas is broken up into small pulses which then provide the patient with breaths necessary for ventilation TO FQ 5 The Life Pulse is routinely used without attaching a conventional ventilator TO FQ 6 The Life Pulse is designed to improve the patient s blood gases while using less pressure TO FQ d Each ventilator performs distinct functions when using a conventional ventilator in tandem with the Life Pulse Check which ventilator primarily performs the following functions Check both ventilators if they provide an equally important function Life Pulse Conventional a Provides gas for patient s spontaneous breathing EN EE b Monitors Mean Airway Pressure MAP EE mE c Controls Positive End Expiratory Pressure PEEP mE TM d Controls high frequency Rate and PIP E e Provides supplementary IMV E o f Humidifies blended gas delivered to the patient EE g Blends oxygen and compressed air 8 major advantage of the LifePort adapter is that reintubation is not required in order to provide high frequency ventilation TO FQ 75 123 Appendix A POST TEST QUESTIONS Section 2 SET UP REAR PANEL 1 The Life Pulse s power cord may be
89. y rate is much less effective than increasing delta P AP for reducing PCOs Changes in CV Rate PIP and to a lesser degree I Time may also effect HFV minute ventilation Raising CV Rate or PIP seldom improves ventilation but it may be helpful in extreme cases if HFV is not interrupted e The main choices for raising PCOzare of course doing the opposite of the above suggestions for lowering PCO Decreasing HFV PIP 1s the most effective way to increase PCOz However the concomitant drop in mean airway pressure may cause POsto fall Thus it 1s very important to raise PEEP in such cases to maintain adequate mean airway pressure Reducing HFV Rate will also increase PCO unless inadvertent PEEP is present If monitored PEEP falls when HFV Rate is dropped PEEP may need to be increased to maintain adequate oxygenation Do not hesitate to use the minimum Life Pulse HFV Rate of 240 bpm when indicated for hyperinflation The Life Pulse can provide adequate ventilation over its entire range of HFV Rates 240 660 bpm 38 So UNDERSTANDING SERVO PRESSURE Understanding Servo Pressure what it is why it changes how it changes can indicate when a patients condition is improving or worsening The diagram and text below may be helpful in understanding Servo Pressure and how it can help manage patients e Servo Pressure driving pressure that automatically regulates flow e Servo Pressure changes as lung volume or m

Life Pulse High Frequency Ventilator In

Contents

Download Pdf Manuals

Related Search

Related Contents