Blease
Blease Anesthesia Devices and Accessories
Model 2200 Anaesthesia Ventilator User Manual Issue 1 Aug 1998
User Manual
47 Pages
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Page 1
2200 Anaesthesia Ventilator
User Manual
2200 Ventilator
Blease 2200 Ventilator User and Maintenance Manual MODIFICATIONS LABEL
ECN 3559
1
ECN 3707
2
ECN
3
ECN
4
ECN
5
ECN
6
ECN
7
ECN
8
ECN
9
ECN
10
0120
Part Number: 127UM000 Issue 1 /August 1998
User Manual
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2200 Ventilator
Read this Manual before operating the ventilator.
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2200 Ventilator
Contents
Table of Contents Product Improvement ................................ ................................ ........................... 5 Responsibilities of the Manufacturer ................................ ................................ ... 5 Responsibilities of the User ................................ ................................ ................... 5 Note to Service P ersonnel ................................ ................................ .................... 5 Service Policy ................................ ................................ ................................ ........... 6 Copyright ................................ ................................ ................................ ................. 7 Warnings ................................ ................................ ................................ ................ 11 Symbols & Abbreviations ................................ ................................ .................... 13 1. Introduction ................................ ................................ ................... 15 1.1 Purpose ................................ ................................ ................................ .15 1.2 Description ................................ ................................ ............................ 15 1.2.1 Front Panel Description ................................ ........................ 18 1.3 Major Features ................................ ................................ ..................... 20 1.4 Data Summary ................................ ................................ ..................... 20 1.5 Associated Equipment & Accessories ................................ ............... 22 2. Installation ................................ ................................ ..................... 23 2.1 Ventilator Set -up Procedure ................................ .............................. 23 2.2 Unpacking ................................ ................................ ............................. 23 2.3 Preparation for Use ................................ ................................ ............. 24 2.4 Changing bellows Units ................................ ................................ ...... 25 2.4.1 Installing the Paedi atric Bellows ................................ .......... 25 2.4.2 Installing the Adult Bellows ................................ .................. 25 2.4.3 Adult Bellows Assembly Description ................................ ..26 3. Operation ................................ ................................ ....................... 29 3.1 Pneumatic System ................................ ................................ ................ 29 3.1.1 Pneumatic Circuit Description ................................ ............. 30 3.2 Ventilati on Cycle Description Using Bellows ................................ ... 32 3.3 Control Unit ................................ ................................ .......................... 33 3.4 Using the 2200 Ventilator in a Circle Breathing Sy stem ............... 34 3.5 In Use ................................ ................................ ................................ ..... 35 3.6 Safety ................................ ................................ ................................ ..... 36 3.6.1 Pneumatic Safety ................................ ................................ ... 36 4. Preventative Inspection & Mai ntenance ................................ ..... 37 4.1 Pre -Use Function Test ................................ ................................ ......... 37 4.2 Clinical Operation ................................ ................................ ................ 38 4.3 Incidental & User Maintenance ................................ ......................... 38 4.3.1 Service Schedule ................................ ................................ ..... 38 4.3.2 Cleaning of the Ventilator Control Unit ............................. 39
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2200 Ventilator
Contents
4.3.3 Cleaning and Sterilisation of the Bellows Unit ................. 39 4.4 Cleaning and Sterilisation ................................ ................................ .. 40 4.4.1 Ventilator Surfaces ................................ ................................ . 40 4.4.2 Pop -off Valve Seat ................................ ................................ . 42 5. Troubleshooting ................................ ................................ ..... 45
List of Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9
4
B lease 2200 Anaesthesia Ventilator ................................ ............ 16 Rear View and Underside View ................................ .................... 19 Adult & Paediatric Bellows ................................ ........................... 27 Pneumatic Diagram ................................ ................................ ....... 29 Ventilation Cycle using the Bellows ................................ ............ 31 Circle Breathing System ................................ ................................ 34 Use with a Bain Circuit ................................ ................................ .. 34 Expiratory Valve ................................ ................................ .............. 41 Removing Pop -off Valve Seat ................................ ....................... 43
User Manual
2200 Ventilator
Notices
Product Improvement Blease Medical Equipment Limited has a policy of continued product improvement and therefore reserves the right to make changes which may affect the information contained in the manual without giving prior notice.
Responsibilities of the Manufacturer The manufacturer accepts responsibility for the effects on safety, reliability and performance of the equipment only if assembly operations, extensions, adjustments, modifications and repairs are carried out by persons with written authorisation from the manufacturer, and the equipment is used in accordance with the instructions for use and the electrical installation of the relevant room complies with the ‘Regulations for the Electrical Equipment of Buildings’.
Responsibilities of the User The Blease 2200 anaesthesia ventilator conforms with the specifications and operating procedures described in this manual and on any accompanying notices and labels only if it has been installed, used and maintained in accordance with the instructions. The safe function of the ventilator can only be guaranteed if it is regularly checked and serviced at or in excess of the standards specified in this manual. If the ventilator is suspected of being worn, defective or otherwise unfit for use, it should under no circumstances be used. Broken, worn, missing or contaminated components must be replaced immediately; contact the Blease distributor from whom the ventilator was obtained for further service advice.
Note to Service Personnel The contents of this manual are not binding. If any significant difference is found between the product and this manual please contact Blease Medical Equipment Limited for further information at the following address.
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2200 Ventilator
Notices
Service Policy Blease Medical Equipment Limited recommends that the equipment should be checked at regular intervals by Qualified Service Personnel. There are no serviceable parts within the unit. In the case of a failed unit it is to be returned to Blease for exchange or repair and re-calibration. In communication with Blease Medical Equipment Limited, quote the model and serial number of the equipment, with the approximate date of purchase. If the unit is being returned for repair, indicate the nature of the fault or the work you require to be carried out. Contact: Blease Medical Equipment Limited Beech House • Chiltern Court • Asheridge Road • Chesham • Buckinghamshire HP5 2PX • England Tel: +44 (01) 494 784422 Fax: +44 (01) 494 791497
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User Manual
2200 Ventilator
Notices
Copyright © 1998 Blease Medical Equipment Limited. All rights reserved. The information contained in this publication may not be used for any purpose other than that for which it was originally supplied. This publication may not be reproduced in part or in whole without the written consent of Blease Medical Equipment Limited.
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2200 Ventilator
Notices
IMPORTANT Read this manual before operating the machine. The user must be familiar with the machine and its various functions before using it on a patient.
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2200 Ventilator
Notices
The following statements are made to comply with the requirements of IEC 601-1. 1. This equipment must only be connected to gas pipeline supply lines that are fitted with pressure relief valves that limit the supply pressure to less than 101.5 psi (7 bar). 2. This equipment must not be used with flammable anaesthetic agents. Only anaesthetic agents which comply with the requirements on nonflammable anaesthetic agents in the IEC standard, Particular requirements for the safety of anaesthetic machines, are suitable for use with this equipment. 3. As this machine is not suitable for use with flammable anaesthetic agents such as ether and cyclopropane the use of antistatic breathing tubes and face masks is not necessary. The use of antistatic or electrically conductive breathing tubes when utilizing high frequency electric surgery equipment may cause burns and is therefore not recommended in any application of this machine. 4. Performance of this equipment may be affected at temperatures below 10oC (50oF) and above 40oC (104oF).
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2200 Ventilator
Notices
The Blease 2200 anaesthesia ventilator is intended for use by a qualified practitioner under the direction of a qualified anaesthesiologist. Personnel operating the ventilator must become thoroughly familiar with the instruction manual prior to using the 2200 anaesthesia ventilator with patients. Statements in this manual preceded by the following symbols are of special significance: WARNING: Means there is a possibility of personal injury to yourself or others, or of damage to the instrument or other property. Indicates points of particular interest for more efficient and convenient operation. The following WARNINGS must be read and understood before using the Blease 2200 anaesthesia ventilator. WARNINGS:
10
•
Throughout this manual warnings and cautions relating to various aspects of use of this ventilator are given.
•
It is the responsibility of the user to read this manual and fully understand the functions of this ventilator prior to use.
•
When the ventilator is connected to a patient, it is recommended that a qualified practitioner be in attendance at all times to react to an alarm or other indication of a problem.
•
It is recommended that the patient oxygen concentration be monitored continuously at or near the PROXIMAL AIRWAY with an oxygen monitor that incorporates high/ low alarms.
•
Patient circuit disconnection is a hazard to the patient. Take extreme care to prevent such an occurrence.
User Manual
2200 Ventilator
Warnings
WARNINGS:
•
This ventilator is designed to be driven by oxygen. Using any other gas will cause inaccurate operation.
•
FIRE HAZARD - Never use oil or grease on any anaesthesia or oxygen equipment. In general, oils and greases oxidise readily and will burn v iolently in the presence of oxygen.
•
Before using the ventilator, check that all connections are correct and that there are no leaks.
•
The driving gas is discharged through the port on the back of the ventilator. This opening must be completely free of any obstruc tion and should have nothing connected to it. The discharged driving gas is oxygen and does not contaminate the environment
•
Applying negative or positive pressure to the exhaust port of the bellows assembly marked EXHAUST results in positive pressure in t he patient breathing system. The scavenging system must therefore not generate more than 5cm H 2O positive or negative pressure when connected to the ventilator. The use of an AGSS to BS6834 1987 is recommended.
•
Any problem arising from an improperly func tioning scavenging system is solely the user’s responsibility.
•
The bellows can support only approximately 10cm H differential positive pressure, above which it may be dislodged from the mounting ring, resulting in a dangerous malfunction of the ventilator.
•
Connecting a PEEP valve or any other restrictive device to the EXHAUST port of the bellows assembly could generate increased pressure in the bellows and cause the malfunction described above. Do not connect a PEEP valve to the EXHAUST port of the bellows base. This will increase the pressure inside the bellow s and cause it to detach from the base, causing a serious malfunction.
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O
11
Warnings
2200 Ventilator
WARNINGS:
12
•
OPENING OF THE UNIT BY UNAUTHORISED PERSONNEL AUTOMATICALLY VOIDS ALL WARRANTIES AND SPECIFICATIONS. THE PREVENTION OF TAMPERING IS SOLELY THE USER’S RESPONSIBILITY; THE MANUFACTURER ASSUMES NO LIABILITY FOR ANY MANLFUNCTION OF FAILURE OF THE VENTILATOR IF THE CONTROL UNIT IS OPENED.
•
The actual ventilation of the patient may be different from the ventilator parameters due to compliance and leaks, and therefore must be monitored independently of the ventilator. It is the user’s responsibility to monitor patient ventilation.
User Manual
2200 Ventilator
Symbols & Abbreviations
Symbols and Abbreviations Used on Blease Equipment and in this Manual bpm BPM
Breaths per minute
cmH 2O
Gauge pressure expressed in centimetres of water
CPA P
Continuous positive airway pressure
PEEP
Positive end expiratory pressure
I:E Ratio
A ratio of inspiratory to expiratory time IEC symbol to consult the instructions for use
IEC symbol denoting type of equipment (B)
WA RNING: There is danger of personal injury to the user or patient Further relevant or helpful information
Shows that by turning the control in the direction of the thickening line, an increase in that parameter is produced
Power off
Power on
Dangerous voltage
l/ m
lpm
Litres per minute
ml
Millilitres
O2
Oxygen
psi
Pounds per square inch
psig
Pounds per square inch gauge
l
Litres IEC symbol for alternating current Confers approval under the European Medical Device Directive
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1. Introduction
1 Introduction This manual contains installation and operating instructions for the Blease 2200 and the Blease 2200 MRI anaesthesia ventilators. It also includes sections describing operation, cleaning and sterilization methods, service instructions and troubleshooting procedures.
1.1 Purpose The Blease 2200 anaesthesia ventilator is a pneumatically controlled oxygen driven anaesthesia ventilator designed for mechanical ventilation during anaesthesia. It can be used in closed circuit anaesthesia to drive a bellows assembly and to drive a Bain circuit directly.
1.2 Description The Blease 2200 anaesthesia ventilator is a time cycled flow generator type ventilator that is oxygen driven and can be provided with an ascending bellows unit which is easily detachable for cleaning. The Blease 2200 anaesthesia ventilator, when fitted with a bellows unit, is designed for use with a circle-type absorber and is ideally suited to both low-flow and high-flow applications. The ventilator may also be used with or without the bellows to drive any s emi closed circuit such as a Bain-type coaxial circuit or a Jackson-Rees/ Ayres T-piece type paediatric circuit with no modification being necessary.
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1. Introduction
2200 Ventilator
C
PRESSURERELIEF
40
20
OFF
60
cmHO
ON
A
80
2
30
40
50
20
60
10
cmH2O
70
0
80
-10
B
90
-20
+
A
On/Off switch
B
Manometer
C
Adjustable pressure relief knob
D
Inspiratory time control knob
E
Expiratory time control knob
F
Flow control knob
100
0.25
-
Key to Figure 1
D 2.0 1.5 1.0
INSPIRATORY (SECONDS)
0.5
0.7 5
E 5.0 4.0
3.0
EXPIRATORY (SECONDS)
0.
2.0 1.5
1.0
75
2.0
F
0.3
1.0
0.4
0.
0.6
8
Figure 1 16
FLOWRATE (l/SEC)
Blease 2200
Blease 2200 Anaesthesia Ventilator User Manual
2200 Ventilator
1.2.1
1. Introduction
Front Panel Description Refer to Figure 1 Blease 2200 Anaesthesia Ventilator. 1.
On/Off switch - rotates 90 degrees clockwise to turn the ventilator on (A).
2.
Manometer - calibrated between -20 to +100 cm of water, the gauge must be connected to the inspiratory limb of the breathing circuit via the connector on the underside (B).
3.
Adjustable pressure relief valve which is calibrated at 0.5 litres per second flow. Note - the pressure relief valve will relieve at a slightly lower or higher level depending on the flow rate selected on the flow control knob (C).
WARNING: The pressure relief valve is not intend for use as a pressure limiter but a s a pressure relief valve (safety valve).
4.
Inspiratory time control knob - calibrated between 0.25 and 2.0 seconds (D). Rotation of the knurled knob clockwise increases the inspiratory time.
5.
Expiratory time control knob - calibrated between 0.5 and 5.0 seconds (E). Rotation of the knob in a clockwise direction increases the expiratory time.
Breathes per minute is determined in the following way: BPM = 60 _______________________ Inspiratory time + Expiratory time
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1. Introduction
2200 Ventilator
The I:E ratio is determined in the following way: Inspiratory time I:E Ratio = ____________________________ Expiratory time 6.
Flow control knob - calibrated between 0.2 and 1.0 litres per second (F). Rotation of the grooved knob in an anti clockwise direction increases the flow rate. The tidal volume delivered to the patient is determined in the following way: Tidal volume = inspiratory time (litres) (seconds)
x
flow rate (litres per second)
For further information on the bellows unit assembly see paragraphs 2.4 to 2.4.3.
1.2.2
Underside Description 1.
High pressure oxygen inlet connector - a 1.5 metre long high pressure hose is supplied for connection to the DISS oxygen inlet connector.
2.
Driving gas connector - a patient valve with a 22 mm male taper and a 15 mm female taper which connects to the patient circuit with a flexible corrugated tube (see Figure 2 Rear View and Underside View).
3.
Pressure relief valve exhaust port - this exhaust port allows the drive gas to exhaust to atmosphere when the set pressure at the adjustable pressure relief valve has been reached. WARNING: Do not attempt to block the exhaust port.
4.
18
Manometer connection - this connects to the tube and the 22 mm taper male/female sensing tee which must be placed in the inspiratory limb of the patient breathing circuit.
User Manual
1. Introduction
2200 Ventilator
D PRESSURE RELIEF VALVE EXHAUST DO NOT BLOCK
Blease BEECH HOUSE CHILTERN COURT ASHERIDGE ROAD CHESHAM BUCKS. HP5 2PX ENGLAND TEL. (01494) 784422 TELEX 83119 BLEASE G FAX. (01494) 791497
REAR VIEW Key to Figure 2
ANAESTHESIA VENTILATOR
A High pressure oxygen inlet connector
SERIAL NUMBER
B Scavenging Port C Drive gas outlet D Pressure relief valve exhaust port E
Manometer connection
A
E
B
C
A
E
VIEW OF UNDERSIDE
Figure 2
User Manual
Rear View and Underside View
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1. Introduction
2200 Ventilator
1.3 Major Features The Blease 2200 anaesthesia ventilator consists of two basic modules: the control unit and the bellows assembly. •
Two sizes of bellows housing are available: adult and paediatric. Both housings fit on the bellows base.
•
Direct drive of Bain and other circuits without use of bellows.
•
De-mountable, autoclavable expiratory valve.
1.4 Data Summary
20
Control/Parameter
Range/Value
Input supply gas
40 to 101.5 psig at 120 lpm
Adult bellows size
1600 ml
Paediatric bellows size
350 ml
Flow rate
0.2 to 1.0/sec ± 10%
Inspiratory time
0.2 to 2.0 sec ± 0.05 or ± 10% whichever is the greater
Expiratory time
0.5 to 5.0 sec
Pressure limit control:
adult and paediatric ventilation during anaesthesia.
Gas supply
oxygen
Gas supply hose
1.5 metres of white antistatic hose fitted with a DISS fitting.
User Manual
1. Introduction
2200 Ventilator
Control/Parameter
Range/Value
Hose end
Oxygen probe to BS 5682 mini schräder.
Patient airway pressure gauge
63 mm diameter aneroid pressure gauge with -20 to +100 cm of water.
Ventilator to bellows connection
22 mm male taper/15 mm female.
Bellows to patient taper
22 mm male taper to BS 3049
Bellows exhaust gas taper
30 mm male taper.
Inspiratory time range
0.25 to 2.0 seconds.
Expiratory time range
0.5 to 5.0 seconds.
Frequency range
9 to 80 breaths per minute (derived from inspiratory and expiratory times).
Inspiratory gas flow rate
0.2 to 1.0 litre per second of oxygen.
Tidal volume range
0.05 to 2.0 litres per breath (derived from inspiratory time and inspiratory flow rate).
The maximum tidal volume which can be achieved is 1.6 litres due to the capacity of the bellows. Minute volume range
derived from tidal volume and frequency.
Inspiratory relief pressure
variable between 20 and 80 cm H2O.
I:E ratio
variable between 4:1.0 and 1:20.0
Weight
6.0 Kg
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1. Introduction
2200 Ventilator
Control/Parameter
Range/Value
Dimensions: Height of complete ventilator Height of control unit Width Depth Expiratory valve Alarms
400 mm. 290 mm (excluding expiratory valve). 100 mm. 220 mm. 110 mm. none.
1.5 Associated Equipment and Accessories Part No:
Description
127UM000
User and Maintenance Manual
81031
Paediatric bellows assembly complete
81030
Adult bellows assembly complete
81032
Bellow base assembly
81034
Adult bellows only
81035
Adult bellows cover only
81036
Paediatric bellows only
81037
Paediatric bellows cover only
81038
Paediatric bellows base adapter
ST2101
Corrugated tubing 42-in (22 mm)
SI1509
Clear tube—patient pressure (any length per metre)
10500003
Patient pressure adapter (T-piece)
81010
High Pressure Pipeline
SI0637
Filter - patient pressure internal or external line
SI0638
Luer female to male adapter
SI0639
Luer male to male adapter
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2
2. Installation
Installation 2.1 Ventilator Set -Up Procedure 1.
Mounting the ventilator - the ventilator can be mounted on the anaesthetic machine with a choice of mounting brackets.
2.
High pressure hose assembly - attach the hose to the ventilator, care must be taken to attain a leak free seal without over tightening the fitting. Attach the other end of the hose assembly to the high pressure oxygen supply.
3.
Ventilator to bellows drive hose - attach the corrugated hose to both the ventilator drive gas taper and the bellows drive gas taper.
4.
Manometer tube - attach the tube to the manometer connection on the underside, place the pressure sensing tee piece in the inspiratory limb of the patient breathing circuit.
5.
Patient breathing system drive hose - connect the 22 mm male taper to the breathing system taper.
6.
Scavenging system - connect the exhaust port to a scavenging system.
WARNING: The anaesthetic gas scavenging system must not generate more than 0.5 cm H 2O of neg ative or positive pressure. WARNING: Failure to comply with this requirement will result in positive or negative pressure withi n the breathing circuit.
2.2 Unpacking There is no transit packing used within the Blease 2200 anaesthesia ventilator. However, check that all pneumatic inlets and outlets are completely free from any packing. In particular, check breathing tubes and ports are totally free of any particles and are unobstructed.
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2. Installation
2.3
2200 Ventilator
Preparation for Use Locate the ventilator in a safe place, preferably permanently mounted on the anaesthesia machine to prevent accidental damage due to falling, or accidental hose disconnection. WARNING: The screws must not penetrate more than 7 mm into the ventilator or damage may be caused to internal components. To prepare the ventilator for use, proceed as follows: 1.
Connect the 40 to 101.5 psi driving gas input port on the control unit to a wall or cylinder outlet.
2.
Connect the 22 mm corrugated hose provided between the control unit bellows driving gas port and the bellows base driving gas port.
3.
Connect the bellows base exhaust port to a scavenging system using a 30 mm hose in conjunction with any required adapters. The pop-off valve under the bellows is connected internally to the exhaust port, where excess breathing gas is discharged.
4.
Connect the pressure sensor port, on the underside, to the breathing system. The recommended position is in the inspiratory limb of the breathing circuit, as close as possible to the patient.
5.
Ensure that the correct bellows type for the intended mode of use is installed. Before using the ventilator, check that all connections are correct, and verify there are no leaks (See 4.1 Pre-Use Function Test). Maximum tidal volume for the paediatric bellows is 300 ml. The adult bellows m ust be used to attain tidal volumes of greater than 300 ml up to a maximum of 1600 ml. WARNING: Applying negative or positive pressure to the exhaust port results in positive pressure in the patient breathing system. The scavenging system must not generate more than 5 cm H2O positive or negative pressure when connected to the ventilator.
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2200 Ventilator
2. Installation
WARNING: Connecting a PEEP valve or any other restrictive device to the exhaust port of the bellows assembly could generate inc reased pressure in the bellows and could cause the bellows to become detached. WARNING: Any problem arising from an improperly functioning scavenging system is solely the user’s responsibility.
2.4 Changing Bellows Units Refer to Figure 3 Adult and Paediatric Bellows. If the ventilator is used for paediatric patients at 300 ml tidal volume or less, the optional paediatric bellows should be used.
2.4.1
2.4.2
Installing the Paediatric Bellows 1.
R emove the bellows housing by twisting it slightly counter-clockwise until the bayonet tabs are free, then lift it from the base.
2.
Remove the bellows by pulling gently off the base.
3.
Press the paediatric bellows adapter into place.
4.
Mount the paediatric bellows over the adapter.
5.
Push the paediatric bellows housing down over the bellows, then twist it slightly clockwise to engage the bayonet tabs.
Installing the Adult Bellows 1.
Remove the bellows housing by twisting it slightly counter-clockwise until the bayonet tabs are free, then lift it from the base.
2.
Remove the paediatric bellows by pulling gently off the adapter.
3.
Remove the paediatric adapter.
4.
Mount the adult bellows.
5.
Push the adult bellows housing down over the bellows, then twist it slightly clockwise to engage the bayonet tabs.
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2. Installation
2200 Ventilator
WARNING: If there is any malfunction, do not use the ventilator. Refer to Trouble shooting for help. If the problem cannot be located, call an authorised service engineer or return the ventilator to the supplier.
2.4.3
Adult Bellows Assembly Description 1.
Bellows base assembly - the bellows base assembly is attached to the top of the ventilator case and incorporates an O-ring for the bellows housing to seal against and an O-ring to seal between the bellows base and the exhaust gas diaphragm assembly.
2.
Bellows unit assembly - the bellows canister is marked with a scale which allows the tidal volume to the patient to be determined with bellows movement.
3.
An exhaust valve seat which allows the escape of excess exhaust gas to the bellows exhaust port on the rear of the assembly at the end of the expiratory phase is situated in the centre of the assembly. WARNING: Care must be taken n ot to damage the exhaust valve seat.
26
4.
Bellows base screws - thumb screws which hold the bellows base to the top of the ventilator case (4 off).
5.
Exhaust diaphragm assembly - this assembly contains a diaphragm and a sealing disc which seals on the exhaust valve seat in the bellows base during the expiratory phase.
6.
Exhaust diaphragm assembly screws - thumb screws which hold the diaphragm assembly onto the bellows base assembly (3 off).
7.
Adult bellows - the bellows are attached to the bellows base assembly by the lower convolution on the shoulder of the bellows base assembly.
8.
Adult bellows housing - the adult bellows housing is located on the bellows base assembly by the location ring on the bellows base assembly it is then locked in position by twisting clockwise until the lugs are located in the bellows base assembly.
User Manual
2. Installation
2200 Ventilator PRESSURE RELIEF
40
60
20
80
cmH2O
OFF
40
30
ON
50
20
60
10
cmH2O
70
0
80
-10
90
-20
+
0.25
-
100
2.0 1.5 1.0
INSPIRATORY (SECONDS)
5
0.5
0.7
0.5 5. 0 4.0
3.0
EXPIRATORY (SECONDS)
2 .0
5 0.7
0.2
1.5
1.0
0.3
1.0
F
0.4
0.8
0. 6
H E G
D
A J
Blease 2200
A
Bellows base assembly
B
Bellows base screws
C
Exhaust diaphragm assembly
D
Exhaust diaphragm assembly screws
E
Adult bellows
F
Adult bellows housing
G
Paediatric bellows
H
Paediatric bellows housing
J
Mounting bracket
C B
FLOW RATE (l/SEC)
0.5
Figure 3 Adult and Paediatric Bellows User Manual
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3
3. Operation
Operation
3.1 Pneumatic System F D
Exhaust
R Inspiratory Timer
Logic Gate
O2 Supply Regulator 40-101.5 psi
Spool Valve
On/Off Switch
Flow Control Valve
J
35 psi
E
Expiratory Timer
A P
Exhaust
G
Adjustable Pressure Relief Valve
H Patient Circuit Manometer Patient Circuit
Patient Valve
Exhaust to Scavenging System
Figure 4 Pneumatic Diagram Key to Figure 4 A
Drive gas input port 40 to 101.5 psi
D
Input pressure regulator (set to 34.5 psi)
E
Flow control valves
F
Timer (inspiratory)
G
Timer (expiratory)
H
Patient valve
J
Logic gate
P
Pressure gauge
R
On/Off switch
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3. Operation
3.1.1
2200 Ventilator
Pneumatic Circuit Description The pneumatic circuit consists of two pneumatic timers which control a spool valve supplying high pressure oxygen to the flow control valve. The oxygen inlet pressure is regulated down by a regulator which incorporates a sintered metal filter. As the ventilator enters the inspiratory phase the flow activates a diaphragm valve and blocks the exhaust port. At the expiratory phase the diaphragm deflates through a logic valve allowing the drive gas or expired gas to exhaust to the scavenging port. The patient valve which is attached to the underside incorporates the exhaust diaphragm. An adjustable pressure relief valve, which relieves if the circuit pressure reaches the preset level during the inspiratory phase, is upstream of the patient valve. The relief valve consists of a spring loaded plunger which seals on a seat with a silicone seal. The relief pressure is adjusted by changing the spring loading via the knob on the front panel.
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3. Operation
Ventilation Cycle Driving gas flow
Stops at set TV C
C
End of inspiration
Start of inspiration Driving gas flow
C
Start of expiration
C
End of expiration
Figure 5 Ventilation Cycle Using the Bellows
Key to Figure 5 A
Drive gas port
B
Pop-off valve
C
Breathing system port
D
Exhaust (to scavenging system)
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3. Operation
2200 Ventilator
3.2 Ventilation Cycle Description Using Bellows The following is a brief description of the functioning of the bellows assembly (See Figure 5 Ventilation Cycle Using the Bellows). 1.
The bellows prior to the start of the inspiratory phase is fully inflated and retain this position due to the weight of the exhaust diaphragm valve giving a slight back pressure within the bellows with the fresh gas flow entering the breathing circuit.
2.
At the start of the inspiratory phase drive gas from the ventilator enters the inside of the bellows housing and forces the bellows down driving the patient gas within the bellows into the breathing circuit.
3.
During the inspiratory phase the ventilator patient valve exhaust diaphragm inflates blocking the exhaust port and the bellows exhaust diaphragm is held shut by the pressure of the drive gas flow from the ventilator. At the start of the expiratory phase the flow of drive gas from the ventilator ceases and the ventilator patient valve exhaust diaphragm deflates allowing the drive gas within the bellows housing to exhaust through the ventilator patient valve exhaust port as the bellows rise as the exhaled gas enters the bellows. Excess exhaled gas exhausts through the bellows exhaust port into the scavenging system. Start of inspiration: Controlled drive gas enters the bellows assembly via the driving gas input port A. This causes the pop-off valve B to close due to the differential pressure created across the valve by the drive gas flow. As pressure rises in the canister, the bellows are driven down and anaesthesia gases are driven out of the breathing system port C to the breathing circuit. End of inspiration: Controlled driving gas ceases to be applied to the bellows assembly once the desired volume of gas has been delivered, and the pressure exerted on the pop-off valve B equalizes with the patient pressure.
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3. Operation
Start of expiration: The pneumatic module is now in expiratory mode. The pop-off valve B remains closed as the pressure required to open it must be positive on the patient side by approximately 2 cm H2O. The bellows is forced up by the returning anaesthesia gases and the gas exhausts through the patient valve. End of expiration: As the bellows reaches the top of the inside of the canister the internal pressure in the bellows rises by approximately 2 cm H2O and the pop-off valve is forced open. Excess anaesthesia gases are expelled through the exhaust port D and into the external scavenging system. WARNING: Avoid control combin ations which may produce very short inspiratory times (<150mS) as inconsistent breath delivery may occur. WARNING: Pressure lim iting is a safety feature. It is not intended to create micro -breaths or emulate other specialised high frequency/low volume ve ntilation systems.
3.3 Control Unit Please refer to Chapter 1 Installation for the location of front panel controls and indicators.
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3. Operation
3.4
2200 Ventilator
Using the 2200 Anaesthesia Ventilator in a Circle Breathing System
Figure 6 Circle Breathing Sys tem Figure 7 Use with a Bain Circuit 34
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3. Operation
3.5 In Use •
Perform the pre-use checks (4.1 Pre-Use Function Test).
•
Prior to patient use, check that all connections are correct and that there are no leaks.
To start ventilating the patient, switch the breathing system from the breathing bag to the ventilator, close the APL valve (if not already isolated) and turn the ventilator on. If PEEP is required, the PEEP valve must be located in the expiratory limb of the breathing system, between the patient connection and the expiratory valve. The only pressurized parts of the breathing system should be the patient and the connecting hoses between the inspiratory and expiratory valves. WARNING: Do not connect a PEEP valve to the exhaust port of the bellows base. This will increase the pressure inside the bellows and could detach it from its base, causing a serious malfunction. The bellows can support no more than 10 cm H2O pressure. Normally the internal and external bellows pressures are about the same. During the expiratory phase the pop-off valve under the bellows is released so that the inside of the bellows is connected to ambient air pressure through the exhaust port. WARNING: Do not allow the bellows internal pressure to rise above 10 cm H2O. This could detach it from its base, causing a serious malfunction. The pop-off valve has approximately a 2 cm H2O opening pressure to keep the bellows from collapsing. The outside of the bellows inside the housing is connected to ambient air pressure through the discharge valve in the control unit. Therefore the only pressure gradient across the bellows is the opening pressure of the pop-off valve. WARNING: Do not use oxygen flush during inspiration.
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3. Operation
2200 Ventilator
3.6 Safety 3.6.1
Pneumatic Safety The maximum gas supply pressure is 7 bar (101.5 psi).
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4. Inspection and Maintenance
4 Preventative Inspection and Maintenance 4.1 Pre-Use Function Test 1.
Ensure that the ventilator is correctly connected - refer to the ventilator set up procedure.
2.
Set the adjustable pressure relief valve to the required setting.
3.
Set the desired inspiratory time.
4.
Set the desired expiratory time.
5.
Set the desired flow rate.
6.
Attach a 2 litre breathing bag to the patient connection as a test lung.
7.
Fill the bellows by using the anaesthetic machine oxygen flush.
8.
Turn the ventilator on and ensure that the ventilator delivers the correct tidal volume - this can be checked by the scale on the bellows housing.
9.
Remove the breathing bag occlude the end of the patient connector.
10. Refill the bellows with the oxygen flush. 11. Turn the ventilator back on and check that the patient circuit relieves at the set level. WARNING: The pressure relief valve is not intended for use as a pressure limiter but as a pressure relief valve. WARNING: The pressure at which the circuit relieves is effected by the flow rate set at the ventilator.
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4. Inspection and Maintenance
2200 Ventilator
4.2 Clinical Operation 1.
Prior to use with a patient check that all connections are correct and that there are no leaks.
2.
Perform the pre-use function test (see 4.1 Pre-Use Function Test).
3.
Set the desired ventilator parameters.
WARNING: The actual ventilation of the patient may vary from the set ventilator parameters due to compliance and circuit leaks. WARNING: The patient ventilation must be monitored independently from the ventilator. WARNING: It is the respon sibility of the user to monitor patient ventilation. WARNING: The use of this ventilator is not recommended without the use of a breathing circuit disconnection alarm.
4.3 Incidental & User Maintenance 4.3.1
Service schedule The ventilator must be serviced by a factory trained engineer to the following schedule: a. 3 monthly inspection and function check. b. 12 monthly bellows replacement. c. 12 monthly replacement of patient valve exhaust diaphragm. d. 5 yearly major service. Service requirements are available to factory trained personnel. There are no user serviceable parts within the control unit.
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4. Inspection and Maintenance
Further details are available from: The Service Department Blease Medical Equipment Limited Beech House • Chiltern Court • Asheridge Road • Chesham • Buckinghamshire HP5 2PX • England Tel: +44 (0)1494 784422 Fax: +44 (0)1494 791497 Always provide the following information with any communication: a. Type of product and part number. b. Product name. c. Serial number. d. Date of purchase. e. Details of suspected fault.
4.3.2
Cleaning of the ventilator control unit The ventilator control unit must only be cleaned with a damp cloth and if necessary with warm mild detergent to remove persistent grime. WARNING: Do not allow the cleaning liquid to enter the control unit. WARNING: Do not use harsh or abrasive cleaning any parts of the ventilator.
4.3.3
agents on
Cleaning and sterilisation of the bellows unit To disassemble the bellows assembly for cleaning and sterilisation. 1. Twist the bellows housing anticlockwise until the location lugs clear the bellows base, then lift it off by pushing gently at the front. 2. Pull the bellows gently off the bellows base. 3. Unscrew the exhaust diaphragm from the bellows base.
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2200 Ventilator
4. Inspection and Maintenance
WARNING: Do not lose the O -ring which seals between the bellows base and the expiratory diaphragm. WARNING: Do not damage the exhaust seat or the seat on the exhaust diaphragm.
4.4 Cleaning and Sterilization Item
Sterilisation Method
Bellows housing
Gas, liquid or low temperature autoclave
Bellows
Gas, liquid or low temperature autoclave
Exhaust diaphragm assembly
Gas, liquid or low temperature autoclave
Bellows base assembly
Gas, liquid or low temperature autoclave
The complete bellows assembly is suitable for autoclave sterilisation to 134oC. Each time the bellows assemblies are opened for cleaning, all visible parts should be inspected carefully and damaged components replaced. The bellows material deteriorates with age and use, and should be examined and replaced, if necessary, every twelve months.
4.4.1
Ventilator Surfaces Clean the outside surfaces of the ventilator with a damp cloth. If necessary, a warm, mild detergent solution can also be used. Ensure all residues are removed after cleaning. Never use abrasive cleaning agents as the surfaces are not scratchresistant. WARNING: Ensure no water enters the control unit, as serious damage may result.
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4. Inspection and Maintenance
WARNING: Follow the sterilization agent manufacturer’s instructions. WARNING: PATIENT VALVE ONLY WARNING: Gas sterilization s hould be followed by quarantine in a well -ventilated area to allow dissipation of residual absorbed gas. WARNING: The expirator y valve must be disassembled prior to autoclaving to prevent the occurrence of clamping stresses.
Figure 8 Expiratory Valve Key A
Diaphragm
B
Valve top
C
To circuit
D
Scavenging port
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4. Inspection and Maintenance
4.4.2
2200 Ventilator
Pop-Off Valve Seat 1. Remove the bellows housing and bellows (See 2.4 Changing Bellows Units). 2. Loosen the three red thumbscrews to remove the pop-off valve. 3. Clean the valve seat carefully. WARNING: Take care not to damage the precision -moulded surface of the valve seat. Never use a hard object or abrasive detergent. Use only a soft cloth. If the valve seat is damaged, the pop -off valve will leak and may cause serious malfunction. 4.
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After cleaning, check that the O-ring located in the bellows base which seals against the pop-off valve is in place, as the ventilator cannot function correctly without it.
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4. Inspection and Maintenance
Key A B
Bellows cover Bellows
C
Pop-off valve
D
Valve seat
E
Bellows base
F
Mounting bracket
Figure 9 R emoving the Pop -off Valve
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5. Troubleshooting
5 Troubleshooting Fault Condition
Possible Cause
Bellows cannot be fille d, or collapses.
Breathing system hose disconnected or leaking. Broken bellows base. Defective or detached bellows. Damaged pop-off valve. Missing or defective O-rings.
Bellows progressively deflates despite norma l fresh gas flow.
Breathing system leak. Open or defective pop-off valve. Damaged pop-off valve seat. Damaged bellows base O-ring. Damaged bellows base.
Tidal volume not delivered .
Pressure limit set too low. Obstruction in breathing system or bellows drive gas.
Unwanted PEEP and overfull bellow s.
Defective or poorly regulated scavenging system. Partially obstructed exhaust.
When the ventilator is turned on it does not cycle.
The oxygen high pressure hose is not connected. The oxygen supply is not turned on
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