COSMED srl
Hemodynamic and Metabolic Monitors
COSMED Step-by-step Guide for Single Rebreathing Guide Rev 02 Aug 2022
Step-by-step Guide
10 Pages
![Step-by-Step guide for Single Rebreathing 22.08.2022 Revision 02 TEST • • • • • • • • • • • • • • • • • • • • • • Power Innocor on. Open Gas cylinder by turning gas cylinder 1½ times clockwise. Press Measurement on Screen. Select appropriate configuration: Model 100 & 300: Standard RVU Model 400 & 500: Standard RVU (adult, +25kg) Press Prepare. Press Change on Ambient data and enter actual data. Press Calibrate Oxygen and follow calibration guide. Expose gas sample line to air by removing it from breathing assembly. Press OK (to Exit Prepare). Press OK (to select configuration). Press New Pt. and enter patient data Enter height [cm], weight [kg], sex [M,F] and date of birth in actual format. Move cursor to the patient and press Select. Press Demo to get the patient familiar with the rebreathing procedure. Press Test. Press Single RB. (if Single RB is only option, then not displayed). Connect patient to breathing assembly. Check patient is breathing normally Start guiding the patient by “in” & “out” Press Start when patient is ready (best during expiration) Continue guiding the patient by “in” & “out”, but at a higher frequency and check that the subject is emptying the bag at each breath during the rebreathing test. Go to Graph to evaluate data: Check insoluble gas: - flat on the top during first inspiration - regression line nearly horizontal - no down-going spikes Check soluble gas: - regression line through expiration points (blue area) - regression line close to expiration points before blue area E.g. go to Pt. Data and add blood pressure values Go to Results and Details to evaluate results. Go to Report to print data. CONTACT INFORMATION Knud Pedersen COSMED Nordic ApS Lucernemarken 23 DK-5260 Odense Denmark Tel.: +45 65 95 91 00 Dir.: + 45 63 10 06 20 (direct to Knud Pedersen) e-mail: nordic@cosmed.com e-mail: kp@cosmed.com (direct to Knud Pedersen) www.cosmed.com Daily use of Innocor for Single RB v2.docx page 1 of 10](https://public.bioclinicalservices.com.au/library/representations/proxy/eyJfcmFpbHMiOnsiZGF0YSI6MTU5NDgzLCJwdXIiOiJibG9iX2lkIn19--7883972104ac38345d9929c517dabea7046c7ade/eyJfcmFpbHMiOnsiZGF0YSI6eyJyZXNpemUiOiIzMjB4In0sInB1ciI6InZhcmlhdGlvbiJ9fQ==--4214356078d1f110e449cda512a9432562da3e70/Daily%20use%20of%20Innocor%20for%20Single%20RB%20v2.pdf.png)
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
TEST • • • • • • • • • • • • • • • • • • •
• • •
Power Innocor on. Open Gas cylinder by turning gas cylinder 1½ times clockwise. Press Measurement on Screen. Select appropriate configuration: Model 100 & 300: Standard RVU Model 400 & 500: Standard RVU (adult, +25kg) Press Prepare. Press Change on Ambient data and enter actual data. Press Calibrate Oxygen and follow calibration guide. Expose gas sample line to air by removing it from breathing assembly. Press OK (to Exit Prepare). Press OK (to select configuration). Press New Pt. and enter patient data Enter height [cm], weight [kg], sex [M,F] and date of birth in actual format. Move cursor to the patient and press Select. Press Demo to get the patient familiar with the rebreathing procedure. Press Test. Press Single RB. (if Single RB is only option, then not displayed). Connect patient to breathing assembly. Check patient is breathing normally Start guiding the patient by “in” & “out” Press Start when patient is ready (best during expiration) Continue guiding the patient by “in” & “out”, but at a higher frequency and check that the subject is emptying the bag at each breath during the rebreathing test. Go to Graph to evaluate data: Check insoluble gas: - flat on the top during first inspiration - regression line nearly horizontal - no down-going spikes Check soluble gas: - regression line through expiration points (blue area) - regression line close to expiration points before blue area E.g. go to Pt. Data and add blood pressure values Go to Results and Details to evaluate results. Go to Report to print data.
CONTACT INFORMATION Knud Pedersen COSMED Nordic ApS Lucernemarken 23 DK-5260 Odense Denmark Tel.: +45 65 95 91 00 Dir.: + 45 63 10 06 20 (direct to Knud Pedersen) e-mail: [email protected] e-mail: [email protected] (direct to Knud Pedersen) www.cosmed.com
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
TEST:
Press Measurement
Select Standard RVU or Standard RVU (adult, +25kg) Press Prepare
Press Change ambient data and enter actual values. Press Calibrate Oxygen and follow calibration guide. Expose gas sample line to air by removing it from breathing assembly. Daily use of Innocor for Single RB v2.docx page 2 of 10
Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
All the calibrations above shall be performed once a day before performing the rebreathing tests – i.e. setting of ambient data and calibration of Oxygen sensor. Press OK (to Exit Prepare).
Select patient or press New Pt. to enter a new subject.
Press OK to save new patient data. Press Select to select patient.
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
Press Demo. The test is not using bolus gas from the gas cylinder – the only purpose is to let the patient be familiar with the rebreathing procedure. I.e. be able to listen to guidance from the operator and able to empty the bag on every inspiration during the rebreathing test. When trained press Test for doing a real test. Either Single RB or Protocol. Protocol (optional) is a defined sequence of rebreathings link together with an exercise profile. Running a protocol will automatically adjust the bag volume when exercise level is increased.
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
Enter or change patient data. Normal values for haemoglobin (Hb) concentration: Male = 8-11 mmol/l (12.9-17.7 g/dl) Female = 7-10 mmol/l (11.3-16.1 g/dl)
Check the rebreathing bag is free floating in order to mix the gas well during the filling. Press OK to start emptying and filling the bag.
Connect patient to breathing assembly using a new respiratory bacterial/viral filter and a nose clip. Connect SpO2 sensor and check HR and SpO2 is shown at the bottom of the screen after a few seconds. Ask patient to breathe normally. Check message “Inspiration” and “Expiration” at the lower left corner. If not present and model 100 or 300 then insert breathing resistance in breathing port. Start guiding the patient by “in” & “out”.
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
Press Start when patient is ready (best during expiration) and prolong the last “out”, so the patient makes a deeper expiration prior to the rebreathing test. And thereby ease the following emptying of the bag at each inspiration. Continue guiding the patient by “in” & “out”, but at a higher frequency and check that the subject is emptying the bag at each breath during the rebreathing test.
Rebreathing will automatically stop when 3 good expirations are found or timelimit of 25 seconds has passed. Press comments field below graphs to enter comments. Note rebreathing tests must be separated in time of at least 5 minutes (3 minutes during exercise) in order to let the inert gases be washed out of the body.
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
Press Graph to see details.
Press Insoluble Gas to zoom plot.
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
Check curve is flat during first inspiration (i.e. good mixing of the bag). Check regression line is nearly horizontal Check no down-going spikes (i.e. no leaks) Press Normalized Soluble Gas to zoom plot.
Check regression line goes through expiration points (blue area) Check regression line close to expiration points before blue area – not required but a good indication of a good test.
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
Press Pt. Data to add or change patient parameters – e.g blood pressure parameters. Press toggle until “Patient data related to test:…” is shown.
Press Details to see all calculated parameters.
Press Report to print or save results as PDF.
Daily use of Innocor for Single RB v2.docx
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Step-by-Step guide for Single Rebreathing
22.08.2022 Revision 02
Typical warnings / error messages: Message Only 2 breaths are included in the analysis. Too few breaths.
Correction Breathe faster and check bag is emptied at each inspiration. Breathe faster and check bag is emptied at each inspiration.
Slow mixing.
Empty bag at the end of each inspiration.
High insoluble gas concentration.
Check bag is well mixed prior to the test: either have it hanging free floating or shake the bag manual
Low insoluble gas concentration.
Check gas cylinder pressure
High background on soluble gas. Test stopped due to high CO2 level. Test stopped due to low O2 level. Test stopped due to exceeding Max rebreathing time.
Daily use of Innocor for Single RB v2.docx
Increase time between tests. At rest 5 minutes are enough – during exercise 3 minutes is accepted. Increase bag-volume, breathing frequency or max CO2 limit. Increase bolus fraction, bag-volume, breathing frequency or reduce min O2 limit. Breathe faster and check bag is emptied at each inspiration.
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