S5 ADU Users Guide March 2003

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About this Guide This User’s Guide describes the most common features and functions for the use of the Datex-Ohmeda S/5 Anesthesia Delivery Unit (ADU) and AS/3 ADU from S/N: 40 000 000 and onwards. In this guide, both the S/5 ADU and the AS/3 ADU will be referred to as ADU. This Guide is not intended to give a complete and detailed description of all functions to the operator, such description will be found in S/5 Anesthesia Delivery Unit User’s Reference Manual. This Guide is not meant to replace these Reference Manuals. The Guide is meant to be a complement to the Reference Manuals and support the user in his daily work. The Guide has a table of contents, index and also tabs with headings for a quick way of getting the desired information. In this Guide pictures and text refer to an ADU designed according to IEC standards. The following conventions are used: Keys on Command Board are written in a lager and bold typeface: Setup Menu items are written in bold italic typeface, for example Gas Usage Menu access is described from top to bottom. For example the selection of the Screen Layout menu item and the CO2 Setup menu item below would be shown as Screen Layout - CO2 Setup Messages (alarm messages, informative messages) displayed on the screen are written inside single quotes, for example ‘PEEP high’. When referring to different sections in this guide, the sections are written in italic typeface and inside in double quotes, for example “Alarms Setup“ In this manual the word “select” means choosing and confirming.

Related Documentation Clinical aspects and technical background: S/5 Anesthesia Delivery Unit, User’s Reference Manual Service, installation information and technical solutions: S/5 Anesthesia Delivery Unit, Technical Reference Manual Complement to User’s Reference Manual: S/5 Anesthesia Delivery Unit, Cleaning Instruction Poster Monitoring functions in detail: S/5 Anesthesia Monitor User’s Reference manual S/5 Anesthesia Monitor User’s Guide Capnomac Ultima Reference Manual Related clinical information refer to following documents: Patient Spirometry, quick guide Patient Spirometry, appliguide Patient Oxygen, appliguide First step in CO2 Monitoring, appliguide Optimizing low and minimal flow anesthesia, appliguide

Warnings In this guide you will find text labelled “Warning” which is an indication of a situation in which the user or patient may be in danger of injury or death. The label “Caution” indicates a situation in which the unit or the devices connected to it may be damaged.

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Contents System introduction... 3

Assembly and preparations... 31

Rear view of the ADU... 5

Starting and Ending... 36

Compact patient breathing circuit and bellows unit... 6

System Check... 37

Display/keys... 7

Fresh Gas Delivery... 39

Setup... 9

Alarms Setup... 41

Trends... 11

Manual Ventilation... 43

Monitoring... 13

Controlled mechanical ventilation (AUTO)... 44

Safety precautions... 15

VCV, Volume Controlled Ventilation... 46

Cleaning and Care... 17

SIMV, Synchronized Intermittent Mandatory Ventilation . 47

Symbols... 22

PCV, Pressure Controlled Ventilation... 49

Abbreviations... 23

Index... 51

Units... 24 Troubleshooting... 25 Messages... 28

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System introduction The Anesthesia Delivery Unit is designed to mix and dose respiratory gases and to ventilate the patient. The delivery unit is the basis for a flexible anesthesia system with full monitoring and data management capabilities.

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Intro (7) Aladin Anesthesia Vaporizer cassette The anesthesia vaporizer cassette is a liquid container. The casettes are color coded for each anesthetic agent. The cassette are also magnetically coded so that the ADU can identify the inserted agent cassette.

(1) Y-piece with inspiration and expiration hoses (2) Compact Block The compact block is the connection manifold for the patient hoses, fresh gas and the CO2 absorber. (3) Bellows Unit During the inspiratory phase of the breathing cycle, the driving gas pushes the breathing gas in the bellows into the patient circuit. During the expiratory phase, the exhaled gas goes through the bellows on its way to the evacuation system. (4) ADU color display Consists of fields for fresh gas, ventilator settings, CO2 waveforms, alarm messages, battery, clock and timer. Can also display both graphical and numerical trends. Menu keys for quick access to the different menus and quick function keys for adjustment of the most common ventilator settings are found beside the display.

Figure 1

Aladin cassette

(8) ON/Standby switch (9) S/5 Anesthesia Monitor central unit and modules (10) O2 flush The O2 flush is used to flush the system with a high flow of oxygen.

(5) S/5™ Anesthesia Monitor The S/5™ Anesthesia Monitor is used for multiparameter patient monitoring and has optional patient care documentation.

(11) Fresh gas flow controls The O2, Air and N2O flow adjustment controls are for adjusting gas flow. Together with oxygen you can administer either nitrous oxide or air, The choice is made with the N2O/Air selector. The Agent Wheel is for increasing or decreasing the agent concentration.

(6) ComWheel The ComWheel is used to navigate in and between menus and to confirm choices.

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Rear view of the ADU (1) Auxiliary mains outlets (optional) The three main socket outlets are reserved for monitors and other electrical devices mounted on the ADU. 1

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(2) Cylinder yokes (optional) When no wall mounted gas supply is available, gas can be supplied from reserve gas cylinders. The unit can be equipped with up to three reserve gas yokes. (3) Auxiliary gas and vacuum outlets (optional)

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(4) Gas supply and scavenging connectors 5

(5) Scavenging ejector or scavenging flow indicator (optional)

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Intro

Compact patient breathing circuit and bellows unit Ventilator with compact patient circuit 4

Bellows unit

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(1) (2) (3) (4) (5) (6) (7) (8) (9)

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(1) Auto/manual selector (2) Chamber locking handle (3) Bellows block (4) Overflow valve (5) Bellows chamber (6) Bellows (7) Bellows base (8) APL valve (9) Manual bag quick connector (10) Occluder cone (11) Patient breathing circuit connector

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Water trap Compact block Absorber canister Inspiration and expiration hoses with Y-piece Manual ventilation bag with hose Bellows block Fresh gas outlet Circuit boom Ventilation hose 6

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Display/keys

Start/Stop Timer Reset Timer

Start/Stop Timer

Start a timer and pause it

Reset Timer

Reset the timer

Ventilator

Adjust Ventilator settings Quick key to adjust Volume/Pressure settings

Rate

Quick key to adjust Rate

I:E

Quick key to adjust I:E Ratio

PEEP

Quick key to adjust PEEP settings

Silence Alarms

Silence active alarms or pre-silence alarms

Help

The key is not in use

I:E

Reset Case

Reset settings, trends and/or screen (Only on ADU with 12.1” display)

PEEP

Trends

Review trends

Setup

Reset case, adjust screen layout, set time and date or view gas usage

Alarms Setup

Review alarm limits, adjust volume or view alarm history

System Check

To perform full or separate checks

Normal Screen

Close menus, return to basic screen

Volume/ Pressure

Rate

Help

Function

Volume Pressure Ventilator

Silence Alarms

Key

Normal Screen Reset Case

Trends

Setup

Alarms Setup

System Check

ComWheel, navigate in menus and confirm choices

Note: The figure shows a 12.1” display, the ADU is also available with a 10.4” display. The differences, beside the size, are the placement of the short cut menu keys and that the 12.1” display has an additional key, Reset Case.

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Handling the menus

Menu

WARNING: If you do not want to confirm a change of setting, always use the ComWheel to return to the previous setting before exiting the menu.

A menu is a list of functions or commands, displayed on the ADU screen. To display a menu push one of the grey keys next to the screen or push the ComWheel to view the Menu Functions menu. Cursor

Display fields

Symbol for submenu

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Frame with help text

Moving in menus

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The ComWheel is used to navigate in menus and confirm choices. Setup

1. Push a menu key.

2. Turn the ComWheel to move around in the menu and to change values.

(1) (2) (3) (4) (5) (6) (7)

3. Confirm your choice by pushing the ComWheel.

Confirmation of a selected change of setting, can be achieved by either: • Pushing the ComWheel • Pushing the corresponding quick key • Pushing any of the keys grouped around the display screen NOTE: This is also valid if Normal screen is pushed.

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Fresh gas field Ventilator settings field Middle field with trends or gas and volume monitoring information Airway Pressure/CO2 waveform Alarm message field Battery and clock field Timer Field

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Setup Set the screen layout 1. Push Setup key. 2. Select Screen Layout. Select Screen Layout to configure waveforms and digital fields at the far right on the normal screen.

Waveform setup Up to two waveforms can be displayed at the same time. Circuit pressure - Pcirc - is always displayed but the second waveform may either show interfaced CO2, or be turned off.

Pcirc setup 1. Push Setup key. 2. Select Screen Layout. 3. Select Pcirc Setup. 4. Select the desired presentation for Scale, Sweep Speed or Color.

CO2 setup 1. Push Setup key. 2. Select Screen Layout. 3. Select CO2 Setup. 4. Select Field 2. 5. Select CO2 or off. 6. Select the desired presentation for Scale, Sweep Speed or Color.

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Setup

Showing menu graphs 1. Push Setup key.

Adding or removing boxes in the Ventilator setting field 1. Push Setup key.

2. Select Screen layout. 3. Select Show Menu Graphs. 4. Select YES or NO. An advisory menu can always be presented when Volume/Pressure, Resp. Rate, I:E Ratio or PEEP is set.

2. Select Screen Layout. 3. Select Minute Volume, Inspiratory pause or Extra I:E Times. 4. Select YES or NO.

Adjusting flowmeter height 1. Push Setup key. 2. Select Screen Layout. 3. Select Flowmeter Height. 4. Select desired presentation. Short or long flowmeter can be chosen. By selecting AUTO the length of a meter will automatically adjust itself according to the current flow.

Showing total flow 1. Push Setup key.

The most important settings such as TV (MV), Pressure limit (in PCV), RR, I:E, PEEP and ventilation mode are always displayed. Other field boxes may be removed.

2. Select Screen layout. 3. Select Show total flow. 4. Select YES or NO. Total flow data may either be displayed or removed.

Set time and date 1. Push Setup key.

Adjusting settings in the middle field 1. Push Setup key.

2. Select Set Time and Date. 3. Highlight the desired setting and adjust. The time is displayed in the upper right corner of the screen. If an Anesthesia Monitor is interfaced, the clock will be set in the Monitor only. The ADU clock can not be set in this case.

2. Select Screen Layout. 3. Select Middle field. 4. Select desired presentation. The middle field may either be vacant or it may contain trends or digital information interfaced from a patient monitor. 10

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Trends The ADU is able to show both numerical and graphical trends for the latest 24 hours of set values as well as measured fresh gas values. The machine accumulates and displays trend data for user selected periods between 20 minutes and 24 hours. During trend display, the ADU is active and the numeric information is continuously updated and displayed.

Trends view (1) List of selections (2) Parameter field (3) Trend cursor 3 1

Ppeak Pplat PEEP

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Set scales

Changing trend pages 1. Push the Trends key.

1. Push the Trends key. 2. Select trend page, by using Next Trend. 3. Select Set Scales. 4. Select the field you want to change in the Field menu. 5. Select Graph Scale and adjust the settings.

2. Select Next Trend to see the other graphical or numeric trend pages. Next Trend has a scrolling function. When all pages has been displayed the first one is displayed again.

Viewing graphical trend pages 1. Push the Trends key.

Trends

Viewing numeric trends 1. Push the Trends key.

2. Select Graphical. 3. To see more parameters, select Next Trend. 4. Too see more data, select Move Cursor and scroll with the ComWheel. There are a total of six graphical trend pages of which three are arranged according to the factory settings. Each trend page can have up to six parameter fields.

2. Select Numerical. 3. To see more parameters, select Next Trend. 4. Too see more data, select Move Cursor and scroll with the ComWheel. The numeric trend information is updated every five minutes. The last minute information is displayed at the bottom of the page. The last accessed page is saved in the memory. When entering the Trends menu again, it appears as the first page.

Graphical trend length 1. Push the Trends key. 2. Select Graph time. 3. Adjust the trend length.

Resetting trend data 1. Push the Setup key.

Trend

Resolution

20 minutes

10 seconds

2 hours

1 minute

4 hours

2 minutes

12 hours

6 minutes

24 hours

12 minutes

2. Select Reset Case. 3. Select Reset Trends. 4. Select Confirm. Trend data should always be reset before a new patient.

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Monitoring Optimal anesthesia delivery is achieved by adjusting ventilator settings with help of measured patient data. The Anesthesia Delivery Unit is compatible with the Datex-Ohmeda Anesthesia Monitor and the Datex-Ohmeda Capnomac Ultima. Gas and patient spirometry data are measured by the Datex-Ohmeda D-lite, D-lite+ and Pedi-lite sensors. Integration of following Datex-Ohmeda monitors:

Information transferred to the ADU:

Anesthesia Monitor

CO2 wave form with Et/FiCO2, RR (MAN only), exp. minute volume and tidal volume numerics, O2, N2O, CO2 and AA numerics

Capnomac Ultima

as above

Installation is described in the Installation section in the ADU Technical Reference Manual.

Sampling gas The gas monitors draw sampling gas from the patient circuit at an approx. rate of 200 ml/min. This should be taken into account when the gas monitor sampling gas is not returned to the patient circuit.

Selecting sensor Adult and pediatric patients are measured with different sensors. Select, on the monitor in “monitor settings“, the correct type to be used.

D-lite and D-lite+ sensor The D-lite and D-lite+ sensors are intended for patients having tidal volumes from 150 to 2000 ml.

Pedi-lite sensor The Pedi-lite sensor is intended for pediatric patients with tidal volumes from 15 to 300 ml.

WARNING: According to standards EN 740 and IEC 60601-2-13, an anesthesia delivery unit shall always be used with monitors for O2, anesthetic agent and CO2 concentrations, as well as for expired volume. These monitors shall comply with the particular relevant standards.

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Monitoring data Airway pressure measured in the patient breathing circuit Patient gas monitor CO2 waveform and numeric value

Ventilator settings

Patient spirometry data

Monitor

Patient gas monitoring data

Showing patient spirometry data and patient gas monitoring data 1. Push the Setup key.

Showing Patient gas monitor CO2 waveform and numeric value 1. Push the Setup key. 2. Select Screen Layout. 3. Select CO2 Setup. 4. Select Field 2. 5. Select CO2.

2. Select Screen Layout. 3. Select Middle field. 4. Select Gases.

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Safety precautions These precautions refers to the entire system. Warnings and cautions specific to parts of the system may be found in the relevant section.

Warnings

WARNING: Indicates a situation in which the user or the patient may be in danger of injury or death • The ADU is only to be operated by, or on the order of, physician or

licensed medical practitioner. • The constant attention of qualified personnel is required whenever a • •

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patient is under anesthesia and connected to the ADU. Proper use of the product depends upon careful reading and understanding of labeling. Flammable anesthetic gases such as ether and cyclopropane must not be used with this work station. Only agents which comply with the requirements for non-flammable anesthetic agents according to IEC 60601-1 shall be used. The use of antistatic breathing tubes and facemask is not recommended. Burns may occur if antistatic or electricallyconductive breathing tubes are used while high-frequency electric surgery equipment is in use. High pressure or pure oxygen may cause explosion or burn strongly when reacting with organic material such as lubricants, paint, greasy fingerprints, dirt, dust fluff and other organic waste. The connection of equipment to the auxiliary mains socket outlets may increase the patient leakage currents to values exceeding the allowable limits in the event of a defective protectice earth conductor.

• In order to reduce the risk arising from excessive leakage currents,

and in accordance with EN 740, an anesthetic workstation shall not be provided with more than four operator accessible auxiliary mains socket outlets. • Do not connect external equipment to the ADU system other than those specified by Datex-Ohmeda. (Also see the Installation section in the Datex-Ohmeda ADU Technical Reference Manual).

Cautions

CAUTION: Indicates a situation in which the ADU or device connected may be damaged • The function of this machine may be adversely affected by the

operation of equipment such as high frequency surgical apparatus or short-wave therapy equipment in the vicinity. • The function of this anesthetic workstation or module, as applicable, may be adversely affected by electromagnetic interference exceeding the levels specified in IEC 60601-1-2. • In order to prevent over-heating of the ADU while in operation, sufficient space should be left around the machine.

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ADU Safety features The following safety features are incorporated in the ADU.

Safety

Gas supply

• O2, N2O and Air supply failure alarm • Overpressure limitation for wall inlets O2, Air and N2O at 900 kPa/130 psi

Gas mixer

• Electronic O2/N2O ratio control and N2O cut-off • Automatic switching from N2O to Air if N2O pressure is lost

Ventilator

• With loss of primary ventilator driving gas (Air or O2) automatic switch to the secondary driving gas (O2 or Air) • Visible rising bellows allow leakage detection • Adjustable maximum pressure release in AUTO mode (mechanical ventilation), Pmax Release with automatic switch to expiration • Overpressure release valve in fresh gas outlet at 80 cmH2O • Single switch operation of the ventilator • High pressure alarm in the breathing system • Low pressure alarm in the breathing system • Sustained pressure alarm • APL valve in the manual breathing circuit

Other

• Mains power failure alarm • Full battery back up for 20 minutes* • Optional reserve gas cylinders

Aladin cassette • Overfilling protection • The Desflurane cassette is equipped with a special over-pressure relief valve • Automatic cassette identification • Automatic vaporizer shut-off - in case fresh gas flow is lost - in case cassette is removed Patient breathing circuit

• Absorber locking mechanism allows easy canister/absorber replacement during operation • Clearly visible absorber canister and one-way valves

NOTE: In the User’s Reference Manual you can read about safety standards and equipment classification. *) NOTE: The backup battery supplies power only to the ADU, not the patient monitor.

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Cleaning and Care Disinfection methods Concerning the level of frequency of disinfection always follow the hospital routines.

NOTE: If you have a Standard patient circuit on your ADU, see the User’s Reference Manual for cleaning instructions.

Intermediate level disinfection

High level disinfection

• Wash by hand using water and mild detergent and wipe with 70%

• Steam autoclave at maximum 134° C, but note that:

alcohol. or • Wash in a washer-disinfector with a decontaminating program

(min. 10 minutes at 85° C).

Overflow valve membrane, Bellows

May change shape and have to be replaced after repeated autoclaving. The bellows should be hung so that the lower folds can hang freely during the autoclaving cycle.

Bellows chamber

Does not normally have to be autoclaved since it is not in direct contact with patient gases. May create small cracks on the surface after repeated autoclaving.

Compact block

Compact Block II can be autoclaved, but Compact Block I can only be high level disinfected with a liquid chemical glutaraldehyd, 2%.

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Compact block Mechanical cleaning

Manual cleaning

1. Remove all the patient circuit hoses.

2. Push down the latch and lift the absorber off the compact block.

1. Remove all the patient circuit hoses.

2. Push down the latch and lift the absorber off the compact block.

3. Remove the water container on Compact Block II.

4. Hook the cleaning cassette under the pins on the compact block. Push down the latch and push down the cleaning cassette until it locks.

3. Remove the water container on Compact Block II.

5. Flush the compact block with fresh running water for 1 minute. Press down the piston valve while flushing. Flush into all openings.

6. Turn the compact block upside down and connect the hyrtel tube to the water source in dishwasher.

6. Soak and twist the compact block in cleaning agent for at least 3 minutes. Press down the piston valve.

4. Remove the valve covers.

Care

5. Connect the white exp. labeled tube and the hyrtel tube on cleaning cassette.

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7. Flush with water for 1 minute. 8. Manual cleaning is recommended to be followed by autoclaving.

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Before reusing the compact block

Patient breathing circuit tubing, manual bag tubing and connections A

B

2. Lift the green membranes (A) and press the valve housing (B). The valve housing should be in bottom position. 3. Ensure that green membranes are in contact with valve seats.

4. Check visually that the O-rings on the valve covers are undamaged. 5. Push the transparent covers over the valves.

6. Then twist to lock them.

7. Put the water container in place.

How to attach the compact absorber to the compact block, see page 32.

Figure 2

Patient breathing circuit tubing and connectors 1. Disconnect the patient circuit hoses from the inspiratory and expiratory check valve connectors. 2. Disinfect the hoses and connectors according to the methods in “Disinfection methods table”. To prevent damage of hose, hold the hose connector at the ends of the hose.

PicAdu0240

Aladin Cassette

1. Press the lock in the handle and pull outwards to unlock the cassette.

PicAdu0241

1. Check visually that the compact block is clean, dry and undamaged.

2. Use a cloth with mild soap solution to clean the cassette.