Aisys CS² Clinical Reference Guide Sw Rev 11 Nov 2018

Notice The materials contained in this document are intended for educational purposes only. This document does not establish specifications, operating procedures or maintenance methods for any of the products referenced. Always refer to the official written materials (labeling) provided with the product for specifications, operating procedures and maintenance requirements. 2

Contents 01 Overview... 4 Front View... 4 Rear View... 6 Advanced Breathing System (ABS) Components... 8 Breathing System Options ... 10 Display Controls ... 11 System Power ... 12 Vaporization...13 O2 Flush Button... 15 Alternate O2 Control ... 16 02 Operation... 17 System Display Overview... 17 Digit Fields...18 Waveform Fields...18 Split Screen Field ... 19 Display Touch Points... 20 Navigating the Display ... 22 Starting a Case ... 24 Gas Settings... 27 Turning On and Adjusting Agent Level Using Quick Keys... 27 Ventilator Settings...28 ecoFLOW... 30 Alarm Management... 34 Trends... 37 Checkout ... 38

3

01 Overview

Front View 1. Anesthesia Display: The anesthesia display is used throughout the anesthesia delivery process and allows the clinician to interact with the system. The display also provides real-time patient data. 2. Aladin2 Cassette and Active Bay: The Aladin2 cassette is an electronic vaporizer that controls agent mixing and delivery. 3. Alternate O2 Control: The Alternate O2 control activates automatically in the case of certain failures or errors and delivers O2 through an independent path to the vaporizers and patient circuit. It can also be activated manually. 4. Mains Indicator: The mains indicator is lit when AC power is connected. 5. System Switch: Used to turn the system on and off. When the system is turned on, the display will show the power-up screen and the system does a series of automated self-tests. 6. O2 Flush Button: Push the O2 flush button to deliver a high flow of O2 to the breathing system. 7. Aladin2 Cassette Storage Bay: Storage bay for Aladin cassettes that are not in use. 8. Brake: Push down the brake pedal to lock the system in place. Lift up on the brake pedal to release the brake. 9. Integrated Suction: The optional integrated suction adjusts the vacuum used to suction fluids from the patient during a case. The switch can be set to max for full vacuum, Off for no vacuum, or On for adjustable vacuum. 10. Auxiliary O2 Control: The optional auxiliary O2 flowmeter is most often used to deliver oxygen through a nasal cannula or mask.

4

~

1

Anesthesia Display

Stop Start-up Continue

Check Entropy Sensor

NMT

Entropy

!

E-NMT

E-ENTROPY

cassette 2 Aladin2 and active bay

Auxiliary O2 Flow Control 10 Integrated Suction

9

O2 3 Alternate Control

4 Mains Indicator 5 System Switch 6 O2 Flush Button cassette 7 Aladin2 storage bay

Brake

8 Brake 5

Rear View 1. Collection Bottle: The collection bottle prevents fluids from entering the optional suction regulator. 2. Vacuum Connection: Connect the vacuum connection to the source vacuum supply. 3. AGSS (Anesthesia Gas Scavenging System): The scavenging system is designed to safely remove excess gas from the anesthesia machine. 4. Mains Inlet: AC power is connected to the system through the mains inlet. 5. System Circuit Breaker: This is the main circuit breaker. It should not be mistaken for an on/off switch. Accidentally pressing this switch will cause the system to be powered by its reserve battery instead of electricity from the wall outlet. 6. Isolated Electrical Outlet: A place to plug in low power accessories that are used in conjunction with the anesthesia machine. Note! The electrical outlets are for low power only! Do not use these outlets for equipment such as blanket warmers and operating room beds. 7. Outlet Circuit Breaker: An automatically operated electrical switch designed to protect the system from damage caused by overload. Unlike a fuse, which operates once and then must be replaced, a circuit breaker can be reset to resume normal operation. 8. Cylinder Yokes: Gas cylinders are mounted on the cylinder yoke. 9. Pipeline Connections: Hoses are connected between the pipeline inlets and the gas outlets in the hospital. 10. Cylinder Wrench: The cylinder wrench is used to open and close the gas cylinders.

6

Cylinder wrench 10

1 Collection bottle 2 Vacuum connection

Pipeline connections

Cylinder yokes

8

Outlet circuit breakers

7

9

3 AGSS (Anesthesia

Gas Scavenging System)

Isolated electrical outlet

6

System circuit breaker

5

Mains inlet

4

7

Advanced Breathing System (ABS) Components 1.

Airway Module (optional): The airway module measures and monitors gases delivered to the patient. Depending on the configuration, this component may include sensors for measuring carbon dioxide, nitrous oxide, anesthetic agents and oxygen.

2.

Adjustable Pressure Limiting (APL) Valve: During manual ventilation, the APL Valve allows you to change the pressure limit from minimum to 70 cmH2O.

3.

Bellows Assembly: During mechanical ventilation, the gases that are to be delivered to the patient are contained within the bellows assembly.

4.

Bag/Vent Switch: The Bag/Vent switch selects between manual ventilation (bag) and mechanical ventilation (vent). When the switch is changed from bag to vent mode, the ventilator is automatically switched on.

5.

Expiratory Check Valve: The expiratory check valve opens during expiration and closes at the start of inspiration.

6.

Inspiratory Check Valve: The inspiratory check valve opens during inspiration and closes at the start of expiration.

7.

Inspiratory Flow Sensor: The inspiratory flow sensor determines the volume of gas flowing to the patient.

8.

Expiratory Flow Sensor: The expiratory flow sensor determines the volume of gas flowing from the patient.

9.

Absorber Canister: This component removes carbon dioxide from the patient’s exhaled breath. These scrubbed gases can then be sent back to the patient.

10. Absorber Canister Release: Push the absorber canister release to remove the canister from the holder. 11. Leak Test Plug: Occlude the breathing circuit using the leak test plug as part of the preoperative tests. 12. Breathing System Release: Push the absorber canister release to remove the breathing system. 13. Manual Bag Port: The bag hose and rebreathing bag attach to the manual bag port. 14. AGSS Indicator (only on some AGSS versions): With an active Anesthesia Gas Scavenging System (AGSS) that includes a flow indicator, the ball on the indicator should rise to the green zone.

8

1 Airway Module Stop Start-up Continue

Check Entropy Sensor

NMT

Entropy

!

E-NMT

Adjustable Pressure Limiting (APL) Valve)

E-ENTROPY

2

4 Bag/ Vent

Switch

Bellows Assembly

3

AGSS Indicator

14

Manual Bag Port

13

Breathing System Release

12

5 Expiratory Check Valve 6 Inspiratory Check Valve

7 Inspiratory Flow Sensor 8 Expiratory Flow Sensor 9 Absorber Canister 11 Leak Test Plug

Canister 10 Absorber Release

9

Breathing System Options 1. Bag Support Arm: Use the optional bag support arm to hold the breathing circuit bag. 2. EZchange Canister Mode (CO2 bypass): Use the optional EZchange canister mode for continued ventilation of the patient while changing the absorber canister.

1

3. EZchange Canister Release: Push the EZchange canister release to unlock the canister cradle. 4. Condenser: Use the optional condenser to remove water in the system that is produced from the reaction of CO2 gas with the absorbent. 5. Condenser Drain Button: Place a container under the reservoir and push the drain button to empty any water in the condenser.

10

2 3

4 5

Display Controls The touchscreen has numerous touch point areas that make accessing menus and settings quick and easy. The buttons on the right side of the screen provide direct access to commonly used functions. The ventilation quick keys enable setup of ventilation modes. The gas control quick keys provide a method to set up the gas used for a case. Touch only one touch point at a time to ensure the correct selection is made. 1. ComWheel: Selects a menu item or confirms a setting. Turn clockwise or counterclockwise to scroll through menu items or change settings. 2. Home Key: Removes all menus from the screen. 3. Screen Lock/Unlock Key: Locks the touchscreen. Toggles between lock and unlock functions. 4. Start/End Case Key: Initiates Start or End Case function. 5. Touchscreen: Activates functions when touch areas on the screen are selected. 6. Audio Pause Key: Stops audio for 120 seconds for any active, eligible high and medium priority alarms. Prevents audio (audio off) for 90 seconds when no medium or high priority alarms are active. Allows the operator to acknowledge any non-active medium or high priority latched alarms.

6

5

4

3

2

1

11

System Power Turning On the System 1. Plug the power cord into an electrical outlet and make sure the system circuit breaker is on. The mains indicator is lit when AC power is connected and the battery is charging (if it is not already fully charged). 2. Check that the breathing system is properly connected. 3. Turn the System Switch to On. The display will show the power up screen and the system does a series of automated self-tests.

System Mains Switch Indicator

4. Perform a Full Test before the first case of the day (this is covered in full detail later in the course). 5. Perform a preoperative checkout before each case. See the Preoperative checkout section of the user's manual for more information.

Battery Information If AC power is lost, the battery has the capacity to operate for 90 minutes under typical operating conditions and 30 minutes under extreme conditions. The color and fill amount of the battery in use symbol indicates the amount of battery power remaining.

Green indicates greater

than 10 minutes.

Yellow indicates between 10 and 5 minutes.

Red indicates less

than 5 minutes.

12

Note! Electrical outlets (if provided) will not function while the system is on battery power.

Vaporization Overview The working principle behind the Aladin2 cassette is based on the free vaporizing of the liquid agent inside the cassette. Agent concentration is adjusted by electronically controlling gas flow through the cassette in order to achieve the set concentration. Output of agent concentration remains constant with changes in fresh gas flow, and the vaporizer is not out of commission if cassettes are tilted. Aladin2 cassettes are agent specific and color coded. Each cassette is magnetically coded for its specific agent allowing the unit to automatically identify the cassette being used. Scheduled maintenance or calibration is not needed for Aladin2 cassettes, as they contain an electronic self-diagnosis.

Inlet Valve

Outlet Valve

Note! Desflurane is heated by the internal electronics of the system and is available immediately without a warm-up period.

Temperature Sensor

Wicking Material

Identification Magnet Positions

Locking Mechanism

Fill System

Liquid Level Indicator Handle

13

Aladin2 Features Below are the external features of the Aladin2 vaporizer. Note! The Aladin2 is the newer version of the vaporizer cassette. Older units may have the original Aladin cassette. The Aladin2 cassette has a handle lock, a larger liquid level indicator and electronic agent level sensing.

Locking Mechanism

Electronic Bus

Handle Agent Filling Port with Cap

Large Label

Lock

ISO

Liquid Level Indicator

Outlet Valve

Inlet Valve

Temperature Sensor

14

O2 Flush Button The O2 Flush Button delivers a high flow of 100% O2 to the breathing system, bypassing the vaporizers.

Stop Start-up Continue

Check Entropy Sensor

NMT

Entropy

!

E-NMT

E-ENTROPY

15

Alternate O2 Control When Alternate O2 control is enabled, flow from the electronic mixer is stopped and the agent concentration is set to off. O2 is flowing through the Alternate O2 control to the breathing system. To activate anesthetic agent flow to the breathing system, set the agent to the desired concentration. Use the Alternate O2 control to deliver O2 through an independent pneumatic path to the vaporizer and patient circuit. Alternate O2 is connected to the system O2 supply. Alternate O2 control activates automatically in the case of certain failures or errors. It can also be activated manually. The Alternate O2 control is available approximately 20 seconds after the system is turned on. The Alternate O2 flow is adjustable from approximately 0.5 l/min to 10 l/min as indicated on the flow tube. 1. Alternate O2 ON/OFF button 2. Flow control

1

3. Flow tube

2 3

Using Alternate O2 control 1. Push the Alternate O2 ON/OFF button. The O2 flow is indicated on the flow tube. 2. Use the flow control to adjust the O2 flow. 3. Set the agent to the desired concentration. 4. To end Alternate O2 control, push the Alternate O2 ON/OFF button.

16

02 Operation System Display Overview 2

1 13

Apnea > 120 s

MVexp low

60 Paw cmH20

Please Do Checkout

Paw cmH2O Ppeak

20

I/min

25

VCV

0

80 100

-20

Flow 60

5.0

0

10

-60

1

CO2 40

0.5

0 Gas Supplies psi 02

0.95

Fresh Gas: O2 + Air O2 Total Flow

50 %

Alarm Setup

PEEP

System Setup

2.0 10.0

Next Page

7

35

N2O

Resp Air

0

0

0

57

54

89

2.6

Off Off

RR /min Compl ml/cmH2O

VCV

Gas Setup

%

l/min

11

10

Gases % O2

20

Ventilator On: Volume Control Mode TV

Sev

2.60

500

20 60

Et

O2

1.6

40 Pmean

TVexp ml

CO2 mmHg

5

Air

Audio Pause

2

Flow l/min

10

500 ml

21 Off Et

42

Fi

47 RR

MAC 40 y

I:E

10

1:2

/min

Trends

7

Spirometry Procedures

Fi

0

Agent % Sev

6

11:07

MV

15

12

Unable to drive bellows

Paw 40

40 20 0

4 5

3

Stop 00:27:32

Off 8.0 Et

8

Fi

1.4 2.6 0.7

PEEP

Off

End Case

More Settings

cmH2O

9

1. Alarm Message Fields: Displays the active alarms.

8. Digit Fields: Contains information for Spirometry, Resp, Agent, and Gases.

2. Waveform Fields: Displays the waveforms of measured values. For example: Paw, Flow, and CO2.

9. Ventilator Quick Keys: Displays mode, associated ventilation parameters, and more settings. For example: Mode, TV, RR, I:E, PEEP, and More Settings.

3. General Message Fields or Lock Touchscreen Indicator: Displays general messages and the touchscreen lock indicator. 4. Network Icon: Indicates if the Network is receiving patient data from a Sapphire client. 5. Clock: Displays the current time. 6. Measured Values Fields: Displays the measured values. For example: Paw, Flow, and CO2. 7. Function Keys: Functions available are Audio Pause, Alarm Setup, System Setup, Next Page, Trends, Spirometry, Procedures, Timer, Start, and End Case.

10. Ventilation Mode: Displays the selected ventilation mode. For example: Ventilator On, and Volume Control. 11. Gas Quick Keys: Displays O2, Total Flow, and Gas Setup. 12. Split Screen Field: Contains airway pressure, gas flow values, compliance, trends, and optional ecoFLOW information. 13. Audio Pause Symbol and Countdown Clock: Indicates when alarm audio is paused and the countdown clock until audio is on. 17

MV

5.0

I/min 15

$ 12.10/h

0

ml/h

-60

Digit Fields 9

3 be set to show specific information such as gas types, gas supply, flow, agent, respiration, and The digit fields can 200 spirometry loops. If the digit field is set to show agent and no airway module is inserted, the area is blank. CO2 40 2 TVexp or CO2 must show on the display during a case. If any of these parameters are not Paw, O2, and either selected to show on the display, the 20 right most digit field information is replaced with the missing parameter. 1 Apnea > 120 s

MVexp low

60

20

Paw cmH20

O2 Total

Flow 60

I/min

15

1.3

0

10

-60 CO2 40

0.5

0 Gas Supplies psi

Air

02

1.6

0.95

Fresh Gas: O2 + Air O2 Total Flow

50

Air

0

0

57

54

89

10

Gases %

21 Off

Et

%

Flow l/min

2.0 10.0

7

System Setup

PEEP

2

Sev

CO2 mmHg

20 60

35 Et

Trends

Spirometry

Procedures Fi

0

Agent %

MAC 40 y

RR

ml

Resp

O2

N2O

Air

0

0

0

57

54

89

Next Page

37

TVexp ml

500

0 Gas Supplies psi

Stop 00:27:32

Off 8.0 Et

I:E

PEEP

/min

Off Off

10

RR /min Compl ml/cmH2O

Gases % O2

21 Off Et

42

20

Fi

47

Fi

1.4 2.6

20 Fresh Gas: O20.7+ Air VCV 500 O2 10 1:2 OffTotal Flow

Compl ml/cmH2O

Gas Setup

Alarm Setup

Sev

Fi

47

42

O2

Ventilator On: Volume Control Mode TV

2.6

l/min

Off Off

RR /min

Sev

2.60

%

N2O

0

40 Pmean

5.0

0.79

Resp

O2

Paw cmH2O Ppeak

MV

Fi25 O2 Total

5 1

Audio Pause

25

VCV

0

80 100

-20

11:07

Please Do Checkout

Paw 40

40 20 0

Fi25

Unable to drive bellows

Ventilator On: Volume Control Mode TV

End Case

More Settings

cmH2O

50 2.60 % l/min Waveform Fields

Gas Setup

VCV

500 ml

RR

I:E

10

1:2

/min

CO2 mmH

35 Et

Agent % Sev

1

MAC 40 y

0

Tpause

Off %

Up to three waveforms can be shown on the normal screen view. Each waveform can be set to show specific Paw, agent, flow, or CO2 data. The corresponding numeric information shows in the measured values field to the right of the waveform. If the waveform is set to show the agent and no airway module is inserted, that waveform and numeric area is blank. When one waveform is turned off, that waveform and the corresponding numerics information are removed from the normal screen view. The remaining waveforms and numerics increase in size to fill the waveform area. When two waveforms are turned off, those waveforms and the corresponding numerics information are removed from the normal screen view. The remaining waveform is centered in the waveform area. When in a case, touch the waveform field area to close the menu. 40 Paw 40 Apnea > 120 s

MVexp low

60 Paw cmH20

0

20

Unable to drive bellows

Paw cmH2O Ppeak

20

I/min

0

Flow 60

-60

-20

5

CO2 40

1

0 Gas Supplies psi

0.5

O2 02

0.95

Fresh Gas: O2 + Air O2 Total Flow %

PEEP

System Setup

2.0 10.0

5.0

0

10

50

Alarm Setup

MV

15

Air

Audio Pause

40 Pmean

cmH20 Flow l/min

2.60 l/min

N2O

Resp Air

0

0

0

57

54

89

%

Gas Setup

VCV

15500 ml

21 Off

Et

Ventilator On: Volume Control Mode TV

Sev

2.6

Gases %

O2

Compl ml/cmH2O

500

35

20 60

Et

Total Flow 10I/min 42 47 20 Off Off

RR /min

TVexp ml

CO2 mmHg

Fi

RR

10 /min

MAC 40 y

Next Page

20 80

Fi

Spirometry

100

Agent

0

Stop

00:27:32

Flow 60

Flow l/min

Off 8.0 Et

Fi

1.4 2.6 0.7

I:E

1:2

9 3

MV

0

ml/h

-60

Off

5.0

End Case

$ 12.10/h

PEEP

More Settings

cmH2O

CO2 mmHg

200

35 Et

CO2 40

2 20 1

Fi25

O2 Total

18

25

VCV

0

Trends

Procedures

Agent % Sev

60

11:07

25 72 Paw

VCV

0

80 100

-20

1.6

Please Do Checkout

Paw 40

40 20

Paw cmH2O Ppeak

1.3

Fi25 O2 Total

Sev

37

0 Gas Supplies psi

Resp

O2

N2O

Air

0

0

0

57

54

89

RR /min Compl ml/cmH2O

Off Off

10 20

Gases % O2

21 Off Et

42

Fi

47

Agent % Sev MAC

Et

1.4

0.

Split Screen Field The split screen field can be set to show gas delivery, trends, spirometry loops, Paw gauge, airway compliance, and optional ecoFLOW information. If None is selected, the split screen area will be blank. Touch the spilt screen field to directly open the Screen Setup menu.

Apnea > 120 s

MVexp low

60

20 Paw cmH20

0

Unable to drive bellows

Please Do Checkout

Paw 40

40

20

I/min

25

VCV

0

80 100

-20

Paw cmH2O Ppeak

Flow 60

Flow l/min

0

5.0

10

-60

2.0 10.0

Next Page

O2 02

0.95

Fresh Gas: O2 + Air O2 Total Flow

2.60 l/min

TVexp ml

500

35

0 Gas Supplies psi

0.5

%

PEEP

System Setup

20 60

Et

CO2 40

1

50

Alarm Setup

7 2

CO2 mmHg

5

Air

Audio Pause

40 Pmean

MV

15

1.6

11:07

N2O

Resp Air

0

0

0

57

54

89

Compl ml/cmH2O

%

10

Gases % O2

20

Ventilator On: Volume Control Mode TV

Sev

2.6

Off Off

RR /min

Gas Setup

VCV

500 ml

21 Off Et

42

Fi

47 RR

10 /min

0

Agent % Sev MAC 40 y

I:E

1:2

0.7

PEEP

Off

80

00:27:32

Fi

1.4 2.6

Paw cmH20

0

Stop

Off 8.0 Et

60

20

Trends Spirometry Procedures

Fi

40

End Case

100

-20

I/min

More Settings

cmH2O

15 10 5 1

0.5

Air

1.6

02

0.95

19

Display Touch Points CAUTION! Do not apply excessive force to the touchscreen as damage may occur. The blue outlined areas indicates the touch points of the display.

2

1

1. Split screen values

4

3

2. Wave fields 3. Measured values 4. Function keys 5. Digit fields

Apnea > 120 s

80 100

60 Paw cmH20

0

Unable to drive bellows

Please Do Checkout

Paw 40

40 20

60

6. Ventilator quick keys 7. Gas quick keys

MVexp low

I/min

25

VCV

0

80 100

-20

Paw cmH2O Ppeak

20

Flow 60

5.0

-60

O2 02

0.95

Fresh Gas: O2 + Air O2 Total Flow

N2O

Resp Air

0

0

0

57

54

89

2.6

2.60

%

l/min

Off Off

10

RR /min Compl ml/cmH2O

Gases % O2

20

Ventilator On: Volume Control Mode TV

Sev

7

20

2.0 10.0

Next Page

500

35

0 Gas Supplies psi

0.5

%

System Setup

20 60

Et

CO2 40

1

50

PEEP

TVexp ml

CO2 mmHg

5

1.6

Alarm Setup

7 2

Flow l/min

0

10

Air

Audio Pause

40 Pmean

MV

15

02

11:07

Gas Setup

VCV

5

500 ml

21 Off Et

42

Fi

47 RR

MAC 40 y

I:E

10

1:2

/min

6

Spirometry Procedures

Fi

0

Agent % Sev

Trends

Stop 00:27:32

Off 8.0 Et

Fi

1.4 2.6 0.7

PEEP

Off

cmH2O

End Case

More Settings