Kangaroo Joey Enteral Feed and Flush Pump Operating Manual Rev Aug 2014

Operating Manual

Kangaroo

TM

Joey Enteral Feed and Flush Pump with Pole Clamp, Programmable

en Thank you for purchasing the Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp. With proper care, this device will provide you with years of precision service.

Table of Contents Page

Section I - General Information... 1 Section II - Safety and Warnings... 3 Section III - Icon Identification ... 6 Section IV - Initial Setup

Attaching the A/C Power Adapter ... 7 Battery Setup... 7 Attaching Pole Clamp... 7

Section V - Instructions for Use Quick Start... 8 General Startup Placement/Mounting... 8 A/C Power Operation... 8 Battery Power Operation ... 9 Power On/Off... 9 Language Selection, First Power Up... 9 Keep or Clear Prior Pump Settings... 9 Loading Pump Sets... 10 Prime Pump... 11 Auto Priming... 11 Hold-To-Prime... 11 Re-priming after Bag Empty... 12 Selecting Feed Mode... 12 Selecting EZ Pump Mode... 13

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

Table of Contents Selecting Continuous or Intermittent Feed Mode ... 13 Continuous Mode (Adjust Feed) Continuous Mode Feeding ... 14 Continuous Mode Flushing... 14 Intermittent Mode (Adjust Bolus) Intermittent Mode Feeding... 15 Intermittent Mode Feeding – Bolus Max... 15 Intermittent Mode Flushing... 16 Run... 16 Keep Tube Open - KTO... 17 Lock Screen Feature... 17 Hold... 18 Flush Now... 19 More Options... 19 Buzzer Alarm Volume ... 19 History... 19 Language Selection... 19 Continuous/Intermittent Mode... 19 BioTech Menu... 20 Accessing the BioTech Screen... 20 BioTech Screen Data... 20 BioTech Options Lock Settings Feature (Program Locked)... 20 EZ Pump Mode... 20

Section VI - Performance Evaluation

System Performance Tests... 21 Certifying the Accuracy of Pump Flow Rate ... 21

Section VII - Cleaning... 22 Section VIII - Battery Replacement... 24

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

Table of Contents Section IX - Error/Warning/Informational Screens and Troubleshooting

System Error... 25 Hold Error... 26 Rotor Error... 26 Feed Error... 26 Flush Error... 26 Flow Error ... 26 Pump Set Dislodged Error... 27 Battery Low... 27 Feeding Complete... 27 Pump Set Use >24 Hours Warning... 27 LED Array... 27

Section X - Specifications and Symbols Specifications... 28 Symbols on Pump and Accessories... 30

Section XI - Customer Service... 31 Section XII - Maintenance Top Door Enclosing Pump Set Loading Area... 32 Battery Pack ... 32 Battery Door... 32 A/C Power Adapter... 32 Pole Clamp... 32

Section XIII - Service Part Numbers Accessory Items ... 33

Section XIV - Warranty... 34 Section XV - Electromagnetic Conformity Declaration... 35 This product contains software solely owned by Covidien. Covidien grants the user a non-exclusive, limited license to use the software according to the operating instructions. A copy of the license can be obtained from Covidien.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

Section I – General Information The Kangaroo Joey enteral feed and flush pump with pole clamp is a simple-to-use, precision enteral feeding pump. It is easily programmed to provide patients with either continuous or intermittent feeding, and can provide automatic flushing capability when used with Kangaroo™ Joey feed and flush sets. Indications for use: Intended for use in patients with any condition requiring enteral feeding and/or enteral hydration, which can be accomplished by means of an enteral feeding, pump and pump set. The pump and feeding sets are intended to be used in alternate, acute and home care settings by users ranging from laypersons to clinicians. The purpose of this device is to deliver enteral nutrition at a controlled rate to a patient’s gastrointestinal system. User Interface: • • • •

Intuitive user interface Large, backlit LCD display Step-by-step prompts to guide programming and operation “Stoplight” LED array visually indicates pump status in a bright or darkened room

Ergonomics: • • • • • • • •

Quiet operation Compact, portable aesthetic design Tabletop usage or IV pole mounting Simple loading of pump sets Transparent top door to protect pump set Water-resistant “Soft Touch” rubberized casing for easy grip and drop protection “Quick Release” pole clamp for easy detachment of pump

Features: • MISTIC (Magnetic Intelligent Set Type Identification Connector) Feed-Only vs. Feed & Flush Set identification system to ensure match between the pump’s user interface and pump set type • Automatic Anti-Free-Flow (AFF) System • Audible alarm to indicate errors or pump set loading conditions • Orientation-independent delivery design eliminates need for drip chamber on pump set • Sensor technology detects both upstream and downstream flow conditions • Continuous feed, intermittent feed, and flush capability • Auto-prime feature reduces the need for time-consuming manual priming • Hold feature with restart • “Keep Tube Open” (KTO) feature • Stores previous 72 hours of feeding and flushing history • 15 Languages

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Service: • •

Uses replaceable, rechargeable Lithium-Ion battery pack for 18 hours of backup power Easily removable A/C power adapter

Status Line

Menu Selections

Status LEDs

Input Settings Menu Selection Buttons

Output Totals Power Button

Graphic Display

Front

Battery Status

Door Buzzer Alarm Hole Location A/C Adapter Port

Pole Clamp Attachment Point Battery Door

(Serial I/O Port is BEHIND Battery Door)

Back Figure 1A. Kangaroo Joey enteral feeding pump features, front and rear views.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Feeding Set Loading Area

Figure 1B. Kangaroo Joey enteral feed and flush pump with pole clamp set loading area.

Section II - Safety and Warnings Note to healthcare personnel who provide training to lay operators or lay responsible organizations: Be sure to include all of the Warnings below when providing training to lay operators, especially in a Home Care Environment. Lay users should be instructed to contact Customer Service if there is a change in the performance of the pump. Additionally, Lay Operators should be instructed on proper cleaning procedures to avoid hazards such as electric shock. Lay users should also be trained on inappropriate environments for use (e.g., bathtub) of the pump. For guidance on training, please contact Customer Service. Caution: U.S. federal law restricts the sale of this device to physicians or to their direct representatives. 1. Read this booklet thoroughly before using the Kangaroo Joey enteral feed and flush pump with pole clamp. 2. Do not use this device near flammable anesthetics. 3. Disconnect power supply before cleaning or servicing. 4. The Kangaroo Joey enteral feed and flush pump with pole clamp utilizes a two prong, medical grade power supply cord specifically designed for use only with the Kangaroo Joey feeding pump’s Lithium Ion battery charging circuit. Use of an alternate consumer style AC power adapter or DC car adapter may cause damage to the charging circuit and battery of the Kangaroo Joey feeding pump. Use only the supplied power adapter to charge your Kangaroo Joey feeding pump from an AC power source. Use only Kangaroo Joey enteral feed and flush pump with pole clamp A/C power adapter (with built-in A/C adapter) with pump. See Section XIII - Service Part Numbers for replacement of A/C power adapter. 5. Use only Kangaroo Joey enteral feeding pump sets with this device. Pump is not compatible with other pump sets. 6. For performance tests, see Section VI - Performance Tests. For other integrity checks, consult with a qualified biomedical technician or contact the manufacturer. (Section XI - Customer Service). Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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7. For service or for technical information, please contact Customer Service (Section XI). 8. Do not open the main housing, as there are no user-serviceable parts inside. Opening may affect function of device and voids the warranty. To replace battery, see Section VIII. 9. Dispose of old battery-powered electronic equipment in a manner consistent with institutional policy for expired equipment disposal. 10. Cleaning frequency and practices must be consistent with institutional policy for cleaning of non-sterile devices. See Section VII - Cleaning, for instructions on cleaning the Kangaroo Joey enteral feed and flush pump with pole clamp. 11. See icon descriptions in Section III - Icon Identification and Section X - Specifications and Symbols for additional safety information. 12. This device is designed to minimize the effects of uncontrolled electromagnetic interference and other types of interference from external sources. Avoid use of other equipment that may cause erratic operation or degradation in the performance of this device. 13. Warning: The serial I/O port (see Figure 1A) is intended only for use by the manufacturer or trained service technician. Covidien is not responsible for any changes attempted or made to the system using an unauthorized connection. 14.  Caution: This enteral feeding pump should only be used for patients who can tolerate the flow rates and accuracy levels delivered by the pump. Premature infants may require higher accuracy rates than specified for this enteral feeding pump. For optimal accuracy, the top of the starting volume of formula should be 6 inches above the pump, do not reuse feeding sets and avoid overstretching the silicone that wraps around the pump rotor. 15. Do not attempt to rotate the valve stem inside the feeding set valve assembly. Rotation of the valve stem can only be done by the pump while the valve assembly is properly loaded into the pump. 16. Should feeding sets require rinsing, it is recommended that the feeding sets be rinsed while they are loaded in the pump. 17. Used feeding sets should be disposed of in accordance with current hospital procedure or local disposal guidelines. 18.  The Kangaroo Joey enteral feed and flush pump with pole clamp has been programmed to optimize accuracy by taking into account the viscosity of formula. Formula that has been diluted and has a low viscosity will tend to deliver like water and thus deliver to the high side of the accuracy specification. 19.  Caution: Ensure buzzer hole is unobstructed during normal operation so as to allow clear recognition of alarm. 20. Caution: The battery cells used in this device may present a fire or chemical hazard if mistreated. Do not disassemble, heat above 100°C (212°F), or incinerate. 21.  Danger: Strangulation Hazard. Avoid leaving power adapter wires, feeding set tubing or other choking hazards where infants or young children can become caught. If these objects get wrapped around a child’s neck, strangulation and death can occur. 22.  Danger: The pump and disposable feeding set all contain small parts which could become detached and pose a choking hazard. Some of these components could be inhaled or swallowed by a small child, toddler, or infant, which could result in suffocation and death. Keep all small components out of reach of small children. 23.  Danger: Explosion Hazard. Do not use the pump in the presence of flammable anesthetics. Flammable anesthetics can ignite due to a spark within the unit, which could result in fire or explosion. 24. Danger: Do not power the pump while plugged into a power outlet above 2000m altitude, especially while on an airplane or other air vehicle. Do not attempt to charge the pump battery above 2000m altitude. Failure to comply could result in overheating, fire, or explosion of the internal rechargeable battery pack. Run the pump only using the internal pump battery power in these situations. 25. Caution: Do not store the pump or power adapter at temperatures >50ºC (122ºF). This can damage the equipment sensors, which will prevent the pump from operating under normal conditions. Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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26. Warning: Do not modify this equipment without authorization of the manufacturer. Modification of any devices or accessories can result in physical hazards including delayed therapy, over delivery, under delivery, electrocution, and fire. These hazards could result in patient injury or death. 27.  Caution: The power adapter wires, feeding set tubing, and pump accessories may cause a tripping hazard. Avoid leaving wires, cords, or tubing in a pathway where a person could trip on them and sustain an injury. 28. Caution: Avoid using accessories, detachable parts and materials with the pump that are not recommended in this manual. Use only approved Kangaroo™ Joey accessories with the pump. 29. Caution: Use the pump only as directed in this user manual. Do not interconnect this device with other devices or modify the equipment in any way outside of the recommendations in this manual. Failure to comply could result in incorrect delivery of formula to the patient and could result in damage to the pump. 30.  Caution: Ensure buzzer hole is unobstructed during normal operation so as to allow clear recognition of alarm. Inability to hear the alarms could pose a serious risk to the patient, since the operator may not hear a critical alarm. 31. Caution: This pump is not intended to be used in MRI environments or in the presence of strong magnetic fields. Do not use these devices in any areas with strong magnetic fields. The pump contains metal components which could cause unintended movement. This unexpected movement could cause harm due to falling objects or collisions. 32.  Caution: There are significant hazards associated with accidental misconnections with other infusion devices, which could lead to patient harm or death. For more information about hazards and risk reduction strategies associated with misconnections, see the following: The Joint Commission Sentinel Event Alert Issue 36 - April 13, 2006. 33. Do not use the pump for delivery of any fluids or substances that are not enteral solutions prescribed by qualified medical personnel. 34. The pump is designed to be used outdoors for short periods of time (no more than 24 hours). Leaving the pump outdoors for extended periods of time (exceeding 24 hours) can result in damage and/or fading of the pump devices. 35. This device is designed for use on a conventional IV pole. As with any medical device, it is possible for the weight of the pump to cause the IV pole to tip over. This could result in injury to a patient or operator. When attaching the pump to the IV pole, take precautions to ensure the IV pole remains stable while in use. 36. This enteral feeding system was designed to meet IEC 60601-1 safety standards. For clarification, purposes, the feeding set is considered an Applied Part and has been tested and evaluated accordingly. 37.  Warning: Not for intravenous use. Do not use for intravenous infusion into a patient. Intravenous infusion of enteral fluids can result in serious complications up to and including death. 38. Warning: This enteral feeding pump should only be used for patients who can tolerate the flow rates and accuracy levels delivered by the pump. Premature infants may require higher accuracy rates than specified for this enteral feeding pump. Delivery of fluid to patients who cannot tolerate the pump accuracy can result in over or under delivery with the possibility of aspiration. 39. Use only commercially available pre-packed or commercially prepared feeding solutions prescribed by a licensed health care provider, dietitian or nutritionist. Do not use homemade blenderized or liquidised foods or other non-prescribed, non-commercially available feeding solutions.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Section III – Icon Identification Run Mode Vertically-moving droplet in RUNNING screen indicates Run mode.

Battery Symbols • Full charge • 2/3 or less charge • 1/3 or less charge • Very low battery (15 minutes max.)

Auto Priming Indicator When auto priming, the bar will progress to show auto prime feature is active.

Volume Setting Indicates alarm volume setting.

Error Indicator Pump operations are stopped until the error is resolved.

Information Indicator This indicates information only, and does not require any immediate action.

EZ Pump Mode Indicator Indicates that EZ Pump Mode feature is activated.

Volume to be Delivered Indicator Indicates that a VTBD has been programmed.

Keep Tube Open Indicates that Keep Tube Open feature is in operation.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Section IV - Initial Setup Attaching the A/C Power Adapter Plug the A/C Power Adapter (Part Number 383491) into the A/C adapter port on the back of the pump. See Figure 1A to locate port on pump. Note: It is important to make sure the power plug is pushed all the way into the pump for proper operation. If the display screen shows the pump is running on battery power after plugging in the A/C adaptor, check to make sure the A/C adaptor plug is flush with the back of the pump. (A power cord retention accessory is available that will help to retain the A/C adapter plug in the A/C adapter port.) Do not detach the connector by pulling on the cord only.

A/C Adapter Port

A/C Adapter Plug

Use care aligning adapter with pump connector Figure 2. A lignment of A/C Adapter plug with pump’s adapter port.

Battery Setup The battery is packed partially charged. Charge battery 6 hours prior to use off A/C power. It is also recommended that the battery charge be “topped off” before battery-only operation is utilized. The battery pack will charge continuously whenever the pump is plugged into a wall outlet, including during normal use of the pump with A/C power. 6 hours of charging is required to fully recharge the battery pack. A new battery pack will provide approximately 18 hours of service before needing to be recharged.

Attaching Pole Clamp The Kangaroo Joey enteral feed and flush pump with pole clamp can be attached to a vertical pole using the pole clamp which is included with the pump. The pole clamp provides the ability to retain the A/C power adapter to prevent accidental cord removal or cord loss. Simply wrap the cord around the cord wrap posts to ensure that the cord stays with the pump. To attach the pole clamp to the pump, simply slide the clamp onto the mounting stud on the back of the pump (Figure 3A). When engaged, turn the lever to secure attachment. Avoid overtightening or loosening of handle.

Figure 3A.

Figure 3B. Attaching and using the pole clamps.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Section V - Instructions For Use Quick Start POWER on lower, right-hand corner of control panel.

1.

Press

2.

Open blue door enclosing pump set loading area.

3.

To load pump set (refer to Figure 4):

4.

• Grasp finger tab on valve and insert into front pocket (1). • Grasp black ring retainer and wrap tubing around rotor (2). Pull up on retainer and insert into back pocket (3). Avoid overstretching the silicone tube. • Push finger tab to right to ensure that valve is fully seated in the pocket. • Close blue door. (Note: display status line should read SET LOADED). Suspend the pump set bag so that the top of the starting volume of formula is 6 inches above the pump (Figure 4B).

Black Ring Retainer (MISTIC)

3 2

Finger Tab

1

To automatically prime the pump, press PRIME PUMP and For feed & flush sets, auto priming will prime both lines.

6.

To directly control pump priming, press PRIME PUMP and then press and hold the HOLD TO PRIME button(s) . If a feed & flush set is used, remember to first press HOLD TO PRIME FLUSH until the flushing fluid has reached the valve, and then press HOLD TO PRIME FEED until the feeding fluid has reached past the valve and down to the distal end connector.

AUTO PRIME.

Use buttons on left side of LCD to set the feeding parameters. Set flushing parameters if a feed & flush set is loaded. The continuous or intermittent feed mode selection is made under the MORE options menu.

8.

Press

9.

To stop, press

RUN when ready to start. The screen will display RUNNING.

6 in (15.2 cm)

182541

7.

POWER button.

Valve

Figure 4A. Installation of pump set. (See Figure 6 for detailed view. Warning: Do Not Overstretch Tube.

5.

HOLD or press and hold the

Rotor

Figure 4B. Correct Fluid Level.

General Startup Placement/Mounting

There are two recommended placement methods for the Kangaroo Joey enteral feed and flush pump with pole clamp. • Attached to a vertical IV pole via the pole clamp peripheral device, included with the pump. • Placed on any stable surface. A/C Power Operation Plug the Kangaroo Joey enteral feed and flush pump with pole clamp into an A/C power outlet for normal operation. When the pump is not plugged in, or if A/C power is interrupted, a built-in rechargeable battery will run the pump.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Battery Power Operation If A/C power is not available to the pump, or if A/C power is interrupted, the pump will automatically operate on backup battery power. The built-in battery recharges any time the pump is plugged into an outlet. A fully-charged, new battery will supply 18 hours of backup power at 125 mL/hr before requiring recharging. Contact Customer Service, Section XI, to replace the battery pack if battery life degrades. Note: The Kangaroo Joey enteral feed and flush pump with pole clamp will not operate unless an approved Kangaroo Joey enteral feed and flush pump with pole clamp battery pack is installed in the pump. Power On/Off To power up the pump, press the POWER button on the lower right of the front panel. To power down the pump, press and hold the POWER button. A countdown will begin on the display; when the countdown reaches 0, immediately release the Power button. Note: The display backlight and Status LED array will remain on for a short period after releasing the Power button while the pump completes its internal power down process and will then extinguish. Language Selection, First Power Up Immediately after powering up the pump for the first time, the language option screen will appear. Select the language using the ( ) or ( ) buttons. When the language is selected, push the fifth button ( ) to enter the language selection. After the language is selected the first time the pump is powered up, the language selection screen will not appear during future power up operations. Should the language need to be changed after the initial power up, it can be changed through the “MORE OPTIONS” menu (see Figure 10A). Keep or Clear Prior Pump Settings Immediately after powering up the pump, if the prior feed or flush settings were not cleared and the settings are not locked in the BioTech Screen, the pump will give the following two options: KEEP SETTINGS - Select this option to start with the same settings that were most recently programmed into the pump. Any of the previously-programmed settings can be modified, if needed. The feed volume totals, “mL FED” (Continuous Feed Mode) or “BOLUSES FED” (Intermittent Feed Mode) and “mL FLUSH” are also maintained. If VTBD has been set, the VTBD setting will reset to the originally programmed value. CLEAR SETTINGS - Select this option to reset all input feeding settings and the output feed totals to zero. It will then be necessary to program all settings before running the pump. The BioTech options settings will not change. The status line of the pump will then show LOAD A SET (Figures 5A-5B), or, if the pump set is already loaded, it will show SET LOADED (Figures 7A-7D). Note: The output feed totals (“mL FED,” “BOLUSES FED,” “mL FLUSH”) can be cleared at any time, and without clearing the input settings, by doing the following: • Start the pump RUNNING • Press HOLD • Press CLEAR VOLUME

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Loading Pump Sets The Kangaroo Joey enteral feed and flush pump with pole clamp will indicate LOAD A SET in the screen’s status line if a pump set is not installed. A blinking icon of a pump set will also appear in the upper left corner of the screen. Figure 5A shows the screen for continuous feeding mode and Figure 5B shows the screen for intermittent feeding mode (intermittent feeding mode not available in EZ Pump Mode). To load a pump set, follow the steps below: 1.

With the pump display facing you, open the blue transparent door that encloses the rotor and pump set loading area.

2.

Load the pump set by holding the finger tab on the valve, then inserting the valve into the valve slot on the left. (Figure 6A)

3.

Grasp the MISTIC retainer end (black ring retainer) and wrap the tubing counterclockwise around the rotor. Avoid overstretching the silicone tubing. (Figure 6B).

4.

Carefully pull the MISTIC retainer end left and upwards to position it over the slot on the left, and then lower the retainer into the slot. Push down on the retainer then release to ensure proper engagement. (Figure 6B)

5.

Push the valve’s finger tab to the right to ensure proper seating.

6.

Close the blue transparent door, checking to make sure the valve finger tab is captured by the slot in the blue door. Note: To avoid nuisance alarms, make sure the pump set exterior is free from droplets of water or formula.

7.

Figure 5A. LOAD A SET opening menu screen for Continuous Feeding mode (EZ Pump Mode not activated).

Figure 5B. LOAD A SET opening menu screen for Intermittent Feeding mode (EZ Pump Mode not activated).

The top of the starting volume of formula should be 6 inches above the pump (Figure 4B).

MISTIC Retainer End

Finger Tab

Set Loading Door

Pump Set

Valve

Valve Slot

RetainerSlot

Power Button

Figure 6A.

Figure 6B.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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The display should read SET LOADED and will show one of the following opening menus, depending on the type of pump set detected, and whether continuous or intermittent feeding mode has been selected.

Figure 7A. Opening menu for Continuous Feed mode with a feed-only set.

Figure 7C. Opening menu for Intermittent Feed mode with a feed-only set.

Figure 7B. Opening menu for Continuous Feed mode with a feed & flush set.

Figure 7D. Opening menu for Intermittent Feed mode with a feed & flush set.

Prime Pump The Kangaroo Joey enteral feed and flush pump with pole clamp may be primed automatically with a single button push, including the flushing line if a feed & flush set is loaded. The pump can also be primed in a more interactive method using the hold-toprime feature. After a pump set has been loaded and the status line shows SET LOADED, press 7A-7D) to get one of the PRIME PUMP menus shown in Figures 8A and 8B.

Figure 8A. PRIME PUMP menu for feed-only set.

PRIME PUMP in the opening menu (Figures

Figure 8B. PRIME PUMP menu for feed & flush set.

Auto Priming The AUTO PRIME option will be available if the pump senses that the currently installed pump set was not previously primed, and that there is no fluid in the line near the rotor. If auto-priming is desired, press and release AUTO PRIME to automatically prime the line(s). For feed & flush pump sets, the auto prime feature will automatically prime both lines, starting with the flush line. Press

STOP to cancel AUTO PRIME.

When auto-priming is completed, the status line will show AUTO PRIME COMPLETE and will no longer show the AUTO PRIME option. Be sure that the line(s) are fully primed. If not, use the hold-to-prime option(s) to complete the priming, as described below.

Hold-to-Prime The hold-to-prime options allow for precise interactive control of the priming process. Feed-Only Pump Sets For feed-only pump sets, the screen will appear as in Figure 8A. Press and hold been primed down to the stepped end connector at the end of the pump set.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

HOLD TO PRIME FEED until the feed line has

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Feed & Flush Pump Sets For feed & flush pump sets, the display will appear as in Figure 8B. First press and hold HOLD TO PRIME FLUSH to prime the flushing line, and then press and hold HOLD TO PRIME FEED to prime the feed line down to the stepped end connector at the end of the pump set. If a feed & flush pump set is used, remember to first press HOLD TO PRIME FLUSH until the flushing fluid has reached the valve, and then press HOLD TO PRIME FEED until the feeding fluid has reached past the valve and down to the stepped end connector. If the feeding line is primed first, subsequent priming of the flushing line will force the air between the flush solution bag and valve into the main line, which already has been primed with enteral formula. Re-priming after Bag Empty A pump set bag that has been emptied will trigger the FEED ERROR screen. In this condition the pump set bag can be refilled to continue the feeding, but only after the pump set has been re-primed. To re-prime the pump set, do the following: • Disconnect the feeding line from the patient • Refill the bag • Press CONTINUE to begin the pump RUNNING • Press HOLD • Press ADJUST SETTINGS • Press PRIME PUMP • Press HOLD TO PRIME to prime the line(s) Pump sets should not be reused after 24 hours of initial usage.

Selecting Feed Mode EZ Pump Mode Option The EZ PUMP MODE option is a limited, CONTINUOUS MODE only setting of Kangaroo Joey enteral feed and flush pump with pole clamp. It feeds non-stop (no VTBD option) at a rate 0-400mL/hr as defined by the user until manually stopped. It has no BOLUS, FLUSHING, RUN MODE SCREEN LOCK, or AUTORESUME capability and displays no HISTORY information. Turning on EZ PUMP MODE will automatically force the unit out of the INTERMITTENT (BOLUS FEED) MODE if set. Although the Continuous Mode feed VTBD will be set to 0 while EZ PUMP MODE is enabled, the previous value of the FEED VTBD will be stored in the pump memory and recalled when “EZ PUMP MODE” is deselected. The user can change the Feed Rate by normal means. All other user settings, including those not compatible with the EZ PUMP MODE (BOLUS VTBD, NUMBER OF BOLUSES, SUPER BOLUS, etc), that were set before the pump was put into the EZ PUMP MODE will be ignored and invisible while in EZ PUMP MODE but remain stored in the pump memory for when EZ PUMP MODE is deselected. EZ PUMP MODE essentially has no effect on CLEAR SETTINGS; pressing CLEAR SETTINGS while EZ PUMP MODE is enabled will clear all feed and flush settings and totalizers as normal, not just those that apply to EZ PUMP MODE. Selecting the CLEAR SETTINGS option on power up will not clear Biotech Options such as EZ PUMP MODE or LOCK SETTINGS. If the user selects the ADJUST FEED option from either the LOAD A SET or SET LOADED screens, control will pass directly to and from the Enter Feed Rate screen and bypass the ADJUST FEED screen since without the ability to adjust VTBD in EZ PUMP MODE, the Adjust Feed screen is redundant.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Selecting EZ Pump Mode EZ PUMP MODE may be selected through the Biotech Options button which may be accessed on the Biotech screen (see page 20). The EZ PUMP MODE setting will be stored in the machine pump memory and saved when the unit is shut off. Note: If the user inserts a feed/flush set while the EZ PUMP MODE is enabled, EZ PUMP MODE will be cancelled and the unit will immediately revert back to the normal mode. If EZ PUMP MODE is desired, the user must then re-enable EZ PUMP MODE through the Biotech Options screen. When enabled and not in CERTIFICATION MODE, a small EZ icon will be visible on the bottom of the screen near the battery icon. However, it will not appear in the POWER DOWN, SYSTEM ERROR, or LOW BATTERY SCREENS.

Figure 9.

EZ Mode icon

Selecting Continuous or Intermittent Feed Mode The Kangaroo Joey enteral feed and flush pump with pole clamp can be programmed to feed continuously or intermittently. The continuous feeding mode will deliver the enteral nutrition at a steady rate, either until the programmed volume has been delivered or until the supply has been exhausted. The intermittent feeding mode delivers boluses of enteral nutrition at programmed time intervals. The bolus volume and feed rate are also programmed. To select continuous feed mode or intermittent feed mode, press 7A-7D, to access the MORE OPTIONS menu, Figure 10A.

MORE on the opening menu, shown in Figures 5A-5B or Figures

The MORE option is available either before a pump set has been loaded (Figures 5A-5B) or after the pump set is loaded (Figures 7A-7D). See subsection “More Options” for information on the other options in the MORE OPTIONS menu. Select CONTINUOUS/INTERMITTENT under the MORE OPTIONS menu, Figure 10A. Then press INTERMITTENT MODE from the SELECT MODE menu, Figure 10B. Press DONE to exit.

Figure 10A. MORE OPTIONS menu.

CONTINUOUS MODE or

Figure 10B. SELECT MODE menu for continuous or intermittent mode selection.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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Continuous Mode - Adjust Feed Continuous Mode Feeding For CONTINUOUS feeding mode, the ADJUST FEED option is available in the opening menus (Figure 7A for feed-only sets or Figure 7B for feed & flush sets). Select this option to program the feeding parameters from the ADJUST FEED screen, Figure 11A. Press FEED RATE in Figure 11A to define the rate of delivery. Press the in increments of 1 mL/hr. Press ENTER (top button) to exit the menu.

buttons in Figure 11B to program the rate from 1 to 400

Press FEED VTBD in Figure 11A to define the Volume To Be Delivered. Press the buttons in Figure 11C to program the volume from 1 to 3000 mL in increments of 1 mL. Press ENTER (top button) to exit the menu. If the FEED VTBD is set to zero, the pump will run until the supply is exhausted. NOTE: When a FEED VTBD is set, the remaining volume to be delivered (remaining VTBD) will be displayed next to the v icon on the lower right-hand portion of the screen (Figure 11A). If the FEED VTBD is reprogrammed during a feeding, from HOLDING mode, the pump will restart the feeding and deliver the entire volume of the new VTBD setting.

VTBD symbol Figure 11A. ADJUST FEED menu.

Figure 11B. Setting the Feed Rate.

Figure 11C. Setting the Feed Volume to be Delivered.

Continuous Mode Flushing (Not Available in EZMODE) For CONTINUOUS feeding mode with a feed & flush set loaded, the opening menu will appear as shown in Figure 7B. Press ADJUST FLUSH in Figure 7B to program the flushing parameters from the ADJUST FLUSH screen, shown in Figure 12A. Press FLUSH VOLUME in Figure 12A to define the volume per flush occurrence. Press the buttons in Figure 12B to program the flush volume from 10 to 500 in increments of 1 mL. Press ENTER (top button) to exit the menu. Press FLUSH INTERVAL in Figure 12A to define the time interval between starts of flushing. Press the buttons in Figure 12C to program the time interval from 1 to 24 hours in increments of 1 hour. Press ENTER (top button) to exit the menu. The pump will automatically limit flushing settings which exceed pump capabilities to deliver. Caution: The Kangaroo Joey enteral feed and flush pump with pole clamp flushes at a rate of 1960 mL/hr (32.7 mL/minute). Use care when programming the flush volume so that it matches the patient’s need. Note: The pump will automatically flush an additional 25 mL of water after completing the programmed delivery of formula, as long as at least one flush had occurred during formula delivery.

Figure 12A. A DJUST FLUSH menu, continuous mode.

Figure 12B. Setting the Flush Volume.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

Figure 12C. Setting the Flush Time Interval.

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Intermittent Mode - Adjust Bolus (Not Available in EZ Pump Mode) Intermittent Mode Feeding For INTERMITTENT feeding mode, the ADJUST BOLUS option is available in the opening menus (Figure 7C for a feed-only set or Figure 7D for a feed & flush set). Select this option to program the feeding parameters from the ADJUST BOLUS screen, Figure 13A. Press

BOLUS RATE in Figure 13A to define the rate of delivery.

Press the buttons in Figure 13B to program the delivery rate from 1 to 400 in increments of 1 mL/hr. Press ENTER (top button) to exit the menu.

Figure 13A. ADJUST BOLUS menu.

Press NUMBER OF BOLUSES in Figure 13A to define the total number of boluses to be delivered. Press the

buttons in Figure 13C to program the number of boluses, up to a maximum of 99.

Press ENTER (top button) to exit the menu. The number of boluses can be set as zero, in which case the pump will run until the supply is exhausted. Press VOLUME PER BOLUS in Figure 13A to define the volume to be delivered in each bolus.

Figure 13B. Setting the Bolus Rate.

Press the buttons in Figure 13D to program the volume per bolus from 1 to 3000 mL in increments of 1 mL. Press

ENTER (top button) to exit the menu.

Press BOLUS INTERVAL in Figure 13A to define the time interval between starts of bolus deliveries. Press the buttons in Figure 13E to program the time interval between starts of bolus deliveries from 1 to 24 hours in increments of 1 hour. Press ENTER (top button) to exit the menu.

Figure 13C. Setting the Number of Boluses.

The pump will automatically limit bolus settings which exceed pump delivery capabilities. For example, a bolus delivery volume of 200 mL cannot be made once per hour if a rate of 150 mL/hr is already programmed. In this case, the maximum volume allowed would be 150 mL. Note: If the NUMBER OF BOLUSES is reprogrammed during a feeding (from HOLD mode), the pump will restart the bolus feeding and will deliver all the boluses as defined by the new setting. Intermittent Mode Feeding – Bolus Max (Not Available in EZ Pump Mode) The BOLUS MAX option can be used to deliver a bolus at a high rate, similar to gravity feeding.

Figure 13D. S etting the volume per Bolus.

Press BOLUS MAX in the BOLUS RATE menu, Figure 13B, to program the BOLUS MAX mode. The feeding rate for BOLUS MAX is 999 mL/hr.

Figure 13E. Setting the time interval between starts of bolus.

Kangaroo™ Joey Enteral Feed and Flush Pump with Pole Clamp

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