Model 710 and 715 Capnograph and Oximeter Users Manual

Revision History 30-Oct-98

Release, Rev. 00

15-Dec-98

Revision 01, R-N626

27-Jan-99

Revision 02

10-Dec-99

Revision 03, R-N719

6-Apr-00

Revision 04, R-N746

12-Oct-00

Revision 05, R-N835

Declaration of Conformity with European Union Directives The authorized representative for Novametrix Equipment is: European Compliance Services Limited Oakdene House Oak Road Watchfield Swindon, Wilts SN6 8TD UK Novametrix manufacturing facility is certified to ISO 9001 and EN46001 (MDD93/42/EEC Annex II). Novametrix Medical Systems Inc. products bear the “CE 0086” mark. The product is certified by Underwriter’s Laboratories (UL) to bear the UL mark; and tested by TUV Rheinland to IEC601-1 / EN60601-1. TIDAL WAVE Sp and CAPNOSTAT are registered trademarks and Y-Sensor, SuperBright and OxySnap are trademarks of Novametrix Medical Systems Inc. Velcro is a registered trademark of Velcro USA, Inc. Cidex is a trademark of Arbook, Inc. Nafion is a registered trademark of Dow Corning Corp. Models 710 and 715 are Year 2000 compliant.

Copyright 1998-2000 Novametrix Medical Systems Inc. This document contains information which is proprietary and the property of Novametrix Medical Systems Inc., and may not be reproduced, stored in a retrieval system, translated, transcribed or transmitted in any form, or by any means, without prior explicit written permission from Novametrix Medical Systems Inc.

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Contents General Description ...1 Indication for use ...1 Keypanel Controls and Indicators ...1 Connections and Labeling ...4 Principle of operation ...5 Safety ...7 Preparation for Use ...9 AC/Battery Operation ...9 Battery Status and Alerts ...9 Battery Use and Options ...10 Configuration Menus ...16 Sensors and Patient Connections ...21 Adapter Types Available ...21 Setting Adapter Type ...21 Adapter Zero Procedure ...22 CAPNOSTAT CO2 Sensor and Airway Adapter Setup ...24 SpO2 Sensors ...27 Monitoring ...41 Display of Data ...41 Monitoring Mode ...41 Screen Displays ...42 Messages ...44 Alerts ...47 Setting Alert Limits ...47 Alert Audio ...49 Capnogram Sample Waveforms and Interpretations ...50 Reference Handbooks ...51 Printing and RS232 Options ...53 Power and RS232 Serial Port Communications ...53 Printing ...54 Interpreting Printer Output ...57 Maintenance ...61 Cleaning and Sterilization ...61 Battery Maintenance ...63 Maintenance Schedules ...64 Specifications ...65 General ...65 Capnograph ...65 SpO2 Section ...66 Pulse Rate Section ...66 Monitor Specifications ...67 Additional Features ...67 Accessories ...69

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Warranty ... 73 Service Policy ... 74

vi TIDAL WAVE Sp User’s Manual

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Section 1

General Description

Indication for use The Model 710 and Model 715 TIDAL WAVE Sp handheld, portable Capnometer/Oximeters are intended to be used for monitoring end tidal CO2, respiration rate, functional oxygen saturation and pulse rate in monitoring environments such as ventilatory support, emergency and anesthesia. The Model 715 incorporates a miniature vacuum pump to draw expired respiratory gases through the CAPNOSTAT CO2 Sensor using a sampling airway adapter and nasal cannula. TIDAL WAVE Sp is designed to monitor adult, pediatric and neonatal patients. TIDAL WAVE Sp is not intended for any other purpose.

NOTE Components of this product and its associated accessories which have patient contact are free of latex.

Keypanel Controls and Indicators

Page key

Display screen

Power key

Alert key

Backlight key

Adapter key

Battery charge indicator and LED

AC indicator Alert LED

Controls Power Key Switches power on/off. Press the POWER key to place the unit into operate mode (ON) or to turn the unit OFF. Refer to “AC/Battery Operation” on page 9. With monitor ON, press and hold the POWER key to enter the MONITORING MODE selection menu. Refer to “Monitoring Mode” on page 41 for more information.

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Keypanel Controls and Indicators

Page Key Press to set display screen to Data Display, EtCO2 waveform, plethysmogram, EtCO2 trend, Respiration trend or SpO2 trend. Press and hold to enter the PRINT SELECTION menu. See “Printing” on page 54.

Alert Key When pressed, will set the 2 minute silence (audible alerts muted for two minutes) and displays the SET ALERTS menu. If the SET ALERTS menu is not needed, it will automatically disappear after 3 seconds. For 2 minute silence, the

icon will illuminate for the duration. Press again to cancel.

Press and hold for 3 seconds to disable audible alerts, and the

icon will flash. Press and hold again to cancel.

The Alert Key LED will display the following: • • •

Steady yellow: audio silenced for 2 min., no alert in progress. Flashing yellow: audio silenced (no alert in progress). Flashing red and yellow: alert in progress; audio is off or 2 minute silence.

Audible alerts may be permanently disabled from the Configuration menu. Refer to “Configuration Menus” on page 16 for more information.

Adapter Key Press to set adapter type: adult, neonatal or sampling. Press and hold for 4 seconds to zero an adapter. See “Adapter Zero Procedure” on page 22 for more information. Press to cancel Auto Power Off function.

Backlight Key Press to turn backlight on/off, or press and hold to adjust contrast for up/down viewing angles and for adjustment due to extreme temperature variations.

Indicators Battery Alert Indicator Illuminates when the unit is on battery power. Green; battery is fully charged, slow flashing yellow; battery power is low (approximately 20 minutes of operation remains), Fast flashing red; battery is exhausted (approximately 5 minutes of operation remains). The battery alert indicator is off when external power is connected. Refer to “AC/Battery Operation” on page 9 for information on connecting AC power and charging the battery.

AC Power Indicator Illuminated green when the monitor is connected to an AC power source (e.g. the external power supply (PN 9220-10), or the BaseStation (PN 6998-00), while powered by the external power supply).

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General Description

Keypanel Controls and Indicators

Icons The icons listed below may appear on the display screen when the TIDAL WAVE Sp is in use.

Alert Silence Icon Audible alerts silenced.

2-Minute Silence Icon Audible alert silenced for two minutes.

Alert Limits Disabled Icon Alert limits disabled. Select ENABLED or DISABLED in the CONFIGURATION menu.

Airway Adapter Icon Indicates adapter key.

Time/Date Icon Set time/date. Press

from the CONFIGURATION menu to set time and date.

Backlight Icon Indicates backlight key.

Trend Screen Icon Displayed beside any Trend screen.

Temperature Icon Sensor not up to temperature icon. Displayed when performing an adapter zero and the sensor is not at operating temperature.

Waveform Icon CO2 detected icon. Displayed when selecting an adapter zero and the monitor detects breaths.

Heart Icon Pulse detected icon. Displayed when SpO2 sensor is attached to patient and the monitor detects a pulse.

Lung Icon Breaths detected icon. Displayed when CAPNOSTAT CO2 sensor is attached to patient and breaths are detected.

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Section 1

Connections and Labeling

Connections and Labeling DB-9 SpO2 sensor connection Endview Model 710

Sampling system output Endview Model 715

Sampling system input CO2 sensor connection DC input

Rearview Model 710/715

Sideview Model 710/715

RS232 connection and external power input from BaseStation

Battery compartment

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General Description

Principle of operation

Symbols Patient isolation: Identifies connection as type BF

Attention: Consult manual for detailed information

Sampling System: Gas output

Sampling System: Gas input DC input. Connect external power supply to this port. Use only Novametrix external power supply, Catalogue number 9220-10. Recyclable item. This symbol is found on the internal battery and should not concern the common user. Refer to qualified service personnel when battery replacement is required. Separate collection. Appropriate steps must be taken to ensure that spent batteries are collected separately when disposed of. This symbol is found on the internal battery and should not concern the common user. Refer to qualified service personnel when battery replacement is required.

Principle of operation CO2 TIDAL WAVE Sp uses the CAPNOSTAT CO2 sensor to measure CO2 by using the infrared absorbtion technique, which has endured and evolved in the clinical setting for over two decades and remains the most popular and versatile technique today. The principle is based on the fact that CO2 molecules absorb infrared (IR) light energy of specific wavelengths, with the amount of energy absorbed being directly related to the CO2 concentration. When an IR beam is passed through a gas sample containing CO2, the electronic signal from the photodetector (which measures the remaining light energy) can be obtained. This signal is then compared to the energy of the IR source and calibrated to accurately reflect CO2 concentration in the sample. To calibrate, the photodetector’s response to a known concentration of CO2 is stored at the factory in the monitor’s memory. A reference channel accounts for optical changes in the sensor, allowing the system to remain in calibration without user intervention.

SpO2 The TIDAL WAVE Sp determines oxygen saturation using sensors that contain red and infrared (660 and 940 nanometer) light sources, called light emitting diodes (LEDs). The light energy from each LED is beamed through a tissue sample-a pulsating vascular bed such as the patient’s finger or toe. The remaining light energy not absorbed by the tissue sample reaches a photodiode light receptor in the sensor. Oxygen saturated blood absorbs

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Section 1

Principle of operation

different amounts of light at each wavelength as compared to desaturated blood. Therefore, the amount of light absorbed by the blood in each pulse can be used to calculate oxygen saturation. The TIDAL WAVE Sp is calibrated to display “functional” saturation. This differs from the “fractional” saturation value displayed by most co-oximeters. Functional saturation is defined as:

HbO2

Functional Saturation =

100 - (COHb + METHb) HbO2 = Fractional Oxyhemoglobin COHb = Carboxyhemoglobin METHb = Methemoglobin This can be considered to represent the amount of oxyhemoglobin as a percentage of the hemoglobin that can be oxygenated. Dysfunctional hemoglobins (COHb and METHb) are not included in the measurement of functional saturation. Pulse Rate is calculated by measuring the time interval between peaks of the infrared light waveform. The inverse of this measurement is displayed as pulse rate. The oxygen saturation and pulse rate values are updated once each second. Presence of a pulse is indicated visibly by a plethysmogram graphic display and audibly by a “beep,” when configured. The TIDAL WAVE Sp must be used in conjunction with SuperBright™ Sensors. See “Accessories” on page 69 for a list of available sensors and accessories.

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Section 2

Safety

For maximum patient and operator safety, you must follow the following warnings and cautions.

WARNINGS

!

Indicates a potentially harmful condition that can lead to personal injury. • • • • • • • • • • • •

•

•

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Explosion Hazard: DO NOT use TIDAL WAVE Sp in the presence of flammable anesthetics. Use of this instrument in such an environment may present an explosion hazard. Electrical Shock Hazard: Always turn TIDAL WAVE Sp off and remove any external devices before cleaning it. Refer servicing to qualified service personnel. Failure of Operation: If the monitor fails to respond as described, do not use it until the situation has been corrected by qualified personnel. Do not operate TIDAL WAVE Sp if it appears to have been dropped or damaged. Do not operate TIDAL WAVE Sp or its accessories when it is wet due to spills or condensation. Never sterilize or immerse the monitor, sensor or accessories in liquids. The monitor does not alert for NO RESPIRATION if the airway adapter is removed from the CAPNOSTAT CO2 sensor. Verify the “No Resp Timer” setting prior to use. Do not position any sensor cable in a way that may cause entanglement or strangulation. The TIDAL WAVE Sp is not intended to be used as a primary diagnostic apnea monitor and/or recording device. Patient Safety: Care should be exercised to assure continued peripheral perfusion distal to the SpO2 sensor site after application. Inspect the SpO2 sensor site often for adequate circulation - at least once every four hours. When applying sensors take note of patient’s physiological condition. For example, burn patients may exhibit more sensitivity to heat and pressure and therefore additional consideration such as more frequent site checks may be appropriate. Data Validity: As with all pulse oximeters, inaccurate SpO2 and Pulse Rate values may be caused by: - Incorrect application or use of sensor; - Significant levels of dysfunctional hemoglobin; carboxyhemoglobin or methemoglobin; - Significant levels of indocyanine green, methylene blue, or other intravascular dyes; - Exposure to excessive illumination such as surgical lamps-especially those with a xenon light source, or direct sunlight; - Excessive patient movement; - Venous pulsations; - Electrosurgical interference. The external battery charger should NOT be used to recharge the battery near or in close proximity to patients and/or other medical equipment in operation. It is intended for use in service areas only (i.e. nurses station, biomed lab, etc.).

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Section 2

•

Connection of an external device (e.g. printer or computer) to the RS232 serial port on the BaseStation may compromise patient safety.

CAUTIONS

!

Indicates a condition that may lead to equipment damage or malfunction. • • • • • • • • • • • • •

•

•

Federal (U.S.A.) law restricts this device to sale, distribution, or use by or on the order of a licensed medical practitioner. Use only an external power supply approved by Novametrix for use with this device. Use of any other power supply may damage the TIDAL WAVE Sp and void the warranty. Do not operate TIDAL WAVE Sp or its accessories when it is wet due to spills or condensation. Do not operate TIDAL WAVE Sp if it appears to have been dropped or damaged. Keep TIDAL WAVE Sp and its accessories clean. Inspect the integrity of the TIDAL WAVE Sp and its accessories prior to use. Never sterilize or immerse the monitor, sensor or accessories in liquids. Do not sterilize or immerse sensors except as directed in this manual. Do not apply excessive tension to any sensor cable or pneumatic tubing. Do not store the monitor or sensors at temperatures less than 14°F (-10°C) or above 131°F (55°C). Do not operate the monitor or sensors at temperatures below 50°F (10°C) or above 104°F (40°C). If a Single Patient Use Sampling Adapter becomes occluded, replace and discard the adapter. It is recommended that the CAPNOSTAT CO2 sensor be removed from the circuit whenever an aerosolized medication is delivered. This is due to the increased viscosity of the medications which may contaminate the sensor windows, causing the sensor to fail prematurely. Where electromagnetic devices (i.e. electrocautery) are used, patient monitoring may be interrupted due to electromagnetic interference. Electromagnetic fields up to 3V/m will not adversely affect system performance. Refer servicing to qualified personnel.

NOTES Indicates points of particular interest or emphasis for more efficient or convenient operation. • • • •

•

8

The TIDAL WAVE Sp monitor is intended for operation with Novametrix Single Patient Use airway adapters. Operating the TIDAL WAVE Sp below 50°F (10°C) will result in longer warm-up time and reduce battery life. Components of this product and its associated accessories which have patient contact are free of latex. Certain rebreathing circuits, or the presence of artifacts such as cardiogenic oscillations, may cause TIDAL WAVE Sp to react to non-respiratory CO2 fluctuations as if they were breaths. This condition affects only the RESP numerical displays; the capnogram display continues to provide an accurate picture of the CO2 waveform. After the life cycle of our equipment and all accessories has been met, disposal of the equipment should be accomplished following the national requirements. Contact the local Novametrix representative for questions concerning disposal.

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Section 3

Preparation for Use

The TIDAL WAVE Sp can be powered four ways: from seven “AA” disposable lithium batteries, a rechargeable NiMH battery, the 9220-10 external power supply or the 6998-00 BaseStation combined with the external power supply, all available from Novametrix.

AC/Battery Operation Press the POWER key to place the unit into operate mode (ON) or to turn the unit OFF. The status of the unit is dependent upon both the Power key and the power source. The monitor can operate for up to 4.5 hours while powered from a fully charged internal battery (4 hours when using sampling pump, Model 715). The battery is charging when the monitor is powered through its DC input and the keypanel icon is green. The battery will charge even if the monitor is off. Power to the DC input is supplied by the external power supply (Cat. No. 9220-10) with or without the optional BaseStation (Cat. No. 6998-00). Rechargeable and disposable battery capacity is shown in the table titled, “Battery Life and Recharge Times” on page 14. Times may be reduced in colder temperatures or with the sampling adapter; operation with the backlight off may slightly increase these times.

Battery Status and Alerts When the monitor is operating on battery power, and the battery is sufficiently charged, the battery icon LED on the keypanel will be green. The battery level is reflected on the battery icon by different colors (for example, battery fully charged: green, battery low: flashing yellow). The LED on the keypanel flashes red when the monitor is powered by its internal battery and approximately 5 minutes remain. The monitor will sound an audible alert, then when the battery is depleted, turn itself off. This alert can only be silenced by connecting the external supply or turning the monitor off. The NiMH battery pack should be replaced, or the TIDAL WAVE Sp BaseStation (Cat. No. 6998-00) or external power supply (Cat. No. 9220-10) should be connected to recharge the battery (rechargeable batteries only) and power the monitor. See “Battery Life and Recharge Times” on page 14.

NOTE When the battery is low (red blinking battery LED on keypanel) the monitor has shut down CO2 and SpO2 functions. Connect to AC power as soon as possible.

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Battery Use and Options

NOTE • The battery life indicator may not reflect the true battery status upon power-up for approximately 30 seconds. • The battery life indicator is inactive when the monitor is powered by the BaseStation or the external power supply.

Battery Use and Options Removing and Installing the Battery Grasp the finger grips on each end of the battery cover. Squeeze together and pull so that the cover opens to reveal the internal battery (the cover is hinged on the bottom of the case). Remove the battery from the monitor.

Finger grip

Power jack

Interface connector WARNING: Do NOT connect to any device not approved by Novametrix

Hinged side Battery cover

The battery is keyed so that it can be installed in only one way (see illustration inside battery compartment). The contacts should go in first and be located toward the top left of the monitor when inserting. Make certain the battery cover is properly closed before operating the monitor.

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Battery Use and Options

Rechargeable Batteries The NiMH rechargeable battery pack (Cat. No. 400043) can be used to power the TIDAL WAVE Sp for approximately 4.5 hours of continuous operation (4 hours when using sampling pump, Model 715).

Optional Rechargeable battery, (NiMH 7.2 vdc)

NOTE • Refer to the instruction sheet packaged with the rechargeable battery for complete operating instructions. To charge a rechargeable battery while in the monitor: External Power Supply Alternatively, plug the external power supply directly into the DC power jack on the side of the monitor, and connect a hospital-grade line cord to an AC source. The AC icon will illuminate green and the battery will charge in approximately 5.5 hours. If the monitor has been stored with the battery installed for thirty (30) days or more, charge the battery for 24 hours prior to use.

DC input

Connect line cord (Cat. No. 600075)

External power supply (Cat. No. 9220-10)

CAUTION • •

Use only Novametrix supplied devices when connecting to the power input jacks on the TIDAL WAVE Sp or on the BaseStation. Do not attempt to use the adapter for the external battery charger for this function.

NOTE • •

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When powered by the external power supply, the TIDAL WAVE Sp will not overcharge a rechargeable battery. The external power supply has a universal power input. The IEC 320 input receptacle for line cord connection allows compatibility with every country’s voltage and frequency requirements.

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Battery Use and Options

Optional BaseStation Power for the BaseStation is supplied by an external power supply (PN 9220-10) or the internal battery. When the power supply is properly connected to the BaseStation and a monitor is placed within the station the green, “In Use” LED will illuminate. The icon on the monitor will also illuminate indicating that external power is connected. Connect the external power supply jack to the monitor and connect a hospital-grade line cord from the external power supply to an AC source.

External power supply (Cat. No. 9220-10) Connect line cord IEC 320 receptacle (Cat. No. 600075)

The 9220-10 Power Supply is approved by the following regulatory agencies: : Canadian Standards Assoc.

Monitor in BaseStation (BaseStation Cat. No. 6998-00)

DC input

Green “In Use” LED illuminates indicating a monitor is in place and the power supply is active

Illuminates indicating external power

: SEMKO (Sweden) V

D E

: VDE (Germany)

FI

: FINKO (Finland)

D : DEMKO (Denmark)

CAUTION •

•

12

Although other connectors may physically fit, do not attempt to connect any device other than power supplies approved by Novametrix for use with this device. Doing so may damage the TIDAL WAVE Sp and will void the warranty. Never sterilize or immerse the monitor, sensor or accessories in liquids.

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Preparation for Use

Battery Use and Options

Charging NiMH Rechargeable Battery with External Charger In a non-patient area, connect the adapter to an AC source, then plug the adapter jack into the charger. Remove the battery from the TIDAL WAVE Sp and insert it into the external charger. The battery will be fully charged in approximately 4.5 hours. The external charger is for use with the NiMH rechargeable battery pack (Cat. No. 400043) only. Refer to the instructions supplied with the charger for additional information.

NiMH Rechargeable Battery (Cat. No. 400043)

Connect adapter

Battery is keyed to fit into slot in only one direction Connect line cord

WARNING •

The external battery charger should NOT be used to recharge the battery near or in close proximity to patients and/or other medical equipment in operation. It is intended for use in service areas only (i.e. nurses station, biomed lab, etc.).

NOTE • • • •

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With a new battery, or a battery that has not been used for 30 days or more, charge the battery for 24 hours prior to use. When powered by the external power supply or the BaseStation, the TIDAL WAVE Sp will not overcharge a rechargeable battery. The monitor may not operate on battery power if the battery is not sufficiently charged. Dispose of batteries in accordance with local laws.

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Battery Use and Options

AA Lithium Batteries To power TIDAL WAVE Sp from AA lithium batteries, insert seven disposable batteries (Energizer L91 or equivalent) into the optional Battery Case (Cat. No. 6862-00) following the polarity markings on the Battery Case.

Standard AA lithium batteries (7 ea. - disposable)

WARNING • •

Batteries can explode, leak or catch on fire if heated or exposed to fire or high temperatures. Do not mix battery types (e.g. disposable and rechargeable AA batteries).

Battery Life and Recharge Times Configuring the monitor to turn off unused functions will result in longer battery life. The following table lists battery operation times with Sampling pump off (Model 710/715), Sampling pump on (Model 715) for each mode: CO2/SpO2, CO2, or SpO2. See “Monitoring Mode” on page 41. Power source - Approximate Monitoring Times Configuration Rechargeable NiMH battery

AA lithium batteries

Model 710/715 - CO2/SpO2

4.5 hours

4.0 hours

Model 715 - CO2 Sampling/SpO2

4.0 hours

3.5 hours

Model 710/715 - CO2 only

4.5 hours

4.0 hours

Model 715 - CO2 Sampling only

4.0 hours

3.5 hours

Model 710/715 - SpO2 only

7.0 hours

6.5 hours

Recharge Time: External charger w/adapter

4.5 hours

n/a

5.5 hours (in monitor)

n/a

Recharge Time: External power supply or External power supply/BaseStation

NOTE Excessive alerting reduces battery life when operating on battery power.

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Battery Use and Options

Automatic Power Off Feature The automatic power off feature is included to conserve battery power in the event of an unintentional power up of the monitor. This option will shut the monitor off if there is no CO2 breath or pulse detection after 5 minutes from when the unit powers on, or after 20 minutes of no monitoring (no breath or pulse detected and no alert conditions). After the 5 or 20 minutes has elapsed, an AUTO POWER OFF IN X:XX message will appear on the screen and the timer (X:XX) will count down from one minute to zero. Pressing the adapter key, or detection of a CO2 breath or pulse will cancel the shutdown, otherwise the unit will shut off.

Long Term Storage If the monitor has not been used or powered by the external power supply for an extended time* (3 months or more) allow the battery to charge before use or replace the battery with a fully charged battery and continue monitoring. The monitor may not power up on battery power if the battery is not sufficiently charged. Refer to “Battery Life and Recharge Times” on page 14.

NOTE • New batteries, or batteries stored for extended periods of time may need to be fully charged and discharged up to five (5) times before performing at full capacity. • With a new battery, or a battery that has not been used for 30 days, charge the battery for 24 hours prior to use.

Serial Communications/Power Interface Connector Located on the enclosure rear is a six pin modular contact which provides an RS232 interface as well as a power input for unit operation and battery charging when connected to Novametrix accessories. This connector meets the patient safety requirements of the following agencies: IEC 601-1, UL544. The BaseStation (Cat. No. 6998-00) is an optional accessory onto which Novametrix hand-held monitors can be placed, providing a platform for communication support between the monitor and a host computer or printer. The BaseStation is meant for table-top (horizontal), not pole-mounted (vertical) applications and can be used anywhere the TIDAL WAVE Sp monitor is used; including but not limited to the sleep lab, ICU, anesthesia, post anesthesia, emergency department, respiratory care, home care, and pre-hospital emergency. The BaseStation provides RS232 serial communications as supported by the monitor, with or without the external power supply connected. In addition, the BaseStation is capable of providing power to charge a rechargeable battery inside the monitor when used with the external power supply.

*The internal battery will slowly discharge over long periods of non-use.

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Configuration Menus

Configuration Menus CONFIGURATION menus are provided on the TIDAL WAVE Sp to allow customizing of various settings. To access the CONFIGURATION menus, press and hold the key, then simultaneously press the key until the first CONFIGURATION menu is displayed. Press the PAGE key to move through the menus. The SELECT key moves the arrow pointer; the parameter chosen will flash. Press the EXIT key at any time to return to monitoring mode (selections will be saved).

**

**Press SELECT to scroll down to INST in the EtCO2 Averaging menu.

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