LP6 Plus and LP10 Volume Ventilator Clinicians Manual

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Contents Introduction... 1 Purpose of the Manual... 1 Symbols and definitions... 2 Warnings and Cautions... 3 Electrical Interference... 4 General Description... 5 Alarm Condition... 6 Responding to Alarms... 6 Troubleshooting Guide... 8 Front Panel... 11 Upper Section... 12 Lower Left Section... 13 Lower Right Section... 14 Rear Panel... 15 Operating Controls... 17 Operating Modes... 19 Assist/Control... 19 Assist/Control with Pressure Limit (LP10 Only)... 19 SIMV (Synchronized Intermittent Mandatory Ventilation)... 19 SIMV with Pressure Limit... 20 Pressure Cycle... 20 Standby... 20 Ventilator Parameters... 21 Volume... 21 Breath Rate... 21 Inspiratory or I-Time... 21 Breathing Effort... 23 Pressure Alarms... 23 Pressure Limit Control (LP10 Only)... 24 Power Sources... 27 AC Power... 27 External Battery 12 Volt DC... 28 Using a Car Battery... 28 Internal Battery 12 Volt DC... 29 Routine Safety Check... 30 Monthly Safety Check... 32 Installation... 35 Mounting or Positioning... 35 Page iii

Emergency Vehicle... 36 Wheelchair... 37 Power Connections... 38 General... 38 AC Power... 38 External Battery 12 Volt DC... 39 Battery Performance... 40 Testing the Batteries... 41 Special precautions when using an external battery... 42 Internal Battery 12 Volt DC... 43 Patient Ventilator Circuit... 45 Exhalation Manifold... 48 Humidification... 48 Short Term... 48 Extended Use... 48 Supplemental Oxygen... 50 Methods... 50 Accessories... 52 Positive End Expiratory Pressure (PEEP)... 53 Pressure Monitoring... 55 Supplemental Oxygen... 55 Humidification... 55 Remote Alarm... 56 Printer... 56 Cleaning and Maintenance... 57 Patient Circuit and Humidifier... 58 Inlet Air Filter... 59 Ventilator Surface... 59 Storage of the Ventilator... 60 Scheduled Maintenance... 61 Service Policy... 62 Specifications... 63 Manufacturer’s Declaration... 65 Limited Warranty... 72 Keyword Index... 73

Page iv

Introduction Purpose of the Manual This Clinician’s Manual will help you understand the operation of the LP6 Plus and LP10 Volume Ventilators. It provides detailed information for physicians and other clinical personnel about the installation, safe use, and verification of the operation of the LP6 Plus and LP10 Volume Ventilators. It provides the caregiver guidelines for safe ventilation that are specific to the ventilator. It is not a complete maintenance document. Therefore, it contains no disassembly, repair, or reassembly instructions or diagrams. Carefully read and understand all instructions before using the ventilator. Use the instructions contained herein in conjunction with those set by the patient’s physician. No instruction in this manual is intended to replace accepted medical practice regarding the use of the ventilator or the care of the patient. As you read this manual, you will notice Cautions and Warnings in boxes on many pages. Pay very special attention to these boxes. They will tell you what to do and what to avoid as you use the ventilator. The difference between Warnings and Cautions is: A Warning contains information about possible hazards to the patient, the care provider, or the service technician. A Caution includes information about how to avoid equipment damage. The Notes and Accessories sections found at the back of this manual are for your use in applying this manual’s information to a specific patient. Puritan Bennett-supplied accessories include information concerning their use with the ventilator.

Page 1

Symbols and definitions LP6 Plus and LP10 Clinician’s Manual

Symbols and definitions The following symbols appear on the LP6 Plus and LP10 ventilators.

I O

Power switch ON position, connection to mains power

!

Attention, consult accompanying manual.

Power switch OFF position, disconnection from mains power

Alternating current Direct current

V A

Volts Amperes Standby mode of operation Canadian Standards Association Battery test switch Alarm silence switch Alarm Power Patient pressure External battery connection Remote alarm Battery test level Manual reset

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Warnings and Cautions Warnings

Always follow the physician's prescription when using the ventilator. Always operate and store the ventilator according to the specifications and instructions set forth in this manual. Use only Puritan Bennett-approved accessories and products with the ventilator. The use of other accessories may damage the unit and endanger the patient. Perform daily and monthly verification of the ventilator's operation as identified in this manual. Always stabilize and verify ventilator performance before connecting the patient to the unit. All alarms indicate a potential risk to patient safety. When an alarm sounds, provide immediate attention, care, and support to the patient as dictated by the situation. The LP6 Plus and LP10 ventilators shall not be used with flammable anesthetic agents. Do not use in direct sunlight.

Cautions

Refer any adjustments or procedures exceeding the scope of this manual to a Puritan Bennett Technical Service Representative. Refer to the Puritan Bennett Service Policy on page 62. Caution: Federal Law (U.S.A.) restricts this device to sale or use by or on the order of a licensed physician.

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Electrical Interference LP6 Plus and LP10 Clinician’s Manual

Electrical Interference Caution

Your ventilator is an electronic instrument. Any electronic instrument is subject to electrical interference. Electrical interference in excess of 10 V/m may keep your ventilator from working properly. Television sets, cordless or cellular telephones, microwave ovens, air conditioners, food processors, and other appliances can be sources of electrical interference. To avoid electrical interference between your ventilator and these appliances, you must follow these instructions:

Warning

•

Never place your ventilator near these appliances.

•

Never plug the ventilator into the same A.C. electrical outlet as these appliances, nor into electrical outlets on the same circuit as these appliances.

•

Never place the cables from ventilator accessories near these appliances. Electrical interference may keep your ventilator from working properly, which may create a hazard to the patient.

Note The ventilator is exempt under Section 15.801 (c)(5) of the no interfer-

ence regulations adopted by the FCC. If television interference does occur, contact Technical Services at Puritan Bennett, Inc. or a television repair technician for suggestions. Or, move the television to an A.C. electrical outlet that does not allow interference.

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General Description

The Puritan Bennett LP6 Plus and LP10 Volume Ventilators are intended for use in a non-acute care institution or transport, on pediatric and adult patients. It is to be operated in accordance with the product labeling contained in this instruction manual. The LP6 Plus and LP10 Volume Ventilators are microprocessor-controlled volume ventilators. They provide continuous respiratory support for patients with respiratory insufficiencies in a skilled nursing facility or hospital, or during transport. Because of the compact design and light weight, the units are highly portable. The ventilators offer a wide range of delivery volumes, inspiratory times, and breathing rates. The physician or the respiratory therapist can set the appropriate ventilation via the controls located in the recessed front panel. The magnetically latched door panel and the control knobs are designed to prevent tampering and accidental resetting. Audible and visual alarms quickly identify problems. See pages 6 through 10 for a complete discussion of these alarms. Page 5

Alarm Condition LP6 Plus and LP10 Clinician’s Manual

Alarm Condition Warnings

All alarms indicate a potential risk to patient safety. When an alarm sounds, provide immediate attention, care, and support to the patient as dictated by the situation. Any device is subject to unpredictable failures. To ensure patient safety, an appropriately trained caregiver should monitor ventilation. If the patient's condition warrants the use of an independent secondary alarm, remote alarm, or another external monitoring device, the physician should prescribe it. The physician should also determine to what level the patient may require an alternate means of ventilation. Certain types of ventilators, including the LP Series, have a Low Inspiratory Pressure Alarm. The purpose of this alarm is to alert the clinician or caregiver when the pre-set alarm parameters are violated. As set forth in the LP Series Clinician's and User's Manuals, a number of environmental factors and circuit accessories/components can affect the pressure in the breathing circuit. These factors may prevent circuit pressure from violating the low-pressure parameters, even in the event of a circuit being disconnected from the patient. Therefore, it is important for the clinician to consider and monitor these environmental factors when establishing pressure alarm parameters. Depending on the specific clinical situation (e.g., risk of disconnect perceived as high, patient is ventilator dependent) a secondary means of monitoring ventilation (e.g., pulse oximetry) should be considered.

Responding to Alarms The ventilator has visual and audible alarms. The audible alarm is usually a pulsating tone. Both the ventilator and the remote alarm emit these tones. Flashing or steady light(s) on the ventilator indicate the source of the problem. A Pulsating Audible Alarm and Flashing Light(s): The Low Power, High Pressure, Setting Error, and Power Switchover alarms all use this type of alert signal.

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Responding to Alarms LP6 Plus and LP10 Clinician’s Manual

A Steady Audible Alarm and Steady Lights: This combination indicates a detected microprocessor error in the ventilator. Single Reminder Tone: A single tone sounds every five minutes when the internal battery powers the ventilator.

Note In Assist/Control and SIMV modes, the High Pressure Alarm sounds whenever the air pressure exceeds the selected high pressure limit. In the Pressure Cycle mode, however, the High Pressure Alarm sounds only when the air pressure exceeds the selected high pressure limit by 10 cmH2O/hPa. When an alarm sounds: First, attend to the patient immediately. Then, check the flashing or steady light(s) on the ventilator to identify the source of the problem. You may press the Alarm Silence/Reset button to silence the alarm. This turns off the signal for one minute. If the alarm condition is corrected during that minute, the alarm light will turn off. A microprocessor error cannot be silenced. You cannot silence an alarm before it occurs.

Note If a High Pressure, or Setting Error alarm condition is corrected before

you press Alarm Silence/Reset, the audible alarm will stop but the light will continue to flash. Press Alarm Silence/Reset to turn off the light. If a Low Pressure/Apnea, Low Power or Power Switchover alarm condition is corrected before you press Alarm Silence/Reset, both the audible and visual alarms will continue. You must press Alarm Silence/Reset to turn off the audible alarm and the light.

Warning

If alarms continue to sound, provide another means of ventilation and contact your homecare dealer.

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Troubleshooting Guide LP6 Plus and LP10 Clinician’s Manual

Troubleshooting Guide Conditions All lights turn on and audible alarm sounds

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Probable Cause

Solution

Normal condition. Alarms test when unit is turned on.

Alarms will stop in two seconds.

Normal; manual alarm test.

Alarms will stop in one second.

Microprocessor error.

Turn vent off and set mode to Standby. Wait a few seconds. Return switches to prescribed settings. If alarm persists, provide another means of ventilation.

Troubleshooting Guide LP6 Plus and LP10 Clinician’s Manual

Conditions Low Pressure/Apnea Alarm: Pulsating audible tone with flashing light

Probable Cause

Solution

The patient is not breathing.

Check the patient for breathing effort.

Leaks or loose connections in the patient circuit.

Check connection of the patient circuit to the ventilator; check all connections for leaks and tightness, especially at the humidifier, trach tube, and exhalation valve.

Water in small-bore tubing.

Inspect and remove water from smallbore tubing.

Crimped small-bore tubing.

Uncrimp the small-bore tubing.

PEEP pressure set higher than the Low Alarm control setting.

Set Low Alarm control setting higher than the PEEP pressure.

The patient’s breathing effort is less Set Breathing Effort so the patient’s than the Breathing Effort control setting. breathing effort turns on the Breathing Effort light.

Low Power Alarm: Pulsating audible tone with flashing light

Patient speech or other activities lower patient airway pressure.

Low pressure alarm sounds whenever low pressure limit is not reached for two consecutive breaths. Review the section on alarms.

Low alarm setting is higher than Pressure limit setting. (LP10 only)

Correct to the prescribed value.

Volume set below patient’s tidal volume.

Correct to the prescribed value.

Pressure Limit level is set too low. (LP10 only)

Correct to the prescribed value.

Incorrect control settings.

Reset to prescribed values.

Leaks or obstructions in the patient circuit.

Check for leaks or crimped tubing.

Other causes.

Notify your physician and your homecare dealer

Failure to recharge the Internal battery.

Operate the ventilator on AC power for at least three hours, or place ventilator in Standby Mode while on AC power; use backup ventilator.

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Troubleshooting Guide LP6 Plus and LP10 Clinician’s Manual

Conditions

Probable Cause

High Pressure Alarm: Pulsating audible tone with flashing light

Solution

Water in the tubing.

Remove water from tubing.

Crimped tubing.

Straighten crimped tubing.

Coughing or other high-flow expiratory efforts.

Treat patient’s cough. The alarm is appropriate for these conditions.

Patient inspiratory resistance or compli- Have physician determine new ventilaance changes. tor settings. A sticky Pressure Limit control.

Occlude the end of the patient circuit to free the valve.

Airway obstruction

Check for trach obstruction or for a condition in which the patient requires suctioning.

Malfunction in the exhalation manifold. See the manifold manufacturer’s instructions.

Setting Error Alarm

Pressure Limit setting is higher than the High Alarm setting. (LP10 only)

Reset both to the prescribed values.

Inappropriate setting or settings beyond the capabilities of the machine.

Readjust settings to the physician’s prescription.

Dirty inlet filter.

Replace filter.

Internal Battery light flashes Unit has not switched to external battery.

Check for unconnected or misconnected battery cable. Check for blown fuse in the battery cable. Use another external battery.

DC circuit breaker is open.

Reset by pushing in protruding rod.

Single tone

Unit is operating on internal battery.

Check for unconnected or misconnected battery cable. Check for blown fuse in the battery cable. Use another external battery.

Green AC Power light does not glow

AC circuit breaker is open.

Turn it back ON.

AC power cord is not connected.

Plug in the cord.

No power at the wall outlet.

Use an active outlet.

Warning

Page 10

If the problems continue, provide another means of ventilation and contact your homecare dealer.

Front Panel LP6 Plus and LP10 Clinician’s Manual

Front Panel

The Front Panel of the ventilator has three sections: •

The upper section has small lights, two touch button pads, and a meter. • The lower left section has the operating controls. The physician prescribes their setting. To prevent accidental resetting, they are behind a closed panel. • The lower right section has the Pressure Limit control and the connections for the Patient Circuit.

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Front Panel LP6 Plus and LP10 Clinician’s Manual

Upper Section 1. Alarm Lights: When flashing or continuously lit, they identify a condition that demands immediate attention. There is also an audible tone when these lights begin flashing. 2. Alarm Silence/Reset Button: This has five uses.

• • • • •

Push to test the alarms. Push to silence alarms for 60 seconds. Push to reset the alarm after correcting the problem. Push simultaneously with the Battery Test Button for operating hours. (See the Scheduled Maintenance portion of the manual, page 61.) Use this button with other controls to start the self-test. (See page 31.)

3. Power Source Lights:

• • •

The top light is green when the ventilator is AC powered. The middle light is amber when an external battery powers the ventilator. The bottom light flashes amber when the ventilator’s internal battery is in use. A single tone also beeps every five minutes.

4. Battery Test Button: It has four uses.

• • • •

When pressed, the Pressure Meter displays the charge status of the battery in use (internal or optional external battery). Push simultaneously with the Alarm Silence/Reset button for an indication of operating hours. (See the Scheduled Maintenance portion of this manual, page 56.) Press the button to print a report from an attached printer. Use this button with other controls to start the self test. (See page 31.)

5. Breathing Effort Light: This light turns green whenever the venti-

lator senses the patient’s effort to breathe. The Breathing Effort control sets the sensitivity. 6. Patient Pressure Meter: The meter displays three pieces of infor-

mation: • • •

Page 12

Pressure at the Exhalation Manifold. The number of hours of ventilator operation. The charge status of the internal or attached external battery.

Front Panel LP6 Plus and LP10 Clinician’s Manual

Lower Left Section

1. Control Panel Door: This door is latched magnetically to pro-

tect the controls from accidental resetting. 2. Alarm Reference Guide: Consult this guide for a summary of

alarms and the action you should take. You will find the Guide on the inside of the Control Panel Door. 3. Control Knobs: They are behind the closed Control Panel Door.

The patient’s physician prescribes the settings for these controls. See pages 17 through 23 for details.

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Front Panel LP6 Plus and LP10 Clinician’s Manual

Lower Right Section

1. Patient Air Tube: The Patient air hose connects to this tube. The

ventilator delivers air through this tube. 2. Exhalation Valve Port: The Exhalation Pressure Tube of the

Patient Circuit connects to this port. 3. Patient Pressure Port: The Patient Pressure Tube of the Patient

Circuit connects to this port. 4. Pressure Limit Control (LP10 Only): This control sets the air pres-

sure limit during a forced or assisted breath. For use in Assist/Control or SIMV modes only; use in other modes may not allow effective ventilation. See pages 24 through 26.

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Rear Panel LP6 Plus and LP10 Clinician’s Manual

Rear Panel Vent

10

External 12 Volt DC Battery Connector

Carrying AC Plug Handle Holder Recess

9

6

8

Mounting Rails

Remote Alarm Connector

7

DC Circuit Breaker

12

14

Communication Port

4 Inlet Filter

5

1

Serial Number Plate

11 Pressure Relief

2

13

3

Cord Wrap Rear Feet

Voltage Select Switch

AC Power Switch

Page 15

Rear Panel LP6 Plus and LP10 Clinician’s Manual

1. Inlet Filter: The ventilator draws in air through this filter.

Warning

Do not block the inlet filter. (Keep away from curtains.) 2. Cord Wrap and Rear Feet: There is a foot at each corner. 3. AC Power Switch/Circuit Breaker: This is the ON/OFF switch

for AC power. It also has a built-in circuit breaker. 1 is power connected to mains and 0 is power disconnected from mains. 4. Communications Port: A special cable fits here and leads to an optional printer. Note The ventilator and printer should be turned off before connection or disconnection of the printer. 5. Serial Number Plate: This has Puritan Bennett’s identification number for the ventilator. It also lists the unit’s power requirements. 6. External 12 Volt DC Battery Connector: This is where you plug in an external battery cable. 7. Remote Alarm Connection: A remote alarm (optional) can summon the caregiver when an alarm sounds. 8. Rear Carrying Handle Recess 9. AC Plug Holder 10. Vent: Warm air from the unit’s circuitry leaves the ventilator and cool air enters through this vent. This cools the ventilator.

Warning

Do not block rear panel vent 11. Pressure Relief: This prevents the air pressure from exceeding

approximately 100 cmH2O/hPa.

Warning

Do not block the pressure relief valve. 12. DC Circuit Breaker: This circuit breaker protects the ventilator

when it is powered by an external battery. 13. Voltage Select Switch: This switch selects 110 or 220 volts when it

is powered by an external battery

Caution An incorrect switch setting may damage your ventilator. 14. Mounting Rails: These are used to mount and connect accessories to

the ventilator. Page 16