R Series EtCO2 Operators Guide Rev D Jan 2018.pdf
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R Series
End Tidal Carbon Dioxide
(EtCO2)
®
9650-0915-01 Rev. D
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The issue date for the R Series End Tidal Carbon Dioxide (EtCO2) guide (REF 9650-0915-01 Rev. D) is
January, 2018.
ZOLL and R Series are trademarks or registered trademarks of ZOLL Medical Corporation.
Copyright © 2018 by ZOLL Medical Corporation. All rights reserved.
CAPNOSTAT is a registered trademark, and CAPNO2mask and LoFlo are trademarks of Respironics
Novametrix LLC.
Cidex is a registered trademark of Advanced Sterilization Products, a Johnson & Johnson Company.
Nafion is a registered trademark of DuPont.
System 1 is a registered trademark of the Steris Corporation.
All other trademarks and registered trademarks are property of their respective owners.
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Indication of use
Indication of use
The R Series system is indicated for the continuous noninvasive monitoring of end tidal carbon dioxide (EtCO2)
and respiration rate in patients requiring ventilator support, in-hospital transport, or anesthesia. EtCO2
Monitoring is indicated for in patients from newborn (neonate) to adult.
Contraindications for Use
There are no known contraindications for the use of the EtCO2 monitor.
General Information
Federal (U.S.A.) law restricts this defibrillator to sale by or on the order of a physician.
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ZEUS Pulse Oximetry (SpO2)
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End-Tidal Carbon Dioxide
(EtCO2)
Product Description
R Series® units equipped with software revision 12.xx or higher support two End Tidal Carbon
Dioxide (EtCO2) monitoring options for the continuous measurement of respiratory carbon
dioxide (CO2) and respiration rate. These options use the same connector on the R Series unit
and may be used interchangeably.
For R Series BLS/Plus models, these EtCO2 options can only be used while the unit is in
Manual mode.
The first option uses a unique, mainstream, solid-state, infrared sensor called the
CAPNOSTAT® 5 Mainstream CO2 Sensor. The CAPNOSTAT 5 CO2 sensor is attached to an
airway adapter that connects to an endotracheal (ET) tube or other airway and measures gases
flowing through these breathing circuit components. A disposable mouthpiece may be
connected to the adapter for monitoring non-intubated patients. A CAPNO2mask™ is also
available for use with non-intubated patients. This option provides for O2 delivery while
monitoring expired CO2.
The second option is a sidestream sampling system called the LoFlo™ CO2 Module. The LoFlo
module contains a gas sampling pump, which draws small samples of gas from the patient’s
airway via a nasal/oral cannula or airway adapter, and passes these gases through a solid state
infrared sensor (located away from the patient’s airway) that measures CO2. While the
sidestream system is typically used on non-intubated patients, it can also be used for EtCO2
measurement on intubated infant, pediatric and adult patients. The sidestream system should
not be used, however, on patients who cannot tolerate the 50ml/min removal of the sample
gases from their breathing circuit. The sidestream module uses specially designed cannulas and
airway adapters for sampling airway gases and passing them through an integrated sample cell,
which connects to the LoFlo module’s CO2 sensor. These cannulas incorporate a filter and
sample cell, providing maximum filtration of fluids and contaminants, and protecting the
system from aspiration of these fluids.
In both systems, the CO2 sensor generates infrared light and beams it through the airway adapter
or sample cell to a detector on the opposite side. CO2 from the patient, flowing through the
mainstream airway adapter or sample cell, absorbs some of this infrared energy. The R Series
unit determines CO2 concentration in the breathing gases by measuring the amount of light
absorbed by gases flowing through the airway or sample cell.
The R Series unit displays EtCO2 (the concentration of carbon dioxide detected at the end of
each exhalation) as a numerical value in millimeters of mercury (mmHg), percent (%), or
kilopascals (kPa). In addition, the unit can display a capnogram. This capnogram is a valuable
clinical tool that can be used to assess patient airway integrity and proper endotracheal (ET)
tube placement. The unit calculates respiration rate by measuring the time interval between
detected peaks of the CO2 waveform. The technology differentiates between waveforms caused
by breathing and those caused by cardiogenic oscillations and artifact.
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
How to Use This Manual
This section explains how to set up and use the R Series End Tidal Carbon Dioxide option.
Important safety information relating to general use of the R Series End Tidal Carbon Dioxide
monitor appears in the “Safety Considerations” section of this manual.
The R Series Operator’s Guide provides information operators need for the safe and effective
use and care of the R Series unit. It is important that persons using this device read and
understand all the information contained therein.
Please read both safety considerations and warnings sections thoroughly before operating your
R Series unit.
All CAPNOSTAT 5 sensor , LoFlo module, airway adapter and cannula questions with regards
to the Declaration of Conformity with European Union Directives should be directed to the
authorized ZOLL representative:
ZOLL International Holding B.V.
Newtonweg 18
6662 PV ELST
The Netherlands
+31 (0) 481 366410 Telephone
+31 (0) 481 366411 Telefax
Safety Considerations
Warnings
General
Carefully read the R Series Operator’s Guide and these operating instructions before operating
the EtCO2 monitoring option.
Ensure that the R Series EtCO2 option is operated by qualified personnel only.
Do not use the R Series EtCO2 option as an apnea monitor.
Do not immerse the R Series unit, patient cables, or sensors in water, solvents, or cleaning
solutions.
If the accuracy of any reading is suspect, first check the patient’s vital signs by alternate means
and then check the R Series EtCO2 option for proper operation.
If an alarm condition occurs while the alarms are suspended, the suspended alarm indications
will only be visual displays and symbols. No audio alarm indications will occur.
Elevated oxygen levels, nitrous oxide, or halogenated agents contained in the breathing gases
may degrade the accuracy of measurements made with the R Series EtCO2 option. Activate
oxygen compensation if O2 levels in excess of 60% are introduced. Activate N2O compensation
if nitrous oxide is introduced into the airway circuit.
Do not use the LoFlo module on patients who cannot tolerate the removal of 50ml/min of
breathing gases from the airway.
The presence of Desflurane beyond 5% may positively bias the carbon dioxide reading by up to
3 mmHg. The presence of Xenon in the exhaled breath may negatively bias the reading by up to
5 mmHg.
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Safety Considerations
Carefully route patient cabling to reduce the possibility of patient entanglement or
strangulation.
Do not touch the bed, patient, or any equipment connected to the patient during defibrillation.
A severe shock can result. Do not allow exposed portions of the patient’s body to come in
contact with metal objects, such as a bed frame, as unwanted pathways for defibrillation current
may result.
CAPNOSTAT 5 and Accessories
Always ensure the integrity of the patient breathing circuit after insertion of the airway adapter
by verifying a proper CO2 waveform (capnogram) on the monitor display.
Do not use CAPNOSTAT 5 or LoFlo sensors in the presence of flammable anesthetics or other
flammable gases.
Do not attempt to open the sensor. An electrical shock hazard exists internally. Refer servicing
to qualified personnel.
Do not operate the sensor when it is wet or has exterior condensation.
Cautions
CAUTION: Federal (U.S.A.) law restricts this device to sale, or use by or on the order of a
licensed medical practitioner.
Use only ZOLL/Respironics Novametrix CAPNOSTAT 5 sensors and LoFlo modules, airway
adapters, nasal and nasal/oral cannula sets with the R Series EtCO2 option.
The device is protected against interference from radio frequency emissions typical of two-way
radios and cellular phones (digital and analog) used in emergency service/public safety
activities. Users should assess the device’s performance in their typical environment of use for
the possibility of radio frequency interference from high-power sources. Radio Frequency
Interference (RFI) may be observed as shifts in monitor baseline, trace compression, display
brightness changes or transient spikes on the display.
Do NOT sterilize or immerse the CAPNOSTAT 5 CO2 sensor or LoFlo module.
Do NOT reuse, disassemble, sterilize, disinfect, or clean the disposable airway adapter, airway
adapter with mouthpiece, CAPNO2mask, nasal or or nasal/oral sampling cannula sets, as
system performance will be compromised. These items are intended for single patient use only.
Do NOT use a damaged sensor or airway adapter.
Do NOT use the device if it fails to operate properly.
Do NOT place the mainstream or sidestream airway adapters between the ET tube and the
breathing circuit elbow, as this may cause patient secretions to accumulate in the adapter.
Position airway adapters with windows in a vertical, NOT a horizontal, position. This helps
keep patient secretions from pooling on the windows.
Do NOT insert any object other than the sample cell into the sample cell receptacle on the
LoFlo module.
Remove the LoFlo sample cell from the sample cell receptacle when not in use.
Clean or replace the airway adapter if excessive secretions are observed.
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
ZOLL Medical Corporation recommends that the airway adapter be removed from the circuit
whenever aerosolized medication is delivered. The increased viscosity of the medications may
contaminate the adapter windows, requiring premature cleaning or replacement of the adapter.
In order to eliminate the potential build up of CO2 inside the storage bag, ensure that the LoFlo
module exhaust tube vents gases away from the module environment.
To avoid injury to the patient, remove the nasal/oral cannula from the patient before cutting the
oral cannula tip.
Do NOT apply tension to the sensor cable.
Periodically inspect the sampling tubing for the absence of kinks.
Monitor the capnogram for an elevated baseline. If an elevated baseline is observed, verify
patient condition first. If the caregiver determines that the patient condition is not contributing
to the elevated baseline, follow the instructions for zeroing the sensor or module detailed in this
manual.
Do NOT store sensors, modules, airway adapters, or cannula sets at temperatures less than
-40° C or greater than 70° C.
Do not operate CAPNOSTAT sensors at temperatures less than 0° C or greater than 45° C. Do
not operate LoFlo modules at temperatures less than 0° C or greater than 40° C.
Do not use the LoFlo module on R Series units that have a software version lower than 12.xx.
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EtCO2 Intended Use
EtCO Intended Use
2
The ZOLL R Series EtCO2 option with Respironics Novametrix technology is intended to be
used for continuous noninvasive monitoring of end tidal carbon dioxide (EtCO2) and
respiration rate in patients requiring ventilator support, in-hospital transport, or anesthesia. The
R Series EtCO2 option with Respironics Novametrix technology supports two methods for
continuous measurement of end tidal carbon dioxide (EtCO2) and respiration rate.
The first method uses the CAPNOSTAT 5 Mainstream CO2 sensor attached to an airway adapter
that connects to an endotracheal tube, mask or disposable mouthpiece.
The second method uses the LoFlo CO2 module to monitor both non-intubated and intubated
patients using specially designed sampling cannulas and airway adapters.
The R Series EtCO2 option is designed to monitor adult, pediatric, and neonatal patients.
The following substances can influence CO2 measurements made with the CAPNOSTAT 5 CO2
sensor:
elevated oxygen levels
• nitrous oxide
• halogenated agents
•
The R Series EtCO2 option provides settings for high oxygen and/or nitrous oxide
compensation. Halogenated anesthetic agents alter CO2 readings, but the R Series unit will
monitor CO2 within specifications when these agents are present at normal clinical levels. The
presence of Desflurane in the exhaled breath beyond normal values (5%) may positively bias
measured carbon dioxide values by up to an additional 3 mmHg.
The R Series EtCO2 option is intended for use only with the ZOLL/Respironics Novametrix
CAPNOSTAT 5 Mainstream CO2 Sensor and mainstream airway adapters, the LoFlo CO2
Module, nasal and nasal/oral sampling cannula sets, and sidestream on-airway adapters.The
R Series EtCO2 option can be used on adult patients (21 years of age and older) and on pediatric
patients, as described in the following table:
Pediatric Subpopulation
Approximate Age Range
Newborn (neonate)
Birth to 1 month of age
Infant
1 month to 2 years of age
Child
2 to 12 years of age
Adolescent
12-21 years of age
Mainstream EtCO2 Setup
There are several steps involved with mainstream EtCO2 setup. These steps include:
• Attaching the CAPNOSTAT sensor cable.
• Selecting a mainstream airway adapter.
• Attaching the airway adapter to the CAPNOSTAT sensor.
• Zeroing the CAPNOSTAT sensor/airway adapter.
• Attaching the airway adapter to the airway circuit.
• Applying an airway adapter with mouthpiece.
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
Attaching the CAPNOSTAT 5 CO2 Sensor Cable
To attach the CAPNOSTAT 5 CO2 sensor cable, plug the cable’s connector into the yellow CO2
connector at the back of the R Series unit by matching the key on the cable to the key on the
connector (Figure 1).
Proper Grasp
Improper Grasp
Figure 1
Note:
To remove the sensor cable from the R Series unit, grasp the collar surrounding the
cable’s R Series connector and pull up.
Selecting a Mainstream Airway Adapter
Select an airway adapter based on the patient’s ET tube diameter and monitoring situation. For
more information refer to the following table or contact ZOLL Medical Corporation.
Airway Adapter Type
ET Tube Diameter
SPU* Pediatric/Adult
> 4.0 mm
Adult Reusable
> 4.0 mm
SPU* Neonatal/Pediatric
4.0 mm
Neonatal Reusable
4.0 mm
*SPU = Single Patient Use
Attaching the Airway Adapter to the CAPNOSTAT 5 CO2 Sensor
Before attaching the airway adapter to the CAPNOSTAT 5 CO2 sensor, verify that the airway
adapter windows are clean and dry. Clean or replace the adapter if necessary.
Caution
The disposable (SPU) Pediatric/Adult and the Neonatal/Pediatric airway adapters are intended
for single patient use. Do NOT reuse or sterilize these adapters as system performance will be
compromised.
Attach the airway adapter to the CAPNOSTAT sensor, as follows:
1. Align the arrow on the bottom of the airway adapter with the arrow on the bottom of the
sensor.
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Mainstream EtCO2 Setup
2. Press the sensor and airway adapter together until they click.
3. Turn the Selector switch on the R Series unit to MONITOR (ON for BLS/Plus units, and
select Manual mode).
4. Wait for the airway adapter and sensor to warm up.
The unit will display the CO2 WARM UP message for approximately one minute while the
sensor and adapter warm to operating temperature. The message disappears when the sensor
is ready to use.
Note:
Warm up time varies with ambient temperature of the sensor.
5. If the unit displays the CHECK CO2 ADAPTER message, follow steps a through c.
a. Verify proper connection of the adapter to the sensor.
b.Verify that the airway adapter windows are clean and dry.
c.If the adapter is properly connected, and the windows are clean and dry, then zero the
adapter as described in the next section, “Zeroing the Mainstream CAPNOSTAT 5 CO2
Sensor/Airway Adapter.”
Zeroing the Mainstream CAPNOSTAT 5 CO2 Sensor/Airway Adapter
Note:
Do not zero the CAPNOSTAT without an airway adapter installed.
Adapter zeroing compensates for the optical differences between airway adapters and should be
performed at certain times. Zeroing is recommended after switching between single patient use
and reusable airway adapters, in order to obtain accurate readings. It is also recommended the
first time a particular CAPNOSTAT 5 CO2 sensor is connected to the unit.
1. Place the sensor with the adapter installed away from all sources of CO2 (including the
patient’s – and your own – exhaled breath and ventilator exhaust valves).
2. Press the Param softkey, then the CO2 softkey.
3. Press the Zero softkey.
The unit zeroes the adapter and displays the ZEROING CO2 ADAPTER message for 15 to
20 seconds.
The unit displays the message ZERO DONE upon completion of the zeroing.
Note:
Do not attempt zeroing for 20 seconds after removing the adapter from the patient’s
airway. This time allows any CO2 remaining in the adapter to dissipate before zeroing.
Do not attempt to zero the adapter while it is connected to the patient’s airway. Zeroing
with CO2 in the adapter can lead to inaccurate measurement and/or other error
conditions. If you attempt zeroing while CO2 remains in the adapter, the time required
to zero the adapter may be increased. If zeroing cannot be completed, the message
ZERO FAILED will be displayed. If this occurs, clear any occlusion in the adapter,
remove any source of CO2, wait 20 seconds, and try zeroing again.
Attaching the Airway Adapter to the Airway Circuit
If you have not yet done so, you must attach the airway adapter to the CAPNOSTAT 5 CO2
sensor before attaching the breathing adapter to the airway circuit. Refer to “Attaching the
Airway Adapter to the CAPNOSTAT 5 CO2 Sensor” on page 6 if necessary.
Attach the airway adapter to the breathing circuit as follows:
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
1. Place the CAPNOSTAT 5 CO2 sensor/airway adapter assembly between the elbow and the
ventilator circuit wye, as shown in Figure 2.
Note:
Do NOT place the airway adapter between the ET tube and the elbow, as this may
allow patient secretions to accumulate in the adapter.
Position the airway adapter with its windows in a vertical, NOT a horizontal, position. This
helps keep patient secretions from pooling on the windows. If pooling does occur, the
airway adapter may be removed from the circuit, rinsed with water and reinserted into the
circuit. To prevent moisture from draining into the airway adapter, do NOT place the
airway adapter in a gravity dependent position.
CAPNOSTAT
CO2 Sensor
Ventilator Wye
Reusable Adult
Airway Adapter
To Patient
Figure 2
2. Check that connections have been made correctly by verifying the presence of a proper CO2
waveform on the R Series display.
3. The sensor cable should face away from the patient.
Applying an Airway Adapter with Mouthpiece
The disposable Pediatric/Adult airway adapter with mouthpiece can be used for spot checking
CO2 on non-intubated adult or pediatric patients.
Caution
The disposable Pediatric/Adult Airway Adapter with mouthpiece is intended for single patient
use. Do NOT reuse or sterilize the adapter, as system performance will be compromised.
1. Remove adapter with mouthpiece from the package. Verify that the adapter and mouthpiece
are intact and securely fastened to each other.
2. Attach the airway adapter to the CAPNOSTAT 5 CO2 sensor, as follows:
a. Align the arrow on the bottom of the airway adapter with the arrow on the bottom of the
CAPNOSTAT sensor.
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Sidestream EtCO2 Setup
b.Press the sensor and airway adapter together until they click (see Figure 3).
CAPNOSTAT
CO2 Sensor
Mouthpiece
Airway
Adapter
To Patient
Figure 3
3. If the unit displays the CHECK CO2 ADAPTER message, follow steps a through c, then go
to step 4.
a. Verify proper connection of the adapter to the sensor.
b.Verify that the airway adapter windows are clean and dry.
c.If the adapter is properly connected, and the windows are clean and dry, then zero the
adapter as described in “Zeroing the Mainstream CAPNOSTAT 5 CO2 Sensor/Airway
Adapter” on page 7.
4. Ensure the patient seals his or her mouth completely around the mouthpiece and breathes
normally.
A nose clip may be needed if the patient is exhaling through the nose. It is important that all, or
most, of the exhalation be routed through the airway adapter.
Sidestream EtCO2 Setup
There are several steps involved with sidestream EtCO2 setup. These steps include:
• Attaching the LoFlo Module Cable
• Selecting a Sidestream Airway Adapter Kit or Cannula
• Inserting the Sample Cell
• Zeroing the LoFlo CO2 Module/Sample Cell
• Applying a Sidestream Airway Adapter Kit
• Applying a Nasal or Nasal/Oral Cannula
Attaching the LoFlo Module Cable
To attach the LoFlo module cable, plug the cable into the yellow CO2 connector at the back of
the R Series unit by matching the key on the cable to the key on the connector.
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
Proper Grasp
Improper Grasp
Figure 4
To remove the sensor cable from the R Series unit, grasp the collar surrounding the cable’s
R Series connector and pull up.
Selecting a Sidestream Airway Adapter Kit
Select an airway adapter kit based on the patient’s size, ET tube diameter, and monitoring
situation. Airway adapter kits are disposable and single patient use.
Airway Adapter Kit
ET Tube Diameter
Adult/Pediatric Airway Adapter Kit
> 4.0 mm
Adult/Pediatric Airway Adapter Kit with Nafion® tubing
4.0 mm
Pediatric/Infant Airway Adapter Kit
Pediatric/Infant Airway Adapter Kit with Nafion tubing
Note:
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For monitoring times exceeding 6 hours, Nafion tubing is recommended.
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Sidestream EtCO2 Setup
Selecting a Sidestream Cannula
Select a sidestream cannula based on the patient’s size and monitoring situation. Nasal and
nasal/oral cannulas are disposable and single patient use.
Cannula
Application
Nasal CO2 Sampling Cannula, Adult
Nasal CO2 sampling only
Nasal CO2 Sampling Cannula, Pediatric
Nasal CO2 Sampling Cannula, Infant
Oral/Nasal CO2 Sampling Cannula, Adult
Oral/Nasal CO2 sampling only
Oral/Nasal CO2 Sampling Cannula, Pediatric
Nasal CO2 Sampling with O2 Delivery Cannula, Adult
Nasal CO2 sampling with oxygen delivery
Nasal CO2 Sampling with O2 Delivery Cannula, Pediatric
Oral/Nasal CO2 Sampling with O2 Delivery Cannula, Adult
Oral/Nasal CO2 sampling with oxygen delivery
Oral/Nasal CO2 Sampling with O2 Delivery Cannula, Pediatric
Inserting the Sample Cell
Follow these steps:
1. Remove the LoFlo sampling cannula or airway adapter kit from the package.
2. Insert the LoFlo sample cell into the LoFlo sample cell receptacle and ensure that it clicks
into place.
Exhaust
Tube
Module Cable
Sample Cell
Receptacle
LoFlo C5 Module
LoFlo Module
Figure 5
3. Ensure that the LoFlo module exhaust tube vents gases away from the module environment.
4. Turn the selector switch on the R Series to MONITOR (ON for BLS/Plus units).
5. Wait for the CO2 module to warm up.
The unit will display the WARM UP message for approximately one minute while the
module warms up to operating temperature. The message disappears when the module is
ready for use.
Note:
Warm up time varies with ambient temperature of the module.
Zeroing the LoFlo CO2 Module/Sample Cell
The module/sample cell zero allows the LoFlo CO2 module to adjust to the optical
characteristics of the sample cell. While zeroing is recommended the first time a particular
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
LoFlo module is connected to the unit, it is only absolutely necessary when the message ZERO
CO2 MODULE is displayed.
Caution
Always ensure that the sample cell is properly connected to the LoFlo module before zeroing.
1. Ensure that the nasal cannula or on-airway adapter is not connected to the patient or close to
any source of CO2 (including the patient’s—and your own—exhaled breath and ventilator
exhaust valves).
2. Press the Param. softkey and then the CO2 softkey, then press Enter.
3. Press the Zero softkey.
The unit zeroes the module and displays the ZEROING CO2 MODULE message for
approximately 15-20 seconds.
The units displays the message ZERO DONE upon completion of the zeroing.
Note:
Do not attempt zeroing for 20 seconds after removing the adapter or cannula from the
patient’s airway. This time allows any CO2 remaining in the adapter or cannula to
dissipate before zeroing. Do not attempt to zero the module while the adapter or
cannula is in the patient’s airway. Zeroing with CO2 in the adapter or cannula can lead
to inaccurate measurements and/or other error conditions. If you attempt zeroing while
CO2 remains in the adapter or cannula, the time required to zero the module may be
increased. If zeroing cannot be completed, the message “ZERO FAILED” will be
displayed. If this occurs, clear any occlusion in the adapter or cannula, remove the
source of CO2, wait 20 seconds, and try zeroing again.
Applying a Sidestream Airway Adapter Kit
The sidestream airway adapter kit is intended for monitoring the EtCO2 of intubated patients.
Before attaching the airway adapter to the breathing circuit, verify that the adapter is clean, dry,
and undamaged. Replace if necessary.
Caution
The disposable (SPU) Adult/Pediatric and Pediatric/Infant airway adapter kits are intended for
single patient use. Do NOT reuse or sterilize these adapters as system performance will be
compromised.
1. Attach the airway adapter kit’s sample cell to the sample cell receptacle on the LoFlo
module, and ensure that it clicks into place.
2. If the unit displays either of the following messages take the appropriate action.
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If you see this message:
Take this action:
CHECK CO2 LINE
Verify that the sample cell is plugged into the module and seated
properly.
Verify that neither the sample line nor the exhaust tube are blocked,
kinked, or pinched. Verify that the airway adapter is not blocked. If
the sample line, exhaust tube, or the airway adapter is blocked or
otherwise compromised for 15 seconds, this message will appear.
The pump will shut off after 2 minutes if the condition that caused the
message is not cleared. To restart the pump, correct the blockage,
then remove and reinsert the sample cell into the sample cell
receptacle.
If the problem persists, replace the sample line.
CHECK CO2 MODULE
Check that module cable is plugged in and seated properly.
Check that module is not exposed to excessive heat.
If problem persists, replace module.
3. Place the airway adapter assembly at the proximal end of the airway circuit between the
elbow and the ventilator circuit wye. Do NOT place the airway adapter between the ET tube
and the elbow as this may allow patient secretions to accumulate in the adapter.
If pooling does occur, the airway adapter may be removed from the circuit, rinsed with
water and reinserted into the circuit. To prevent moisture from draining into the sample
tubing, ensure that the sampling tube exits from the top of the airway adapter, not its bottom
or sides. See Figure 6.
Sampling Tube
Figure 6
4. Check that connections have been made correctly by verifying the presence of a proper
capnogram on the R Series display.
Applying a Nasal or Nasal/Oral Cannula
The nasal and nasal/oral cannulas are intended for monitoring EtCO2 in non-intubated patients.
Oral/nasal sampling cannulas should be used on patients who are prone to mouth breathing,
since most (if not all) of the CO2 is exhaled through the mouth. If a standard nasal CO2 sampling
cannula is used on such patients, the EtCO2 values and capnogram displayed will be
substantially lower than the actual CO2 levels present in the patient’s expired breath.
Caution
The disposable nasal and nasal/oral cannula sets are intended for single patient use. Do NOT
reuse or sterilize the cannula, as system performance will be compromised.
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1. Remove the cannula from the package. Verify that the cannula is clean, dry, and undamaged.
Replace if necessary.
2. Attach the cannula’s sample cell to the sample cell receptacle on the LoFlo module, and
ensure that it clicks into place.
3. If the unit displays either of the following messages take the appropriate action.
If you see this message:
Take this action:
CHECK CO2 LINE
Verify that the sample cell is plugged into the module and seated
properly.
Verify that neither the sample line nor the exhaust tube are blocked,
kinked, or pinched. If the sample line, or exhaust tube is blocked or
otherwise compromised for 15 seconds, this message will appear.
The pump will shut off after 2 minutes if the condition that caused the
message is not cleared. To restart the pump, correct the blockage,
then remove and reinsert the sample cell into the sample cell
receptacle.
If the problem persists, replace the sample line.
CHECK CO2 MODULE
Check that module cable is plugged in and seated properly.
Check that module is not exposed to excessive heat.
If problem persists, replace module.
4. Place the nasal cannula onto the patient as shown in Figure 7.
Figure 7
5. Place the oral/nasal cannula onto the patient as shown in Figure 8.
Figure 8
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Cleaning the CAPNOSTAT 5 CO2 Sensor and LoFlo Module
Cleaning the CAPNOSTAT 5 CO2 Sensor and
LoFlo Module
The outside of the sensor or module may be cleaned and disinfected by wiping with 70%
isopropyl alcohol, a 10% bleach solution, or mild soap.
After cleaning, wipe with a clean, water-dampened cloth to rinse. Dry before use.
Cleaning Reusable Airway Adapters
Reusable airway adapters may be cleaned by rinsing in a warm soapy solution, followed by
soaking in a liquid disinfectant such as 70% isopropyl alcohol, a 10% bleach solution, Cidex®
or System 1® (refer to the disinfectant manufacturer’s instructions for use). Adapters should
then be rinsed with sterile water and dried.
The adult reusable airway adapter may be autoclaved at 121° C (250°F) for 20 minutes,
unwrapped.
Note:
The Neonatal reusable airway adapter cannot be autoclaved.
Before reusing the adapter, ensure the windows are dry and residue-free, and that the adapter
has not been damaged during handling or by the cleaning process.
How EtCO2 is Displayed
The R Series unit displays the numeric EtCO2 value in units of mmHg, unless configured for
percent or kPa. Refer to the R Series Configuration Guide (Part No. 9650-1201-01) for
instructions on how to configure alternate units of measure. The unit also displays the number
of breaths per minute, labeled “RR” for respiration rate. In addition, a capnogram may be
displayed using the Trace 2 or Trace 3 softkey.
Displaying the Capnogram Waveform
The R Series unit can display 1, 2 or 3 waveforms in Monitor, Defib, or Manual (BLS/Plus
models) mode, as long as the defibrillator is not charging or ECG analysis is not in progress.
The unit displays only 1 or 2 waveforms in Pacer mode.
Note:
9650-0915-01 Rev. D
If you don’t see the CO2 display box on the monitor, check the sensor cable connection
to the R Series unit. The CO2 display box is not displayed if the sensor is not
connected to the unit. Once the box is displayed, after power-on, it remains displayed
even if the sensor is disconnected from the unit.
R Series End-Tidal Carbon Dioxide (EtCO2)
15
Page 20
R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
With EtCO2 monitoring, the unit can display a capnogram below the ECG trace for a visual
indicator of the moment-by-moment CO2 values. The unit displays the capnogram at half the
speed of the ECG display, and provides 8 or 10 seconds of data, depending on the setup.
SpO2%
CPR
IDLE
0:00
x1
PADS
Depth
Rate
99
ECG
Ɔ
PPI
72
NIBP mmHg
----ECG
--CO2
RR
mmHg
35
13
50
CO2
0
MONITOR
11:24
Options
Param
Code
Marker
Report
Data
Alarms
The unit removes the third waveform from the display when the user presses the CHARGE,
ANALYZE, or ENERGY SELECT buttons, or the Sync On/Off softkey.
To cycle the display from the capnogram to other waveforms (SpO2, CPR, or Filt ECG) press
the Options softkey, then the Traces softkey. Select Trace 2 or Trace 3 and then the desired
waveform. Press Off to remove any additional waveforms.
Use the Zoom softkey from the EtCO2 submenu to adjust the waveform display size. Numbers
shown on the left side of the capnogram display indicate the scaling.
Physiological Monitoring
The physiological monitoring menu includes the following softkeys: Options, Param, Code
Marker, Report Data, and Alarms.
Param Softkey
When you press the Param softkey, the following softkeys are displayed: ECG, SpO2, NIBP,
CO2, and Return.
Note:
ECG
SpO2, NIBP, and CO2 will only appear if these options are installed on your unit.
SpO2
NIBP
CO2
Return
Press the Return softkey to return to the physiological monitoring menu.
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9650-0915-01 Rev. D
Page 21
Physiological Monitoring
Selecting the CO2 parameter causes the following softkeys to appear: Zero, Average, Comp.,
Zoom, Disable EtCO2 (or Enable EtCO2), and Return.
RR Filter/
Zero Average Comp.
Zoom
Disable
EtCO2 Return
The Zoom softkey will only appear if a capnogram is currently displayed.
Pressing the Disable EtCO2 softkey puts the sensor into the power saving sleep mode.
Pressing Enable EtCO2 softkey takes the sensor out of sleep mode and turns the heater on for
normal operation.
Press the Return softkey to return to the physiological monitoring menu.
Zero Softkey
Adapter zeroing should be performed whenever you switch between reusable and disposable
adapters, or if a CAPNOSTAT 5 CO2 sensor is being connected to the unit for the first time.
Module zeroing may be necessary if the unit displays the message ZERO CO2 MODULE.
Adapter zeroing may also be necessary if the unit displays ZERO CO2 ADAPTER.
Note:
Do not attempt zeroing for 20 seconds after removing the adapter or cannula from the
patient’s airway. This time allows any CO2 remaining in the adapter or cannula to
dissipate before zeroing. Do not attempt to zero while the adapter or cannula is in the
patient’s airway. Zeroing with CO2 in the adapter or cannula can lead to inaccurate
measurements and/or other error conditions. If you attempt zeroing while CO2 remains
in the adapter or cannula, the time required to zero may be increased. If zeroing cannot
be completed, the message ZERO FAILED will be displayed. If this occurs, clear any
occlusion in the adapter or cannula, remove any source of CO2, wait 20 seconds, and
try zeroing again.
Press the Zero softkey to initiate adapter or module zeroing.
The unit displays the ZEROING CO2 ADAPTER or ZEROING CO2 MODULE message during
the zeroing process, which is typically finished in 15-20 seconds.
The unit displays the ZERO DONE message when the zeroing process is complete.
The unit displays the ZERO FAILED message if the zeroing process did not complete
successfully. If this occurs, clear any occlusion in the adapter or sample line, remove any source
of CO2, and try zeroing again.
Press the Return softkey to return to the main menu.
Zoom Softkey
The Zoom softkey will only appear if a capnogram is currently displayed. Select the full scale
range for the displayed capnogram by scrolling among the different zoom levels. Zoom levels
change with each press of the Zoom softkey. They are as follows:
• 0-12.5 mmHg
• 0-25 mmHg
• 0-50 mmHg
• 0-75 mmHg
9650-0915-01 Rev. D
R Series End-Tidal Carbon Dioxide (EtCO2)
17
Page 22
R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
• 0-100 mmHg
• 0-150 mmHg
If the unit is using kPa or %, the scales are 0-1.7, 0-3.3, 0-6.6, 0-10, 0-13.3, and 0-20.0. (Refer
to the R Series Configuration Guide for instructions on how to configure alternate units of
measure.)
Average Softkey
The R Series unit provides 3 different time periods over which EtCO2 values are averaged: 1
breath, 10 seconds (default), and 20 seconds.
The user can select the averaging period by pressing the Average softkey. When the Average
softkey is pressed, the unit displays the selections.
1 breath 10 secs 20 secs
RR Filter
Enable Return
Press the 1 breath, 10 secs or 20 secs softkey for the desired time period.
RR Filter Enable/Disable
The respiration rate filter makes respiration rate counting more accurate in the presence of
artifact, and is only valid when the LoFlo module is in use. Pressing the:
• RR Filter Enable softkey turns the respiration rate filter on.
• RR Filter Disable softkey turns the respiration rate filter off.
Note that when the RR filter is in use, the R Series adapts more slowly to sudden changes in
respiratory rate.
Press the Return softkey to return to the main menu.
Comp. Softkey
The R Series unit can compensate for elevated levels of oxygen and/or the presence of nitrous
oxide. Oxygen compensation should be activated when oxygen levels in excess of 60% are
present in the airway circuit. Nitrous oxide compensation should be activated when nitrous
oxide is present in the airway circuit. If the concentration of oxygen in the breathing circuit
exceeds 60% and nitrous oxide is in use, both O2 and N2O should be activated.
When the Comp softkey is pressed, the unit displays the None, O2, N2O, O2&N2O, and
Return softkeys.
None
O2
N2O
O2&N2O
Return
The O2 selection turns oxygen compensation on and displays an asterisk in the upper left of the
CO2 box. The N2O selection turns nitrous oxide compensation on and displays an asterisk (*)
to the right of the O2 asterisk. The None selection turns all compensations off and eliminates
the asterisks from the display.
The O2&N2O selection turns oxygen and nitrous oxide compensation on. The unit displays two
asterisks (* *) in the upper left of the CO2 box to indicate compensation for both oxygen and
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9650-0915-01 Rev. D
Page 23
Alarms
nitrous oxide. The left asterisk indicates oxygen compensation is active and the right asterisk
indicates nitrous oxide compensation is active.
Press the Return softkey to return to the main menu.
Alarms
The R Series EtCO2 option provides user programmable “out-of-range” alarms for both EtCO2
and respiration rate.
Note:
The EtCO2 and respiration rate alarms cannot be enabled or disabled separately.
Enabling the EtCO2 alarms enables both EtCO2 and respiration rate alarm functions;
disabling EtCO2 or respiration rate alarms disables both functions. See the R Series
Operator’s Guide for details on enabling, disabling, and suspending alarm functions on
the R Series unit.
When the EtCO2 and respiration rate alarm states are set to AUTO, the unit automatically sets
the lower and upper limits for EtCO2 and respiration rate. The unit sets the upper and lower
alarm limits to +/- 25% of the patient’s currently measured CO2 value. If the EtCO2 value is
greater than 40 mmHg (equivalent to 5.3 kPa or 5.3% at a barometric pressure of 760 mmHg),
then 10 mmHg (1.3 for kPa or %) is added and subtracted from the current reading to set the
upper and lower limits. The auto alarm limits are set only if valid measurements are present for
the vital sign.
For the automatic respiration rate alarm limits, the unit sets the upper and lower limits for
respiration by adding and subtracting the values shown in the following table to/from the
patient's current breath rate.
Respiration Limits (Auto)
Respiration Rate
Average
High Limit
Low Limit
1-15 breaths/min.
+7 breaths/min.
-50% value
16-40 breaths/min. +10 breaths/min. -7 breaths/min.
> 40 breaths/min.
+15 breaths/min. -10 breaths/min.
See “Default Settings” on page 21 for low and high alarm limit default values and ranges.
Recorder Operation
If EtCO2 measurements have been taken, press the RECORDER button to print a stripchart that
includes the following values across the top part of the paper:
• Date and time
• ECG lead and size
• Heart rate
• EtCO2 value
• Respiration rate
The recorder runs continuously until the button is pressed again. If selected, the capnogram is
also printed at a fixed scale of 40 mmHg/cm or 5.3 kPa/cm. All waveforms printed by the
recorder are delayed by 6 seconds relative to their occurrence.
9650-0915-01 Rev. D
R Series End-Tidal Carbon Dioxide (EtCO2)
19
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
Check Out Procedures
The following procedures verify that the EtCO2 option is functioning properly.
Mainstream EtCO2 (CAPNOSTAT 5 CO2 Sensor)
1. Connect the CAPNOSTAT 5 CO2 sensor cable to the yellow EtCO2 connector at the back of
the R Series unit.
2. Connect an airway adapter to the CAPNOSTAT 5 CO2 sensor.
3. Turn the selector switch to MONITOR mode (ON for BLS/Plus units and select Manual
mode).
If the CO2 box displays DISABLED, enable the sensor by pressing the Param softkey, then
the CO2 softkey, then the Enable EtCO2 softkey.
4. Wait for the CO2 sensor to warm up. The message CO2 WARM UP is displayed for
approximately one minute.
5. Perform a zero procedure if necessary (see “Zeroing the Mainstream CAPNOSTAT 5 CO2
Sensor/Airway Adapter” on page 7).
6. Breath normally into the adapter.
7. Verify that the unit displays appropriate readings in the EtCO2 display area of the monitor.
8. With alarms enabled, verify that the patient alarms are functional by adjusting the high and
low limits until the unit:
• Emits a continuous audio tone.
• Highlights the alarming parameter’s value and flashes the alarm symbol on the display.
Sidestream EtCO2 (LoFlo Module)
Use an Adult/Pediatric Airway Adapter kit when performing this procedure.
1. Connect the LoFlo module cable to the EtCO2 connector at the back of the R Series unit.
2. Insert the sample cell into the LoFlo module sample cell receptacle.
3. Turn the selector switch to MONITOR mode (ON for BLS/Plus units and select Manual
4.
5.
6.
7.
8.
20
Mode), and wait approximately one minute while the module warms to operating
temperature (unit displays WARM UP message).
Perform a zero procedure if necessary (see “Zeroing the LoFlo CO2 Module/Sample Cell”
on page 11).
Breath normally into the adapter.
Verify that the unit displays EtCO2 readings in the EtCO2 display area of the monitor.
Verify the capnogram is displayed by pressing the Options softkey, then the Traces softkey.
With alarms enabled, verify that the patient alarms are functional by adjusting the high and
low limits until the unit:
• Emits a continuous audio tone.
• Highlights the alarming parameter’s value and flashes the alarm symbol on the display.
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9650-0915-01 Rev. D
Page 25
Default Settings
Default Settings
When the unit is turned on, the following default EtCO2 settings are automatically
selected and remain in operation until changed.
Parameter
Default Setting
Range
Averaging Mode
10 seconds
1 breath
10 seconds
20 seconds
High EtCO2 Alarm Limit
55 mmHg
7.2%
7.3 kPa
5 - 100 mmHg, OFF
0.6 - 13.1%, OFF
0.6 -13.3 kPa, OFF
Low EtCO2 Alarm Limit
25 mmHg
3.2%
3.3 kPa
0 - 95 mmHg, OFF
0 - 12.5%, OFF
0 -12.6 kPa, OFF
High Respiration Rate Alarm Limit
120 respirations per minute
5 - 150 respirations per minute, OFF
Low Respiration Rate Alarm Limit
5 respirations per minute
0 - 100 respirations per minute, OFF
Note:
The power-on default settings for the capnogram waveform scale and
CO2 compensation are set in System Configuration, as are the power-on
default settings for alarm limits. See the R Series Configuration Guide
for more information.
EtCO2 Accessories
The following table lists the accessories available for the R Series mainstream
EtCO2 monitoring option.
Table 1-1.
CAPNOSTAT 5 Mainstream CO2 Accessories
Accessory
REF
Application
CAPNOSTAT 5 CO2 Sensor and Cable
8000-0312-01
Reusable
SPU* Pediatric/Adult Airway Adapter
8000-0260-01
Single patient use, for ET tube sizes
> 4.0 mm
SPU* Neonatal/Pediatric Airway Adapter
8000-0261-01
Single patient use, for ET tube sizes
< 4.0 mm
Reusable Adult Airway Adapter
8000-0262-01
Reusable, for ET tube sizes > 4.0 mm
Reusable Neonatal/Pediatric Airway Adapter
8000-0263-01
Reusable, for ET tube sizes < 4.0 mm
SPU Pediatric/Adult Airway Adapter with
Mouthpiece
8000-0265-01
Single patient use, for non-intubated patients
CAPNO2mask, Large Adult
8000-0761
SPU, for non-intubated large adults
CAPNO2mask, Standard Adult
8000-0760
SPU, for non-intubated adults
CAPNO2mask, Pediatric
8000-0762
SPU, for non-intubated adults pediatric
patients
*
* SPU = Single Patient Use
9650-0915-01 Rev. D
R Series End-Tidal Carbon Dioxide (EtCO2)
21
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R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
Table 1-2.
LoFlo Sidestream CO2 Accessories
Accessory
REF
Application
LoFlo Module and Cable
8000-0367
Nasal CO2 Sampling Cannula, Adult
8000-0351
SPU, Nasal CO2 sampling only (adult)
Nasal CO2 Sampling Cannula, Pediatric
8000-0352
SPU, Nasal CO2 sampling only (pediatric)
Nasal CO2 Sampling Cannula, Infant
8000-0353
SPU, Nasal CO2 sampling only (neonate)
Oral/Nasal CO2 Sampling Cannula, Adult
8000-0354
SPU, Oral/Nasal CO2 sampling only (adult)
Oral/ Nasal CO2 Sampling Cannula, Pediatric
8000-0355
SPU, Oral/Nasal CO2 sampling only
(pediatric)
Nasal CO2 Sampling with O2 Delivery Cannula,
Adult
8000-0356
SPU, Nasal CO2 sampling with O2 delivery
(adult)
Nasal CO2 Sampling with O2 Delivery Cannula,
Pediatric
8000-0357
SPU, Nasal CO2 sampling with O2 delivery
(pediatric)
Oral/Nasal CO2 Sampling with O2 Delivery
Cannula, Adult
8000-0358
SPU, Oral/Nasal CO2 sampling with O2
delivery (adult)
Oral/Nasal CO2 Sampling with O2 Delivery
Cannula, Pediatric
8000-0359
SPU, Oral/Nasal CO2 sampling with O2
delivery (pediatric)
Adult/Pediatric Airway Adapter Kit
8000-0362
SPU, for ET tube sizes > 4.0 mm
Adult/Pediatric Airway Adapter Kit with Nafion
tubing
8000-0363
SPU, for ET tube sizes > 4.0 mm
Pediatric/Infant Airway Adapter Kit
8000-0361
SPU, for ET tube sizes 4.0 mm
Pediatric/Infant Airway Adapter Kit with Nafion
tubing
8000-0364
SPU, for ET tube sizes 4.0 mm
* SPU = Single Patient Use
•
•
•
•
•
5,146,092
5,153,436
5,369,277
5,616,923
5,793,044
Note:
Components of this product and its associated EtCO2 accessories that
make patient contact are free of latex.
Note:
The CAPNOSTAT 5 and its accessories are covered by the following US
patents:
D490,332
• 7,004,168
D501,802
• 7,059,322
5,693,944
• 7,121,134
6,935,338
• 7,291,851
6,954,702
• 7,294,839
•
•
•
•
•
Other patents pending.
22
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9650-0915-01 Rev. D
Page 27
Messages and Troubleshooting
Messages and Troubleshooting
The following three tables list the messages that may appear on the R Series unit,
possible causes, and the action(s) to take if the message indicates a problem. You
should become thoroughly familiar with this information before monitoring
patients.
COMMON MESSAGES
Message/Symptom
Possible Cause(s)
Recommended Action(s)
----- (dashed lines in
EtCO2 field)
After a defibrillation discharge, the numeric
None, normal operation.
value displays as “----” for up to 10 seconds.
When the respiration rate is zero, the
numeric CO2 value will display “---”. When
the respiration rate is greater than zero, the
actual CO2 numeric value will be displayed.
The EtCO2 module is warming up (up to 1
minute).
Cable not plugged in.
Check/replace sensor or module.
Cable defective.
Adjust to higher scale setting using the Zoom
softkey.
----- (dashed lines at
top of capnograph
waveform)
The scale value setting is incorrect. CO2
higher than scale limits was detected.
CAL BARO.
PRESSURE
Barometric pressure reading is out of range. Calibrate the barometric pressure as
described in the R Series Service Manual.
CO2 COMM ERROR
There is no communication from the EtCO2
module or sensor.
Turn R Series unit off, then on again to reset.
Try another EtCO2 sensor.
If the problem persists, return sensor and/or
unit for service.
CO2 DEVICE NOT
READY
The zero operation cannot be initiated
because:
Wait for sensor or module to warm up.
• The sensor or module is still warming up.
Attach sensor or module to the unit.
• No sensor or module is attached to the unit.
Plug sample cell into sample cell receptacle
• The sample cell is not plugged into the
on module.
module.
• Zeroing was attempted within 20 seconds of
a detected breath.
CO2 OUT OF RANGE
(dashed lines for CO2)
The calculated CO2 value is greater than
150 mmHg.
CO2 UNIT ERROR
The EtCO2 sensor or module has detected a Check that the sensor is properly plugged in.
hardware error.
Reinsert the sensor. Turn R Series unit off,
then on again to reset. Perform a
mainstream airway adapter or module zero,
as described in “Zeroing the Mainstream
CAPNOSTAT 5 CO2 Sensor/Airway
Adapter” on page 7 and “Zeroing the LoFlo
CO2 Module/Sample Cell” on page 11.
If error persists, perform a mainstream
airway adapter or module zero, as described
in “Zeroing the Mainstream CAPNOSTAT 5
CO2 Sensor/Airway Adapter” on page 7 and
“Zeroing the LoFlo CO2 Module/Sample
Cell” on page 11.
If the problem persists, contact Technical
Support.
9650-0915-01 Rev. D
R Series End-Tidal Carbon Dioxide (EtCO2)
23
Page 28
R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
COMMON MESSAGES (continued)
Message/Symptom
Possible Cause(s)
Recommended Action(s)
CO2 WARM UP
The mainstream sensor or LoFlo module is
warming up. This may take up to 5 minutes.
Wait for sensor or module to warm up.
ZERO DONE
The sensor/adapter zero or the LoFlo
module zero is finished.
No action required.
ZERO FAILED
The zero operation did not complete
successfully.
Clear the occlusion, remove any source of
CO2, and try zeroing again. If problem
persists, contact Technical Support.
If the message persists more than 5 minutes,
replace the sensor.
MAINSTREAM MESSAGES
Message/Symptom
Possible Cause(s)
Recommended Action(s)
CHECK CO2 ADAPTER
This is usually caused when the airway
adapter is removed from the
CAPNOSTAT 5 CO2 sensor, or when
there is an optical blockage on the
windows of the airway adapter.
Clean the airway adapter and reattach it.
If the problem persists or the adapter
type was changed, perform a mainstream
airway adapter zero as described in
“Zeroing the Mainstream CAPNOSTAT 5
CO2 Sensor/Airway Adapter” on page 7.
It may also be caused by not having
performed an adapter zero after
changing the adapter type (single patient
use vs. reusable).
CHECK CO2 SENSOR
The CAPNOSTAT 5 CO2 sensor cable is Check that the sensor cable is plugged in
not properly plugged in or is over
and properly seated in the connector.
temperature.
Check that the sensor is not exposed to
excessive heat.
If the problem persists, replace the
sensor.
CO2 DEVICE NOT READY
There is CO2 in the airway adapter when Remove airway adapter from CO2 source
attempting to zero.
including the patient’s, and your own
exhaled breaths, and ventilator exhaust
Zeroing was attempted within 20 seconds
valves.
of previous zero operation.
Wait up to 20 seconds before retrying a
mainstream airway adapter zero, as
described in “Zeroing the Mainstream
CAPNOSTAT 5 CO2 Sensor/Airway
Adapter” on page 7.
ZERO CO2 ADAPTER
Negative CO2 detected. May be caused
by a sensor that was zeroed with CO2 in
the airway, or by an optical blockage of
the airway adapter.
Check the airway adapter and clean if
necessary. Perform a mainstream airway
adapter zero as described in “Zeroing the
Mainstream CAPNOSTAT 5 CO2
Sensor/Airway Adapter” on page 7.
ZEROING CO2 ADAPTER
Adapter zeroing is in progress.
Wait for the adapter zeroing to finish.
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9650-0915-01 Rev. D
Page 29
Messages and Troubleshooting
SIDESTREAM MESSAGES
Message/Symptom
Possible Cause(s)
Recommended Action(s)
CHECK CO2 LINE
Sample line blockage or damage.
Verify that the sample line is plugged into
the module and seated properly.
Sample line is kinked or pinched.
Exhaust tube is blocked.
Verify that neither the sample line nor the
exhaust tube are blocked, kinked, or
pinched. Verify that the airway adapter is
not blocked. If the sample line, exhaust
tube, or the airway adapter is blocked or
otherwise compromised for 15 seconds,
this message will appear. The pump will
shut off after 2 minutes if the condition that
caused the message is not cleared. To
restart the pump, correct the blockage, then
remove and reinsert the sample cell into the
sample cell receptacle.
If the problem persists, replace the sample
line.
CHECK CO2 MODULE
Module not properly plugged in. Module
over temperature.
Check that module cable is plugged in and
seated properly in the connector.
Check that module is not exposed to
excessive heat.
If problem persists, replace module.
CO2 IN LINE: WAIT
ZERO CO2 MODULE
CO2 in cannula/adapter when attempting to Wait up to 20 seconds before retrying
module zero.
zero.
Sample line disconnected while zero in
progress.
Remove adapter or cannula tip from CO2
source including the patient’s - and your
own - exhaled breaths, and ventilator
exhaust valves.
Negative CO2 detected.
Perform module zero as described in
“Zeroing the LoFlo CO2 Module/Sample
Cell” on page 11.
May be caused by a module that was
zeroed with CO2 in the sample line.
ZEROING CO2 MODULE
9650-0915-01 Rev. D
Module zeroing in progress.
Wait for module zeroing to finish.
R Series End-Tidal Carbon Dioxide (EtCO2)
25
Page 30
R SERIES — END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT
Specifications
This section summarizes the specifications of the R Series End Tidal Carbon
Dioxide (EtCO2) option.
CAPNOSTAT 5® CO2 Sensor
LoFlo™
Transducer Type
Mainstream
Sidestream
Principle of Operation
Non-Dispersive Infrared (NDIR) single beam optics, dual wavelength,
no moving parts.
Warm Up Time
Full specifications within 2 minutes at an ambient temperature of 25º C. Capnogram
in 15 seconds.
EtCO2 Measurement Range
0 - 150 mmHg
0 - 20%
0 - 20 kPa
EtCO2 Accuracy
(at 760 mmHg, ambient
temperature of 25°C)
0 - 40 mmHg, ±2 mmHg
41 - 70 mmHg, ±5% of actual
71 - 100 mmHg, ±8% of actual
101 - 150 mmHg, ±10% of reading
(At respiration rates > 80 breaths per minute, all ranges are ±12% of actual.)
EtCO2 Resolution
0.1 mmHg 0 - 69 mmHg
0.25 mmHg 70 - 150 mmHg
EtCO2 Stability
Short-Term Drift: Drift over four hours < 0.8 mmHg.
Long-Term Drift: Accuracy specification will be maintained over a 120 hour period
after zeroing.
EtCO2 Noise
RMS noise of the sensor < 0.25 mmHg
at 7.5% CO2.
RMS noise of the sensor < 0.25 mmHg
at 5% CO2.
EtCO2 Rise Time (10-90%)
< 60 ms (Adult/pediatric adapters)
< 60 ms (Infant/pediatric adapters)
< 3 seconds (includes transport and
rise time)
Respiration Rate Range
2 - 150 breaths per minute
Respiration Rate Accuracy
±1 breath per minute.
Verified using a solenoid test setup to deliver a square wave of known CO2
concentration to the device. 5% and 10% CO2 concentrations were used and
respiration rate was varied over the range of the device. Pass/Fail criteria was
comparison of the respiratory rate output from the sensor to the frequency of the
square wave. EtCO2 measurements at those rates were compared to the CO2
readings under static flow conditions.
Sample Flow Rate
N/A
Compensations
Barometric pressure 400 - 850 mmHg (automatic).
Operator selectable O2/N2O compensation.
EtCO2 Alarm Limits
User selectable, High 5 - 100 mmHg, Low 0 - 95 mmHg, OFF.
Respiration Rate (RR) Alarm
Limits
User selectable, High 5 - 150 respirations per minute, Low 0 - 100 respirations per
minute, OFF.
Halogenated Agents
Specification allows for halogenated anesthetic agents that may be present at
normal clinical levels. The presence of Desflurane in the exhaled breath beyond
normal values (5-6%) may positively bias carbon dioxide values by up to an
additional 2-3 mmHg.
Airway Adapter Deadspace
Adult < 5 cc
Infant < 1.0 cc
26
50 ml/min ±10 ml/min
Adult <7.3 cc Maximum
Pediatric/Infant < 1.0 cc
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9650-0915-01 Rev. D
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Specifications
CAPNOSTAT 5® CO2 Sensor
Environmental (sensor or
module)
LoFlo™
Operating Temperature: 0º C to 40º C
Storage and Shipping Temperature: -40º C to 70º C
The R Series unit may not perform to specifications when stored at the upper or
lower extreme limits of storage temperature and immediately put into use.
Electromagnetic Immunity
AAMI DF-80:2003, IEC 60601-1-2, 10 V/m
Software Hazards
Minimized by compliance with EN60601-1-4
Operating Time with
EtCO2 and SpO2 Options
For a new fully charged battery pack at 20º C (68° F):
9650-0915-01 Rev. D
• 90 defibrillator discharges at maximum energy (200 J), or
• 3.0 hours minimum of continuous ECG monitoring, or
• 2.5 hours of continuous ECG monitoring/pacing at 60 mA, 70 beats per minute.
R Series End-Tidal Carbon Dioxide (EtCO2)
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