carnomac ULTIMA™ OPERATOR’S MANUAL INTRODUCTION 1 2) 3 4 5 6 7 8 9 11 12 13 14 15 SAFETY PRECAUTIONS UNPACKING AND INITIAL SET UP FUNCTIONAL DESCRIPTION QUICK MONITORING GUIDE ALARMS AIRWAY GAS MONITORING AUTOMATIC AGENT IDENTIFICATION PULSE OXIMETRY/PLETH MEASUREMENTS SIDE STREAM SPIROMETRY™ MISCELLANEOUS, TRENDS INTERFACE AND DOCUMENTATION PRODUCTS MAINTENANCE SPECIFICATIONS SUPPLIES AND ACCESSORIES6Basser om ___carnonsc ULTIMA™ OPERATOR’S MANUAL INTRODUCTION The CAPNOMAC ULTIMA™ series of multiparameter airway gas monitors is designed to offer you maximum flexibility in meeting your patient monitoring requirements. All CAPNOMAC ULTIMA™ monitors include real time CO,, NO, Oz and anesthetic agent monitoring. They also provide the ability to display and trend gas data and waveforms. In addition, other parameters are available as options: SpO,, Side Stream Spirometry™, and automatic agent identification. The table below outlines the different models and their features of the CAPNOMAC ULTIMA™ monitors: urt-sy| utr-v | utr-s | utr | utr: | uer-si| urr-vil uLr-svi COs, NO, 05 * . * + * . . . Anesth. Agent | * . 7 , . . . ‘ SpO,/Pleth . * * . Side Stream Spirometry™ : 7 v . Agent identification . . * * How to Use This ‘This Operator's Manual describes all the functions and parameters Manual offered by the CAPNOMAC ULTIMA™ monitor family. Some of the parameters described may not be available in the monitor you are using. NOTE: Before using your CAPNOMAC ULTIMA™ monitor, please read this Operator’s Manual thoroughly. Pay special attention to WARNING and CAUTION statements that appear throughout the manual.Datex Engstrom ___sens: ULTIMA™ OPERATO! 7 AUTOMATIC AGENT IDENTIFICATION 7A 7.2 7.3 7.4 7.5 7.6 Automatic Identification . Agent Mixtures .. Manual Agent Selection with Agent Id Monitors .. Calibration Self-diagnosi Miscellaneous . Typical Performance ~ Agent Identification...7 7A Datex Engstrom. AUTOMATIC AGENT IDENTIFICATION Automatic Identification CAPNOMAC ULTIMAT models that include the agent identification option will automatically identify and select Halothane, Enflurane, Isoflurane, Sevoflurane and Desflurane. They will also warn of the presence of an agent mixture, and display values for both agents. When the monitor identifies and selects the agent, it displays a message "XXX SELECTED’ (XXX being HAL or ENF or ISO or SEV or DES), The monitor displays the message for 60 seconds and produces two beep sounds. The inspiratory and expiratory concentrations of the agent will be shown in the digit field. fins 146 aid> 16 (a NAN ia NS “ow oi vee Yt Coxe Opa MeO HAL ARC [RR ST 48 27 65 1.1 22) 125 Ot 32 64 1.4 3 9? Toros LHAL SELECTED imum concentration for the identification is 0.15 vol %. The agent selection remains active, even if the concentration decreases below 0.15 vol% during the case. The agent identification is based on infrared technique, by comparing the absorption spectrum of the agent being used to reference spectra of pure agents. The automatic agent identification will operate after the normal monitor warm up time (approximately 3 minutes). TH carnomac ULTIMA™ OPERATOR’S MANUALDatex Engstrom ULTIMA™ OPERATOR’S MANUAL 7.2 Agent Mixtures The agent identification will warn you if a mixture of anesthetic agents is detected. The mixture warning is activated when the concentration of the minority agent is greater than 0.3 vol % and more than 15% of the total anesthetic agent concentration. When a mixed agent is detected, the message "MIXED AGENT? is displayed, and an audible alarm is produced. The message remains active until the mixed agent situation is resolved. During a mixed agent situation the inspiratory and expiratory concentrations of two dominating agents will be shown, LMA NANA ARS Me VW VU WY fee 16 em 0 unset 7H — BAnAnnAe AAS Ocoe@ OFA MO] nx [RAC [RR aT le 48 22, 65) 20 [2.2 fee Tos i Oe 008 Fe O.1 32 64Joco2 a 97 mix 180 HAL 0.4 0.2 0.6 0.2 When the anesthetic agent is changed, there will be a mixed agent situation, before the first agent is washed out of the patient and the circuit, The "MIXED AGENT’ message disappears when the concentration of the first agent becomes insignificant, NOTE: Alcohol does not affect mixture identification. NOTE: In Desflurane mixtures, the concentration of the other anesthetic may become clinically significant before the mixture warning is given. NOTE: Some hydrocarbons (e.g. acetone and methane) may also cause the message MIXED AGENT to appear. 7-2Datex Engstrom —___© ULTIMA™ OPERATOR’S MANUAL 7.3. Manual Agent Selection with Agent ID Monitors You may select the agent manually if desired. Automatic agent identification is activated after power up. To override automatic identification and manually select the agent: * Press SELECT AGENT key. * Press softkey 4 (NEXT) to highlight the desired agent. * Press NORMAL SCREEN key. saucer acent | prev SEECL AGENT | rrcu y Select previous 0 AGT 150 LURANE waLoTHINE erLuRee SEVOFLURANE vesrueme | next pe Select next If the manual selection differs from the automatic identification, the monitor will display the automatic identification message (e.g., ‘HAL DETECTED"). At the same time a message: ‘Check your AA selection! will be shown, and the monitor produces two beep sounds. In this situation, enter the “SELECT AGENT’ menu to confirm the selection. The "Check your AA selection!” message will remain active on the screen as long as the manual selection differs from the automatic identification. When ‘NO AGENT is selected, and automatic identification detects an agent, an alarm XXX DETECTED is displayed. This message will blink and remain active on the screen until a selection is made, or the agent is no more detected. An audible alarm, two beep sounds followed by one beep every minute, is produced when this alarm is active. The monitor will operate the same way, if an agent is selected manually and mixed agent are detected, as described in Section 7.2. 1-3Datex Engstrom _. capwomac ULTIMA™ OPERATOR’S MANUAL 7.4 Calibration Self-Diagnosis When the agent concentration is over 1 % the calibrations of the identification sensor are automatically checked. If a gas calibration needed, a message 'RECALIBRATE AGENTS’ is displayed. This message is displayed after turn on until breathing is detected. 7.5 Miscellaneous When the monitor is in automatic mode and it detects calibration gas and no anesthetic agent (e.g. from Datex-Engstrom Quick Cal calibration gas), a message ‘CAL GAS IDENTIFIED" appears in the message field. If the identification sensor should fail, a message "AGENT ID INOPERATIVE’ will be displayed. ‘The previously used agent may cause the monitor to ‘detect’ an agent even if there is no agent present. To reset this, press SELECT AGENT, and select NO AGENT. Then start automatic identification again by selecting SELECT AGENT/AUTO. 7.6 Typical Performance - Agent Identification Identified agents HAL, ENF, ISO, SEV, DES Identification threshold 0.15 vol % *) Identification time 30 seconds *) Mixture detection threshold 0.3 vol % of minority agent and 15 % of total concentration *) typical performance with pure agents> Datex Engstrom _. 2 UNPACKING AND INITIAL SET UP..... 24 2.2 2.3 24 2.5 Operational Checks... installation ... 2.2.1 Sample Gas Exhaust .. 2.2.2 Returning Sample Gas to Patient Circuit ... Start Up Menu ... 2.3.1 User Preset Alarm Limit: 2.3.2 User Configurations... Service Menu... Final Checks... carwomac ULTIMA™ OPERATOR’S MANUALanh Datex Engstrom . 2 UNPACKING AND INITIAL SET UP ‘The monitor is shipped in one carton. ‘Check the shipping carton and the monitor for damage. If the monitor is damaged notify the carrier immediately. Test the electrical performance of the monitor. In event of electrical or operational damage, contact your sales representative. 2.1 Operational Checks Connect the power cord to the power receptacle located on the rear panel. CAUTION: Before connecting power cord to power outlet, check focal voltage and frequency stated on the device plate on the monitor's rear panel. Gas Check Out . Plug the power cord into the power outlet. Attach a sampling line to the water trap and turn on the monitor. The monitor initiates its start-up and self-check sequence. Confirm that no error messages appear. Confirm that the inspiratory Oy (FiO,) reading is 21 % and no other gas is detected, Breathe 5 times into the sampling line and confirm that a capnogram and an end tidal CO, value is displayed. ‘Stop breathing into the sampling line. After 20 seconds, the monitor will activate the first audio and visual alarm indicators, Press the SILENCE SUSPEND key. 2-1 mac ULTIMA™ OPERATOR’S MANUALDatex Engstrom ‘SpO, Check Out Side Stream Spirometry™ Agent Identification ULTIMA™ OPERATOR’S MANUAL * Connect the pulse oximeter sensor to the monitor. The message ‘NO PROBE! is replaced by "PROBE OFF". * Confirm that the red light is seen from the sensor, and that the sensor surface is undamaged. * Attach the pulse oximeter sensor to your finger. Wait for the pulse search to be completed and that the SpO, readings are in the expected range and that the plethysmographic pulse waveform is regular. * Attach the spirometry tube and gas sampling line to the D- LITE™€ sensor, see Section 9.7 * Attach the other ends of the spirometry tube and gas sampling line into the connectors on the front panel. * Press SPIROMETRY, and select the flow-volume loop (V'/¥) from the menu. es The message “Adult Spirometry Sensor" appears. Confirm that the message is in accordance with the sensor you are using. * Breathe a couple of times into the D-LITET™ sensor. Confirm that a loop is displayed and volume values are shown. : Feed calibration gas into the sampling line in normal monitoring mode. * If the message ‘CAL GAS IDENTIFIED’ comes up, the identification is functioning properly. WARNING: FAILURE OF OPERATION: Note any error messages or deviations from normal operation. If the instrument fails to respond as described, do not use the monitor until the situation has been corrected by qualified personnel. 2-2Date: En est rom carnonac ULTIMA™ OPERATOR’S MANUAL 2.2 Installation Install the monitor in a location that permits good ventilation. Confirm that the dust filter at the rear panel is in place and clear of dust. Install the monitor in such a_manner that the user can conveniently see the display. The front feet can be put down, to raise the display. Connect the power cord to a hospital grade grounded outlet. Turn on the monitor. Adjust the brightness of the screen to the desired level. The control is located on the rear panel. 2-3Datex Engstrom capromac ULTIMA™ OPERATOR’S MANUAL 2.2.1 Sample Gas Exhaust When N,O and/or volatile anesthetics are used, pollution of the operation room by these gases must be prevented. Connect the sample gas outlet of the monitor to the scavenging system or return it to the patient circle. Connect the sample gas outlet of the monitor to the scavenging system - through ventilator’s reservoir, see Figure 2-1a - when scavenging directly through the scavenging tube, a T- fitting is required, see Figure 2-1b CAUTION: Be sure that the sample gas is not removed from the monitor under too strong suction. To prevent excessive suction, there must always be an opening to the room air. Strong suction may change the operating pressure of the monitor and cause inaccurate readings or internal damage. Scavenging through * Connect an exhaust line (p/n 733195) to the sample gas reservoir outlet at the monitor's rear panel. Attach the other end of the line to the ventilator’s reservoir. ) Note that the diameter of the scavenging system connection must be larger than that of the exhaust line, see Figure 2- Ia, scavenging SAIPLE Gs ou reservoir Figure 2-12 Connection through Ventilator's Reservoir | 24Datex Engstrom 2 Scavenging directly through scavenging tube carnomac ULTIMA™ OPERATOR’S MANUAL room air sample gas out Figure 2-1b Connection Directly to Scavenging Tube * Use T-fitting (p/n 882377) between the monitor and exhaust line (p/n 733195), see Figure 2-1b. * Attach the other end of the line to the scavenging tube. 2-5 anDatex Engstrom “nn GAPNOMAE ULTIMA™ OPERATOR’S MANUAL 2.2.2 Returning Sample Gas to Patient Circuit ‘The outlet gas from the measuring system can be delivered back to the patient circuit using exhaust line (p/n 733195) and adapter (p/n DMIO01). Figure 2-2 Returning Gas to Patient Cireult (1) Exhaust line (2) Adapter Place the adapter (2) between the expiratory valve and expiratory tube in the respiratory circuit, see Figure 2-2. Connect the exhaust line (1) to the sample gas outlet on the ‘monitor's rear panel, and to the adapter (2). 2-6=) Bogstrom capwomac ULTIMA™ OPERATOR’S MANUAL 2.3 Start Up Menu Upon installation, permanent user settings may be established from the start up menu. This menu will allow you: a) Set up and save user preset alarm limits. b) Establish certain configurations for the digital display, printers, format for the serial output and analog output signals ete. ©) Access to the Service Menu. Once the settings and configurations are established and stored in memory, they are saved until changed again. To Enter Start Up * Press and hold any key during the power-up sequence until Meauw the main start up menu appears dn the video screen. —e=_ | pues: user preseT] = [+ Li | > UseR conricuearzons | > [2 ‘inalon kay SERUICE MENU wonrrorme | 4 Start up Menuate > Pagstrom __carnonac ULTIMA™ OPERATOR’S MANUAL 2.3.1 User Preset Alarm Limits * Press key 1 to activate USER PRESET menu. The alarm limit adjusting menu appears. Adjust beams save and save we USER PRESET — | Fiore alarm vimits Re? Ss) ae ica Adjusted Limits | feorase a”! will be lost | Freeat of| 83 [en if not saved! [mar orl or To returns press NORNAL SCREEN Alarm Preset Menu * Select the limit to be adjusted with key 4, * Make the desired adjustment with either key 2 or 3. * Press key 1 to save the limits to permanent memory. * Press NORMAL SCREEN to restore the STARTUP menu. * Press MONITORING (key 4) to start monitoring, NOTE: AA Fi and AA ET limits are adjusted in MAC values. In the display the correspondence between 1 MAC and anesthetic agent percentages are represented.Batex Engstrorna ___cimoue ULTIMA™ OPERATOR’S MANUAL 2.3.2 User Configurations Set the digital display, the choice of printers, the scale of the anesthetic agent graphics, spelling of word PEDI and the configuration of the serial port from the User Configuration Menu. * In the STARTUP menu, press USER CONFIGURATIONS (key 2). WER coMELGENTIS | omey ef > | see piers ELE Exco2 o161TS oma aime ron-reo | “Se [2 senna rene 98 SCALE sreLLine a fe 3 ru ens on ato ty [4 User Configuration Menu * Press key 1 (PREV) or key 4 (NEXT) to select the item or parameter to be configured. The item or parameter selected will be underlined and its current status is shown and highlighted with a box. * Choose the desired alternative with keys 2 and 3. * Press NORMAL SCREEN. Possible Selections * Location of the SpO, digital display area (right, left). for Parameters to be Configured * Size of the EtCO, digital display (normal, large). * Printer selection: Canon BJ-30 (IBM-PRO), Kodak, HP ‘Thinkjet (HP), Seiko, Panasonic (EPSON). * Numerical or graphic output (numeric, graph) * The scale of anaesthetic agent graphic recording, choices are 5, 10 or 20 % * Spelling (PEDI, PAEDI)Datex > Engstrom ... Factory Defaults 2.4 2.5 carnomac ULTIMA™ OPERATOR’S MANUAL * Selection for including or excluding audible apnea alarm during AUDIO OFF (incl, excl) * Volume normalization (BTPS, ATPD, STPD) - BIPS= 37°C, ambient pressure, 100 % humidity - ATPD= 25°C, ambient pressure, 0 % humidity - STPD= —_0°C, 760 mmHg, 0 % humidity NOTE: The selected normalization is valid only when measured EtCO, values are more than 0.9%. Otherwise the ambient (room) pressure, humidity and temperature are used. Sp0, digits Right EtCO, digits Normal Printer choice IBM-PRO Serial output Numeric ‘AA grph scale 5% Spelling Paedi Audio off apnea EXCL Volume normalization BTPS Service Menu Final Checks Service menu is for authorized service personnel only. Calibrate the airway gas monitoring portion of the monitor. See Chapter 13. After calibration complete, sample calibration gas in the normal monitoring mode, Confirm that displayed values are within specifications. If the measurement is out of specification, re-calibrate the monitor.Datex Engstrom rs ence 3. FUNCTIONAL DESCRIPTION... 3.1 3.2 3.3 3.4 carnomac ULTIMA™ OPERATOR’S MANUAL Front Panel .... 3.1.1 Video Screen 3.1.2 Keyboard Rear Panel... Symbols on Equipment: Summary of Abbrevi3 34 FUNCTIONAL DESCRIPTION Front Panel Figure 3-1 CAPNOMAC ULTIMA™ Front Panel a) Q) @) (4) () (6) a Video screen Keyboard D-FEND™ water trap with sampling line connector Alarm led Connectors for Side Stream Spirometry™ Pulse oximeter sensor connector Power switchDatex Engstrom 3.1.1 Video Screen Figure 3~ a @) GB) (4) (S) (6) _EAPNOMAG ULTIMA™ OPERATOR’S MANUAL A ARALSS Penne PSUS AANA we PAs : eonw Op Fad HAL HAC \er BA we, 9 0.98 1.8 "38 64 0.89 2 Example of Monitoring Display 3 fields for waveform display. Display area for tidal volume or minute volume, compliance, peak airway pressure, positive end expiratory pressure and spirometry loop. Respiratory rate. Field for pulse oximeter information. Field for alarms and other messages. Field for measured expiratory and inspiratory airway gas values.Datex Ce cnet 3.1.2 Keyboard ul q i a5 Figure 3-3 Keyboard Action displayed varies with menu function. NOTE: Underlined key functions require a "Press and Hold” action. 33Datex En gst HOT ID an SAPNOMAC ULTI MA™ OPERATOR’S MANUAL Calls up the menu to set alarm limits. Press and hold for 2 seconds to set AUTO larm limits according to measured values. See Section 5.2. Calls up the set up menu to establish the alarm volume and pitch, beep volume, CO, units, SpO, mode, real-time clock, trend scale for SpO, and the airway pressure unit. | Calls up the menu to manually select the anesthetic agent, See Section 6.2. Calls up the menu to establish waveform displays and scales. Displays trends, and calls up the trend menu. Pressing for 2 seconds erases all trend data and saved loops from the memory. Calls up a menu to initiate calibrations. Numbers the trend displays and printouts. Press and hold for 5 seconds to reset the monitor. When numerical trends are selected for display pressing for 1 second prints the displayed page, and 2 seconds prints the whole trend. Displays short instructions. During menu functions produces quick guides of each menu. Returns to normal monitoring display. In spirometry menu: Clears the menu from the SeneEN |) display and displays enlarged loop. Silences an active audible alarm for 2 minutes. Press and hold for 2 seconds to silence in advance audible alarms for 2 minutes. Freezes the display. Draws an enlarged spirometry loop on the screen and enables access to spirometry menu. 34carnomac ULTIMA™ OPERATOR’S MANUAL @ © @® @ Figure 3-4 CAPNOMAC ULTIMA™ Rear Panel qQ) Q) GB) @) (@) 6) M (8) (9) (10) (iy Connectors for serial and analog input/output. ‘Video screen brightness adjustment knob. ‘Video output connector. Connector pin for potential equalization. Identification label. Fuse information. Fuse. ‘Sample gas outlet. Cooling air intet. Receptacle for power cord. Alarm loud-speaker. 3-5 I | | |Engstrom cosa SAPNOMAC ULTIMA™ OPERATOR’S MANUAL Datex | i i 3.3. Symbols on Equipment NS Alternating current (When this mark is displayed the low O, alarm limit is less \ Attention, consult accompanying documents. than 21 %, see Section 5.2.) Brightness (of screen) Equipotentiality i ed STL Power ON | OLD dower oFF R ‘Type BF equipment (IEC-601-1) protection against electrical | shock. 3-6BD: =) Engstrom 7 carnomac ULTIMA™ OPERATOR’S MANUAL 3.4 Summary of Abbreviations RR ET 1-E BAL PR Sp0; MAC Respiratory rate End tidal concentration Fractional concentration of inspired gas Difference between inspiratory and expiratory values. Balance gas (100 % ~ all measured gas concentrations) Pulse rate ‘Oxygen saturation measured by pulse oximetry Minimum Alveolar Concentration WARNING: correspond children, which 50 % of individuals fail to move in response to a noxious stimulus. Be aware that MAC values are empiric, not absolute values. CAPNOMAC ULTIMAT™ monitor's MAC values MAC is the alveolar concentration of an agent at to those of healthy adults and cannot be applied to Vv Mv Ppeak Pplat PEEP vo.s vio PEDI SSS display Tidal volume Minute volume Peak airway pressure Plateau pressure = end inspiratory pressure End expiratory pressure ‘Volume expired during the first 0.5 seconds of expiration Volume expired during the first second of expiration Dynamic compliance Ratio of inspiratory and expiratory times Pause is included in inspiration time Pediatric Side Stream Spirometry™ display on Normal Screen 37Datex Engstrom carnomac ULTIMA™ OPERATOR’S MANUAL 4 QUICK MONITORING GUIDE .... 4.1. Getting Help... 4.2 Summary of Functions ......=} Datex Engstror come ULTIMA™ OPERATOR’S MANUAL 4 QUICK MONITORING GUIDE STEP PROCEDURE To start . Confirm that water trap container is empty and the water trap is inserted properly into the monitor. 2 Connect a new sampling line to the water trap. Attach the spirometry tube to the pressure connectors on the monitor (when Side Stream Spirometry™ is included). gs Turn the power on. A self-check is performed. Alarms are activated and all parameter default settings are selected, 4, Select anesthetic agent: press SELECT AGENT to call the selection menu. Models including agent identification will select the agent automatically. 5. Insert the pulse oximeter sensor plug into the connector on the front panel. 6, Connect sampling line to patient's airway adapter. Attach the pulse oximeter sensor to the patient. | ‘Attach the spirometry tube to the D-LITE™/PEDI-LITE™ sensor (when Side Stream Spirometry™ measurement is included). Be sure that you are using the right sensor mode. If adjustments are desired 1 Adjust alarm limits if desired: press SET ALARMS_AUTO to call the menu. 2, Press SET UP SCREEN to change displayed waveforms. Between patients 1 To erase trend data and to select alarm limit defaults press the EVENT MARK RESET key for 5 seconds to perform a monitor rest. 2. Replace sampling line, and change or clean the water trap container. Replace the disposable D-LITE™/PEDI-LITE™ sensor and spirometry tube. Clean or replace the reusable D-LITE™/ PEDI-LITE™ sensor. 3. Clean the pulse oximeter sensor. atDatex Engstrom _2 At the end of a day's use a 2, 3, Turn the power switch off. | ‘Unplug the monitor and clean it. Disinfect the water trap container. Disinfect the reusable D-LITE™/PEDI-LITE™ sensor. | WARNING: OCCUPATIONAL SAFETY: Handle the water trap and its contents as you would any body fluid. Infectious hazard may be present. CAUTION: Remove sampling line from patient airway while nebulized medications are being delivered. NOTE: Check water trap container regularly during monitoring. Empty the water trap whenever more than half full. NOTE: Replace the sampling line and clean the water trap container between each patient. 42 ULTIMA™ OPERATOR’S MANUALBasstrom capnomac ULTIMA™ OPERATOR’S MANUAL 4.1 Get g Help Pressing the HELP? key initiates 8 pages of short on-screen instructions. Use the keys 1 and 4 to select the following topics: page 1) Most important messages | page 2) Airway gas measurements page 3) Miscellaneous | page 4) Alarms | page 5) Pulse oximeter alarms page 6) Side Stream Spirometry™ measurement | page 7) Side Stream Spirometry™ measurement | page 8) Agent identification When a menu function is displayed, pressing HELP? key will provide short instructions for that menu. 4-3=) Pagstrom __SAPNOMAG ULTIMA™ OPERATOR’S MANUAL 4.2. Summary of Functions * Press a function key to call up menu function, Then use the numbered keys to make adjustments. * Press NORMAL SCREEN after completing your selection or adjustment, to return to the normal waveform display. If no key stroke has occurred within 60 seconds, the screen will return to the waveform display automatically. Press Appears Make adjustments eit > 7] Move cursor ” > fe] Sstato p 2 | Adjust the Tits. g fentop [>] setuser o 3 | dustin reset its ; Bt own fe] saavaie & 4 | Move cursor ‘slams ONOFF com [ setecr | eee > f smisaan | ey [T] soe evius RE v6 fmt Isor RAN Select the desied anesthetic agnt wth ey 1 or 4 peered ‘Then press NORMAL SCREEN to ret e mentong revue SEF UAE scsrumme [ror p [* ] solectnent 4-4Datex Engstrom Summary of Functions (continued) Press ‘Appears Make adjustments sew lp > fi Mowe cursor to sores previous item u Move cursor » to Previous parameter Move cursor to ‘ext parameter Move cursor to le nxt tem =a > fi Move cursor to ee | > previous parameter > [? | cnoose bigger scale >i Choose smi scale @ Move cursor to ee no parameter mene] rey fT Move cursor to > >a previous parameter sm ani“ 3 am lz Adjust setting up Adjust setting down j aL Move cursor to > fF ‘next parameterDatex Engstrom capromac ULTIMA™ OPERATOR’S MANUAL Summary of Functions (continued) Press Make adjustments CALIBRATION 4-6Datex Engstrom capnomac ULTIMA™ OPERATOR’S MANUAL Summary of Functions (continued) Press Appears Make adjustments =e Display mans ends > [P| cage pase fons » [2 | ress zseconssto race > [2] serone page eS trend data op 3( wee Sele tne scale FF] sero one pope eee Z for trend disphay. » down, Tf» ‘cnange pane. > FE] magn one ‘tence anaeve alam, 2 seconds pressing: slonces hm aovance ausble alarms fortwo minutes rcrull FRetum norma! wavetorm play. Display shoninsrutons on the screen ‘Ada a rumored mark on sereen/printot, 5 seconds pressing resets the monty Wile on numeric wend dieplay press to rit the cisplayed page, ress and hold to pint the whe butter. Draw a spirometry loop onthe screen. Access to spirometry mens NOTE: Normal wavelor display is not returned automaticaly. TT] Move cursor to 7 previous parameter. 8 2 | Choose anciner sentor. re 36 SS o ca, Save te oops 3} Snoose anomer sensor. fnew 3 i > fe] ses qo] Move curserto oe at prometty mens ex parameter 4-7Datex Engstrom 5 ALARMS. 51 5.2 5.3 54 5.5 seers Sod, Alarm Descriptions and Definitions Alarm Limits ..... 5.2.1 To Adjust Alarm Limits...... 5.2.2 AUTO Alarm Limits ..... 5.2.3 User Preset Limits.. To Silence Audible Alarms 5.3.1 To Silence an Active Alarm for 2 Minutes... 5.3.2 To Suspend Audi for 2 Minute: 5.3.3 To Turn Audible Alarms Off/O1 To Adjust Alarm Volume and Pitch... Typical Performance - Alarms... capnomac ULTIMA™ OPERATOR’S MANUAL5 Datex Engstrom ____ssmonse ULTIMA™ OPERATOR’S MANUAL ALARMS: When a monitored parameter acquires a value outside its alarm limits, visual and audible alarms are activated. During an alarm, alarm message is displayed, the digital display of the effected parameter blinks, and an audible alarm is heard. The audible alarm sequence is: ~ one beep when alarm is triggered = two beeps after 20 seconds (pulse oximeter alarms after 10 seconds) = continuous alarm after 40 seconds (pulse oximeter alarms after 20 seconds) The alarms are automatically enabled after the power has been turned on. *FIN,O > 82 %' and "FiO, < 18 % are always active. The alarms are operative during all menu functions, except calibration. 5-1=) Pagstrom capromac ULTIMA™ OPERATOR’S MANUAL 5.1 Alarm Descriptions and Defi ns |Gas Measurement APNEA X:XX ‘The apnea alarm is activated if Alarms no breaths have been detected for 20 seconds. The duration of the Apnea is displayed in the alarm window. When the apnea alarm is active; CO, alarms and audible alarms for low Oz and low anesthetic agent are disabled. HIGH and LOW EtCO, The measured end tidal CO, reaches or exceeds the alarm limit of end tidal CO,. HIGH and LOW FiO, The measured inspiratory O, reaches or exceeds the alarm limit of O,. Low O, alarm limit cannot be set lower than 18 %. REBREATHING ‘The inhaled CO, (FiCO,) concentration is the same or higher than the rebreathing alarm limit. FIO, < 18 % The inspiratory Q, concentration is 18 % or less. Continuous audible alarm is activated immediately. FIN,O > 82 % The inspiratory N,O concentration is 82 % or more. Continuous audible alarm is activated immediately. IRespiratory Rate (RR) The high or low alarm limit of HIGH and LOW the respiratory rate is violated. 5-2carnomac ULTI MA™ OPERATOR’S MANUAL Gas Measurement Alarms (continued) SELECT AGENT without agent id with agent id Expiratory Anesthetic Agent HIGH and LOW Inspiratory Anesthetic Agent HIGH and LOW When anesthetic agent is detected though no agent is selected, an alarm is triggered, and a message "SELECT AGENT” appeé Audible alarm sequence is: two beeps immediately, and one beep every minute. ‘This message is also given, when ‘no agent has been selected, and the agent identification detects a mixture. The measured value of exhaled anesthetic agent reaches or exceeds the alarm limit. If the high limit is set higher than 3 times minimum alveolar concentration (3 MAC) continuous audible alarm is activated immediately. The measured value of inhaled Janesthetic agent reaches or exceeds the alarm limit. 5-3Bugscrom __camonae ULTIMA™ OPERATOR’S MANUAL Agent Identification Alarms |XXX SELECTED When the automatic agent identification identifies the agent, this message is given along with two beeps. The message stays for 60 seconds on the screen. XXX DETECTED This message is given, when the manual agent selection differs from the automatic identification. Along with this a message: CHECK YOUR AGENT SELECTION! is given. MIXED AGENT When the monitor identifies more than one agent at the same time, it warns of mixture. In the number field the concentrations of two dominating agents will be shown. This message stays on, as long as the situation persists. [UNKNOWN AGENT When the monitor identifies more than two agents at the same time or when some unknown agent exists, this message is given. 5-4Batex Eagstrom ___eaenonac ULTIMA™ OPERATOR’S MANUAL Pulse Oximeter SpO, HIGH and LOW ‘The oxygen saturation Alarms percentage reaches or exceeds the alarm limit, I Pulse Rate (PR) HIGH The measured pulse rate reaches and LOW or exceeds the alarm limit, PULSE SEARCH ‘The monitor is searching pulse. NO PROBE ‘The SpO, sensor is not connected to the monitor. PROBE OFF ‘A SpO, sensor is not attached to the patient, or the contact is loose. CHECK PROBE ‘The SpO, sensor is loose or inoperative. ARTIFACT The measured signal is noisy due to patient movement (visible alarm message only). LOW PLETH SIGNAL Pulse wave amplitude is low and irregular (visible alarm message only). NO PULSE ‘The monitor is unable to detect pulse (even though the sensor is detected). 5-5Bagster ont ___carnonse ULTIMA™ OPERATOR’S MANUAL | Side Stream Ppeak HIGH and LOW Peak airway pressure reaches or Spirometry™ Alarms exceeds the alarm limit. PEEP HIGH End expiratory pressure exceeds the alarm limit, MIN. VOL. HIGH AND The measured expiratory minute | LOW volume reaches or exceeds the alarm limit, The following additional messages are displayed in the alarm field together with the above mentioned alarms: Disconnection alarm is activated if the ventilator tubes or the DISCONN spirometry tube becomes disconnected. Leaking ventilator valves may also cause the alarm to be activated. OBSTR The obstruction alarm is activated if the ventilator tubes or the airway is obstructed. ‘Malfunction of the ventilator valves may also trigger the alarm, LEAK Leak alarm is activated if there isa leak distal to D-LITE™/ | PEDI-LITE™ sensor. 5-6=) Datex Engstrom —. capnomac ULTIMA™ OPERATOR’S MANUAL Equipment Related Alarms OCCLUSION REPLACE TRAP AIR LEAK. The occlusion alarm is activated, if the sampling line or the internal tubing is blocked, or if the water trap is occluded. If occlusion persists the measured gas values are replaced with dashes. Indicates a residue build-up on the water trap membrane. Replace the water trap. WARNING: Monitoring during "REPLACE TRAP" alarm may result in incorrect oxygen values. leak alarm is activated = the water trap is not connected on the monitor's front pane! = the gas outlet on the rear panel is blocked ~ there is a leak in the sampling line inside the monitor. If the air leak persists, the sampling pump is turned off and the measured gas values are replaced with check out instructions. Press NORMAL SCREEN to resume gas sampling. 5-7Datex Engstrom capromac ULTIMA™ OPERATOR’S MANUAL 5.2 Alarm Limits Alarm limits are activated at the factory default values upon power-up when the monitor has been off more than 15 minutes, or after reset. The factory default limits and limit selection ranges are given in the Table 5-1. Table $-1 Default Alarm Limits Parameter Factory defaults | Selection range CO, High 8% Low limit to 15 %, (end tidal) (114 mmHg, 15 kPa) | (61 mmHg, 8 kPa), | Off Low 3% Off, 0.1 % to High (23 mmHg, 3 kPa) CO, Rebreathing 3 % 1% ~ 2% - 3% - Off (inspiratory) (23 mmHg, 3 kPa) | (8-15-23 mmHg - Off, 1-2-3 kPa - Off) High off, Low to 99 %, Off (inspiratory) Low 18% 18 to High % <18% Non adjustable N,O 282% Non adjustable (inspiratory) ENF inspiratory High 5.1% 7") Low to 8 % **) Low ofr Off, 0.1 to High% end tidal High 3.4%") Low to 8 % *") Low off Off, 0.1 to High’ HAL inspiratory High 2.2%) Low to 6% “") Low off Off, 0.1 to High end tidal High 15%") Low to 6% “") Low off Off, 0.1 to High% 180 inspiratory High 3.4%") Low to 6 % “) Low ofr Off, 0.1 to High% end tidal High 2.3%") Low to 6 % “*) Low ort Off, 0.1 to High% 5-8cnastrent CAPNOMAC ULTIMA™ OPERATOR’S MANUAL Parameter Factory defaults [Selection range bad os inspiratory High 6.1%") Low to 8 % “) Low conta Off, 0.1 to High% end tidal High 41%") Low to 8% Low oft Off, 0.1 to High DES | inspiratory High 18% **) ‘Low to 20 % “*) i Low ore, Off, 0.1 to Hight | end tidal High 29 Low to 20 % *) Low off Off, 0.1 to High % Respiratory High ort Low to 60 breath/min, rate Off Low ort Off, 3 to High breath/min SpO, High oft Low to 100 %, Off Low 90 % 50 to High % Pulse rate High 160 bpm Low to 250 bpm Low 40 bpm 30 to High bpm Ppeak High 40 cmH,0 Low to 80 cmH,O - Off for adults: (4.0 kPa, 30 mmHg, |(Low to 8.0 kPa - Off, 40 mbar) Low to 60 mmHg - Off, Low to 80 mbar ~ Off) Low ofr Off to high Ppeak High 30 cmH,0****) Low to 80 cmH,0 - Off for pediatrics: G.0 kPa, 22 mmHg, |(Low to 8.0 kPa - Off, 30 mbar) Low to 60 mmHg - Off, Low to 80 mbar - Off) Low oft Off to high PEEP High 10 cmH,0 1 - 60 cmH,0- Off for adults: (1.0 kPa, 7 mmHg, |(0.2 - 6.0 kPa - Off, 16 mbar) 1 45 mmHg - Off, 1 60 mbar - Off) PEEP High 7 emH,0 1 - 60 cmH,0- Off for pediatrics: (0.7 kPa, 5 mmHg, |(0.2 — 6.0 kba - Off, 7 mbar) 1 = 45 mmHg - Off, 1 = 60 mbar ~ Off) MV exp High ort Low = 30 I/min - Off Low off Off, 0.1 1/min to high Ry Gegesponds. 192 Mac. ) If the high limit is adjusted over 3 MAC, a warning message een) i§ displayed on the screen. ) Corresponds to 3 MAC. ‘There is no alarm for static over-pressure nee) When this symbol is displayed beside O, the low O, limit is A set lower than 31%. 0 : _ 5-9Datex Engstrom _ capnomac ULTIMA™ OPERATOR’S MANUAL 5.2.1 To Adjust Alarm Limits * Press SET ALARMS AUTO to call up the alarm set up ‘menu and current alarm limits. 1 scan > tian | ees eee. gel £5 >|? EET] Gu 98% Press ADJUST (key 1) to access the adjustment menu. Press PREY or NEXT (keys 1 or 4) to select desired alarm limit. The cursor box highlights the selection. Change the value with keys 2 and 3. See Table 5-1 for alarm limit ranges. NOTE: HIGH alarm limit cannot be set lower than LOW alarm limit and vice vers * Press NORMAL SCREEN to return to normal display. 5-10Datex Engstrom ‘5.2.2 AUTO Alarm Limits To Set AUTO Limits The AUTO alarm limits option is a set of alarm limits which are calculated from the measured patient parameters during past two minutes. These limits allow close patient control. See Table 5-2. Table 5-2 AUTO Alarm limits capnomac ULTIMA™ OPERATOR’S MANUAL Parameter AUTO Alarm Limits CO, high | average + 5 mmHg (average + 0.65 % or 0.65 kPa) low | average - 5 mmHg (average - 0.65 % or 0.65 kPa) pO, high | average +5 % low | average - 5 % Pulse rate high | average +20 beats / minute low | average - 20 beats / minute Peak airway high | Average peak pressure + 10 cmH,0 low | Average peak - 10 emH,O PEEP high | Average + 5 cmH,0 Minute volume high | Average + 2 I/min low | Average - 2 1/min Other alarm limits are not set using AUTO. ‘There are two ways to set auto limits: 1) Press AUTO key for 2 seconds. A message ‘AUTO LIMITS ACTIVATED" appears after limits have been set. 2) Press SET ALARMS AUTO to call up the alarm setup menu. Press AUTO (key 2). AUTO alarm limits may be ‘igure in Section 5.2.1. Press adjusted further. See NORMAL SCREEN to return to normal display. S-lDatex Engstrom mac ULTIMA™ OPERATOR’S MANUAL 5.2.3 User Preset imits If you have established your own alarm limits as described in Chapter 2, you may activate them as follows: * Press SET ALARMS AUTO key. + Press USER PRESET to activate the user preset limits (key 3). + The activated alarm limits may be further adjusted (see Section 5.2.1). * Press NORMAL SCREEN to return to normal display. 5.3. To Silence Audible Alarms The audible alarms can be silenced for two minutes or turned off. ‘The visual alarm messages and indicators cannot be disabled. They are displayed until the cause of the alarm has been corrected. WARNING: PATIENT SAFETY: Do not silence or disable audible alarms, without providing continuous, direct observation to the patient. 5.3.1 To Silence an Active Alarm for 2 Minutes * Press SILENCE SUSPEND key. The audible alarm will be reactivated after 2 minutes if the alarm condition continues. Exceptions - The "FiO, < 18 %' and "FIN,O > 82 % audible alarms are reactivated after 20 seconds. - The ‘APNEA’ alarm is silenced for 2 minutes and until 5 breaths are detected. = "NO PROBE’ and ‘PROBE OFF" alarms are silenced for 2 minutes and until the sensor is reattached and the pulse search is successful = The ‘OCCLUSION’, ‘REPLACE TRAP’, ‘AIR LEAK* alarms are permanently silenced. 5-12=} Datex Engstrom carnomac ULTIMA™ OPERATOR’S MANUAL 5.3.2 To Suspend Audible Alarms for 2 Minutes Press SILENCE SUSPEND for 2 seconds. The message ‘ALARMS SILENT FOR 2:00" appears. To Reactivate Alarms Audible alarms are enabled after 2 minutes. The duration of the alarm suspension is displayed and updated every 10 seconds. Exceptions The "FiO, < 18 %' and ‘FIN;O > 82 % alarms will be activated during suspension. ‘APNEA’ alarm is suspended for 2 minutes and until 5 breaths are detected. ‘NO PROBE’ and ‘PROBE OFF" alarms are silenced for 2 minutes and until the sensor is reattached and the pulse search is successful ‘OCCLUSION’, "REPLACE TRAP" and ‘AIR LEAK‘ alarms will be activated during suspension. WARNING: PATIENT SAFETY: Do not suspend audible alarms, without providing continuous, direct observation to the patient. Press the SILENCE SUSPEND key. 5-13Datex Engstrom — carnomac ULTIMA™ OPERATOR’S MANUAL 5.3.3 To Turn Audible Alarms Off/On To Turn Audible 7 Press SET ALARMS AUTO key. Alarms Off * Press AUDIO ON/OFF (key 4) to select OFF. ‘A message AUDIO ALARM OFF’ appears on the normal screen. Exceptions = Audible alarms of "FiO, < 18 %' and "FIN,O > 82 %' cannot be turned off, - Audible alarm for apnea cannot be deactivated, unless such selection has been made in the user configuration menu. See Section 2.3.2. In that case, during AUDIO OFF situation, the message is "AUDIO ALARM (INCL. APNEA) OFF’. - The ‘OCCLUSION’, "REPLACE TRAP’, and ‘AIR LEAK’ alarms are not deactivated. WARNING: PATIENT SAFETY: Do not silence or disable audible alarms, without providing continuous, direct observation to the patient. To Turn Audible . Press SET ALARMS AUTO key. Alarms On . Press AUDIO ON/OFF KEY (key 4) to select ON. . Press NORMAL SCREEN.Datex Engstrom PERATOR’S MANUAL 5.4 To Adjust Alarm Volume and Pitch To Adjust Volume To Adjust Pitch penn If + fmurenritowin 3p Sm [2 sone RUERRCE Ss S002 TRENOCE) 0-100 coeur mmf V2 LS coe rureees eT Pav atte f ggg cock tine oceos | "© : The audible alarm volume can be adjusted. However, audible alarms cannot be totally silenced. * Press SET UP MONITOR key to call up the menu. Press NEXT key to select ‘ALARM VOLUME’. Press keys 2 or 3 to select the desired volume. A beep tone will sound at different volumes with each key stroke. Press NORMAL SCREEN. Press NEXT key to select "ALARM PITCH’. Press keys 2 and 3 to adjust pitch. ‘A beep tone will sound at different pitches with each key stroke. Press NORMAL SCREEN.5.5 Typical Performance - Alarms Alarms Adjustable Non-adjustable RATOR’S MANUAL EtCO, (high and low) FIO, (high and low) Expiratory anesthetic agent (high and low) Inspiratory anesthetic agent (high and low) Respiratory rate (high and low) CO, rebreathing SpO, (high and low) Pulse rate (high and low) Airway pressure (high and low) PEEP (high) Expiratory minute volume (high and low) FIN,O > 82 % FiO, < 18 % Apnea Select agent XXX selected XXX detected Mixed agent Unknown agent Occlusion Replace water trap Air leak No probe Probe off. Airway leak Disconnection Obstruction 5-16Datex Engstrom 6 AIRWAY GAS MONITORING 6.1 To Display Gas Waveforms ..... 6.2 To Manually Select Anesthetic Agent 6.3 To Change CO, Unit of Measure and Hui Compensation... - 6.4 To Select Gas Waveform Scales .... 6.5 To Display MAC Values 6.6 To Display Balance Gas.. 6.7 Patient Connections ... 6.8 Measuring Principles... 6.9 Typical Performance - Airway Gas ... carnomac ULTIMA™ OPERATOR’S MANUALDatex Engstrom capnomac ULTIMA™ OPERATOR’S MANUAL 6 AIRWAY GAS MONITORING 6.1 To Display G Screen Description To Change Waveform in a Field oar >| eet mi mie 6 Shadow Traces jas Waveforms ‘The CAPNOMAC ULTIMA™ waveform screen consists of three fields (TOP, MID and LOW), for the waveform display. You may display a different waveform in each field. The choices for CO3, Oy, and AA waveform display in any desired field are: CO, CO, slow oO, 0, slow AA AA slow ‘The ‘slow’ waveforms have a sweep speed of one tenth of the normal, for a full screen sweep (2.5 minutes). * Press SET UP SCREEN to call up the set up screen menu and list of current waveforms for each field. So =) ene te aoe res [ay [F] toma one nota maar a ‘next parameter as > 4 ‘next parameter = Press key 1 (PREV) or key 4 (NEXT) to select the desired field for adjustment. A list of the waveforms available appears in the corresponding field. The current choice is pointed and highlighted in the menu, * Press key 2 or 3 to select the desired waveform. The pointer and highlight will change with each key stroke. * Press NORMAL SCREEN after selection is made, In order not to loose the information of the slow Oz, CO, and AA waveforms, shadow traces are drawn on the waveform fields when returning to the normal display from any menu function. The shadow traces are drawn according to the latest Fi and ET values. 616.2 Datex Engstrom capromac ULTIMA™ OPERATOR’S MANUAL To Manually Select Anesthetic Agent CAPNOMAC ULTIMA™ can monitor Halothane, Enflurane, Isoflurane, Desflurane, and Sevoflurane concentrations in the airway. Upon turn on, the anesthetic agent displays are not active. The ‘SELECT AGENT" alarm will be displayed, and audio tone will sound when an agent is sensed by the monitor and no agent has been selected. * Press SELECT AGENT key serectasent | racu mcisou | wy ff Select previous no en TOE HRLOTHRRE ere LURE SEUOFLURANE val DESFLURANE ret pe 14 | Selectnex * Press key 1 (PREV) or 4 (NEXT) to select the desired agent. After an agent has been selected, its Fl and ET concentrations are displayed in the numeric field, and high and low alarms are enabled. When the concen-tration is less than 1 %, the walue is displayed to two decimal places. WARNING: PATIENT SAFETY: Models without agent identification cannot distinguish between anesthetic agents. ‘Manufacturer assumes no liability for an incorrect anesthetic selection. WARNING: DATA VALIDITY: Alcohol in breath may increase anesthetic agent readings. In models with agent id, AA-readings are compensated for, if alcohol is present. 6-2Datex Engstrom nnn APNOMAE ULTIMA™ OPERATOR’S MANUAL 6.3 To Change CO, Unit of Measure and Humidity Compensal To Change CO, Unit CO, can be expressed as a percentage ('6) or partial pressure (mmHg or kPa). * Press SET UP MONITOR to call up the set up screen menu. 7] | seem [ws ” [| ran eoe=> 3 LJ moereestea Ni tet arama 5 = veto wit 5 a reo co ; face tine once | Te * Press key 1 (PREV) or 4 (NEXT) to highlight CO, UNIT. ) * Press key 2 or 3 to select the desired unit of measure (%, kPa and mmHg). To Select Humidity When you are monitoring CO, as a partial pressure (units mmHg or Compensation for KPa, see above) you can take into account partial pressure of H,0. CO, Nambers * Select CO, unit mmHg or kPa, see above. * Press key 4 (NEXT) to highlight CO2 NUMBERS. * Press key 2 or 3 to select the humidity compensation (WET) ‘or no compensation (DRY). * Press NORMAL SCREEN. ‘The humidity compensation selection is stored in permanent memory. Factory Default The factory default is CO, numbers DRY. 6-3Datex En gstrom “ccna tarnomac ULTIMA™ OPERATOR’S MANUAL 6.4 To Select Gas Waveform Scales Choices of Scales CO, scales: Percent %| mmHg | kPa 0t06 | 01050 | 0106 01010 | 0t080 | 0t010 01015 | Oto 110 | 0015 O, scales: Absolute | 0 - 100 % 10 - 60% Differencd 30 % 6 or 10 or 15 % (according to CO, scale) AA scales: 0 - 1.2% 0 - 2.5% 0-5 % 0- 10% 0- 20% 6-4Bagstrom “cnn SAPNOMAC ULTIMA™ OPERATOR’S MANUAL To Change Scales * Press SET UP SCREEN to call up the set up screen menu. see amy » [4 > ;uesie Zoom] OP I acre cae faeces “LO & [F mite: RL fF | Li » [a * Press key 4 (NEXT) until the *CO2 SCALE’, '02 SCALE’, or ‘AA SCALE! is highlighted. + Press key 2 or 3 until the desired scale is highlighted. * Press NORMAL SCREEN. The selection is stored in permanent memory. The selection made effects the scales used for normal monitoring and trend display. For O, difference scale, the scale indicator is determined by the maximum measured oxygen value. 6-5Datex Engstrom ___ciwmac ULTIMA™ OPERATOR'S MANUAL _ 6.5 To Display MAC Values 1 MAC (Minimum Alveolar Concentration) is the alveolar concentration of the agent at which 50 % of individuals fail to move in response to a noxious stimulus. Table 6-1 MAC Numbers at Different Gas Concentrations waL | ENF | Iso SEV DES N,0 rMmac]o7s% | 1.7% | 115% | 2.05% | 6% 100 % zmac|1s% [34% ]23% [41% |az% | - 3MAC|23% | 51% | 345% | 615% | 18% | - CAPNOMAC ULTIMA™ shows a MAC value, which tells the combined effect of inhaled agents (anesthetic agent and nitrous oxide) compared to the 1 MAC level. Example on MAC When the end-tidal N,O concentration is 60 %, and the end tidal Value Calculation concentration of Isoflurane is 0.8 %, the MAC value displayed on the screen is calculated as follows: Calculated MAC = EtN,O/1 MAC concentration of NzO + EtAA/1 MAC concentration of the agent = 60/100 + 0.8/1.15 = 0.6 + 0.7 = 1.3 WARNING: Be aware that MAC values are empiric, not absolute values, CAPNOMAC ULTIMA™ monitor's MAC values correspond to those of healthy adults and cannot be applied to children, Age and some other individual factors influencing the behavior of volatile agents are not taken into account. The selection to display MAC is done in the SET UP SCREEN menu.=) Peston __ssmome ULTIMA™ OPERATOR'S MANUAL 6.6 To Display Balance Gas Balance gas is a calculated concentration of all the gases not directly measured by the monitor (100 - CO, - O, - N,O - AA %). In the SET UP SCREEN menu you can select either balance gas (BAL) or MAC-values (MAC) for display. 6-7an) Datex Engstrom ULTIMA™ OPE! 6.7 Patient Connections WARNING: PATIENT SAFETY: Always test sampling line adapter for a tight connection and proper operation before attaching to a patient. CAUTION: Use only original Datex-Engstrom sampling lines and accessories; other sampling lines may cause inaccurate readings and malfunctions. Change sampling line and airway adapter for each patient, and change or clean water trap container. Empty the water’ trap container whenever it is more than half full, Use Datex-Engstrom sampling line (p/n 73319) specially made to be used with D-FEND™ water trap. Take the gas sample as close to the patient's airway as possible. See Figures 6-1a, b, ¢ and d for illustrations of connections in different situations. NOTE: Position adapter's sampling port upwards to prevent fluid from entering the sampling line. Figure 6-1a Normal Endotracheal Intubation Using a Moisture Exchanger (1) Intubation tube with 15 mm connector (@) Airway adapter 6-8=) Pagscrom __sinoue ULTIMA™ OPERATOR'S MANUAL Figure 6-1b Tracheostomy (1) Tracheostomy tube with 15 mm connector (2) Heat and moisture exchanger (HME) @) Airway adapter Figure 6-1¢ Mask Ventilation (1) Mask (2) Bacteria filter @G) Airway adapter 6-9 |=» Datex Engstrom capnomac ULTIMA™ OPERATOR’S MANUAL Figure 6-1d Endotracheal Intubation of Pediatric Patients (1) Endotracheal tube (2) Pediatric airway adapter*) G) Pediatric heat and moisture exchager (HME) (4) Fresh gas inlet *) Replaces regular pediatric endotracheal tube connector. For sizes 2.5-4.0 endotracheal tubes. Some pediatric ventilation circuits have the fresh gas inlet located so close to the airway connector that the pediatric sampling line adapters prevent proper seating. See Figure 6-1e for illustration of an example of a safe way of leading tubes, lines and sensors to the patient. Figure 6-1e A safe way of directing Tubes , Lines and Sensors to the PatientDatex Engstrom __ capnomac ULTIMA™ OPERATOR’S MANUAL 6.8 Measuring Principles ‘The monitor draws a continuous gas sample (200 ml/min) from the patient's airway through the airway adapter and sampling line. Water and secreations are separated by the D-FEND™ water separation system, so that only the gas sample is passed to the measuring unit. Internal special tubing ensures that the water vapor pressure in the measuring unit is that of the ambient air during both calibration and measurements. CO, N,O and anesthetic agents are measured using infrared measuring technique. ‘Oxygen is measured by a fast paramagnetic oxygen sensor. I~ E value is calculated as difference between inspiratory - expiratory oxygen concentrations. Respiratory rate is the frequency of peak (end tidal) CO, measurements per minute. A "breath is defined as a change in CO; signal which exceeds 1 % (8 mmHg). All concentrations are measured and displayed breath by breath. See ‘First steps in CO, Monitoring" (p/n 876972) _ in ‘APPLIGUIDE™ series published by Datex-Engstrom for further information about CO, monitoring applications. 6-11Batex Engstrom 6.9 CO, Range Rise time Accuracy Display, Range Rise time Accuracy Display, N,O Range Rise time Accuracy Display, Anesthetic agent *) numeric waveform numeric waveform numeric HAL, ISO, ENF SEV DES Rise time Display Extended Extended Extended numeric waveform jomac ULTIMA™ OPERATOR’S MANUAL Typical Performance - Airway Gas 0.15 % (0..114 mmHg, 0...15 kPa) (accuracy unspecified 10...15 %) <360 ms 50.2 vol%, (<1.5 mmHg)(0...8 %) +<0.4 vol%, (<3 mmHg)(8...10 %) end tidal and scales 0...6%, 5 One (50, 80, 110 mmHg; 6, 10, 15 kPa) ‘Two sweep speeds 0.100 % <480 ms <2 vol% end tidal and inspiratory and I - E difference scales 10...60 %, 0...100 %, diff 30%, diff 6/10/15 % Two sweep speeds 0...100 % <360 ms <2 vol% end tidal and inspiratory Measuring Range Accuracy 0.5 % <0.2 vol % 5.15 96 unspecified 0.8 % <0.2 vol % 8.15 9 unspecified 0.18 % <0.2 vol % ( +<0.5 vol % ( ‘51 vol % (1 18...25 % unspecified <520 ms end tidal and inspiratory scales 0...1.2 %, 0...2.5 %, 0..5 %, 0.010 %, Two sweep speeds *) performance with pure agents Respiratory rate numeric 4-60 breaths/miné=) Datex Engstrom ____camome ULTIMA™ OPERATOR’S MANUAL 1 SAFETY PRECAUTIONS 1.1 Warnings .... 1.2 CautionsoDatex Engstrom ——_< ULTIMA™ OPERATOR’S MANUAL a SAFETY PRECAUTIONS 1.4. Warnings EXPLOSION HAZARD ELECTRICAL SHOCK HAZARD A WARNING INDICATES A SITUATION IN WHICH THE USER OR THE PATIENT MAY BE IN DANGER OF INJURY OR DEATH Do not use monitor in the presence of flammable anesthetics. Use only hospital grade grounded electrical outlet and power cord, Always unplug monitor before cleaning. Do not autoclave the monitor with steam or ethylene oxide. Do not immerse in liquids or allow liquids to enter the monitor. Do not open the cover. Refer servicing to authorized service personnel. When you connect other equipment to the monitor make sure that the whole combination complies with the international safety standard IEC 601-1-1 for the medical electrical systems and with the requirements of the local authorities. Non-medical electrical equipment connected to the monitor shall be supplied from an appropriate extra isolating transformer. The transformer shall be equipped with a protectively earthed socket outlet. Without an appropriate transformer the leakage current in the system may exceed the value allowed for the medical electrical equipment, Il=) Datex Engstrom PATIENT SAFETY OCCUPATIONAL SAFETY FAILURE OF OPERATION DATA VALIDITY caPpNomac ULTIMA™ OPERATOR’S MANUAL Constant attention by a qualified individual is needed whenever a patient is under anesthesia or connected to a ventilator. Some equipment malfunctions may occur in spite of equipment or monitor alarms. Always test sampling line adapter for a tight connection and proper operation before attaching to a patient. Monitor models not including the automatic agent identification cannot distinguish between anesthetic agents. Manofacturer assumes no liability for an incorrect anesthetic selection. Do not use a wet or damaged sensor. They may cause burns during electrosurgery. Change the pulse oximetry sensor site frequently to diminish possibility of pressure necrosis. Connect sample gas outlet on monitor's rear panel to scavenging system to prevent pollution of room Handle the water trap and its contents as you would any body fluid. Infectious hazard may be present. If the unit fails to respond as described, do not use the monitor until tested and repaired by authorized service personnel. Organic vapors (e.g. from cleaning agents) in sampling line or room air may alter anesthetic agent readings. Alcohol in patient's breath may increase anesthetic agent readings. In models with agent id, AA readings are compensated for, if alcohol is present. 1-2Datex Engstrom .... 1.2 Cautions SAFETY SYMBOLS CLASSIFICATION DISPOSAL carpnomac ULTIMA™ OPERATOR’S MANUAL CAUTION INDICATES A SITUATION IN WHICH THE UNIT OR DEVICES CONNECTED TO IT MAY BE DAMAGED * Incorrect line voltage may damage instrument. “ Inadequate ventilation may cause inaccurate readings or damage to electronic components. + Be sure that the sample gas is not removed from the monitor under too strong suction, To prevent suction, there must always be an opening to the room air. Strong suction may change the operating pressure of the monitor and cause inaccurate readings or internal damage. * Remove sampling line from patient airway while nebulized medications are being delivered. . Use only original Datex-Engstrom sampling lines and accessories; other sampling lines may cause inaccurate readings and malfunctions. * Do not disinfect or open water trap cartridge. Do not touch water trap membrane, . Do not steam autoclave sensors. * Im models with Side Stream SpirometryTM: Do not inject any gas or liquid into the pressure connectors on the front panel. a Avoid ammonia, phenol or acetone based cleaners for they ‘may damage the monitor surface. * Use only specified Datex-Engstrom interface cables. Other cables may damage the monitor or a device connected to it. See Chapter 3.3. Symbols on Equipment See Chapter 14.1 Equipment Classification. Dispose of the monitor and parts thereof according to local regulations. 13