Aestiva MRI Quick Reference Guide sw rev 4.X Rev B Oct 2003

For step-by-step instructions, refer to the Operation and Maintenance Manual. Do not use this system unless you have read each component’s Operation and Maintenance Manual. Improper use of this Anesthesia Machine in an MRI room can cause significant injury to the operator or patient and significant equipment damage. w WARNINGS

Before you use the system • Complete all of the preoperative tests. • Test all other system components.

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Use only MRI compatible cylinders.

Important: The Aestiva™/5 MRI is MRI Compatible* *Tested with an active shielded 1.5 Tesla MRI unit in a magnetic fringe field ≤ 300 gauss. Tested with an active shielded 3.0 Tesla MRI unit in a magnetic fringe field ≤ 300 gauss.

w WARNINGS

Do not set up or service this machine in MRI room. Do not add or remove accessories or components in MRI room. Use only MRI compatible accessories. Store only MRI compatible items in the drawer. Set brake during use or storage in MRI room.

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The Aestiva/5 MRI will function to specifications in an MRI environment that does not exceed 300 gauss. Do not store or operate the Aestiva/5 MRI within the 300 gauss line for your unit.

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The Aestiva/5 MRI does contain some ferromagnetic material and will be attracted to the MR Imager if positioned closer than 300 gauss. Always keep the Aestiva/5 MRI in a fringe field of 300 gauss or less. The system includes an integral gauss alarm that monitors the strength of the magnetic fringe field in which the machine is located. The alarm warns the operator if the machine is moved into a magnetic fringe field that is greater than 300 gauss.

<275 Gauss

2

275-300 Gauss

>300 Gauss

Step-by-Step Guide 1.

Make sure the breathing circuit is correctly assembled. On

2.

Set the system switch to on ( m ) to permit gas flow and to turn on the monitoring.

3.

Do the preoperative checkout. Refer to the preoperative checklist.

4.

Set the ventilation mode and controls. • Volume control mode supplies a set tidal volume. • Pressure control mode supplies a set pressure during inspiration.

Pmean

Pmax

PEEP

Pinsp

Pmax

PEEP

5.

Set the alarm limits.

6.

To start mechanical ventilation, set the Bag/Vent switch to Vent - r. • Use the volume alarm key to prevent false alarms during manual ventilation.

7.

To stop mechanical ventilation, set the Bag/Vent switch to Bag or select the auxiliary gas outlet.

R

• Use the end case key at the end of a case to prevent volume and apnea alarms and to set the pressure limit and PEEP to default values (40 cm H2O; 0 cm H2O). Mechanical ventilation must be off. Push end case. Push the knob to save.

Aestiva™ /5 MRI Quick Reference Guide

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Checklist Every day - before the first patient Outside the MRI room: ∫

Do MRI compatibility test.

∫

Check that the gas cylinders are MRI compatible.

∫

Check that only MRI compatible items are stored in the drawer.

∫

Inspect the system. Look for damage, necessary drugs and equipment, correct breathing circuit setup, and hazardous conditions.

∫

Verify that the green (<275 Gauss) light is on.

∫

Turn on the system.

∫

Do a low-pressure leak test.

Inside the MRI room: ∫

Set the brake.

∫

Set the ventilator controls to decrease alarms.

∫

Do the pipeline and cylinder tests. Look for sufficient pressures and no high pressure leak (cylinders).

∫

Do the flow control tests: • Minimum flows: O2 25-75 mL/min, all other gases no flow. • Link system: Increase N2O flow to drive up O2 flow. Decrease O2 flow to drive down N2O flow. The O2 flow is ≥ nominal 25%. • O2 supply failure alarm. Alarm operates when O2 pressure is decreased below set limit. Air flow continues. All other gases stop.

∫

Do the vaporizer back pressure tests: • Set the O2 flow to 6 L/min. • Slowly turn on one vaporizer at a time. • Make sure that the O2 flow stays above 5 L/min.

∫

Do the ventilator alarm tests. • Make sure all monitors operate correctly. • Make sure the O2 sensor operates correctly. It shows approx. 21% O2 in room air and 100% O2 after two minutes in pure O2. • Make sure these ventilator alarms operate correctly: high and low O2; low minute volume; high airway pressure; apnea and low airway pressure; sustained airway pressure.

∫

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Verify that the machine is positioned so that only the green (<275 Gauss) or the amber (275–300 Gauss) light is on.

Checklist Every time a different clinician uses the system Outside the MRI room: ∫

Do a low-pressure leak test.

∫

Verify that the green (<275 Gauss) light is on.

Before every patient Inside the MRI room: ∫

Look for damage, necessary drugs and equipment, correct breathing circuit setup, and hazardous conditions.

∫

Check vaporizer installation: • Make sure the top of each vaporizer is horizontal (not crooked). • Make sure each vaporizer is locked and cannot be removed. • Make sure you cannot turn on more than one vaporizer at the same time.

∫

Do the breathing system tests: • Make sure the one way valves and auxiliary equipment operate correctly. • With a circle breathing-circuit module, push the drain button for ≥ 10 sec. to remove condensate. • Ventilator circuit leak test. • Bag/Manual circuit leak test. • Bag/Manual circuit APL valve test. • Circuit leak test.

∫

Set the appropriate controls and alarm limits for the case.

∫

Verify that the machine is positioned so that only the green (<275 Gauss) or the amber (275–300 Gauss) light is on.

Aestiva™ /5 MRI Quick Reference Guide

5

Control Basics Menu 1.

Push the menu key to see the main menu.

2.

Turn the knob to select an option (highlight).

3.

Push the knob to show the next screen. • During a calibration or other procedure, the screen shows the instructions.

1

2

Main Menu Ventilation Mode Alarm Settings Setup/Calibration Screen and Audio Setup Cardiac Bypass No Exit to Normal Screen

Main Menu Ventilation Mode Alarm Settings Setup/Calibration Screen and Audio Setup Cardiac Bypass No Exit to Normal Screen

3 Setup/Calibration SIMV/PSVPro Setup O2 Sensor Cal Inspiratory Pause Off Heliox Mode Off About Ventilator ... Go to Main Menu

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Control Basics Menu Map Main Menu Ventilation Mode Volume Control Alarm Settings Pressure Cntrl Setup/Calibration SIMV Mode Screen and Audio PSVPro Mode Cardiac Bypass Nw Exit to Normal Screen

Main Menu Ventilation Mode Alarm Settings Setup/Calibration Screen and Audio Setup Cardiac Bypass No Exit to Normal Screen

Alarm Settings O2 VE Auto Limits VTE Circuit Leak

18 5.0 600 Audio On

75 Off Off

Go to Main Menu

Screen and Audio Setup Display Contrast 5 Alarm Loudness 4 Alarm Limits Show Units of Measure Show Go to Main Menu

Aestiva™ /5 MRI Quick Reference Guide

Setup/Calibration SIMV/PSVPro Setup O2 Sensor Cal Inspiratory Pause Off Heliox Mode Off About Ventilator ... Go to Main Menu

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Control Basics Selection Keys The bottom of the screen shows control settings. To change a setting: 1.

Push the selection key below the setting.

Mode Key

2.

Turn the knob to change the setting.

Knob

3.

8

Push the knob or the key to save the change.

Ventilation Mode Set the mode: text above the waveform shows the ventilation mode. Volume control: supplies a set tidal volume. Pressure control: supplies a set pressure during ventilation. 1.

Push the menu key.

2.

Turn, then push the knob to select Ventilation Mode Mode.

3.

Turn, then push the knob to change the mode. You must push the knob to save the change.

1

2

3

Aestiva™ /5 MRI Quick Reference Guide

Main Menu Ventilation Mode Alarm Settings Setup/Calibration Screen and Audio Setup Cardiac Bypass No Exit to Normal Screen

Main Menu Ventilation Mode Volume Control Alarm Settings Pressure Cntrl Setup/Calibration SIMV Mode Screen and Audio PSVPro Mode Cardiac Bypass Nw Exit to Normal Screen

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Start/Stop Mechanical Ventilation To Start w WARNING

Make sure the patient circuit is correctly assembled and the control settings are correct before you start or stop ventilation.

Mechanical ventilation is off when you first turn on the system.

1.

Make sure the control settings are correct.

2.

Turn off the auxiliary common gas outlet (some models).

3.

Set the Bag/Vent switch back to Vent - r. • If mechanical ventilation is not available, a message tells you what to do.

To Stop Make sure the patient circuit is correctly assembled and the control settings are correct before you start or stop ventilation.

MI

N

Make sure control settings are correct. 30

1.

70

w WARNING

20

2.

10

Set the Bag/Vent switch to Bag -

R.

Alarm Settings O2 and volume alarms: high and low volume and high O2 alarms can be turned off. The low O2 alarm cannot be set to less than 18%. Circuit leak audio: to prevent alarms from a known leak (e.g. an uncuffed tube), set the audio to off. Cardiac Bypass: set Cardiac Bypass to “in progress” to prevent volume and Apnea alarms when the patient is on cardio-pulmonary bypass. When Cardiac Bypass is in progress, the display shows Cardiac Bypass and Apnea Alarm Off Off. Note: mechanical ventilation must be off. 1.

Push the menu key.

2.

Turn, then push the knob to select Alarm Settings Settings.

3.

Turn, then push the knob to select an alarm limit.

4.

Turn, then push the knob to change the limit. You must push the knob to save the change.

1 Main Menu Ventilation Mode Alarm Settings Setup/Calibration Screen and Audio Setup Cardiac Bypass No Exit to Normal Screen

2

Main Menu Ventilation Mode Alarm Settings Setup/Calibration Screen and Audio Setup Cardiac Bypass No Exit to Normal Screen

3

18

4

20

Alarm Settings O2 VE Auto Limits VTE Circuit Leak

18 5.0 600 Audio On

75 Off Off

Go to Main Menu

Aestiva™ /5 MRI Quick Reference Guide

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Alarm Settings 5.

The pressure limit alarm uses a selection key.

Pressure Limit

Key

Turn the Volume Alarms On or Off w WARNING

Do not turn off volume alarms with a spontaneously breathing patient. The system will not alarm for low volume.

The volume alarm key (VE/VTE) turns volume alarms on and off. When the alarms are off, the alarm limits are hidden. Use this control to prevent false alarms if you switch to manual ventilation at lower tidal volumes.

Vol Alarms On

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Troubleshooting w WARNING

Do not use malfunctioning equipment. Contact Datex-Ohmeda for service. Refer to the Operation Manual - Cleaning, Setup, Maintenance, and Troubleshooting for more information.

Message

Cause

Action/Concern

12 Hour Test

System in use for more than 12 hours without a power-up self test.

The system continues to operate. To do the test, move the system switch from standby to on.

Check Flow Sensors

No flow or negative flow during inspiration. Negative flow during expiration.

Are flow sensors correctly installed? Are the connectors reversed? Inspect check valves.

Low Paw

Paw does not rise at least 4 cm from the lowest pressure measured during the last 20 seconds.

Are circuit connections OK? Look at the Paw gauge on the absorber. Look for circuit disconnection.

Minimum System Failure

A severe malfunction prevents mechanical ventilation and monitoring. Other alarms may also occur.

Ventilate manually. Use a stand-alone monitor. Cycle system power (on-standby-on). If the alarm clears, restart mechanical ventilation.

Patient Circuit Leak

Exhaled volume < 50% of inspired volume for at least 30 sec.

Check breathing circuit and flow sensor connections. With an uncuffed tube or known leak, set circuit leak audio to off (alarm limits).

Cannot Drive Bellows

The drive pressure to the bellows housing > Paw.

Fill the bellows if empty. Check the patient connection.

Volume Apnea

No measured breath in last 30 seconds.

Check patient. Bag as needed. Look for disconnects. If the patient is on cardio-pulmonary bypass, select Cardiac bypass on the alarm menu.

VT not achieved

The tidal volume measured by the inspiratory flow sensor < set value.

Adjust controls to supply adequate tidal volume.

Aestiva™ /5 MRI Quick Reference Guide

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Troubleshooting Leaks 1.

Are absorber canisters correctly installed?

2.

Is auxiliary outlet off?

Off

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3.

Calibrate/replace flow sensors.

4.

Do circuit leak tests • Bag circuit • Ventilator circuit.

On

Auxiliary Outlet Switch (Option) This switch sends gas to the selected outlet when the system has an auxiliary common gas outlet. Ventilation and volume monitoring turns off when the auxiliary outlet is selected.

Gas to Breathing Circuit

Gas to Auxiliary Outlet

Aestiva™ /5 MRI Quick Reference Guide

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Bag Arm Adjustment Only the long arm can be adjusted (option).

16

1.

Push in and turn.

2.

Release the arm. It stays in position.

Aestiva™ /5 MRI Quick Reference Guide

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Aestiva/5 MRI Quick Reference Guide Software Revision 4.X

Step-by-Step Guide Checklist Control Basics Ventilation Mode Start/Stop Mechanical Ventilation Alarm Settings Troubleshooting Auxiliary Outlet Switch (Option) Bag Arm Adjustment

© 2002 Datex-Ohmeda, Inc.

All rights reserved Subject to change without notice Printed in USA 10 03 1006 0990 000 B

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