Aisys CS² Clinical Reference Guide Sw Rev 12

User responsiblity Refer to the User's Reference manual for step-by-step instructions. Read each component's User's Reference manual before using this system. All Warnings and Cautions are in the User's Reference Manual. WARNING Before using this system: • Complete all of the preoperative tests. • Test all other system components.

System controls and menus System controls and menus

System overview 15

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AB.75.251

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1. 2. 3. 4. 5. 6. 7. 8.

Patient monitoring modules Dovetail Aladin cassette and active bay Light switch Alternate O2 control System switch Mains indicator Integrated suction

9. Aladin cassette storage bay 10. Brake 11. O2 flush button 12. Advanced breathing system 13. Auxiliary O2 flow control 14. Anesthesia display 15. Patient monitoring display

Figure 1 • Front view

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AB.75.255

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Network connections Serial port Collection bottle connection Cylinder wrench (key) storage Cylinder yoke Anesthesia Gas Scavenging System

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7. Pipeline connections 8. Mains inlet 9. System circuit breaker 10. Equipotential stud 11. Outlet circuit breaker 12. Isolated electrical outlet

Figure 2 • Rear view

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Using the brake The central brake holds the system in place.

AC.22.009

WARNING Do not use the brake while moving the anesthesia system. This could cause the machine to tip over. Only use the brake to keep the system in place.

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Push down on the brake pedal to lock the system in place. Lift up on the brake pedal to release the brake.

Using the O2 flush button The O2 flush button supplies a high flow of O2 to the breathing system. 1. 2.

Push the O2 flush button to deliver a high flow of O2. Release the O2 flush button to stop the delivery of a high flow of O2.

Positioning the display The display can be moved for optimal viewing. 1. 2. 3. 4. 5. 6.

Unlock the display arm. Raise or lower the display arm to adjust the height of the display. Lock the display arm. Rotate the display arm toward or away from the system to adjust the horizontal position of the display. Tilt the display up or down to adjust the vertical angle of the display. Tilt the display left or right to adjust the horizontal angle of the display.

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Advanced breathing system components 13

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Expiratory check valve Inspiratory check valve Inspiratory flow sensor Expiratory flow sensor Absorber canister Absorber canister release Leak test plug

8. Breathing system release 9. Manual bag port 10. Adjustable pressure-limiting valve 11. Bag/Vent switch 12. Bellows assembly 13. Airway module

Figure 3 • Advanced breathing system

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1. 2. 3. 4. 5. 6. 7.

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Bag support arm Auxiliary Common Gas Outlet (ACGO) switch ACGO port EZchange canister module (CO2 bypass) Ezchange canister release Condenser Condenser drain button

Figure 4 • Breathing system options

Using the bag support arm

AB.82.023

Use the optional bag support arm to hold the breathing circuit bag.

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To raise the bag support arm, squeeze the button and rotate the arm up to the top position. To lower the bag support arm, squeeze the button and rotate the arm down to the lower position.

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Aladin cassette controls The electronically controlled vaporizer consists of the internal electronic control unit and the Aladin agent cassette. Refer to the "Vaporizer cassettes" section in the User’s Reference manual for more information.

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AB.60.038

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Handle with release trigger Lock Liquid level indicator Agent filling port

Figure 5 • Aladin2 cassette

Display controls The system uses touchscreen technology, hard keys, and a ComWheel to access system functions, menus, and settings. WARNING Liquids on the display may degrade the performance of the touchscreen. If liquids come in contact with the display, lock the touchscreen and clean the display. Unlock the touchscreen once the display has been cleaned to resume use of the touchscreen. CAUTION Do not apply excessive force to the touchscreen as damage may occur.

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AC.22.001

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ComWheel

Selects a menu item or confirms a setting. Turn clockwise or counterclockwise to scroll through menu items or change settings.

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Home key

Removes all menus from the screen.

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Screen Lock/ Unlock key

Locks the touchscreen. Toggles between lock and unlock functions.

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Start/End Case key

Initiates Start or End Case function.

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Touchscreen

Activates functions when touch areas on the screen are selected.

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Audio Pause key

Stops audio for 120 seconds for any active, eligible high and medium priority alarms. Prevents audio (audio off) for 90 seconds when no medium or high priority alarms are active. Allows the operator to acknowledge any nonactive medium or high priority latched alarms.

Figure 6 • Display controls

Touch points The touchscreen has touch point areas for quick access to menus and settings. The function keys on the right side of the screen provide direct access to commonly used menus and settings. The ventilator quick keys provide access to the ventilation modes and settings. The gas quick keys provide access to the gas settings used during a case. 5824843

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Touch only one touch point at a time to make sure the correct selection is made. 1

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AB.75.256

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Wave fields Measured values Function keys Digit fields

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Ventilator quick keys Gas quick keys Split screen values

Figure 7 • Normal/Full screen view with shaded touch point areas

Using menus Use the function keys to access the corresponding menus. When a menu is selected, the menu field overlays the normal view and the waveform fields start at the right edge of the menu. 1. 2. 3.

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Select the menu key to access the corresponding menu. Select a menu item to choose the item, or turn the ComWheel left or right to highlight a menu item and then push to confirm. If the menu item selected is an adjustment, turn the ComWheel left or right to make the setting and then push to confirm. 5824843

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If the menu item has a drop-down list, select the desired value from the list by touching the item. Select Close, touch the waveform area, or push the Home key to exit the menu.

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Operation Operation

Turning on the system 1.

2.

Plug the power cord into an electrical outlet. Make sure the system circuit breaker is on. • The mains indicator is lit when AC power is connected. • Battery is charging if it is not already fully charged. Check that the breathing system is properly connected. CAUTION Do not turn on the system with the right-hand (inspiratory) port plugged. --

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Turn the System switch to On. The display shows the power-up screen. The system does a series of automated self tests. Perform a Full Test before the first case of the day. Perform a preoperative checkout before each case. Note The system must perform a power-up self test after 12 hours of remaining on. If the system has been on longer than 12 hours without a power-up self test, the ‘Turn power Off and On for self tests’ alarm occurs. Turn the power off and then back on between cases to resolve the alarm. --

Start anesthesia using custom settings 1. 2.

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Set the Bag/Vent switch to Bag. Select Start Case. The Case Defaults selection shows the first preset case type. Ideal Weight, Age, CO2 Alarms, and Volume Apnea Alarm show the default settings that correspond to the case type shown. Change Ideal Weight, Age, or Volume Apnea Alarm settings on the menu. The Case Defaults changes from the case name to Preset. If the CO2 Alarms setting on the menu is changed, the Case Defaults remains as previously selected. To change ventilation mode, select Mode. Make the change. To change the ventilation settings, select a ventilator quick key or More Settings. Make the change. To change alarm settings, select Alarm Setup. Make the change.

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To change the gas settings or the circuit type, select Gas Setup. Make the change. From the Anesthesia tab, select Start Anesthesia. Gas flow starts.

Patient/Case ID Change or view patient data in the Patient/ Case ID tab. The patient data includes Medical Record Number, Case ID, First Name, Last Name, and Location. The system assigns a unique Medical Record Number for each case by default. All the patient data except Case ID value is exchanged when the system has a direct network connection to a Sapphire client. Access to this tab is controlled through the Super User settings. Note A message shows when patient data is received from the Sapphire client patient demographics exchange. 1. 2.

To change patient data, select the Patient/ Case ID tab. Select a field to enter information.

3. 4. 5.

The Edit Patient/ Case ID menu shows. Enter text in the available fields. Select Previous Menu to return to the Patient/ Case ID tab. Select Close.

Start monitoring only Use Monitoring Only to view monitoring parameters on the anesthesia display. There is no ventilation, fresh gas flow through the common gas outlet, or agent delivery while the system is in Monitoring Only. Changes made to the settings on the Monitoring Only tab carry over to anesthesia delivery. 1. 2. 3.

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Set the Bag/Vent switch to Bag. Select Start Case. Select the Monitoring Only tab. The Case Defaults selection shows the first preset case type if no select was made on the Anesthesia tab. Verify or change the preset case type. The CO2 Alarms setting corresponds to the preset case type. Any changes made to the settings carry over to anesthesia delivery. Connect the patient to the auxiliary O2 outlet.

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Connect the gas monitor sample line to the patient connection. Select Start Monitoring Only. Fresh gas, agent delivery, and ventilation are not available. The ‘Gas Monitoring Only’: ‘Ventilator Off’ message shows. Note If ventilation or anesthesia delivery is needed while in Monitoring Only, select Start Anesthesia. Verify that a patient circuit is connected. Select Confirm. Note Gas sampled from a cannula could be diluted by room air.

End a case Use the End Case menu to stop gas flow and end the patient alarms. The amount of gas used and agent used during the case shows in the menu. 1. 2. 3.

Set the Bag/Vent switch to Bag. Select End Case. Select End Case Now on the menu. (The gas flow and patient alarms stop). The system is now in Standby. Select a quick key or the Start Case button to start anesthesia delivery or monitoring only.

Ventilator setup WARNING Most anesthetic agents will cause patients to have reduced ventilatory responses to carbon dioxide and to hypoxemia. Therefore, triggered modes of ventilation may not produce adequate ventilation. The use of neuromuscular blocking agents will reduce the patient’s breathing response, which will interfere with triggering. Changing ventilator mode 1. Select the Mode quick key. The Vent Mode menu shows. 2. Select the desired ventilation mode. 3. Set and confirm the primary ventilation setting to activate the ventilation mode. Controls that are frequently used in the ventilation mode can be adjusted with the ventilator quick keys and the More Settings quick key.

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Changing ventilator setting 1. Select the ventilation setting to be adjusted. Set the desired value. 2. Push the ComWheel to activate the change.

Gas setup Use the Gas Setup menu to adjust the agent, O2% and total flow, to change the balance gas, and to change the circuit type. If ecoFlow is enabled, minimum O2 marker can be set. Changing gas settings 1. Select the Gas Setup quick key. 2. Select the setting to change from the Gas Setup menu. 3. Change the setting. 4. For Circuit, select the menu item and change using the drop-down menu. Select Confirm. 5. For Other Gas, select the menu item and change using the dropdown menu. 6. For Agent, O2% and Total Flow, select the setting and make the change using the ComWheel and push to confirm the setting. 7. For Minimum O2 Marker, select the setting and make the change using the ComWheel. Select the FiO2 value to maintain the calculated minimum O2 fresh gas flow. Push the ComWheel to confirm the setting. Changing balance gas 1. Select the Gas Setup quick key. 2. Select the Other Gas menu item. 3. Select the balance gas to use with O2. Changing circuit type 1. Select the Gas Setup quick key. 2. Select Circle or Non-Circle 3. Select Confirm. Using the circle circuit 1. Select the Gas Setup quick key. 2. Select Circle. Fresh gas oxygen concentration is displayed on the screen. Fresh gas flow combines with the exhaled gas and exits out through the inspiratory port. 3.

Set the alarm limits to clinically appropriate settings.

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Using the non-circle circuit 1. Select the Gas Setup quick key. 2. Select Non-Circle. Fresh gas oxygen concentration is displayed on the screen. Fresh gas flow is diverted around the inspiratory check valve and out through the inspiratory port. 3. Set the alarm limits to clinically appropriate settings.

System setup Use System Setup to access menus and settings for Patient Demographics, Screen Setup, Fresh Gas Usage, System Status, Calibration, and Checkout History. Patient demographics Use the Patient Demographics menu to access the Age and Weight tab and the Patient/ Case ID tab. The Age and Weight tab has settings forAge, Ideal Weight, TV for Ideal Body Weight, and Set Vent by Weight. Use the Patient/ Case ID tab to access the patient data. Age and weight Use the Age and Weight tab to make ventilator settings by proposed age and weight settings. 1. 2. 3. 4.

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Select System Setup - Patient Demographics. Set the Age, Ideal Weight, and TV for Ideal Body Weight values. The proposed values for TV and RR show. Select Set Vent by Weight to accept the proposed TV and RR values. Select Close.

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Entering Patient/Case ID data Change or view patient data in the Patient/ Case ID tab. The patient data includes Medical Record Number, Case ID, First Name, Last Name, and Location. The system assigns a unique Medical Record Number for each case by default. All the patient data except Case ID value is exchanged when the system has a direct network connection to a Sapphire client. Access to this tab is controlled through the Super User settings. Note A message shows when patient data is received from the Sapphire client patient demographics exchange. 1. 2. 3.

Select System Setup - Patient Demographics. Select the Patient/ Case ID tab. Select a field to enter information.

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The Edit Patient/ Case ID menu shows. Enter text in the available fields. Select Previous Menu to return to the Patient/ Case ID tab. Select Close.

Screen setup menu Use the Screen Setup menus to customize the screen view. Areas of the screen can be customized to show specific information. Waveform fields and the split screen view cannot be changed while in Monitoring Only. Setting waveform fields 1. Select System Setup - Screen Setup. 2. Select the Layout tab. 3. Select the desired waveform button and select the value from the drop-down menu. 4. Select Close. Setting digit fields 1. Select System Setup - Screen Setup. 2. Select the Layout tab. 3. Select the desired digit field button and select the value from the drop-down menu. 4. Select Close. Setting the split screen 1. Select System Setup - Screen Setup. 5824843

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Select the Layout tab. Select Split Screen and select the desired view from the drop-down menu. Select Close.

Setting the data source 1. Select System Setup - Screen Setup - More Settings or Spirometry - Setup Loops. 2. Select Data Source. 3. Select Patient to have spirometry data sourced from the airway module or Vent to have spirometry data sourced from the ventilator. 4. Select Back to view changes made and access other functions of the Spirometry menu. Setting fresh gas controls 1. Select System Setup - Screen Setup. 2. Select More Settings. 3. Select Fresh Gas Controls. 4. Select O2% or Flow from the drop-down menu. When set to O2%, balance gas adjusts automatically when either the O2% or the Total Flow is changed using the gas quick keys. When set to Flow, balance gas and the O2% are controlled individually using the gas quick keys. 5. Select Close. Fresh gas usage Use Fresh Gas Usage to view the volume of O2, Air, N2O, and agents used for the three most recent cases. • Data only shows for gases available on the system. • Agent data shows the three most recently used agents. 1. 2. 3.

Select System Setup - Fresh Gas Usage. Select Case Start Time to select the patient case to view. Select Close.

System status Use the System Status menu to access the system information. •

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Select Anesthesia to view the status of gas supplies, electrical supplies, the software version, ventilation volume basis setting, the airway gas module basis setting, and the airway module configuration. 5824843

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Select Network to see the system network status. Select Log Transfer to view the log transfer configuration information, to see the set log transfer time, or to manually transfer the service log files. If a case is in progress during the set transfer time, the transfer occurs when the case ends. If the transfer is in progress when a case is started, the transfer stops and does not complete. Select Clock Sync. to view the clock synchronization method if configured. Clock synchronization is disabled during a case and will occur outside of a case.

Alarm setup Use the Alarm Setup menu to set and adjust alarm limits, alarm volume, and other alarm settings and to view alarm history. The Alarm Setup menu contains the Primary Limits, More Limits, Alarm History, and Configure tabs. Setting CO2 alarms 1. Select Alarm Setup. 2. To turn off the CO2 alarms, select the Primary Limits tab and set CO2 Alarms to Off. The ‘CO2 Alarms Off’ message shows in the general message field. The CO2 alarm limit waveform numerics shows the Alarm Off symbol during a case. The alarms remain disabled until the Bag/Vent switch is set to Vent, the case is ended, or the CO2 Alarms is set to On. 3. To turn on the CO2 alarms, set CO2 Alarms to On. 4. Select Close. Setting volume apnea alarm 1. Select Alarm Setup. 2. To turn the volume apnea alarms off, select the Primary Limits tab set the Vol Apnea Alarm to Off. ‘Volume Apnea Off’ shows in the general message field. • If mechanical ventilation is started, the volume apnea alarms are active. • If manual ventilation is restarted, a pop-up confirmation window appears to resume the Off setting. 3. To turn the volume apnea alarms on, set Vol Apnea Alarm to On. 4.

Select Close.

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Setting MV/TV alarms 1. Select Alarm Setup. 2. To turn the volume alarms off, select the Primary Limits tab and set MV/TV Alarms to Off. ‘MV/TV Alarms Off’ appears in the general message field. The volume alarm limits waveform numerics shows dashes during a case. 3. To turn the volume alarms on, set MV/TV Alarms to On. 4. Select Close. Setting alarm limits WARNING Do not set alarm limits to extreme values. Setting limits to extreme values can render the alarm useless. 1. 2. 3.

Select Alarm Setup. From the Primary Limits and More Limits tabs, select the alarm limit and make the change. Push the Home key, touch the waveform area of the display, or select Close to close the menu.

Viewing alarm history 1. Select Alarm Setup. 2. Select the Alarm History tab. The list of alarms shows in the window. 3. Select Close. Setting alarm volume WARNING Set alarm volume loud enough to be heard over surrounding noise. If the volume is not loud enough, the user may not hear the alarm. 1. 2. 3. 4.

Select Alarm Setup. Select the Configure tab. Set Alarm Volume to the desired value. The alarm volume range is 1 to 5. Select Close.

Setting apnea delay 1. Select Alarm Setup. 2. Select the Configure tab. 18

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