Avance CS2 Quick Reference Guide sw rev 10.X Rev A

User responsibility 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 the system:

•

Complete all of the preoperative tests.

•

Test all other system components.

System controls and menus System overview





  

  

 



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

Light knob Vaporizer Upper Dovetail Alternate O2 control System switch Mains indicator Integrated suction (optional)

8. Lower dovetail 9. Brake 10. O2 flush button 11. Advanced breathing system 12. Auxiliary O2 flow control 13. Anesthesia display

Figure 1 • Front view

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1. 2. 3. 4. 5.

Outlet circuit breaker Isolated electrical outlet Vacuum connection Collection bottle connection Cylinder yoke

6. AGSS 7. Equipotential stud 8. Mains inlet 9. System circuit breaker 10. Pipeline connections

Figure 2 • Rear view

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Advanced breathing system components

    

 

   

 

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

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

9. Breathing system release 10. Adjustable pressure-limiting (APL) valve 11. Bag/Vent switch 12. Bellows assembly 13. AGSS indicator (only on some versions) 14. Sample gas return port 15. Airway module (optional)

Figure 3 • Advanced breathing system M1241484

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1. 2. 3. 4.

Bag support arm ACGO switch ACGO port EZchange canister module (CO2 bypass)

5. EZchange canister release 6. Condenser 7. Condenser drain button

Figure 4 • Breathing system options

Vaporizer controls Refer to the vaporizer User’s Reference manual for more detailed information on the vaporizer. 







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1. Lock lever 2. Concentration control and release 3. Silence alarm touch key

Figure 5 • Vaporizer controls

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Display controls The system uses touchscreen technology, hard keys, and a ComWheel to access system functions, menus, and settings. Touch only one touch point at a time to ensure the correct selection is made.

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CAUTION Do not apply excessive force to the touchscreen as damage may occur.













1.

ComWheel

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

2.

Home key

Removes all menus from the screen.

3.

Screen Lock/ Unlock key

Locks the touchscreen. Toggles between lock and unlock functions.

4.

Start/End Case key

Initiates Start or End Case function.

5.

Touchscreen

Activates functions when touch areas on the screen are selected.

6.

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 non-active medium or high priority latched alarms. Hold the key for 2 seconds to cancel the audio pause function.

Figure 6 • Display controls M1241484

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Touch points 





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1. 2. 3. 4.

Wave fields Measured values Function keys Digit fields





5. Ventilator quick keys 6. Gas quick keys 7. 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. Select the menu key to access the corresponding menu. 2. 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. 3. If the menu item selected is an adjustment, turn the ComWheel left or 6

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right to make the setting and then push to confirm. If the menu item has a drop-down list, select the desired value from the list by touching the item. 4. Select Close, touch the waveform area, or push the Home key to exit the menu.

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Operation Turning on the system 1. 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. 2. Check that the breathing system is properly connected. CAUTION Do not turn on the system with the right-hand (inspiratory) port plugged. 3. Turn the System switch to On. The display shows the power-up screen. The system does a series of automated self tests. 4. Perform a Full Test before the first case of the day. 5. Perform a preoperative checkout before each case. See the “Preoperative checkout” section. 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.

Starting a case using custom settings 1. Set the Bag/Vent switch to Bag. 2. 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. 3. 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. 4. 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. 5. To change alarm settings, select Alarm Setup. Make the change. 6. To change the gas settings or the circuit type, select Gas Setup. Make the change. 7. From the Start Case menu, select Start Case Now. Gas flow starts. 8

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End a case 1. Set the Bag/Vent switch to Bag. 2. Select End Case. 3. Select End Case Now on the menu to put the system in standby (stops the gas flow and patient alarms). The End Case menu shows the gas and agent usage for the case.

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.

Changing ventilator settings 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 O2% and total flow, to change the balance gas, and to change the circuit type.

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 O2% and Total Flow, select the setting and make the change using the ComWheel and push 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. M1241484

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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.

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.

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. 2. Select the Layout tab. 3. Select Split Screen and select the desired view from the drop-down menu. 4. Select Close.

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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 display brightness 1. Select System Setup - Screen Setup. 2. Select More Settings. 3. Select Display Brightness. 4. Select the desired brightness level with 1 being the dimmest and 5 being the brightest. 5. Select Close.

Setting keypad brightness 1. Select System Setup - Screen Setup. 2. Select More Settings. 3. Select Keypad Brightness. 4. Select the desired brightness level with 1 being the dimmest and 5 being the brightest. 5. Select Close.

Setting CO2 alarms 1. Select Alarm Setup. 2. To turn off the CO2 alarms, set CO2 Alarms to Off. The ‘CO2 Alarms Off’ message shows in the general message field. The CO2 alarm limit waveform numerics shows dashes 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 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. M1241484

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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.

Setting MV/TV alarms 1. Select Alarm Setup. 2. To turn the volume alarms off, 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. Select Alarm Setup. 2. From the Primary Limits and More Limits tabs, select the alarm limit and make the change. 3. 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 1. Select Alarm Setup. 2. Select the Configure tab. 3. Set Alarm Volume to the desired value. The alarm volume range is 1 to 5. 4. Select Close.

Silencing leak audio alarms 1. Select Alarm Setup. 2. Select the Configure tab. 3. Set Leak Audio to Off. The audio alarms for small leaks are silenced. 12

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4. To turn audio alarms back on, set Leak Audio to On. 5. Select Close.

Setting auto MV limits 1. Select Alarm Setup. 2. Select the Configure tab. 3. Set Auto MV Limits to On. The MV alarm limits are automatically calculated until Auto MV Limits is set to Off or until an MV limit is manually adjusted during mechanical ventilation. The MV alarm limits are automatically calculated based on TV and RR settings. 4. Select Close.

Setting to default limits 1. Select Alarm Setup. 2. Select the Configure tab. 3. Select Change to Default Limits. 4. Select Close.

Trends Use the Trends menu to view patient trends and set the time scale. There are three views for patient trends: measured (numerical), settings, and graphical. Trend information is saved every 15 seconds for the most recent 24 hours.

Setting trends 1. Select Trends. 2. Select the desired view. 3. Select Scroll to move through the current trend view. 4. Select Time Scale to select the desired scale from the drop-down menu. 5. Select Next Page to view additional parameters. 6. Select Close.

Setting loop type 1. Select Spirometry. 2. Select Loop Type and select the loop from the drop-down list. 3. Select Close.

Setting loop graph scaling 1. Select Spirometry - Setup Loops. M1241484

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2. Select Spirometry Scaling and set the scale type from the dropdown list. 3. Select Back to view changes made and access other functions of the Spirometry menu.

Setting patient and sensor type 1. Select Spirometry - Setup Loops. 2. Select Patient and Sensor and then select Adult or Pedi depending on the sensor used. 3. Select Back to view changes made and access other functions of the Spirometry menu.

Setting spirometry volume type 1. Select Spirometry - Setup Loops. 2. Select Show MV or TV and select MV or TV from the drop-down list. Set to TV to show TVinsp and TVexp on the spirometry split screen. Set to MV to show MVexp and TVexp on the spirometry split screen. 3. Select Back to view changes made and access other functions of the Spirometry menu.

Saving, viewing, and deleting spirometry loops 1. Select Spirometry. 2. To store a loop to memory, select Save Loop. Up to six loops can be saved. 3. To view a saved loop, set Show Ref. Loop to the time at which it was saved. 4. To delete a saved loop, set Delete Ref. Loop to the time at which it was saved. 5. Select Close.

Using the timer 1. Select Start to start the clock. 2. Select Stop to pause or stop the clock. If Start is selected, the clock will resume operation. If Start is selected and held for longer than 1 second, the clock will reset to zero.

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Preoperative tests Circuit compliance compensation The ventilator adjusts gas delivery and monitoring to compensate for the compliance of the patient circuit if: • • •

The system has a airway module installed. The Circuit Compliance is set to On from Super User - System Config. - Ventilator Settings. The Checkout is completed after the system is turned on.

Circuit compliance is determined during the Checkout - Full Test or when the Vent and Gas check is done as an individual test. Circuit compliance must be set by the Super User for the Circuit Compliance compensation function to be active. See the “Super user mode” section for information on the circuit compliance setting. In volume modes, circuit compliance compensation increases the volume delivered at the inspiratory port by taking into consideration the circuit compliance value. In all modes, circuit compliance compensation adjusts the volume measurements. Circuit compliance compensation provides consistent ventilator accuracy at the patient circuit. WARNING Perform a Vent and Gas test after changing the patient tube type. Changing the patient breathing circuit after completing a Vent and Gas test affects the volume measurements in all modes.

Breathing circuits and breathing circuit components are available in many different configurations from multiple suppliers. Attributes of the breathing circuits such as materials, tube length, tube diameter, and configuration of components within the breathing circuit, may result in hazards to the patient from increased leakage, added resistance, or changed circuit compliance.

Checkout menu The Checkout menu shows on the display after turning on the system. To access the Checkout menu between cases, select Checkout. Step-bystep instructions show in the Checkout menu during the tests. Use the Checkout menu to: • • • •

Perform a Full Test. Perform any of the individual tests. View the Test Log. Start a case.

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Full test The Full Test or the individual tests must be performed at least once within every 24-hour period. Perform the Full Test at the start of each day. The full test runs automatically and beeps to indicate when it is finished or if interaction is required. The Full Test does the following tests: Vent and Gas, Circuit Leak, and Circuit O2 Cell (if circuit O2 cell is present). When one of the tests is completed, the next test begins. 1. From the Checkout menu, select Full Test and follow the instructions. 2. If a test fails, follow the instructions to perform a retest or accept the results. 3. When the Full Test is completed, start a case. Note In case of a patient emergency, the Full Test may be bypassed by selecting Start Case. The general message ‘Please Do Checkout’ is displayed if a Full Test or all of the individual tests are not completed with passing results within 24 hours.

Full test - vent and gas The Vent and Gas test checks the Bag/Vent switch, proper gas supply pressures, ventilator operation and leak, battery and electrical power, circuit compliance, and flow control operation. This is a two-step test. To run this test, follow the on-screen instructions. When the test passes, the next test starts.

Full test - circuit leak The Circuit Leak test checks the Bag/Vent switch, proper gas supply pressures, airway pressure measurement transducer, APL valve, and manual circuit leak. To run this test, follow the on-screen instructions. When the test passes, the next test starts.

Full test - circuit O2 cell The Circuit O2 Cell test measures the O2 percent. To run this test, follow the on-screen instructions. Do not select Done when 21 is first displayed. Allow the reading to stabilize, then select Done. Calibrate the O2 cell if necessary.

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Alarms and troubleshooting Alarms WARNING Do not use malfunctioning equipment. Contact an authorized service representative for service. Refer to the User’s Reference manual for a complete list of alarms and troubleshooting information.

Message

Cause

Action

Apnea

Apnea time delay 10-30 seconds) has passed without a measured breath. Apnea time delay (20-30 seconds) has passed without a change in measured CO2 by at least 1%. Apnea time exceeds 120 seconds.

Check for leaks in the patient circuit. Check for patient disconnection.

Bellows is collapsed.

Check the drive gas. Increase fresh gas flow (or push the O2 flush button) to fill the bellows.

Apnea > 120 s

Increase low MV limit

MVexp high

MVexp low

Ppeak high Reverse exp flow. Check valves ok? Set Alt O2 flow! Check agent setting! Unable to drive bellows

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Check for leaks or blockages in the breathing circuit. Ensure the Bag/Vent switch is in the Vent position. Check the patient. Low MV limit is off in SIMV VCV, Increase low MV alarm limit SIMV PCV, SIMV PCV-VG, to improve patient CPAP + PSV, or PSVPro disconnection detection. modes. MVexp is greater than MVexp Set alarm limits high alarm limit (for nine breaths appropriately. Check the or one minute). ventilation settings. MVexp is less than MVexp low Set alarm limits appropriately. Check the alarm limit (for nine breaths or ventilation settings. less than one minute). Paw is greater than Pmax alarm Check for blockages in the limit. patient circuit. Flow toward the patient seen in Calibrate the flow sensors. the expiratory flow sensor during inspiration for six breaths in a row. Software or hardware failure Contact an authorized prevents mixed gas delivery. service representative.

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Message

Cause

Action

Ventilate manually!

Software or hardware failure prevent mechanical ventilation. No pressure, no flow, and no volume monitoring from ventilator.

Use a manual bag to ventilate the patient or use an alternate machine. Shut down the system as soon as possible and contact an authorized service representative.

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