Aisys CS² Participant Guide Version A PG Rev A

Aisys CS2 Participant Guide Version A

Clinical Systems Clinical and Educational Development

Customer Support Center: 800-345-2700 Notice Configurations available for this product depend on local market and standards requirements. Illustrations in this course may not represent all configurations of the product. This course does not cover the operation of every accessory. The materials contained in this document are intended for educational purposes only. This document does not establish specifications, operating procedures or maintenance methods for any of the products referenced. Always refer to the official written materials (labeling) provided with the product for specifications, operating procedures and maintenance requirements. Proprietary Training Material Property of GE Healthcare. The materials contained in this document are intended for educational purposes only. Use of these materials is limited to agents and employees of GE Healthcare of other parties expressly licensed by GE. Unlicensed use is strictly prohibited. These materials may include clinical concepts and definitions. No diagnostic statements are inferred or included in these materials. All clinical diagnosis should be made by a trained physician or clinician. All patient names or other protected health information or data contained in any image within this material is fictitious. Any similarity to actual persons is coincidental. Note! This participant guide is not intended to replace the User’s Reference Manuals that you received with the machine. Please refer to the disclaimer notice at the end of this participant guide for more information. This course is intended for Aisys CS2 software level 10.X. The material contained in this course is intended for educational purposes only. Always refer to the official written materials provided with the Aisys CS2 for specifications, operating procedures, and maintenance requirements. i

Contents 1 Welcome... 1.1

Navigating the Display... 3.8

Class Description... 1.1

Menu Components... 3.8

Class Objectives... 1.2

Using Menus... 3.8 Using the ComWheel... 3.9

2 Overview... 2.1

Using Quick Keys... 3.9

Aisys CS2 Overview Objectives... 2.1 Front View... 2.2 Rear View... 2.4 Advanced Breathing System (ABS) Components... 2.6 Breathing System Options... 2.8 Display Controls... 2.10 System Power ... 2.11 O2 Information Sources... 2.12

4 Vaporization ... 4.1 Vaporization - Aladin2 Cassettes... 4.1 Overview ... 4.1 Aladin2 Features ... 4.2 Turning On and Adjusting Agent Level Using Quick Keys... 4.3 Filling the Aladin2 Cassette... 4.4 Changing Aladin2 Cassettes... 4.6

O2 Flush Button... 2.14 Alternate O2 Control... 2.15

5 Advanced Breathing System ... 5.1

Types of Scavenging Systems ... 2.16 Active Adjustable Flow... 2.16

Aisys CS2 Advanced Breathing System Objectives ... 5.1

Active AGSS with Flow Indicator... 2.17

Bag/Vent Switch ... 5.3

Connecting Passive AGSS... 2.18

APL Valve... 5.3 Bag Support Arm... 5.4

3 Display Navigation ... 3.1

Absorber Canister... 5.5

Aisys CS2 Display Navigation Objectives ... 3.1

Canister Access on a Standard Machine... 5.6

Positioning the Display... 3.2

Canister Access on a Machine with the EZchange Mode... 5.7

System Display Overview ... 3.3 Digit Fields... 3.4 Waveform Fields... 3.4 Split Screen Field... 3.5 Display Touch Points ... 3.6 Measured Value Touch Points... 3.7 Active Alarm Touch Points ... 3.7 ii

Condenser... 5.8 Flow Sensors... 5.9 Preventing Moisture Buildup... 5.10 Auxiliary Common Gas Outlet (ACGO)... 5.11

6 Operation ... 6.1

7 Ventilation Modes ... 7.1

Aisys CS2 Operation Objectives... 6.1

Aisys CS2 Ventilation Modes Objectives... 7.1

Starting a Case... 6.2

About Ventilator Modes... 7.2

Minimum Alveolar Concentration (MAC)... 6.3

Volume Control Mode (VCV)... 7.2

Starting a Case Using Default Settings ... 6.3

Pressure Control Mode (PCV)... 7.3

Starting a Case Using Custom Settings... 6.3

Pressure Control Ventilation with Volume Guarantee Mode (PCV-VG) ... 7.4

Ending a Case... 6.4 Turning Off the System... 6.4 Ventilator Setup... 6.5 Changing Ventilator Mode... 6.5 Changing Ventilator Settings... 6.5 Gas Setup... 6.6 Changing Gas Settings ... 6.6 Changing Balance Gas ... 6.6 Changing Circuit Type... 6.6 System Setup... 6.7 Patient Demographics... 6.7 Screen Setup Menu... 6.7 ecoFLOW ... 6.11 Using ecoFLOW ... 6.13 Alarm Management... 6.14 Alarm Priorities... 6.14 Pausing Alarms ... 6.14 Cancelling Audio Pause... 6.14 De-escalating Alarms ... 6.14 Setting Alarm Limits... 6.15 Setting Volume Apnea Alarm... 6.15 Setting MV/TV Alarm ... 6.15 Viewing Alarm History... 6.16

Synchronized Intermittent Mandatory Ventilation - Volume Control Ventilation Mode (SIMV-VCV) ... 7.5 Synchronized Intermittent Mandatory Ventilation – Pressure Control Ventilation Mode (SIMV-PCV)... 7.6 Synchronized Intermittent Mandatory Ventilation – Pressure Control Ventilation Volume Guaranteed Mode (SIMV PCV-VG) . . . 7.7 PSVPro Mode... 7.8 CPAP + PSV Mode... 7.9

8 Spirometry ... 8.1 Aisys CS2 Spirometry Objectives... 8.1 About the Spirometry Menu ... 8.2 Spirometry Loops ... 8.2 Using the Spirometry Loop Split Screen ... 8.3 Setting the Loop Type ... 8.3 Saving, Viewing, and Deleting Spirometry Loops ... 8.3 Spirometry Menu Setup ... 8.4 Setting Loop Graph Scaling... 8.4 Setting Patient and Sensor Type ... 8.5 Setting the Data Source ... 8.5 Setting Spirometry Volume Type... 8.5

Alarm Setup Configure Tab... 6.16 Trends... 6.17 iii

9 Procedures ... 9.1

Breathing Circuit Module ... 11.6

Aisys CS2 Procedures Objectives...9.1

Remove the Breathing Circuit Module ... 11.6

The Procedure Menu ... 9.2

Replace the Breathing Circuit Module ... 11.7

Pause Gas Flow... 9.2

Bellows Assembly... 11.8

Cardiac bypass ... 9.3

Disassemble the Bellows Assembly ... 11.8

Using Manual Ventilation Cardiac Bypass . . . 9.3

Assemble the Bellows Assembly... 11.9

Using VCV Cardiac Bypass... 9.3

Exhalation Valve ... 11.10

Vital Capacity... 9.4

Remove the Exhalation Valve Assembly... 11.10

Using Vital Capacity... 9.4

Replace the Exhalation Valve Assembly ... 11.10

Changing Vital Capacity Settings...9.4 Cycling ... 9.5

12 Resources... 12.1

Using Cycling ... 9.5

Aisys CS2 User Operational Maintenance Schedule... 12.1

Changing Cycling Settings... 9.5

Aisys CS2 Anesthesia Supplies and Accessories... 12.3 10 Checkout... 10.1 Aisys CS2 Checkout Objectives...10.1

Aisys CS2 Quick Guide... 12.5 Aisys CS2 Troubleshooting Guide... 12.7

About the Checkout Menu... 10.2 Full Test...10.2 Performing a Full Test ... 10.2 Tests Performed During a Full Test ... 10.3 Individual Tests...10.3 Low P Leak... 10.3

11 Assembly and Cleaning ... 11.1 Aisys CS2 Assembly and Cleaning Objectives . . 11.1 Advanced Breathing System... 11.2 Replace the Breathing System... 11.3 Flow Sensor Module... 11.4

13 Clinical Training Documents... 13.1 Aisys CS2 Clinical Training Checklist... 13.1 Aisys CS2 Clinical Skills Checklist... 13.3 Aisys CS2 Clinical Training Quiz... 13.5 Aisys CS2 Clinical Training Quiz Answers... 13.8

14 Non-clinical Training Documents... 14.1 Aisys CS2 Non-Clinical Training Checklist... 14.1 Aisys CS2 Non-clinical Skills Checklist...14.3 Aisys CS2 Non-clinical Training Quiz... 14.5 Aisys CS2 Non-clinical Training Quiz Answers . . 14.8

Remove the Flow Sensor Module... 11.4 Remove the Flow Sensors... 11.4 Replace the Flow sensors... 11.5 Replace the Flow Sensor Module... 11.5

iv

15 Course Evaluation... 15.1

Aisys CS2 1 Welcome

We would like to take a moment to thank you for choosing GE Healthcare for your anesthesia system needs. Our goal now is to provide you with the best training service available while continuing to support you as you use our products in your workplace.

Class Description This course is designed to give Participants the information and product knowledge needed to proficiently operate the Aisys CS2 anesthesia system. This class will use discussion, scenarios and return demonstrations.

Participant Learning Objectives Specific learning objectives will be listed for each section at the beginning of the section. Overall learning objectives include: • Describe the main components of the system • Power up and shut down the system • Utilize the O2 flush and alternate O2 control • Navigate the display • Replace and fill an Aladin2 cassette • Utilize the bag/vent switch and APL valve • Replace the CO2 canister • Zero the flow sensors • Start and end a case • Change ventilation mode and balance gas • Utilize ecoFLOW • Manage alarms • View trends • Describe the eight modes of ventilation available • View, save and erase a spirometry loop • Perform a Pause Gas Flow, Cardiac Bypass, Vital Capacity and Cycling procedure • Perform a full test from the checkout menu

1.1

1 Welcome

1 Welcome

Aisys CS2 2 Overview

2 Overview Aisys CS2 Overview Objectives After completing this section, the participant will be able to: • Describe the main components on the front of the system 2 Overview

• Describe the main components on the rear of the system • Describe the main components of the Advanced Breathing System (ABS) • Describe the optional breathing system options • Describe the display controls • Power up the system and recognize when AC power is connected • Identify the three types of battery symbols • Identify the components of the airway module and galvanic cell • Utilize the O2 flush button • Active alternate O2 control and adjust the flow. • Describe the three types of scavenging systems available

~

Spirometry

Ref. Gas Gas Exhaust

2.1

Aisys CS2 Participant Guide

Front View 1. Aladin2 Cassette Storage Bay: Storage bay for Aladin cassettes that are not in use. 2. Aladin2 Cassette and Active Bay: The Aladin2 cassette is an electronic vaporizer that controls agent mixing and delivery. 3. Alternate O2 Control: The Alternate O2 control activates automatically in the case of certain failures or errors and delivers O2 through an independent path to the vaporizers and patient circuit. It can also be activated manually. 4. System Switch: Used to turn the system on and off. When the system is turned on, the display will show the power-up screen and the system does a series of automated selftests. 5. Mains Indicator: The mains indicator is lit when AC power is connected. 6. O2 Flush Button: Push the O2 flush button to deliver a high flow of O2 to the breathing system. 7. Brake: Push down the brake pedal to lock the system in place. Lift up on the brake pedal to release the brake. 8. Integrated Suction: The optional integrated suction adjusts the vacuum used to suction fluids from the patient during a case. The switch can be set to max for full vacuum, Off for no vacuum, or On for adjustable vacuum. 9. Auxiliary O2 Control: The optional auxiliary O2 flowmeter is most often used to deliver oxygen through a nasal cannula or mask. 10. Anesthesia Display: The anesthesia display is used throughout the anesthesia delivery process and allows the clinician to interact with the system. The display also provides real-time patient data.

2.2

Aisys CS2 2 Overview

2 Overview

~

Anesthesia Display 10

Spirometry

Ref. Gas Gas Exhaust

Auxiliary O2 Flow Control

9

Integrated Suction

8

cassette 1 Aladin2 storage bay cassette 2 Aladin2 and active bay O2 3 Alternate Control

4 System Switch 5 Mains Indicator 2 Flush 6 OButton

7

Brake

Figure 2.1 Aisys CS2 Front View

2.3

Aisys CS2 Participant Guide

Rear View 1. Collection Bottle: The collection bottle prevents fluids from entering the optional suction regulator. 2. Vacuum Connection: Connect the vacuum connection to the source vacuum supply. 3. AGSS (Anesthesia Gas Scavenging System): The scavenging system is designed to safely remove excess gas from the anesthesia machine. 4. Mains Inlet: AC power is connected to the system through the mains inlet. 5. System Circuit Breaker: This is the main circuit breaker. It should not be mistaken for an on/off switch. Accidentally pressing this switch will cause the system to be powered by its reserve battery instead of electricity from the wall outlet. 6. Isolated Electrical Outlet: A place to plug in low power accessories that are used in conjunction with the anesthesia machine. Note! The electrical outlets are for low power only! Do not use these outlets for equipment such as blanket warmers and operating room beds. 7. Outlet Circuit Breaker: An automatically operated electrical switch designed to protect the system from damage caused by overload. Unlike a fuse, which operates once and then must be replaced, a circuit breaker can be reset to resume normal operation. 8. Cylinder Yokes: Gas cylinders are mounted on the cylinder yoke. 9. Pipeline Connections: Hoses are connected between the pipeline inlets and the gas outlets in the hospital. 10. Cylinder Wrench: The cylinder wrench is used to open and close the gas cylinders.

2.4

2 Overview

Aisys CS2 2 Overview

Cylinder wrench 10

1 Collection bottle 2 Vacuum connection

Pipeline connections

9

Cylinder yokes

8

Outlet circuit breakers Isolated electrical outlet

7 6

3 AGSS

(Anesthesia Gas Scavenging System)

System circuit breaker

5

Mains inlet

4

Figure 2.2 Aisys CS2 Rear View

2.5

Aisys CS2 Participant Guide

Advanced Breathing System (ABS) Components 1. Airway Module (optional): The airway module measures and monitors gases delivered to the patient. Depending on the configuration, this component may include sensors for measuring carbon dioxide, nitrous oxide, anesthetic agents and oxygen. 2. Adjustable Pressure Limiting (APL) Valve: During manual ventilation, the APL Valve allows you to change the pressure limit from minimum to 70 cmH2O. 3. Bellows Assembly: During mechanical ventilation, the gases that are to be delivered to the patient are contained within the bellows assembly. 4. Bag/Vent Switch: The Bag/Vent switch selects between manual ventilation (bag) and mechanical ventilation (vent). When the switch is changed from bag to vent mode, the ventilator is automatically switched on. 5. Expiratory Check Valve: The expiratory check valve opens during expiration and closes at the start of inspiration. 6. Inspiratory Check Valve: The inspiratory check valve opens during inspiration and closes at the start of expiration. 7.

Inspiratory Flow Sensor: The inspiratory flow sensor determines the volume of gas flowing to the patient.

8. Expiratory Flow Sensor: The expiratory flow sensor determines the volume of gas flowing from the patient. 9. Absorber Canister: This component removes carbon dioxide from the patient’s exhaled breath. These scrubbed gases can then be sent back to the patient. 10. Absorber Canister Release: Push the absorber canister release to remove the canister from the holder. 11. Leak Test Plug: Occlude the breathing circuit using the leak test plug as part of the preoperative tests. 12. Breathing System Release: Push the absorber canister release to remove the breathing system. 13. Manual Bag Port: The bag hose and rebreathing bag attach to the manual bag port. 14. AGSS Indicator (only on some AGSS versions): With an active Anesthesia Gas Scavenging System (AGSS) that includes a flow indicator, the ball on the indicator should rise to the green zone.

.

2.6

Aisys CS2 2 Overview

1 Airway Module

Spirometry

Ref. Gas

2 Overview

Gas Exhaust

2 Adjustable Pressure Limiting (APL) Valve) Bellows Assembly

3

Bag/Vent Switch

4

Inspiratory Expiratory Check Valve Check Valve

5

6

AGSS Indicator 14

Manual Bag Port 13

7 Inspiratory Flow Sensor 8 Expiratory Flow Sensor 12 Breathing System Release

9 Absorber Canister Canister 10 Absorber Release

11 Leak Test Plug Figure 2.3 Advanced Breathing System

2.7

Aisys CS2 Participant Guide

Breathing System Options 1. Bag Support Arm: Use the optional bag support arm to hold the breathing circuit bag. 2. ACGO Port: Fresh gas flows through the ACGO port when the ACGO switch is set to the ACGO position. 3. Auxiliary Common Gas Outlet (ACGO) Switch: Use the optional Auxiliary Common Gas Outlet (ACGO) switch to direct the fresh gas flow through the ACGO port on the front of the system to a manual breathing circuit. 4. EZchange Canister Mode (CO2 bypass): Use the optional EZchange canister mode for continued ventilation of the patient while changing the absorber canister. 5. EZchange Canister Release: Push the EZchange canister release to unlock the canister cradle. 6. Condenser: Use the optional condenser to remove water in the system that is produced from the reaction of CO2 gas with the absorbent. 7.

2.8

Condenser Drain Button: Place a container under the reservoir and push the drain button to empty any water in the condenser.

Aisys CS2 2 Overview

Spirometry

Ref. Gas

2 Overview

Gas Exhaust

1

2

3

4 5

6 7 Figure 2.4 Breathing System Options

2.9

Aisys CS2 Participant Guide

Display Controls The touchscreen has numerous touch point areas that make accessing menus and settings quick and easy. The buttons on the right side of the screen provide direct access to commonly used functions. The ventilation quick keys enable setup of ventilation modes. The gas control quick keys provide a method to set up the gas used for a case. Touch only one touch point at a time to ensure the correct selection is made. 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.

6

5

4

3

Figure 2.5 Display Controls

2.10

2

1

Aisys CS2 2 Overview

System Power Turning On the System 1. Plug the power cord into an electrical outlet and make sure the system circuit breaker is on. The mains indicator is lit when AC power is connected and the battery is charging (if it is not already fully charged).

3. Turn the System Switch to On. The display will show the power up screen and the system does a series of automated self-tests. 4. Perform a Full Test before the first case of the day (this is covered in full detail later in the course). 5. Perform a preoperative checkout before each case. See the Preoperative checkout section of the user's manual for more information.

Figure 2.6 Mains Indicator and System Switch

System Mains Switch Indicator

Battery Information If AC power is lost, the battery has the capacity to operate for 50 minutes under typical operating conditions and 30 minutes under extreme conditions. The color and fill amount of the battery in use symbol indicates the amount of battery power remaining. Note! Electrical outlets (if provided) will not function while the system is on battery power.

Green indicates greater than 10 minutes.

Yellow indicates between 10 and 5 minutes.

Red indicates less than 5 minutes. Figure 2.7 Battery in use symbol

2.11

2 Overview

2. Check that the breathing system is properly connected.

Aisys CS2 Participant Guide

O2 Information Sources Airway Modules There are two sources of O2 information available on the system. The first source is the optional compact airway module. The compact airway modules measure and monitor gases delivered to the patient and exhaled through the breathing circuit. The modules consist of: • An infrared sensor for measuring CO2, N2O, and anesthetic agents. • A paramagnetic O2 sensor. • A gas sampling system with D-fend water separation system.

1 Spirometry

2 3

Ref. Gas Gas Exhaust

4 5 6 7 8 Figure 2.8 Compact Airway Module

1. Connectors for patient spirometry only. 2. D-fend water trap with washable container. 3. Sampling line connector on the D-fend water trap. 4. Water trap latch. 5. Oxygen reference gas inlet. 6. Sample gas outlet. 7. Cooling fan with dust filter. 8. Sample gas return port. 2.12

Aisys CS2 2 Overview

Galvanic Cell

2 Overview

The second O2 information source is an optional Galvanic Cell, or O2 Sensor, located within the Advanced Breathing System (ABS). The Galvanic Cell measures the circuit O2. The O2 sensor is calibrated daily during the system checkout, and can be expected to last approximately eighteen months. It CANNOT be disinfected.

O2 Cell

Figure 2.9 O2 Sensor

Note! Systems with an airway gas module may not include the optional Galvanic Cell. Systems with both an airway module and an O2 cell will display the patient inspired O2 value obtained from the airway module.

2.13

Aisys CS2 Participant Guide

O2 Flush Button The O2 Flush Button delivers a high flow of 100% O2 to the breathing system, bypassing the vaporizers.

Spirometry

Ref. Gas Gas Exhaust

Figure 2.10 O2 Flush Button

2.14