Jaeger Rhinoscreen Instruction Manual

Table of Contents Page 2

On this Manual Unpacking and Installation

3

The Rhinoscreen

6

Performance Features

8

The Keyboard

9

Switching on and Main Menu

10

Routine Sequence of a Measurement

12

Enter Patient Data

13

Load Patient Data

15

Rhinomanometry Measurement

16

Rhinomanometry Measurement after Provocation

22

Support in Diagnosing (Interpretation)

29

Unit Settings

31

• Updating Date and Time

31

• Enter Hospital/Practice Heading

32

• Interpretation and EBM Numbers

33

• Printer Generation

33

Output

34

Data Output at an External Printer (Option)

35

RAMDISK

37

Hygiene

39

Appendix A

Flowscreen and Rhinoscreen

42

Appendix B

Guidelines for Performing Nasal Provocation Tests

43

Change Fuses

49

Safety Precautions and Operational Procedure

2

2

We congratulate you on buying RHINOSCREEN, the portable small spirometer from JAEGER and thank you for the confidence you have shown in us and our product.

On this Manual When compiling the instruction manual value was placed on a description of the individual programs which was as simple and comprehensible as possible. The user, especially the medical technician, should be able to use the RHINOSCREEN with all its programs with the help of the manual. Each program has been explained in such a way that it can be carried out without the user having to know another program. It should, however, not be expected that this is a textbook, which if studied will enable the user to perform perfect lung function measurements in every detail. Instruction in this is a main part of the seminars which take place in the JAEGER factory. Instructing the patient: Many of the patients will never before have been submitted to a pulmonary function test. Such patients (but also experienced ones) will generally be very agitated and nervous. It will be in the interests of the operator and patient if the procedure is explained with regard to the time taken and purpose aimed at.

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3

Unpacking and Installation

The RHINOSCREEN is delivered in a case which consists of two parts. The upper part contains the RHINOSCREEN accessories. Standard version Item no. 2 rolls of thermal paper 891 109 6 nasal tips D14 mm 709 479 4 nasal tips D16 mm 709 480 4 nasal tips D18 mm 709 481 1 box for nasal tips 845 117 2 fuses 0,4 A 914 208 1 mains cable 918 100

4

ThelowerpartcontainstheRHINOSCREENitself.

4

Installation 1. 2. 3.

Take out the RHINOSCREEN and put it to the place reserved for it. Connect the handle to the unit via the connection cable. Connect the mains cable: ATTENTION: Ex works power cable and voltage adjustment meet the requirements of the country of destination. 3.1 Plug the power cable into the power supply socket at the rear of the Rhinoscreen. 3.2 Plug the power plug of the power cable into a socket with ground contact.

Mains cable

Rhino head

Handle

Connection cable

4.

Connect Rhino head to the handle. Please note: Before connecting the Rhino head, the locking ring at the handle is to be pulled downwards. Only then the Rhino head may be connected.

5

5

5.

When connecting the Rhino head the symbols "Patient" and "Arrow" at the handle and the Rhino head have to correspond.

6.

Open LCD screen.

7.

Switch on RHINOSCREEN with the mains switch at the back of the unit.

Same symbols!

The main menu appears on the screen:

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DATE TIME

)0($685(

18.03.96 08:31:23

)3$5$0(7(5 )35,17287

8.

F1 0

F9

F8

F7

F6

F5

F4

F3

F2

F1

5KLQRVFUHHQ

Open the cover for the thermal paper and insert the paper below the paper transport platen. The paper will be transported automatically. Note: The lever for releasing the platen has to be in "locked" position. ATTENTION: The bright side of the paper must be above. Locked

Paper transport platen

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6

The Rhinoscreen Rhinoscreen is our answer to many inquiries from ENT specialists, allergists, pulmonologists and pediatricians regarding measurement and evaluation of nasal airway resistances according to the active anterior rhinomanometry (AAR). Rhinomanometry means the syncrhonous measurement of the nasal volume flow and the difference in pressure between choana and anterior nostril. The active anterior rhinomanometry (AAR) is considered to be the most common physiologic method. With this method the volume flow is measured at each open side of the nose, the choanal pressure is measured at the closed side of the nose. In case of septal perforations or blockage of the nose on one side other techniques have to be used. The nasal flow resistance can directly be taken from the nasal resistance curve determined via AAR. Literature: "Die Bestimmung des nasalen Strömungswiderstandes mit der aktiven anterioren Rhinomanometrie" C. Bachart, Mannheim und andere. Allergologie, Jahrgang 13, Nr. 2/1990, s. 56 ("The determination of the nasal flow resistance via active anterior rhinomanometry"), C. Bachart, Mannheim and others. Allergology, No. 2, 13th year/1990, see page 56

LCD screen

Handle with Rhino head

Keyboard

Thermal printer

7

Compared with the measurement via mask, the measurement via nasal tips has considerable advantages. Nasal tips are favourably priced, quickly to exchange and easily to disinfect. Many physicians refused to perform measurements via nasal tips because of their functional weakness. We, however, have developed a completely new type of nasal tips: the nose-adaptable tip on the Rhino head. These tips have overcome the disadvantages of the previous nasal tips and show all the advantages of measurements via nasal tips.

7

Tips

One pair of nasal tips is fixed on the "Rhino head". The tips are available at three different sizes. The distance between the tips and their inclination can quickly and easily be changed. Thus, an individual adaptation to the patient's nose is guaranteed. The nasal tips close tightly without a troublesome distortion of the nasal cavity. Rhinoscreen is part of a system and offers much more than the determina-tion of the nasal airway resistance. Combined with a pneumotach and equipped with the corresponding software you will have one of the most successfully sold spirometers: Flowscreen from JAEGER. Measurements of spirometry, maximum voluntary ventilation (MVV), flow/volume and, as an option, airway resistance (ROCC) are possible. Using this unit for several of the above-mentioned measurements increases its efficiency, expedites its amortization and your practice nurses require only one operating strategy for both applications. Should you have any questions regarding the extension of your Rhinoscreen, please contact your local JAEGER distributor or representative.

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8

Performance Features Screen: The graphic display for the on-line display of measurement curves safely guides you through the complete measurement sequence via menu control. The immediate evaluation of provocation is possible by the fading-in of marks representing predicted values. Memory (RAMDISK): The unremovable RAMDISK can save about 40 patient data records (patient data, parameters, diagrams). Easy Handling: Function and arrow keys make the Rhinoscreen easy to handle. All the patient data as well as name and dose of provocative substance are entered via the easy-care and practical touch-sensitive keyboard. For measurements on children and adults you have several possibilities for displaying mea-surement curves. Measurements: - Respiratory volume flow at a differential pressure of either 150 Pa or 75 Pa - Sum of flow values of both sides of the nose - Airway resistance R (separated according to right and left side of the nose) - Nasal provocation with up to 6 documented measurements - Type and dose of allergen can be documented. Output: The high-resolution thermal printer quickly supplies you with all parameters with predicted/actual value comparison, diagrams, interpretation texts and charge codes. Hygiene: The quickly to exchange nasal tips can be disinfected in a cleansing bath and thus protect the patients from infection. Portability: Thanks to the extremely compact construction it is possible to perform measurements in your practice as well as during your round in the hospital or at a home visit.

9 Compatibility: If desired, the RHINOSCREEN can transfer all data to your PC or to a mainframe (special software necessary) via the integrated R232 interface.

9

The Keyboard At some points in this instruction manual you will be asked to carry out certain operations via the keyboard. The following diagram gives you a summary of the key names in this manual.

Arrow keys

RETURN Function keys F1 - F10

F1

F2

F3

F4

F5

F6

F7

F8

F9

F10

TAB

ESC

DEL

Control

Print

Space keys Shift (for capital letters)

Line feed Output of screen display on the thermal printer.

Output of the report or the latest data according to the unit settings on the thermal printer.

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10

Switching on and Main Menu The RHINOSCREEN is turned on with the main switch at the back of the unit. Then, the available storage capacity of the RAMDISK is automatically checked. If less than 30% of the storage capacity is available, a correspond-ing message will appear (see page 37). If more than 30% of the storage capacity is available the main menu appears directly after switching on.

)3$7,(17

DATE TIME

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18.03.96 08:31:23

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F1 0

F9

F8

F7

F6

F5

F4

F3

F2

F1

5KLQRVFUHHQ

The displayed programs are called up from the main menu by pressing the appropriate function keys.

F3

"PATIENT"

Program for entering patient data.

F5

Explanation

"TEST"

Call up of the "Rhinomanometry" measurement program.

F7

Function key Program

"SETTINGS"

This program offers the follow-ing functions which are normally entered only once: • Date and time • Hospital heading 11 • Layout of output report • Report output at a thermal printer or external printer (option)

11

F1 0

"PRINTOUT"

Here the recorded data can be output after a measurement. The data can be output on screen, at a thermal printer or an external EPSON compatible printer (option). Data transfer to an external computer is possible (special software required).

ATTENTION: Even if the unit is switched off, important settings such as - date, time - hospital/practice heading which often are to be set only once are stored on a battery-operated storage medium (lithium battery) for a long time. Advantage: If the unit is switched off or the current is switched off the data remains stored and must not be entered again.

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12

Routine Sequence of a Measurement The routine measurement sequence is essentially confined to the processing of a few programs only. 1. Enter patient data The personal data of the patient is entered in the computer or the data is transferred, i. e. loaded from the RAMDISK if a measurement is to be re-peated. 2. Perform measurement Perform the measurement and save it. 3. Printout or new measurement? After completion of the measuring cycle, all of the stored data (patient data, measurement data) can be output on printer or screen or a new measurement can be performed. We recommend to print out a report on the thermal printer after each mea-surement. The output is started by pressing the key "PRINT" shown on the left. Print

Repeated measurement with the same patient: Call up the program requested and perform the measurement. Measurement with a new patient: Enter or load personal data and perform the measurement.

PLEASE NOTE: If special working steps shall be documented, a copy of the screen display is output on the thermal printer by pressing the key shown on the left. Pressing this key results in a line feed.

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13

The program is called up from the main menu by pressing "F3=PATIENT". The following entry field for patient data appears on the screen. The cursor blinks in the field "ID NO" and the program waits for your entry.

PATIENT DATA ID NO NAME BIRTH SEX HEIGHT WEIGHT

: : : : : :

(L/F) (dd.mm.yy) (CM) (KG)

CONFIRM WITH RETURN NEW

0 F1

F9

F8

F7

F6

F5

F4

F3

MENU

F2

F1

F3

Enter Patient Data

Now enter "ID NO" and patient name. Each entry is to be confirmed with "RETURN". Some of our customers asked us to suppress required entries such as BIRTH, SEX, HEIGHT, WEIGHT. Therefore, in the "standard version", the patient data entry will be ended after having the entered name confirmed and the measurement program will be started. Only in connection with the "lung function" option where predicted values are required, birth, sex, height and weight are to be entered.

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14

Example:

PATIENT DATA ID NO NAME BIRTH SEX HEIGHT WEIGHT

: 120552 : Smith John : : : (CM) : (KG)

(L/F) (dd.mm.yy)

CONFIRM WITH RETURN

0 F1

F9

F8

F7

F6

F5

F4

F3

MENU

F2

F1

NEW

F1

Correction Possibilities: 1. Complete deletion of displayed patient data by "F1=NEW".

DEL

2. With "DEL" you can delete line by line. 3. Overwriting of single letters/numbers: Move the cursor with the help of the cursor keys to the corresponding line and overwrite the wrong letters/numbers. After having confirmed the last entry field "WEIGHT" with "RETURN", a switch to the "Rhinomanometry" measurement program is made.

15

15

Load Patient Data

Procedure: Call up the entry field for patient data with "F3=PATIENT". The cursor blinks in the entry field "ID NO" and the program waits for the entry. Now enter the "ID NO" of the patient saved and confirm this entry with "RETURN".

PATIENT DATA ID NO NAME BIRTH SEX HEIGHT WEIGHT

: 120552 : Smith John : : : (CM) : (KG)

(L/F) (dd.mm.yy)

CONFIRM WITH RETURN NEW

0 F1

F9

F8

F7

F6

F5

F4

F3

MENU

F2

F1

F3

Patient data can be loaded from the RAMDISK if a patient saved on the RAMDISK is measured again. Thus, a repeated entry is not necessary.

All the data available for this patient will be loaded automatically. Bypressing"RETURN"thepatientdataentryisendedandaswitchtothe"Rhinomanometry"measurementprogramfollows.

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Rhinomanometry Measurement This measurement is performed by registering the breathing manoeuvre in the flow/ pressure diagram. As a result the computer calculates the most important parameters of the active anterior rhinomanometry (AAR). Measurement Sequence: The measurement is simple to perform. The patient is asked to breathe via the nasal tips at the Rhino head. At first, he should breathe quite normally. This tidal breathing must be carried out for a longer period of time as it must be ensured that the patient is in a state of rest. As soon as the curves of several breaths lie on top of each other, the other side of the nose can be measured. Both sides of the nose will be measured, first the right side, then the left side. Evaluation: The assessment of the measurement values as well as the analysis of the nasal resistance curve give information about the patency, i. e. resistance of the nose.

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17

F5

The measurement program is called up from the main menu with "F5=TEST" or it is called up automatically after having entered the patient data.

PLEASE

RHINO - CURVE START WITH (F8)

- KEEP HANDLE IN ADEQUATE POSITION FOR BREATHING - DO NOT APPROACH THE DEVICE YET - MEASUREMENT STARTS WITH RIGHT NOSTRIL

F1 0

MENU

F9

F8

F7

F6

F5

F4

F3

F2

F1

START

Before starting the measurement, connect the Rhino head to the handle. Please observe that the symbols on the handle and the Rhino head correspond to each other.

The measurement is started by pressing "F8=START". The following message appears: Please wait As long as this message is displayed on the screen, the patient must not yet breathe at the nasal tips (internal zero adjustment).

ML/S

EX

IN

800

400

RIGHT 300

200

100

100

200

300

400

500

END

MENU

F1 0

400

F9

PA 500

18

400

SCALE

F7

F8

SIDE

F6

F5

F4

F3

F2

800

F1

F8

Preparing for the measurement: 1. Select nasal tips which are suitable for the patient´s nose. 2. Connect disinfected nasal tips to the Rhino head. 3. Adjust distance between the tips by turning them. 4. Ask the patient to take the handle; the white marking (R) at the Rhino head must be on the right side (see illustration).

18

Now ask the patient to introduce the tips into his nose and to inhale and exhale quite normally while his mouth is closed. The nasal resistance curve is displayed on the screen. Please note: Children and many older patients are not able to achieve the set differential pressure of 150 Pa. Therefore this pressure can be reduced to 75 Pa by pressing the key "F7=SCALE". At the same time the scaling of the pressure and flow axis is changed. The rhinomanometry measurement depends on the patient´s cooperation. Therefore, the patient should breathe until several successive breaths lying on top of each other (about 4 - 6 breaths) are displayed on the screen. As the first breathing cycles are often not adequate, they will automatically be discarded. Screen display during the measurement:

EX

IN

ML/S 800

400

RIGHT 300

200

100

100

200

300

400

500

END

MENU

F1 0

400

F9

PA 500

400

F6

DEL

SCALE

F7

F8

SIDE

F6

F5

F4

F3

F2

F1

800

If the patient´s cooperation is bad or not sufficient, the recording of the curve can be erased at any time. Press the "DEL" key. The screen will be cleared and a new recording of the curve starts. If the measurement of the right side of the nose has been performed correctly, ask the patient to remove the tips from his nose. Then press the key "F6=SIDE". The following message is displayed: Please wait Now the message "LEFT" appears on the screen. Ask the patient to turn the handle; the white marking (L) at the Rhino19 head must now be at the left side (see illustration).

19

The patient shall introduce the nasal tips into his nose and inspire and expire quite normally with his mouth closed. The recording of the nasal resistance curve is displayed on the screen.

ML/S

EX

IN

800

400

LEFT PA 500

400

300

200

100

100

200

300

400

500

END

MENU

400

F9

F1 0

F7

F9

SCALE

F8

SIDE

F6

F5

F4

F3

F2

F1

800

If the measurement of the left side of the nose has been performed correctly, ask the patient to remove the nasal tips from his nose. The measurement will be ended by pressing the key "F9=END". The calculated parameters and the nasal resistance curve will immediately be displayed on the screen.

ML/S

EX

IN

800

400 PA 400

TEST

REF

FLOW R RESIST. R FLOW L RESIST. L FLOW SUM

366 0.40 260 0.57 626

MEAS

%REF

RIGHT

200

200

400 LEFT

400

800

F8

F1 0

MENU

F9

F8

F7

F6

F5

F4

F3

F2

F1

CONTINUE

If a further measurement is to be performed, press "F8=CONTINUE".

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