Training Manual
123 Pages
Preview
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The Medical Graphics Corporation Elite Breeze Suite Pulmonary Operator Training Manual is Part No. 142168-001 Rev. A. CAUTION: Federal law restricts this device for sale by or per order of a physician. MedGraphics® is a registered trademark of Medical Graphics Corporation. BREEZE™, BREEZESUITE™, Elite Series™, BreathPath™, and preVent™ are trademarks of Medical Graphics Corporation. Medical Graphics Corporation makes no claim for use of the product other than for those uses specified herein and disclaims any liability resulting from other uses. Observe all warnings and cautions. Copyright © Medical Graphics Corporation 2007.
All rights reserved. Unauthorized use, copying, or distribution is prohibited. Medical Graphics Corporation 350 Oak Grove Parkway St. Paul, Minnesota 55127 (651) 484-4874 (800) 950-5597 (651) 484-8941 (Fax) www,medgraphics.com
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Table of Contents Chapter I
9
SYSTEM OVERVIEW
9
1-1
The Elite System
10
1-2
Power-up/Warm-up Power-up Sequence Warm-up Power-down Sequence
10 10 11 11
1-3
Gas Pressures
11
1-4
Gases Concentrations
12
1-5
Head Assembly
13
1-6
Panels Elite – Left Panel – Gas Connections Elite – Left Panel – Adjustment Knobs
13 13 14
1-7
preVent Pneumotach Pneumotach/Umbilical Assembly
15 15
1-8
Testing Components Pneumotach Barrier Filter Patient Circuit Patient Mouthpiece Noseclips Umbilical Cable N2 Calibration Port Pneumotach Testing Circuit Assembly with Barrier Filter
16 16 16 16 16 17 17 17 18
Chapter II
19
STARTING A TEST
19
2-1
Pneumotach Calibration
20
2-2
Plethysmography Calibration
22
2-3
MIP/MEP Calibration
23
2-4
Calibration Report
23
2-5
Patient Information
24
2-6
Opening an Existing Patient
27
2-7
Searching the Database
27
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Chapter III
29
TESTING
29
3-1
Slow Vital Capacity (SVC) Testing Key Terms & Definitions Physiology SVC Requirements Performing a SVC Test
30 30 31 31 32
3-2
Forced Vital Capacity (FVC) Testing Key Terms & Definitions FVC Test Requirements Flow Volume Loop Curves Performing a FVC Test
34 34 35 36 37
3-3
Maximal Voluntary Ventilation (MVV) Testing Physiology Key Terms Performing a MVV Test
40 40 40 41
3-4
Lung Diffusion (DLCO) Testing Physiology Key Terms & Definitions Gas Chromatography (GC) Test Setup/Considerations Performing a DLco Test Interpretation Collection Protocols & Discard Volumes
43 43 43 44 45 46 48 48
3-5
Functional Residual Capacity (FRC) Testing Physiology FRC Technique Washout Shape Irregularities Due to a Leak Acceptable Repeatable Maneuvers Performing a FRC Test
49 49 49 50 50 51
3-6
Single Breath Nitrogen (SBN2) Key Terms & Definitions Physiology Testing Tips Performing a SBN2 Test
52 52 53 53 54
3-7
Plethysmography Testing Airways Resistance Thoracic Gas Volume Physiology Testing Tips Performing a Combined Test Review Reporting
56 56 58 59 59 60 62 62
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Improper Patient Maneuvers Angle Adjustments
62 63
3-8
Maximum Inspiratory Pressure (MIP/MEP) Testing Key Terms Performing a MIP/MEP Test
64 64 65
3-9
Bronchial Provocation (BRP) Testing
67
Protocol Selection
68
Conducting Bronchial Provocation (BRP) Testing
69
3-10
Chapter IV
71
REPORTS
71
4-1
Accessing the Switchboard
72
4-2
Printing a Report
72
4-3
Customizing Report Variables & Graphics
72
4-4
Adding Graphics to a Report Header
73
4-5
Designing a Page Header
73
4-6
Trend Plots
73
4-7
BRP Trend Plots
74
Chapter V
75
SOFTWARE CONFIGURATIONS
75
5-1
Accessing and Modifying Test Configurations
76
5-2
Setting up the Data Grid
76
5-3
Graph Properties
76
5-4
Editing Patient and Staff Members
76
5-5
Modifying PF Predicteds
77
Chapter VI
79
Quality control
79
6-1
Introduction
80
6-2
Adding a Syringe QC to the Database
80
6-3
Spirometry
80
6-4
Diffusion
80
6-5
Nitrogen Washout
81
6-6
Plethysmography
81
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Chapter VII
83
Troubleshooting
83
7-1
Cleaning & Maintenance preVent Pneumotach System Surfaces
84 84 84
7-2
Flow Offset Errors
85
7-3
Diffusion
86
7-4
GC Column Replacement
87
7-5
Nitrogen Washout
88
7-6
N2 Pump Oil
89
7-7
Changing the N2 Pump Oil
89
7-7
Technical Support
89
Chapter VIII
91
DB TOOLS
91
8-1
Accessing DB Tools
92
8-2
Loading Shape Tables
92
8-3
Converting Old Visits
92
8-4
Purging the Database
92
8-5
Compact/Repair Database
93
8-6
Backup/Restore Database
93
8-7
Import/Export Patients
93
Chapter IX
95
Security/HIPAA
95
9-1
Security & Compliance
96
9-2
Create/Modify a User
96
9-3
Defining Roles
97
9-4
Database Security Key Terms Changing a Password
97 98 98
9-5
Audit Trail Configuration
99
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Chapter X
101
REVIEW STATION
101
10-1
Introduction
102
10-2
Patient Selection
103
10-3
PF Data
104
10-4
Options
105
Glossary of Terms
107
APPENDIX A
111
Changing out a Gas Tank
111
APPENDIX B
112
Pulmonary References
112
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CHAPTER I SYSTEM OVERVIEW
1-1
The Elite System
1-3
Gas Pressures
1-2
Power-up/Warm-up
1-4
Gas Concentrations
1-5
Head Assembly
1-6
Panels
1-8
Testing Components
1-7
preVent Pneumotach
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1-1 The Elite System
Head Assembly
Arm Assembly
The Elite System
1-2 Power-up/Warm-up Power-up Sequence 1. Switch the Elite system to ON. 2. Power-up the computer. 3. Click on the BREEZESUITE icon, on the computer desktop, to access the software.
Breeze.lnk
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Warm-up The following warm-up conditions must exist before the tests listed can be executed: • • •
Warm-up the Elite system for at least 30 minutes before calibration or testing. Warm-up the Nitrogen Pump for 30 minutes before testing. Once 30 minutes has elapsed, the timer turns green and reads, “Ready.” Warm-up the Helium for 12 minutes before DLco testing. Once 12 minutes has elapsed, the timer turns green and reads, “Ready.”
Power-down Sequence 1. Exit the BREEZESUITE software. 2. Power-down the computer. 3. Flip the switch of the Elite to OFF.
1-3 Gas Pressures • • • • • • •
Air or N2: ~20psi (Elite only – door seal) Oxygen and Diffusion: 135 psi Helium: 10-25 psi Gas tank adequate pressure: > 500psi Oxygen is used for N2 FRC testing Diffusion & Helium are used for DLco Calibration &Testing Open tanks slowly to properly pressurize the circuit. Note: For instructions on how to change out a gas tank, refer to Appendix A.
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1-4 Gases Concentrations Specific concentrations are needed for DLCO, O2 and Helium. They are as follows: Oxygen 100% - Profiler Dx and Elite Dx only Diffusion Gas Mixture: •
0.5 ± 0.05% Ne
•
0.3 ± 0.015% CO
•
21 ± 0.15% O2
•
Remaining balance N2
Helium 100% (10 - 25 psi):
•
99.995% He
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1-5 Head Assembly Demand Valve Sample Chamber Patient Circuit Scissor Valves
1-6 Panels Elite – Left Panel – Gas Connections Helium (1/8) Air or Nitrogen (1/4)
Power Switch
DLCO (1/2)
Oxygen (3/8)
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Elite – Left Panel – Adjustment Knobs
Door Seal Switch Neon Gain N2 Gain / N2 Zero Intercom Volume Box Pressure Zero
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1-7 preVent Pneumotach The preVent Pneumotach is a respiratory device used to measure inspiratory and expiratory airflow. The Pneumotach requires calibration on a daily basis; recalibration between patients is not required.
Pneumotach/Umbilical Assembly The following instructions demonstrate the proper method for connecting the Pneumotach to the Umbilical Clip:
•
The base of the preVent Pneumotach has a tab protruding outward and an indented notch. The base of the Umbilical Clip also has a tab protruding outward. When the two pieces are connected, the Umbilical Tab snaps into the notch of the Pneumotach.
•
Ensure that the honeycomb end of the Pneumotach is facing the patient, and that the open end connects to the Patient Circuit connection. The flat end of the Umbilical Clip faces the patient and the tab side faces away from the patient. The flat end of the Umbilical Clip always faces the honeycomb side of the Pneumotach.
•
•
•
To connect the two units, align and insert the metal probes of the Umbilical Clip into the holes at the base of the preVent Pneumotach. The units should snap together and form a tight fit.
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1-8 Testing Components Pneumotach The Pneumotach is the clear component of the Pneumotach Testing Assembly that a patient forces air though during testing to measure inspiratory and expiratory airflow.
Barrier Filter If a Barrier Filter is used, dead space and resistance must be entered into the software as follows: File>Open>Site (current)> Workstation
Patient Circuit
Round
The Patient Circuit is inserted into the Head Assembly for N2 FRC, TGV, RAW and DLco Testing. • • •
The round end attaches to the Sample Chamber. The oval end attaches to the Demand Valve. Because this part is quite flexible, ensure that is does not become twisted upon installation. A twist may result in a leak.
Oval
Patient Mouthpiece The Patient Mouthpiece is placed in the patient’s mouth while testing is being performed.
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Noseclips Noseclips are placed over the patients nose during testing to prevent leakage.
Umbilical Cable The Umbilical Cable connects to the Elite and is the means by which the testing data is transferred to the system for processing.
N2 Calibration Port Attach the Umbilical Clip in the Calibration Port (shown within the white circle) for N2 calibration, or to protect the Umbilical Clip during storage.
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Pneumotach Testing Circuit Assembly with Barrier Filter Pneuomotach Testing Circuit
Refer to the photo above, and follow the steps below for assembling the Pneumotach Testing Circuit (only when using a Barrier Filter): 1. Gather the following parts:(Pneumotach, Blue Rubber Coupler, Barrier Filter, Patient Mouthpiece.) These parts comprise the Pneumotach Testing Circuit. 2. Attach to filter. 3. Firmly push the Barrier Filter onto the opposite end of the Blue Rubber Coupler. 4. Firmly push the Patient Mouthpiece onto the opposite end of the Barrier Filter. 5. Attach the Umbilical Clip to the Pneumotach. 6. Attach the Pneumotach Testing Circuit to the Patient Circuit positioned inside the Head Assembly.
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CHAPTER II STARTING A TEST
2-1
Pneumotach Calibration
2-2
Plethysmography Calibration
2-3
MIP/MEP Calibration
2-4
Calibration Report
2-5
Patient Information
2-6
Opening an Existing Patient
2-7
Searching the Patient Database
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2-1 Pneumotach Calibration
1. Click the Calibrate button, on the Breeze computer screen, to calibrate the Pneumotach then enter the appropriate values for temperature, barometric pressure and humidity (circled at the bottom of the screen). 2. Attach a syringe to the patient end of the Prevent Pneumotach. 3. Click the Zero Flow button, circled at the top of the screen, ensuring that there is no airflow through the Pneumotach. 4. Click Start, then withdraw and inject the syringe according to the varied rates*. Follow the computer prompts to know when to withdraw and inject. 5. Vary the speed of subsequent strokes to test the linearity of the flow system. Always provide smooth, consistent strokes. 6. Breeze confirms when the calibration is successful. 7. Do not click Reset. If calibration fails, see Note that follows.
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*Note - If the syringe sticks during calibration, execute the following steps: a. Click STOP b. Push the syringe in c.
Click START
d. Fully withdraw the syringe e. Wait for the prompt to appear, then f.
Inject the syringe
g. Click STOP h. Return to step three of the Pneumotach Calibration process above
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