MicroRPM Operating Manual

MicroRPM (Respiratory Pressure Meter) Operating manual I. Introduction - English The respiratory pressure meter is a hand held instrument designed for rapid assessment of inspiratory and expiratory muscle strength. The unit can measure the maximum inspiratory and expiratory mouth pressures, MIP and MEP, and the Sniff Nasal Inspiratory Pressure, SNIP. The result of each measurement is presented in units of cmH2O gauge pressure on the liquid crystal display screen. The unit is easy to operate, battery powered, and is supplied with all the necessary attachments required for immediate use. The functionality of the unit may be greatly increased when connected to a PC running PUMA software. This application has many advanced features including: •

Real time display of pressure/time curves

•

Overlay of successive curves

•

Predicted values

•

Patient database

•

Incentive display

•

Manoeuvre quality check

•

Manoeuvre variability measurement 4

Contents The MicroRPM is supplied as follows: 1.

MicroRPM Microcomputer Unit

2.

Rubber Flanged Mouthpiece

Cat. No. 36-MTH6400

3.

Alkaline PP3 battery

Cat. No. 36-BAT1002

4.

Expiratory Pressure Valve Assembly

Cat. No. 36-ASS1221

5.

Inspiratory Pressure Valve Assembly

Cat. No. 36-ASS1222 Cat. No. 36-MEC1299

6.

Calibration Screwdriver

7.

Nasal Probes Size 1-4

8.

Nasal Probe Adapter

9.

Mouth Pressure Bacterial Filters

Cat. No. 36-ASS1091 Cat. No. 36-FIL6050 (50)

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3

SNIP MIP / MEP OFF

8 4

3

2

1

9 6 2 1 5 4

5

PUMA PC Software

The functionality of the portable MicroRPM is greatly increased when connected to the PUMA PC Software, via an RS232 cable to the Serial Port on the side of the unit. PUMA PC Software is available as a free download from www.carefusion.com/micromedical. Please contact Technical Services for installation instructions and system requirements. The PUMA PC Software is a unique, user friendly multi windows platform for the performance, storage and analysis of the respiratory muscle strength measurements of PImax or MIP (Maximum Inspiratory Pressure), PEmax or MEP (Maximum Expiratory Pressure) and SNIP (Sniff Nasal Inspiratory Pressure). In addition, PUMA PC Software offers the user features such as live graphical displays, predicted values, printing formats, incentives, trends, post medication or exercise comparisons and additional fatigue indicators. 6

Operation – Mouth Pressures (PImax/MIP + PEmax/MEP) Insert the battery into the compartment at the rear of the MicroRPM. Fit the required Pressure Valve Assembly (‘Inspiratory’ for PImax (MIP), ‘Expiratory’ for PEmax (MEP)) into the MicroRPM; insert a new Bacterial Filter into the Pressure Valve Assembly and then the Rubber Flanged Mouthpiece onto the Bacterial Filter, as shown below.

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PImax (MIP) Test Slide the MicroRPM switch from ‘Off’ to ‘MIP/MEP’, whilst applying no pressure to the mouthpiece. Rotating segments will be displayed whilst the unit performs an auto-zero function. When the MicroRPM is ready a ‘beep’ will be heard and ‘0’ displayed. To perform the test instruct the subject to insert the mouthpiece into the mouth, ensuring the flange is positioned over the gums and inside the lips, whilst the ‘bite blocks’ are between the teeth. The subject should then exhale to RV (Residual Volume), lungs empty, then perform a ‘Mueller’ manoeuvre, a forced inhalation against the MicroRPM with as much effort as possible for as long as possible (minimum 2 seconds). The display will report the result, the maximum average inspiratory pressure sustained over a 1 second period of the test, in centimetres of water (cmH2O). Ideally, the subject should repeat this test 3 times to ascertain a best value.

PEmax (MEP) Test Slide the MicroRPM switch from ‘Off’ to ‘MIP/MEP’, whilst applying no pressure to the mouthpiece. Rotating segments will be displayed whilst the unit performs an auto-zero function. When the MicroRPM is ready a ‘beep’ will be heard and ‘0’ displayed. To perform the test instruct the subject to insert the mouthpiece into the mouth, ensuring the flange is positioned over the gums and inside the lips, whilst the ‘bite blocks’ are between the teeth.

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The subject should then inhale to TLC (Total Lung Capacity), lungs full, then perform a ‘Valsalva’ manoeuvre, a forced exhalation against the MicroRPM with as much effort as possible for as long as possible (minimum 2 seconds). The display will report the result, the maximum average expiratory pressure sustained over a 1 second period of the test, in cmH2O. Ideally, the subject should repeat this test 3 times to ascertain a best value. To repeat either the PImax or PEmax tests the MicroRPM must firstly be returned to the ‘Off’ position. _____ For more information on these procedures, and for interactive presentations and video demonstrations, go to our dedicated website:

WWW.RESPIRATORYMUSCLES.COM ____

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Operation – SNIP (Sniff Nasal Inspiratory Pressure) Insert the battery into the rear of the MicroRPM. Fit the Nasal Probe Adapter into the MicroRPM and then attach the correct size Nasal Probe, as shown below. The correct size (1-4) can be ascertained by fitting a Nasal Probe to the unit, then firmly inserting the Nasal Probe into a nostril. Instruct the subject to block the open nostril with a finger and then to attempt a sniff. The correct Nasal Probe size has been selected once there is no leakage around the Nasal Probe.

2

Nasal probe

Nasal plug adapter

Microcomputer unit

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SNIP Test Slide the MicroRPM switch from ‘Off’ to ‘SNIP’, whilst applying no pressure to the Nasal Probe. Rotating segments will be displayed whilst the unit performs an auto-zero function. When the MicroRPM is ready a ‘beep’ will be heard and ‘0’ displayed. To perform the test, instruct the subject to insert the chosen Nasal Probe firmly into a nostril, whilst ensuring the other nostril remains open throughout the test. The subject should then breathe normally and at the end of a normal tidal expiration, FRC (Functional Residual Capacity), be instructed to perform a short, sharp voluntary sniffing manoeuvre with as much effort as possible. The display will report the result, the peak inspiratory nasal pressure, in cmH2O. On subsequent tests the MicroRPM will continue to display the highest SNIP value, overwriting previous values. Ideally, the subject should repeat this test 10-15 times to ascertain the highest value.

____ For more information on these procedures, and for interactive presentations and video demonstrations, go to our dedicated website:

WWW.RESPIRATORYMUSCLES.COM ____

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Battery The battery level is automatically checked when the unit is switched on. When the battery is low ‘bAt’ will be displayed before the auto-zero procedure. The MicroRPM may be used when this occurs, but the battery should be replaced as soon as possible. When the battery is completely exhausted the unit will beep twice and turn itself off immediately. Note: If the MicroRPM is not to be used for long periods the battery should be removed to prevent damage by a possible leak.

Cleaning The MicroRPM unit requires no routine maintenance and is protected from contamination by the Bacterial Filter (36-FIL6050). The Rubber Flanged Mouthpiece (36-MTH6400) and Nasal Probes, however, may be immersed in a cold sterilising solution such as PeraSafe (36-SSC5000A). Rinse thoroughly and leave to dry before reassembly. The Nasal Probes can additionally be dried with a flow of air provided by the CareFusion Nasal Probe Pump (36-MEC1219).

Calibration The calibration is factory set and should remain stable indefinitely. The calibration may be checked and altered, however, by connecting the device via the Pressure Calibration Kit (36-ASS1234) to a Water Manometer, as shown below: 12

Connecting line

Female Luer T Piece

Nasal plug adapter

10 9

Syringe

8 7 6 5 4 3 2 1 0

Manometer

cm H 2O

Slide the MicroRPM switch from ‘Off’ to ‘SNIP’ whilst applying no pressure to the unit. Gently fill the syringe until negative pressure of between 200 and 300cmH2O is read on the Water Manometer. Check that the reading on the MicroRPM is within 3% of this reading. Please Note: Calibration can only be adjusted in a positive direction, as the MicroRPM measures the highest peak value. Therefore, if the reading was greater than that on the Water Manometer, the calibration screw must be turned anti-clockwise first, before calibration is attempted.

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Serial port

Calibration screw

To calibrate the MicroRPM, connect to the Water Manometer as before, filling the syringe to obtain the required negative pressure. To change the calibration, slowly turn the calibration screw in a clockwise direction until the same value is displayed on the MicroRPM.

Servicing If your unit requires service or repair please see page 68 for contact details. A full service manual including circuit diagrams and parts list is available on request.

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Consumables and Accessories Cat. No.

Description

36-FIL6050

Bacterial Filters (50 per box)

36-MTH6400

Rubber Flanged Mouthpiece

36-ASS1221

Expiratory Pressure Valve Assembly

36-ASS1222

Inspiratory Pressure Valve Assembly

36-NPROBE01

Extra Small Nasal Probes (10 per box)

36-NPROBE02

Small Nasal Probes (10 per box)

36-NPROBE03

Medium Nasal Probes (10 per box)

36-NPROBE04

Large Nasal Probes (10 per box)

36-ASS1091

Nasal Probe Adapter

36-MEC1299

Calibration Screwdriver

36-BAT1002

Alkaline PP3 Battery

36-SSC5000A

PeraSafe Sterilising Powder – 81g (Makes 5 litres of solution)

36-ASS1234

Pressure Calibration Kit

Caution •

Pulmonary filters are single patient use. If used on more than one patient there is a risk of cross-infection. Repeat use may increase air resistance and lead to an incorrect measurement.

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Symbols Type B device

In accordance with Directive 93/42/EEC 0086

Disposal in compliance with WEEE

Environment This instrument complies with directive EN60601-1-2 electromagnetic compatibility but can be affected by cellular phones and by electromagnetic interference exceeding levels specified in EN 50082-1:1992

Specifications Operating Pressure:

+/- 300cmH2O

Burst Pressure:

+/- 700cmH2O

Accuracy:

+/-3%

Resolution:

1cmH2O

Power Supply:

Single 9v PP3

Dimensions:

170 x 60 x 26mm

Weight (unit with battery):

175g

Weight (in carry case) :

750g

Operating Temperature :

0 - 40 °C

Operating Humidity:

30% - 90% RH

Storage Temperature:

-20 - +70 ° C

Storage Humidity:

10% - 90% RH

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MicroRPM (Respiratory Pressure Meter) Operating manual

Federal (USA) law restricts this device to sale by or on the order of a physician or licensed practitioner.

CareFusion, 22745 Savi Ranch Parkway, Yorba Linda CA 92887-4668 USA

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II. Introduction – CareFusion USA The respiratory pressure meter is a hand held instrument designed for rapid assessment of inspiratory and expiratory muscle strength. The unit can measure the maximum inspiratory and expiratory mouth pressures, MIP and MEP, and the Sniff Nasal Inspiratory Pressure, SNIP. The result of each measurement is presented in units of cmH2O gauge pressure on the liquid crystal display screen. The unit is easy to operate, battery powered, and is supplied with all the necessary attachments required for immediate use. The functionality of the unit may be greatly increased when connected to a PC running PUMA software. This application has many advanced features including: •

Real time display of pressure/time curves

•

Overlay of successive curves

•

Predicted values

•

Patient database

•

Incentive display

•

Manoeuvre quality check

•

Manoeuvre variability measurement

18

Package Contents The respiratory pressure meter is supplied with the following items:1. Microcomputer unit 2. Rubber mouthpiece 3. Alkaline PP3 battery 4. Expiration pressure valve assembly 5. Inspiration pressure valve assembly 6. Calibration screwdriver 7. Nasal probe sizes 1 to 4 8. Nasal probe adapter 9. Mouth pressure bacterial filters 7

3

SNIP MIP / MEP OFF

8 4

3

2

1

9 6 2 1 5 4

19

PUMA PC Software

The functionality of the portable MicroRPM is greatly increased when connected to the PUMA PC Software, via an RS232 cable to the Serial Port on the side of the unit. PUMA PC Software is available as a free download from www.carefusion.com/micromedical. Please contact Technical Services for installation instructions and system requirements. The PUMA PC Software is a unique, user friendly multi windows platform for the performance, storage and analysis of the respiratory muscle strength measurements of PImax or MIP (Maximum Inspiratory Pressure), PEmax or MEP (Maximum Expiratory Pressure) and SNIP (Sniff Nasal Inspiratory Pressure). In addition, PUMA PC Software offers the user features such as live graphical displays, predicted values, printing formats, incentives, trends, post medication or exercise comparisons and additional fatigue indicators.

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Operation – Mouth Pressures Insert the battery into the battery compartment at the rear of the unit, fit the flanged rubber mouthpiece over the required valve assembly and insert into the respiratory pressure meter as shown below:

Two valve assemblies are provided. The one marked expiration pressure allows the patient to inspire fully through the valve, which then closes during expiration to allow the meter to measure the maximum expired pressure averaged over one second. The valve marked inspiratory pressure works in the exact opposite manner. To measure the maximum expiratory pressure (PEmax), slide the switch from the “off” position to the MIP/MEP position. Rotating 21

segments will be displayed whilst the unit performs an auto-zero function. During this time there should be no applied pressure. When the unit is ready for use 0 will be displayed. To perform an expiratory pressure test instruct the subject to insert the mouthpiece into the mouth ensuring that the flange is positioned over the gums and inside the lips and that the “bite blocks” are between the teeth. They should then inhale to TLC (total lung capacity) and then exhale with as much effort as possible through the controlled leak of the meter for at least 2 seconds. The reading displayed is the maximum average expiratory pressure over 1 second. For an accurate measurement it is important that there are no leaks in the system other than the small controlled leak of the instrument. This leak prevents the generation of a false high reading generated by closure of the glottis and compression of air in the mouth using the facial muscles. Before repeating the measurement, or before performing an inspiratory manoeuvre, the instrument must be reset by sliding the switch to the “off” position. To measure the maximum inspiratory pressure (PImax) follow the above procedure but with the valve marked inspiratory pressure connected. Slide the switch on the face of the meter from ‘off’ position to the MIP/MEP position and instruct the subject to exhale to RV (residual volume) through the mouthpiece and then to inhale with as much effort as possible for at least 2 seconds. The reading displayed is the maximum average inspiratory pressure that was sustained over 1 second.

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