SERVO VENTILATOR 900C OPERATING MANUAL

Important ! General information ▲ • Servo Ventilator 900 C must be operated only by authorized personnel who are well trained in its use. It must be operated according to the instructions in this Operating Manual. • After unpacking, the ventilator must be checked and, if necessary, calibrated. • All data on pressures for Servo Ventilator 900 C are given in cm H2O. 1 kPa (kilopascal) ≈ 10 cm H2O 100 kPa = 1 bar ≈ 1 atm ≈ 1 kgf/cm2 (kp/cm2) 100 kPa ≈ 15 psi • Responsibility for the safe functioning of the equipment reverts to the owner or user in all cases in which service or repair has been done by a non-professional or by persons who are not employed or authorized by MAQUET, and when the equipment is used for other than its intended purpose. • A full technical description – including circuit diagrams, parts list and service data – is contained in the service documentation, copies of which are held by your supplier.

Connection • When connected to a patient, the ventilator must never be left unattended. • A check on functions must be done before a patient is connected to the ventilator. • When anaesthetic gas is metered via a flow meter on the low pressure inlet, compressed air must not be connected at the same time. • To avoid explosion hazards, flammable agents such as ether and cyclopropane must not be used in this machine. Only agents which comply with the requirements on nonflammable agents in the IEC standard “Particular requirements for electrical safety of anaesthetic machines” are suitable in this machine. • As this machine is not suitable for use with flammable agents such as ether and cyclopropane, the use of antistatic breathing tubes and face masks is not necessary. The use of antistatic or electrically conductive breathing tubes when using high frequency electric surgery equipment, may cause burns and is therefore not recommended in any application of this machine. • Never connect or disconnect auxiliary equipment to the outlet on the rear of the ventilator when the ventilator is connected to mains. • All gases must fulfill the specifications for medical grade gas. The gases supplied must be dry and free from oil and dust. Air H2O < 5 g/m3 Oil < 0.5 mg/m3 Oxygen H2O < 20 mg/m3 Nitrous oxide/gaseous phase) H2O < 58 ppm

Operation • The APNEA ALARM is not intended to and will not monitor for disconnections. • The APNEA ALARM is not functional in VOL. CONTR., VOL. CONTR. + SIGH, PRESS. CONTR. or MAN. • In the case of a power failure, manual ventilation using a Servo Ventilator 900 C is possible only with the help of power supply from external battery. A resuscitator should always be available, however, as an extra safety measure. • The SV 900 C is certified, with regard to safety, to be compatible with electromagnetic environments complying with IEC 601-1-2. It is the responsibility of the user to take necessary measures in order to ascertain that the specified limits are not exceeded as this may impair the safety of the ventilator. Such measures should include, but are not limited to: – normal precautions with regard to relative humidity and conductive characteristics of clothing in order to minimize the build-up of electrostatic charges. – avoiding the use of radio emitting devices in close

proximity of the ventilator, such as high-frequency surgery apparatus or cordless (mobile) telephones, resulting in a field level exceeding 3 V/m (IEC 601-1-2). Magnetic fields of MR equipment having flux densities above 20 mT may cause deactivation of the ventilator functions and may result in permanent damage to the Servo Ventilator. • To protect the patient against high pressures, the WORKING PRESSURE and UPPER PRESS. LIMIT must always be set at suitable values. • Do not forget to set the manual ventilation valve to position AUT after completed manual ventilation. Otherwise the patient may be hypoventilated without any alarm from the ventilator. (Not applicable to manual ventilation accessory with motor). • When mains supply is switched off or in the case of a mains power failure, the inspiratory and expiratory valves will automatically open. This may also occur in the case of an internal electronic failure. Thus, if the WORKING PRESSURE is set too high and the gas supply through the gas supply unit continues, this may result in increased airway pressure. • When excess gas is being scavenged, the scavenging system must meet the following requirements: – At the point at which the scavenging system is connected to the ventilator, the sub-atmospheric pressure must not exceed 0.5 cm H2O or cause an induced flow from the breathing system greater than 0.5 l/min. – With continuous air flows of 30 l/min and 90 l/min for not less than 5 seconds at the inlet of the anaesthetic gas scavenging system, the resistance in the system shall not exceed 0.25 cm H2O and 2.5 cm H2O, respectively. The Servo Evac 180 basic evacuation unit meets these requirements. • If the ventilator is equipped with electronic gas supply unit, the following applies: When mains supply is switched off or in the case of power failure, the gas supply is automatically blocked.

Cleaning • The ventilator must not be gas sterilized. • The flow transducers must not be cleaned in a dish washing machine, by ultrasonic methods or by using agents that contain aldehydes. • Agents used for cleaning must have a pH value between 4–8.5. • Complete cleaning should be done after every 1000 hours of operation or, at the latest, after every six months.

Service • The Servo Ventilator 900 C must be serviced at regular intervals by specially trained personnel. Any maintenance must be noted in the log book provided for that purpose, in accordance with national regulations. We recommend that service is done as a part of a service contract with MAQUET. • The 1000 hours overhaul shall be done after every 1000 operating hours or, at the latest, every six months. In addition, the ventilator shall undergo a technical safety check twice a year, at six months intervals, according to national regulations. • Service and repairs on the ventilator may be done only by MAQUET authorized personnel. • Only original parts from MAQUET must be used in the ventilator.

Equipment combinations • Only MAQUET-approved accessories and auxiliary equipment may be connected to the ventilator. • In order to maintain system safety and integrity only accessories complying with IEC 601-1, or the safety of which has been verified in another way must be connected to the signal outputs on the rear of the ventilator. For details on connections and allowed voltages, please see Circuit Diagram.

Product information program This Operating Manual is a part of a comprehensive information program for Servo Ventilator 900 C. The program is planned to contain the following:

Promotional and Scientific Publications Brochure

Servo Ventilator Concept

Application Brochures: Intensive Care Anesthesia Transportation

Product Leaflet

Reprints

Wall Diagram with Cleaning Instructions

Service Manual

Circuit Diagram

The Patient’s ABSee® Cards and Poster

Operating and Service Instructions Operating Manual

Brief Operating Instructions

Product Training Material Training Instructions

Advisory Booklet for Instructors

Slide Series including Textbook

“I am breathing through a ventilator” Film and Booklet

Front Panel Flip-chart

Panel Block

Trainee’s set

Video programs Video guide Video news

Servo Ventilator 900 C-Front

Operating instructions Servo Ventilator 900 C is simple to operate. Operating instructions are found:

! On the ventilator in the form of a panel and cleaning instructions on the lid of the pneumatic unit. “Normal” settings are indicated in green on the front panel. Settings indicated in red should be used with caution, since these settings may involve a certain risk for the patient.

@ In the Brief Operating Instructions in the drawer under the ventilator. A log sheet is available with the Brief Operating Instructions. After certain routines, e. g. cleaning etc., the person responsible for the work should complete and sign the log sheet. The log sheet can then be filed.

# On a separate wall poster with cleaning instructions.

$ In this Operating Manual. The inside of the cover shows a picture of the ventilator. This picture can be used as a foldout when reading the manual. The following information is found in the corresponding chapters:

Description ... 1-3 Operating ... 4-9 Maintenance ... 10-13 Technical specifications ... 14

Contents

1. Arbetsprincip Basic principles 2. Kontrollpanel Control panel och and ventilationssätt ventilation modes 3. Patientsäkerhet Patient safety 4. Uppställningar Set-ups 5. Förberedelser Preparations 6. Funktionskontroll Check on functions 7. Anslutning Connectiontill to patient 8. Klinisk och troubleshooting felsökning Clinicalbedömning judgement and 9. Registrering Recording 10. Rutinrengöring Routine cleaning 11. 1000-tim.-översyn med fullständig 1000 hours overhaul with completerengöring cleaning 12. Utbyte av O2-cell Replacement of O2 cell 13. Kalibrering Calibration 14. Tekniska Technicalspecifikationer specifications 1

Chapter 1

Basic principles In this chapter: General design ... 1:2 Pneumatic unit... 1:3 Rear ...1:4

11

General design 12

Low pressure

High pressure

Pneumatic unit

Electronic unit

The pneumatic unit comprises the gas conduction system, pressure and flow transducers and control valves. The control of flow and pressure is done by a feed-back system. The transducers continually measure the flow and pressures. The information is compared with the panel settings and a difference between the actual and the preset values results in correction signals to the control valves. For detailed description, see chapter “Basic principles” in the Training Instructions.

The electronic unit contains a number of plugin PC-boards with the circuits for regulation, alarms and monitoring. The unit effects the electronic control of the pneumatic unit. Servicing of the ventilator is facilitated by the spare parts exchange system. The faulty parts are replaced by factory trimmed exchange parts. Service on the electronic unit must be done by MAQUET, or by MAQUET authorized personnel only.

Pneumatic unit 13

!

(

Gas connection. The upper inlet, not visible in the picture, is used for low pressure gas and the lower inlet is used for high pressure gas. For anaesthesia, a gas supply unit with three inlets is available.

The flow transducer on the inspiration side measures the gas flow to the patient.

BL

@

The inspiration valve regulates the inspiratory gas flow. It is closed during the pause and expiratory parts of the respiratory cycle.

The gas supply is regulated by a valve so that a constant pressure is maintained in the bellows.

BM

#

The pressure transducer on the inspiration side measures the airway pressure.

The O2 cell measures the O2 concentration in the gas.

BN

$ The gas flows through a bacteria filter.

% The respiratory gases are mixed and stored at a constant pressure in the bellows.

^ The working pressure is set with an adjustment screw.

& A manometer shows the working pressure.

* A safety valve opens if the bellows is overfilled, or if the pressure exceeds approx. 120 cm H2O.

The flow transducer on the expiration side measures the gas flow from the patient. To prevent condensation, the transducer is heated to approx. 60°C.

BO The pressure transducer on the expiration side measures the airway pressure.

BP The expiration valve is closed during inspiration. During the expiratory phase it is either fully open or regulating the PEEP level.

BQ The flap valve prevents a back flow of exhaled gases. It is also necessary for the trigg function.

Rear 14 Operating time meter Equipotential socket On/Off switch Fuse holders

Outputs for auxiliary equipment

Control terminal

Recorder output

Rear of Servo Ventilator 900 C To the right on the electronic unit are the mains inlet socket, fuse holders, On/Off switch, voltage rating, equipotential socket and operating time meter. To the left on the electronic unit are three 15-pole sockets for auxiliary equipment. The 37-pole socket is used for recording of pressure and flow curves. There are labels with the serial number of the apparatus on both the pneumatic unit and the electronic unit.

Mains inlet socket

Control terminal Under the secured lid, there is a connector for external control of ventilation. For details see separate Operating Manual.

Chapter 2

Control panel and ventilation modes In this chapter: Panel design and symbols ... 2:2 Panel functions... 2:3 Working pressure ... 2:3 Mode selection ... 2:3 Respiratory pattern ... 2:4 I:E ratio ... 2:5 Expired minute volume .. 2:6 Special functions... 2:7 Airway pressure ... 2:8 SIMV ... 2:10 O2 alarm ... 2:11 Parameter selection ... 2:11 Controlled ventilation ... 2:12 Supported ventilation ... 2:13 Spontaneous ventilation. 2:15 Manual ventilation ... 2:16

2 1

Panel design and symbols

2 2

For easy operation, the panel is divided into fields. Each field is described in this chapter. “Normal” settings are indicated in green on the front panel. Settings indicated in red should be used with caution since these settings may involve a certain risk for the patient. A number of knobs and the EXPIRED MINUTE VOLUME meter have dual scales.

The blue scale is always to be used when the low range is selected. Power on is indicated by a green lamp. A yellow lamp is either an indication of a certain setting or a reminder to set an alarm limit. A red lamp always indicates an alarm.

! Working Pressure @ Mode Selection # Respiratory Pattern $ Expired Minute Volume % Special Functions ^ Airway Pressure & SIMV * O2 Concentration Alarm ( Monitoring

Panel functions Working pressure The working pressure is set with an adjustment screw and is read on the manometer WORKING PRESSURE. The working pressure must always be set at a value somewhat higher than the highest airway pressure.

Mode selection The Servo Ventilator 900 C can be operated in 8 different modes, which are selected by means of the mode selector. The modes are described in special sections in this chapter. Controlled ventilation Volume controlled ventilation (VOL. CONTR.) Volume controlled ventilation + sigh (VOL. CONTR. + SIGH) Pressure controlled ventilation (PRESS. CONTR) Supported ventilation Pressure supported ventilation (PRESS. SUPPORT) SIMV (Synchronized Intermittent Mandatory Ventilation) SIMV + Pressure support (SIMV + PRESS. SUPPORT) Spontaneous ventilation CPAP (Continuous Positive Airway Pressure) Manual ventilation MAN

2 3

Panel functions Respiratory pattern Preset inspiratory minute volume The inspiratory minute volume is set with the knob PRESET INSP. MIN.VOL. l/min. The knob has a locking button on the underside. A suitable initial value can be calculated by, for instance, using a Radford nomogram. The minute volume can be readjusted after indication from a CO2 Analyzer 930, which is auxiliary equipment for the Servo Ventilator. The setting range is 0.4-40 l/min. The tidal volume = PRESET INSP. MIN. VOL. l/min BREATHS/min The tidal volume can be read on the digital display. At extremely high flows it may be necessary to increase the working pressure in order to obtain the desired minute volume.

2 4

Flow pattern switch During VOL. CONTR. and VOL. CONTR. + SIGH, a constant or an accelerating inspiratory flow can be selected. Constant flow gives a lower peak pressure and is the pattern normally used. A decelerating flow will be obtained in PRESS. CONTR.

PRESET INSP. MIN. VOL./min

50

60

70

40

25

80

33

50

90

30

100

20

110 120 BREATHS/min

INSP. TIME %

PAUSE TIME 10 % (INSP. PAUSE)

Breaths per minute The respiratory rate is steplessly adjustable within the range of 5 to 120 BREATHS/min. Inspiration time % There are 6 fixed inspiration times, 20, 25, 33, 50, 67 and 80% of the breathing cycle. Pause time % There are 5 fixed pause times, 0, 5, 10, 20 and 30% of the breathing cycle.

Panel functions I:E ratio Insp. Pause time % 20 0 20 5 25 0 20 10 25 5 33 0 25 10 33 5 20 20 33 10 25 20 20 30 50 0 33 20 25 30 50 5 50 10 33 30 67 0 50 20 67 5 67 10 67 20* 80 0 * Reduced to 13%

I:E ratio time % 1:4 1:3 1:3 1:2.3 1:2.3 1:2 1:1.9 1:1.6 1:1.5 1:1.3 1:1.2 1:1 1:1 1.1:1 1.2:1 1.2:1 1.5:1 1.7:1 2:1 2.3:1 2.6:1 3.4:1 4:1 4:1

To the left is a conversion table for INSP. TIME % and PAUSE TIME % to I:E ratio for those who are more used to working with the latter. On the basis of an I:E ratio, i.e. the relation of inspiration time to expiration time, the pause is allocated to inspiration time. For example, insp. time 25% and pause time 10% = I:E ratio 35/65 = approx. 1:1.9. If the ventilator has been set so that insp. time + pause time exceeds 80%, then expiration automatically begins when 20% of the respiratory cycle remains (safety function). The pause time is then reduced.

Example 1: Preset insp. time = 67% ➞ 67% inspiration Preset pause time = 20% ➞ 13% pause 20% expiration Example 2: Preset insp. time = 80% ➞ 80% inspiration Preset pause time = 30% ➞ 0% pause 20% expiration The settings are independent of changes in the patient’s compliance and resistance.

Inspiratory flow In mode VOL. CONTR. (constant flow) or SIMV the inspiratory flow is calculated by:

Inspiration time settings of 33%, 67% or 80% should be avoided in volumecontrolled respiration with accelerating flow patterns. With these settings patient triggering may cause the temporary partial blocking of the inspiration valve which, however, would be indicated by a minute volume alarm. Should the valve be blocked, the situation can be remedied immediately by switching over to a constant flow.

PRESET INSP. MIN. VOL. l/min INSP./TIME % Example: PRESET INSP. MIN. VOL. l/min INSP. TIME % Results in an inspiratory flow:

= 8 l/min = 25% = 8 × 100/25 = 32 l/min

Or Adjustment of INSP. TIME% (use reverse value) 20% = 1/5 = 5 25% = 1/4 = 4 33% = 1/3 = 3 50% = 1/2 = 2 67% = 2/1.5 = 1.5 80% = 4/1.25 = 1.25 × PRESET INSP. MIN. VOL = inspiratory flow (l/min)

2 5

Panel functions Expired minute volume

2 6

EXPIRED MINUTE VOLUME is indicated on a meter which has dual scales: 0-40 l/min and 0-4 l/min. The scale 0-4 l/min is intended for use when greater accuracy, e. g. for infants, is needed. The knobs for LOWER ALARM LIMIT and UPPER ALARM LIMIT also have the same dual scales. The end stop positions for the knobs do not coincide with the end positions on the scale. This is correct and no attempt should be made to alter the range. The desired scale is selected with the switch INFANTS/ADULTS. The alarm limits for expired minute volume must always be set. If either of the knobs has been set in end position (out of scale), the yellow lamp SET MIN. VOL. ALARM flashes. The alarm limits are normally set at approx. 20% below and above the selected minute volume. The upper limit may be set at approx. 30% above the selected minute volume in the mode VOL. CONTR. + SIGH. The APNEA ALARM is activated with audible signals and flashing light if the time between any two consecutive breaths, spontaneous or mandatory or a combination of the two, is greater than approximately 15 seconds (4 breaths per minute or less). The APNEA ALARM is not intended to and will not monitor for disconnections. The APNEA ALARM is operative in CPAP, PRESS. SUPPORT, SIMV and SIMV + PRESS. SUPPORT. Failure of gas supply to the ventilator will result in visual and audible GAS SUPPLY ALARM signals. The GAS SUPPLY ALARM is not operative at respiratory rates over 80 breaths/min., and INSP. TIME % 20 or 25.

Panel functions Special functions Under the small hood below the UPPER ALARM LIMIT knob are three pushbuttons for special functions. Inspiratory pause hold When the pushbutton INSP. PAUSE HOLD is depressed, the valves close after inspiration and the pause is prolonged as long as the pushbutton is depressed. This provides an exact measurement of the end inspiratory lung pressure. It may also give time for an equilibration of the blood gas and alveolar pressures.

INSP. PAUSE HOLD

EXP. PAUSE HOLD

GAS CHANGE

Expiratory pause hold The valves are closed, after the expiration, as long as the pushbutton EXP. PAUSE HOLD is depressed, i.e. a prolonged expiratory pause. This provides an exact measurement of the end expiratory lung pressure.

EXP. PAUSE HOLD must not be used in SIMV or SIMV + PRESS. SUPPORT mode. Two inspirations may occur at the same time. However, the UPPER PRESS. LIMIT is still functional.

Gas Change The pushbutton GAS CHANGE is used, for instance, when it is desirable to rapidly alter the gas mixture to the patient. The concentration setting on the vaporizer/gas mixer/flowmeters must be altered first. The inspiration and expiration valves open so that the pressure in the patient circuit is max. 20 cm H2O. During the gas changing time, the EXPIRED MINUTE VOLUME meter is zeroed automatically.

2 7

Panel functions Airway Pressure

2 8

Airway pressure meter The meter continually indicates the airway pressure reading. Upper pressure limit The knob UPPER PRESS. LIMIT is used to set the upper limit for airway pressure. When this pressure limit has been reached, inspiration is immediately discontinued and there is a change over to the expiratory phase. Visual and audible alarms are activated. Since the inspiration is discontinued, the complete tidal volume will not be delivered and, consequently, the LOWER ALARM LIMIT for EXPIRED MINUTE VOLUME may be activated. Upper pressure limit is connected in all modes. There are safety catches on the knob at 80 and 100 cm H2O. PEEP PEEP is the setting of a Positive End Expiratory Pressure, e.g. used to counteract the formation of atelectasis. The PEEP range is from 0 to 50 cm H2O. There are safety catches on the PEEP knob at 0 and at 20 cm H2O. In case of a leakage, e.g. if a tracheal tube without cuff is being used, the PEEP-setting may cause self-triggering. To avoid this, the TRIG. SENSITIVITY should be set at a somewhat lower value. The PEEP knob is prepared for NEEP (Negative End Expiratory Pressure). In order to use NEEP, it is necessary to connect auxiliary equipment to the expiration outlet. The NEEP range is from 0 to -10 cm H2O.

Panel functions Trig. sensitivity The knob TRIG. SENSITIVITY is used to set the value of negative pressure that the patient must produce in order to trigger a breath. The TRIG. SENSITIVITY is relative to PEEP. For instance, PEEP +10 and TRIG. SENSITIVITY -2 cm H2O mean that the patient must produce a pressure of -2 cm H2O relative to the setting to trigger a breath. This corresponds to a pressure of +8 cm H2O relative to atmospheric pressure in the patient’s airways. The airway pressure, measured on the expiration side, is compared with the preset TRIG. SENSITIVITY + PEEP. If the airway pressure drops below TRIG. SENSITIVITY + PEEP, a breath is triggered. If it is desirable for the patient to be able to easily trigger the ventilator, the knob is set at green value. If it is undesirable for the patient to be able to trigger the ventilator, the knob is set at -20 cm H2O. Trig. sensitivity is connected in all modes except MAN. For further details, see description on different modes.

Inspiratory pressure level The knob INSP. PRESS. LEVEL is used to set the constant inspiratory pressure, relative to PEEP, when any of the following modes of ventilation are used: PRESS. CONTR., PRESS. SUPPORT, SIMV + PRESS. SUPPORT. A safety catch is located at 30 cm H2O.

The total inspiratory pressure level also includes PEEP. This is why there is a marking under the PEEP knob leading to the INSP. PRESS. LEVEL knob. At a PEEP of +5 cm H2O and an INSP. PRESS. LEVEL of +15 cm H2O, the total inspiratory pressure level would be +20 cm H2O, relative to atmospheric pressure.

2 9

Panel functions SIMV

2 10

SIMV (Synchronized Intermittent Mandatory Ventilation) means that the patient gets mandatory breaths controlled by the ventilator, and that he also has the possibility of breathing spontaneously. The mandatory breaths are synchronized with the breaths of the patient so that he need not breathe against the ventilator. SIMV-rate (SIMV BREATHS/min) is the rate of the mandatory breaths per minute. The rate is set between 0.4 and 4 breaths per minute on the LOW RATE scale, and between 4 and 40 breaths/min on the HIGH RATE scale. The desired rate is selected by means of a switch. There are two indicating lamps, one for each rate. The tidal volume and the frequency can be read on the digital display.

Minute volume, respiratory rate, inspiration time and pause time must be set for the SIMV mode. These functions determine the respiratory pattern of the mandatory breaths. The BREATHS/min must always be set higher than the SIMV BREATHS/min to allow time for the spontaneous period.

The SIMV cycle is divided into SIMV period and spontaneous period. See page 2:14.