Pneupac Models 110, 330, 550, 770 and 880 Anaesthetic Machine Users Manual Issue 2B Feb 2008

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PNEUPAC ANAESTHETIC MACHINE List Of Contents Para

Page

I.

FOREWORD...3

II.

SAFETY INFORMATION: WARNINGS & CAUTIONS...5

SECTION 1

TECHNICAL INFORMATION...9

SECTION 2

OPERATION AND MAINTENANCE ...21

APPENDIX A: 110 ANAESTHETIC MACHINE SUPPLEMENT ...39 APPENDIX B: 330 ANAESTHETIC MACHINE SUPPLEMENT ...41 APPENDIX C: 550 ANAESTHETIC MACHINE SUPPLEMENT ...43 APPENDIX D: 770 ANAESTHETIC MACHINE SUPPLEMENT ...45 APPENDIX E: 880 ANAESTHETIC MACHINE SUPPLEMENT ...47 APPENDIX F: VARIOUS ANAESTHETIC MACHINES...55

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I.

FOREWORD

1.

The information contained in this manual is applicable to the Pneupac Anaesthetic machine range. Due to customer specifications, Anaesthetic machines will not always contain all the facilities described in this manual.

WARNINGS:

FAILURE TO READ THIS USER’S HANDBOOK BEFORE FIRST USE OF THIS DEVICE MAY RESULT IN DEATH OR SERIOUS INJURY. TO AVOID HARM TO THE PATIENT, THIS EQUIPMENT SHOULD ONLY BE USED BY PERSONNEL TRAINED IN THE USE OF AUTOMATIC VENTILATION

2.

The Anaesthetic machine must only be used by medical personnel who possess a full understanding of the techniques required for its use. Information given in addition to basic operation is only intended as a guide, to supplement proper medical training and indicate specific operational requirements of the Anaesthetic machine.

3.

The Manufacturer reserves the right to make changes, without notice, to the design of the Anaesthetic machine which may affect the information contained in this manual.

4.

The chemical symbols used in this manual are as follows:

5.

6.

O2

Oxygen

N2O

Nitrous Oxide

CO2

Carbon Dioxide

Pressures stated in this manual are according to the following conversion scale: 100 kPa

= 1bar

1 bar

= 15 psi

Unless otherwise stated in this manual all measured values are shown at Ambient Pressure Temperature Saturated (ATPS).

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II.

SAFETY INFORMATION: WARNINGS & CAUTIONS

WARNINGS 1.

USER’S HANDBOOK FAILURE TO READ THIS USER’S HANDBOOK BEFORE FIRST USE OF THIS DEVICE MAY RESULT IN DEATH OR SERIOUS INJURY (Sections I, 1.2 & 2.1).

2.

TRAINED PERSONNEL TO AVOID HARM TO THE PATIENT, THIS EQUIPMENT SHOULD ONLY BE USED BY PERSONNEL TRAINED IN THE USE OF AUTOMATIC VENTILATION (Sections I, 1.2 & 2.1).

3.

CONSTANT SURVEILLANCE THE ANAESTHESIA SYSTEM IS DESIGNED TO BE OPERATED UNDER THE CONSTANT SURVEILLANCE AND CONTROL OF A QUALIFIED USER. FAILURE TO CONSTANTLY MONITOR THE PATIENT WHILST USING THIS EQUIPMENT, MAY LEAD TO DEATH OR SERIOUS INJURY (Section 1.2).

4.

ALTERNATIVE MEANS OF VENTILATION ALWAYS ENSURE THAT AN ALTERNATIVE MEANS OF RESUSCITATING IS AVAILABLE IN THE EVENT OF A MALFUNCTION (Sections 1.2 & 2.6.5).

5.

SERVICING OR ADJUSTMENT TO AVOID THE RISK OF HARM TO THE PATIENT FROM AN INCORRECTLY SET ANAESTHETIC MACHINE, SERVICING OR ADJUSTMENT OF THIS EQUIPMENT SHOULD ONLY BE CARRIED OUT BY COMPETENT PERSONNEL WHO HAVE BEEN TRAINED BY SMITHS MEDICAL INTERNATIONAL LTD. TO CARRY OUT SUCH WORK (Section 1.2).

6.

FIRE RISK. TO AVOID THE RISK OF IGNITION AVOID SMOKING, NAKED FLAMES. ALSO AVOID ANY OIL, GREASE OR COMBUSTIBLE LUBRICANTS FROM COMING INTO CONTACT WITH ANY PART OF THE ANAESTHETIC MACHINE. ONLY USE APPROVED LUBRICANTS THAT ARE COMPATIBLE FOR USE WITH OXYGEN (Section 1.2).

7.

DEFECTIVE PROTECTIVE EARTH CONDUCTOR THE CONNECTION OF EQUIPMENT TO AUXILIARY MAINS SOCKET OUTLETS MAY, IN THE EVENT OF A DEFECTIVE PROTECTIVE EARTH CONDUCTOR, INCREASE PATIENT LEAKAGE CURRENT TO A VALUE EXCEEDING ALLOWABLE LIMITS. ONLY EQUIPMENT CONFORMING TO EN60601-1 SHOULD BE CONNECTED TO THE AUXILIARY ELECTRICAL SOCKETS, WHERE FITTED AS AN OPTION (Section 1.2).

8.

CYLINDER PRESSURE GAUGE A CYLINDER PRESSURE GAUGE DOES NOT NECESSARILY REFLECT THE CONTENTS OF A CYLINDER. IN THE CASE OF NITROUS OXIDE (N2O) AND CARBON DIOXIDE (CO2), THE CONTENTS OF THE CYLINDER ARE LIQUEFIED AND THEREFORE THE TEMPERATURE OF THE GAS IS AN IMPORTANT AND VARYING FACTOR (Section 1.2.2).

9.

RESERVE OXYGEN SUPPLY TO CONSERVE THE RESERVE OXYGEN SUPPLY, ENSURE THAT IT IS TURNED OFF DURING NORMAL USE (Section 1.2.3).

10. OVERLOADING THE ANAESTHETIC MACHINE THE USER SHOULD NOT OVERLOAD THE ANAESTHETIC MACHINE. THE USER SHOULD BE SATISFIED OF THE STABILITY OF ANY MONITORING EQUIPMENT MOUNTED ON THE TOP SHELF BEFORE THE ANAESTHETIC MACHINE IS MOVED (Sections 1.2.11 & 2.2 # 8).

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11. USE OF ANTISTATIC OR ELECTRICALLY CONDUCTIVE BREATHING TUBES THE USE OF ANTISTATIC OR ELECTRICALLY CONDUCTIVE BREATHING TUBES, WHEN UTILISING HIGH FREQUENCY ELECTRICAL SURGERY EQUIPMENT, MAY CAUSE BURNS AND THEREFORE IS NOT RECOMMENDED IN ANY APPLICATION OF THIS MACHINE (Section 1.3.7). 12. DETATCHABLE COMPONENTS TO SAFEGUARD THE PATIENT’S HEALTH, ENSURE THAT YOU HAVE READ AND FULLY UNDERSTOOD ANY RELATED DOCUMENTATION ON HOW TO EXAMINE, FIT AND USE ANY DETATCHABLE COMPONENTS ASSOCIATED WITH THIS EQUIPMENT, INCLUDING EXAMINING FOR BLOCKAGES (Sections 1.4 & 2.5). 13. AUXILIARY ELECTRICAL SOCKETS, WHERE FITTED AS AN OPTION UNDER NO CIRCUMSTANCES SHOULD MORE THAN FOUR APPLIANCES BE CONNECTED TO THE AUXILIARY ELECTRICAL SOCKETS, WHERE FITTED AS AN OPTION (Sections 1.6.1 (m) & 2.2). 14. IMPAIRED PERFORMANCE IMPAIRED PERFORMANCE SHOULD BE REPORTED IMMEDIATELY TO SMITHS MEDICAL INTERNATIONAL LTD. AND THE UNIT MUST BE TAKEN OUT OF SERVICE TO AVOID THE RISK OF DEATH OR SERIOUS INJURY (Sections 2.1 & 2.6). 15. FLAMMABLE AGENTS UNDER NO CIRCUMSTANCES SHOULD FLAMMABLE AGENTS BE USED, E.G. ETHER OR CYCLOPROPANE. ONLY ANAESTHETIC AGENTS THAT COMPLY WITH THE REQUIREMENTS OF NON-FLAMMABLE ANAESTHETIC AGENTS IN THE STANDARD EN740 ‘ANAESTHETIC WORKSTATIONS AND THEIR MODULES, PARTICULAR REQUIREMENTS’ ARE SUITABLE FOR USE IN THIS MACHINE (Section 2.2 # 8). 16. CLEARING A CYLINDER GAS PORT THE GAS IN THE CYLINDERS IS UNDER HIGH PRESSURE. WHEN CLEARING A CYLINDER GAS PORT OF FOREIGN MATTER, ENSURE THAT THE PORT IS DIRECTED AWAY FROM YOU OR ANY OTHER PEOPLE IN THE ROOM, PRIOR TO OPENING THE VALVE (Section 2.7.3 # 2). 17. ISOLATION FROM THE MAINS THE ANAESTHETIC MACHINE MUST BE ISOLATED FROM THE MAINS ELECTRICAL SUPPLY BEFORE CLEANING IT. IT MUST BE COMPLETELY DRY BEFORE RESTORING THE SUPPLY (Section 2.3). 18. CLEANING AGENTS ENSURE THAT CLEANING AGENTS DO NOT ENTER TAPERS OR PIPE BORES (Section 2.3). 19. PRE-USE CHECKS TO AVOID HARM TO THE PATIENT, PRE-USE CHECKS MUST BE PERFORMED BEFORE EACH USE (Section 2.5). 20. BACK UP OXYGEN CYLINDER THE USER SHOULD ENSURE THAT A BACK UP OXYGEN CYLINDER AND REGULATOR WITH A COMPATIBLE OUTLET IS ALWAYS AVAILABLE FOR USE WITH ANAESTHETIC MACHINES SUPPLIED ONLY WITH AN OXYGEN PIPELINE INLET, EG. WALL AND PORTABLE MACHINES (Section 2.7.5).

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21. PIPELINE DISCONNECTION ALWAYS DISCONNECT PIPELINES FROM THE WALL OUTLET BEFORE THEY ARE REMOVED FROM THE ANAESTHETIC MACHINE (Section 2.6.2). 22. ADIABATIC COMPRESSION ALWAYS TURN CYLINDERS ON SLOWLY TO AVOID THE RISK OF IGNITION RESULTING FROM THE HEAT WHICH CAN BE GENERATED BY ADIABATIC COMPRESSION (Section 2.7.5). 23. MAGNETIC ATTRACTION TO PREVENT POSSIBLE RISK OF PROJECTILE INJURY WITHIN A MRI ENVIRONMENT, IT IS THE USER’S RESPONSIBILITY TO CHECK ANY COMPONENTS OR ACCESSORIES FOR MAGNETIC ATTRACTION PRIOR TO ENTERING A MRI ENVIRONMENT (Section E).

CAUTIONS Cautions warn of dangerous conditions that can occur and cause damage to the anaesthetic machine or its accessories, if you do not obey all of the instructions given in this manual: 1. To ensure that cylinder contents are not lost during storage due to small leaks, it is recommended that the valve on the gas cylinder is turned off after use (Section 2.2). 2. Flowmeter accuracy will be affected by variations in backpressure and temperature (Sections 1.2.5 & 1.6.1 (h)). 3. When turning on a gas cylinder supply, open the valve slowly to avoid causing a sudden increase in pressure in the high pressure circuit of the anaesthetic machine (Sections 2.2 #11 & 2.7.4). 4. Do not use solvent or abrasive cleaning agents on any surfaces of the Anaesthetic machine (Sections 2.3 # 1). 5. Do not use anaesthetic agents for cleaning purposes (Sections 2.3 # 1). 6. When replacing a bodoc seal, care must be taken not to scratch or damage the seal housing (Sections 2.7.3 #2 & 2.7.4).

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SECTION 1

TECHNICAL INFORMATION List Of Contents

Para Page 1.1 INTRODUCTION ...11

1.2

USER'S RESPONSIBILITIES ...11

1.3

GENERAL DESCRIPTION...12 1.3.1 Central Pipelines...12 1.3.2 Cylinder Supplies ...12 1.3.3 Oxygen supply Failure System...12 1.3.4 Hypoxic Prevention Device...13 1.3.5 Flowmeters ...13 1.3.6 Oxygen Flush...13 1.3.7 Back Bar ...13 1.3.8 Common Gas Outlet ...14 1.3.9 Auxiliary Outlets ...14 1.3.10 Frame ...14 1.3.11 Stability and loading...14

1.4

ACCESSORIES...15 1.4.1 1.4.2 1.4.3 1.4.4 1.4.5 1.4.6 1.4.7 1.4.8

Vaporisers ...15 Ventilator ...15 Low Flow Manifold...15 Absorber ...16 Suction Unit...16 Active Gas Scavenging System (AGSS) ...16 Breathing Circuits...16 Sphygmomanometer ...17

1.5

CONSUMABLE SPARES ...17

1.6

OTHER ACCESSORIES ...17

1.7

SPECIFICATIONS ...17 1.7.1 Anaesthetic machine...17

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1.1

INTRODUCTION

The Pneupac anaesthetic machines are general purpose anaesthetic delivery units which can be equipped with a wide range of options to meet the needs of modern anaesthesia. The anaesthetic machines can be used with medical gas cylinders and/or medical pipeline systems. The range of machines comply with BS 4272 Part 3:1989. 1.2

USER'S RESPONSIBILITIES

1.

The user must know and observe the instructions in this manual before the Anaesthetic machine is operated. Special attention must be paid to warnings and cautions.

WARNINGS:

FAILURE TO READ THIS USER’S HANDBOOK BEFORE FIRST USE OF THIS DEVICE MAY RESULT IN DEATH OR SERIOUS INJURY. TO AVOID HARM TO THE PATIENT, THIS EQUIPMENT SHOULD ONLY BE USED BY PERSONNEL TRAINED IN THE USE OF AUTOMATIC VENTILATION

2.

The Anaesthetic machine must only be used by medical personnel who possess a full understanding of the techniques required for its use. Information given in addition to basic operation is only intended as a guide, to supplement proper medical training and indicate specific operational requirements of the Anaesthetic machine.

WARNINGS:

3.

The patient should never be left unattended while anaesthetised.

WARNING:

4.

ALWAYS ENSURE THAT AN ALTERNATIVE MEANS OF RESUSCITATING IS AVAILABLE IN THE EVENT OF A MALFUNCTION.

An alternative means of resuscitating the patient should be available when this Anaesthetic machine is used.

WARNING:

5.

THE ANAESTHESIA SYSTEM IS DESIGNED TO BE OPERATED UNDER THE CONSTANT SURVEILLANCE AND CONTROL OF A QUALIFIED USER. FAILURE TO CONSTANTLY MONITOR THE PATIENT WHILST USING THIS EQUIPMENT, MAY LEAD TO DEATH OR SERIOUS INJURY.

TO AVOID THE RISK OF HARM TO THE PATIENT FROM AN INCORRECTLY SET ANAESTHETIC MACHINE, SERVICING OR ADJUSTMENT OF THIS EQUIPMENT SHOULD ONLY BE CARRIED OUT BY COMPETENT PERSONNEL WHO HAVE BEEN TRAINED BY SMITHS MEDICAL INTERNATIONAL LTD. TO CARRY OUT SUCH WORK

Servicing or adjustment of the Anaesthetic machine must only be carried out by competent personnel who have been trained for such work.

WARNING:

TO AVOID THE RISK OF IGNITION AVOID SMOKING, NAKED FLAMES. ALSO AVOID ANY OIL, GREASE OR COMBUSTIBLE LUBRICANTS FROM COMING INTO CONTACT WITH ANY PART OF THE ANAESTHETIC MACHINE. ONLY USE APPROVED LUBRICANTS THAT ARE COMPATIBLE FOR USE WITH OXYGEN.

6.

A danger from naked flames exists when oxygen is used as the gas source. Never oil or grease any part of the Anaesthetic machine.

7.

The Anaesthetic machine should only be supplied with dry, filtered, oil free, breathing quality oxygen or air.

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WARNING:

THE CONNECTION OF EQUIPMENT TO AUXILIARY ELECTRICAL SOCKETS (WHERE FITTED AS AN OPTION) MAY, IN THE EVENT OF A DEFECTIVE PROTECTIVE EARTH CONDUCTOR, INCREASE PATIENT LEAKAGE CURRENT TO A VALUE EXCEEDING ALLOWABLE LIMITS. ONLY EQUIPMENT CONFORMING TO EN60601-1 SHOULD BE CONNECTED TO THE AUXILIARY ELECTRICAL SOCKETS, WHERE FITTED AS AN OPTION.

8.

Where the Anaesthetic machine is connected to an electrical supply this supply should always comply with local regulations.

1.3

GENERAL DESCRIPTION

1.3.1 Central Pipelines When pipeline supplies are fitted to a Pneupac anesthetic machine, it is supplied with 4 metre long, colour-coded hose assemblies for each gas supply. The hose assemblies have NIST fittings at the anaesthetic machine end complying with EN 739 and probes complying with BS 5682 at the pipeline terminal unit end. If required, the length of the hose may be altered by a suffix ‘/Length’ in metres. Where national conditions require, a different end fitting can be supplied to suit the terminal unit on request. Colour coding can also be altered to allow for national conditions. Each pipeline supply is filtered and has a pipeline pressure gauge to monitor the input pressure. If 7 bar air is specified the correct fittings and additional pressure regulation to 420kPa is automatically supplied. 1.3.2 Cylinder Supplies Each cylinder supply (when fitted) uses a pin-index connecting yoke complying with EN850 1997. WARNING:

A CYLINDER PRESSURE GAUGE DOES NOT NECESSARILY REFLECT THE CONTENTS OF A CYLINDER. IN THE CASE OF NITROUS OXIDE (N2O) AND CARBON DIOXIDE (CO2), THE CONTENTS OF THE CYLINDER ARE LIQUEFIED AND THEREFORE THE TEMPERATURE OF THE GAS IS AN IMPORTANT AND VARYING FACTOR.

Each connecting yoke is provided with a filter, a regulator and a cylinder gauge. Where two or more supplies are provided for a particular gas, non-return valves are built into the machine to prevent gas loss from an unconnected port. Connecting yokes are supplied with ‘Full’ , ‘In use’ and ‘Empty labels’ and a key to open the cylinder. 1.3.3 Oxygen supply Failure System All anaesthetic machines are provided with an alarm and cut-off system, powered from the oxygen supply, to prevent the delivery of nitrous oxide (and carbon dioxide, if fitted) if oxygen is not present. When oxygen supply pressure falls to between 200-230kPa an audible alarm sounds and a visual alarm indicator changes from green to red. When oxygen supply pressure falls to between 170-200kPa, all gases other than oxygen and air are cutoff. The oxygen supply failure alarm can only be re-set by restoring the supply pressure of oxygen above the alarm activation pressure.

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WARNING:

TO CONSERVE THE RESERVE OXYGEN SUPPLY, ENSURE THAT IT IS TURNED OFF DURING NORMAL USE.

If a reserve oxygen supply system is deployed, ensure that it is turned off during normal use to avoid depleting the contents of the reserve oxygen supply. 1.3.4 Hypoxic Prevention Device All machines are provided with a flow ratio device which prevents the oxygen concentration falling below 25% oxygen (V/V) when oxygen and nitrous oxide only are in use. This works by measuring the nitrous oxide flow rate selected and automatically adjusting the oxygen flow rate. Additional oxygen is always available by increasing the oxygen flow rate. A master on/off switch is supplied that turns off the supply of all gasses to the anaesthetic machine. 1.3.5 Flowmeters CAUTION: Flowmeter accuracy will be affected by variations in backpressure and temperature

All anaesthetic machines are provided with flowmeters for the user to control and monitor the supply of each gas available from the machine. Flow control valves continuously increase the gas flow when turned in an anti-clockwise direction and continuously decrease the gas flow when turned in a clockwise direction. The flow of each gas is read from the flowmeter supplied for that gas. The total fresh gas flow is the sum of all the flows from the flowmeters. The oxygen control knob is specially profiled to make it easily distinguishable from the other flow control knobs. Where applicable, the flowmeters are arranged in the sequence oxygen, air, carbon dioxide, nitrous oxide from left to right, when viewed from the front. Oxygen enters the common manifold downstream of all other gases to ensure the preferential delivery of oxygen in case of leakage from any flowmeter tube and all flow control valves are protected by a guard to prevent inadvertent movement of a flow control valve. When fitted, carbon dioxide flow is limited to 0.6L/min. 1.3.6 Oxygen Flush All machines are provided with an oxygen flush control which, when pressed, delivers an unmetered supply of oxygen directly to the common gas outlet. The control is shrouded to prevent accidental operation and self-closes when released. The steady flow from the common gas outlet is between 40L/min and 50L/min. 1.3.7 Back Bar The back bar of a 110, 330 and 880 MRI Anaesthetic machine is based on the industry standard selectatec system and will accept one selectatec vaporiser. The back bar of a 550 and 770 Anaesthetic machine system will accept one or two selectatec vaporisers. One station consists of two valves that open when a vaporiser is fitted and locked into place. When the vaporiser is removed the two valves are automatically sealed to prevent gas loss to atmosphere and allow gas to continue to flow to the next station if fitted, or to the patient. 13

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1.3.8 Common Gas Outlet All anaesthetic machines are provided with a common gas outlet with a 22mm male and a 15mm female connection to the breathing system. The outlet contains a pressure relief valve to protect the Anaesthetic machine. On the 110 and 330 anaesthetic machine, the Common Gas Outlet is mounted on the back bar and does not swivel. On all other anaesthetic machines the common gas outlet is a ‘Cardiff Swivel’ type. 1.3.9 Auxiliary Outlets One oxygen auxiliary gas outlet is provided on all anaesthetic machines to power other pneumatic equipment. If air is provided on the anaesthetic machine an air auxiliary gas outlet is provided too. Each coupling is self-sealing. Additional oxygen or air gas outlets can be provided on request up to a maximum of three outlets. 1.3.10 Frame The 110 is primarily intended as a portable anaesthetic machine although it can be fitted to a mobile stand or hung from the wall using the universal mounting clamps fitted to the rear of the machine (refer to Appendix A for further details). The 330 is a mobile anaesthetic machine with four castors (the front two are braked). It can carry up to two pin-index cylinders as standard and an optional 2 more if required. A drawer and top tray are standard for this model (refer to Appendix B for further details). The 550 is a mobile anaesthetic machine with four castors (the front two are braked). It can carry up to four cylinders if required. A drawer is supplied as standard. An additional drawer can be provided when the machine is ordered. A top tray is standard on a 550 machine (refer to Appendix C for further details). The 770 is a wall-rail mounted anaesthetic machine which can also be hung from a pendant system. A top tray is standard on a 770 (refer to Appendix D for further details). The 880 machine is a magnetic resonance imaging (MRI) compatible, mobile anaesthetic machine with four castors. It can carry up to two pin-index cylinders if required. An open box unit replaces the drawer unit on this model and a top tray is supplied as standard (refer to Appendix E for further details). All anaesthetic machines except the 110 and 770 can be provided with a mounting for an absorber. All anaesthetic machines are finished in textured, hospital-white powder coat with stainless steel trays. 1.3.11 Stability and loading The 110 anaesthetic machine is not designed to carry any other equipment. WARNING:

THE USER SHOULD NOT OVERLOAD THE ANAESTHETIC MACHINE. THE USER SHOULD BE SATISFIED OF THE STABILITY OF ANY MONITORING EQUIPMENT MOUNTED ON THE TOP SHELF BEFORE THE ANAESTHETIC MACHINE IS MOVED.

On the 330 and 550, users should check the stability of monitors or other equipment mounted on the top shelf especially before moving the unit. The 770 unit loading is mainly dependent on the strength of the wall mounting unit. The top shelf is only intended to carry small light instruments and small monitors.

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The 880 MRI unit is not designed to carry heavy monitors, users should check the stability of monitors or other equipment mounted on the top shelf especially before moving the unit. 1.4

ACCESSORIES

WARNING:

TO SAFEGUARD THE PATIENT’S HEALTH, ENSURE THAT YOU HAVE READ AND FULLY UNDERSTOOD ANY RELATED DOCUMENTATION ON HOW TO EXAMINE, FIT AND USE ANY DETATCHABLE COMPONENTS ASSOCIATED WITH THIS EQUIPMENT, INCLUDING EXAMINING FOR BLOCKAGES.

1.4.1 Vaporisers The vaporiser on the Anaesthetic machine is used to convert liquid anaesthetic agent to its vapour form and deliver a controlled concentration of vapour to the fresh gas flow. The agents that are available are Halothane, Enflurane, Isoflurane and Sevoflurane. A range of selectatec mounted non interlock or interlock vaporisers can be supplied with standard filler or keyed filler versions. Only ‘Interlock’ vaporisers can be specified or used with twin stage selectatec manifolds to prevent more than one vaporiser being turned on at a time. Standard fillers can be filled directly from a bottle of anaesthetic agent. Keyed fillers must be used with key filler versions. All vaporisers have a single control knobwhich is used to adjust the concentration of anaesthetic agent and to turn the vaporizer off. Control knobs continuously increase the delivered concentration when turned in an anti-clockwise direction. The manufacturer’s instruction manual should always be consulted before use. 1.4.2 Ventilator All mobile anaesthetic machines can be adapted to mount a Pneupac ventiPAC V51 ventilator. Refer to the ventilator user manual for further information. 1.4.3 Low Flow Manifold The Low-Flow Manifold circuit facilitates automatic ventilation in a circle system while at the same time isolating the breathing system from the ventilator driving gas. It has been specifically designed to be driven by the Pneupac V51 ventiPAC ventilator. The manifold system has been designed to accommodate all the drive circuits for the Bag-In-Bottle together with an audible disconnect/over pressure alarm. This versatile alarm will indicate over pressure condition, and also leaks or disconnection of the circuit in most of adult patients when it relieves this pressure. The manifold also has a facility for connecting a bag for manual ventilation. The bag operates the bellows and so an indication of tidal volume is provided. When the APL valve is fully opened to the spontaneous position and the ventilator is switched off, the patient can breath spontaneously through the system. An air entrainment valve is fitted to ensure that this is always possible. Porting on the manifold connects the bag for manual ventilation to an Adjustable Pressure Limit (APL) valve to set the pressure during manual ventilation. The APL valve is also connected to the spill valve on the base of the manifold. The spill valve spills gas from the bellows when the bellows reaches the top of its stroke. Hence all the scavenging for the system can be connected to the output port of the APL valve. The Bag-In-Bottle manifold may be used in paediatric ventilation by replacing the bellows in the BagIn-Bottle with a paediatric bellows assembly. 15

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1.4.4 Absorber The optional Pneupac absorber module is a self-contained unit that can be mounted on all Pneupac anaesthetic machines when a circle system is required. The function of the absorber is to remove carbon dioxide from the mixture of gases exhaled by the patient. Fresh gas is then added to the remaining gas mixture. The resulting gas is then rebreathed by the patient. Inspiratory and expiratory unidirectional valves are mounted in the base of the absorber to ensure that the patient only breathes in the gas after the carbon dioxide has been removed. The base of the absorber also carries an APL valve and bag / ventilator connection which is directly after the expiratory unidirectional valve. This would normally be connected to the Pneupac low flow manifold in which case the APL valve is not used and remains closed. The absorber can however be used independently with a rebreathing bag. After adjustment of the APL valve the absorber can then be used for spontaneous and manual ventilation. Refer to the absorber user manual for further information. 1.4.5 Suction Unit A high suction unit can be mounted on the anaesthetic machine. Two options are available depending on the services available. If central piped vacuum is available then a central pipeline vacuum unit is supplied with a 1.8L jar. The controls for this unit are an on/off switch and a control knob to adjust the level of suction. If no central piped vacuum is available then an injector pipeline unit can be supplied with a 0.5L jar. This would normally driven from the oxygen/air supply on the anaesthetic machine. There is one control on these units to control the level of suction. The appropriate handbook should always be consulted before using a suction unit. 1.4.6 Active Gas Scavenging System (AGSS) The optional AGSS supplied by Smiths Medical International Ltd. is a receiver used with the anaesthetic machine to admit the waste gas discharged from the patient via the transfer system. The receiver passes the gas to the disposal system. Incorporated in the AGSS receiver is an air break to ensure that suction from the disposal system is not transferred to the patient. A flow indicator is also incorporated in the unit to show that the unit is drawing sufficient flow from the patient circuit. The appropriate user manual should always be consulted before installing and using a scavenging system. Refer to the AGSS user manual for further information. 1.4.7 Breathing Circuits WARNING:

THE USE OF ANTISTATIC OR ELECTRICALLY CONDUCTIVE BREATHING TUBES, WHEN UTILISING HIGH FREQUENCY ELECTRICAL SURGERY EQUIPMENT, MAY CAUSE BURNS AND THEREFORE IS NOT RECOMMENDED IN ANY APPLICATION OF THIS MACHINE.

A range of breathing circuits can be supplied with the anaesthetic machine. The circuit supplied will depend on the accessories supplied. A disposable breathing circuit is supplied with each accessory item, for example, Low flow Manifold, Absorber Circuit etc. Other circuits of different lengths are available such as Baine circuits.

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1.4.8 Sphygmomanometer On 550 anaesthetic machines a sphygmomanometer can be supplied either as a mercury column type or aneroid type with the information displayed on a 15cm diameter circular gauge. In each case the sphygmomanometer is supplied complete with bag, cuff, and tubing. The device is mounted to the lefthand side of the anaesthetic machine. 1.5

CONSUMABLE SPARES

A range of consumables are available for use with the Anaesthetic machine, including face masks, bags and laryngoscopes. 1.6

OTHER ACCESSORIES

A range of other accessories are also available from Smiths Medical International Ltd., e.g. rails and stowage hooks 1.7

SPECIFICATIONS

1.7.1 Anaesthetic machine (a)

Central Pipelines

The anaesthetic machine should be used with oil-free, dry and filtered piped medical gases, such as oxygen, air and nitrous oxide. Colour-coded hoses, 4 metres in length, or to customer specification, are supplied with the anaesthetic machine for pipeline connection. Standard hose connections: Standard hose colour code:

Equipment end Wall end O2 N2O Air Vacuum

NIST fitting (to EN 740) Probes (to BS 5682) White Blue Black Yellow

Hoses can be provided to comply with most national standards A pressure gauge is supplied to indicate the pressure applied at each pipeline inlet connection. Pressure scale and colour code O2 0 to 10 kPa x 100 white N2O 0 to 10 kPa x 100 blue Air 0 to 10 kPa x 100 black

The accuracy of all pipeline gauges is ±(4% of FSD + 8% of reading). (b)

Cylinder Supplies

The following common cylinder sizes can be accommodated. Only use medical quality grade gas. Gas Size Oxygen E Nitrous oxide E Carbon dioxide E Carbon dioxide D

Contents (litres) 680 1800 1800 900

Pin-index connecting yokes, conforming to EN 850 , are provided for the connection of gas cylinders. 17

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(c)

Gauges (High Pressure)

A separate high pressure gauge is fitted for each connecting yoke provided on the unit. Pressure scale and colour code O2

0 to 250 kPa x 100

white

N2O

0 to 100 kPa x 100

blue

CO2

0 to 100 kPa x 100

grey

Air

0 to 250 kPa x 100

black

The accuracy of all cylinder gauges is ±(4% of FSD + 8% of reading). The units of pressure are expressed in kPa x 100 on the pressure gauges. A separate gauge is associated with each cylinder. The high-pressure gauges provide an indication of gas cylinder contents but do not necessarily give a proportional representation. In the case of carbon dioxide and nitrous oxide the contents of the cylinder are liquefied and therefore the temperature of the gas is an important factor. As gas is drawn from a cylinder it will cool reducing the pressure reading and therefore while liquid remains, the cylinder pressure will be dependent on the balance between the gas drawn off and the evaporation rate. (d)

Regulators

An individual pressure regulator is fitted to each high-pressure connecting yoke. This regulates the cylinder pressure to a value of 450 - 550 kPa (e)

Oxygen System Failure Alarm

All anaesthetic machines are provided with an alarm and cut-off system, powered from the oxygen supply, to prevent the delivery of nitrous oxide (and carbon dioxide, if fitted) if oxygen is not present. When oxygen supply pressure falls to between 200 and 230kPa an audible alarm sounds for a minimum of seven seconds and a visual alarm indicator changes from green to red. When oxygen supply pressure falls to between 170 and 200kPa, all gases other than oxygen and air are cut-off. The oxygen supply failure alarm can only be re-set by restoring the supply pressure of oxygen above the alarm activation pressure. (f)

Hypoxic Prevention Device

Ratio Flowmeter A ratio flow-control device prevents the oxygen concentration falling below 25% oxygen (V/V) when oxygen and nitrous oxide only are in use. This minimum concentration of oxygen is always maintained at a nominal 25% of the nitrous oxide flow but above the minimum ratio, the oxygen flow can be adjusted with the oxygen flow control in the normal way. Lower fresh gas flows in a circle system would normally require a higher oxygen concentration than 25% and so a minimum pre-set flow of oxygen, the ‘basal flow’ of 250-350 ml of oxygen is preset to ensure that higher concentrations are achieved at the lower flow rates. It should be noted that the Ratio Flowmeter is designed as a safety device not an oxygen mixer. (g)

On/Off Valve

The On/Off valve is provided to facilitates the simultaneous switching of all gas supplies. This allows the anaesthetic machine to be turned off between cases and the flowmeter settings to be left preset. It also turns off the oxygen basal flow. 18

504-6003CE Iss 2