R-Series EtCO2 Instructions Rev E April 2019

The issue date for the R Series End Tidal Carbon Dioxide (EtCO2) guide (REF 9650-0915-01 Rev. E) is April, 2019. ZOLL and R Series are trademarks or registered trademarks of ZOLL Medical Corporation. Copyright © 2019 by ZOLL Medical Corporation. All rights reserved. CAPNOSTAT is a registered trademark, and CAPNO2mask and LoFlo are trademarks of Respironics Novametrix LLC. Cidex is a registered trademark of Advanced Sterilization Products, a Johnson & Johnson Company. Nafion is a registered trademark of DuPont. System 1 is a registered trademark of the Steris Corporation. All other trademarks and registered trademarks are property of their respective owners.

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Indication of use

Indication of use The R Series system is indicated for the continuous noninvasive monitoring of end tidal carbon dioxide (EtCO2) and respiration rate in patients requiring ventilator support, in-hospital transport, or anesthesia. EtCO2 Monitoring is indicated for in patients from newborn (neonate) to adult.

Contraindications for Use There are no known contraindications for the use of the EtCO2 monitor.

General Information Federal (U.S.A.) law restricts this defibrillator to sale by or on the order of a physician.

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End-Tidal Carbon Dioxide (EtCO2) Product Description R Series® units equipped with software revision 12.xx or higher support two End Tidal Carbon Dioxide (EtCO2) monitoring options for the continuous measurement of respiratory carbon dioxide (CO2) and respiration rate. These options use the same connector on the R Series unit and may be used interchangeably. For R Series BLS/Plus models, these EtCO2 options can only be used while the unit is in Manual mode. The first option uses a unique, mainstream, solid-state, infrared sensor called the CAPNOSTAT® 5 Mainstream CO2 Sensor. The CAPNOSTAT 5 CO2 sensor is attached to an airway adapter that connects to an endotracheal (ET) tube or other airway and measures gases flowing through these breathing circuit components. A disposable mouthpiece may be connected to the adapter for monitoring non-intubated patients. A CAPNO2mask™ is also available for use with non-intubated patients. This option provides for O2 delivery while monitoring expired CO2. The second option is a sidestream sampling system called the LoFlo™ CO2 Module. The LoFlo module contains a gas sampling pump, which draws small samples of gas from the patient’s airway via a nasal/oral cannula or airway adapter, and passes these gases through a solid state infrared sensor (located away from the patient’s airway) that measures CO2. While the sidestream system is typically used on non-intubated patients, it can also be used for EtCO2 measurement on intubated infant, pediatric and adult patients. The sidestream system should not be used, however, on patients who cannot tolerate the 50ml/min removal of the sample gases from their breathing circuit. The sidestream module uses specially designed cannulas and airway adapters for sampling airway gases and passing them through an integrated sample cell, which connects to the LoFlo module’s CO2 sensor. These cannulas incorporate a filter and sample cell, providing maximum filtration of fluids and contaminants, and protecting the system from aspiration of these fluids. In both systems, the CO2 sensor generates infrared light and beams it through the airway adapter or sample cell to a detector on the opposite side. CO2 from the patient, flowing through the mainstream airway adapter or sample cell, absorbs some of this infrared energy. The R Series unit determines CO2 concentration in the breathing gases by measuring the amount of light absorbed by gases flowing through the airway or sample cell. The R Series unit displays EtCO2 (the concentration of carbon dioxide detected at the end of each exhalation) as a numerical value in millimeters of mercury (mmHg), percent (%), or kilopascals (kPa). In addition, the unit can display a capnogram. This capnogram is a valuable clinical tool that can be used to assess patient airway integrity and proper endotracheal (ET) tube placement. The unit calculates respiration rate by measuring the time interval between detected peaks of the CO2 waveform. The technology differentiates between waveforms caused by breathing and those caused by cardiogenic oscillations and artifact.

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT

How to Use This Manual This section explains how to set up and use the R Series End Tidal Carbon Dioxide option. Important safety information relating to general use of the R Series End Tidal Carbon Dioxide monitor appears in the “Safety Considerations” section of this manual. The R Series Operator’s Guide provides information operators need for the safe and effective use and care of the R Series unit. It is important that persons using this device read and understand all the information contained therein. Please read both safety considerations and warnings sections thoroughly before operating your R Series unit. All CAPNOSTAT 5 sensor , LoFlo module, airway adapter and cannula questions with regards to the Declaration of Conformity with European Union Directives should be directed to the authorized ZOLL representative: ZOLL International Holding B.V. Newtonweg 18 6662 PV ELST The Netherlands +31 (0) 481 366410 Telephone +31 (0) 481 366411 Telefax

Safety Considerations Warnings General Carefully read the R Series Operator’s Guide and these operating instructions before operating the EtCO2 monitoring option. Ensure that the R Series EtCO2 option is operated by qualified personnel only. Do not use the R Series EtCO2 option as an apnea monitor. Do not immerse the R Series unit, patient cables, or sensors in water, solvents, or cleaning solutions. If the accuracy of any reading is suspect, first check the patient’s vital signs by alternate means and then check the R Series EtCO2 option for proper operation. If an alarm condition occurs while the alarms are suspended, the suspended alarm indications will only be visual displays and symbols. No audio alarm indications will occur. Elevated oxygen levels, nitrous oxide, or halogenated agents contained in the breathing gases may degrade the accuracy of measurements made with the R Series EtCO2 option. Activate oxygen compensation if O2 levels in excess of 60% are introduced. Activate N2O compensation if nitrous oxide is introduced into the airway circuit. Do not use the LoFlo module on patients who cannot tolerate the removal of 50ml/min of breathing gases from the airway. The presence of Desflurane beyond 5% may positively bias the carbon dioxide reading by up to 3 mmHg. The presence of Xenon in the exhaled breath may negatively bias the reading by up to 5 mmHg.

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Safety Considerations Carefully route patient cabling to reduce the possibility of patient entanglement or strangulation. Do not touch the bed, patient, or any equipment connected to the patient during defibrillation. A severe shock can result. Do not allow exposed portions of the patient’s body to come in contact with metal objects, such as a bed frame, as unwanted pathways for defibrillation current may result.

CAPNOSTAT 5 and Accessories Always ensure the integrity of the patient breathing circuit after insertion of the airway adapter by verifying a proper CO2 waveform (capnogram) on the monitor display. Do not use CAPNOSTAT 5 or LoFlo sensors in the presence of flammable anesthetics or other flammable gases. Do not attempt to open the sensor. An electrical shock hazard exists internally. Refer servicing to qualified personnel. Do not operate the sensor when it is wet or has exterior condensation.

Cautions CAUTION: Federal (U.S.A.) law restricts this device to sale, or use by or on the order of a licensed medical practitioner. Use only ZOLL/Respironics Novametrix CAPNOSTAT 5 sensors and LoFlo modules, airway adapters, nasal and nasal/oral cannula sets with the R Series EtCO2 option. The device is protected against interference from radio frequency emissions typical of two-way radios and cellular phones (digital and analog) used in emergency service/public safety activities. Users should assess the device’s performance in their typical environment of use for the possibility of radio frequency interference from high-power sources. Radio Frequency Interference (RFI) may be observed as shifts in monitor baseline, trace compression, display brightness changes or transient spikes on the display. Do NOT sterilize or immerse the CAPNOSTAT 5 CO2 sensor or LoFlo module. Do NOT reuse, disassemble, sterilize, disinfect, or clean the disposable airway adapter, airway adapter with mouthpiece, CAPNO2mask, nasal or or nasal/oral sampling cannula sets, as system performance will be compromised. These items are intended for single patient use only. Do NOT use a damaged sensor or airway adapter. Do NOT use the device if it fails to operate properly. Do NOT place the mainstream or sidestream airway adapters between the ET tube and the breathing circuit elbow, as this may cause patient secretions to accumulate in the adapter. Position airway adapters with windows in a vertical, NOT a horizontal, position. This helps keep patient secretions from pooling on the windows. Do NOT insert any object other than the sample cell into the sample cell receptacle on the LoFlo module. Remove the LoFlo sample cell from the sample cell receptacle when not in use. Clean or replace the airway adapter if excessive secretions are observed.

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT ZOLL Medical Corporation recommends that the airway adapter be removed from the circuit whenever aerosolized medication is delivered. The increased viscosity of the medications may contaminate the adapter windows, requiring premature cleaning or replacement of the adapter. In order to eliminate the potential build up of CO2 inside the storage bag, ensure that the LoFlo module exhaust tube vents gases away from the module environment. To avoid injury to the patient, remove the nasal/oral cannula from the patient before cutting the oral cannula tip. Do NOT apply tension to the sensor cable. Periodically inspect the sampling tubing for the absence of kinks. Monitor the capnogram for an elevated baseline. If an elevated baseline is observed, verify patient condition first. If the caregiver determines that the patient condition is not contributing to the elevated baseline, follow the instructions for zeroing the sensor or module detailed in this manual. Do NOT store sensors, modules, airway adapters, or cannula sets at temperatures less than -40° C or greater than 70° C. Do not operate CAPNOSTAT sensors at temperatures less than 0° C or greater than 45° C. Do not operate LoFlo modules at temperatures less than 0° C or greater than 40° C. Do not use the LoFlo module on R Series units that have a software version lower than 12.xx.

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EtCO2 Intended Use

EtCO Intended Use 2

The ZOLL R Series EtCO2 option with Respironics Novametrix technology is intended to be used for continuous noninvasive monitoring of end tidal carbon dioxide (EtCO2) and respiration rate in patients requiring ventilator support, in-hospital transport, or anesthesia. The R Series EtCO2 option with Respironics Novametrix technology supports two methods for continuous measurement of end tidal carbon dioxide (EtCO2) and respiration rate. The first method uses the CAPNOSTAT 5 Mainstream CO2 sensor attached to an airway adapter that connects to an endotracheal tube, mask or disposable mouthpiece. The second method uses the LoFlo CO2 module to monitor both non-intubated and intubated patients using specially designed sampling cannulas and airway adapters. The R Series EtCO2 option is designed to monitor adult, pediatric, and neonatal patients. The following substances can influence CO2 measurements made with the CAPNOSTAT 5 CO2 sensor: elevated oxygen levels • nitrous oxide • halogenated agents •

The R Series EtCO2 option provides settings for high oxygen and/or nitrous oxide compensation. Halogenated anesthetic agents alter CO2 readings, but the R Series unit will monitor CO2 within specifications when these agents are present at normal clinical levels. The presence of Desflurane in the exhaled breath beyond normal values (5%) may positively bias measured carbon dioxide values by up to an additional 3 mmHg. The R Series EtCO2 option is intended for use only with the ZOLL/Respironics Novametrix CAPNOSTAT 5 Mainstream CO2 Sensor and mainstream airway adapters, the LoFlo CO2 Module, nasal and nasal/oral sampling cannula sets, and sidestream on-airway adapters.The R Series EtCO2 option can be used on adult patients (21 years of age and older) and on pediatric patients, as described in the following table: Pediatric Subpopulation

Approximate Age Range

Newborn (neonate)

Birth to 1 month of age

Infant

1 month to 2 years of age

Child

2 to 12 years of age

Adolescent

12-21 years of age

Mainstream EtCO2 Setup There are several steps involved with mainstream EtCO2 setup. These steps include: • Attaching the CAPNOSTAT sensor cable. • Selecting a mainstream airway adapter. • Attaching the airway adapter to the CAPNOSTAT sensor. • Zeroing the CAPNOSTAT sensor/airway adapter. • Attaching the airway adapter to the airway circuit. • Applying an airway adapter with mouthpiece.

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R Series End-Tidal Carbon Dioxide (EtCO2)

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT

Attaching the CAPNOSTAT 5 CO2 Sensor Cable To attach the CAPNOSTAT 5 CO2 sensor cable, plug the cable’s connector into the yellow CO2 connector at the back of the R Series unit by matching the key on the cable to the key on the connector (Figure 1).

Proper Grasp

Improper Grasp

Figure 1

Note:

To remove the sensor cable from the R Series unit, grasp the collar surrounding the cable’s R Series connector and pull up.

Selecting a Mainstream Airway Adapter Select an airway adapter based on the patient’s ET tube diameter and monitoring situation. For more information refer to the following table or contact ZOLL Medical Corporation. Airway Adapter Type

ET Tube Diameter

SPU* Pediatric/Adult

> 4.0 mm

Adult Reusable

> 4.0 mm

SPU* Neonatal/Pediatric

≤ 4.0 mm

Neonatal Reusable

≤ 4.0 mm

*SPU = Single Patient Use

Attaching the Airway Adapter to the CAPNOSTAT 5 CO2 Sensor Before attaching the airway adapter to the CAPNOSTAT 5 CO2 sensor, verify that the airway adapter windows are clean and dry. Clean or replace the adapter if necessary. Caution

The disposable (SPU) Pediatric/Adult and the Neonatal/Pediatric airway adapters are intended for single patient use. Do NOT reuse or sterilize these adapters as system performance will be compromised. Attach the airway adapter to the CAPNOSTAT sensor, as follows: 1. Align the arrow on the bottom of the airway adapter with the arrow on the bottom of the sensor.

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Mainstream EtCO2 Setup 2. Press the sensor and airway adapter together until they click. 3. Turn the Selector switch on the R Series unit to MONITOR (ON for BLS/Plus units, and

select Manual mode). 4. Wait for the airway adapter and sensor to warm up. The unit will display the CO2 WARM UP message for approximately one minute while the sensor and adapter warm to operating temperature. The message disappears when the sensor is ready to use. Note:

Warm up time varies with ambient temperature of the sensor.

5. If the unit displays the CHECK CO2 ADAPTER message, follow steps a through c.

a. Verify proper connection of the adapter to the sensor. b.Verify that the airway adapter windows are clean and dry. c.If the adapter is properly connected, and the windows are clean and dry, then zero the adapter as described in the next section, “Zeroing the Mainstream CAPNOSTAT 5 CO2 Sensor/Airway Adapter.”

Zeroing the Mainstream CAPNOSTAT 5 CO2 Sensor/Airway Adapter Note:

Do not zero the CAPNOSTAT without an airway adapter installed.

Adapter zeroing compensates for the optical differences between airway adapters and should be performed at certain times. Zeroing is recommended after switching between single patient use and reusable airway adapters, in order to obtain accurate readings. It is also recommended the first time a particular CAPNOSTAT 5 CO2 sensor is connected to the unit. 1. Place the sensor with the adapter installed away from all sources of CO2 (including the patient’s – and your own – exhaled breath and ventilator exhaust valves). 2. Press the Param softkey, then the CO2 softkey. 3. Press the Zero softkey. The unit zeroes the adapter and displays the ZEROING CO2 ADAPTER message for 15 to 20 seconds. The unit displays the message ZERO DONE upon completion of the zeroing. Note:

Do not attempt zeroing for 20 seconds after removing the adapter from the patient’s airway. This time allows any CO2 remaining in the adapter to dissipate before zeroing. Do not attempt to zero the adapter while it is connected to the patient’s airway. Zeroing with CO2 in the adapter can lead to inaccurate measurement and/or other error conditions. If you attempt zeroing while CO2 remains in the adapter, the time required to zero the adapter may be increased. If zeroing cannot be completed, the message ZERO FAILED will be displayed. If this occurs, clear any occlusion in the adapter, remove any source of CO2, wait 20 seconds, and try zeroing again.

Attaching the Airway Adapter to the Airway Circuit If you have not yet done so, you must attach the airway adapter to the CAPNOSTAT 5 CO2 sensor before attaching the breathing adapter to the airway circuit. Refer to “Attaching the Airway Adapter to the CAPNOSTAT 5 CO2 Sensor” on page 6 if necessary. Attach the airway adapter to the breathing circuit as follows:

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT 1. Place the CAPNOSTAT 5 CO2 sensor/airway adapter assembly between the elbow and the ventilator circuit wye, as shown in Figure 2. Note:

Do NOT place the airway adapter between the ET tube and the elbow, as this may allow patient secretions to accumulate in the adapter.

Position the airway adapter with its windows in a vertical, NOT a horizontal, position. This helps keep patient secretions from pooling on the windows. If pooling does occur, the airway adapter may be removed from the circuit, rinsed with water and reinserted into the circuit. To prevent moisture from draining into the airway adapter, do NOT place the airway adapter in a gravity dependent position.

CAPNOSTAT CO2 Sensor

Ventilator Wye Reusable Adult Airway Adapter To Patient

Figure 2 2. Check that connections have been made correctly by verifying the presence of a proper CO2

waveform on the R Series display. 3. The sensor cable should face away from the patient.

Applying an Airway Adapter with Mouthpiece The disposable Pediatric/Adult airway adapter with mouthpiece can be used for spot checking CO2 on non-intubated adult or pediatric patients. Caution

The disposable Pediatric/Adult Airway Adapter with mouthpiece is intended for single patient use. Do NOT reuse or sterilize the adapter, as system performance will be compromised. 1. Remove adapter with mouthpiece from the package. Verify that the adapter and mouthpiece are intact and securely fastened to each other. 2. Attach the airway adapter to the CAPNOSTAT 5 CO2 sensor, as follows: a. Align the arrow on the bottom of the airway adapter with the arrow on the bottom of the CAPNOSTAT sensor.

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Sidestream EtCO2 Setup b.Press the sensor and airway adapter together until they click (see Figure 3). CAPNOSTAT CO2 Sensor

Mouthpiece Airway Adapter To Patient

Figure 3

3. If the unit displays the CHECK CO2 ADAPTER message, follow steps a through c, then go

to step 4. a. Verify proper connection of the adapter to the sensor. b.Verify that the airway adapter windows are clean and dry. c.If the adapter is properly connected, and the windows are clean and dry, then zero the adapter as described in “Zeroing the Mainstream CAPNOSTAT 5 CO2 Sensor/Airway Adapter” on page 7. 4. Ensure the patient seals his or her mouth completely around the mouthpiece and breathes normally. A nose clip may be needed if the patient is exhaling through the nose. It is important that all, or most, of the exhalation be routed through the airway adapter.

Sidestream EtCO2 Setup There are several steps involved with sidestream EtCO2 setup. These steps include: • Attaching the LoFlo Module Cable • Selecting a Sidestream Airway Adapter Kit or Cannula • Inserting the Sample Cell • Zeroing the LoFlo CO2 Module/Sample Cell • Applying a Sidestream Airway Adapter Kit • Applying a Nasal or Nasal/Oral Cannula

Attaching the LoFlo Module Cable To attach the LoFlo module cable, plug the cable into the yellow CO2 connector at the back of the R Series unit by matching the key on the cable to the key on the connector.

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT

Proper Grasp

Improper Grasp

Figure 4

To remove the sensor cable from the R Series unit, grasp the collar surrounding the cable’s R Series connector and pull up.

Selecting a Sidestream Airway Adapter Kit Select an airway adapter kit based on the patient’s size, ET tube diameter, and monitoring situation. Airway adapter kits are disposable and single patient use. Airway Adapter Kit

ET Tube Diameter

Adult/Pediatric Airway Adapter Kit

> 4.0 mm

Adult/Pediatric Airway Adapter Kit with Nafion® tubing ≤ 4.0 mm

Pediatric/Infant Airway Adapter Kit Pediatric/Infant Airway Adapter Kit with Nafion tubing

Note:

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For monitoring times exceeding 6 hours, Nafion tubing is recommended.

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Sidestream EtCO2 Setup

Selecting a Sidestream Cannula Select a sidestream cannula based on the patient’s size and monitoring situation. Nasal and nasal/oral cannulas are disposable and single patient use. Cannula

Application

Nasal CO2 Sampling Cannula, Adult

Nasal CO2 sampling only

Nasal CO2 Sampling Cannula, Pediatric Nasal CO2 Sampling Cannula, Infant Oral/Nasal CO2 Sampling Cannula, Adult

Oral/Nasal CO2 sampling only

Oral/Nasal CO2 Sampling Cannula, Pediatric Nasal CO2 Sampling with O2 Delivery Cannula, Adult

Nasal CO2 sampling with oxygen delivery

Nasal CO2 Sampling with O2 Delivery Cannula, Pediatric Oral/Nasal CO2 Sampling with O2 Delivery Cannula, Adult

Oral/Nasal CO2 sampling with oxygen delivery

Oral/Nasal CO2 Sampling with O2 Delivery Cannula, Pediatric

Inserting the Sample Cell Follow these steps: 1. Remove the LoFlo sampling cannula or airway adapter kit from the package. 2. Insert the LoFlo sample cell into the LoFlo sample cell receptacle and ensure that it clicks into place. Exhaust Tube Module Cable

Sample Cell Receptacle

LoFlo C5 Module LoFlo Module

Figure 5

3. Ensure that the LoFlo module exhaust tube vents gases away from the module environment. 4. Turn the selector switch on the R Series to MONITOR (ON for BLS/Plus units). 5. Wait for the CO2 module to warm up.

The unit will display the WARM UP message for approximately one minute while the module warms up to operating temperature. The message disappears when the module is ready for use. Note:

Warm up time varies with ambient temperature of the module.

Zeroing the LoFlo CO2 Module/Sample Cell The module/sample cell zero allows the LoFlo CO2 module to adjust to the optical characteristics of the sample cell. While zeroing is recommended the first time a particular 9650-0915-01 Rev. E

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT LoFlo module is connected to the unit, it is only absolutely necessary when the message ZERO CO2 MODULE is displayed. Caution

Always ensure that the sample cell is properly connected to the LoFlo module before zeroing. 1. Ensure that the nasal cannula or on-airway adapter is not connected to the patient or close to any source of CO2 (including the patient’s-and your own-exhaled breath and ventilator exhaust valves). 2. Press the Param. softkey and then the CO2 softkey, then press Enter. 3. Press the Zero softkey. The unit zeroes the module and displays the ZEROING CO2 MODULE message for approximately 15-20 seconds. The units displays the message ZERO DONE upon completion of the zeroing. Note:

Do not attempt zeroing for 20 seconds after removing the adapter or cannula from the patient’s airway. This time allows any CO2 remaining in the adapter or cannula to dissipate before zeroing. Do not attempt to zero the module while the adapter or cannula is in the patient’s airway. Zeroing with CO2 in the adapter or cannula can lead to inaccurate measurements and/or other error conditions. If you attempt zeroing while CO2 remains in the adapter or cannula, the time required to zero the module may be increased. If zeroing cannot be completed, the message “ZERO FAILED” will be displayed. If this occurs, clear any occlusion in the adapter or cannula, remove the source of CO2, wait 20 seconds, and try zeroing again.

Applying a Sidestream Airway Adapter Kit The sidestream airway adapter kit is intended for monitoring the EtCO2 of intubated patients. Before attaching the airway adapter to the breathing circuit, verify that the adapter is clean, dry, and undamaged. Replace if necessary. Caution

The disposable (SPU) Adult/Pediatric and Pediatric/Infant airway adapter kits are intended for single patient use. Do NOT reuse or sterilize these adapters as system performance will be compromised. 1. Attach the airway adapter kit’s sample cell to the sample cell receptacle on the LoFlo module, and ensure that it clicks into place. 2. If the unit displays either of the following messages take the appropriate action.

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Sidestream EtCO2 Setup

If you see this message:

Take this action:

CHECK CO2 LINE

Verify that the sample cell is plugged into the module and seated properly. Verify that neither the sample line nor the exhaust tube are blocked, kinked, or pinched. Verify that the airway adapter is not blocked. If the sample line, exhaust tube, or the airway adapter is blocked or otherwise compromised for 15 seconds, this message will appear. The pump will shut off after 2 minutes if the condition that caused the message is not cleared. To restart the pump, correct the blockage, then remove and reinsert the sample cell into the sample cell receptacle. If the problem persists, replace the sample line.

CHECK CO2 MODULE

Check that module cable is plugged in and seated properly. Check that module is not exposed to excessive heat. If problem persists, replace module.

3. Place the airway adapter assembly at the proximal end of the airway circuit between the

elbow and the ventilator circuit wye. Do NOT place the airway adapter between the ET tube and the elbow as this may allow patient secretions to accumulate in the adapter. If pooling does occur, the airway adapter may be removed from the circuit, rinsed with water and reinserted into the circuit. To prevent moisture from draining into the sample tubing, ensure that the sampling tube exits from the top of the airway adapter, not its bottom or sides. See Figure 6.

Sampling Tube

Figure 6

4. Check that connections have been made correctly by verifying the presence of a proper

capnogram on the R Series display.

Applying a Nasal or Nasal/Oral Cannula The nasal and nasal/oral cannulas are intended for monitoring EtCO2 in non-intubated patients. Oral/nasal sampling cannulas should be used on patients who are prone to mouth breathing, since most (if not all) of the CO2 is exhaled through the mouth. If a standard nasal CO2 sampling cannula is used on such patients, the EtCO2 values and capnogram displayed will be substantially lower than the actual CO2 levels present in the patient’s expired breath. Caution

The disposable nasal and nasal/oral cannula sets are intended for single patient use. Do NOT reuse or sterilize the cannula, as system performance will be compromised.

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT 1. Remove the cannula from the package. Verify that the cannula is clean, dry, and undamaged. Replace if necessary. 2. Attach the cannula’s sample cell to the sample cell receptacle on the LoFlo module, and ensure that it clicks into place. 3. If the unit displays either of the following messages take the appropriate action. If you see this message:

Take this action:

CHECK CO2 LINE

Verify that the sample cell is plugged into the module and seated properly. Verify that neither the sample line nor the exhaust tube are blocked, kinked, or pinched. If the sample line, or exhaust tube is blocked or otherwise compromised for 15 seconds, this message will appear. The pump will shut off after 2 minutes if the condition that caused the message is not cleared. To restart the pump, correct the blockage, then remove and reinsert the sample cell into the sample cell receptacle. If the problem persists, replace the sample line.

CHECK CO2 MODULE

Check that module cable is plugged in and seated properly. Check that module is not exposed to excessive heat. If problem persists, replace module.

4. Place the nasal cannula onto the patient as shown in Figure 7.

Figure 7

5. Place the oral/nasal cannula onto the patient as shown in Figure 8.

Figure 8

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Cleaning the CAPNOSTAT 5 CO2 Sensor and LoFlo Module

Cleaning the CAPNOSTAT 5 CO2 Sensor and LoFlo Module The outside of the sensor or module may be cleaned and disinfected by wiping with 70% isopropyl alcohol, a 10% bleach solution, or mild soap. After cleaning, wipe with a clean, water-dampened cloth to rinse. Dry before use.

Cleaning Reusable Airway Adapters Reusable airway adapters may be cleaned by rinsing in a warm soapy solution, followed by soaking in a liquid disinfectant such as 70% isopropyl alcohol, a 10% bleach solution, Cidex® or System 1® (refer to the disinfectant manufacturer’s instructions for use). Adapters should then be rinsed with sterile water and dried. The adult reusable airway adapter may be autoclaved at 121° C (250°F) for 20 minutes, unwrapped. Note:

The Neonatal reusable airway adapter cannot be autoclaved.

Before reusing the adapter, ensure the windows are dry and residue-free, and that the adapter has not been damaged during handling or by the cleaning process.

How EtCO2 is Displayed The R Series unit displays the numeric EtCO2 value in units of mmHg, unless configured for percent or kPa. Refer to the R Series Configuration Guide (Part No. 9650-1201-01) for instructions on how to configure alternate units of measure. The unit also displays the number of breaths per minute, labeled “RR” for respiration rate. In addition, a capnogram may be displayed using the Trace 2 or Trace 3 softkey.

Displaying the Capnogram Waveform The R Series unit can display 1, 2 or 3 waveforms in Monitor, Defib, or Manual (BLS/Plus models) mode, as long as the defibrillator is not charging or ECG analysis is not in progress. The unit displays only 1 or 2 waveforms in Pacer mode. Note:

9650-0915-01 Rev. E

If you don’t see the CO2 display box on the monitor, check the sensor cable connection to the R Series unit. The CO2 display box is not displayed if the sensor is not connected to the unit. Once the box is displayed, after power-on, it remains displayed even if the sensor is disconnected from the unit.

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R SERIES - END-TIDAL CARBON DIOXIDE (ETCO2) OPTION INSERT With EtCO2 monitoring, the unit can display a capnogram below the ECG trace for a visual indicator of the moment-by-moment CO2 values. The unit displays the capnogram at half the speed of the ECG display, and provides 8 or 10 seconds of data, depending on the setup.

SpO2%

CPR

IDLE 0:00

x1

PADS

Depth Rate

99

ECG

Ɔ

PPI

72

NIBP mmHg ----ECG --CO2 RR

mmHg

35 13

50

CO2 0

MONITOR

11:24 Options

Param

Code Marker

Report Data

Alarms

The unit removes the third waveform from the display when the user presses the CHARGE, ANALYZE, or ENERGY SELECT buttons, or the Sync On/Off softkey. To cycle the display from the capnogram to other waveforms (SpO2, CPR, or Filt ECG) press the Options softkey, then the Traces softkey. Select Trace 2 or Trace 3 and then the desired waveform. Press Off to remove any additional waveforms. Use the Zoom softkey from the EtCO2 submenu to adjust the waveform display size. Numbers shown on the left side of the capnogram display indicate the scaling.

Physiological Monitoring The physiological monitoring menu includes the following softkeys: Options, Param, Code Marker, Report Data, and Alarms.

Param Softkey When you press the Param softkey, the following softkeys are displayed: ECG, SpO2, NIBP, CO2, and Return. Note: ECG

SpO2, NIBP, and CO2 will only appear if these options are installed on your unit.

SpO2

NIBP

CO2

Return

Press the Return softkey to return to the physiological monitoring menu.

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9650-0915-01 Rev. E

Physiological Monitoring Selecting the CO2 parameter causes the following softkeys to appear: Zero, Average, Comp., Zoom, Disable EtCO2 (or Enable EtCO2), and Return. RR Filter/ Zero Average Comp.

Zoom

Disable EtCO2 Return

The Zoom softkey will only appear if a capnogram is currently displayed. Pressing the Disable EtCO2 softkey puts the sensor into the power saving sleep mode. Pressing Enable EtCO2 softkey takes the sensor out of sleep mode and turns the heater on for normal operation. Press the Return softkey to return to the physiological monitoring menu.

Zero Softkey Adapter zeroing should be performed whenever you switch between reusable and disposable adapters, or if a CAPNOSTAT 5 CO2 sensor is being connected to the unit for the first time. Module zeroing may be necessary if the unit displays the message ZERO CO2 MODULE. Adapter zeroing may also be necessary if the unit displays ZERO CO2 ADAPTER. Note:

Do not attempt zeroing for 20 seconds after removing the adapter or cannula from the patient’s airway. This time allows any CO2 remaining in the adapter or cannula to dissipate before zeroing. Do not attempt to zero while the adapter or cannula is in the patient’s airway. Zeroing with CO2 in the adapter or cannula can lead to inaccurate measurements and/or other error conditions. If you attempt zeroing while CO2 remains in the adapter or cannula, the time required to zero may be increased. If zeroing cannot be completed, the message ZERO FAILED will be displayed. If this occurs, clear any occlusion in the adapter or cannula, remove any source of CO2, wait 20 seconds, and try zeroing again.

Press the Zero softkey to initiate adapter or module zeroing. The unit displays the ZEROING CO2 ADAPTER or ZEROING CO2 MODULE message during the zeroing process, which is typically finished in 15-20 seconds. The unit displays the ZERO DONE message when the zeroing process is complete. The unit displays the ZERO FAILED message if the zeroing process did not complete successfully. If this occurs, clear any occlusion in the adapter or sample line, remove any source of CO2, and try zeroing again. Press the Return softkey to return to the main menu.

Zoom Softkey The Zoom softkey will only appear if a capnogram is currently displayed. Select the full scale range for the displayed capnogram by scrolling among the different zoom levels. Zoom levels change with each press of the Zoom softkey. They are as follows: • 0-12.5 mmHg • 0-25 mmHg • 0-50 mmHg • 0-75 mmHg

9650-0915-01 Rev. E

R Series End-Tidal Carbon Dioxide (EtCO2)

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