Dräger Medical Narkomed MRI-2 Operator'S Instruction Manual Download Page 138

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Breathing Pressure Monitoring

13-14

Part Number: 4116841-001

Narkomed MRI-2 Operator’s Manual

Rev: E

APNEA-P
ALM STBY
(LO)

Any time that the apnea pressure alarm (threshold pressure alarm limit)
has been set to Standby, the LO message

APNEA-P ALM STBY

appears in

the Alarm window.

BR PRS ERR
(LO)

If the Narkomed MRI-2 detects an internal electronic failure that would
prevent proper operation, the LO message

BR PRS ERR

appears in the

Alarm window. If this happens, contact an authorized representative of
DrägerService.

CONTNG
PRES (HI)

If the measured breathing pressure remains above the threshold pressure
alarm limit for more than 15 seconds, the breathing pressure display area
is cleared, the HI message

CONTNG PRES

appears in the Alarm window,

and an intermittent audible alarm sounds.

When the measured breathing pressure drops below the threshold
pressure alarm limit, alarm annunciation ceases.

O2 MON ERR
(LO)

If the Narkomed MRI-2 detects an internal electronic failure that would
prevent proper operation, the LO message

O2 MON ERR

appears in the

Alarm window. If this happens, contact an authorized representative of
DrägerService.

PEEP > 4
(LO)

Any time the monitor measures a PEEP of 5 cm H

O or greater, the LO

message

PEEP > 4

appears in the Alarm window.

When the measured PEEP drops below 5 cm H

O, the LO message is

cleared from the display.

PEEP > 25
(ME)

Any time that the monitor measures a PEEP of 26 cm H

O or greater, the

ME message

PEEP > 25

appears in the Alarm window and an intermittent

audible alarm sounds.

Alarm annunciation ceases when the measured PEEP drops below 26 cm
H

O. Also, an

APNEA

CONTNG PRES

alarm condition will clear this

alarm condition.

SUB ATM
PRES (HI)

If the measured breathing pressure falls below -10 cm H

O, the HI

message

SUB ATM PRES

appears in the Alarm window and a continuously

repeating audible alarm sounds.

This alarm condition is cleared when the sensed pressure rises above -10
cm H

O. However, the alarm message is extended for 5 seconds to allow

the recognition of a momentary subatmospheric pressure condition.

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Summary of Contents for Narkomed MRI-2

Page 1: ...uction Manual Operator s Part Number 4116841 001 Rev E WARNING For a full understanding of the performance characteristics of this anesthesia machine the user should carefully read this manual before operating RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 2: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 3: ...er Systems 2 17 Tracheal Suction System 2 19 AV2 Ventilator 2 20 Main Switch Panel 2 21 Power Supply System 2 23 Monitoring System 2 26 Monitor Screen and Controls 2 26 Alarm System 2 27 Section 3 Daily Checkout Daily Checkout Procedure 3 2 Section 4 Preuse Checkout Preuse Checkout Procedure 4 2 Section 5 Gas Delivery System Operation Overview 5 2 Connecting the Pipeline Gas Supply 5 3 Connecting ...

Page 4: ...n 10 Monitoring System Overview 10 2 Power On Screen 10 2 Monitor Screen and Controls 10 3 Configuring the Anesthesia Machine 10 7 Setting Alarms to Standby 10 10 Silencing Alarms 10 10 Section 11 Oxygen Monitoring Overview 11 2 Monitor Display 11 3 Monitor Controls 11 3 Setting Alarm Limits 11 4 Calibrating the Oxygen Sensor 11 4 Unsuccessful Calibration 11 7 Oxygen Alarm Messages 11 9 Low Oxygen...

Page 5: ... 14 2 Routine Maintenance 14 2 Removing Parts for Cleaning and Disinfection 14 11 Disassembling Parts for Cleaning and Disinfection 14 13 General Guidelines for Cleaning and Disinfection 14 16 Reassembly Instructions 14 23 Section 15 Specifications General 15 2 Environmental 15 2 Electrical 15 2 Gas Delivery System 15 2 Vaporizers 15 3 AV2 Ventilator 15 3 Absorber System 15 4 Oxygen Monitoring 15 ...

Page 6: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 7: ...AC Power Failure Indicator 2 22 Figure 2 15 Power Supply System 2 24 Figure 2 16 Monitor Screen and Controls 2 26 Figure 2 17 Alarm Display 2 27 Section 5 Gas Delivery System Operation Figure 5 1 Gas Fittings and Yokes 5 2 Figure 5 2 Connecting the Pipeline Gas Supply 5 4 Figure 5 3 Connecting the Gas Cylinder 5 6 Figure 5 4 Using the Oxygen Flush 5 7 Section 6 Open Reservoir Scavenger Operation F...

Page 8: ...3 Breathing Pressure Monitor Window 13 6 Figure 13 4 Breathing Pressure Trace Window 13 7 Figure 13 5 Breathing Pressure Trace Window with Examples of High Alarm Limit Markers 13 8 Figure 13 6 Monitor Controls 13 9 Figure 13 7 Sample Threshold Limit Settings 13 12 Section 14 Routine Maintenance and Cleaning Figure 14 1 Replacing the Absorbent 14 3 Figure 14 2 Replacing the Oxygen Sensor 14 4 Figur...

Page 9: ...Oxygen Monitoring Table 11 1 Alarm Limits 11 4 Table 11 2 Unsuccessful Calibration Causes and Solutions 11 7 Table 11 3 Oxygen Monitoring Problem Resolution 11 10 Section 12 Respiratory Volume Monitoring Table 12 1 Respiratory Volume Monitoring Problem Resolution 12 8 Section 13 Breathing Pressure Monitoring Table 13 1 Breathing Pressure Monitoring Problem Resolution 13 15 Section 14 Routine Maint...

Page 10: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 11: ...ity for Patient Safety 1 2 Limitation of Liability 1 2 Restriction 1 3 Copyright 1 3 Trademark Notices 1 3 Disclaimer 1 3 Recommendations 1 4 Symbol Definition 1 4 Purpose of This Manual 1 4 How This Manual Is Organized 1 5 Conventions Used in This Manual 1 5 General Warnings and Cautions 1 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 12: ...components of the system It is the operator and not the various manufacturers or suppliers of components who has control over the final composition and arrangement of the anesthesia system used in the clinical practice Therefore the responsibility for choosing the appropriate safety monitoring devices rests with the operator and user of the equipment Patient safety may be achieved through a variet...

Page 13: ...uipment and parts sold reflects the allocation of risk and the limitations of liability referenced herein Restriction Federal law restricts this device to sale by or on the order of a physician Copyright Copyright 2004 by Draeger Medical Inc All rights reserved No part of this publication may be reproduced transmitted transcribed or stored in a retrieval system in any form or by any means electron...

Page 14: ... concerning these agreements contact DrägerService at 800 543 5047 Symbol Definition The following symbols appear on the labeling on the back of the Narkomed MRI 2 and are defined below CAUTION Refer to accompanying documents before operating equipment ATTENTION Consulter les documents ci joints avant de faire fonctionner l apparail CAUTION Risk of electric shock do not remove cover Refer servicin...

Page 15: ...ual has several conventions to help organize the information presented Please read about these conventions carefully to understand their significance in the manual Typefaces Different typefaces are used throughout the manual to differentiate between narrative information and machine messages and labels Warningsand Cautions All parts of this manual contain warning and caution statements about the N...

Page 16: ...s been tested only with magnets with field strengths of up to 3 0 tesla Moving the machine near higher strength magnets greater than 3 0 tesla could result in machine malfunction or unmanageable attractive forces that could lead to serious injury or death WARNING This anesthesia system will not respond automatically to certain changes in patient condition operator error or failure of components Th...

Page 17: ... that individual components of the system can be safely used with MRI scanners CAUTION Although the Narkomed MRI 2 is designed to minimize the effects of ambient radio frequency interference machine functions may be adversely affected by the operation of electrosurgical equipment or short wave or microwave diathermy equipment in the vicinity CAUTION Do not place any objects on top of the machine A...

Page 18: ...tte appareil d anesthésie á été vérifiée avec des aimants possédant des champs magnétiques jusqu á 3 0 tesla Installé l appareil prés d un aimant plus puissant plus de 3 0 tesla pourrait amener l appareil á mal fonctionner ou produire des forces d attractions incontrôlables qui pourrait causer des blessures sérieuses ou la mort AVERTISSEMENT Ce système d anesthésie ne réagit pas automatiquement à ...

Page 19: ...acement sur des plans inclinés dans des angles et au passage de seuils portes et ascenseurs par exemple Ne pas faire passer l appareil sur des tuyaux des fils électriques ou d autres obstacles se trouvant sur le sol AVERTISSEMENT Utiliser seulement des piéces de remplacement fournies par le manufacturier Des piéces non approuvées peuvent causer des problémes de fonctionnement des blessures ou la m...

Page 20: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 21: ...machine Overview 2 2 Gas Delivery System 2 4 Vaporizers 2 12 Absorber 2 13 Bain Circuit Adapters 2 15 Scavenger Systems 2 17 Tracheal Suction System 2 19 AV2 Ventilator 2 20 Main Switch Panel 2 21 Power Supply System 2 23 Monitoring System 2 26 Monitor Screen and Controls 2 26 Alarm System 2 27 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 22: ...ration breathing pressure and respiratory volume The Narkomed MRI 2 can be used in MRI scanner rooms with magnets of 3 0 tesla or less A front view is shown in the figure below Figure 2 1 Narkomed MRI 2 Front View OP00122 VPO MONITOR VENTILATOR BATTERY BOX ABSORBER VENTILATOR BELLOWS SUCTION SYSTEM FLOWMETER BANK VAPORIZERS MAIN SWITCH PANEL PRESSURE GAUGES SLIDING WRITING TRAY 100 200 300 400 500...

Page 23: ...gure 2 2 Narkomed MRI 2 Back View OP00615 VAPORIZER MOUNTS PIPELINE GAS FITTINGS CYLINDER GAS YOKES TETHERED CYLINDER WRENCH POWER CORD MOUNT VPO MONITOR SCAVENGER INTERFACE BRACKET BATTERY BOX DC CONNECTOR TO REMOTE BATTERY CHARGER ABSORBER SUCTION SYSTEM RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 24: ...owmeter housing The indexed connector system reduces the risk of delivering the wrong gas to a patient by preventing incorrect connection of gas pipes The inlets have check valves which prevent backflow leakage into the atmosphere when supply hoses are not connected or into the attached supply hoses when reserve cylinders are in use Each pipeline connection is equipped with a filter to prevent for...

Page 25: ...w pipeline pressure may activate the corresponding reserve cylinder and deplete its contents if the reserve cylinder valve was left in the open position CAUTION To ensure that gas supplies are at adequate pressure pipeline pressure gauges must indicate steady pressures of 50 55 psi FLOW TUBE l min INDICATOR FLOAT FLOWMETER GUARD KNOB FLOW CONTROL VALVE PIPELINE PRESSURE GAUGE CYLINDER PRESSURE GAU...

Page 26: ...Using multiple washers may compromise the pin indexed safety system Be sure to verify the integrity of both index pins when installing a new cylinder WARNING Check the cylinder yokes to make sure the two index pins are intact each time you attach a cylinder to the machine Use only one cylinder gasket for each yoke Using more than one gasket could cause cylinder gas leakage and compromise the pin i...

Page 27: ...in open with an unrestricted gas flow Oxygen pressure loss causes the valves to close proportionally to the loss of pressure As a result OFPD controlled gases can be restricted or shut down in response to loss of oxygen pressure Gas flow reductions are indicated on the flowmeter When the oxygen supply from the pipeline or reserve cylinders drops below about 37 psi the red O2 SUPPLY PRESSURE indica...

Page 28: ...n Ratio Controller ORC The ORC is a pneumatic oxygen nitrous oxide interlock system designed to maintain a fresh gas oxygen concentration of 25 4 It provides independent control of the oxygen and nitrous oxide flows The ORC works by proportionally limiting the nitrous oxide flow whenever the selected oxygen and nitrous oxide flow control valve settings would otherwise result in a hypoxic fresh gas...

Page 29: ...t a 15 mm male fitting on the absorber fresh gas hose The male fitting slides into a retaining slot in the spring loaded safety locking bar to prevent the fresh gas hose from being disconnected accidentally The 15 mm male fitting on the fresh gas hose is unique to Draeger Medical design and should not be replaced by a hose from any other manufacturer Figure 2 4 Fresh Gas Outlet 15 mm O2 FLUSH CONT...

Page 30: ...edical absorbers and Bain circuit adapters When using a 15 mm fitting place the spring loaded locking bar over the male fitting to secure it to the female fitting a 22 mm female fitting with a load bearing threaded mount such as the ones for Magill circuits or ISO type nonrebreathing adapters When using an ISO type nonrebreathing adapter swing the spring loaded locking bar to the side to gain acce...

Page 31: ...f oxygen through a nasal cannula an auxiliary oxygen flowmeter is mounted on the left side of the main switch panel This flowmeter can be used when the machine is turned off A zero stop prevents damage to the flow control valve seat Figure 2 6 Auxiliary Oxygen Flowmeter OP00155 AUXILIARY OXYGEN FLOWMETER RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 32: ...ystem is incorporated into the vaporizer bank and requires the unused vaporizer to be locked in the zero percent position WARNING Only one vaporizer can be activated at a time If the exclusion system permits simultaneous activation of more than one vaporizer do not use the anesthesia machine Contact an authorized representative of DrägerService for adjustment Handling the Vaporizer If a vaporizer ...

Page 33: ...tic ventilation The absorber system has a manual automatic selector valve for selecting manual or automatic ventilation WARNING Waste gas scavenging systems used with Draeger Medical absorber systems must have safety features to ensure that excessive subatmospheric pressure lower than 0 5 cmH2O and excessive positive pressure higher than 0 5 cmH2O are not possible at the connection point OP00322 R...

Page 34: ...the valve disks are missing or damaged or the valve seat is damaged Canister Each absorber unit has two transparent plastic canisters to contain absorbent The absorbent soda lime or barium hydroxide lime can be purchased in loose granular or prepacked cartridge form The canisters are interchangeable Dust Cup A removable transparent plastic cup located below the bottom assembly collects absorbent d...

Page 35: ...he adapter includes an adjustable pressure limiter APL valve a breathing pressure gauge a quick connect fitting for the breathing pressure pilot line a port for the oxygen sensor a 15 22 mm port for non rebreathing circuits and a connector for a patient breathing bag Figure 2 8 Absorber Mount Bain Circuit Adapter OXYGEN SENSOR 22MM M 15MM F EXPIRATION TERMINAL BAIN CIRCUIT BAIN CIRCUIT HOSE BARB F...

Page 36: ...le Mount Bain Circuit Adapter OXYGEN SENSOR BAIN CIRCUIT BREATHING BAG MOUNT 19 MM SCAVENGER HOSE 22MM VENTILATOR HOSE BAIN CIRCUIT HOSE BARB FOR FRESH GAS HOSE MOUNTING STUD FRESH GAS HOSE OP00659 SET SCREW BREATHING PRESSURE PILOT LINE MANUAL AUTOMATIC SELECTOR VALVE ABSORBER POLE BREATHING SYSTEM PRESSURE GAUGE APL VALVE RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTEN...

Page 37: ...n reservoir scavenger is used with suction vacuum waste gas disposal systems This scavenger is an open system with continually open relief ports for positive and negative pressure control Figure 2 10 Open Reservoir Scavenger VACUUM DISS HOSE TERMINAL THREADED INPUT PORT CAP 19MM SCAVENGER HOSE TERMINAL RELIEF PORT NEEDLE VALVE KNOB FLOWMETER RESERVOIR CANISTER 19MM SCAVENGER HOSE TERMINAL OP75121 ...

Page 38: ...tive pressure relief WARNING Do not use this device with a waste gas disposal system capable of applying a negative pressure to the scavenger interface a suction or vacuum waste gas disposal system Figure 2 11 Scavenger Interface for Passive Systems WASTE GAS INPUT PORT 19MM HOSE TERMINAL INPUT PORT CAP SAFETY RELIEF VALVE SHOWN CLOSED WASTE GAS INPUT PORT 19MM HOSE TERMINAL WASTE GAS EXHAUST PORT...

Page 39: ...side of the machine For complete information see the manufacturer s instructions supplied with the suction system assembly WARNING Do not apply unregulated suction to the patient circuit when using this device Figure 2 12 Tracheal Suction System Rear View HOSPITAL VACUUM SYSTEM HOSE CONNECTION REAR VIEW OF CONNECTIONS ANESTHESIA MACHINE VACUUM DISS CONNECTOR CAP ASSEMBLY METAL INLET STEM SUCTION B...

Page 40: ...e limiter APL valve for manual ventilation or the ventilator bellows for automatic ventilation During automatic ventilation the manual automatic selector valve isolates the APL valve from the breathing system The ventilator has a relief valve mounted behind the bellows chamber to compensate for introducing continuous fresh gas into the breathing system When the bellows is completely filled any exc...

Page 41: ...m circuits are on The green indicator next to the switch lights In the STANDBY position the switch shuts down the gas supplies and all electrical power to the machine The battery charging circuit remains on I E RATIO CONTROL I E RATIO DISPLAY FREQUENCY CONTROL FREQUENCY DISPLAY INSPIRATORY FLOW GAUGE INSPIRATORY FLOW CONTROL VENTILATOR ON OFF CONTROL TIDAL VOLUME CONTROL PRESSURE LIMIT CONTROL TID...

Page 42: ... supplies power to the electronic ventilator If the battery is completely discharged the AC power failure indicator does not have power and will not function Figure 2 14 AC Power Failure Indicator RED O2 SUPPLY PRESSURE LOW INDICATOR YELLOW AC POWER LOW INDICATOR YELLOW BATTERY LOW INDICATOR GREEN BATTERY TEST INDICATOR BATTERY TEST PUSH BUTTON SYSTEM POWER SWITCH OP20050 RETURN TO THIS MANUAL S T...

Page 43: ...ressure alarm will not activate if only one source of oxygen supply pressure either the cylinder or pipeline fails and the other maintains proper supply pressure in the machine s oxygen supply lines Power Supply System The Narkomed MRI 2 is equipped with a battery backed up power supply for the ventilator and alarm system When in use the Narkomed MRI 2 should be plugged into an AC outlet WARNING T...

Page 44: ... SUPPLY FILTER BOX ASSEMBLY OUTSIDE MRI ROOM POWER SUPPLY CHARGER ASSEMBLY INSIDE BOX INSIDE MRI ROOM MRI ROOM ACCESSS PANE PLATE 6 FT POWER SUPPLY CABLE 12 FT POWER SUPPLY CORD NOTE ACTUAL CABLE LENGTHS MAY VARY DEPENDING UPON THE POWER CABLE OPTION SELECTED FOR A PARTICULAR SITE OP00316 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 45: ...e charger can recharge a fully discharged battery in about 16 hours with the Narkomed MRI 2 in the Standby mode Machine Functions on Battery Power When the battery system is used the yellow AC POWER FAIL indicator on the alarm panel lights the AC PWR FAIL ME monitor display message appears When the battery reserve approaches depletion the yellow BATTERY LOW indicator lights the BATTERY LOW LO moni...

Page 46: ... shown on the machine s monitor screen The control keys on either side of the screen allow you to establish monitoring settings With the left keypad you can control system wide settings such as alarm annunciation and monitor configuration With the right keypad you can control settings for specific monitors oxygen concentration breathing pressure and respiratory volume See Figure 2 16 Figure 2 16 M...

Page 47: ...messages for active alarm conditions in the Alarm window at the top of the monitor screen as shown in Figure 2 17 Messages are displayed for up to three of the highest priority active alarm conditions Any additional lower priority active alarm conditions are retained in the monitor s memory Messages for these lower priority conditions are displayed when the higher priority alarm conditions have be...

Page 48: ... caused by simultaneous alarms Ventilation Alarms When the system power switch is turned from STANDBY to ON the volume and pressure apnea alarms default to Standby to allow machine setup without nuisance alarms An interlock with the ventilator ensures that when the ventilator is turned on the alarms are enabled You can also enable the alarms individually using the keypad When the ventilator is tur...

Page 49: ... 3 Daily Checkout This section provides you with instructions detailing the steps for you to perform a daily checkout of the Narkomed MRI 2 anesthesia machine Daily Checkout Procedure 3 2 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 50: ...y fifty 50 cmH2O the apnea pressure alarm will become latched Avoid producing this condition during the checkout procedures by keeping the maximum breathing circuit pressure below fifty 50 cmH2O while the monitor is energized or by bringing successive peak pressures down in twenty five 25 cmH2O increments until the peak pressure is below fifty 50 cmH2O Initial Setup and Verification 1 Enter the se...

Page 51: ...f about 1900 psi Replace any cylinder with pressure less than 1000 psi To check for a high pressure leak close the cylinder and observe the cylinder pressure gauge for a prominent decrease in the pressure With the oxygen cylinder closed press the oxygen flush button on the front of the anesthesia machine Hold the button in until the pressure gauges indicate no pressure 10 Check the nitrous oxide c...

Page 52: ...ification 12 Vaporizer Verification a Check for a sufficient supply of liquid anesthetic in the vaporizer using the vaporizer sight glass The liquid level must be between the minimum and maximum markings b Make sure the vaporizer fill and drain valves are completely closed c Check the vaporizer exclusion system which prevents more than one vaporizer from being activated simultaneously Make sure th...

Page 53: ...t least 25 4 oxygen NOTE When the nitrous oxide flow control valve is open and oxygen is flowing at a minimum rate 150 200 ml min nitrous oxide flows at about 500 ml min Oxygen Flush Verification 17 Check the oxygen flush a Press the oxygen flush button Listen for an audible gas flow sound accompanied by a marked increase in oxygen concentration in the breathing system b Check the delivered oxygen...

Page 54: ...ropriate construction is connected to the breathing bag terminal of the breathing system f Make sure the breathing pressure pilot line is properly connected between the BREATHING PRESSURE interface and either the absorber quick connect fitting or the appropriate fitting at or near the patient Y piece g Make sure the oxygen sensor and flow sensor are properly installed 21 Make sure the absorber can...

Page 55: ...spiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm hose d Completely open the APL valve by turning the control knob fully counterclockwise to its stop position e Turn the SYSTEM POWER switch to ON f Open the oxygen flow control valve to a flow of 8 l min g Occlude the bag mount opening and watch for a pressure increase on the breathing system pressure gauge...

Page 56: ... hose terminal on the rear of the absorber pole c Make sure a 19 mm scavenger hose is connected between the bottom of the absorber pole and the scavenger interface d Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found e Verify the safe performance of the open reservoir scavenger system With the scavenger system properly installed and operating test for po...

Page 57: ...valve and the scavenger interface t Make sure a 19 mm scavenger hose is connected between the APL valve on the absorber and the 19 mm hose terminal on the back of the absorber pole u Make sure a 19 mm scavenger hose is connected between the bottom of the absorber pole and the scavenger interface v Check for moisture accumulation in the breathing and scavenger hoses Remove any moisture found w Shor...

Page 58: ...e monitor alarm limits are automatically set to a default configuration when the SYSTEM POWER switch is turned on Check these settings and adjust them if necessary Alarm limits can be adjusted at the beginning of or during a procedure Also make sure that any external monitors if any are connected properly 28 Test the alarm functions Simulate alarm conditions and check for appropriate alarm signals...

Page 59: ... Preuse Checkout This section provides you with instructions detailing the steps for you to perform a preuse checkout of the Narkomed MRI 2 anesthesia machine Preuse Checkout Procedure 4 2 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 60: ...urs The battery charging system works only when the machine is plugged into an active AC power source The charging system takes about 16 hours to charge a fully discharged battery Bain Circuit Adapter Verification 4 Verify that the inner tube of the Bain circuit is intact and not occluded First deliver a flow of oxygen to the Bain circuit through the fresh gas hose Then occlude the inner tube of t...

Page 61: ...tinuously with 100 oxygen for at least one minute before the first case of the day is recommended Remove accumulated absorbent dust and water from the absorber dust cup WARNING Absorbent is caustic and is a strong eye skin and respiratory tract irritant When emptying the absorber dust cup take care not to spill its caustic contents NOTE When changing the CO2 absorbent take care not to chip or crac...

Page 62: ...rol valves on the anesthesia machine b Turn the SYSTEM POWER switch to the STANDBY position c Turn the vaporizer to 0 concentration d Interconnect the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose e Set the manual automatic selector valve to BAG f Close the APL valve by turning the knob fully clockwise to its stop position g Check that...

Page 63: ...S threaded terminal on the left hand side of the scavenger or attach a wall suction hose onto the adapter s hose barb fitting g Short circuit the inspiratory valve and the expiratory hose terminal on the ultrasonic flow sensor with a 22 mm breathing hose h Set the absorber s manual automatic selector valve to BAG i Turn the APL valve control knob fully counterclockwise j Verify that the suction wa...

Page 64: ... control valve to a flow of 10 l min and occlude the 19 mm scavenger terminal labeled EXHAUST z After the ventilator bellows inflates the flow of oxygen exits the system through the positive pressure safety relief valve At this point the absorber system s breathing pressure gauge must indicate a pressure of less than 10 cmH2O Manual and Automatic Ventilation Systems 11 Check for proper pressure an...

Page 65: ...rocedure verify that the final status of the machine is as follows a vaporizers are off handwheels set to 0 b the APL valve is open fully counterclockwise c Ensure that the ventilator on off switch is in the off position the autobag selector switch does not control the ventilator on the Narkomed MRI 2 d the manual automatic switch is set to BAG e all flowmeters are indicating 0 or minimum f the pa...

Page 66: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 67: ... description of the Gas Delivery System of the Narkomed MRI 2 anesthesia machine Overview 5 2 Connecting the Pipeline Gas Supply 5 3 Connecting the Gas Cylinder 5 5 Connecting the Fresh Gas Hose 5 6 Adjusting the Gas Flow 5 6 Using the Oxygen Flush 5 7 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 68: ...gent vapor The pneumatic system can deliver up to three gases and one anesthetic agent simultaneously Oxygen air and nitrous oxide are standard In addition two vaporizers can be mounted on the machine Vaporizers are available for halothane enflurane isoflurane and sevoflurane Figure 5 1 Gas Fittings and Yokes OP00123 O2 YOKE N2O YOKE PIPELINE SUPPLY GAS FITTINGS RETURN TO THIS MANUAL S TABLE OF CO...

Page 69: ...ply hose to the corresponding gas fitting on the side of the flowmeter housing Use a wrench to tighten the hex nut WARNING Carefully check hoses each time you connect the machine to a wall or ceiling outlet to ensure that both ends of the hose are indexed for the same gas Pipeline delivery hoses used between wall outlets and anesthesia machines have caused accidents when an oxygen fitting was plac...

Page 70: ...y O2 NIST GAS FITTING AIR NIST GAS FITTING O2 DISS NUT GAS FITTING O2 DISS BODY GAS FITTING OP14700 N2O DISS NUT GAS FITTING N2O DISS BODY GAS FITTING N2O NIST GAS FITTING DISS BODY OPTION NIST OPTION AIR DISS BODY GAS FITTING AIR DISS NUT GAS FITTING DISS NUT OPTION RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 71: ... yoke Using more than one washer could cause cylinder gas leakage and compromise the pin indexing system 2 Verify that the two index pins below the gas inlet are intact WARNING Check cylinder yokes for the integrity of the two index pins each time you attach a cylinder to the machine 3 Insert the head of a gas cylinder with matching gas into the yoke from below The gas outlet and index holes on th...

Page 72: ...just the gas flow 1 Turn the flow control knob located below the flowmeter tube for the preferred gas Turning the valve knob counterclockwise increases flow Turning the knob clockwise decreases flow 2 While adjusting the flow control knob observe the flow rate Flow rate is indicated by the flowmeter scale reading at the center of the float CAUTION The flow of oxygen cannot be completely shut off s...

Page 73: ...n the front of the machine for a few seconds This introduces an unmetered flow of pure oxygen into the breathing circuit at a rate of about 55 l min Figure 5 4 Using the Oxygen Flush O2 FLUSH CONTROL BUTTON HANDLE FRESH GAS LOCKING BAR EXTENDED POSITION RELEASE TO LOCK FRESH GAS OUTLET FRESH GAS HOSE OP79056 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 74: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 75: ...ration This section describes the open reservoir scavenger used in the Narkomed MRI 2 anesthesia machine Overview 6 2 Connecting the Open Reservoir Scavenger System 6 3 Operating the Open Reservoir Scavenger System 6 4 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 76: ...e gas from the scavenger to the disposal system The open reservoir scavenger is an open system which uses continually open relief ports to provide positive and negative pressure relief Figure 6 1 Open Reservoir Scavenger VACUUM DISS HOSE TERMINAL THREADED INPUT PORT CAP 19MM SCAVENGER HOSE TERMINAL RELIEF PORT NEEDLE VALVE KNOB FLOWMETER RESERVOIR CANISTER 19MM SCAVENGER HOSE TERMINAL OP75121 LOCK...

Page 77: ...enger WARNING Make sure the 19 mm scavenger hoses leading from the absorber are not pinched kinked or blocked in any manner 2 Attach the short 19 mm scavenger hose between the 19 mm terminal marked SCAVENGER HOSE on the rear of the APL valve and the 19 mm terminal marked SCAVENGER HOSE on the rear of the absorber pole 3 Attach another 19 mm scavenger hose between the 19 mm terminal marked SCAVENGE...

Page 78: ...anister In this way positive pressure does not build up within the patient breathing system CAUTION Waste gas vented from the relief ports may contaminate the operating room To prevent such contamination be sure to adjust the needle valve properly If the disposal system s flow rate suction exceeds the waste gas flow rate from the patient breathing system the disposal system draws room air through ...

Page 79: ... rate of about 25 l min Depending on the fresh gas flow rate the needle valve setting may need to be increased or decreased to settings either above or below the lines on the flowmeter If the suction flow rate is set too low waste gas will exit the canister through the relief ports around the top of the canister and contaminate the operating room If the suction flow rate is too high the waste gas ...

Page 80: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 81: ... Passive Systems Operation This section describes the scavenger interface for passive systems used in the Narkomed MRI 2 anesthesia machine Overview 7 2 Operating the Scavenger Interface for Nonactive Systems 7 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 82: ...cavenger interface is a closed system which uses a spring loaded valve for positive pressure relief WARNING Do not use this device with a waste gas disposal system capable of applying a negative pressure to the scavenger interface a suction or vacuum waste gas disposal system Figure 7 1 Scavenger Interface for Passive Systems WASTE GAS INPUT PORT 19MM HOSE TERMINAL INPUT PORT CAP SAFETY RELIEF VAL...

Page 83: ...sure buildup the scavenger s positive pressure relief valve is set to open at a pressure of 5 cm H2O Waste gas then exits through the holes in the relief valve housing so you do not need to adjust this scavenger However make sure that hoses are properly connected and that the positive pressure safety relief valve is functioning WARNING The positive pressure relief valve must be inspected and clean...

Page 84: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 85: ...anual 8 Main Switch Panel Operation This section describes the main switch panel in the Narkomed MRI 2 anesthesia machine Overview 8 2 System Power Switch 8 3 Testing the Battery 8 3 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 86: ...indicator lights for low O2 supply pressure AC power failure and battery low alarms A continuous alarm sounds when the O2 supply pressure is low Figure 8 1 Main Switch Panel RED O2 SUPPLY PRESSURE LOW INDICATOR YELLOW AC POWER LOW INDICATOR YELLOW BATTERY LOW INDICATOR GREEN BATTERY TEST INDICATOR BATTERY TEST PUSH BUTTON SYSTEM POWER SWITCH OP20050 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN...

Page 87: ... Test the battery system before each use To test the battery 1 Turn the SYSTEM POWER switch to ON 2 Press and hold the BATTERY TEST button 3 If the battery is sufficiently charged only the green BATTERY TEST indicator lights A fully charged battery can power the electrical components of the anesthesia machine for up to three hours NOTE The BATTERY LOW indicator lights when the battery reserve appr...

Page 88: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 89: ...esthesia machine Overview 9 2 Activating the Ventilator 9 3 Adjusting the Tidal Volume 9 4 Setting the Respiratory Frequency 9 4 Setting the Inspiratory Expiratory I E Phase Time Ratio 9 5 Setting the Inspiratory Flow Rate 9 5 Setting the Inspiratory Pressure Limit 9 5 Problem Resolution 9 6 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 90: ...valve This valve is for selecting either the breathing bag and adjustable pressure limiter APL valve for manual ventilation or the ventilator bellows for automatic ventilation During automatic ventilation the manual automatic selector valve isolates the absorber s APL valve from the breathing system To compensate for the continuous introduction of fresh gas into the breathing system the ventilator...

Page 91: ...ain lighted but the ventilator does not function Using the Ventilator ON OFF Control The ventilator ON OFF control is a momentary switch that returns to its center position after being turned in either direction To activate the ventilator turn the switch clockwise The green ON indicator lights and the switch returns to its center position I E RATIO CONTROL I E RATIO DISPLAY FREQUENCY CONTROL FREQU...

Page 92: ...0 and 1500 ml Smaller tidal volumes can be adjusted by setting the pointer below the 200 ml marking on the bellows chamber Larger tidal volumes can be selected by setting the pointer above the 1400 ml calibration As in any volume preset anesthesia ventilator the actual tidal volume delivered to the patient s lungs may differ from the preset volume at the bellows due to the compliance of the breath...

Page 93: ...ce the flow gauge is labeled with nominal zones The scale on the label is only a reference Adjust the flow setting to a point where the ventilator bellows is fully compressed but not deformed at the end of the inspiratory phase of the breathing cycle Use the inspiratory flow control to create an inspiratory plateau at the end of the inspiratory cycle and to affect the potential peak inspiratory pr...

Page 94: ...lected tidal volume Decrease frequency Increase expiratory phase time Improperly adjusted ventilator relief valve Contact an authorized representative of DrägerService Breathing system leak Repair leak Ventilator won t cycle Low oxygen supply pressure Provide sufficient oxygen supply pressure Bellows won t compress during inspiration Absorber manual automatic selector valve in BAG position Place s...

Page 95: ...es the monitoring system of the Narkomed MRI 2 anesthesia machine Overview 10 2 Power On Screen 10 2 Monitor Screen and Controls 10 3 Configuring the Anesthesia Machine 10 7 Setting Alarms to Standby 10 10 Silencing Alarms 10 10 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 96: ...tics one of three possible conclusions to the self tests is posted on the screen FUNCTIONAL Every component of the monitoring system is in satisfactory operational order After a brief delay the Monitor screen appears CONDITION ALLY FUNCTIONAL A noncritical fault was detected such as a low inspiratory oxygen percentage The Narkomed MRI 2 may be used but an authorized representative of DrägerService...

Page 97: ...tion is displayed on the Monitor screen The control keys to the left and right of this screen allow you to establish monitoring settings See Figure 10 2 Figure 10 2 Monitor Screen and System Controls OP00306 Alarms Config Oxygen Breathing Volume Breathing Pressure Liters cm H O 2 High Limit Low Limit Cal Low Limit Off On Off On High Limit Auto Set All Stby TID VOL BPM MIN VOL OXYGEN PEAK 1 0 50 12...

Page 98: ...l as the anesthesia machine s minute volume low alarm limit Breathing Pressure Monitor Window Displays the patient s peak airway pressure mean airway pressure and positive end expiratory pressure PEEP Breathing Pressure Trace Window Displays a trace or waveform of the patient s breathing pressure and the anesthesia machine s breathing pressure alarm limits to the left of the waveform OP00307 TID V...

Page 99: ...e alarms until a valid breath is detected If the ventilator is on only the respiratory volume alarms are affected Silence Alarms Silences all audible alarm tones for 2 minutes Configure Displays the Configure screen where you can set system parameters such as the time date alarm volume and contrast You also enter the Alarm Log by way of the Configure screen These functions are described in detail ...

Page 100: ...ons are described in the following sections Section 11 Oxygen Monitoring Section 12 Respiratory Volume Monitoring and Section 13 Breathing Pressure Monitoring Figure 10 5 Right Keypad Oxygen Breathing Volume Breathing Pressure Liters cm H O 2 High Limit Low Limit Cal Low Limit Off On Off On High Limit Auto Set OP87008 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 101: ... were established the last time the machine was configured You can view or change these values on the Configure screen Displaying the Configure Screen To display the Configure screen press the Config key which is located on the left keypad The Configure screen replaces the standard Monitor screen You must begin configuration within 1 minute or the Monitor screen will replace the Configure screen F...

Page 102: ...nd no keys are pressed When you exit the Configure screen the values displayed on the screen are saved The monitoring system uses these values until they are changed Using the Alarm Log If you miss a HI or ME message in the Alarm window you can look for it in the Alarm Log It contains up to 100 of the most recent HI and ME messages When there are more than 100 HI and ME messages the oldest message...

Page 103: ... delete all of the messages from the Alarm Log press the CLEAR LOG key The messages are permanently deleted from the Log Exiting the Alarm Log To exit the Alarm Log immediately press the EXIT key NOTE The monitoring system automatically exits the Alarm Log if a minute passes and no keys are pressed When you exit the Alarm Log you are returned to the Monitor screen Low Limit ALARM LOG OP87029 EXIT ...

Page 104: ...r To silence alarm tones for 2 minutes press the Silence Alarms key The LED next to the Silence Alarms key lights and remains lit for the duration of the silence period Pressing the Silence Alarms key while the LED is lit restarts the 2 minute silence period If a new alarm condition occurs during the silence period a single tone pattern sounds corresponding to the priority of the alarm After the s...

Page 105: ...rkomed MRI 2 anesthesia machine Overview 11 2 Monitor Display 11 3 Monitor Controls 11 3 Setting Alarm Limits 11 4 Calibrating the Oxygen Sensor 11 4 Unsuccessful Calibration 11 7 Oxygen Alarm Messages 11 9 Low Oxygen Supply Whistle 11 10 Problem Resolution 11 10 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 106: ...ement CAUTION Never remove an oxygen sensor from its housing except to replace it If a sensor is removed from its housing you must do the following before continuing normal operations Reinstall the sensor in the housing Wait for a period equal to the time that the sensor spent outside the housing Calibrate the sensor CAUTION Only the oxygen sensor assembly supplied with a Narkomed MRI 2 should be ...

Page 107: ...et oxygen concentration alarm limits and calibrate the oxygen sensor The oxygen monitor control keys are located next to the Oxygen Monitor window See Figure 11 2 Figure 11 2 Monitor Controls 8 12 49 ME MIN VOL LOW HI APNEA VOL 0 71 OP00308 TID VOL BPM MIN VOL OXYGEN PEAK 1 0 50 12 11 7 8 33 LO THRESHOLD LO 16 100 MEAN PEEP INSPIRATORY OXYGEN CONCENTRATION HIGH OXYGEN CONCENTRATION ALARM LIMIT LOW...

Page 108: ...ighting box disappears 5 seconds or press a different alarm limit key The new value is saved as the alarm limit Calibrating the Oxygen Sensor To calibrate the oxygen sensor correctly make sure it is exposed only to room air during the entire calibration period You should calibrate the oxygen sensor as part of the daily preoperative setup of the anesthesia equipment Refer to Figure 11 3 1 Remove th...

Page 109: ...sed oxygen concentration appears in the Oxygen Monitor window If the calibration was not successful the Oxygen Monitor window is blank See Unsuccessful Calibration on page 11 7 for further information Typically calibration lasts less than 30 seconds However the time may vary depending on the amount of oxygen the sensor was exposed to before calibration Oxygen Exposure Typical Calibration Time 21 1...

Page 110: ... Narkomed MRI 2 Operator s Manual Rev E 5 When the Narkomed MRI 2 successfully completes the calibration pull the inspiratory valve dome plug and reinsert the sensor assembly RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 111: ...that the sensor is exposed to room air only for the entire calibration period Sensor did not receive the proper waiting period If the sensor capsule was removed from the sensor assembly a waiting period equal to the time that the capsule spent outside the sensor assembly up to one week is necessary prior to calibration New sensors require a 15 minute waiting period Sensor is exhausted If the oxyge...

Page 112: ...than the actual oxygen percentage Therefore make sure that the sensor is exposed only to room air during the entire calibration period Figure 11 4 illustrates the relationship between the calibration mixture and the accuracy of oxygen measurement Figure 11 4 Measurement Error Due to Incorrect Calibration DISPLAYED O2 PERCENTAGE ACTUAL O2 PERCENTAGE Correct calibration of room air 21 O2 for entire ...

Page 113: ...he Narkomed MRI 2 checks the sensor s output against a range of acceptable output voltages There are three possible causes for deviation from within this range Exhausted sensor If the sensor s capacity is exhausted its output voltage will not meet the required minimum Incorrect calibration environment If the sensor is exposed to an excessive oxygen during calibration the sensor s output will be ab...

Page 114: ...pply Whistle If the Narkomed MRI 2 is configured to do so it sounds a 10 second whistle when the oxygen supply drops too low to properly pressurize the fresh gas circuit below about 37 psi If this alarm sounds it cannot be silenced Problem Resolution Table 11 3 Oxygen Monitoring Problem Resolution PROBLEM POSSIBLE CAUSE REMEDY Display area remains blank when a reading is expected O2 NOT CAL messag...

Page 115: ...sed to incorrect oxygen concentration Expose sensor to room air for 21 calibration Sensor exposed to constantly changing calibration mixture Sensor capsule was removed from housing for a prolonged period Allow a waiting period equal to duration of capsule removal New capsule not given proper waiting period Allow 15 minute waiting period Exhausted or defective sensor capsule Replace housing cable a...

Page 116: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 117: ...Narkomed MRI 2 anesthesia machine Overview 12 2 Monitor Display 12 3 Monitor Controls 12 4 Setting the Minute Volume Low Alarm Limit 12 5 Turning Respiratory Volume Alarms Off 12 5 Turning Respiratory Volume Alarms On 12 5 Respiratory Volume Alarm Messages 12 6 Problem Resolution 12 8 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 118: ...nd respiratory rate displays Figure 12 1 Respiratory Volume System WARNING The ultrasonic flow sensor can be used with all normal anesthetic gases except oxygen helium heliox Incorrect flow measurements will result if heliox is used CAUTION Although the Narkomed MRI 2 is designed to minimize the effects of ambient radio frequency interference the functioning of the respiratory volume monitor may b...

Page 119: ...t detect a valid breath within 30 seconds the display area goes blank Breathing Rate Measurement BPM Shows the number of breaths during the previous minute of respiration If the BPM display is blank a full minute of respiration has not occurred Minute Volume Measurement MIN VOL Continuously displays the volume of exhaled gas accumulated during the previous minute of respiration A blank MIN VOL dis...

Page 120: ...e sensor While the ventilator is on apnea volume alarms are generated at 15 seconds ME and 30 seconds HI if the respiratory volume monitor does not sense a valid breath While the ventilator is off these alarms are generated at 30 seconds ME and 60 seconds HI The Narkomed MRI 2 s volume alarms are automatically enabled when the ventilator power switch is turned to the ON position A disconnected or ...

Page 121: ...crease the highlighted alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different alarm Limit key The new value is saved as the alarm limit Turning Respiratory Volume Alarms Off To turn off the respiratory volume alarms press the Breathing Volume Off key The alarms stop sounding and their messages are erased from the display In...

Page 122: ...ume measurements disappear after 30 seconds When a valid breath is detected alarm annunciation ceases and a tidal volume measurement appears in the display window However a full minute of respiratory activity must be registered before the minute volume and respiratory rate appear NOTE You can disable volume related alarms by pressing the Breathing Volume Off key NOTE During some breathing system d...

Page 123: ...the Alarm window if there is an internal sensor fault or if the electronics housing is not properly seated on the flow housing transducer assembly VOL ALM STBY LO When the volume alarms have been set to Standby the LO message VOL ALM STBY appears in the Alarm window SERVICE VENT MON LO If the Narkomed MRI 2 detects an internal electronic failure that would prevent proper operation the LO message S...

Page 124: ... properly connected to the expiratory valve Blank display area VOL SEN DISC alarm message in Alarm window Sensor fault Replace sensor assembly Electronics housing is not properly seated on flow housing transducer assembly Reseat electronics housing on the flow housing transducer assembly and ensure it is locked in place REVERSE FLOW alarm message in Alarm window Expiratory valve not closing comple...

Page 125: ...of Breathing Pressure Monitoring Location 13 2 Installing the Breathing Pressure Pilot Line 13 4 Monitor Displays 13 5 Monitor Controls 13 9 Setting the Threshold Pressure Alarm Limit 13 10 Turning the Apnea Pressure Alarm Off 13 13 Turning the Apnea Pressure Alarm On 13 13 Breathing Pressure Alarm Messages 13 13 Problem Resolution 13 15 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM T...

Page 126: ...ocked breathing system can be more easily detected with this method when compared with pressure monitoring at the absorber For example if the inspiratory breathing hose became kinked or blocked during automatic ventilation the ventilator bellows would continue to cycle against the blocked hose A pressure monitor connected at the Y piece downstream of the occlusion could sense either an absence of ...

Page 127: ...ion within the pilot line and the introduction of additional disconnection points if the pilot line connects to a 15 mm adapter In conclusion the responsibility for the selection of pressure monitoring at either the absorber or the Y piece rests with you the operator Your clinical considerations over which Draeger Medical has no control must be included in this decision Draeger Medical is availabl...

Page 128: ...as follows refer to Figure 13 1 1 Connect one end of the pilot line to the fitting mounted on the rear of the pipe extending from the absorber top assembly 2 Connect the other end of the pilot line to the BREATHING PRESSURE interface on the rear of the ventilator monitor Figure 13 1 Absorber Monitoring OP00315 QUICK CONNECT FITTINGS ABSORBER TOP ASSEMBLY SHORT PILOT LINE REAR PANEL OF MONITOR RETU...

Page 129: ...left displays a breathing pressure trace or waveform To the left of the waveform in small type are the pressure high and threshold pressure alarm limits Breathing Pressure Monitor Window This small window on the right contains numerical breathing pressure measurements 8 12 49 ME MIN VOL LOW HI APNEA VOL 0 71 OP00311 TID VOL BPM MIN VOL OXYGEN PEAK 1 0 50 12 11 7 8 33 LO THRESHOLD LO 16 100 MEAN PE...

Page 130: ...uring each breath PEEP Positive End Expiratory Pressure The breathing pressure at the end of exhalation During apneic conditions the pressure monitor displays numeric information as long as it detects a peak pressure at least 10 cm H2O greater than PEEP pressure When this pressure difference drops below 10 cm H2O the numeric information remains 1 minute longer and then disappears 8 12 49 ME MIN VO...

Page 131: ... Breathing Pressure Trace Window The peak of the waveform corresponds to the peak pressure The slope of the trace as it rises toward the peak pressure is correlated with the inspiratory flow rate the steeper the slope the higher the flow rate The amount of pressure that the baseline is raised from zero corresponds to the patient s positive end expiratory pressure PEEP The length of the plateau fro...

Page 132: ...d by a marker on the Y axis only when it is less than or equal to the top of the scale set by the system In Figure 13 4 the pressure high alarm limit 35 cm H2O is greater than the top of the scale 20 cm H2O When a high alarm limit marker is displayed its appearance depends on whether the pressure high alarm limit is less than or equal to the top of the scale Figure 13 5 illustrates the difference ...

Page 133: ... high alarm limit follow these steps 1 Press the Breathing Pressure High Limit key A box is drawn around the pressure high alarm limit 2 Press the up arrow or down arrow key to increase or decrease the pressure high alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different Alarm Limit key The new value is saved and displayed a...

Page 134: ...ithin the range of 5 30 cm H2O and less than the pressure high alarm limit 1 Press the Breathing Pressure Threshold key A box is drawn around the threshold pressure alarm limit 2 Press the up arrow or down arrow key to increase or decrease the threshold pressure alarm limit 3 To save the new value stop pressing arrow keys until the highlighting box disappears 5 seconds or press a different Alarm L...

Page 135: ...he problem the LO message THRESHOLD LO appears in the Alarm window when either of the following conditions occurs The sensed peak pressure exceeds the set threshold by more than 6 cm H2O at threshold pressure alarm limit settings of 5 20 cm H2O The sensed peak pressure exceeds the set threshold by more than 8 cm H2O at threshold pressure alarm limit settings of 21 29 cm H2O NOTE The threshold sett...

Page 136: ...cm H2O below peak pressure 2 Thus after partial breathing system disconnection or leak small pressure fluctuation in system satisfies incorrectly set threshold pressure alarm limit Operator is not alerted of apnea condition 1 2 Thus after partial breathing system disconnection or leak small pressure fluctuation does not cross threshold pressure alarm limit Operator is warned of apnea condition Thr...

Page 137: ... Alarm Messages The following list contains all HI ME and LO alarms associated with breathing pressure monitoring APNEA PRESSURE HI ME When the ventilator is on If the measured breathing pressure remains below the threshold pressure alarm limit for more than 15 seconds the ME message APNEA PRES appears in the Alarm window and an intermittent audible alarm sounds If the breathing pressure remains b...

Page 138: ...c failure that would prevent proper operation the LO message O2 MON ERR appears in the Alarm window If this happens contact an authorized representative of DrägerService PEEP 4 LO Any time the monitor measures a PEEP of 5 cm H2O or greater the LO message PEEP 4 appears in the Alarm window When the measured PEEP drops below 5 cm H2O the LO message is cleared from the display PEEP 25 ME Any time tha...

Page 139: ...message VENT PRES HI appears in the Alarm window and a continuously repeating audible alarm sounds This alarm condition is cleared when the measured breathing pressure drops below the high pressure alarm limit However the alarm message is extended for 5 seconds to allow for a momentary high pressure condition Problem Resolution Table 13 1 Breathing Pressure Monitoring Problem Resolution PROBLEM PO...

Page 140: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 141: ...ing for the Narkomed MRI 2 anesthesia machine Overview 14 2 Routine Maintenance 14 2 Removing Parts for Cleaning and Disinfection 14 11 Disassembling Parts for Cleaning and Disinfection 14 13 General Guidelines for Cleaning and Disinfection 14 16 Reassembly Instructions 14 23 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 142: ... when the absorbent is exhausted If the machine has been out of use or in storage replace the absorbent before using the machine Draeger Medical recommends establishing a routine schedule with a sufficient safety margin for replacing absorbent When using loose absorbent do not fill above the maximum fill level line located about a quarter inch from the top of the canister The clearance and the rat...

Page 143: ...ine Do not overfill 6 Stack one canister on top of the other and center the stack on the gasket of the bottom dome 7 Raise the bottom dome remove and empty the dust cup if loose absorbent is present and replace the dust cup 8 Pull the canister release lever up to close the absorber system 9 Perform the absorber portion of the daily checkout procedure provided in the Daily Checkout section to verif...

Page 144: ...the sensor capsule Figure 14 2 Replacing the Oxygen Sensor 4 Remove the replacement sensor capsule from its shipping container and install it in the housing Ensure that the copper rings on the capsule mate with the electrical contacts in the sensor housing 5 Wait 15 minutes to allow the sensor capsule to stabilize 6 Restore power to the machine and perform an oxygen sensor calibration as described...

Page 145: ... scavenger hoses for signs of deterioration Replace any worn hoses 3 If applicable unscrew the wing nut until the needle valve assembly can be removed from its seat Remove the nut and disassemble the valve Inspect the needle valve and seat for lint or dust accumulation Clean with compressed air if necessary Figure 14 3 Open Reservoir Scavenger Maintenance VACUUM SOURCE TERMINAL ADAPTER INPUT PORT ...

Page 146: ...moist cloth 2 Inspect all scavenger hoses for deterioration Replace any worn hoses 3 Remove the relief valve housing by unscrewing it counterclockwise 4 Inspect the rubber o ring If it is worn replace it 5 Remove the relief valve by twisting it counterclockwise out of the housing You can use the tips of a needle nose pliers to turn the valve but take care not to damage the relief valve s fragile v...

Page 147: ...m Maintenance For information on tracheal suction system maintenance see the manufacturer s instructions supplied with the suction system assembly OP00277 INPUT PORT CAP SECONDARY WASTE GAS INPUT PORT WASTE GAS EXHAUST PORT WASTE GAS INPUT PORT O RING SAFETY RELIEF VALVE PLASTIC WASHER SAFETY RELIEF VALVE HOUSING RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 148: ... the patient hose from the expiratory hose terminal on the flow sensor 3 Lift the flow sensor off the bracket 4 Press down on the lever under the flow housing and remove the flow housing transducer assembly from the electronics housing 5 Pull both transducers out of the flow housing Figure 14 5 Clearing Condensation in the Ultrasonic Flow Sensor 6 Tip and shake the flow housing to release fluid tr...

Page 149: ... clockwise Battery Maintenance The backup battery is located in the battery box at the bottom of the machine Access to the battery requires removal of the battery box cover 1 Turn the System Power switch to STANDBY and remove the power cable from the back of the battery box 2 Remove the top cover from the battery box 3 Disconnect the battery wire harness from J2 on the PCB 4 Remove the two retaine...

Page 150: ...of the battery box 13 Perform the PMS Procedure in the Narkomed MRI 2 Setup and Installation Manual End of Life Battery Disposal Dispose of a spent rechargeable sealed lead acid battery in conformance with local waste disposal regulations OP00324 BATTERY WIRE HARNESS ELECTRONICS MODULE J2 RETAINER NUT 2X TERMINAL SCREW AND NUT 2X BATTERY RETAINER BATTERY BATTERY BOX AT BOTTOM OF MACHINE SHOWN WITH...

Page 151: ...nects the sensor to the monitor 5 Remove the connector hose assembly between the flow sensor and the expiratory valve by turning the ring nut counterclockwise 6 Lift the flow sensor off the bracket 7 Disconnect the fresh gas hose from the fresh gas outlet 8 Disconnect the breathing pressure pilot line from the absorber and the monitor 9 Remove the absorbent canisters and dust cup Discard the absor...

Page 152: ...he absorber using a 3 16 inch hex screwdriver to loosen the hex screw securing the absorber assembly to the absorber pole Do not remove the screw Lift the absorber off the absorber pole Do not misplace the o ring 14 Remove the bellows assembly by loosening the two wing nuts on the bottom of the assembly until the assembly releases from the canister OP00262 GAUGE MOUNT O RING MRI COMPATIBLE BREATHI...

Page 153: ...fection oxygen sensor assembly respiratory sensor flow housing transducer assembly ventilator bellows assembly inspiratory expiratory valves Disassem bling the Oxygen Sensor Assembly Unscrew the cover from the sensor housing and remove the sensor capsule Take care not to drop the sensor housed inside The sensor is not connected to the housing OP00260A WINGNUT 2X PILOT LINE RELIEF VALVE BODY BELLOW...

Page 154: ...erclockwise direction until it is released 2 Unscrew the knurled ring nut around the ventilator relief valve and pull the relief valve dome and pilot line away from the relief valve body CAUTION Take special care not to change the position of the adjustment lock ring on the ventilator relief valve dome Do not attempt to loosen the knurled relief valve ring nut by twisting the pilot line hose barb ...

Page 155: ...atory Valves OP00642 INSPIRATORY VALVE DOME INSPIRATORY VALVE DOME PLUG INSPIRATORY VALVE BODY INSPIRATORY VALVE MOUNT EXPIRATORY VALVE BODY EXPIRATORY VALVE MOUNT EXPIRATORY VALVE DOME RING NUT DOME PINS INSIDE DOME GASKET VALVE DISK VALVE PINS CAPTIVE RING NUT VALVE MOUNT GASKET RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 156: ...cy of cleaning or disinfecting any particular component is the responsibility of the user institution These procedures should be performed according to procedures established by the user institution following the specific instructions provided by the manufacturer of the equipment or agent used For additional information about infection control practice refer to the APIC Guideline for Selection and...

Page 157: ...stic Surfaces x x Corrugated Breathing Hoses Mask Elbow and Breathing Bag x x x x Y Piece and Mask x x x Ventilator Bellows x x x Ventilator Bellows Bottom Assembly x Oxygen Sensor Capsule x Oxygen Sensor Housing x x Oxygen Sensor Housing Cover x x x Inspiratory Expiratory Valves x x x x Ultrasonic Flow Sensor Housing and Transducers x Ultrasonic Flow Sensor Cable x x Breathing System Pressure Gau...

Page 158: ...er Medical makes no claims about the efficacy of these agents or this method of cleaning for infection control Consult your hospital s infection control officer or epidemiologist Cleaning and Disinfecting Corrugated Breathing Hoses Mask Elbow and Bag Contact with oxygen ether mineral or vegetable oils phenols cresois terpenes hydrocarbon solvents chlorinated hydrocarbons esters or oxidizing acids ...

Page 159: ...dehyde based formulations EtO and wet pasteurization processes can also be used Cleaning and Disinfecting the Ventilator Bellows The ventilator bellows and its bottom assembly are the only ventilator components that come in contact with the patient s breath Refer back to Cleaning and Disinfecting Exterior Surfaces for instructions on cleaning and disinfecting the surface of the ventilator bellows ...

Page 160: ...ilized or autoclaved at a temperature not exceeding 121 C The valve disks can also be autoclaved in certain instances but should not be autoclaved routinely Be careful while handling the valve disks Improper handling can damage them After cleaning or disinfecting the inspiratory or expiratory valve assembly verify that the valve disk and all internal pins are undamaged and that the valve disks are...

Page 161: ...lier in this chapter under the heading Replacing the Absorbent for instructions on removing the absorbent canister assemblies from the absorber Clean the canisters frequently Remove used absorbent and clean absorbent residues for the canister and gasket surfaces Check the dust cup periodically Empty and clean it when necessary WARNING Absorbent is caustic Avoid contact with the skin and eyes After...

Page 162: ...ates more slowly than halothane and collects in the vaporizer Over time thymol may decompose into compounds that affect the wick material and turn the halothane yellow If you see particles in the sight glass of a halothane vaporizer or if the halothane turns yellow rinse the vaporizer chamber with fresh halothane as follows 1 Drain the discolored halothane from the vaporizer 2 Fill the vaporizer w...

Page 163: ...llows assembly Fit the relief valve dome onto the relief valve body and tighten the knurled ring nut Place the ventilator bellows on bellows bottom assembly and turn it clockwise until it is secure 2 Replace the bellows assembly Fit the bellows assembly into the ventilator bellows canister and tighten the two wing nuts 3 Replace the absorber Fit the absorber assembly on the absorber pole making su...

Page 164: ...ory hose terminal on the flow sensor 12 Install the connector hose assembly between the flow sensor and the expiratory valve and secure it by turning the ring nut clockwise 13 Replace the oxygen sensor in the inspiratory valve port Connect the sensor cord to the monitor 14 Connect the fresh gas hose to the fresh gas outlet on the machine WARNING Do not pinch or kink the fresh gas hose leading form...

Page 165: ...onnections Figure 14 10 Open Reservoir Scavenger Connections OP00143B 19MM SCAVENGER HOSE VENTILATOR RELIEF VALVE 19MM SCAVENGER HOSE TERMINAL VACUUM TERMINAL 19MM SCAVENGER HOSE TERMINAL 19MM SCAVENGER HOSE OPEN RESERVOIR SCAVENGER ABSORBER POLE APL VALVE RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 166: ...ns Figure 14 11 Passive Systems Scavenger Connections OP00196 SHORT 19MM SCAVENGER HOSE TO HOSPITAL EXHAUST SYSTEM 19MM SCAVENGER HOSE ABSORBER POLE VENTILATOR RELIEF VALVE 19MM SCAVENGER HOSE TERMINAL SCAVENGER INTERFACE FOR NON ACTIVE SYSTEMS 19MM SCAVENGER HOSE RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 167: ...arkomed MRI 2 anesthesia machine General 15 2 Environmental 15 2 Electrical 15 2 Gas Delivery System 15 2 Vaporizers 15 3 AV2 Ventilator 15 3 Absorber System 15 4 Oxygen Monitoring 15 4 Breathing Pressure Monitoring 15 4 Respiratory Volume Monitoring 15 5 RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 168: ...ge current 300 microamps UL 544 Ground impedance 0 1 ohm 60 Hz source Dielectric withstand mains to chassis 1500 VAC UL 544 Charger chassis resistance between any metallic point and ground pin on power cord 0 1 ohm on AC powered component Power Supply Nominal input voltage acceptable range 100 240 VAC 50 60 Hz Input current 2 amps max Battery Battery type sealed lead acid 12 VDC 17 AH Charging tim...

Page 169: ...0 psi 13100 kPa Nitrous oxide 745 psi 5130 kPa Use only E size nonmagnetic aluminum cylinders Flowmeter Accuracy at 20 C and 760 mmHg Oxygen Nitrous Oxide Air Fine 100 1000 ml min 2 5 FS Oxygen Nitrous Oxide Air Coarse 1 10 l min 2 5 FS Air Dual Tapered 0 2 1 l min 50 ml min of reading 2 10 l min 5 FS Carbon Dioxide 0 05 1 0 l min 5 FS Oxygen Auxiliary Oxygen 1 10 l min 5 FS Vaporizers For technic...

Page 170: ...flow resistance 2 cmH2O at 8 l min Hose terminal 19 mm male Breathing Bag Terminal Bag terminal 22 mm male Oxygen Monitoring Range 10 100 vol O2 Resolution 1 vol O2 Accuracy 3 vol O2 When calibrated within 18 hours and constant temperature and pressure Response time 25 sec T90 Zero drift 0 1 vol O2 month Span drift 1 vol O2 8 hours Temperature error 3 of reading 15 to 40 C Sensor service life 8 mo...

Page 171: ... Display Range 0 1 50 0 l Resolution 0 1 l Accuracy 10 of reading or 0 01 l x breath rate whichever is greater Tidal Volume Display Range 0 01 2 0 l Note the standard bellows will deliver up to 1 5 l Resolution 0 01 l Accuracy 10 of reading or 0 015 l whichever is greater Volume Apnea Threshold 0 02 l Respiratory Rate Numeric display range 2 99 bpm Resolution 1 bpm Accuracy 10 of reading or 1 bpm ...

Page 172: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 173: ...r s Manual A Appendix Spare and Replacement Parts This section describes the spare and replacement parts for the Narkomed MRI 2 anesthesia machine along with their part numbers RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 174: ...7 Valve Assembly Inspiratory with ported dome assembly and plug assembly 4107649 Valve Assembly Expiratory 4107650 Ring Nut inspiratory or expiratory valve upper ring nut 2109228 Gasket flat washer inspiratory or expiratory valve mount 1101690 Dust Cup 4106874 Spring Clip absorber rod 1100097 O ring 020 Silicone absorber mount 4105868 O ring 237 Silicone dust cup fitting 4102940 Breathing System A...

Page 175: ...50645 Sensor Housing Cable Assembly 4115351 Inspiratory Valve Dome 4108329 Inspiratory Valve Dome Plug 4106387 Respiratory Volume Monitoring Accessories Flow Sensor Assembly MRI 2 4116236 Connector Hose Assembly 4114912 Flow Housing 4114444 Transducer Set 4114445 O ring Set 4115147 Power Supply Accessories 52 foot ASM MRI 2 power cable 4114158 6 foot ASM power cord 4110334 Battery 12V rechargeable...

Page 176: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 177: ...RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

Page 178: ...cal Inc 3135 Quarry Road Telford PA 18969 Tel 215 721 5404 800 462 7566 Fax 215 721 9561 Web www draegermedical com Printed in the U S A RETURN TO THIS MANUAL S TABLE OF CONTENTS RETURN TO CD ROM TABLE OF CONTENTS ...

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