Mallinckrodt INOMAX DSir Plus, Operation Manual

Page: 80 / 206

Part No. 20717 Rev-01
2014-07
3-28
Bagging Systems While Using the Injector Module
WARNING:
• The hyperinflation bag will, under some conditions, contain NO
2
in excess of
one ppm. Use of large tidal volume breaths may expose the patients to the NO
2
present in the bag for part of the breath. In general, if the inspiratory flow rate
induced by the manual ventilation does not exceed the fresh gas flow rate, the
patient should not be exposed to the concentrations of NO
2
present in the
hyperinflation bag.
• Adult and infant hyperinflation bags generate more NO
2
when used at lower
minute ventilation. If use of the bag is interrupted (for example to adjust the
tracheal tube), before resuming ventilation of the patient, the user should
squeeze the bag several times to empty residual gas from the bag.
• Because of the potential for inhalation of excessive concentrations of NO
2
, and
the difficulty in monitoring the peak inhaled NO
2
concentrations, ventilation with
a hyperinflation bag or self inflating bag is intended only for short term use.
• The monitoring system within the INOmax DS
IR
will not detect generation of NO
2
within the hyperinflation bag or self-inflating bag devices and the alarms for
excessive NO
2
cannot warn of NO
2
produced within the manual bag system.
To minimize the delivered concentration of NO
2
, the following steps should be taken
for use with the manual resuscitator bags:
• Use the smallest bag adequate to deliver the desired tidal volume.
• Oxygen tubing lengths greater than 72 inches should not be used (between the
injector module and the bag).
• Use the highest fresh gas flow rated (up to 15 L/min) that is practical.
• Use the lowest practical inspired oxygen concentration.
• After starting fresh gas flow, squeeze the bag several times to empty residual
gas in the bag prior to using the system to ventilate a patient.