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248 Operator’s Manual

Summary of Contents for RAPIDLAB 248

Page 1: ...248 91 001N Rev T 2008 04 Operator s Manual ...

Page 2: ...uctions for setting up and using the 248 Service information for use by appropriately qualified personnel is also available The 248 is intended for use by persons knowledgeable in safe laboratory practices If the 248 is not used in accordance with these instructions for use the protection provided by the equipment may be impaired The information contained in this manual was correct at the time of ...

Page 3: ...s and Agents consider themselves responsible for the effects of safety reliability and performance of the 248 only if Assembly operations extensions re adjustments modifications or repairs are only carried out by persons authorized by them The electrical installation of the relevant room complies with IEC requirements or the local regulatory code The equipment is used in accordance with the instru...

Page 4: ...autions you about the risk of exposure to potential electrical hazards Alerts you to important information about the fuses Indicates that the input electricity is alternating current Indicates the gas connectors Alerts you to important information about gas bottle pressure Conventions Used in this Manual This manual uses the following text and symbol conventions Convention Description B o l d Bold...

Page 5: ...g U S and Canadian requirements for safety Indicates that the system meets the requirements of the European Union Indicates an in vitro diagnostic medical device Manufacturer Date of manufacture Authorized Representative Shows the manufacturer of the serial plate Donprint Catalog Number Cautions you about the risk of exposure to biohazards Advises you to consult the operating instructions to obtai...

Page 6: ...inted on recycled materials Indicates compliance with Green Dot packaging standards Indicates compliance with RESY packaging standards This system contains certain toxic or hazardous substances or elements The environmental protection use period for this system is 50 years The system can be used safely during its environmental protection use period The system should be recycled immediately after i...

Page 7: ...e Information 1 9 Reagents 1 10 Waste Disposal 1 11 Calibration 1 12 QC 1 13 2 Operating the System 2 1 Ready Screen 2 1 Probe Lever Position 2 1 Analyzing Syringe Samples 2 2 Analyzing Capillary Samples 2 5 Measuring a Short Sample or a Sample with a Bubble 2 8 Requesting an Additional Calibration 2 9 Calibrating the Barometer 2 9 Recalling Last Sample Data 2 10 Analyzing QC Samples 2 11 Recallin...

Page 8: ...ime Routine 3 9 Checking the Gas Pressure and Changing the Cylinders 3 10 Checking the Gas Flow Rate 3 12 Changing the Pump Tubing and Cleaning and Lubricating the Rollers 3 13 Refilling or Replacing the Measurement Sensors 3 17 Replacing the Reference Sensor Cassette 3 19 Replacing the Bottle Tubing 3 21 Cleaning or Replacing the Drip Tray 3 22 Replacing the Printer Paper 3 23 Replacing the Probe...

Page 9: ... 4 7 Printer Problems 4 8 Hydraulic Problems 4 9 Heater Problems 4 10 Using the Troubleshooting Routines 4 10 Measurement Block Routine 4 10 Sample Flow Routine 4 12 Heater Routine 4 13 Electronics Routine 4 13 Roll Printer Routine 4 13 Using the Status Indicators 4 14 Other Problems 4 14 5 Configuring the System 5 1 Operating Setup 5 1 Setting QC Ranges 5 1 Setting Reference Ranges 5 2 Choosing U...

Page 10: ...urity 5 6 Printing Setup Report 5 7 Service Setup 5 7 Entering System Information 5 7 Changing Language 5 7 6 Service and Supplies 6 1 Ordering Information 6 1 Spares 6 1 Reagents 6 3 Addresses 6 4 Warranty 6 6 Appendix A Protecting Yourself From Biohazards A 1 Appendix B Precautions and Hazards B 1 Appendix C References C 1 Appendix D Interfacing to External Devices D 1 Appendix E Specifications ...

Page 11: ... vials and other open top containers Lift to second position to sample from syringes and capillaries Operating Keys The Front Panel Figure 1 2 The Front Panel Waste Bottle Printer Paper 6 8 7 3 Buffer Wash Reagent Sample Pump Tubing Measurement Block Cover Measurement Block Catch and Tensioner Controls Paper Advance Control Sensors Pre heater Front Cover raised Probe Lever Drip Tray Waste Cap Reag...

Page 12: ...rt 1 9 way D line Port 2 Data Port 2 9 way D line Status Status Indicators Indicators Indicates that the input electricity is alternating current Shows the manufacturer of the serial plate Donprint Indicates an in vitro diagnostic device Manufacturer Cautions you about the risk of exposure to potential electrical hazards Advises you to consult the instructions for use to obtain safety related info...

Page 13: ...nadian requirements for safety Indicates that the system meets the requirements of the European Union Indicates that the analyzer is classed as IEC Type B equipment Class 1 equipment providing an adequate degree of protection against electric shocks particularly regarding allowable leakage currents and reliability of the protective earth connection Indicates the gas connectors Understanding the Sy...

Page 14: ...easurement Exits procedures where exit is possible Returns display to previous screen when moving round menu setting options and so on key selects alternative action where one is displayed Moves round data entry screens Choosing Options The bottom instruction line of the Ready screen says press for menu From Ready press The Main Menu has 8 sub menus The status line shows where you are Main Menu th...

Page 15: ... boxes These options are also selected by pressing the corresponding number on the keypad To see an example of check boxes From Ready press for menu 5 to select Operating Setup and 3 to select Units means that the option is selected means that the option is not selected Press the corresponding number on the keypad to select alternative options Press 3 times to backstep through the menu screens to ...

Page 16: ...ext field The Deproteinize Condition field is then highlighted Press 3 times to backstep through the menu screens to the Ready screen The main points to remember are You cannot enter or change a number unless its field is highlighted A number is not entered until confirmed by pressing or Press to confirm and move to the next field or to confirm and exit the screen You can move around the fields in...

Page 17: ...l L H pCO2 5 0 250 0 mmHg 0 67 33 33 kPa pO2 0 00 749 0 mmHg 0 00 99 86 kPa Reference Ranges pH 7 350 7 450 35 5 44 7 H nmol L pCO2 35 0 45 0 mmHg 4 67 6 00 kPa pO2 80 0 100 0 mmHg 10 67 13 33 kPa Units pH pH units Gases mmHg ctHb g dL Calibration method and interval flexible time 30 minutes gas values cal 5 CO2 12 O2 slope 10 CO2 0 O2 Printer Options printer on print results only Correlation pH s...

Page 18: ...y 7 days Parameters measured pH pCO2 and pO2 selected calculated none selected Beeper beeper on Communications Port 1 CMSI Port 2 CMSI Security menu password not set Service Setup System Information serial number set service number not set Language Selection English Page 1 8 248 Operator s Manual ...

Page 19: ...turation values must be labelled as such to allow the correct interpretation of the results Capillary blood when carefully collected under the proper conditions closely resembles arterial blood and may be used for blood gas studies Capillary analysis has the advantage that only small quantities of blood are necessary for measurement Capillary blood may be obtained from the heel finger or earlobe T...

Page 20: ...es Samples with high white blood cell counts or high reticulocyte counts deteriorate more rapidly and should be analyzed immediately Improper mixing of samples before analysis may give erroneous results Blood cells settle during storage and if not well mixed before sampling the results obtained can be higher or lower than the actual values Syringes should be rolled between the hands and gently inv...

Page 21: ...tioner cleans and conditions the pH sensor It is used regularly as preventative maintenance for the 248 Storage Store all reagents away from direct sunlight at 4 25 C Discard 7 382 and 6 838 buffers 30 days after opening Do not use reagents after the expiry date Discard Deproteinizer and Conditioner solution after single use Handling and Preparation 7 382 buffer 6 838 buffer Wash and Conditioner r...

Page 22: ...e these gases for the calibration of clinical and research instrumentation only US Law prohibits dispensing these gases for drug use The contents are under pressure do not puncture Do not use or store near heat or open flame Do not expose cylinders to temperatures above 54 C 130 F as this may cause the contents to vent or explode Never throw cylinders into fire or incinerators Follow the disposal ...

Page 23: ...t up to monitor instrument and operator performance Because the needs of each laboratory are different due to size of workload number of hours worked statutory regulations and so on no attempt has been made to formulate a rigid program Users should follow local regulatory guidelines to establish a QC program Use only Siemens approved QC materials If you report your results to a quality control sta...

Page 24: ......

Page 25: ... important that you use the correct position for your sampling device The first position is for sampling from ampules and other open top containers In this position the probe is deeper in the solution enabling a more representative sample to be taken The second position is for sampling from syringes and capillaries In this position the probe will not protrude as far lessening the possibility of it...

Page 26: ...position the probe to obtain the most representative sample do not allow the probe tip to touch the syringe plunger NOTE If you have a very small syringe sample present the sample and press then confirm syringe sample when prompted 4 Hold the sample in place The 248 beeps when sampling is complete 5 Remove the sample and close the probe Lift probe to analyze syringe sample 11 03 48 press for menu ...

Page 27: ...tions O2 CT will not be reported unless ctHb is entered and pO2 A a and pO2 a A will not be reported unless FI O2 is entered Results may also be corrected for patient temperature ctHb and FI O2 after measurement see Recalling Last Sample Data Page 2 10 Example result If the measured values are outside the reference ranges an arrow indicates if they are above or below the range If you selected calc...

Page 28: ...pO2 78 4 mmHg outside ref range Reference Ranges Reference Ranges Reference Ranges Reference Ranges Reference Ranges pH 7 350 7 450 pCO2 35 0 45 0 Reference ranges pO2 80 0 100 0 Calculated Data Calculated Data Calculated Data Calculated Data Calculated Data HCO3 act 24 8 mmol L BE ecf 0 1 mmol L O2 CT 20 2 mL dL Calculated parameters O2 SAT 95 5 ctCO2 26 1 mmol L pO2 A a T 42 8 mmHg pO2 a A T 0 5...

Page 29: ...the caps from the end of the capillary and carefully fit a capillary adaptor Slide the adaptor onto the probe then press The 248 beeps when you press 4 Hold the capillary in place The 248 beeps when sampling is complete 5 Remove the capillary and adaptor and close the probe Lift probe to analyze capillary sample 11 03 48 press for menu Ready or press 1 syringe 2 QC Probe open Present sample then p...

Page 30: ...en calculating the results If you do not enter patient data the 248 uses normal default temperature 37 C ctHb 15 g dL 150 g L 9 6 mmol L and FI O2 20 9 values in the calculations with the following exceptions O2 CT will not be reported unless ctHb is entered and pO2 A a and pO2 a A will not be reported unless FI O2 is entered Results may also be corrected for patient temperature ctHb and FI O2 aft...

Page 31: ...s pO2 78 4 mmHg outside ref range Reference Ranges Reference Ranges Reference Ranges Reference Ranges Reference Ranges pH 7 350 7 450 pCO2 35 0 45 0 Reference ranges pO2 80 0 100 0 Calculated Data Calculated Data Calculated Data Calculated Data Calculated Data HCO3 act 24 8 mmol L BE ecf 0 1 mmol L O2 CT 20 2 mL dL Calculated parameters O2 SAT 95 5 ctCO2 26 1 mmol L pO2 A a T 42 8 mmHg pO2 a A T 0...

Page 32: ...lushes the sample out of the measurement block Continuing with the Sample Analysis 1 If you want to measure the sample lift the front cover and look at the measurement block 2 Turn the sample pump rotor the sample pump is the lefthand pump in the direction indicated so that the sample is repositioned directly beneath the sensors for which results are required Figure 2 2 Repositioning Samples CAUTI...

Page 33: ...l Calibration The 248 automatically calibrates using one of the user selectable methods see Section 1 Understanding the System for details The Calibration menu allows additional user requested calibrations to be carried out 1 From Ready press for menu and 1 for Calibration 2 Press 1 6 to select the type of calibration you want The 248 displays each stage of the calibration on the status line The c...

Page 34: ...and patient ID You can use the decimal point to insert dashes The other values that can be entered are patient temperature 10 0 43 9 C ctHb 2 0 25 0 g dL 20 250 g L or 1 2 15 5 mmol L FI O2 15 0 100 0 The 248 will use these values for recalculating the results If you do not enter patient data the 248 uses the values entered previously or if none were entered normal default temperature 37 C ctHb 15...

Page 35: ...he QC sample to the probe and gently push the probe sleeve back The 248 beeps when the probe sleeve is in the correct position and starts sampling 4 Hold the sample in place The 248 beeps when sampling is complete 5 Remove the sample and close the probe Lift probe to analyze QC sample 11 03 48 press for menu Ready or press 1 syringe 2 capillary Probe open Sampling close probe to cancel Sampling co...

Page 36: ... number Level 1 Level 1 Level 1 Level 1 Level 1 Lot 123456 pH 7 143 pCO2 69 4 mmHg Measured values pO2 66 5 mmHg QC Ranges QC Ranges QC Ranges QC Ranges QC Ranges pH 7 127 7 167 pCO2 67 1 77 1 QC ranges pO2 59 4 69 4 While the results are displayed and printed the 248 washes the probe and sample path When the wash has finished the 248 returns to the Ready screen The Ready screen main message will ...

Page 37: ...e thoroughly and once opened sample the QC immediately Do not re use an opened ampule Position the probe near the bottom of the ampule to obtain a representative sample Recalling the Last QC Data The 248 retains the data for the last QC sample measured at each level 1 From Ready press for menu 4 for Data Recall and 2 for QC Data 2 Press 1 4 to select the QC level 3 The QC data is recalled to the d...

Page 38: ...2 You can restart the 248 from standby mode in two ways a press to restart the 248 immediately or b set an auto restart time If a time is set the 248 automatically restarts at that time Setting Auto Restart Time 1 To set the auto restart time press 2 Enter the time required and press to Exit If the time displayed is the time you want for auto restart just press Standby Press to restart now press t...

Page 39: ...g probe housing and probe protector replacing the pre heater tube The Deproteinize Condition Prime Disinfect and Stop System routines are in the Maintenance Menu Maintenance should be carried out with the instrument functions suspended using the Stop System routine When replacing the pump tubing kits drain the 248 using the Prime routine Daily Maintenance Equipment Buffer Pack 473496 as required W...

Page 40: ...bles Pages 3 17 and 3 19 3 Deproteinize and condition the sensors Deproteinizing and conditioning may be prompted more frequently than once a week see Section 5 Configuring the System 4 Check the reference sensor for bubbles in the fill solution and for crystal growth If air bubbles are present remove the sensor and tap it to dislodge air bubbles If crystal growth is present remove the sensor empt...

Page 41: ...ate Quarterly Use Disinfect routine replace pump tubing clean and lubricate rollers replace drip tray if difficult to clean Six monthly replace bottle tubing Maintaining the System Page 3 3 when maintenance has been carried out Start Date 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Month 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27...

Page 42: ...ady press for menu 2 for Maintenance and 5 for Stop System 2 Remove the waste bottle a Lift the front cover b Carefully pull the waste bottle forwards tilting the top slightly away from you 3 Dispose of the waste in accordance with your laboratory guidelines 4 The Wash bottle and the 7 3 buffer bottle from the Buffer Pack can both be used as new waste bottles when they are empty a Peel off the top...

Page 43: ...hen the Ready screen reappears press to cancel the waste bottle prompt Changing the Reagents Check the reagent levels and change by date regularly If either the Buffer Pack or Wash bottle is empty or if the Buffer bottle is past the change by date replace it as follows 1 Stop the 248 system From Ready press for menu 2 for Maintenance and 5 for Stop System 2 Raise the front cover and remove the emp...

Page 44: ...onto the neck of the bottle 7 If you are changing the buffer bottles date the label 30 days ahead Figure 3 4 Dating the Buffer Label 8 Lower the front cover and press to restart the 248 9 From Maintenance press 3 for Prime The Prime routine pumps the new reagent through the system 10 When the Prime routine has finished press twice to exit The 248 calibrates on return to the Ready screen ...

Page 45: ...or 5 minutes and the screen shows the time remaining When deproteinizing is finished the 248 washes and will calibrate on return to the Ready screen You can cancel the Deproteinize routine to measure a sample by pressing The 248 washes and will calibrate on return to the Ready screen Conditioning the Sensors Equipment Deproteinizer Conditioner pack or Conditioner Cat 478701 1 From the Ready screen...

Page 46: ...infect routine 1 From Ready press for menu 2 for Maintenance and 4 for Disinfect 2 Following the instructions on the screen lift the probe to the first position and present the disinfectant Hold the solution in place until prompted to remove it then close the probe 3 The Disinfectant is left in the measurement block for 10 minutes and the screen shows the time remaining When the routine is finishe...

Page 47: ...ing the 248 1 Raise the front cover and remove the Buffer pack and Wash bottle Do not remove the Waste bottle Place tissues under the bottle tubes to catch any spillage 2 From Ready press for menu 2 for Maintenance and 3 for Prime 3 The 248 pumps and drains the system Priming the 248 1 Follow the appropriate maintenance procedure then from Ready press for menu 2 for Maintenance and 3 for Prime 2 T...

Page 48: ...nge 4 to 6 and 12 O2 acceptable range 10 to 14 balance N2 For slope gas the value should be 10 CO2 acceptable range 8 to 12 and 0 O2 acceptable range 0 to 2 balance N2 The gas values used must be entered see Section 5 Configuring the System The regulator must have a low diffusion diaphragm to prevent selective diffusion and alteration of the gas values All fittings must be leak free The regulator ...

Page 49: ...ot use or store near heat or open flame Do not expose cylinders to temperatures above 54 C 130 F as this may cause the contents to vent or explode Never throw cylinders into fire or incinerators Follow the disposal instructions on the cylinders Equipment Cal gas cylinder Slope gas cylinder as required 1 Stop the 248 system Page 3 8 2 Remove and dispose of the empty cylinder Figure 3 7 Changing the...

Page 50: ...o check for bubbles CAUTION The needle valve is easily damaged Turn the valve gently when opening i Check the needle valve is fully open j If the gas will not be used for an extended period of time close the cylinder by turning the cylinder valve clockwise otherwise continue 4 Restart the 248 system Checking the Gas Flow Rate 1 Initiate a full 2 point calibration From Ready press for menu 1 for Ca...

Page 51: ... Pump Tubing 1 Use the Disinfect routine and drain the 248 Pages 3 8 and 3 9 Stop the 248 system Page 3 8 2 Raise the front cover Sample Pump Remove the tubing a Remove the waste bottle b Disconnect the waste cap connector from the manifold c Disconnect the sample tube from the measurement block tube and the waste tube from the manifold d Release the tension on the tubes by pulling each tube down ...

Page 52: ...n place and slide the rotor off the moulding NOTE The drive pin may drop out if you lose it there is a spare in the Spares box Figure 3 10 Removing the Pump Rotor 2 Remove the pump rotor mouldings a Pull the pump rotor ends apart and wash the rollers in mild detergent solution rinse and dry with tissues Figure 3 11 Removing the Pump Rotor Mouldings Drive Pin Rubber Connector ...

Page 53: ...nths ahead Figure 3 13 Dating the Pump Tubing Label Sample Pump 2 Install the new sample pump tubing a Connect the waste cap connector to the manifold Push firmly into position b Place the pump tubes over the rotor knob c Connect the front tube to the measurement block tube and the back tube to the manifold d Pull the tube lugs underneath the tensioners e Replace the waste bottle Reagent Pump 3 In...

Page 54: ...tubes are fitted correctly Figure 3 14 Reagent Pump Tubing Correctly Installed 4 Make sure none of the pump tubes are kinked or twisted refer to Figure 3 15 Figure 3 15 Example of Twisted Tube 5 Replace the reagent bottles lower the front cover and restart the 248 system 6 Prime the 248 Page 3 9 Page 3 16 248 Operator s Manual ...

Page 55: ...routine and then stop the 248 system Page 3 8 2 Raise the front cover 3 Slide the measurement block catch down and raise the block cover Figure 3 16 Opening the Measurement Block Cover 4 Swing and hold the tensioner to the right and remove the appropriate sensor Figure 3 17 Removing a Sensor 5 Refilling the pH sensor CAUTION Make sure you use pH fill solution Do not use reference sensor fill solut...

Page 56: ...hand side and is in good condition 6 Tap the sensor to release any trapped air bubbles 7 Install the sensor top first aligning the sensor contacts Press the bottom of the sensor into position Gently release the tensioner and push it firmly home to make a good seal Lower the block door snapping it into place Lower the front cover 8 Press to restart the 248 system The 248 calibrates on return to the...

Page 57: ...de the measurement block catch down and raise the block cover Figure 3 19 Opening the Measurement Block Cover 4 Swing and hold the tensioner to the right and remove the reference sensor Figure 3 20 Removing the Reference Sensor 5 Replace the reference sensor cassette CAUTION Make sure you use reference fill solution Do not use pH sensor fill solution a Break the top off the reference fill solution...

Page 58: ...stalling a new reference inner remove it from its container and screw into the new internal reference compartment Do not cross thread the electrode inner Figure 3 22 Changing the Reference Inner d Inject the remaining solution into the reservoir up to the fill line and replace the reservoir cap until finger tight Figure 3 23 Filling the Reference Reservoir and Replacing the Cap e Tilt the referenc...

Page 59: ...es before optimum performance is obtained If an over or under range condition is present on the pH channel there is probably an air bubble trapped in the reference sensor Remove the sensor and tap it until the air bubble has been dislodged Re install the sensor Figure 3 24 Trapped Air Bubble in Reference Sensor Replacing the Bottle Tubing Equipment Bottle tubing kit Cat 673250 1 Drain the 248 and ...

Page 60: ...nd pull upwards and out Figure 3 25 Removing the Drip Tray CAUTION The drip tray is not designed to be autoclaved and reused 6 Clean the drip tray with disinfectant Replacement drip trays are available see Section 6 Service and Supplies if it becomes difficult to clean 7 Refit the drip tray Make sure the connector is reconnected to the manifold WARNING The drip tray is designed to contain any bloo...

Page 61: ...with the paper coming from the bottom of the roll and towards you Bend the end of the paper back slightly CAUTION Make sure you feed the paper in correctly If the paper is fed in incorrectly the printer will not print and it may cause paper jams Figure 3 26 Loading the Printer Paper 4 Feed the paper down into the paper slot and press the key until the feed mechanism takes up the paper and pulls it...

Page 62: ...at 673390 1 Use the Disinfect routine and stop the 248 system Page 3 8 2 Raise the front cover 3 Lift the probe lever to the second position 4 Push the probe connector to the left and pull it out of the reagent inlet connector Figure 3 28 Disconnecting the Probe Connector 5 Lift the probe lever past the second position and hold in place Figure 3 29 Probe Lever Positions Closed First Position Secon...

Page 63: ...h step 8 8 If you want to clean the probe and housing Soak the assembly for 10 minutes in 10 v v bleach Rinse with deionized water and gently dry with tissues Lightly grease the probe shaft mechanism use the grease supplied in the Spares box Figure 3 31 Greasing the Probe Shaft Mechanism 9 Disconnect the probe tubing from the housing Pull the probe out of the housing Discard the old part WARNING M...

Page 64: ...as required feed the probe down through the hole in the probe sleeve Make sure it is seated correctly Figure 3 34 Probe Sleeve Hole 11 Connect the probe tubing to the housing 12 Lift the probe lever past the second position and hold in place 13 Hold the probe sleeve and slide the probe housing up the lever guides into position in the lever Release the probe lever Page 3 26 248 Operator s Manual ...

Page 65: ... are in the Spares box 15 Slide the probe connector back into the reagent inlet connector 16 Lower the probe lever 17 Remove the reference sensor Page 3 19 steps 3 and 4 18 Disconnect the measurement block tube from the sample pump tubing Figure 3 36 Disconnecting the Measurement Block Tube 19 Remove the measurement block tube and discard Figure 3 37 Removing the Measurement Block Tube ...

Page 66: ...the tip of the probe in a small beaker of strong soap solution for 10 to 15 seconds c Lower the probe lever and Prime the 248 Page 3 9 Replacing the Probe Protector BIOHAZARD See Appendix A Protecting Yourself from Biohazards Equipment Probe protector supplied in Spares box Probe and tubing kit Probe and housing kit and as Cat 673373 1 Remove the probe housing and probe Page 3 24 steps 1 to 6 Do n...

Page 67: ... 17 steps 3 and 4 4 Disconnect the reagent manifold connector Figure 3 39 Pre heater Components 5 Remove the sample detector cover 6 Remove the screw from the pre heater cover and remove the cover Figure 3 40 Removing the Sample Detector Cover CAUTION Handle the pre heater tube carefully as it is quite fragile and can easily be kinked 7 Slide the reagent inlet connector towards you Ease the pre he...

Page 68: ...ck connector is in place The reagent inlet connector is in place The pre heater cover and sample detector cover are replaced The reagent manifold connector is connected The sensors are replaced and seated correctly and the block cover is closed 11 Replace the probe and probe housing Page 3 26 steps 12 16 12 Lower the front cover and restart the 248 Page 3 30 248 Operator s Manual Reagent Inlet Con...

Page 69: ...may damage the 248 1 Stop the 248 system Page 3 8 Clearing a Blockage in the Probe 2 Remove the probe and housing Page 3 24 steps 2 to 6 3 Carefully thread the clot removal line up the probe until it appears through the probe connector then pull the line through Figure 3 42 Clearing a Blockage in the Probe Clearing a Blockage in the Pre heater 4 Remove the pre heater tube assembly Page 3 29 steps ...

Page 70: ...s the clot removal line through the grounding block Do not pass the clot removal line through the sensors Figure 3 45 Clearing a Blockage in the Grounding Block Clearing a Blockage in the Drip Tray Connector Drain Hole 9 Remove the drip tray Page 3 22 steps 3 to 5 10 Carefully inject water into the ports in the back of the drip tray connector WARNING Point the drip tray away from you while you do ...

Page 71: ...ot removal line up the measurement block tube until it appears in the measurement block Pull the line through Figure 3 48 Clearing a Blockage in the Measurement Block Tube 13 Carefully inject water into the sample pump tubing until water appears at the waste cap Figure 3 49 Clearing a Blockage in the Sample Pump Tubing 14 Reconnect the sample pump tubing to the measurement block tube Maintaining t...

Page 72: ... the system and deproteinize the sensors Page 3 7 Replacing a Fuse Equipment Fuses Cat 478648 or 478916 CAUTION For continued protection against fire hazard use only the same type and rating of fuse that was fitted originally to the 248 refer to instrument rear panel 1 Remove the power supply cord 2 Open the voltage selector cover with the screwdriver supplied in the Spares box Figure 3 51 Opening...

Page 73: ... supply cord Shutting Down the 248 BIOHAZARD See Appendix A Protecting Yourself from Biohazards Wear gloves while carrying out the following procedures Siemens recommends that the 248 is connected to the a c supply at all times so it is always ready for immediate use However if it is necessary to disconnect the a c supply this procedure should be followed to prevent damage to the instrument Equipm...

Page 74: ...rd from the power supply socket 6 Remove the probe and housing and immerse in 10 v v bleach for 10 minutes Page 3 24 Rinse with deionized water then gently wipe dry If necessary grease the probe shaft lightly with the grease supplied in the Spares box 7 Remove the pH pCO2 and pO2 sensors Page 3 17 8 Remove the reference sensor Page 3 19 If you are removing the reference sensor from the 248 for mor...

Page 75: ...ion failure have been grouped together under the following headings calibration or slope drift on display and printout calibration or slope no endpoint on display and printout calibration or slope outside range on display and printout fluidics failures Calibration or Slope Drift New Sensors Installed If a new sensor has been installed allow up to 90 minutes for it to stabilize If the calibration s...

Page 76: ... in gas system gas cylinders connected incorrectly Check gas pressure and flow rate cure leaks check gases connected correctly cal to cal slope to slope See Page 3 10 Incorrect gas values entered Enter correct values Page 5 2 Barometric pressure incorrect or changed Enter correct barometric pressure Page 2 9 Calibration or Slope no Endpoint All calibrations and sample measurements must be carried ...

Page 77: ... are seated properly and the tensioner is pushed firmly home See Pages 3 17 and 3 19 Partial blockage in sensors Clear blockage Page 3 31 Gas pressure incorrect gas flow rate incorrect leaks in gas system gas cylinders connected incorrectly Check gas pressure and flow rate cure leaks check gases connected correctly Page 3 10 Bubble in sample path specifically under the reference sensor Repeat meas...

Page 78: ...concentrated fill solution Debubble sensor or empty and refill Page 3 17 Sensor failure confirm by measurement block routine Page 4 10 Empty and refill sensor If problem is not solved replace sensor pCO2 pO2 Sensor Sensor needs deproteinizing Deproteinize sensor Page 3 7 Sensor failure confirm by measurement block routine Page 4 10 Replace sensor System Measurement block assembly and sensors are w...

Page 79: ... probe sleeve caused by bent probe Replace probe and housing Page 3 24 Pump Tubing Insufficient pull on calibrant line Check reagent pump tubing is tensioned Check rubber connector is pushed firmly onto manifold Replace tubing Page 3 13 Tubing is blocked Clear blockage Page 3 31 If fault persists replace tubing Mechanical Pump rollers are dirty Remove pump rollers clean grease and re assemble Page...

Page 80: ...crystals and refill using reference sensor fill solution Leaking membrane Replace sensor cassette See Page 3 19 System Correlation factors changed Reset to correct factors Page 5 3 Calibrants used for longer than 30 days Replace Buffer Pack Gas pressure gas flow rate incorrect leaks in gas system Check pressure and flow rate cure leak Page 3 10 Incorrect gas values entered Enter correct values Pag...

Page 81: ... sample indications Clear blockages in drip tray manifold pump tubing Page 3 31 Leaks in sample path Check sensor O rings and replace if necessary Pages 3 17 and 3 19 Check sensors are seated correctly and the sensor tensioner is pushed firmly home Page 3 17 Check probe connector O rings and replace if necessary Page 3 24 Sucking in air on sample line Cure leak Fluid Detector Sample detector cover...

Page 82: ...aper core to free the other end If this does not free the paper continue with step 3 3 Lift the paper roll and cut the paper 4 Gently try pulling the end of the paper through the tearer If this does not free the paper continue with step 5 5 Use the screwdriver to gently prise the paper cradle away from the front panel Figure 4 1 Separating the Paper Cradle From the Front Panel 6 Lift the paper cra...

Page 83: ...lure will cause calibration problems on the pCO2 and pO2 channels Gas Calibrant Select Solenoid Selects gas or calibrant Failure will cause problems during a calibration cycle Gas Select Solenoid Selects calibration or slope gas Failure will cause calibration problems on the pCO2 and pO2 channels pH Cal Solenoid Delivers 7 382 buffer to the sensors Failure will cause calibration problems on the pH...

Page 84: ...and 3 for Troubleshooting Measurement Block Routine This routine measures and displays the sensor output in mV or pA By comparing the readings to the values given you can see if the sensors require maintenance or if they should be replaced NOTE Channels that have been turned off Page 5 5 are still measured and displayed in this routine 1 From Troubleshooting press 1 for Measurement Block 2 Select ...

Page 85: ... gases Cal 5 CO2 12 O2 and Slope 10 CO2 and 0 O2 4 Stability for 7 3 Buffer and Cal Gas a typical sensor will show the following performance pH pCO2 pO2 Noise after 15 seconds the display will not change by more than 0 2 mV 10 secs 1 0 mV 10 secs 2 pA 10 secs Drift after 15 seconds the display will not change unidirectionally by more than 1 0 mV 5 0 mV 15 pA during the remainder of the measurement...

Page 86: ...ond fluid detector check that the FD2 box on the display changes from empty to solid 6 Continue pressing and remove the sample from the probe Watch the trailing edge of the sample as it goes through the pre heater 7 When the trailing edge of the sample reaches the first fluid detector check that the FD1 box on the display changes from solid to empty 8 Watch the trailing edge as it goes through the...

Page 87: ...d detectors 1 From Ready or Not Ready press for menu and 3 for Troubleshooting From Troubleshooting press 4 for Electronics When the 248 completes this routine it confirms that the testing was successful If any of the tests fail testing stops and the test name is displayed with a failed message Contact your Siemens distributor Roll Printer Routine The Roll Printer routine checks the internal print...

Page 88: ...Contact your Siemens distributor Maintenance prompts do not appear Prompts not set Page 5 5 Clock has failed No data shown for measured parameters on display or printout Parameter has not been selected Page 5 5 No data shown for calculated parameters on display or printout Maximum of 8 parameters are shown on display but all selected parameters are printed Parameter has not been selected Page 5 5 ...

Page 89: ...s Operating Setup System Setup Service Setup When you have configured the 248 print the Setup Report Page 5 7 so you have a record of the options selected Operating Setup From Ready press for menu and 5 for Operating Setup Setting QC Ranges QC ranges can be set for three levels of QC Level X has no ranges If a QC measurement is outside these ranges the result is flagged on the display and on the p...

Page 90: ...d 2 for Reference Ranges Maximum range that can be entered is the instrument measurement range Page E 1 Set the ranges to the maximum instrument measurement range if you do not want to use the reference range facility Choosing Units You can choose the units of measure for parameters The choices are pH units or H nmol L mmHg or kPa for gases g dL g L or mmol L for ctHb To choose units from Ready pr...

Page 91: ...usting Correlation The 248 is set during manufacture to give results which correlate with tonometered blood If you wish to change the values to correlate with another blood gas analyzer you must use the following procedure 1 The correlation factors in the 248 must be reset to pH pCO2 and pO2 slope 1 000 pH pCO2 and pO2 intercept 0 000 2 Use a large sample population covering the physiological rang...

Page 92: ... nmol L or kPa for measurement these values must be converted into pH units and mmHg before entering To convert from H nmol L to pH pH 9 0 log10 H nmol L To convert to mmHg from kPa mmHg kPa x 7 50062 To adjust the correlation from Ready press for menu 5 for Operating Setup and 6 for Correlation Default setting pH pCO2 pO2 slope 1 000 pH pCO2 pO2 intercept 0 000 System Setup From Ready press for m...

Page 93: ...o select parameters from Ready press for menu 6 for System Setup and 3 for Parameters To select measured parameters press 1 Choose from all three channels selected any two of the three channels selected any one of the three channels selected selected not selected NOTE The 248 will not allow you to turn off all three channels NOTES Calculated parameters will only be displayed if all three measureme...

Page 94: ...ting CMSI Setting Security You can protect access to the Main Menu This guards against unauthorized or accidental changing of setup options The security password only protects the Main Menu The 248 will allow sample and QC measurement and will calibrate as required If the security option is used an overlay appears on the Main Menu screen prompting you to enter the password Menu access is prevented...

Page 95: ...only enter the 248 serial number 4 digits and the service telephone number up to 12 digits You can use the decimal point key to insert a dash The 248 automatically records the software revision Default setting serial number entered service contact telephone number not entered Changing Language You can change the language on the 248 display and printer The list of available languages includes Engli...

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Page 97: ...anual Spares Description Quantity Catalog Article Number Number Reference electrode inner with KCl fill solution 1 478509 09388182 Reference sensor refill contains reference sensor cassette KCI fill solution and O rings 1 kit 478498 04273425 Probe and tubing kit 1 kit 673251 05738022 Probe and housing kit 1 kit 673253 06152072 Probe protectors pack of 10 1 pack 673373 06565849 Bottle tubing kit 1 ...

Page 98: ...se 1 673348 04964460 Operator s Manual Spanish 1 04917624 Operator s Guide Spanish 1 673351 08107414 Operator s Manual Italian 1 04917772 Operator s Guide Polish 1 570012 04850961 Operator s Manual Portuguese 1 05038802 Operator s Manual German 1 04919597 248 Interface Manual 1 570030 00305144 pH blood gas blood collection capillary tubes 100 x 100 μL capillaries 1 pack 478600 04996974 Caps for ca...

Page 99: ...le 248 to DataMate Complement 2 and Expert datacare DMS sysems 1 673379 05047747 Reagents Description Quantity Catalog Article Number Number 6 8 7 3 Buffer Pack contains 4 Buffer Packs 1 pack 473496 03788731 Wash Pack contains 4 Wash bottles and 4 Deproteinizer Conditioner Packs 1 pack 473497 02436114 Deproteinizer pack of 10 1 pack 105610 08915030 Conditioner pack of 5 1 pack 478701 02578644 Acti...

Page 100: ...ur local authorized distributor Authorized Representative Siemens Healthcare Diagnostics Ltd Sir William Siemens Square Frimley Camberley GU16 8QD UK Manufactured by Siemens Healthcare Diagnostics Inc Tarrytown NY 10591 5097 USA Siemens Healthcare Diagnostics Pty Ltd ABN 65 007 436 651 885 Mountain Highway Bayswater Victoria 3153 Australia www siemens com diagnostics ...

Page 101: ...the Siemens location or authorized distributor Refer to the list of Siemens locations in this section Extent of a Warranty Service Call During the warranty period Siemens or an authorized distributor will repair the instrument during normal business hours at their expense subject to the exclusions listed below Siemens or an authorized distributor will initiate a warranty field service call when no...

Page 102: ...xpense to retrofit components or make design changes which will not adversely affect the instrument s performance characteristics Key Operator Designation Customers will designate a key operator who will be available to Siemens representatives to describe instrument malfunctions by telephone and or to perform simple adjustments and corrections as requested If a key operator is not designated or is...

Page 103: ...nual 10 Damage was caused by water from any source external to the instrument 11 The customer has purchased an alternative agreement whose terms of warranty supersede this agreement Siemens or its authorized distributors will invoice customers at current standard labour and parts rates for instruments repaired to correct damage or malfunctions due to any of the reasons listed above Limitations of ...

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Page 105: ... potentially infectious agents are hand to mouth contact hand to eye contact direct contact with superficial cuts open wounds and other skin conditions that may permit absorption into subcutaneous skin layers splashes or aerosol contact with skin and eyes To prevent accidental contamination in a clinical laboratory strictly adhere to the following procedures Wear gloves while servicing parts of th...

Page 106: ...et any liquid including water Do not place tools or any other items in your mouth Do not use the biohazard sink for personal cleaning such as rinsing coffee cups or washing hands To prevent needlestick injuries needles should not be recapped purposely bent cut broken or otherwise manipulated by hand Page A 2 248 Operator s Manual ...

Page 107: ...ty the waste bottle daily and add approximately 10 mL of disinfectant or sodium hypochlorite to the bottle When replacing the Buffer Pack or Wash bottle always remove the waste bottle and put the empty 7 3 Buffer or Wash bottle in its place Siemens recommends that approximately 10 mL of disinfectant or sodium hypochlorite is put into the empty bottle before placing it in position as the new waste ...

Page 108: ...otect your fingers Do not remove the rear cover from the 248 There are no user replaceable parts within the instrument All samples should be treated with the caution accorded to those known to contain pathogenic organisms Gloves should always be worn when handling samples and waste materials Make sure that before handling the component parts of the 248 such as the probe sensors measurement block p...

Page 109: ...cal Laboratory Standards Protection of laboratory workers from instrument biohazards NCCLS Document I17 Villanova PA NCCLS 1991 10 Siggaard Anderson O Electrochemistry In Tietz NW editor Fundamentals of clinical chemistry 3rd ed Philadelphia WB Saunders 1987 87 100 11 Siggaard Anderson O Durst RA Maas AHJ Physicochemical quantities and units in clinical chemistry with special emphasis on activitie...

Page 110: ...F Lunte CE Heineman WR Electrochemistry principles and measurements In Kaplan LA Pesce AJ editors Clinical Chemistry theory analysis and correlation 2nd ed St Louis CV Mosby 1989 213 227 22 Douglas IHS McKenzie PJ Leadingham I Smith G Effect of halothane h on pO2 electrode Lancet 1978 Dec 23 and 30 23 Thomas LJ Algorithms for selected blood acid base and blood gas calculations J Appl Physiol 1972 ...

Page 111: ...used Pin 9 5V digital For full details on interfacing to external devices refer to the 248 Interface Manual Cat 570030 The 248 supports three data communication protocols on both ports CMSI CMSI allows communication with Ciba Corning Diagnostics instrumentation for example the 270 CO oximeter 2500 CO oximeter and the Complement data management system A current loop convertor is required for interf...

Page 112: ...ment 2 and HIS and LIS systems Data Format Baud rate 9600 Start bit 1 Stop bit 1 Data bits 8 Parity OFF The transmitted data will have the format and protocol defined in the 248 Interface Manual Connecting to a 270 Equipment 270 interface cable Cat 673365 Select CMSI on the 248 Following the instructions in the 270 Operator s Manual connect the 248 as a 200 series instrument to the 270 Connecting ...

Page 113: ...49 0 mmHg 0 00 99 86 kPa pO2 a A 0 00 1 00 Method Comparison A comparison of whole blood samples run on four 248 analyzers and the Ciba Corning Model R for pH and tonometered precision gases for pCO2 and pO2 was performed The linear regression analysis equation is y mx b C of C is the coefficient of correlation pH n Range Equation C of C 335 6 776 7 614 M248 Model R x 1 015 0 107 0 995 pCO2 n Rang...

Page 114: ... 300 7 299 100 0 0 11 pCO2 20 0 522 49 6 49 0 98 7 1 07 pO2 20 0 301 49 8 49 8 100 0 0 60 Level 4 pH 19 0 010 7 073 7 064 99 9 0 14 pCO2 19 2 081 99 1 98 9 99 8 2 10 pO2 19 2 309 148 6 147 4 99 2 1 57 Level 5 pH 19 0 007 6 972 6 972 100 0 0 10 pCO2 19 0 737 148 6 148 5 99 9 0 50 pO2 19 1 252 106 2 104 8 98 7 1 19 WRSD within run standard deviation Precision on Controls Data was collected from nine...

Page 115: ...hin 45 to 120 seconds of returning the probe typically less than 60 seconds Heater The sensor operating temperature is 37 0 C 0 15 C The pre heater temperature is 37 C 1 C Samples Whole blood properly collected refer to Page 1 7 Free from hemolysis and if not analyzed immediately stored as stated on Page 1 8 Fresh samples can be analyzed at a temperature of up to 40 C QC material Siemens Healthcar...

Page 116: ...nvironmental Conditions Operation Temperature range 15 C to 32 C Maximum relative humidity 85 at 32 C non condensing Barometric pressure range 400 to 825 mmHg Maximum ambient light 8000 lux Transportation Temperature range 4 C to 37 C Maximum relative humidity 95 at 37 C Storage Temperature range 4 C to 25 C Maximum relative humidity 95 at 25 C Power Requirements Fuse rating Two 1A fuses time dela...

Page 117: ... 4 inches Depth 321 mm 12 5 8 inches Height 371 mm 14 5 8 inches Weight 9 1 kg 20 lb 248 only Reagents Please refer to Section 6 for a complete list of reagents for use with the 248 Solutions should be stored at 4 to 25 C away from direct sunlight ...

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Page 119: ...ements 100V 85 to 110V 120V 102 to 132V 50 60Hz 220V 187 to 242V 240V 204 to 264V NOTE If you have a 230V supply use the 240V setting on the voltage selector bobbin Power Rating 80VA Leakage current 0 5mA Ambient Operating Temperature 15 32 C Ambient Operating Relative Humidity 5 85 non condensing Ambient Light 8000 lux maximum Ambient Operating Barometric Pressure 400 825 mmHg The 248 should be p...

Page 120: ...owing items Description Qty Clot removal line 1 pack Fuse 1A time delay 2 OR Fuse 1A slo blo 2 O rings 2 Probe and tubing 1 Screwdriver 1 Grounding block 1 Voltage selector bobbin 1 Probe protectors 3 Pump roller 1 Pump roller drive pin 1 Grease 1 vial Sample detector cover 1 Sample detector cover screw 1 Bottle tubing connector 2 WARNING The 248 weighs approximately 9 kg 20 lb Observe safe liftin...

Page 121: ...structions It is particularly important to make sure there are no air bubbles trapped in the left chamber of the sensor cassette immediately above the sample pathway Do not overfill the righthand reservoir chamber 2 Swing the block tensioner to the right and insert the reference sensor from the side Push the bottom of the sensor to click it into place Make sure all the sensors are seated correctly...

Page 122: ... use other cylinders and regulators they must meet the following specfication Only certified value gas cylinders should be used For calibration gas the value should be 5 CO2 acceptable range 4 to 6 and 12 O2 acceptable range 10 to 14 balance N2 For slope gas the value should be 10 CO2 acceptable range 8 to 12 and 0 O2 acceptable range 0 to 2 balance N2 The gas values used must be entered see Page ...

Page 123: ...ders into their final position and secure 2 Remove the plastic protective wrapping from the valve assemblies 3 Fit the gas cylinder seals on the regulators 4 Attach the gas regulators to the cylinders with the regulator nipple engaging the opening in the cylinder valve 5 Attach and tighten the yoke screws firmly 6 Attach and tighten the tubing adapter fitting into the needle valves 7 Connect one e...

Page 124: ...Maintenance and 3 for Prime 2 If necessary repeat the routine to thoroughly prime the system b Condition the sensors 1 From Maintenance press 2 for Condition c Initiate a 2 point calibration 1 From Maintenance press 1 for Calibration and 2 for Full 2 Point The data from this calibration will not be used d Configure the 248 1 Refer to Section 5 Configuring the System 3 When the 248 reaches operatin...

Page 125: ...on The potential is related to the amount of analyte in the sample The reference sensor provides a fixed potential which is independent of analyte activity and is used to compare the measured potential The sensor potential corresponds to the analyte activity and is directly related of the concentration of the analyte in solution The potential is expressed by the Nernst equation Ecell K 2 3RT ZF lo...

Page 126: ...thode This voltage attracts molecules from the analyte in solution to the cathode causing a chemical reaction reduction that uses electrons The electrons are replaced immediately in the sample solution by a separate reaction oxidation that takes place at the anode The two reactions result in a current flow that can be measured The current measured is directly proportional to the concentration of a...

Page 127: ...e and specific for hydrogen ions separates the sample from the solution As the sample comes into contact with the membrane of the pH sensor a potential develops due to the exchange of hydrogen ions in the membrane The silver silver chloride wire conducts the potential to a voltmeter where it is compared to the constant potential of the reference sensor The final measured potential reflects the hyd...

Page 128: ...lectrode This results in a measurement that reflects pH change in the chloride bicarbonate solution The change in pH is proportional to the log of the partial pressure of pCO2 Figure G 3 pCO2 sensor cutaway view pO2 Sensor The pO2 sensor is based on the electrode described by Clark13 and uses amperometric technology The sensor consists of a platinum Pt cathode a silver Ag anode an electrolyte solu...

Page 129: ...ssary The Henderson Hasselbalch equation describes how pH expresses the interaction of acid and base in blood base pH pK log acid where K is the dissociation constant which describes the ability of a solution to release hydrogen ions Since K and therefore pK is a constant this equation can be used to demonstrate that pH is proportional to the acid base concentrations in blood pH is clinically sign...

Page 130: ...CO2 is retained and a decrease in CO2 indicates increased ventilation hyperventilation as CO2 is expired from the lungs Together pH and pCO2 provide a more definitive diagnostic tool in assessing respiratory function An increase in the pCO2 value and a decrease in pH indicates respiratory acidosis a condition where CO2 is retained by the lungs A decrease in the pCO2 value and an increase in pH ind...

Page 131: ...ynamic state of CO2 in the blood The majority of CO2 is transported as HCO3 The kidneys are the major controller of bicarbonate ion Bicarbonate levels are clinically significant in helping to determine the non respiratory renal metabolic component in acid base disorders Changes in HCO3 levels along with pH values can help determine if acidosis or alkalosis disorders are of metabolic origin In meta...

Page 132: ...ances BE ecf cHCO3 act 24 8 16 2 pH 7 4 Base Excess of Blood BE B The base excess of blood formerly known as in vitro base excess is calculated from the following equation BE B 1 0 014ctHb cHCO3 act 24 8 1 43ctHb 7 7 pH 7 4 If no ctHb value has been entered a value of 15g dL is assumed Oxygen Content O2 CT Oxygen content is the concentration of the total oxygen carried by the blood including oxyge...

Page 133: ...d for patients showing abnormal levels of 2 3 DPG or carbon monoxide The equation does not account for these variations therefore the oxygen saturation that is reported should only be used as an estimate of the actual value Total Carbon Dioxide ctCO2 Total carbon dioxide ctCO2 in combination with pH and pCO2 is useful in distinguishing between metabolic and respiratory acid base disorders Carbon d...

Page 134: ...O2 100 where T patient temperature C pH2 O 10 0 0244 x T 0 7655 0 4 Arterial Alveolar Oxygen Tension Difference The arterial alveolar oxygen tension difference pO2 A a or A aDO2 is useful as an index of gas exchange within the lungs if ctO2 measurements are not available The following equation14 19 is used pO2 A a T pO2 A T pO2 a T where pO2 A T is the temperature corrected oxygen tension of alveo...

Page 135: ...E ecf 1 0 004ctHb x HCO3 act 24 9 0 3ctHb x pH 7 4 0 3ctHb x 100 O2SAT 100 Base Excess of Blood BE B Formerly BE vt BE B 1 0 014ctHb x HCO3 act 24 9 5 1 63ctHb x pH 7 4 Oxygen Content O2CT O2CT 1 39ctHb x O2SAT 100 0 003 pO2 Oxygen Saturation Estimated No change Total Carbon Dioxide ctCO2 ctCO2 0 031pCO2 HCO3 act Patient Temperature Correction pH T pH 0 015 x T 37 pCO2 no change pO2 T pO2 x 10 A x...

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