Zimmer A.T.S. 2000, Operators & Service Manual

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8. AC INDICATOR LIGHT
Identifies that the unit is plugged into an ~ (AC) power
source. The unit is operating on battery if this light is
not illuminated.
9. QUICK REFERENCE CARDS
Pull-out cards that contain general use instructions and
help codes.
10. CUFF CONNECTORS
Ports to connect hoses to cuff(s).
11. POLE CLAMP
Adjustable clamp to mount the unit on a tourniquet
stand.
2.5 SINGLE CUFF OPERATION
1. Connect the power cord to an electrical power
source that is compatible with the ratings listed on
the nameplate of the unit.
2. Connect a dual port cuff to the unit at the main cuff
connectors.
3. Press the ON/STANDBY touch-switch to turn the
unit on. The unit will execute a self-check diagnos-
tic test as described in Section 2.2 of this manual.
Successful completion of the self-check indicates
the unit is ready for use.
CAUTION:
If either cuff is pressurized to 50 mm Hg
or more during power-up, the A.T.S. 2000 Tourni-
quet will declare it an abnormal start-up sequence.
It will assume that a surgical procedure is in pro-
cess, and will adopt pressures sensed in each cuff
as the new set point. It will automatically go into the
regulate mode on the cuff(s) which had the excess
pressure. To alert the operator of this condition, the
unit will sound a high pitch tone and illuminate the
Alarm Silence Switch Light. The operator should
immediately check the pressure set point and read-
just to the proper set point if necessary. The alarm
will be cleared as soon as the set point is exam-
ined.
4. The default settings for cuff pressure and time are
retrieved from the nonvolatile storage during power
up. These values may be changed prior to cuff
inflation by following Section 2.4 step 2b.
For each patient, tourniquet pressure should be set
to the minimum effective pressure. The minimum
effective pressure should be determined by fac-
tors such as: whether the cuff is to be applied to
an upper or lower limb; whether the limb is normal,
hypertrophied, or obese; the patient’s preoperative
systolic pressure; and the maximum anticipated
rise in systolic pressure during the procedure.
5. Prepare the patient in accordance with your estab-
lished procedures and cuff manufacturer’s instruc-
tions. The precautions of Section 1 and the follow-
ing are offered as a guide to assist in
this process.
In most cases a tourniquet cuff should be applied
to the widest part of the limb to allow as much
tissue as possible to lie between the cuff and any
nerves or vascular structures susceptible to dam-
age. The optimum positions are the upper arm and
the proximal third of the thigh. In certain cases of
forefoot surgery, the tourniquet cuff can be applied
around the calf or to the area proximal to the mal-
leoli. For emergency surgery of the hand, a suf-
ficiently small tourniquet can be fitted around the
wrist.
Apply a leak-free tourniquet cuff smoothly without
wrinkles. The valve port and hose connections
should be placed so that the hose will not be
kinked when the limb is positioned for surgery. The
limb is then prepared and draped for surgery. The
viability of the skin and deeper tissues should be
established prior to exsanguination of the limb and
tourniquet inflation.
Exsanguinate the limb by elevating it for a minimum
of 2 minutes and wrapping it, distal to proximal,
using an Esmarch, Martin, or elastic bandage. The
bandage should come up approximately to 1 in.
(2.5 cm) from the edge of the tourniquet cuff. The
elastic bandage is removed following inflation of the
cuff. If regional anesthesia is being used, the anes-
thetic agent or nerve block is then administered.
The tourniquet time depends greatly on the
patient’s anatomy, age, and absence of vascular
disease. The surgeon will determine: 1. when the
tourniquet is to be inflated; 2. to what pressure; 3.
for how long; 4. whether to allow for intermittent
aeration of tissues by deflating the cuff for 10 to
15 minutes; 5. at what point in the operation the
tourniquet should be released. In many operating
rooms, it is customary to prominently note the time
of inflation, and to warn the surgeon after a certain
time has elapsed. This will allow the surgeon to as-
sess the need for further tourniquet time.
There is a general agreement that, for reasonably
healthy adults, about 1 1/2 hours is safe and 2
hours should not be exceeded without releasing the
tourniquet to allow the underlying tissue to breathe.
During this time, the limb should be elevated about
60 degrees, and steady pressure should be applied
to the incision with sterile dressing.
Under optimum conditions, the tourniquet cuff can
be kept inflated until the final compression dress-
ings are in place. Postoperative swelling is then
kept to a minimum.
6. The cuff is inflated by pressing the MAIN CUFF
INFLATE touch-switch. The unit will pressurize the
main cuff to the preset pressure and start the infla-
tion clock. If the unit cannot pressurize the
cuff to within 15 mm Hg of the set point in less then
30 seconds, a pressure alarm will be sounded. See
Section 2.8 for information about possible alarm
conditions.
7. At the end of the procedure, deflate the cuff by
pressing the MAIN CUFF DEFLATE touch-switch.
The PRESSURE display will show the deflation of
the cuff, and the inflation clock will stop. Record the
elapsed time if desired.
8. Remove the tourniquet cuff and any underlying
bandages immediately following final deflation.
The time of tourniquet cuff removal should be not-
ed, and circulation of the limb should be checked.
9. The time clock display(s) may be reset to zero with-
out turning the unit off. This would enable the unit to
be used for multiple procedures without turning the
unit off (and thus erasing the selected pressure set
point if other than the default is used). see Section
2.4 step 3c.