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163

Page

Flow chart of self-test

............................................. 164

Ventilation with automatic adjustment of
rebreathing to match fresh gas flow

...................... 166

Automatic leakage tests IPPV / MAN

..................... 167

Automatic compliance correction

........................... 167

Notes on setting fresh gas flow

.............................. 168

Relationship between fresh gas and
gas concentration in the breathing system

............ 168

Relationship between fresh gas and time
constants in the breathing system

......................... 168

Tips for reducing condensation

.............................. 169

Tips for ECG and heart-rate measurement

............ 170

Tips for NiBP measurement

.................................... 171

Tips for SpO

measurement

................................... 172

Measuring principle of SpO

measurement

........... 174

Measuring principle of temperature
measurement

..........................................................

175

Measuring principle of pressure measurement

..... 175

Measuring principle of O

measurement

............... 175

Measuring principle of flow measurement

............. 177

Measuring principle of CO2 and
anaesthetic agent measurement

........................... 177

Definition of low-flow and minimal-flow
anaesthesia

............................................................. 178

Econometer module

............................................... 179

SIMV ventilation

...................................................... 180

Oxygen Ratio Control – S-ORC

............................... 182

Safety features of gas supply

................................. 183

Principles of the processed EEG (pEEG)

............... 183

Operation of the ceiling version

............................. 184

Abbreviations and symbols

..................................... 189

Descriptions

Содержание Cicero EM

Страница 1: ...Cicero EM Integrated Anaesthetic Workstation 23529278 Instructions for Use Software Versionen Ventilator 6 n 7 n Monitor 4 n...

Страница 2: ...xxxxxx xxx xxx Xxxxxxxxxxxxx xxxx xxxxxxxx X xxxxxxxx Xxxxxxxxxxx Xxxxxx xxxxxxxxx xxxx xxxxxx Xxxxxxx xxxx Xxxxxxxxx Xxxxxx xxx Xxxxxxx xxx Xxxxxxxx xxxxxxxxxx O2 Xxxxxxx Xxxxxxxxxxxxx xxx Xxxxxx xx...

Страница 3: ...supply Compressed gas supply Connecting external equipment Checking workstation with checklist Spontaneous breathing manual ventilation IPPV mode SIMV mode PCV mode Paediatric use Changing patients Af...

Страница 4: ...This apparatus is neither approved nor certified for use in areas where combustible or explosive gas mixtures are likely to occur Safe connection with other electrical equipment Electrical connections...

Страница 5: ...le power supply Passive air conditioning Heated breathing hoses pEEG Notes on operation Only non flammable anaesthetic agents conforming to EN 740 may be used Risk of fire Since this apparatus is not...

Страница 6: ...delivery valve buttons 3 under the measuring tubes If necessary fill the system rapidly with the O2 flush 4 The manual ventilation bag should fill Set the APL pressure limiting valve 5 to MAN Set maxi...

Страница 7: ...h is pressed down The acoustic power failure warning is muted after 30 seconds Deliver fresh gas set APL valve If required press the O2 flush button O2 Note If there is a power failure the piston of t...

Страница 8: ...8...

Страница 9: ...Page Master switch 10 Ventilator operating concept 10 Monitor operating concept 12 9 Operating concepts...

Страница 10: ...e same key is used in PCV mode to set the plateau pressure VT key for setting the tidal volume IPPV key for setting the ventilation frequency in IPPV mode TI TE key for setting the time ratio between...

Страница 11: ...y control is not pressed and not turned again the machine is reset after 10 seconds without changing the setting This dialogue window also displays advisory messages see page 100 Example Infant hoses...

Страница 12: ...s text in the alarm fields Only new warnings will be signalled once by the appropriate tone sequence Inside the dark area there are four keys acting directly on the screen contents S This key is used...

Страница 13: ...he desired parameter in the colour menu and confirm Turn the rotary control until the desired colour is displayed and then confirm Anesth Agent Alarms Calibration Settings 11 59 00 00 W hlen Sie mit d...

Страница 14: ...14...

Страница 15: ...Check Vapor 22 Check anaesthetic gas scavenging 22 Check breathing system 23 Check soda lime 23 Check emergency ventilation bag 23 Check piped medical gas supply 24 Check reserve cylinders optional 24...

Страница 16: ...evices that are switched on and off with the master switch 3 sockets Maximum current per socket 2 A The sum of the derived current in the mains line must not exceed 500 A IEC 601 1 Equipotential bondi...

Страница 17: ...f a power failure In the case of a ceiling unit the auxiliary sockets are not fitted Connecting the compressed gas supply 3 Screw hoses for O2 AIR and N2O into the rear of the apparatus and plug conne...

Страница 18: ...then remains on the connector 3 Connect the transfer hose to the connector on the receiving system Make sure the connection is secure 4 Make sure that the connector for the second transfer hose is se...

Страница 19: ...onnector may also be used as an RS 232 MEDIBUS interface Equipment plugs must be secured with screws For interface configuration see page 64 Connection via the Dr ger RS 232 MEDIBUS interface 5 with d...

Страница 20: ...made To remove the parameter box pull the blue handle on the box to release the locking lever The parameter box can then be simply pulled out of the housing Blue holder 2 Fix the blue holder in a suit...

Страница 21: ...rs Indication in user advisory field Is the Cicero EM o k according to checklist Please confirm The user is consequently prompted to check the points listed The equipment must be checked every time im...

Страница 22: ...Are the two hoses fitted correctly Are the vents open Are all hoses free of kinks 1 Is the transfer hose of the anaesthetic gas scavenging system free of condensate Drain if necessary 22 0 Vol Prepar...

Страница 23: ...ed in both the inspiratory and the expiratory lines during prolonged anaesthesia low flow anaesthesia and when using a humidifier Water traps must be fitted at the lowest point in the hose and hang do...

Страница 24: ...means of rotary control Seal the aspiration holes or fold over the hose and 5 Check negative pressure on pressure gauge 3 Negative pressure switch to O If the negative pressure generated is insufficie...

Страница 25: ...to each use 06 12 98 03129278 03929278 03129278 Check gas delivery 1 Switch over to AIR 2 Open O2 and AIR delivery valves until the floats in the measuring tubes indicate more than 9 L min Open N2O d...

Страница 26: ...piece should be attached to the breathing hoses and the patient connection should be open For instance it may be lying on the table Press rotary control to confirm Wait a few seconds 26 Preparing for...

Страница 27: ...akages The automatic part of the self test follows immediately A list in the middle of the system screen shows with symbols which points have already been completed with results if applicable and whic...

Страница 28: ...on is marginal The piston pump is in withdrawal position Manual ventilation is not possible in standby mode Any attempt to undertake manual ventilation in standby mode is immediately detected and caus...

Страница 29: ...T on ventilator for at least 1 second or press the key and confirm with the rotary control Setting by Dr ger Service 4 Switch on the external fresh gas outlet Press FRESH GAS OUTLET The lamp in the ke...

Страница 30: ...30...

Страница 31: ...with pressure limitation 34 Limit settings 34 Selecting SIMV mode 35 Selecting PCV mode PCV ventilator 36 Special features of mode changes 37 Paediatric use 38 Anaesthesia ventilation with the Kuhn s...

Страница 32: ...an be found in the Annex on page 168 Manual ventilation with breathing bag The airway pressure is limited via the pressure limiting valve APL 4 Set pressure limiting valve APL to MAN and set required...

Страница 33: ...sitive end expiratory pressure 0 mbar 2 Press I 3 Display in dialogue field IPPV Mode 4 Press rotary control to confirm ventilation starts The parameters Pmax VT fIPPV PEEP and piston movement are dis...

Страница 34: ...of inspiration see page 37 The set tidal volume is not fully applied in this case 1 Display on ventilator Pressure limitation 2 The bar graph on the ventilator does not reach 100 If the pressure incre...

Страница 35: ...m med upon delivery are active in SIMV mode They can be changed by Dr gerService on request The ventilation parameters of the preceding mode remain active when changing from IPPV to SIMV mode and vice...

Страница 36: ...in the ventilation function The parameters PCV fIPPV Flow PEEP and piston movement are displayed on the ventilator The system screen is also started and the alarm limits for IPPV are activated PCV cha...

Страница 37: ...tor Press the function key the existing value and the proposed new value are displayed in the dialogue window Turn the rotary control the proposed new value changes On reaching the desired setting Pre...

Страница 38: ...ided by reducing the fresh gas flow or using a 1 5 L breathing bag The setting increments and the metering precision for the tidal volume VT depend on the selected adjustment range The adjustment rang...

Страница 39: ...ventilator for at least one second 4 Set pressure limiting valve APL to MAN Connect inspiration hose via 5 connecting sleeve Symbol 6 Expiration connector remains open Symbol 7 Connect concertina hose...

Страница 40: ...een CO2 O2 breathing gas and N2O measurements will then no longer be possible Remedy Drain the water trap as described Check water separators Water separators must be fitted at the lowest point in the...

Страница 41: ...it downwards Insert the replacement soda lime container from below and turn clockwise as far as possible Reset the machine to previon settings Remove spent soda lime from the container Note hygiene r...

Страница 42: ...ingertip with your index finger The aspiration capacity can be adjusted very accurately with the aid of auxiliary air Check filling level of aspiration vessel regularly and drain if necessary Note hyg...

Страница 43: ...f used disposable articles household refuse 2 Draw the water trap container down and off to be emptied The following must also be changed when working without microbial filters 3 O2 sensor with connec...

Страница 44: ...t In Standby the screen is switched to screen saver mode after two minutes in the absence of any user input The screen is automatically reactivated when any key is pressed or the rotary control is tur...

Страница 45: ...settings 61 Acoustic 61 List entry 61 Transport function 62 External interfaces MEDIBUS printer 63 Basic configuration 64 Calibration O2 flow 65 Testing O2 linearity gas sensor zero point 66 Anaesthet...

Страница 46: ...seconds by the current leakage and compliance values The manual ventilation bag and its hose are not included in the test The machine reverts to Standby after the test Delete trend e g for a new pati...

Страница 47: ...ode Select the digits one by one by turning the rotary control and press to confirm After the fourth correct digit has been entered access is granted to the selection range The operating procedure for...

Страница 48: ...ellow frame Selected menu option Inverse video white on black Current settings Orange background Operating function Action Move cursor Turn rotary control Confirm selection Press rotary control Go bac...

Страница 49: ...Pulse SpO2 NIBP ART sys dia T1 T2 ST 120 50 Standard alarm limits configuration menu Please confirm 100 50 24 8 06 12 98 07829278 07929278 08029278 Mode The Cicero EM has separate operating modes for...

Страница 50: ...e pulse deficit indica indication tion on or off ST segment Switches the ST segment analysis analysis on or off If a 3 wire lead 3 core cable is selected only one ECG can be displayed and so the optio...

Страница 51: ...Settings mode adult neon alarm limits parameter screen acoustic list entry transport RS 232 Medibus record printer basic config Select a menu position Please confirm Change the settings Please confirm...

Страница 52: ...andby Configuration 11 59 00 00 Settings mode adult neon alarm limits parameter screen acoustic list entry transport RS 232 Medibus record printer basic config Select a menu position Please confirm Ch...

Страница 53: ...deleted by pressing Delete The standard screen selected by this method is activated every time the device is switched on on quitting the described standard screen configuration on calling up Standard...

Страница 54: ...Real time curve of the plethysmogram measured by the SpO2 sensor CO2 graph Real time curve of the CO2 concentration of the breathing air in the Y piece The alarm limits are shown as dashed lines The...

Страница 55: ...the Y piece Short curves The curves for CO2 Flow and PAW can also be configured as short curves so that they fit into the area of a numerical module CO2 short with indication of the CO2 value Flow sh...

Страница 56: ...ayed in large figures CO2 module The end expiratory CO2 concentration of the breathing gas etCO2 is indica ted The inspiratory value FiCO2 can also be shown Gases module Shows the composition of the b...

Страница 57: ...l This module displays the temperatures T1 and T2 in the bottom right hand corner of the screen for the configuration see General settings on page 61 Alternatively temperatures T1 and T2 could also be...

Страница 58: ...te volumeter lower bar graph The length of the bar represents the maximum measured value in accordance with the mode selected Mode Breath VT MV Neonates 0 25 L 2 5 L min Adults 1 25 L 12 5 L min Breat...

Страница 59: ...hether the system is filling arrow pointing to right emptying arrow pointing to left or whether the level is remaining constant indicator O Immediate action need only be taken in the event of the FRES...

Страница 60: ...11 59 00 00 06 12 98 Select a menu position Please confirm Change the settings Please confirm again Standby Configuration alarms inactive mode adult neon alarm limits parameter screen acoustic list en...

Страница 61: ...quired If EEG entries are selected they replace the temperature entries Screen configuration menu Please confirm Standby Configuration 11 59 00 00 alarms inactive Settings mode adult neon alarm limits...

Страница 62: ...age 86 The patient is connected for the first time to If a patient is connected for the first time the parameter box will not yet contain any stored data for the patient This will generally be the cas...

Страница 63: ...232 interface MEDIBUS The interface parameters for data transfer are pro grammed here Settenigs for connecting the Dr ger pEEG monitor baud rate 1 2 or 9 6 parity even Information only cannot be selec...

Страница 64: ...he input field Letters are displayed inside this frame in alphabetical order when you turn the rotary control Confirm the desired letters The frame jumps to the next position where a letter can be ent...

Страница 65: ...f the symbols is as before Enquires whether an action has been performed or a setting made u Waiting period The selected test step is being carried out by the system The action has been completed succ...

Страница 66: ...layed does not lie between 18 and 24 Vol O2 Gas sensor zero check Zero alignment of the gas sensor for N2O anaesthetic agent and O2 is generally automatic If manual calibration is desired Select the f...

Страница 67: ...overwrites the manual settings The responsibility for the choice of anaesthetic agent and correct filling of the Vapor remains with the user When the anaesthetic agent is changed the trend memory for...

Страница 68: ...values The list screen contains all the measured values and alarms which have been saved and makes it easier to complete the anaesthetic record See page 70 The top curve and top module of the last sel...

Страница 69: ...pulse 65 99 O2 N2O ISO Fi 29 70 0 8 Fet 26 68 0 6 auto set pat alarm timer start para meter config alarm info screen config limits auto set vent al etCO2 mmHg MV L min T1 T2 C HR Pulse ECG 1 min IBP1...

Страница 70: ...ies are required If EEG entries are selected they replace the temperature entries Print list entry Press the print softkey to print out the complete list on a connected external printer 70 System scre...

Страница 71: ...off the Cicero EM The trend memory and list can also be cleared in standby mode If a parameter box is connected its list memory will also be cleared 1 Press Eto switch over to Standby mode This is onl...

Страница 72: ...turning the rotary control until the required value has been obtained The value is confirmed by pressing the rotary control this value now represents the active limit Each active alarm limit is shown...

Страница 73: ...Softkeys Patient alarm AutoSet 11 59 00 00 The alarm limits of haemodynamic parameters have been automatically adapted to the actual measurement values IPPV alarm limits standard screen 1 adults Warn...

Страница 74: ...ust be in IPPV SIMV or PCV mode The ventilation alarms can be automatically adjusted to the current settings of the ventilator by pressing the auto set vent al softkey The alarm limits previously set...

Страница 75: ...ults Warning Caution Advisory TEMP2 CALIB TEMP1 APNOEA CO2 Select a graph or a module by turning the rotary knob Please confirm Patient Graph Module Graph Module Ventilation 1 ECG 2 ECG 3 ECG iBP1 iBP...

Страница 76: ...changes automatically to timer stop The timer is stopped when the softkey is pressed again 76 System screen functions Softkeys Timer 11 59 00 00 IPPV alarm limits standard screen 1 adults Warning Caut...

Страница 77: ...deactivates all parameter box alarms HLM mode Activates deactivates the heart lung machine monitoring mode Pmax on Ventilator pressure limitation generates a caution message off Ventilator pressure l...

Страница 78: ...marked Text in a white field Warnings are accompanied by a continuous tone caution messages by a tone at 30 second intervals and advisory messages by a single tone Low priority technical messages are...

Страница 79: ...the next measurement is made 3 The red upper or yellow lower LED continues to light up and the text remains on the display To reactivate the alarm tone during the 2 minutes 2 Press Gagain The yellow L...

Страница 80: ...is on and the ventilator is in IPPV mode the inspiratory CO2 concentration in the breathing gas is monitored with a fixed maximum limit of 5 mmHg The inspiratory CO2 concentration can be set by the us...

Страница 81: ...screen 1 adults Warning Caution Advisory 2 ECG II 1mV iBP1 160 0 0 CO2 40 30 PAW 20 0 33 6 0 freq 10 VT 0 60 36 8 37 2 pulse def 4 ST 0 05 65 pulse 65 100 Peak PEEP 32 3 plat 26 mean 21 pulse 65 99 O2...

Страница 82: ...ith indication of the time elapsed Flow No breathing in seconds Pressure Breathing detected CO2 No breathing APNEA With indication of the time elapsed Flow Breathing detected in seconds Pressure No br...

Страница 83: ...broken up and a separate alarm signalled for each parameter Monitoring the alarm limits for heart pulse rates from different sources The heart rate is always determined from the 1st ECG Two of the th...

Страница 84: ...84...

Страница 85: ...measurement 91 Adjusting settings 92 Measuring the blood pressure of neonates 93 Invasive blood pressure iBP 94 Start monitoring 94 Calibrating transducers 94 Adjusting settings 95 Setting functions 9...

Страница 86: ...p in the NiBP cuff when this key is pressed in order to stop the venous blood flow The yellow LED in the key lights up during this time The blood flow is released when the key is pressed again It is r...

Страница 87: ...briefly To disconnect Pull out the blue handle After overcoming a tangible resistance the box is electrically disconnected and freely transportable Blue holder The parameter box can be tilted in the b...

Страница 88: ...irmed unchanged after checking the display These settings are confirmed and then transferred by pressing the rotary control After about 12 seconds all parameter box functions are active List intervals...

Страница 89: ...Punct Act 0 0 11 59 00 00 06 12 98 Man Spont alarm limits standard screen 1 adults Warning Caution Advisory II 1mV iBP1 160 0 0 CO2 40 30 PAW 20 0 33 6 0 freq 10 VT 0 60 36 8 37 2 pulse def 4 ST 0 05...

Страница 90: ...frozen and ECG alarms are suppressed After the high frequency interference has ceased the complete monitoring function is again active If high frequency interference lasts longer than 15 seconds with...

Страница 91: ...mean pressure are displayed when the measurement is complete Incorrect measurements are repeated 5 seconds after releasing the air A third and last attempt is made after 30 seconds if the second meas...

Страница 92: ...ent after reading off the systolic pressure the cuff is inflated to 20 mmHg above the last measured systolic value for the next measurement If the inflation pressure is too low for correct measurement...

Страница 93: ...erlock function between NiBP and iBP The iBP 1 2 PULSE measurement is suppressed while the cuff is inflated NiBP alarms NiBP alarms are suppressed during invasive blood pressure measurement in an arte...

Страница 94: ...ck then appears behind the function Close the transducer dome and reopen the connec tion to the catheter infusion system the pressure trace and pressure values are displayed Or on the parameter box Pr...

Страница 95: ...ous pressure ICP Intracranial pressure Any other site The following parameters are automatically preselected on selecting a location name curve amplitude monitoring type diastolic mean pressure systol...

Страница 96: ...bottom reference line The scale of the upper reference line can be varied or Morphological graph The graph is automatically adjusted to the full height of the trace Manual adjustment of the height is...

Страница 97: ...slowly to changes in oxygen saturation Patient movement has little or no effect normal mode The mode for normal conditions with relatively quiet patients fast mode This mode should be used whenever ra...

Страница 98: ...olour coded green Correct temperature values are displayed after approx three minutes Display If programmed the small temperature module is displayed under the softkeys To set this display mode see pa...

Страница 99: ...bsystems 101 Messages on the system screen 102 Warning messages 102 Caution messages 104 Advisory messages 106 Messages on the ventilator 109 Message in the ventilation system 110 Message during the s...

Страница 100: ...y also appear in the dialogue field during operation and the self test Refer to the table on page 109 In the event of a problem with the ventilator signalled by a message in the dialogue field of the...

Страница 101: ...nd or advisory messages cannot be remedied in accordance with the descriptions or by repeatedly switching off and on again with a delay of approx 5 seconds in between via the master power switch and r...

Страница 102: ...y hand Check patient s spontaneous breathing ability Check hoses tube and ventilator APNEA PRESSURE No breathing ventilation No change of pressure detected for 15 seconds Inadequate supply of fresh ga...

Страница 103: ...P PRESSURE End expiratory pressure exceeds PEEP by more than 10 mbar Check anaesthetic gas scavenging line Extend the expiration time Check the hose system and microbial filter Drain the water traps P...

Страница 104: ...limit if necessary ET CO2 Upper alarm limit for end expiratory CO2 concentration has been exceeded for at least two breaths Check ventilation ET CO2 End expiratory CO2 concentration below lower alarm...

Страница 105: ...if necessary PULS SPO2 Pulse rate exceeds upper alarm limit Check patient s condition Correct alarm limit if necessary S T MV Magnitude of S T segment exceeds upper alarm limit Check patient s conditi...

Страница 106: ...e measurement Check transducer replace if necessary CHECK PRESSURE No breathing phase detected by pressure measurement Check pressure measurement CO2 G OFF CO2 alarm inactive CO2 AGA INOP CO2 anaesthe...

Страница 107: ...sensor and calibrate sensor Plug in sensor connector FLOW SENSOR No gas flow detected by flow sensor although ventilation evidently proceeding correctly Check flow sensor replace if necessary Check f...

Страница 108: ...inactive SPO2 INOP SpO2 measurement faulty Call Dr gerService SPO2 SENSOR No pulse detected by pulsoxymeter although heart is clearly beating Check patient s condition disturbed circulation Check SpO...

Страница 109: ...surements Version Message displayed at the beginning of the self test Software version number is indi cated when switching on Inform Dr gerService of version number when reporting malfunctions Interna...

Страница 110: ...quoting the malfunction No and software No If the malfunctions or advisory messages cannot be switched off by the procedures described above or by switching the master electric switch off and on repe...

Страница 111: ...pletion of the self test Control pressure low Insufficient operating control pressure Breathing system or roller diaphragm faulty Breathing system and piston pump Replace defective parts installed and...

Страница 112: ...stem and piston pump system Blow out any water in the system via greater than 10 mbar the piston pump measuring port If necessary replace breathing system V6 PEEP valve does not open Piston defective...

Страница 113: ...k connector system and sealing rings on Vapor Test x interrupted Displayed after the self test is stopped Select operating mode Valve plate faulty Breathing system valve plate or Replace breathing sys...

Страница 114: ...ufficient fresh gas Displayed if the fresh gas flow is insufficient Increase fresh gas setting Remedy leaks Manual ventilation bag not filled extend expiration time Replace breathing bag connection ho...

Страница 115: ...nutes the inspiratory Repair leaks in subsystem 1 plateau time is thereby increased by 1 5 sec See flow chart on page 164 Test pressure error Test pressure for leak test not attained Repair leak Repea...

Страница 116: ...116...

Страница 117: ...ts and methods 121 Care schematic 122 Care intervals for individual components 122 Disposing of throw away articles 123 Wipe cleaning 123 Disinfectant cleaning in machines 123 Disinfection with formal...

Страница 118: ...n so that the sealing elements are not subject to constant pressure 1 Swing lever back to original position otherwise table top cannot be reclosed Remove anaesthetic gas scavenging system Refer to sep...

Страница 119: ...ately soaked in distilled water Temperature sensor breathing gas if used Draw temperature sensor out of Y piece remove Y piece from ventilation hoses Prise lead out of hose clips Pull connector out of...

Страница 120: ...soiled Empty soda lime container see pages 41 and 128 Dispose of with household refuse not when treating infectious patients Piston pump 3 Release the two quick release screws by turning through a qu...

Страница 121: ...in diluted as specified Both are registered trademarks of Messrs Sch lke Mayr D 22846 Norderstedt may be used to ensure material compatibility The following are not suitable compounds containing pheno...

Страница 122: ...thout microbial filters with or without microbial filters Tube mask after every patient after every patient after every patient Y piece after every patient after every patient after every patient Both...

Страница 123: ...isted in the table on page 125 Parts in contact with breathing gas breathing hoses breathing bag breathing system soda lime container piston pump must not be disinfected with formaldehyde vapour Parts...

Страница 124: ...erilization with moist heat and or wipe cleaning All parts must be dry Steam sterilization is only required after treating an infectious patient Minimum exposure times 20 minutes at 121 C and 10 minut...

Страница 125: ...on pump Parts of breathing system Valves of breathing system Plastic parts Housing of piston pump Soda lime container with screen T piece for sidestream gas measur Water trap for measured gas Water tr...

Страница 126: ...3 Screw piston into position not quick release 4 Fit cylinder head and secure in position two quick release catches Assemble the breathing system Check individual parts Gaskets pressure marks cracks...

Страница 127: ...n valve caps 6 Screw on pressure limitation valve APL scale facing the front Assemble and fit the inspiratory O2 sensor if used Do not touch wire mesh on cell Insert cell with conductors facing wiring...

Страница 128: ...change of colour is also reduced The soda lime should be replaced daily at the latest when two thirds of the charge has changed colour The indicator colour changes back as it dries although the absor...

Страница 129: ...rwise the breathing system may be drained Connect sample line for sampling CO2 O2 and anaesthetic agent If a Y piece with Luer lock is used 4 Connect the sample line to the Luer lock of the Y piece 5...

Страница 130: ...the Y piece After securing the Y piece align the sensor to face upwards so that it remains free from condensation 4 Route the sensor lead back to the machine with hose clips along the inspiration hose...

Страница 131: ...ventilation function 133 Check automatic ventilation function 133 Testing the pneumatic circuit for leaks 135 Testing display errors 135 Disposal of used batteries and O2 sensors 136 Disposal of bact...

Страница 132: ...s not have an uninterruptible power supply Interrupt power supply e g disconnect plug from socket 1 Set Power switch to I On Power failure alarm sounds Continuous tone volume must remain constant for...

Страница 133: ...ly down on the lever of the pressure limiting valve Check automatic ventilation function Connect lung simulator test thorax or breathing bag to Y piece 3 Set fresh gas flow 4 Press I 5 Press rotary co...

Страница 134: ...pear to be blocked The typical service life of a water separator is between 2 and 4 weeks 2 Hold the water separator by its sides and lift out Slide the new water separator onto the guide as far as po...

Страница 135: ...300 mmHg 5 It will also be vented if the pressure falls below 15 mmHg Repeat the test Quit the calibration mode by pressing the rotary control after selecting Check NiBP Deactivate the AUTO key Measur...

Страница 136: ...rged Used batteries must be treated as special waste Dispose of used batteries in accordance with local waste disposal regulations Used O2 sensors can be returned to Dr ger Medizin technik GmbH Dispos...

Страница 137: ...onths Can be incinerated with low emissions at temperatures above 800 C Bacterial filter for pressure measuring line Replace every 6 months Can be incinerated with low emissions at temperatures above...

Страница 138: ...138...

Страница 139: ...42 Operating elements and displays on gas control panel 143 Operating elements and displays on flowmeter bank 144 Operating elements and displays on parameter box 145 Elements on the rear of the machi...

Страница 140: ...l items 25 Optional backup gas cylinders 1 2 3 5 6 7 8 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 1 Hinged arm optional 2 Guides for hoses and leads 3 Support for NiBP cuff and other items of equ...

Страница 141: ...for pressure controlled ventilation PCV 14 Key for setting the maximum pressure Pmax or of the PPCV working pressure in PCV mode 15 Key for setting the tidal volume VT 16 Key for setting the ventilat...

Страница 142: ...messages 14 Red LED for warning messages 15 Key for suppressing the alarm sound 16 Key for freezing real time graphs on screen 17 Key for triggering a list entry 18 Standby key 19 Rotary control 1 St...

Страница 143: ...ion 6 Switch for generating negative pressure 7 Hose connection for measuring airway pressure Paw 8 Connector for flow sensor 9 Hose connector for sample gas return line 10 Master switch for power and...

Страница 144: ...for O2 shortage signal whistle 6 N2O AIR changeover switch 7 Oxygen flow tubes 8 Air flow tube 9 Nitrous oxide flow tube 10 Float for reading off gas flow 11 Control valve for nitrous oxide 12 Control...

Страница 145: ...f each individual measuring channel for invasive blood pressure measurement iBP 8 LEDs in the keys light up when the corresponding function is active in this case alarm sound suppressed 9 Socket for E...

Страница 146: ...ate and serial number 18 Optional backup gas cylinders 19 Fixing of the power supply unit for the passive air conditioning 1 Shelf 2 Rear of monitor details on page 148 3 Holder for coiled cables and...

Страница 147: ...ressure setting turn MAN SPONT changeover two way switch and pressure relief press 8 Plug to seal Y piece for leakage test 9 Support for manual ventilation bag 10 Handle of breathing system 11 Quick r...

Страница 148: ...line to ventilator 8 RS 232 C interface for connecting a printer 9 Connection for pressure measuring line 10 CAN bus connection 11 Connection for parameter box 12 Connection for external screen 13 Gr...

Страница 149: ...g F for the first time invariable frequency displays are shown on screen After pressing for the second time a menu appears in the top third of the screen with the corresponding symbols Use the brightn...

Страница 150: ...D F What s what 19829278 Ceiling version not illustrated dimensions apply accordingly A 1010 mm B 570 mm C 745 mm 840 mm incl transport handle on both sides D 805 mm E 440 mm F 520 mm Trolley version...

Страница 151: ...55 O2 measurement sampling 155 Flow measurement 155 CO2 measurement 155 Anaesthetic agent measurement 156 Breathing gas temperature measurement 156 Data communication 156 Parameter box 157 Electrocard...

Страница 152: ...In the power adapter 2 x 0 25 A DIN 41 662 230 240 VAC Additional fuses in power packand master switch on contactor are only accessible to qualified personnel with tools Two fuses in each auxiliary ma...

Страница 153: ...bar 10 for O2 flush N2O 20 L min at 5 bar 10 AIR 50 L min at 5 bar 10 O2 shortage signal Whistling signal tone Triggered at latest when O2 pressure drops below 170 kPa 1 7 bar Stops at latest when O2...

Страница 154: ...o 80 per minute as from software version 7 2 6 to 60 per minute software version 7 2 Minute ventilation E Up to 25 L min TI TE 1 3 to 2 1 5 TIP TI 0 to 60 5 Inspiratory flow I max Max 75 L min fIMV 3...

Страница 155: ...inute ventilation AMV Range 0 to 99 9 L min Resolution 0 1 L min Accuracy better than 0 2 L min or 8 of the measured value under calibration conditions and BTPS BTPS body temperature current atmospher...

Страница 156: ...s Response time t10 90 at 200 mL min 350 ms at 60 mL min 1 s Warm up phase 4 minutes ISO DIS 11196 accuracy requirement attained Zero drift Within the above accuracy without limitation in time Automat...

Страница 157: ...cases Defibrillator Protected against defibrillation shocks synchronization pulse available Socket receptacle outer contact Ground Socket receptacle inner contact TTL output with 15 ms pulse duration...

Страница 158: ...ease air from the cuff Upon completion of the measurement When measurement is interrupted by pressing Stop button When the maximum measuring time is exceeded When the maximum cuff pressure is reached...

Страница 159: ...Adults 0 to 50 undefined 50 to 70 3 70 to 100 2 Neonates 0 to 70 undefined 70 to 95 3 95 to 100 not specified Accuracy of Durasensor 3 additional Measuring modes Normal measurement over 5 to 7 second...

Страница 160: ...ad Amplitude Pacemaker identification function on off NiBP Function on off Systolic pressure Upper and lower alarm limit Diastolic pressure Upper and lower alarm limit Mean pressure Upper and lower al...

Страница 161: ...alue for the list Alarm limit None None Inspiratory CO2 End expiratory CO2 Inspiratory O2 Expiratory O2 Minute volume AMV Anaesthetic agent Inspiratory anaesthetic concentration Expiratory anaesthetic...

Страница 162: ...162...

Страница 163: ...surement 170 Tips for NiBP measurement 171 Tips for SpO2 measurement 172 Measuring principle of SpO2 measurement 174 Measuring principle of temperature measurement 175 Measuring principle of pressure...

Страница 164: ...leak A Insert piston cyl unit Various electrical tests 2 F Monitor Test operating control pressure Continued overleaf 3 A Test ventilator A Fresh gas occluded A APL 30 mbar A Y piece open A Piston cyl...

Страница 165: ...F F A Fresh gas occluded I IPPV leakage test F A Subsystem 3 leak A Leak mL min F Leak eliminated A Leak accepted F F End of self test 5 L min I MAN leakage test Subsystem 3 breathing bag fresh gas li...

Страница 166: ...uld be designed so that it is impossible firstly for too much expiration gas to disappear in the anaesthetic scavenging line without building up a constant pressure and secondly for fresh gas to escap...

Страница 167: ...to the overall leakage since the mean pressure is normally below 5 mbar Automatic compliance correction The stroke volume applied by a ventilator not only ventilates the patient s lungs but also the...

Страница 168: ...anaesthetic agent in the fresh gas depends on the set fresh gas flow The inspiratory concentration in the breathing system corresponds more and more accurately with the fresh gas concentration as the...

Страница 169: ...ate can collect at the lowest point and not run to the patient or into the breathing system Regularly drain the condensate from the hoses Use water traps when performing operations longer than 1 5 hou...

Страница 170: ...ventricular complexes In such a case calculation of the heart rate would be continued even in the absence of an ECG The following points must also be noted The R waves of the ECG must be greater than...

Страница 171: ...bumps against the cuff or hose during measurement The cuff has a negative effect on an SpO2 sensor applied to the same limb Measure the blood pressure at a different point or activate Interlock to av...

Страница 172: ...atheter infusion or sphygmomanometer cuff Blood circulation must not be impeded during application of the sensor If possible the site should be changed from time to time in order to avoid pressure nec...

Страница 173: ...g to inaccurate results The sensor should be applied to a different site in such cases in order to reduce the risk of artefacts due to movement Coupling with non invasive pressure measurement The inte...

Страница 174: ...nm Red 920 nm Infrared Reduced haemoglobin Hb Oxygenated haemoglobin HbO2 Wavelength nm Absorption coefficient The light alternately emitted by the diodes is completely absorbed by the pulsating arte...

Страница 175: ...stive change of resistance in a membrane Determination of PEEP and plateau pressure PEEP positive end expiratory pressure is the airway pressure at the end of expiration The plateau pressure is the ai...

Страница 176: ...idestream sensor the sensor capsule is worn and must be replaced by a new capsule Description O2 measurement 176 Calibrating the O2 sensor for sampling measurement with 100 by volume O2 Required for t...

Страница 177: ...lete with connecting cable breathing system of the Cicero EM Shake the sensor briefly in the ambient air to purge it of any residual breathing system gases Tightly seal the sensor openings on at least...

Страница 178: ...chgasflow Inhalation anaesthesia with low fresh gas flow published by Thieme Stuttgart 1992 Disturbance variables in sidestream gas measurement When assessing the measured values the temperature humid...

Страница 179: ...nger of fresh gas shortage an advisory message is displayed before the caution message FRESH GAS appears on the screen In the case of excess fresh gas flow the Cicero EM ventilator releases the excess...

Страница 180: ...the patient can breathe spontaneously In order to prevent the next mandatory breath being applied during the expiratory phase of spontaneous breathing a trigger function ensures that the mandatory ven...

Страница 181: ...expiration phase The mandatorily applied minute volume may increase if an automatic ventilation stroke is applied at the beginning of each trigger period The duration of a mandatory stroke plus the s...

Страница 182: ...is limited but at least 9 L min depending on the pressure in the gas supply the minimum O2 concentration increases above approx 2500 mL min until both flow tubes are completely open and the mixing ra...

Страница 183: ...s of these signals contain important diagnostic information which can be determined with the aid of Fourier transformation and displayed on the monitor The amplitudes are determined for specific time...

Страница 184: ...art of the Cicero is normally 83 cm above the floor The height adjustment of the DVE permits a relative adjustment of 30 cm The rate of lift equals 15 mm s Further technical details can be found in th...

Страница 185: ...iliary mains sockets The auxiliary mains sockets are not installed on the ceiling version Articulated arm The articulated arm is attached to the journal of the support at the left hand side Dimensions...

Страница 186: ...DVE units with extension arm Upper key for ceiling and end bearings Lower key for intermediate bearing 4 Swing supporting flap down again The DVE can no longer be operated via its own keypad Plug the...

Страница 187: ...required position Single arm DVE units Upper key for ceiling bearing Lower key for end bearing Two armed DVE units with extension arm Upper key for ceiling and end bearings Lower key for intermediate...

Страница 188: ...Cicero EM The machine can then only be raised via the keypad on the DVE If the machine subsequently remains at an angle on its mounting journal Briefly lower it onto the ground and pick it up again wi...

Страница 189: ...xide haemoglobin HbO2 Oxyhaemoglobin HLM Heart lung mode in CO2 Inspiratory CO2 concentration INOP Malfunctioning IPPV Automatic ventilation mode intermittent positive pressure ventilation KG Body wei...

Страница 190: ...se menu return to preceding menu level Important note P Connection for equipotential bonding m Protection class type B DIN IEC 601 m Protection class type BF DIN IEC 601 Request for action Action has...

Страница 191: ...e location channels 95 Breath volumeter 59 Breathing system assembling 126 Breathing system checking 23 Breathing system dismantling 118 Breathing system heating 118 Breathing system installation 127...

Страница 192: ...ensor calibration 65 Flow sensor installation 130 Flow sensor removal 119 Fresh gas hose connecting 128 Fresh gas setting instructions 168 Function keys parameter box 145 Fuses 152 Gas control plate o...

Страница 193: ...n 142 Operating controls ventilator 141 Operating readiness based on checklist 21 Operating start up quick emergency 6 Overall trend 71 OXISENSOR SpO2 measurement 172 Oxygen saturation calculated meas...

Страница 194: ...by 44 Starting pressure NiBP 92 Steam sterilisation 124 Sterilisation procedure 123 Sterilising steam 124 Stop watch 76 Subsystems location of 101 Switch on lock 17 Switching off end of operation 44 S...

Страница 195: ...195...

Страница 196: ...ormation only and are not intended for use with any specific machine or device Dr ger Medizintechnik GmbH Germany H Moislinger Allee 53 55 D 23542 L beck T 4 51 8 82 0 X 26 80 70 FAX 4 51 8 82 20 80 h...

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