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1-36-96 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Julian Anaesthetic Workstation Instructions for Use Software 3.n How to use these Instructions for Use How to use these Instructions for Use "Only for internal use by Draeger. Not applicable as Instructions for Use!" In the header is the subject… of the main chapter. Underneath is the title of the subchapter, to help you find your way around quickly. Operation Selecting the ventilation mode MAN/SPONT 1 Press the »MAN/SPONT« key, 2 and confirm with the rotary knob. Julian On each page… the instructions for use combining text with illustrations. The information is translated directly into actions to enable the user to learn „hands-on“ how to use the workstation. Left-hand column: the text… provides explanations and guides the user clearly and ergonomically with brief directions on the use of the product. Bullet points indicate the steps to be followed, and where there are several steps, numbers refer to the illustration and indicate the sequence. 2 1 Display (example): MAN/SPONT Pleth SpO2 40 MV 0 O2 VT 0.65 -- N2O 0 0 Start volumeter: Confirm O2 % L/min 50 4.00 Screen displays guide the user and confirm the steps to be followed. 0.5 1 Volumeter --s Freshgas O2 + N2O Right-hand column: the illustration… provides the link with the text and serves as a guide to the workstation. Points mentioned in the text are emphasised and non-essential information is omitted. etCO2 CO2 Enf. 5 10 ! freshgas internal external O2 flush – For flushing and rapidly filling the breathing system and breathing bag with O2 while bypassing the Vapor unit. 3 Press the »O2 +« button. O2 flows into the breathing system without anaesthetic gas as long as the button is held down. 3 2 Iso. 98 38 5.2 67 FiCO2 _ freq 8 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) 1.3 alarm limits CO2-al. on/off alarm info list curves config. Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents For Your Safety and that of Your Patients 5 Intended Use 7 Operating Concept 11 Before Using for the First Time 19 Preparation 21 Starting Up 25 Operation 35 Monitoring 55 Configuring in Standby Mode 81 Care 97 Julian as Wall-mounted Unit 115 Maintenance Intervals 117 Fault – Cause – Remedy 121 What's what 127 Technical Data 133 Abbreviations / Symbols 141 Index 144 3 4 "Only for internal use by Draeger. Not applicable as Instructions for Use!" For Your Safety and that of Your Patients For Your Safety and that of Your Patients "Only for internal use by Draeger. Not applicable as Instructions for Use!" Strictly follow the Instructions for Use Any use of the apparatus requires full understanding and strict observation of these instructions. The apparatus is only to be used for purposes specified here. Maintenance The apparatus must be inspected and serviced regularly by trained service personnel at six monthly intervals (and a record kept). Repair and general overhaul of the apparatus may only be carried out by trained service personnel. We recommend that a service contract be obtained with DrägerService and that all repairs also be carried out by them. Only authentic Dräger spare parts may be used for maintenance. Observe chapter "Maintenance Intervals". Accessories Do not use accessory parts other than those in the order list. Not for use in areas of explosion hazard 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 to equipment which is not listed in these Instructions for Use should only be made following consultations with the respective manufacturers or an expert. Liability for proper function or damage The liability for the proper function of the apparatus is irrevocably transferred to the owner or operator to the extent that the apparatus is serviced or repaired by personnel not employed or authorized by DrägerService or if the apparatus is used in a manner not conforming to its intended use. Dräger cannot be held responsible for damage caused by non-compliance with the recommendations given above. The warranty and liability provisions of the terms of sale and delivery of Dräger are likewise not modified by the recommendations given above. Dräger Medizintechnik GmbH 5 6 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Intended Use Contents Intended Use Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Intended Use............................................................................................. 9 7 8 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Intended Use Intended Use Julian Anaesthetic Workstation for patients with a body weight of 5 kg and over with the use of IPPV ventilation. For the use of: Monitoring by means of adjustable alarm limits that are automatically adapted to the ventilation mode. "Only for internal use by Draeger. Not applicable as Instructions for Use!" – Inhalation anaesthesia in rebreathing systems – Inhalation anaesthesia in semi-closed to virtually closed systems with "low flow" and "minimal flow" techniques (for minimal gas and anaesthetic agent consumption). The workstation may only be used under the supervision of qualified medical personnel, so that assistance can be provided immediately in the event of any malfunctions. – Inhalation anaesthesia in non-rebreathing systems, with separate fresh gas outlet for the connection of e.g. the Bain system or Magill system with a fresh gas flow of 0.5 to 12 L/min. Ventilation modes: – Automatic ventilation (IPPV) and pressure-controlled ventilation (PCV). – Manual ventilation (MAN). – Spontaneous ventilation (SPONT). The following measured values are displayed: – Peak pressure, mean pressure, plateau pressure and PEEP Explosive anaesthetics, such as ether or cyclopropane, must not be used due to the risk of fire. Mobile radio telephones must not be used within 10 metres of the workstation! Mobile telephones may interfere with the operation of electrical and electronic medical equipment.* Julian must not be used with nuclear spin tomography (MRT, NMR, NMI)! Operation of the apparatus may be impaired. – Expiratory minute ventilation Tidal volume VT Breathing rate Patient compliance – Inspiratory and expiratory concentration of O2, N2O, anaesthetic gas and CO2 optional: – Functional oxygen saturation (SpO2) and pulse rate. The following parameters are displayed as curves: – Airway pressure – Expiratory flow – Inspiratory and expiratory concentration of O2, CO2 and anaesthetic gas optional: – Plethysmogram Trend curves and measured value lists are also available. * Dräger medical equipment fulfils the interference resistance requirements according to the product-specific standards or EN 60601-1-2 (IEC 601-1-2). However, depending on the design of the mobile phone and circumstances of use, field strengths may occur in the immediate environment of a mobile phone that exceed the limits of the above standards and therefore cause interference. 9 10 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Operating Concept Contents Operating Concept "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents Screen ergonomics.................................................................................12 Selecting / setting ventilation parameters.................................................. 14 Selecting / setting monitoring functions.....................................................15 Screen layout.......................................................................................... 16 Three basic screens for monitoring........................................................... 17 The standard screen.................................................................................17 The data screen....................................................................................... 17 The trend screen...................................................................................... 18 11 Operating Concept Screen ergonomics Operating Concept Screen ergonomics Monitoring All the settings required for IPPV – Fresh gas delivery Pleth "Only for internal use by Draeger. Not applicable as Instructions for Use!" etCO2 CO2 – Monitoring are entered on the system screen using the appropriate keys and the rotary knob. The keys are grouped in function fields: Left-hand field Fresh gas delivery 40 MV 0 Freshgas O2+N2O O2 % L/min 50 4.00 Pmax Fet 45 53 0.8 0.6 41 51 0.6 0.5 Freq. TI:TE 1/min MAN SPONT IPPV list .. 12... curves config. 1.3 TIP:TI PEEP % mbar 25 600 10 1:2.0 10 AIR N 2O VT mL mbar 0 PCV Ventilation IPPV Pleth SpO2 etCO2 CO2 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 67 38 6.0 freq alarm limits auto set limits 10 alarm info Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O O2 % L/min 50 4.00 AIR N 2O 1 12 alarm info Fi MAC (age: 36) 40 These function keys are located in the bottom row on the control panel. Left-hand block for fresh gas setting Right-hand block for ventilation freq 10 Enf. 0 The main functions for anaesthesia, e.g. selection of N2O or AIR, or selection of ventilation modes, can be selected directly by keys with permanently defined functions ("hardkeys"): 2 Right-hand block The »MAN SPONT«, »IPPV« or »PCV« keys select the ventilation mode. 38 6.0 alarm limits auto set limits N2O Iso. Fresh gas delivery 1 Left-hand block The »N2O« or »AIR« keys are used to select the gas to be mixed with O2 for the fresh gas mix. 67 O2 PAW 20 Right-hand field Ventilation Middle field Monitoring 98 SpO2 – Ventilation Pmax mbar VT mL Freq. TI:TE 1/min IPPV 2 PCV curves config. 1.3 TIP:TI PEEP % mbar 35 600 10 1:2.0 10 MAN SPONT list 0 .. 12... Operating Concept Screen ergonomics Complementary "softkeys" with variable functions are provided at the bottom edge of the screen, above each group of hardkeys. These softkeys are used to set the fresh gas delivery parameters and ventilation parameters. IPPV Pleth etCO2 CO2 40 1 Left-hand block: The keys for setting the O2 concentration and fresh gas flow. MV 0 N2O "Only for internal use by Draeger. Not applicable as Instructions for Use!" Freshgas O2+N2O O2 % Pmax mbar L/min 50 4.00 VT mL Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 Freq. N 2O TI:TE 1/min alarm limits auto set limits alarm info list .. 12... curves config. 1.3 TIP:TI PEEP % mbar 35 600 10 1:2.0 10 1 0 2 MAN SPONT AIR IPPV PCV IPPV In a prominent position at the bottom right-hand side: Pleth SpO2 etCO2 CO2 40 MV 0 O2 PAW 20 – to set and confirm the parameters for fresh gas and ventilation modes, freq MAC (age: 36) The current parameter values are displayed in the softkey field. – to confirm the selected carrier gas or a ventilation mode, 10 Enf. These softkeys have different functions, depending on the operating status or ventilation mode. 4 confirm = press 38 6.0 Iso. 2 Right-hand block: The keys for setting the parameters for the relevant ventilation mode. The example shows the parameters for IPPV controlled ventilation. 3 select = turn 67 O2 PAW 20 0 The "turn-and-push" rotary knob is the main operating control of the apparatus and has the following functions in all setting operations: 98 SpO2 N2O Iso. Enf. 0 98 67 38 6.0 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O O2 % L/min 50 4.00 Pmax mbar VT mL Freq. TI:TE 1/min AIR MAN SPONT alarm info list .. 12... curves config. 1.3 TIP:TI PEEP % mbar 35 600 10 1:2.0 10 – to set and confirm the monitoring functions. N 2O freq alarm limits auto set limits 0 3 IPPV PCV Beside the rotary knob: The standby key E for switching over to standby mode. 5 Press standby key E and confirm by pressing the rotary knob. 5 4 13 Operating Concept Screen ergonomics Selecting / setting ventilation parameters Julian Example: PEEP ventilation parameter 1 Press the softkey »PEEP«. 2 Select the PEEP value = turn the rotary knob. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 3 Confirm the PEEP value = press the rotary knob. 1 2 3 The keys for the various monitoring functions are located on the right-hand side of the screen. IPPV Pleth SpO2 These keys also have different functions = softkeys, depending on the monitoring screen required. etCO2 CO2 40 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 67 38 6.0 freq alarm limits auto set limits 10 alarm info Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O O2 % L/min 50 4.00 N 2O 14 AIR Pmax mbar VT mL Freq. TI:TE 1/min IPPV PCV curves config. 1.3 TIP:TI PEEP % mbar 35 600 10 1:2.0 10 MAN SPONT list 0 .. 12... Operating Concept Screen ergonomics Selecting / setting monitoring functions Julian For example, to change the lower alarm limit of the endtidal CO2 concentration. 1 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Press the »alarm limits« softkey. The alarm limits menu is displayed on the screen. IPPV Pleth SpO2 CO2 etCO2 40 MV 0 FiO2 PAW 20 FiHal. -95 98 67 38 6.0 29 0.8 120 50 42 30 auto set limits alarm info -3.0 list -20 curves 1.0 0.0 0 alarm limits config. 40 8 PAW Select limit: Turn and confirm ! ! Freshgas O2 + N2O Pmax O2 % 50 1.00 ● Freq. TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 IPPV Pleth Set the alarm limit value = turn the rotary knob. SpO2 ● TI:TE 1/min Select the alarm limit value = turn the rotary knob. Confirm the selection = press the rotary knob. The limit value is highlighted. Example: lower alarm limit etCO2: <30 ● VT mL mbar L/min Confirm the new alarm limit = press the rotary knob. The cursor returns to the zsymbol. CO2 etCO2 40 MV 0 FiO2 PAW 20 FiHal. -95 98 67 38 6.0 29 0.8 120 50 42 30 -3.0 -20 1.0 0.0 0 auto set limits alarm info list curves config. 40 8 PAW Select limit value: Turn and confirm alarm limits ! Freshgas O2 + N2O O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 15 Operating Concept Screen ergonomics Screen layout Exit the alarm limits menu: Julian "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Press the rotary knob or 2 Press the Q key. 2 1 The function keys for standard functions are located on the right-hand side of the control panel. IPPV Pleth 98 SpO2 G Suppress the acoustic alarm for 2 minutes. S Select the screen page. Q Back to standard page. etCO2 CO2 40 MV 38 6.0 O2 0 PAW 20 N2O Iso. Enf. 0 67 O2 % Pmax mbar L/min 50 4.00 N 2O Screen layout ➀ Status field: Freq. MAN SPONT AIR 45 53 0.8 0.6 41 51 0.6 0.5 TI:TE 1/min IPPV ➃ Numerical value field: For numerical values ➄ Lower softkeys – for fresh gas parameters ➅ Prompt field: For user guidance ➆ Lower softkeys – for ventilation parameters ➇ Right-hand softkeys – for monitoring: For rapid selection of the desired monitoring function 16 .. 12... curves config. 1.3 TIP:TI PEEP % mbar ➂ 0 ➃ IPPV Pleth SpO2 For curves and bargraphs Displays information on the alarms, warnings, etc. and their priority list PCV ➁ ➁ Graphics field: ➂ Alarm field: alarm info Fet 35 600 10 1:2.0 10 ➀ Displays information on the current operating mode VT mL 10 Fi MAC (age: 36) Freshgas O2+N2O freq alarm limits auto set limits etCO2 CO2 40 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 38 6.0 O2 % L/min 50 4.00 ➄ Pmax VT mbar mL Freq. 1/min freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O 67 TI:TE ➆ auto set limits alarm info list curves config. 1.3 TIP:TI PEEP % mbar 35 600 10 1:2.0 10 ➅ alarm limits 0 ➇ Operating Concept Screen layout Three basic screens for monitoring To call up the standard screen, data screen and trend screen in succession: Julian "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Briefly press the S key until the desired screen is displayed. 2 1 Back to the standard screen: 2 Press the Q key. The fresh gas and ventilation parameters can be set by means of the softkeys in each of the three basic screens. The standard screen with three selectable curves. The most important numerical values are displayed in groups on the right-hand side of the screen. IPPV Pleth 98 SpO2 etCO2 CO2 40 MV 38 6.0 O2 0 PAW 20 N2O Iso. Enf. 0 67 freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 O2 % L/min 50 4.00 The data screen contains all the numerical values with their units of measure. Pmax VT mL mbar Freq. TI:TE auto set limits alarm info list curves config. 1.3 MAC (age: 36) Freshgas O2+N2O alarm limits TIP:TI PEEP % mbar 1/min 25 600 10 1:2.0 10 0 IPPV PAW peak plat. 40 PEEP mean compliance 27 20 5 15 65 mbar 6.0 VT 0.60 freq 10 AW-temp. 34 0 98 67 1/min Fi Fet 0 40 58 0.8 0.4 MAC (age: 36) 36 33 56 0.6 0.5 1.3 1/min 15. Dec. 99 12 : 00 °C sys. comp. 6.40 mL/mbar leckage 10 mL/min mbar CO2 mmHg mbar O2 % mL/mbar N2O % 20 MV SpO2 % mbar Iso. % L/min Enf. % L alarm limits auto set limits alarm info list config. 01-10 8 : 00 Freshgas O2 + N2O Pmax O2 % L/min 50 1.00 mbar VT mL Freq. 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 17 Operating Concept Screen layout The trend screen displays the recorded progress of the numerical values over time since measurement started. The current measured values are displayed on the right-hand side. IPPV PAW 60 SpO2 40 0 11:00 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 20 0 98 67 30 etCO2 Display (example): Trends for CO2 and minute ventilation MV CO2 12:00 13:00 MV MV 15 O2 10 N2O Iso. Enf. 5 38 6.0 freq AGas N 2O Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 O2 compl. Zoom in: Press ! CO2 MV 10 SpO2 pulse full trend 1.3 MAC (age: 36) 0 Select zoom area: Turn alarm limits ! Freshgas O2 + N2O O2 % L/min 50 1.00 18 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Before Using for the First Time Contents Before Using for the First Time Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Charging the battery for emergency operation...................................... 20 When Julian is not in use........................................................................ 20 19 Before Using for the First Time Charging the battery for emergency operation When Julian is not in use Before Using for the First Time "Only for internal use by Draeger. Not applicable as Instructions for Use!" Fit the enclosed O2 sensor, page 119 "Replacing O2 sensor" Fit the flow sensor, page 108. Charging the battery for emergency operation Julian has a built-in uninterruptible power supply UPS which maintains the power supply for 30 minutes in the event of a mains failure, provided that the battery is charged. The switch-over to the battery-powered UPS is automatic and is indicated on the screen by the message: POWER FAIL! The battery recharges automatically when the workstation is plugged into the mains. 1 The battery must be charged for 10 hours before using the Workstation for the first time. ● Plug the mains plug of the Julian workstation into the mains socket. The mains voltage must correspond to the voltage specified on the nameplate. 1 The green LED N lights up. ● Leave Julian connected to the mains for 10 hours. The workstation does not have to be switched on. The devices connected to auxiliary power sockets will not be powered by the UPS in the event of a power failure. When Julian is not in use ● Charge battery at least every 4 weeks. Allowing it to run down can lead to damage. If Julian is out of use for an extended period: ● Leave the workstation connected to the mains at all times. 1 The green LED N is lit. 20 Preparation Contents Preparation "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents Connecting the gas supply..................................................................... 22 Connecting the backup gas cylinders for O2 and N2O .............................23 Caution when handling O2 cylinders......................................................... 23 Connecting the anaesthetic gas scavenging system............................. 23 Connecting the power supply................................................................. 24 Connecting auxiliary systems.................................................................... 24 Equipotential bonding............................................................................... 24 Connecting the power supply................................................................... 24 21 Preparation Connecting the gas supply Preparation Use only cleaned and disinfected parts! "Only for internal use by Draeger. Not applicable as Instructions for Use!" Connecting the gas supply 1 Screw the central gas supply pressure hoses for O2, AIR and N2O into the ports on the back of the gas supply block. The two ports at the front are reserved for the backup gas cylinders. 1 2 N2O AIR O2 VAC 2 The vacuum supply block (VAC) is available as option for secretion aspiration. Plug the other end of the pressure hoses into the wall supply points. ● Make sure the gas pressures of the central gas supply are between 2.7 and 5.5 bar: D Julian 3 All three pressure gauges in the green zone. 3 22 Preparation Connecting the gas supply Connecting the anaesthetic gas scavenging system Connecting the backup gas cylinders for O2 and N2O Even if the workstation is connected to a central gas supply, the cylinders must remain on the apparatus as backup supply. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● 2 2 On the back of the workstation: place full cylinders in the cylinder holders and secure in position. 1 Screw the pressure reducing adapters onto the cylinder valves. 2 Screw the gas hoses into the ports on the front of the gas supply block. 1 1 Switch over immediately to cylinder supply if the central gas supply fails: ● Open the cylinder valves. Caution when handling O2 cylinders ● Do not oil or grease the O2 cylinder valves or O2 pressure reducing adapters, and do not handle with greasy fingers. Danger of explosion! ● The cylinder valves must be opened / closed by hand. Do not use tools. ● If a cylinder valve is leaky or difficult to operate, it must be repaired by an expert. N2O O2 Connecting the anaesthetic gas scavenging system 3 Connect the transfer hose to the waste gas port and to the port of the scavenging system. 3 4 Connect the scavenging hose to the port of the scavenging system. 3 5 Connect the anaesthetic waste gas probe to the aspirating hose. 5 6 Ensure that the second connection to the scavenging system is sealed by a screw plug. ● Follow the Instructions for Use of the anaesthetic gas scavenging system. 6 3 4 23 Preparation Connecting the power supply Connecting the power supply Connecting auxiliary systems 1 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 connect to auxiliary sockets on the back of the workstation. The auxiliary sockets are not powered by the uninterruptible power supply UPS in the event of a power failure! Do not connect HF surgical devices to the auxiliary sockets! Connecting equipment to the auxiliary sockets may cause the patient leakage current to rise above the permitted values in the event of failure of a protective earth conductor. The risk of electric shock cannot be excluded in such cases. Additional power adapter sockets must not be connected to the auxiliary sockets. Equipotential bonding e.g. for intracardial or intracranial operations. 2 Connect one end of the earth cable to one of the connecting pins on the back of the workstation. ● Connect the other end of the earth cable to the specified equipotential bonding point, e.g. on the operating table or ceiling lamp. Connecting the power supply The mains voltage must be the same as specified on the nameplate on the back of the workstation. Voltage range: 90 to 265 V ● 24 Plug the mains plug into the wall socket. 2 Starting Up Contents Starting Up Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Checking the workstation against the checklist.................................... 26 Switching on............................................................................................ 26 Gas pressures.........................................................................................29 Central gas supply................................................................................... 29 Backup gas cylinders............................................................................... 29 Suction system.........................................................................................30 O2 flush .................................................................................................. 30 O2 emergency metering........................................................................... 30 Preparing Julian for the self-test................................................................ 31 Self-test...................................................................................................31 Electronics............................................................................................... 31 Fresh gas mixer........................................................................................31 Ventilator and breathing system ............................................................... 31 System compliance................................................................................ 32 Leakage................................................................................................... 32 Emergency start......................................................................................33 25 Starting Up Checking the workstation against the checklist Starting Up "Only for internal use by Draeger. Not applicable as Instructions for Use!" Checking the workstation against the checklist D Julian Preconditions: The workstation must be prepared as described on pages 97 to 107 and assembled ready for operation as described on pages 108 to 113. The gas supply and power supply must be connected. Switching on 1 Switch on Julian: press the power switch » «. 1 Version without rotary knob for O2 emergency metering: After switching on, Julian delivers an O2 flow of 8 L/min* for manual ventilation. This O2 flow is switched off automatically by Julian as soon as the »cancel test« key appears after acknowledging the checklist. The opening screen appears with the current software version after about 10 seconds. Julian now loads its software and tests its internal memory. Technology for life Julian 03.00 01-may-2000 Please wait ! The checklist is displayed after about 40 seconds. ● If the self-test has to be interrupted, e.g. for a quick start in an emergency: ● ● Check-list Julian Check the components as instructed in the checklist on the screen. Acknowledge the checklist: Press the rotary knob. After a few seconds, the »cancel test« softkey appears on the right-hand edge of the screen. Press the »cancel test« key. See "Emergency start" on page 33 to continue. Examine machine according to check-list prior to operation Before commencing test, close y-piece, connect gas sample-line and set APL valve to 30 Pa*100 (mbar) and "Man" Vapor Filling device Vapor Mont Interlock system Handwheel set to zero, fill level o.k. correctly closed Vaporiser present and locked into position non used vapor blocked Watertrap Gas scavenging system Breathing system Soda lime Emergency breathing bag Central gas supply Back up cylinders Suction unit O2-Flush level ok ? connected and ready for use complete (valve discs) and fixed in place no colour change present and functional O2 pressure, AIR, N2O pressure, 2.7 kPa*100 (bar) O2 pressure > 50 , N2O pressure > 30 kPa*100 (bar) functional audible flow, breathing bag fills Julian o.k. according to check-list? Please confirm * Can be set to 4 L/min by DrägerService 26 ! Starting Up Checking the workstation against the checklist "Vapor" anaesthetic vaporizer (example: Vapor 2000) 3 3 Only use Vapor 19.3, Vapor 2000 or Devapor. Follow the Instructions for Use for the particular vaporizer used. 0 The description and illustrations relate to Vapor 2000. 1 4 0 1 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Handwheel to "0" and engaged. 2 Filled to sufficient level. ● The plug-in adapter must fit evenly on the connection block. 2 2 3 The locking lever must point to the left = locked. 4 The unused Vapor unit must be locked by the interlock slider (example: left-hand Vapor locked). After filling or changing the Vapor: ● Carry out a leakage test, see page 48. Water trap ● Remove water trap container by pulling downwards and empty if necessary. ● Observe the hygiene regulations of the hospital. ● Replace container from below. When using the "Waterlock" water trap ● See separate Instructions for Use 27 Starting Up Checking the workstation against the checklist AGS anaesthetic gas scavenging system 1 The transfer hose from the waste gas port must be connected. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2 The scavenging hose must be connected; the anaesthetic waste gas probe must be plugged into the Dräger wall socket and the indicator must be green. 3 The float must be between the two marks. 1 2 1 2 3 Breathing system ● Complete and engaged, with both valve discs inserted, bellows fitted and hoses securely connected. ● Soda lime renewed, no violet discoloration. 28 Starting Up Checking the workstation against the checklist Emergency ventilating bag Example: Dräger Resutator 2000 "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Ready for operation. Central gas supply Gas pressures: 1 All pressure gauges in the green zone. D Julian 1 Backup gas cylinders 2 Slowly open the cylinder valves. 4 2 2 3 Check the cylinder pressure gauges: 3 O2 pressure greater than 50 bar, 4 N2O pressure greater than 30 bar. 2 Reclose the cylinder valves. N2O O2 29 Starting Up Checking the workstation against the checklist Suction system D Julian 1 Switch to I. 2 Set suction pressure with rotary knob »Vac.«. 3 Block the secretion viewing window or kink the suction hose. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 4 Measure the suction pressure on the pressure gauge. 1 Switch to 0. 4 1 3 O2 flush 2 D Julian 5 Press »O2 +« button. 6 The breathing bag inflates. 7 O2 flows from the Y-piece. Version with rotary knob for O2 emergency metering 8 5 8 Turn on rotary knob »Safety O2« for O2 emergency metering. 6 The breathing bag inflates. 7 O2 flows from the Y-piece. 8 Turn off rotary knob »Safety O2« for O2 emergency metering again. 30 7 6 Starting Up Checking the workstation against the checklist Preparing Julian for the self-test ● 2 Make sure that the breathing system is securely connected. 2 1 Close the Y-piece = plug firmly on to the cone. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2 Ensure that the sample line is connected to the Y-piece and to the water trap on the back of the workstation. 1 Self-test If all points on the checklist are OK: ● Confirm = press the rotary knob. The self-test is started. The self-test is run automatically and takes 3 to 4 minutes. 3 Julian essentially carries out the following automatic tests and actions, which are coded: 3 Electronics – Testing and calibration (Zeroing) of gas metering bench – Testing and calibration of O2 sensor – Testing of pressure sensor for airway pressure measurement – Testing the flow sensor – Activating the default settings for alarm limits, monitoring parameters and the default settings of the ventilator and fresh gas settings Self-test ventilator electronics ✓ 24 ✓ cancel test freshgas mixer Fresh gas mixer – – – – Testing of gas supply O2, N2O, AIR Testing of gas inlet valves Testing of O2 emergency metering Testing of fresh gas failure monitoring (optional) Ventilator – – – – – – Testing and calibration of PEEP/Pmax valves Testing of safety valve Testing of MAN/AUTO switch-over valve Testing of breathing phase valve Testing of internal pressure sensor Determination of compliance and leakage 31 Starting Up Checking the workstation against the checklist System compliance Julian determines the current system compliance. Depending on the breathing hoses used, the system compliance is 5 to 6 mL/bar. "Only for internal use by Draeger. Not applicable as Instructions for Use!" Leakage Julian determines the current leakage of the breathing system and breathing hoses. The system tolerates leaks of up to 150 mL/min. For leaks of more than 150 mL/min: ● Check the components of the breathing system, repair any leaks and repeat the leak test. Possible causes of leaks include: – – – – – – – – – – – damaged breathing hoses O2 sensor not connected, or incorrectly connected gas measurement sensor line not connected water trap not inserted breathing bag perforated Vapor not correctly connected / filling device open absorber not firmly screwed into place flow sensor not firmly screwed into place breathing system not correctly used microbe filter not firmly connected up measured gas return connection is open Self-test ventilator Display (example): electronics A tick (✓) indicates that the relevant test point has been completed successfully. The clock symbol u indicates the test stage is currently in progress. freshgas mixer ✓ ✓ system compliance 72 ✓ 5.00 mL/mbar cancel test leakage 16 mL/mbar Malfunctions detected in the self-test and any gas failures are displayed on the screen. Some malfunctions can be accepted by confirming = pressing the rotary knob, for example no AIR supply (AIR FAILURE!!!). Other malfunctions need to be corrected before starting up the workstation, for example no O2 supply (O2 FAILURE!!!). ● The progress of the self-test is shown on the bar display. Standby Julian leakage test 03.00 01-may-2000 delete trend config. Julian switches to standby after the self-test. Operation with Display: Freshgas O2+N2O O2 % L/min 50 4.00 32 MAN SPONT , IPPV or PCV Starting Up Emergency start Emergency start This procedure should only be used when there is no time for the self-test! D Julian "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Switch on the workstation. Version without rotary knob for O2 emergency metering: After switching on, Julian delivers an O2 flow of 8 L/min* for manual ventilation. Version with rotary knob for O2 emergency metering: 2 Set rotary knob »Safety-O2« for O2 emergency metering to the desired O2 flow. Range 0 to 12 L/min. ● Wait for the software to be internally loaded and for the electronics to be self-tested. The checklist appears after about 40 seconds. ● Confirm the checklist: press the rotary knob. After a few seconds, the »Cancel test« softkey is displayed on the right-hand edge of the screen. 1 2 Display: Self-test ● 36 Press the softkey »Cancel test«. The apparatus only runs through a minimal test. Julian is ready for operation about 1 minute after switching on. Calibration of the O2 sensor is complete after about 2 minutes. The leakage and compliance test is not performed. The accuracy levels specified in the "Technical Data" cannot be guaranteed. ventilator electronics ✓ cancel test freshgas mixer To prevent abuse of this facility, the self-test can only be cancelled 10 times in succession. The self-test cannot be cancelled the next time that Julian is started and a complete self-test must be run through.**. Cancelling a test can lead to malfunction. ● Greater attention is required during operation of the workstation. * ** Can be set to 4 L/min by DrägerService Can be set to unlimited self-test cancellation by DrägerService 33 Starting Up Emergency start The workstation switches to standby mode after completing the minimal test. Display (example): Standby First interruption of self-test Julian leakage test "Only for internal use by Draeger. Not applicable as Instructions for Use!" 03.00 01-may-2000 delete trend config. Operation with Freshgas O2 If no key is pressed in standby mode for two minutes, the standby screen is switched off and a screen saver with the Dräger logo is displayed instead. To switch the standby screen on again: ● Press the rotary knob or any other key. To start Julian: Version with rotary knob for O2 emergency metering: ● Turn rotary knob for O2 emergency metering to 0. ● Select fresh gas setting and ventilation mode. See »Operation«, page 36 onwards. 34 O2 % L/min 50 2.00 MAN SPONT , IPPV or PCV Operation Contents Operation "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents Setting the fresh gas concentrations..................................................... 36 Adjustment ranges................................................................................... 36 Selecting the carrier gas...........................................................................36 Setting the O2 concentration.................................................................... 36 Setting the fresh gas flow......................................................................... 37 Selecting the ventilation mode............................................................... 37 MAN/SPONT ventilation mode................................................................. 37 Manual ventilation..................................................................................... 37 Spontaneous breathing.............................................................................37 Monitoring mode...................................................................................... 40 IPPV ventilation mode...............................................................................40 Starting IPPV............................................................................................41 PCV ventilation mode............................................................................... 43 Starting PCV............................................................................................ 44 Setting the Vapor unit............................................................................. 46 Aspirating secretion................................................................................ 46 Changing patients...................................................................................47 Changing soda lime................................................................................ 47 Leakage test........................................................................................... 48 Ventilating children................................................................................. 49 Connecting the breathing hoses............................................................... 49 Using non-rebreathing systems..............................................................50 In the event of a power failure................................................................52 In the event of a gas failure.................................................................... 53 In the event of a Major Hardware Fault.................................................. 53 End of Operation.....................................................................................54 35 Operation Setting the fresh gas concentrations Operation Setting the fresh gas concentrations "Only for internal use by Draeger. Not applicable as Instructions for Use!" The fresh gas settings are displayed in the Standby screen: – »Fresh gas O2 + N2O« or »Fresh gas O2 + AIR« – O2 concentration »O2 %« – Standby Julian leakage test 03.00 01-may-2000 Fresh gas flow »L/min« The settings correspond to the configurable default values after switching on and after entering standby mode. The fresh gas settings can be modified before selecting the ventilation mode. Fresh gas does not flow in standby mode. The fresh gas flow is not enabled until a ventilation mode has been started. delete trend config. Operation with MAN SPONT , IPPV or PCV Freshgas O2+N2O O2 % L/min 50 4.00 Adjustment ranges and default settings on delivery Fresh gas parameters Carrier gas O2 % Fresh gas flow L/min Adjustment range Default setting on delivery AIR or N2O N2O 25 to 100 100 0* ; 0,5 to 12 2 Selecting the carrier gas 1 Press the »N2O« or »AIR« hardkey. The yellow LED in the selected key flashes. ● Julian Press the rotary knob to confirm. The yellow LED lights up constantly. The selected fresh gas components are displayed on the screen. Setting the O2 concentration 2 2 Press the softkey »O2%«. The key field is highlighted against a white background. ● Set and confirm the O2 concentration by means of the rotary knob. * Only in MAN/SPONT mode 36 1 Operation Setting the fresh gas flow Selecting the ventilation mode MAN/SPONT Setting the fresh gas flow Julian 1 Press the softkey »L/min«. The key field appears dark against a light background. Set and confirm the fresh gas flow by means of the rotary knob. Julian is fitted with an electronic O2 minimum dosing system to avoid hypoxic gas mixtures. For fresh gas flow settings below 1 L/min, the O2 concentration is automatically increased to a value corresponding to an O2 flow of 250 mL/min. If this control system is activated, the O2 value is highlighted in addition to the active softkey »L/min«. 1 Version with fresh gas failure detection (optional): During operation, Julian checks that the bellows are sufficiently full. If the message „Fresh gas ? !!“ appears: ● Increase the fresh gas flow The default settings valid whenever Julian is switched on can also be modified; see "Setting default values" on page 82. Selecting the ventilation mode MAN/SPONT ventilation mode Choose between manual ventilation MAN and spontaneous breathing SPONT on the APL pressure-limiting valve. Manual ventilation 2 Set the lever of the APL pressure-limiting valve to MAN. 2 MAN 3 Set the pressure limit = rotate lever. MAN 3 Spontaneous breathing 4 SPONT 4 Set the lever of the APL pressure-limiting valve to SPONT. The valve is open for a free spontaneous breathing stroke regardless of the set pressure limit. SPONT "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● 37 Operation Selecting the ventilation mode MAN/SPONT 1 Press the »MAN/SPONT« key, Julian "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2 and confirm with the rotary knob. 2 1 Display (example): MAN/SPONT Pleth SpO2 etCO2 CO2 40 MV 0 O2 VT 0.65 -- N2O 0 0.5 Volumeter --s 0 Start volumeter: Confirm Freshgas O2 + N2O O2 % Iso. 1 L/min 50 4.00 Enf. 5 98 38 5.2 FiCO2 _ freq 8 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) 10 67 1.3 ! freshgas internal external O2 flush D Julian – For flushing and rapidly filling the breathing system and breathing bag with O2 while bypassing the Vapor unit. 3 Press the »O2 +« button. O2 flows into the breathing system without anaesthetic gas as long as the button is held down. 3 38 alarm limits CO2-al. on/off alarm info list curves config. Operation Selecting the ventilation mode MAN/SPONT Certain alarms are automatically switched off in MAN/SPONT ventilation mode in order to avoid artefacts. The deactivated alarms are identified by the grey background in the table. "Only for internal use by Draeger. Not applicable as Instructions for Use!" Alarm limits in MAN/SPONT mode Default setting on delivery SpO2 _ ON ON –– 92 Pulse H _ ON ON 120 50 etCO2 _ * * 50 mmHg –– FiCO2 > _ * 5 mmHg * * –– –– FiO2 _ * ON –– 20 Fi Hal. _ ON OFF 1.5 –– Fi Iso. _ ON OFF 2.3 –– Fi Enf. _ ON OFF 3.4 –– Fi Des. _ ON OFF 12.0 –– Fi Sev. _ ON OFF 3.4 –– PAW _ ON OFF 40 –– MV Apnoea pressure OFF Apnoea flow OFF Apnoea CO2 ON activated after 60 seconds – – : The default setting on delivery is outside the monitoring range and the corresponding alarm limit is switched off. * The etCO2 _, FiCO2 >, MV _ and FiO2 > alarms can be configured »ON« or »OFF« in standby mode for the transition from MAN/SPONT. When the alarm limits are set to »ON«, the value is transferred from automatic ventilation mode. To set the values of the alarm limits during operation see page 60. To set the default alarm limits see page 87. 39 Operation Selecting the ventilation mode Monitoring mode IPPV Monitoring mode MAN/SPONT Pleth Fresh gas delivery can be deactivated in MAN/SPONT ventilation mode. ● Set fresh gas flow to 0.00 L/min and confirm. ● An audible signal sounds and Julian is now in monitoring mode. SpO2 et CO2 CO2 40 MV "Only for internal use by Draeger. Not applicable as Instructions for Use!" 0 Display (example): O2 8 VT 4 0.04 0 2 1 Volumeter --s 1 O2 0.5 Enf. 2.7 N2O 0 5 Start volumeter: Confirm Freshgas O2 + N2O O2 % L/min 50 0.00 N2O Iso. 10 98 67 alarm limits FiCO2 38 _ freq 5.2 8 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 CO2-al. on/off alarm info list curves config. 1.3 MAC (age: 36) ! fresh gas Monitoring mode only ! Freshgas delivery deactivated ! internal external IPPV ventilation mode IPPV = Intermittent Positive Pressure Ventilation Volume-controlled ventilation with fixed mandatory minute volume (MV), set with the tidal volume (VT), breathing rate (Freq.) and the ratio of inspiration time to expiration (TI:TE ). Presetting the ventilation parameters for IPPV Julian 1 Press the »IPPV« hardkey; its LED flashes. ● The six ventilation parameters for IPPV are displayed on the screen with their default settings. 2 Press the softkey for the desired ventilation parameter. 3 Set and confirm the ventilation parameter with the rotary knob. 2 3 1 Display (example): Standby Julian 03.00 01-may-2000 Operation with To Start IPPV: Confirm Freshgas O2 + N2O O2 % L/min 50 4.00 40 MAN SPONT , IPPV or PCV ! Pmax mbar VT mL Freq. 1/min TI:TE TIP:TI % 25 600 12 1:2.0 10 PEE mbar 0 Operation Selecting the ventilation mode IPPV Adjustment ranges and default settings on delivery "Only for internal use by Draeger. Not applicable as Instructions for Use!" Ventilation parameters Adjustment range Default setting on delivery* 10 to 70 25 50 to 1400 600 6 to 60 12 2.0:1 to 1:2.0 in increments of 0.1, 1:2.0 to 1:4.0, in increments of 0.5 1 : 2.0 Insp. pause time : Insp. time TIP : TI [%] 0 to 50 10 PEEP [mbar] 0 to 20 0 Pressure limit Pmax [mbar] Tidal volume VT [mL] Frequency Freq. [1/min] Insp/Exp ratio TI : TE For tidal volumes VT of less than 200 mL: ● Use the paediatric hose set, see "Ventilating children", page 49. In IPPV ventilation mode, automatic system compliance compensation takes place, and the applied tidal volume therefore corresponds to the set volume. Julian Starting IPPV 1 Press the »IPPV« hardkey 2 and confirm with the rotary knob. Display (example): 2 1 The preset ventilation parameters are displayed on the screen. The symbol rotates in the softkey »L/min« to indicate that fresh gas is flowing. IPPV Pleth SpO2 If a change in ventilation parameters is required: ● Press the corresponding softkey. Set and confirm the ventilation parameter with the rotary knob. etCO2 CO2 40 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 38 6.0 Freshgas O2+N2O The default values can be set specifically for each hospital, see page 82. O2 % L/min 50 4.00 Pmax mbar VT mL Freq. 1/min freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) * 67 TI:TE alarm limits auto set limits alarm info list curves config. 1.3 TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 41 Operation Selecting the ventilation mode IPPV Alarms effective in IPPV mode "Only for internal use by Draeger. Not applicable as Instructions for Use!" Alarm limits In IPPV mode Default setting on delivery SpO2 _ ON ON –– 92 Pulse H _ ON ON 120 50 etCO2 _ ON ON 50 mmHg –– FiCO2 > _ ON 5 mmHg ON ON –– 3.0 FiO2 _ ON ON –– 20 Fi Hal. _ ON ON 1.5 –– Fi Iso. _ ON ON 2.3 –– Fi Enf. _ ON ON 3.4 –– Fi Des. _ ON ON 12.0 –– Fi Sev. _ ON ON 3.4 –– PAW _ ON ON 40 8 MV Apnoea pressure ON Active after 15 seconds Apnoea flow ON Active after 15 seconds Apnoea CO2 ON Active after 15 seconds – – : The default setting on delivery is outside the monitoring range and the corresponding alarm limit is switched off. To set the values of the alarm limits during operation see page 60. To set the default alarm limits see page 87. 42 Operation Selecting the ventilation mode PCV PCV ventilation mode "Only for internal use by Draeger. Not applicable as Instructions for Use!" PCV = Pressure Controlled Ventilation In pressure controlled ventilation mode, the applied tidal volume depends on the ventilation parameters Pmax, insp. Flow, insp. Time, PEEP and the lung compliance. Changes in ventilation parameters or lung compliance influence the tidal volume and the MV minute volume must therefore be monitored constantly. Presetting ventilation parameters for PCV Julian 1 Press »PCV« its LED flashes. ● The five ventilation parameters for PCV appear on the screen with the default settings. 2 Press the softkey of the relevant ventilation parameter. 3 Set and confirm the ventilation parameter with the rotary knob. 2 3 1 Display (example): Standby Julian 03.00 01-may-2000 Operation with To Start PCV : Confirm Freshgas O2 + N2O O2 % L/min 50 4.00 MAN SPONT , IPPV or PCV ! Pmax Freq. mbar 1/min 15 TI:TE Insp.Flow L/min 12 1:2.0 30 PEE mbar 0 43 Operation Selecting the ventilation mode PCV Adjustment ranges and default settings on delivery* "Only for internal use by Draeger. Not applicable as Instructions for Use!" Ventilation parameter Pressure limit Pmax [mbar] Frequency Freq. [1/min] Insp./Exp. ratio TI : TE Insp. flow [L/min] PEEP [mbar] Adjustment range (PEEP+1) to 70 6 to 60 Default setting on delivery 15 2.0:1 to 1:2.0 in increments of 0.1, 1:2.0 to 1:4.0, in increments of 0.5 1 : 2.0 5 to 50 (75**) 0 to 20 30 0 12 When ventilating infants weighing less than 20 kg: ● Use the paediatric hose set; see page 49 "Ventilating children". Starting PCV Julian 1 Press »PCV«. 2 Confirm by pressing the rotary knob. 2 1 Display (example): IPPV The preset ventilation parameters appear on the screen. Pleth Fresh gas flows, as indicated by the rotating symbol in the softkey »L/min«. If a change in ventilation parameters is required: ● Press the relevant softkey. Set and confirm the ventilation parameter with the rotary knob. SpO2 etCO2 CO2 40 MV 0 O2 PAW 20 N2O Iso. Enf. 0 98 67 38 6.0 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) * The default settings can be set specifically for each hospital, see page 82. ** Can be set by DrägerService. 44 Freshgas O2+N2O O2 % L/min 50 4.00 Pinsp mbar VT mL Freq. 1/min freq TI:TE alarm limits auto set limits alarm info list curves config. 1.3 TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Operation Selecting the ventilation mode PCV Alarms effective in PCV mode "Only for internal use by Draeger. Not applicable as Instructions for Use!" Alarm limits In PCV mode Default setting on delivery SpO2 _ ON ON –– 92 Pulse H _ ON ON 120 50 etCO2 _ ON ON 50 mmHg –– FiCO2 > ON 5 mmHg MV _ ON ON –– 3.0 FiO2 _ ON ON –– 20 Fi Hal. _ ON ON 1.5 –– Fi Iso. _ ON ON 2.3 –– Fi Enf. _ ON ON 3.4 –– Fi Des. _ ON ON 12.0 –– Fi Sev. _ ON ON 3.4 –– PAW _ ON ON 40 8 Apnoea pressure ON Active after 15 seconds Apnoea flow ON Active after 15 seconds Apnoea CO2 ON Active after 15 seconds – – : The default setting on delivery is outside the monitoring range and the corresponding alarm limit is switched off. To set the values of the alarm limits during operation see page 60. To set the default alarm limits see page 87. 45 Operation Setting the Vapor unit Aspirating secretion Setting the Vapor unit 1 Lock the unused Vapor unit = push lever fully in the direction of the unused Vapor (example: left-hand Vapor locked). 0 If the handwheel is in the »T« position: 1 0 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2 Press 0 button and engage handwheel at 0. Wait 5 seconds for pressure compensation. 3 2 2 Press 0 button and 3 Turn handwheel anti-clockwise to required anaesthetic agent concentration. Aspirating secretion ● Swing the bottles forwards. D 1 Set the switch to I. Julian 2 Seal the "fingertip" or kink the suction hose and 3 Set the appropriate suction pressure for the patient with the rotary knob »Vac.« and 4 check on the pressure gauge. 4 Observe the hygiene regulations of the hospital! 1 2 After aspirating ● Rinse the suction hose with the water purifier. 1 Set the switch to 0. 46 3 Operation Changing patients Changing soda lime Changing patients To switch Julian to standby: ● Press the Standby key E and confirm with the rotary knob. Standby "Only for internal use by Draeger. Not applicable as Instructions for Use!" The functions of the workstation are switched off. The set alarm limits are cancelled and the default alarm settings are valid again. Julian leakage test 03.00 01-may-2000 The default settings are loaded for dosing anaesthetic gas and for the ventilation parameters. delete trend config. If the ventilation hoses have been changed: ● Perform a leakage test, page 48. Operation with MAN SPONT , IPPV or PCV Freshgas O2+N2O O2 % L/min 50 4.00 Changing soda lime – If the soda lime in the absorber has turned violet. 1 – If the inspiratory CO2 concentration FiCO2 equals 5 mmHg or more. ● Press the Standby key E and confirm by pressing the rotary knob. 1 Raise the writing top. 2 Pull the catch and draw out the breathing system at the same time. 2 3 Turn the absorber counterclockwise and pull it out downwards. ● Drain the used soda lime and dispose of with domestic waste. ● Fill the absorber with fresh soda lime up to the MAX mark. ● Fit the absorber to the breathing system from below and turn it clockwise as far as it will go. ● Push the breathing system inwards until it clicks into place. ● Fold down the writing top. MAX 3 47 Operation Leakage test Leakage test Must not be performed when a patient is connected to the workstation! – When the soda lime has been changed or "Only for internal use by Draeger. Not applicable as Instructions for Use!" – when the breathing hoses have been changed. – if the Vapor has been changed or topped up. ● test with the handwheel set to »0« and ● test with the handwheel set to less than 0.2% by vol. ● After the leakage test, turn handwheel to »0«. 1 Close the Y-piece = place firmly on the cone. 2 2 Ensure that the sample line is connected to the Y-piece and to the water trap at the back of the workstation. ● 2 Press the softkey »leakage« in standby mode. 1 Julian performs the leakage test for IPPV/PCV and determines the volume correction for system compliance. Duration approx. 30 seconds. The breathing bag and its hose are not included in the test. Display: Leakage test After the test has been successfully completed, the clock symbol disappears and Julian displays the values for leakage and system compliance for a few seconds. The results of the leakage test are continually displayed on the data screen. To return to the standby screen: ● 48 Press the rotary knob. Systemcompliance Leakage Please wait. cancel test Operation Ventilating children Ventilating children For tidal volumes VT of less than 200 mL: ● Use paediatric hoses. Connecting the breathing hoses "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Use Y-piece with connection for sample line. ● The inspiratory and expiratory microbial filter 654 St should not be used – this reduces the system compliance. 1 3 2 2 Connect 0.5 L breathing bag with socket to the breathing hose with the large connection sleeves. Slip the breathing hose over the angled socket. Hang the 0.5 L breathing bag onto the hook. 3 Slip the breathing hoses with the large sleeves onto the inspiratory and expiratory sockets and connect the small sleeves to the Y-piece. 4 Connect the sample line to the Y-piece and water trap. ● 4 Set the sample rate to 200 mL/min, page 84. If the measured gas is not recirculated: ● Increase the tidal volume VT in accordance with the sample rate. Volumeter function: ● Select »Child« scale, page 67. To determine system compliance and leakage: 5 Firmly connect the Y-piece to the cone. ● Determine the system compliance and leakage, see „Leakage test“ on page 48. Set a correspondingly higher tidal volume VT in accordance with the airway pressure PAW. ● Use PCV or IPPV ventilation mode. 5 49 Operation Using non-rebreathing systems Using non-rebreathing systems "Only for internal use by Draeger. Not applicable as Instructions for Use!" Example: Bain system ● Prepare the Bain system in accordance with the separate Instructions for Use. ● Remove sample line from Y-piece, as otherwise Julian activates a PAW NEGATIVE alarm. 2 3 1 For the specified monitoring of O2, CO2 and anaesthetic agents: 1 Screw the sample line to the Luer lock connection of the mask manifold pipe and to the water trap on the back of the workstation. For mask pipes without sample line connector: ● Place a T-piece with filter between the mask pipe and fresh gas connection port. or: ● where applicable, use the Luer lock connection of a filter. 2 Connect the fresh gas hose of the Bain system to the fresh gas outlet. 3 Connect the anaesthetic gas scavenging system AGS to the Bain system. ● Note the Instructions for Use of the Bain system. MAN/SPONT Display (example): Pleth SpO2 In MAN/SPONT ventilation mode: ● Press the softkey »Fresh gas internal / external«, select »Fresh gas external« and confirm by pressing the rotary knob. etCO2 CO2 40 MV 0 O2 VT 0.65 -- 0 0.5 Volumeter --s 0 Start volumeter: Confirm Freshgas O2 + N2O O2 % L/min 50 4.00 50 1 N2O Iso. Enf. 5 10 ! freshgas internal external 98 38 5.2 67 FiCO2 _ freq 8 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) 1.3 alarm limits CO2-al. on/off alarm info list curves config. Operation Using non-rebreathing systems Display (example): FRESHGAS EXTERNAL Pleth The airway pressure (PAW), minute volume (MV) and frequency are not measured. ● Set the fresh gas flow. The fresh gas supply must be at least twice the minute volume in order to prevent rebreathing. SpO2 etCO2 CO2 40 MV "Only for internal use by Draeger. Not applicable as Instructions for Use!" 0 O2 Certain alarms are automatically switched off in order to avoid artefacts. The inactive alarm limits are highlighted by the grey background in the following table. Alarm limits In external fresh gas mode Default setting on delivery N2O Iso. Enf. _ ON ON –– 92 Pulse H _ ON ON 120 50 etCO2 _ * * FiCO2 > * 50 mmHg –– –– MV _ OFF OFF –– –– FiO2 _ * ON –– 20 Fi Hal. _ ON OFF 1,5 –– Fi Iso. _ ON OFF 2,3 –– Fi Enf. _ ON OFF 3,4 –– Fi Des. _ ON OFF 12,0 –– Fi Sev. _ ON OFF 3,4 –– PAW _ ON OFF 40 –– Apnoe Druck OFF Apnoe Volumen OFF Apnoe CO2 ON * 38 -- 67 _ alarm limit freq CO2 al. on/off -- alarm info FiCO2 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) list curves config. 1.3 Freshgas O2 + N2O freshgas O2 % L/min 50 6.00 SpO2 98 internal external The etCO2 _, FiCO2 > and FiO2 > alarms can be configured »ON« or »OFF« in standby mode for the transition from MAN/SPONT. When the alarm limits are set to »ON«, the value is transferred from automatic ventilation mode. 51 Operation Using non-rebreathing systems In the event of a power failure Switch off the external fresh gas output: ● Press the softkey »Fresh gas internal / external«, select »Fresh gas internal« and confirm by pressing the rotary knob: Julian switches over to MAN/SPONT ventilation mode or "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Press the »IPPV« or »PCV« key and confirm with the rotary knob. Julian then switches over directly to controlled ventilation via the original rebreathing system. When changing from the external non-rebreathing system to the rebreathing system of the Julian: ● Reconnect the sample line to the Y-piece. In the event of a power failure IPPV Julian automatically switches over to the integrated uninterruptible power supply (UPS). If the battery is charged, operation will be maintained for an average of 30 minutes. The message POWER FAIL ! Pleth SpO2 etCO2 CO2 40 MV POWER FAIL! 0 appears on the screen together with the remaining available battery capacity in percent. Example: J 95 % O2 PAW 20 N2O Iso. Enf. 0 98 38 6.0 O2 % L/min 50 1.00 Pmax mbar VT mL 25 600 Freq. 1/min freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O 67 TI:TE Version with rotary knob for O2 emergency metering: Set rotary knob »Safety-O2« for O2 emergency metering to the desired O2 flow. Range 0 to 12 L/min. This O2 flow flows through the Vapor unit. ● ● Check Vapor unit setting. ● Ventilate patient manually! * Can be set to 4 L/min by DrägerService 52 auto set limits alarm info list curves config. TIP:TI PEEP % mbar 10 1:2.0 10 In the event of a power failure if the battery is discharged, Julian switches over automatically to MAN/SPONT ventilation mode. The fresh gas mixer is deactivated. D alarm limits 1.3 If the battery is almost completely discharged, the message BATTERY LOW !!! appears on the screen. Version without rotary knob for O2 emergency metering: Julian automatically delivers an O2 flow of 8 L/min*. This O2 flow bypasses the Vapor unit, and so the patient no longer receives any anaesthetic agent. J 95 % Julian 0 Operation In the event of a gas failure System fault In the Event of a Major Hardware Fault In the event of a gas failure "Only for internal use by Draeger. Not applicable as Instructions for Use!" Julian activates an alarm if the O2 or AIR or N2O supply fails. ● Open the valve on the corresponding backup gas cylinder on the rear of the workstation. ● Reconnect the central gas supply. If there is no backup supply of gas available, Julian replaces the set gas mixture with AIR or O2: N2O O2 Julian delivers 100 % AIR if the O2 supply fails. Julian delivers 100 % O2 if the N2O supply fails. Julian delivers 100 % O2 if the AIR supply fails. The amount of fresh gas flow (L/min) remains constant. Fresh gas metering is still possible even in the event of failure of one of the gases. For example, if the N2O supply fails, AIR can be selected as the carrier gas. System fault MAN/SPONT such as implausible measured values, the message: VENT INOP!!! will be displayed. Julian first performs a warm start. Display (example): VENT INOP !!! 98 67 alarm SpO limits Pleth 2 MV 0 0.04 O2 0 0.5 1 Volumeter --s If the warm start is successful, Julian returns to the previous ventilation mode. 2.7 0 10 Fet 41 51 0.6 0.5 MAC (age: 36) alarm info list curves config. 1.3 ! MAN/SPONT SYSTEM FAULT !!! 98 67 alarm SpO limits Pleth 2 et CO2 CO2 40 MV Display (example): 0 O2 VT In the event of total system failure including the screen, an alarm will sound for about 30 seconds. In such cases Julian switches to MAN/SPONT ventilation mode. Fi 45 53 0.8 0.6 CO2-al. on/off MAN/SPONT ventilation mode is activated. Only manual ventilation is possible. Mechanical ventilation not available for about 30 sec. Internal system fault. In the event of a Major Hardware Fault The audio alarm can be switched off by acknowledging via the rotary knob. N2O Iso. Enf. 5 Start volumeter: Confirm such as the failure of the fresh gas mixer, the message: SYSTEM FAULT!!! will be displayed. 38 _ 5.2 8 40 VT If the warm start is unsuccessful, Julian behaves as described under "In the event of a major hardware fault". FiCO2 Freq et CO2 CO2 0.04 0 0.5 1 Volumeter --s 2.7 0 Switch off alarm: 5 N2O Iso. Enf. 10 FiCO2 Freq 38 _ 5.2 8 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) CO2-al. on/off alarm info list curves config. 1.3 Confirm! MAN/SPONT ventilation mode is activated. Only manual ventilation is possible. Fresh gas =100% O2 with fixed dosage >4 L/min. Equipment not dosing anaesthetic agent. Internal system fault has occurred. Mechanical ventilation not possible. 53 End of Operation Version without rotary knob for O2 emergency metering: Julian automatically delivers an O2 flow of 8 L/min*. This O2 flow bypasses the Vapor unit, and so the patient no longer receives any anaesthetic agent. Version with rotary knob for O2 emergency metering: Set rotary knob for O2 emergency metering to the desired O2 flow. Range 0 to 12 L/min. This O2 flow flows through the Vapor unit. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● ● Check the Vapor unit setting. ● Ventilate the patient manually! End of Operation To switch Julian to Standby: ● Press the standby key E and confirm by pressing the rotary knob. The workstation is now on standby. The fresh gas flow is switched off. Manual ventilation is not possible! The following default values are activated in standby mode: Fresh gas default values Ventilation parameters Alarm limits To switch Julian off: ● Press the power switch » « down completely. Julian is fitted with a switch-off delay. When the power switch is pressed, an audible signal sounds and the message "System can be switched on again without loss of data. System is being closed down and switched off" appears for 10 seconds. Within this 10-second period Julian can be restarted immediately by pressing the power switch again. The switch-off delay is not active during the self-test. ● Remove the gas supply probes from the wall sockets. ● Leave Julian plugged into the power supply in order to charge the uninterruptible power supply (UPS). ● In case of mains power supply failure, the power switch should always be switched off. Starting up the workstation with the power switch on and the UPS discharged leads to emergency dosage. To switch off the anaesthetic gas scavenging system AGS: ● Pull back the black sleeve on the connector of the suction hose to release the connector. * Can be set to 4 L/min by DrägerService 54 Monitoring Contents Monitoring Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Selecting the standard screen................................................................56 Selecting the data screen.......................................................................57 Selecting the trend screen..................................................................... 58 Zoom function.......................................................................................... 59 To delete the trend memory...................................................................... 59 Alarms..................................................................................................... 60 Displaying and setting alarm limits............................................................ 60 Adapting limits – AutoSet......................................................................... 62 If an alarm occurs................................................................................... 63 Alarm info................................................................................................64 CO2 alarms on /off................................................................................. 64 List display.............................................................................................. 65 Delete list................................................................................................. 65 Selecting curves..................................................................................... 66 Using the volumeter function................................................................. 67 Starting the volumeter...............................................................................67 Configuring in operation......................................................................... 68 Setting the monitoring functions................................................................69 Setting the pulse tone...............................................................................69 Setting the alarm sound............................................................................69 Selecting the scale................................................................................... 69 Setting the measuring parameters............................................................ 70 Record..................................................................................................... 71 Time.........................................................................................................71 Manual calibration...................................................................................72 Activating monitor defaults........................................................................72 Selecting alarms.......................................................................................72 Default..................................................................................................... 72 Alarm mode for the heart-lung machine HLM............................................ 73 MAC configuration.................................................................................. 74 Anaesthetic agent identification and display.............................................. 74 Calculating the MAC values......................................................................74 Displaying MAC....................................................................................... 75 SpO2 Measurement (optional)................................................................. 76 Sensor selection.......................................................................................76 C-lock-ECG synchronization (optional)..................................................... 77 Tips to prevent artefacts........................................................................... 78 Applying the Durasensor DS-100 A.......................................................... 79 Airway temperature measurement (optional)..........................................80 55 Monitoring Selecting the standard screen Monitoring Selecting the standard screen "Only for internal use by Draeger. Not applicable as Instructions for Use!" The standard screen is automatically displayed on the screen whenever a ventilation mode is selected (MAN/SPONT or IPPV or PCV). This page can always be selected during operation: Julian 1 Press the Q key or 2 1 2 Press the S key several times. Display (example): IPPV Pleth The most important parameters are grouped together on the right-hand side of the screen. Three curves are displayed on the left-hand side (to select other curves, see page 66). SpO2 etCO2 CO2 40 MV O2 0 Measured values shown in grey Calibration is performed automatically by Julian. The measured values are shown in grey until sufficient data are available and until the sensors have reached their operating temperature. In this way, Julian indicates that the accuracy of these data is still reduced in comparison with the "Technical data". For maximum accuracy the sensors can be calibrated manually – see page 72. When measuring CO2, anaesthetic agent and N2O, their numerical values are shown in grey during the warm-up phase whenever the workstation is switched on. Because the gas measuring module switches off internally in standby mode, calibration is carried out each time the unit is switched on. This is indicated by »Cal« in the measured value window. The display CAL appears instead of the numerical value during automatic calibration of the O2 sensor (every 24 hours). The flow sensor is automatically calibrated as soon as a CO2 signal is detected by the gas measuring system. Julian takes account of the relevant gas mixture when calculating the volumetric concentrations. 56 PAW 20 N2O Iso. Enf. 0 98 38 6.0 O2 % L/min 50 4.00 Pmax mbar VT mL Freq. 1/min freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O 67 TI:TE alarm limits auto set limits alarm info list curves config. 1.3 TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Monitoring Selecting the data screen Selecting the data screen ● Press the S key several times until the data page appears. IPPV PAW Display (example): plat. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 40 All numerical values are displayed on the data screen with their units of measure. The bar display on the left of the screen shows the change in airway pressure PAW over time. The lines cutting across the bar graph mark the upper and lower alarm limits. To set the alarm limits for PAW, see page 60. PEEP mean compliance 27 20 5 15 65 mbar 6.0 VT 0.60 freq 10 AW-temp. 34 MV SpO2 % 98 mbar 67 1/min Fi Fet 0 40 58 0.8 0.4 MAC (age: 36) 36 33 56 0.6 0.5 1.3 1/min 15. Dec. 99 12 : 00 °C sys. comp. 6.40 mL/mbar leckage 10 mL/min mbar CO2 mmHg mbar O2 % mL/mbar N2O % 20 0 The system compliance (Sys.-Compl.) and leakage are displayed in the right-hand field, together with the time of the last test. peak Iso. % L/min Enf. % L alarm limits auto set limits alarm info list config. 01-10 8 : 00 Freshgas O2 + N2O Pmax O2 % L/min 50 1.00 mbar VT mL Freq. 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 57 Monitoring Selecting the trend screen Selecting the trend screen Displays the measured values over time since the start of measurement. "Only for internal use by Draeger. Not applicable as Instructions for Use!" Maximum storable time: 8 hours. The following display combinations can be selected: – CO2/MV – AGas/N2O – O2/compliance* – SpO2/pulse rate ● Press the S key several times until the trend screen appears. MV and compliance trends are scaled in accordance with the setting in the configuration menu for adults or children. MV trend scale: 0 to 3 L/min for children 0 to 15 L/min for adults Compliance trend scale: 0 to 20 mL/mbar for children 0 to 100 mL/mbar for adults Display (example): Trend CO2 and MV IPPV PAW 60 SpO2 40 0 11:00 Press the appropriate softkey: »AGas N2O« or »O2 compl.« or »SpO2 pulse« 20 0 98 67 30 etCO2 Selecting other display combinations ● CO2 12:00 13:00 MV MV 15 O2 10 N2O Iso. 38 6.0 AGas N 2O Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 O2 compl. Enf. 0 MAC (age: 36) Zoom in: Press ! CO2 MV 10 5 Select zoom area: Turn freq alarm limits SpO2 pulse full trend 1.3 ! Freshgas O2 + N2O The softkey disappears if a measuring function is not available. ____________ * 58 Lung properties can be monitored continuously with the compliance trend display so that ventilation can be adjusted accordingly. Patient compliance is not measured in MAN/SPONT ventilation mode. O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Monitoring Selecting the trend screen Zoom function The trend display can be magnified with the zoom function after half-an-hour of operation. IPPV PAW 60 CO2 SpO2 40 etCO2 0 Turn the rotary knob = the dashed frames move. 11:00 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 20 To enlarge the selected area to the full width of the display: 0 ● Press the rotary knob. A new dashed frame appears after a corresponding period of operation and can also be enlarged. ● 12:00 MV 13:00 MV 15 O2 10 N2O Iso. Enf. 5 38 6.0 freq CO2 MV AGas N 2O Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 O2 compl. Zoom in: Press ! alarm limits 10 SpO2 pulse full trend 1.3 MAC (age: 36) 0 Select zoom area: Turn ! Freshgas O2 + N2O O2 % To return to the overall trend: 67 30 To select the range: ● 98 L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Press the softkey »full trend« and the complete trend is displayed again. If the trend data are insufficient this softkey has no function. To delete the trend memory Only possible in standby mode. The trend memory and list are deleted together! Standby In standby mode: ● Press the softkey »delete trend«. Julian leakage test 03.00 01-may-2000 delete trend config. Operation with MAN SPONT , IPPV or PCV Freshgas O2+N2O O2 % L/min 50 4.00 The system asks you to confirm that the trend is really to be deleted. To delete: ● Standby Press the softkey »delete«. The stored trend for the anaesthetic gas concentration is deleted automatically when a new anaesthetic gas is selected. Julian delete 03.00 01-may-2000 do not delete config. Operation with MAN SPONT , IPPV or PCV Freshgas O2+N2O O2 % L/min 50 4.00 59 Monitoring Alarms Alarms Displaying and setting alarm limits "Only for internal use by Draeger. Not applicable as Instructions for Use!" Alarms can be displayed and set from all three basic screens (standard, data and trend screen) during operation. The default alarm limits for the ventilation mode are activated automatically when changing from standby to a ventilation mode. These default alarm limits can be used unchanged or they can be set individually for the patient. The individual settings are deleted on changing from ventilation mode to standby and the default alarm limits are reactivated. To call up alarm limits: ● Press the softkey »alarm limits«. IPPV Display (example): Pleth The measured values and their alarm limits are shown on the right-hand side. The curves with the alarm limits represented by dashed lines are shown on the left. SpO2 CO2 etCO2 40 MV 0 FiO2 PAW 20 FiHal. -95 98 67 38 6.0 29 0.8 120 50 42 30 -3.0 -20 1.0 0.0 0 auto set limits alarm info list curves config. 40 8 PAW Select limit value: Turn and confirm alarm limits ! Freshgas O2 + N2O O2 % L/min 50 1.00 Example etCO2: The upper alarm limit (42 mmHg) and the lower alarm limit (30 mmHg) are shown alongside the measured value (38 mmHg). A deactivated alarm limit is indicated by two dashes (– –). To set an alarm limit: ● Place the cursor bar on the alarm limit by turning the rotary knob and press to confirm. The alarm limit is highlighted. ● Set the new value by turning the rotary knob and press to confirm. The new alarm limit is now effective. The cursor bar returns to the z symbol. 60 etCO2 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 38 42 30 0 Monitoring Alarms Adjustment range of the alarm limits "Only for internal use by Draeger. Not applicable as Instructions for Use!" Alarm limit Adjustment range SpO2 [%] _ 51 to 100 50 to 99 Pulse H [1/min] _ 21 to 250 20 to 249 etCO2 [mmHg] _ 1 to 75 0 to 74 FiCO2 [mmHg] _ 0 to 10 –– MV [L/min] _ 0,1 to 39 0 to 38,9 FiO2 [Vol.%] _ 19 to 100 18 to 99 Fi Hal. [Vol.%] _ 0,1 to 7 0 to 6,9 Fi Iso. [Vol.%] _ 0,1 to 7 0 to 6,9 Fi Enf. [Vol.%] _ 0,1 to 7 0 to 6,9 Fi Des. [Vol.%] _ 0,1 to 21,9 0 to 21,8 Fi Sev. [Vol.%] _ 0,1 to 9,9 0 to 9,8 PAW [mbar] _ 5 to 98 4 to 35 To quit the alarm limits menu: ● ● Press the rotary knob or Press the Q key. 61 Monitoring Alarms Adapting limits – AutoSet When the ventilation settings have been made, Julian can automatically adapt the alarm limits for the minute volume (MV) and airway pressure (PAW) to the current ventilation settings in IPPV mode. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Press the softkey »auto set limits«. The alarm limits menu opens automatically. The alarm limits for MV and PAW are adapted. At the same time, an advisory message is displayed: "MV and PAW limits have been automatically adapted". The menu closes again automatically after 5 seconds. The new alarm limits for the set MV are calculated by Julian as follows: MV [L/min] Upper alarm limit Lower alarm limit Measured MV · 1,4 At least 2,0 Measured MV · 0,6 At least 0,5 Julian calculates the new PAW alarm limits by determining PEAK, PPlateau and PEEP by two different methods and selecting the higher value as the "measured value". Method 1: The mean of the last 4 measured breaths. If fewer measured values are available, these are used as the basis of determination. Method 2: The measured value of the last breath. Julian sets the upper alarm limit for PAW to the absolute higher determined measured value of – PEAK + 5 mbar or – PPlateau + 10 mbar, but at not less than 10 mbar in IPPV/PCV. Julian sets the lower alarm limit for PAW from the determined measured values to – PEEP + 0,6 · (PPlateau – PEEP), and not less than 4 mbar in IPPV/PCV. To reset individual alarm limits for MV and PAW: ● See "Displaying and setting alarm limits" on page 60. To reuse all default alarm limits: ● 62 See "Activating monitor defaults" on page 72. Monitoring If an alarm occurs If an alarm occurs Alarm messages are assigned to three priority classes by Julian, depending on their urgency, and identified by exclamation marks: "Only for internal use by Draeger. Not applicable as Instructions for Use!" Warning !!! = message with top priority A warning message requires immediate action. Caution !! = message with medium priority A caution message requires prompt action. Advisory ! = message with lowest priority Least-priority messages can also be displayed by symbols. An advisory message requires to be noted and action taken if necessary. If several alarms occur simultaneously, Julian displays the alarm with the highest priority. The others are not displayed. All warning, caution and advisory messages that have been emitted can be displayed by pressing the »alarm Info« softkey. Each time an alarm message is displayed, the alarm lamp either flashes or lights up continuously and an audible tone sequence is emitted to indicate the alarm priority class: Warning: 1 Red lamp flashes, accompanied by a continuous tone. Caution: 1 Yellow lamp flashes, accompanied by an intermittent tone every 30 seconds. Julian 1 2 Advisory: 1 Yellow lamp lights up continuously, accompanied by a single tone. The alarm tone can be suppressed for two minutes: 2 Press the G key and its yellow LED lights up. To reactivate the alarm tone: 2 Press the G key and its yellow LED goes out. A list of alarm messages can be found on page 122, "Message – Cause – Remedy". 63 Monitoring CO 2 alarms on/off Alarm info Alarm info IPPV This function is used to list all active alarms / warnings in order of priority. ● FIO2 ETCO2 Pleth Press and hold the softkey »alarm info«. !!! !! alarm limits auto set limits CO2 alarm info 40 Display (example): "Only for internal use by Draeger. Not applicable as Instructions for Use!" list Active alarms: FIO2 < !!! 0 PAW 20 Active warning: ETCO2 < !! curves config. 0 Freshgas O2 + N2O Pmax O2 % L/min 50 1.00 The display only remains visible as long as the softkey is pressed. mbar VT mL 25 600 Freq. TI:TE TIP:TI PEEP % mbar 1/min 10 1:2.0 10 0 CO2 alarms on /off The alarm limits for FiCO2, etCO2 and CO2 apnoea monitoring can be switched off with the softkey »CO2-al. on/off« in MAN/SPONT mode. In this case, the symbol CO2 gappears alongside the measured end-expiratory CO2 concentration. The CO2 alarm limits are reactivated by pressing the softkey again. The deactivated CO2 alarm limits are reactivated automatically when changing to a different ventilation mode. The CO2 alarm limits can also be activated and deactivated under "Alarm limits" in the configuration screen in all ventilation modes, see page 72. The etCO2 _ and FiCO2 > alarms can be configured »ON« or »OFF« in standby mode for the transition from MAN/SPONT. When the alarm limits are set to »ON«, the value is transferred from automatic ventilation mode. National and European standards require a minimum monitoring with alarm function. These standards may not be met if the alarm function of the etCO2 monitoring parameter is deactivated. 64 MAN/SPONT Pleth SpO2 etCO2 CO2 40 MV 0 O2 VT N2O 0.35 Volumeter -0 0 Start Volumeter: Confirm 0.5 1 -- s 5 Freshgas O2 + N2O O2 % L/min 50 4.00 Enf. 10 ! freshgas internal external Iso. 98 38 5.2 67 CO2 g freq 8 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) 1.3 alarm limits CO2-al. off / on alarm info list curves config. Monitoring List display List display Record of measured values, alarms and ventilation modes to facilitate compilation of the anaesthetic record. The control criteria for entries can be configured, see "Record" on page 71. ● Press the softkey »list«. "Only for internal use by Draeger. Not applicable as Instructions for Use!" Display (example): IPPV next page PAW time alarm 12:13 FI HAL 12:15 FI O2 HR/Puls NiBP/mmHg Sys/M/Dia 40 "Open" the previous page: 12:20 ● Select »previous page« by turning the rotary knob and press to confirm. !!! !!! previous page SpO2 etCO2 MV O2 Fi/Fet AGas Fi/Fet PAW Peak/Peep 65 99 40 6.0 30/26 1.6/0.6 33/10 65 98 38 5.9 25/20 0.8/0.7 30/10 66 99 40 6.1 30/26 0.8/0.7 30/10 20 "Open" the next page: ● Select »next page« by turning the rotary knob and press to confirm. 0 Freshgas O2 + N2O Return to the standard page: ● O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Place cursor on the zsymbol by turning the rotary knob and press to confirm. or ● Press the Q key. Delete list The list and trend memory are deleted together! Only possible in standby! Standby In standby: ● Julian Press the softkey »delete trend«. leakage test 03.00 01-may-2000 delete trend config. Delete trends and list: ● Press the softkey »delete«. Operation with MAN SPONT , IPPV or PCV Freshgas O2+N2O O2 % L/min 50 4.00 65 Monitoring Selecting curves Selecting curves "Only for internal use by Draeger. Not applicable as Instructions for Use!" Only possible from the standard screen! Three curves can be selected and positioned for the momentary ventilation mode in this menu. The following curves can be selected: CO2 Curve of CO2 concentration at the Y-piece PAW Airway pressure Pressures Digital indication of the measured value for PPEAK, PPlateau, PMEAN and PEEP Flow Expiration flow Pleth The plethysmogram derived from SpO2 measurement (optional) Volumeter A display mode showing the minute volume and tidal volume VT as bar graphs O2 Curve of O2 concentration at the Y-piece AGas Curve of anaesthetic agent concentration at the Y-piece FG/volu Volumeter in combination with bar display of fresh gas flow in L/min for O2 and N2O or AIR (virtual flow tubes) FG/press Pressures in combination with bar display of fresh gas flow in L/min for O2 and N2O or AIR (virtual flow tubes) blank Blank field IPPV Pleth SpO2 et CO2 ● Press the softkey »curves«. Pleth Flow Display (example): PAW The names of the curves in each curve field are displayed together with the choice of possible parameters. The current curves are highlighted by a grey background. In the example, the PAW curve is to be replaced by the volumeter display. Turn the rotary knob to select the required parameter (»volumeter« ) and press to confirm. The cursor jumps to the menu. ● O2 AGas FG/volu MV FG/press O2 blank N2O Iso. Enf. To select curve position: 38 6.0 Freq Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 alarm info list curves config. 1.3 Freshgas O2 + N2O L/min 50 1.00 Pmax VT Freq. mbar mL 1/min 25 600 TI:TE TIP:TI PEEP % mbar 10 1:2.0 10 0 IPPV Pleth Select the desired position with the rotary knob and press to confirm. SpO2 et CO2 Pleth Flow Volumeter To return to the standard page: CO2 PAW Pressures Flow Pleth Volumeter O2 AGas FG/volu MV FG/press O2 blank N2O Iso. Enf. Press the rotary knob. 98 67 38 6.0 Freq To select curve position: If a curve field is to remain blank: Select »blank« with the rotary knob and press to confirm. 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) 66 auto set limits zsymbol of the positioning The curve is replaced and the cursor returns to the z symbol in the selection menu. ● 10 alarm limits turn and confirm! Display (example): ● 67 MAC (age: 36) O2 % ● CO2 PAW Pressures Flow Pleth Volumeter 98 alarm limits auto set limits alarm info list curves config. 1.3 turn and confirm! Freshgas O2 + N2O Pmax O2 % L/min 50 1.00 mbar 25 VT mL Freq. 1/min TI:TE TIP:TI PEEP % mbar 600 10 1:2.0 10 0 Monitoring Using the volumeter function Using the volumeter function MAN/SPONT Pleth To observe and assess ventilation in manual and pressure controlled ventilation modes and during spontaneous breathing. etCO2 CO2 40 ➀ Upper bar: MV Current tidal volume VT, preceded by the numerical value. "Only for internal use by Draeger. Not applicable as Instructions for Use!" SpO2 0 O2 VT 0.35 Volumeter 4.1 ➁ Lower bar: 0 Volumeter (minute volume measurement), preceded by the numerical value. 0 0.5 46 s Enf. 5 Tidal volume VT in L Minute volume MV in L/min Scale for children 0.2 2 Scale for adults 1.0 10 Setting 67 38 5.2 FiCO2 _ freq 8 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 alarm limits CO2-al. off / on alarm info list curves config. 1.3 MAC (age: 36) 10 Volumeter started. To re-start: Confirm The scale of the bar display depends on the default setting, see "Configuring in operation, selecting the scale" on page 69 and "Configuring in standby mode, selecting the scale" on page 83. N2O Iso. 1 98 ! Freshgas O2 + N2O freshgas internal external L/min O2 % 50 4.00 ➁ ➀ Starting the volumeter ● Press the rotary knob. The values are deleted and volumeter restarted if the rotary knob is pressed again before 60 seconds have elapsed. The elapsed time in seconds is displayed above the bar with the summed volume on the left. The individual breaths are separated by segments in the bar. The volumeter stops automatically with an acoustic signal after 60 seconds. The measured values are displayed for 4 minutes and then erased. MAN/SPONT Pleth SpO2 Display combination with flow tubes See »Selecting curves« for selection of display combinations. Possible combinations: 40 MV 0 – »FG/volu« or – »FG/press« VT 4 0.04 0 Display (example): ● »Start volumeter«, see »Using the volumeter function«, page 67. 0.5 1 Volumeter 25s 1 O2 O2 8 2 The fresh gas flow in L/min (O2, N2O or AIR) is displayed in the flow tubes. et CO2 CO2 Enf. 2.7 N2O 0 5 Volumeter started. To re-start: N2O Iso. 10 98 67 FiCO2 Freq 38 _ 5.2 13 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) alarm limits CO2-Al. off/on alarm info list curves config. 1.3 Confirm! Freshgas O2 + N2O O2 % L/min 50 4.00 Freshgas intern extern ● 67 Monitoring Configuring in operation Configuring in operation "Only for internal use by Draeger. Not applicable as Instructions for Use!" The configuration menus are used to select or modify individual monitoring functions for the measurements in progress. The settings entered here are only valid while measurement is in progress and are deleted on switching to standby mode. In the standard screen (example) or data screen: ● IPPV Pleth Press the softkey »config.«. SpO2 etCO2 CO2 40 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 38 6.0 O2 % L/min 50 4.00 Display (example): The softkeys for fresh gas and ventilation parameters remain active. Pmax VT mL mbar Freq. freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O 67 TI:TE 1/min alarm limits auto set limits alarm info list curves config. 1.3 TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 IPPV PAW MAC-config. 40 MAC display The values highlighted in grey represent the current settings. on off alarms default CO2 on MAC correction 20 on off SpO2 on age 36 HLM on calibration settings O2-Sensor pulse tone 0 1 2 3 4 5 6 7 8 9 21 Vol.% ✓ alarm sound 1 2 3 4 5 6 7 8 9 scale adult child gas sensor ✓ parameters off record activate monitor defaults off off FiCO2 > 5 0 Freshgas O2 + N2O O2 % L/min 50 1.00 68 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Monitoring Configuring in operation Setting the monitoring functions Setting the monitoring functions Select the »settings« column by turning the rotary knob and press to confirm. Display (example): ● IPPV PAW MAC-config. 40 MAC display "Only for internal use by Draeger. Not applicable as Instructions for Use!" on off alarms default CO2 on MAC correction 20 on off SpO2 on age 36 HLM on calibration settings O2-Sensor pulse tone 0 1 2 3 4 5 6 7 8 9 21 Vol.% ✓ alarm sound 1 2 3 4 5 6 7 8 9 scale adult child gas sensor ✓ parameters off record activate monitor defaults off off FiCO2 > 5 0 Freshgas O2 + N2O O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Setting the pulse tone 0 = OFF 9 = Maximum volume ● ● Select the line »pulse tone« by turning the rotary knob and press to confirm. The cursor automatically jumps to the last value selected (in the example: setting 5). Set the value with the rotary knob and press to confirm. Setting the alarm sound 1 = Minimum volume 9 = Maximum volume ● Select the line »alarm sound« by turning the rotary knob and press to confirm. The cursor automatically jumps to the last value selected (in the example: setting 4). ● Set the value with the rotary knob and press to confirm. Set a sufficiently loud alarm sound! The audible »NO O2« and »NO FRESH GAS« alarms are always sounded at maximum volume. Julian complies with national regulations in certain countries that stipulate a minimum volume of 45 dB (A). Settings 1 to 4 are programmed at 45 dB (A) for these countries. Selecting the scale To adapt the scale for the volumeter function and trend curve. ● Select the line »scale« with the rotary knob and press to confirm. ● Select »adult« or »child« with the rotary knob and press to confirm. 69 Monitoring Configuring in operation Setting the monitoring functions Setting the measuring parameters ● Select the line »parameters« with the rotary knob and press to confirm. The »parameters« menu appears in the left-hand field. Display (example): IPPV "Only for internal use by Draeger. Not applicable as Instructions for Use!" PAW MAC-config. alarms calibration 40 20 SpO2 measurement on off Sample rate 60 200 mL/min CO2 unit mmHg CO2 scale 0-75 Pressure unit Pa*100 Flow display MV kPa %vol. settings puls tone 0 1 2 3 4 5 6 7 8 9 alarm sound 1 2 3 4 5 6 7 8 9 Scale adult child parameter record activate monitor defaults 0-110 mmHg mbar cmH20 0 Switch SpO2 measurement (optional) on/off: ● ● Select the line »SpO2 measurement« with the rotary knob and press to confirm. Select »on« or »off« with the rotary knob and press to confirm. Select the sample rate for gas measurement: ● Select the line »sample rate« with the rotary knob and press to confirm. ● Select »60« or »200 mL/min« with the rotary knob and press to confirm. For paediatric use: ● Select a sample rate of 200 mL/min in order to obtain more accurate values on account of the high frequencies and time constant of the measuring system. ● Recirculate the measured gas, see page 111. If the measured gas is not recirculated: ● Increase the minute volume accordingly in order to maintain the volume balance. For adult use: ● Select a sample rate of 60 or 200 mL/min. Recommendation: select 200 mL/min and recirculate the measured gas, see page 111. Set CO2 unit: ● Select the line »CO2 unit« with the rotary knob and press to confirm. Either mmHg, kPa or %vol. can be selected as the unit of measurement for CO2. ● Select the required unit of measure by turning the rotary knob and press to confirm. 70 Vt Menu for configuration of measurement parameters. Freshgas O2 + N2O O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Monitoring Configuring in operation Setting the monitoring functions "Only for internal use by Draeger. Not applicable as Instructions for Use!" Selecting CO2 scale: ● Select the line »CO2 scale« by turning the rotary knob and press to confirm. ● Select the required scale by turning the rotary knob and press to confirm. The »CO2 scale« can be selected between two fixed default values. The value depends on the CO2 unit chosen. IPPV Display (example): Setting pressure unit: ● calibration settings puls tone 0 1 2 3 4 5 6 7 8 9 alarm sound 1 2 3 4 5 6 7 8 9 Scale adult child parameter record activate monitor defaults 40 Select the line »Pressure unit« by turning the rotary knob and press to confirm. 20 ● alarms MAC-config. PAW Select »Pa*100« or »mbar« or »cmH2O« by turning the rotary knob and press to confirm. SpO2 measurement on off Sample rate 60 200 mL/min CO2 unit mmHg CO2 scale 0-75 Pressure unit Pa*100 Flow display MV kPa %vol. 0-110 mmHg mbar cmH20 0 Setting flow display: ● ● Vt Menu for configuration of measurement parameters. Freshgas O2 + N2O Select the line »Flow display« by turning the rotary knob and press to confirm. O2 % 50 1.00 Select »MV« or »Vt« by turning the rotary knob and press to confirm. The selected parameter is displayed on the standard page. Vt alarm limits are not monitored. The alarm limits set for MV continue to be monitored in operation. Pmax VT Freq. mbar mL 1/min L/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Record This function is used to determine the type of event that triggers an entry in the record list or a printout on the connected logging printer. ● Select the line »record« with the rotary knob and press to confirm. The »record« menu appears on the left-hand side. Display (example): Time interval-started (min) A list entry is activated after a fixed time interval in minutes. NiBP-started An entry is made after every NiBP measurement with new measured values. This entry can be read by an external Dräger monitor via the MEDIBUS interface. warning-started An entry is made whenever an alarm is triggered. caution-started An entry is made whenever a caution message is triggered. ● IPPV alarms PAW MAC-config. 40 list entry: time intervall (min) NiBP started warning started caution started 1 2 on on on 5 10 off off off off printer entry: time intervall (min) NiBP started warning started caution started 1 2 on on on 5 10 off off off off 20 0 settings calibration puls tone 0 1 2 3 4 5 6 7 8 9 alarm sound 1 2 3 4 5 6 7 8 9 Scale adult child parameter record activate monitor defaults Menu for configuration of measurement parameters. Freshgas O2 + N2O O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Turn the rotary knob to select the event triggering the entry and press to confirm. 71 Monitoring Configuring in operation Manual calibration Manual calibration Julian calibrates its sensors automatically during operation. While calibration is in progress, the letters "CAL" appear in place of the respective measured value. Calibration of the O2 sensor and zero alignment for the other gas sensors can be repeated manually, for instance if automatic calibration has not been successfully performed. IPPV PAW MAC-config. 40 MAC display on off alarms default CO2 on MAC correction 20 on off SpO2 on age 36 HLM on calibration settings O2-Sensor pulse tone 0 1 2 3 4 5 6 7 8 9 21 Vol.% ✓ alarm sound 1 2 3 4 5 6 7 8 9 scale adult child gas sensor ✓ parameters off record activate monitor defaults off off "Only for internal use by Draeger. Not applicable as Instructions for Use!" FiCO2 > 5 ● Turn the rotary knob to select the »Calibration« column and press to confirm. ● Turn the rotary knob to select the corresponding line and press to confirm, e.g. »O2 sensor 21% by vol.« Confirming the selection starts the respective calibration procedure. The clock symbol U appears behind the line = calibration is in progress. Once calibration has been completed, a tick (✓) appears in place of the clock symbol. A question mark (?) indicates that calibration should be repeated, because the previous calibration was defective. Other settings can be altered even though calibration is in progress. 0 Freshgas O2 + N2O O2 % 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 IPPV PAW calibration 40 O2-sensor 21 Vol.% gas sensor ✓ 20 0 Activating monitor defaults Freshgas O2 + N2O O2 % This function is used to activate the default monitoring settings configured in standby mode and active whenever the apparatus is switched on. ● L/min L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Select the line »activate monitor defaults« with the rotary knob and press to confirm. Selecting alarms ● Turn the rotary knob to select the column »alarms« and press to confirm. Default This function is used to activate the default alarm limits set in the standby configuration which are effective whenever the apparatus is switched to standby. IPPV PAW MAC-config. alarms 40 MAC display default on off CO2 on MAC correction 20 on off SpO2 on age 36 HLM on calibration settings O2-Sensor pulse tone 0 1 2 3 4 5 6 7 8 9 21 Vol.% ✓ alarm sound 1 2 3 4 5 6 7 8 9 scale adult. child gas sensor ✓ parameters off record activate monitor defaults off off FiCO2 > 5 Setting default alarm limits: ● Select the »default settings« menu by turning the rotary knob and press to confirm. See page 88 for the further procedure. 0 Freshgas O2 + N2O O2 % L/min 50 1.00 72 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Monitoring Configuring in operation Selecting alarms CO2 alarms on/off To activate / deactivate all CO2 alarms, including the apnoea alarm. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Turn the rotary knob to select »CO2 on« or »CO2 off« and press to confirm. SpO2 alarms on/off To activate/deactivate all SpO2 alarms. ● Turn the rotary knob to select »SpO2 on« or »SpO2 off« and press to confirm. Deactivated alarms are indicated by the symbol _ in the measurement field with a corresponding message. If all the alarms for this measured value are deactivated, this is indicated by the symbol G and a corresponding message. National and European standards require minimum monitoring with alarm function. These standards may not be met when the alarm function of the monitoring parameter etCO2 or SpO2 is deactivated. Alarm mode for the heart-lung machine HLM HLM alarm mode can be used independently of the active ventilation mode for patient monitoring when using the heart-lung machine. In HLM alarm mode, – all apnoea alarms are deactivated. – the gas concentrations are measured continuously regardless of the respiratory phase. – the SpO2 alarms are deactivated. They are reactivated automatically when pulsations are detected by the apparatus again after switching off the HLM alarm mode. MAN/SPONT HLM CO2 _ 40 SpO2 0 etCO2 Selecting HLM alarm mode ● ● ● Press the softkey »config«. Turn the rotary knob to select the column »alarms« and press to confirm. PAW 20 0 MV O2 N2O Iso. Turn the rotary knob to select the line »HLM on« and press to confirm. Enf. -- 5 -.- _ alarm limit freq HLM off -- alarm info FiCO2 _ Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Display (example): -- list curves config. 1.3 Freshgas O2 + AIR freshgas O2 % L/min 50 6.00 internal external The lung is kept open with constant airway pressure. 73 Monitoring Configuring in operation MAC configuration HLM alarm mode can be switched off at any time: ● Press the softkey »HLM off«. IPPV PAW MAC-config. alarms 40 MAC display default on In standby mode, the HLM alarm mode is automatically deactivated. off CO2 on MAC correction 20 on off SpO2 on age 36 HLM on calibration settings O2-Sensor pulse tone 0 1 2 3 4 5 6 7 8 9 21 Vol.% ✓ alarm sound 1 2 3 4 5 6 7 8 9 off scale adult. child gas sensor ✓ parameters off record activate monitor defaults off "Only for internal use by Draeger. Not applicable as Instructions for Use!" FiCO2 > 5 Setting FiCO2 alarm limit To set the upper inspiratory CO2 alarm limit. ● Select »FiCO2« by turning the rotary knob and press to confirm. 0 Freshgas O2 + N2O O2 % ● Set required value by turning the rotary knob and press to confirm. L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 MAC configuration Anaesthetic agent identification and display IPPV Pleth Julian automatically identifies the anaesthetic agent used and adjusts the measurement and monitoring of the anaesthetic gas concentration to suit the gas identified. If there is a mixture of two volatile anaesthetic agents, the concentration of the secondary anaesthetic agent is displayed from a MAC value of 0.1 MAC upwards. The gas with the higher expiratory MAC value is displayed above the secondary gas. A secondary anaesthetic agent becomes the main anaesthetic agent if its MAC value exceeds the MAC value of the main anaesthetic agent by 0.2 MAC. A mixture of more than 2 volatile anaesthetic agents cannot be reliably detected. Calculating the MAC values Julian calculates the MAC value (Minimum Alveolar Concentration) from the linear total of volatile anaesthetic agents measured and N2O. The measured values used are the end-expiratory concentrations. Partial pressures are taken into account. Age-corrected MAC values are calculated according to W. W. Mapleson, British Journal of Anaesthesia 1996, pp. 179-185. 74 SpO2 etCO2 CO2 40 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 38 6.0 O2 % L/min 50 4.00 Pmax mbar VT mL Freq. 1/min freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O 67 TI:TE alarm limits auto set limits alarm info list curves config. 1.3 TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Monitoring Configuring in operation MAC configuration Displaying MAC To activate the MAC display: ● Select column »MAC config.« by turning the rotary knob and press to confirm. ● Select line »MAC display« by turning the rotary knob and press to confirm. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Select line »on« by turning the rotary knob and press to confirm. IPPV To select the age correction for the MAC display: ● Select line »MAC correction« by turning the rotary knob and press to confirm. ● Select line »on« by turning rotary knob and press to confirm. PAW MAC-config. alarms 40 MAC display default on off MAC correction 20 on off SpO2 on age 36 HLM on Select line »age« by turning the rotary knob and press to confirm. ● Set age by turning the rotary knob and press to confirm. settings O2-Sensor pulse tone 0 1 2 3 4 5 6 7 8 9 21 Vol.% ✓ alarm sound 1 2 3 4 5 6 7 8 9 scale adult. child gas sensor ✓ parameters off record activate monitor defaults off off FiCO2 > 5 To select the patient's age: ● CO2 on calibration 0 Freshgas O2 + N2O O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 If the MAC display is configured to »off«, the »MAC correction« and »age« lines are automatically dimmed. If MAC correction is configured to »off«, the »age« line is automatically dimmed. MAC-Definition: 1 MAC is equal to the anesthetic gas concentration at which 50% of all patients no longer respond to a stimulation of the nerves. The influence of other medication(opiates or intravenous hypnotics) is not taken into consideration when calculating MAC values. 75 Monitoring SpO 2 Measurement SpO2 Measurement (optional) Sensor selection "Only for internal use by Draeger. Not applicable as Instructions for Use!" Only use Nellcor sensors. Note the Instructions for Use of the sensors – incorrect positioning or use can cause tissue damage. Select the sensor according to the following criteria: – Patient weight – Patient mobility – Possible application site – Patient perfusion – Duration of use The following table listing the specific sensor types available and their characteristics is intended as an aid for selection. Sensor type OXISENSOR I-20 OXISENSOR D-20 DURASENSOR OXISENSOR DS-100 A D-25 OXISENSOR R-15 Age group Infants Children Adults Adults Adults Patient weight 1 to 20 kg 10 to 50 kg >40 kg >30 kg >50 kg Duration of use Short and long-term Short and long-term Short-term monitoring monitoring monitoring Short and long-term Short and long-term zeitüberwachung monitoring Patient mobility Limited mobility Limited mobility Immobile patients only Limited mobility Immobile patients only Preferred Toe measuring site Finger Finger Finger Nose Sterility1) Sterile packaging ____ Sterile packaging Sterile packaging Sterile packaging OXISENSOR I-20, OXISENSOR D-20, DURASENSOR DS-100 A, OXISENSOR D-25 and OXISENSOR R-15 are registered trademarks. 1) in unopened, undamaged packaging 76 Monitoring SpO 2 Measurement ● Select the appropriate sensor. On back of unit: "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Swing the flap over the socket »SpO2« to the left and insert the sensor plug. 1 C-lock-ECG synchronization (optional) If the patient is highly agitated or the arterial flow is very low, the measurement signals of the SpO2 measurement can be improved with the C-Lock-ECG synchronization. In this case, Julian receives two separate signals that transmit the heart activity: – An optical signal from the SpO2 sensor and – An electrical signal from the separate ECG monitor. 2 ECG monitor Julian uses the R-wave of the ECG signal to identify the pulse and to synchronize with the SpO2 measurement. 2 Channel the ECG signal of the ECG monitor with the cable andyesck-plug to the back of the Julian (»Sync.« socket). See the "Technical data" on page 133 for the requirements for the electrical signal and plug layout. In the event of a delayed ECG signal Synchronization may be impaired if the ECG signal is delayed by more than 40 milliseconds to the QRS complex. If you suspect a fault of this kind: ● Use the Julian without C-Lock-ECG synchronization. 77 Monitoring SpO 2 Measurement Tips to prevent artefacts Only use Nellcor sensors in the recommended positions, otherwise incorrect measurements and tissue damage may result. "Only for internal use by Draeger. Not applicable as Instructions for Use!" Damaged sensors with exposed electrical contacts must not be used – danger of electric shock. Used adhesive strips of the Oxiband-OXI-A/N and OXI-P/I sensor must not be reused, as they may not adhere properly. The strips must not be stretched unduly. Never use two strips together, as this may lead to venous pulsation and failure of the pulse signal. High intrathoracic pressure, pressure on the thorax and other consecutive impairments of the venous flow can lead to venous pulsation with failure of the pulse signal. The pulse signal may fail in the presence of shock, low blood pressure, severe vasoconstriction, major anaemia, hypothermia, arterial occlusion proximal to the sensor and asystolia. The sensor must be protected from exposure to bright light (e.g. surgical lamps and direct sunlight), otherwise the pulse signal may fail or inaccurate results may be obtained. The sensor should not be positioned on limbs together with an arterial catheter, sphygmomanometer cuff or intravascular venous infusion, otherwise the pulse signal may fail and measurement become inaccurate. Measurement accuracy may be reduced in the presence of significant concentrations of dyshaemoglobins, such as carboxyhaemoglobin or methaemoglobin. Intravascular dyes, such as methylene blue, may also impair measurement accuracy. Electrocautery can impair the measuring accuracy; the leads and sensor should therefore be positioned as far away as possible from the electrocautery and its neutral electrode. Sensor performance may be impaired and lead to inaccurate results if the patient moves violently. The sensor should be applied to a different site in such cases in order to reduce the risk of artefacts due to movement. 78 Monitoring SpO 2 Measurement Applying the Durasensor DS-100 A Reusable sensor for short-term monitoring of relatively quiet patients weighing over 40 kg. "Only for internal use by Draeger. Not applicable as Instructions for Use!" The sensor is preferably positioned on the index finger, although other fingers can also be used. The little finger should be used if the patient is particularly large or obese. ● Open the clip slightly and slide the sensor onto the finger. The tip of the finger must touch the end and the soft padding should rest on the nail and tip of the finger. The lead should be on top of the finger. ● Ensure that the finger is not compressed or hurt by the clip. ● Change the application site after not more than 4 hours in order to avoid a build-up of blood pressure (blocked circulation). Follow the specific Instructions for Use when using other Nellcor sensors! 79 Monitoring Airway temperature measurement Airway temperature measurement (optional) "Only for internal use by Draeger. Not applicable as Instructions for Use!" Parts required: – Temperature sensor – Y-piece with connection for temperature sensor – T-piece – Filter with Luer lock connection for gas measurement 84 05 371 M 30 543 86 00 224 86 00 225 1 Connect Y-piece to respiratory hoses. 4 2 Insert T-piece into Y-piece. 1 3 Insert filter into T-piece. 4 Insert temperature sensor into Y-piece. 2 3 5 Connect temperature sensor plug to »Temp.« socket at the back of the workstation. ● The airway temperature is displayed in the data section of the screen: AW temp. XX °C The upper alarm limit is fixed. If the airway temperature exceeds 40°C, the »AW Temp > !!!« alarm will be activated. 5 80 Configuring in Standby Mode Contents Configuring in Standby Mode "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents Setting default values............................................................................. 82 Setting the pulse tone...............................................................................83 Setting the alarm sound............................................................................83 Selecting the scale................................................................................... 83 Setting the measuring parameters............................................................ 84 Record..................................................................................................... 86 Time.........................................................................................................86 Configuring the interfaces........................................................................ 86 Interface...................................................................................................87 Setting default alarm limits........................................................................ 87 Setting default alarm limits for anaesthetic agents..................................... 87 Adjustment range for default alarm limits...................................................88 Configuring curves................................................................................... 89 Setting basic configurations......................................................................89 IPPV default settings................................................................................ 91 PCV default settings.................................................................................91 Setting the fresh gas default settings........................................................ 92 Manual calibration...................................................................................93 100 Vol.% O2 calibration..........................................................................93 O2 linearity test........................................................................................ 94 MAC configuration.................................................................................. 94 Anaesthetic agent identification and display.............................................. 94 Calculating the MAC values......................................................................94 Displaying MAC....................................................................................... 95 81 Configuring in Standby Mode Setting default values "Only for internal use by Draeger. Not applicable as Instructions for Use!" Configuring in Standby Mode The default settings for the monitoring functions and the fresh gas and ventilation parameters can be configured in standby mode. The default values of the monitoring functions apply each time the unit is switched on. The default values for the alarm limits, fresh gas parameters and ventilation parameters are valid after each standby. ● Switch Julian to standby mode. ● Press the softkey »config.«. Display (example): Standby / Configuration MAC-config. calibration – MAC config. MAC display O2-sensor 21 vol.% ✓ – Calibration MAC correction gas sensor ✓ default settings The following settings can be made in the menu: – Default settings on off on off age 36 Fields highlighted by a grey background contain the currently valid settings. The symbol z indicates a return to the previous menu level. ● 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery Select, set and confirm the new settings with the rotary knob. Setting default values Default values are valid whenever the apparatus is switched on. The default monitoring settings can be activated during operation with activate monitor defaults, see "Activating monitor defaults" on page 72. ● Select and confirm the default settings with the rotary knob. Display (example): Standby / Configuration MAC-config. calibration MAC display O2-sensor 21 vol.% ✓ gas sensor ✓ on off MAC correction on off age 36 default settings These default settings are password protected. The default settings are active on start-up. To change the default settings enter the password: 0 1 2 3 4 *** Turn and confirm 82 . 5 6 7 8 9 Configuring in Standby Mode Setting default values The menu requests the user to enter a 4-digit password in order to prevent unauthorized tampering with the basic settings. This password is notified during system training. The function can be disabled by DrägerService if required. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Turn the rotary knob to select the digits con-secutively from the line provided and press to confirm. The password is indicated underneath with asterisks (* * * *). The menu for selecting the default settings appears when the password has been entered correctly. Display (example): Standby / Configuration MAC-config. Setting the pulse tone (optional) 0 = OFF 9 = Maximum volume ● Select the line »pulse tone« by turning the rotary knob and press to confirm. The cursor automatically jumps to the last value selected (example 5). ● Set the value with the rotary knob and press to confirm. calibration default settings 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery Setting the alarm sound 1 = Minimum volume 9 = Maximum volume ● Select the line »alarm sound« by turning the rotary knob and press to confirm. The cursor automatically jumps to the last value selected (example 4). ● Set the value with the rotary knob and press to confirm. Set a sufficiently loud alarm sound! The audible »NO O2« and »NO FRESH GAS« alarms are always sounded at maximum volume. Julian complies with national regulations in certain countries that stipulate a minimum volume of 45 dB (A). Settings 1 to 4 are programmed at 45 dB (A) for these countries. Selecting the scale To adapt the scale for the volumeter function and trend curve. ● Select the line »scale« with the rotary knob and press to confirm. ● Select »adult« or »child« with the rotary knob and press to confirm. 83 Configuring in Standby Mode Setting default values Setting the measuring parameters ● Select the line »parameters« with the rotary knob and press to confirm. The »parameters« menu appears in the left-hand field. Display (example): IPPV PAW "Only for internal use by Draeger. Not applicable as Instructions for Use!" 40 MAC-config. calibration SpO2 measurement on off default settings pulse tone alarm sound 20 Sample rate 60 200 mL/min scale CO2 unit mmHg parameters CO2 scale 0-75 Pressure unit Pa*100 Flow display MV kPa Vol% 0-110 mmHg 0 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 adult record interfaces 0 mbar cmH20 Vt alarm limits curves basic configurations Switch SpO2 measurement (optional) on/off: IPPV default settings ● ● Select the line »SpO2 measurement« with the rotary knob and press to confirm. Select »on« or »off« with the rotary knob and press to confirm. Select the sample rate for gas measurement: ● Select the line »sample rate« with the rotary knob and press to confirm. ● Select »60« or »200 mL/min« with the rotary knob and press to confirm. For paediatric use: ● Select a sample rate of 200 mL/min in order to obtain more accurate values on account of the high frequencies and time constant of the measuring system. ● Recirculate the measured gas, see page 111. If the measured gas is not recirculated: ● Increase the minute volume accordingly in order to maintain the volume balance. For adult use: ● Select a sample rate of 60 or 200 mL/min. Recommendation: select 200 mL/min and recirculate the measured gas, see page 111. Set CO2 unit: ● Select the line »CO2 unit« with the rotary knob and press to confirm. Either mmHg, kPa or %vol. can be selected as the unit of measurement for CO2. ● Select the required unit of measure by turning the rotary knob and press to confirm. 84 PCV default settings fresh gas delivery Menu for configuration of measurement parameters. child Configuring in Standby Mode Setting default values "Only for internal use by Draeger. Not applicable as Instructions for Use!" Selecting CO2 scale: ● Turn rotary knob to select »CO2 scale« line and press to confirm. ● Turn rotary knob to select required scale and press to confirm. The »CO2 scale« can be selected between two fixed default values. The value depends on the CO2 unit chosen. Display (example): IPPV PAW 40 MAC-config. calibration SpO2 measurement on off default settings pulse tone alarm sound 20 Setting pressure unit: ● ● Turn rotary knob to select the »Pressure unit« line and press to confirm. Sample rate 60 200 mL/min scale CO2 unit mmHg parameters CO2 scale 0-75 Pressure unit Pa*100 Flow display MV kPa Vol% 0-110 mmHg 0 1 2 3 4 5 6 7 8 9 1 2 3 4 5 6 7 8 9 adult child record interfaces 0 mbar cmH20 Vt alarm limits curves basic configurations IPPV default settings Turn rotary knob to select »Pa*100« or »mbar« or »cmH2O« and press to confirm. PCV default settings fresh gas delivery Menu for configuration of measurement parameters. Setting flow display: ● Turn rotary knob to select »Flow display« line and press to confirm. ● Turn rotary knob to select »MV« or »Vt« and press to confirm. Julian displays the selected parameters on the standard page. Vt alarm limits are not monitored. The alarm limits set for MV continue to be monitored in operation. 85 Configuring in Standby Mode Setting default values Record This function is used to determine the type of event that triggers an entry in the record list or a printout on the connected record printer. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Select the line »record« with the rotary knob and press to confirm. The »record« menu appears on the left-hand side. Display (example): Standby / Configuration MAC-config. calibration Time interval-started (min) A list entry is activated after a fixed time interval in minutes. list entry: time intervall (min) NiBP started warning started caution started 1 2 on on on 5 10 off off off off NiBP-started An entry is made after every NiBP measurement with new measured values. This entry can be read by an external Dräger monitor via the MEDIBUS interface. printer entry: time intervall (min) NiBP started warning started caution started 1 2 on on on 5 10 off off off off Warning-started An entry is made whenever an alarm is triggered. default settings 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery Menu for configuration of list and printer entries. Caution-started An entry is made whenever a caution message is triggered. ● Turn the rotary knob to select the event triggering the entry and press to confirm. Configuring the interfaces Julian has three serial interfaces: COM1, COM2, COM3. COM2 and COM3 are configured as MEDIBUS* interfaces and COM1 as printer interface. The interfaces can be adapted to the connected equipment. ● Turn the rotary knob to select the line »interfaces« and press to confirm. The »interfaces« menu appears in the left-hand field. Display (example): COM2 is configured in the upper half of the menu and COM1 and COM3 in the bottom half. Standby / Configuration MAC-config. COM 2 (Medibus): baud rate parity data bits stop bits calibration 1.2 9.6 even 8 1 COM 1 (printer), COM 3 (Medibus): config. of: COM 1 COM 3 baud rate 1.2 2.4 4.8 9.6 19.2 parity odd even none data bits 7 8 stop bits 1 2 default settings 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery Menu for configuration of Medibus and printer port. _____________ * MEDIBUS: Dräger communications protocol for medical equipment. 86 Configuring in Standby Mode Setting default values Interface Choice between configuration of COM2 or COM3. "Only for internal use by Draeger. Not applicable as Instructions for Use!" Baud rate Transmission speed (variable, see Instructions for Use of the equipment to be connected). Parity This display is invariable for MEDIBUS and is shown only for information. Data bits This display is invariable for MEDIBUS and is shown only for information. Stop bits This display is invariable for MEDIBUS and is shown only for information. Setting default alarm limits ● Turn the rotary knob to select the line »alarm limits« and press to confirm. The »alarm limits« menu appears in the left-hand field. Display (example): Standby / Configuration MAC-config. ● ● Select required parameter by turning the rotary knob and press to confirm. The "alarm limits" menu appears. In the menu, select the required alarm limit by turning the rotary knob and press to confirm. The default alarm limit is highlighted against a white background. ● Set and confirm the value with the rotary knob. The value is then displayed in normal mode. The cursor bar jumps to the next default alarm limit. ● Set the next default alarm limit as described above. default settings calibration SpO2/pulse CO2/O2 Flow/pressure Anaesthetic agent MAN/SPONT alarms SpO2 100 90 120 50 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery The following alarm limits can be configured: SpO2/pulse CO2/O2 Flow/pressure Anaesth. agent MAN/SPONT alarms SpO2 etCO2 MV Fi Iso. etCO2 Pulse rate FiCO2 PAW Fi Hal. FiCO2 FiO2 Fi Sev. Fi Enf. Fi Des. FiO2 MV The etCO2 _, FiCO2 >, FiO2 > and MV _ alarms can be configured »ON« or »OFF« in standby mode for the transition from MAN/SPONT. When the alarm limits are set to »ON«, the value is transferred from automatic ventilation mode. 87 Configuring in Standby Mode Setting default values Adjustment range for default alarm limits "Only for internal use by Draeger. Not applicable as Instructions for Use!" Alarm limit Adjustment range Default value set on delivery SpO2 [%] _ 51 to 100 50 to 99 –– 92 Pulse H [1/min] _ 31 to 300 30 to 299 120 50 etCO2 [mmHg] _ 1 to 75 0 to 74 50 –– FiCO2 [mmHg] _ 0 to 10 –– 5 –– MV [L/min] _ 0,1 to 39 0 to 38,9 12 3,0 FiO2 [Vol.%] _ 19 to 100 18 to 99 –– 20 Fi Hal. [Vol.%] _ 0,1 to 7 0 to 6,9 1,5 –– Fi Iso. [Vol.%] _ 0,1 to 7 0 to 6,9 2,3 –– Fi Enf. [Vol.%] _ 0,1 to 7 0 to 6,9 3,4 –– Fi Des. [Vol.%] _ 0,1 to 21,9 0 to 21,8 12,0 –– Fi Sev. [Vol.%] _ 0,1 to 9,9 0 to 9,8 3,4 –– PAW [mbar] _ 5 to 98 0 to 35 40 8 Fixed alarm times: Apnoea pressure Apnoea flow Apnoea CO2 after 15 seconds after 15 seconds after 15 seconds (after 60 seconds in MAN/SPONT) – – : The default value set on delivery is outside the monitoring range and the corresponding alarm limit is therefore switched off. The newly set default alarm limits are valid whenever the apparatus is switched on or started up from standby mode. Certain alarm limits are switched off automatically in MAN/SPONT ventilation mode and when using the external fresh gas outlet: see tables, alarm limits for MAN/SPONT, page 39 and alarm limits for non-rebreathing systems, page 51. 88 Configuring in Standby Mode Setting default values Configuring curves Three standard curves can be configured for each of the ventilation modes: MAN/SPONT, IPPV, PCV and Fresh gas external. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Turn the rotary knob to select the line »curves« and press to confirm. The selection menu appears in the left-hand field. Display (example): Standby / Configuration MAC-config. ● Select the required ventilation mode with the rotary knob: calibration default curves Man./Spont. default curves IPPV default curves PCV default curves freshgas external default settings 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery Screen configuration menu. The »Standard IPPV screen« has been selected in the example: Standby / Configuration MAC-config. The currently selected parameters appear in the left-hand field, followed by the selection menu with the curves which can be selected. ● ● Select the required parameter in the selection menu with the aid of the rotary knob and press to confirm. The parameter appears against a white background. Select and confirm the position of the new parameter with the rotary knob. The corresponding position remains unused if »blank« is selected. Setting basic configurations for time, date, language and tone sequence. ● Turn the rotary knob to select the line »basic configurations« and press to confirm. The selection menu appears in the left-hand field. Display (example): calibration default curves IPPV CO2 Flow Volumeter CO2 PAW Pressures Flow FG/volu blank Select curve: Turn and confirm Pleth O2 AGas Volumeter FG/press default settings 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery . Standby / configuration MAC-config. time date language tone sequence Calibration 08 : 15 day month year 01 - 05 - 00 English (GB) Dräger Euro-stand. default settings 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery Menu for setting time, date, language and tone sequence. 89 Configuring in Standby Mode Setting default values "Only for internal use by Draeger. Not applicable as Instructions for Use!" Setting the date/time: ● Select and confirm the »time« line with the rotary knob. The cursor bar marks the hours. ● Press the rotary knob to confirm and the value is highlighted against a white background. It can now be adjusted and confirmed with the rotary knob. The minutes are adjusted and confirmed in the same way. ● Set and confirm the date as described above. Setting the language of the display texts: The last language selected is highlighted by a grey background. The following alternatives can be selected: English (GB) French (F) Italian (I) Spanish (E) Dutch (NL) Danish (DK) Norwegian (N) Swedish (SW) English (US) Polish (PL) Portuguese (P) Japanese (JA) Greek (GR) Hungarian (HU) Catalan (CA) Turkish (T) German (D) To change the language setting: ● Turn the rotary knob to select the line »language« and press to confirm. ● Select and confirm the relevant country code with the rotary knob. The texts in the menu now appear in the language selected. Setting the tone sequence: ● Turn the rotary knob to select the line »tone sequence« and press to confirm. ● Select and confirm either the Dräger alarm tone sequence or the standard European alarm tone sequence. 90 Configuring in Standby Mode Setting default values IPPV default settings ● Select and confirm the line »IPPV default settings« with the rotary knob. The softkeys for IPPV are displayed: "Only for internal use by Draeger. Not applicable as Instructions for Use!" Display (example): Standby / Configuration calibration MAC display O2-sensor 21 vol.% ✓ gas sensor ✓ on To modify the settings: ● Press the relevant softkey. ● Set and confirm with the rotary knob. To return to the »default settings«: ● default settings MAC-config. off MAC correction on off age 36 Modify default settings or confirm Press the rotary knob. 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery . Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 12 1:2.0 10 0 PCV default settings ● Select and confirm the line »PCV default settings« with the rotary knob. The softkeys for PCV are displayed: Display (example): Standby / Configuration calibration MAC display O2-sensor 21 vol.% ✓ gas sensor ✓ on To modify the settings*: ● Press the relevant softkey. ● Set and confirm with the rotary knob. off MAC correction on off age 36 Modify default settings or To return to the »default settings« menu: ● Press the rotary knob. default settings MAC-config. 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery confirm. Pmax freq. mbar 1/min TI:TE Insp. flow 15 12 1:2.0 10 L/min PEEP mbar 0 _____________ * Maximum setting for Pmax: 30 mbar. 91 Configuring in Standby Mode Setting default values Setting the fresh gas default settings ● Select and confirm the line »fresh gas default settings« with the rotary knob. The softkeys for the fresh gas settings are displayed: "Only for internal use by Draeger. Not applicable as Instructions for Use!" Display (example): Standby / Configuration default settings MAC-config. calibration MAC display O2-sensor 21 vol.% ✓ gas sensor ✓ on off MAC correction on off age 36 Modify default settings or confirm Freshgas O2 O2 % 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery ! Carrier gas selection via hardkey. L/min 100 2.00 To modify the settings: Julian 1 Press the keys »N2O« or »Air« to select the default carrier gas and press the rotary knob to confirm. 2 Press the softkey »O2 %«. Set the default O2 concentration with the rotary knob and press to confirm. 3 Press the softkey »L/min«. Set and confirm the default fresh gas flow with the rotary knob. To return to the »fresh gas default settings« menu: ● 92 Press the rotary knob. 2 3 1 Configuring in Standby Mode Manual calibration Manual calibration "Only for internal use by Draeger. Not applicable as Instructions for Use!" Julian calibrates its sensors automatically during operation. The message CAL appears instead of the current measured value during a calibration process. Calibration of the O2 sensor and zero calibration of the other gas sensors can be repeated manually, for instance if automatic calibration was unsuccessful. In standby / configuration mode: ● Turn the rotary knob to select the »calibration« column and press to confirm. ● Select and confirm the appropriate line with the rotary knob, for example: »O2-sensor 21 vol.%« Standby / Configuration MAC-config. calibration MAC display O2-sensor 21 vol.% ✓ gas sensor ✓ on off MAC correction on off age 36 default settings 0 1 2 3 4 5 6 7 8 9 pulse tone 1 2 3 4 5 6 7 8 9 alarm sound adult child scale parameters record interfaces alarm limits curves basic configurations IPPV default settings PCV default settings fresh gas delivery The calibration process is started when the selection is confirmed. The clock symbol Uappears after the relevant line, i.e. calibration is in progress. When calibration is complete, a tick (✓) appears instead of the clock symbol. A question mark (?) indicates that calibration must be repeated because the previous calibration was defective. To improve the measuring accuracy of high O2 concentrations, an additional 100 vol% O2 calibration and a linearity test of the O2 sensor can be performed under the menu option »more«. Standby / Configuration calibration Other settings can already be made during the calibration process. O2-sensor 21 Vol.% ✓ gas sensor ✓ more O2-sensor 100 Vol.% linearity test O2 100 vol.% O2 calibration ● Use a separate O2 source, e.g. O2 flowmeter. O2 from the Julian breathing system is not suitable, as it still contains traces of anaesthetic gas. ● Unscrew the sample line from the Y-piece and place it in the continuous flow of the O2 source. ● Turn the rotary knob to select the line »O2-sensor 100 vol.%« and press to confirm. ● Allow the O2 flow to continue flowing into the sample line. Confirm A tick (✓) appears after the field when calibration is complete. ● Screw the sample line back on to the Y-piece. 93 Configuring in Standby Mode Manual calibration O2 linearity test ● "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Standby / Configuration calibration First perform the "100 vol.% O2 calibration". Then: Turn the rotary knob to select the line »linearity test O2« and press to confirm. ✓ gas sensor ✓ First calibrate with 100 vol.% O2 then expose sample-line to to ambient air for about 2 minutes ! O2 21 Vol. % If the displayed value is outside the range 18 to 24 vol.% O2 the sensor is defective. more O2-sensor 100 Vol.% After approx. 20 seconds: ● O2-sensor 21 Vol.% linearity test O2 Display (example): O2 21 vol.% A display in the range between 18 and 24 vol.% is correct. If the display is outside this range, the O2 sensor is defective or spent (replace O2 sensor, see page 119). After self-test: Confirm . MAC configuration Anaesthetic agent identification and display IPPV Julian automatically identifies the anaesthetic agent used and adjusts the measurement and monitoring of the anaesthetic gas concentration to suit the gas identified. If there is a mixture of two volatile anaesthetic agents, the concentration of the secondary anaesthetic agent is displayed from a MAC value of 0.1 MAC upwards. The gas with the higher expiratory MAC value is displayed above the secondary gas. A secondary anaesthetic agent becomes the main anaesthetic agent if its MAC value exceeds the MAC value of the main anaesthetic agent by 0.2 MAC. A mixture of more than 2 volatile anaesthetic agents cannot be reliably detected. Calculating the MAC values Julian calculates the MAC value (Minimum Alveolar Concentration) from the linear total of volatile anaesthetic agents measured and N2O. The measured values used are the end-expiratory concentrations. Partial pressures are taken into account. Age-corrected MAC values are calculated according to W. W. Mapleson, British Journal of Anaesthesia 1996, pp. 179-185. 94 Pleth SpO2 etCO2 CO2 40 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 38 6.0 O2 % L/min 50 4.00 Pmax mbar VT mL Freq. 1/min freq 10 Fi Fet 45 53 0.8 0.6 41 51 0.6 0.5 MAC (age: 36) Freshgas O2+N2O 67 TI:TE alarm limits auto set limits alarm info list curves config. 1.3 TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 Monitoring Configuring in operation MAC configuration Displaying MAC To activate the MAC display: ● Select column »MAC config.« by turning the rotary knob and press to confirm. ● Select line »MAC display« by turning the rotary knob and press to confirm. Select line »On« by turning the rotary knob and press to confirm. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● IPPV To select the age correction for the MAC display: ● ● Select line »MAC correction« by turning the rotary knob and press to confirm. PAW MAC-config. alarms 40 MAC display default on Select line »On« by turning rotary knob and press to confirm. off CO2 on MAC correction 20 on off SpO2 on age 36 HLM on calibration settings O2-Sensor pulse tone 0 1 2 3 4 5 6 7 8 9 21 Vol.% ✓ alarm sound 1 2 3 4 5 6 7 8 9 off scale adult. child gas sensor ✓ parameters off record activate monitor defaults off FiCO2 > 5 To select the patient's age: ● Select line »Age« by turning the rotary knob and press to confirm. ● Set age by turning the rotary knob and press to confirm. 0 Freshgas O2 + N2O O2 % L/min 50 1.00 Pmax VT Freq. mbar mL 1/min TI:TE TIP:TI PEEP % mbar 25 600 10 1:2.0 10 0 If the MAC display is configured to »Off«, the »MAC correction« and »Age« lines are automatically dimmed. If MAC correction is configured to »Off«, the »Age« line is automatically dimmed. MAC-Definition: 1 MAC is equal to the anesthetic gas concentration at which 50% of all patients no longer respond to a stimulation of the nerves. The influence of other medication(opiates or intravenous hypnotics) is not taken into consideration when calculating MAC values. 95 96 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Care Contents Care "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents Dismantling components........................................................................98 Dismantling sample line............................................................................ 98 Removing water trap container................................................................. 98 Removing breathing hoses........................................................................98 Removing microbial filters......................................................................... 99 Dismantling the suction system...............................................................100 Dismantling the breathing system........................................................... 101 Removing the flow sensor...................................................................... 101 Removing the absorber and bellows....................................................... 101 Opening the breathing system................................................................ 102 Dismantle the anaesthetic gas scavenging system AGS..........................102 Removing waste gas connector..............................................................103 Dismantling emergency ventilation bag................................................... 103 Disinfecting / cleaning / sterilizing...................................................... 104 Breathing system................................................................................... 104 Surfaces................................................................................................ 104 Flow-Sensor.......................................................................................... 104 Microbial filter 654 St............................................................................. 105 Care list for Julian anaesthetic workstation......................................... 106 Assembling........................................................................................... 108 Installing the breathing system................................................................108 Inserting the flow sensor........................................................................ 108 Installing the bellows.............................................................................. 109 Filling and installing the absorber............................................................109 Installing the breathing hoses................................................................. 110 Preparing the suction system..................................................................110 Connecting the measured gas recirculation system................................ 111 Fitting waste gas connector....................................................................112 Sample gas scavenging..........................................................................112 Fitting emergency ventilation bag............................................................113 Connecting the anaesthetic gas scavenging system AGS.......................113 97 Care Dismantling components Care Dismantling components Dismantling sample line "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Unscrew the sample line from the Y-piece and water trap on the back of the unit. The sample line is not reusable and can be disposed of with ordinary domestic waste. Removing water trap container ● Pull the container of the water trap down and off, and empty it. Note the hygiene regulations of the hospital! ● Prepare the container of the water trap for disinfection and cleaning in a washing machine. When using the "Waterlock" water trap ● See separate Instructions for Use. Removing breathing hoses ● Remove the breathing hoses and breathing bag. ● Dismantle Y-piece and connector. ● Prepare the breathing hoses, breathing bag and Y-piece for disinfection and cleaning in a washing machine. 98 Care Dismantling components "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Do not damage the breathing hoses! Always hold the hoses by the connection sleeve and not by the spiral ribbing when removing and connecting the breathing hoses, otherwise the spiral ribbing may be torn off the sleeve. Breathing hoses with damaged spiral ribbing can easily be kinked and interrupt ventilation! Always check the breathing hoses for damage prior to use. Damaged breathing hoses must not be used. Removing microbial filters On the sleeve of the microbial filter: ● Press together the surfaces marked »PRESS« and pull the filter off the connection at the same time. Do not use force, otherwise the sleeve may be damaged. ● Prepare the microbial filter for conditioning in accordance with the separate Instructions for Use. 99 Care Dismantling components Dismantling the suction system 1 Remove the suction hose and vacuum hose. 1 2 Grip the silicone sleeve of the bottle cap and pull it off. 1 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 3 Remove the secretion collecting bottle and flushing bottle from the bracket and empty them. Note the hygiene regulations of the hospital. 2 3 3 4 Remove the silicone sleeve from the lid of the secretion collecting bottle. 5 Remove the overflow protection float from the rising pipe. Store the parts together for disinfection and cleaning in a washing machine. 5 4 6 Replace the bacterial filter in the side panel of the Julian – if soaked through or if contamination is suspected. The filter must be replaced at the latest every two weeks. ● The bacterial filter must be disposed of as infectious special waste. It can be incinerated with little pollution at temperatures of more than 800 °C. 6 100 Care Dismantling components Dismantling the breathing system 1 1 Fold up the writing top. 2 Pull the catch and at the same time pull out the slot-in module. 3 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 3 Hold breathing system by the handle and pull upwards to remove. 2 Removing the flow sensor 4 Unscrew the expiration port. 5 Remove the flow sensor. The flow sensor cannot be disinfected / cleaned in a washing machine, nor can it be sterilized in hightemperature steam. ● ● The flow sensor must be disinfected in 70 % ethanol solution for approx. 1 hour. Leave the sensor to dry in air for at least 30 minutes, otherwise the remaining alcohol can damage the sensor when calibrated. 5 4 The flow sensor can be reused as long as it can be calibrated successfully. Removing the absorber and bellows 6 Turn the absorber counterclockwise and pull it downwards. ● 7 Empty the soda lime; it can be disposed of with ordinary domestic waste. 7 Remove the insert from the absorber. MAX 8 Turn the container of the bellows counterclockwise and pull it downwards. 9 Remove the bellows. ● Prepare the absorber, container of the bellows and the bellows for disinfection and cleaning in a washing machine. 9 6 8 101 Care Dismantling components Opening the breathing system – Weekly 1 Loosen the five sealing screws a quarter-turn with the key supplied. "Only for internal use by Draeger. Not applicable as Instructions for Use!" ● Remove the cover. 1 1 1 1 1 2 Remove the two white ceramic valve discs. ● Lift off the metal valve plate. ● Keep the valve discs in a cassette to protect them against damage and prepare them for disinfection and cleaning in a washing machine. ● 2 2 Prepare the housing parts for disinfection and cleaning in a washing machine. Dismantle the anaesthetic gas scavenging system AGS 3 Remove the scavenging hose. 4 Remove the transfer hose. 4 5 Remove the anaesthetic gas scavenging system. ● Prepare the individual parts for disinfection and cleaning in a washing machine. 5 4 102 3 Care Dismantling components Removing waste gas connector 1 1 Pull hose off connector. 2 Remove waste gas connector completely. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2 Dismantling emergency ventilation bag Example: Dräger Resutator 2000 ● Disconnect the mask or ventilation tube from the patient valve. ● Pull the patient valve out of the bag. ● Compress the retaining ring on the bag completely and remove it. ● Pull the adapter out of the bag. ● Unscrew the bottom part of the valve and remove the diaphragm. The small diaphragm must remain in the upper part of the valve ● Prepare the individual parts for disinfection and cleaning in a washing machine. 103 Care Disinfecting / cleaning / sterilizing Disinfecting / cleaning / sterilizing Only products from the list of surface disinfectants may be used for disinfection. To ensure material compatiblity, products based on the following agents may be used: "Only for internal use by Draeger. Not applicable as Instructions for Use!" – Aldehydes – Alcohols – Quaternary ammonium compounds. The following products are not suitable: – – – – – Alcohols and agents containing alcohol must not be allowed to seep into the sample line! Alcohol can distort the measurement results. Breathing system All parts of the breathing system, valve discs, bellows, bellows container, Y-piece, breathing hoses, water trap containers, breathing bag, parts of the absorber and Resutator 2000, parts of the secretion aspirator and parts of the anaesthetic gas scavenging system Disinfect in hot liquid disinfectant – in a disinfecting machine at 93 °C for 10 minutes. Only use cleaning agent, no alkaline or chlorinereleasing substances – risk of corrosion! All parts of the breathing system (except the flow sensor!), Y-piece, breathing hoses, water trap containers, breathing bag, parts of the absorber, parts of the secretion aspirator and parts of the anaesthetic gas scavenging system ● The surface of the apparatus must not be treated with agents containing alcohol. ● Wipe off impurities with a damp disposable cloth. ● Disinfect with a wipe-on disinfectant, e.g. Buraton 10 F (made by Schülke & Mayr GmbH). Note the manufacturer's Instructions for Use. Do not allow any liquids to enter openings in the apparatus. Compounds containing alkylamines Compounds containing phenols Halogen-releasing compounds Strong organic acids Oxygen-releasing compounds. Users in the Federal Republic of Germany are advised to use disinfectants specified in the current list published by the German Society for Hygiene and Microbiology (DGHM). The DGHM list also specifies the active agent of each disinfectant. Users in countries in which the DGHM list is not available are advised to use the agents mentioned above. ● Surfaces of Julian, compressed gas hoses, cables and Vapor 19.3 / Vapor 2000 / Devapor can be sterilized in hot steam at 134 °C. 104 Flow-Sensor ● Disinfect for approx. 1 hour in 70 % ethanol solution. Leave the sensor to dry in air for at least 30 minutes, otherwise the remaining alcohol can damage the sensor when calibrated. The flow sensor cannot be autoclaved. ● The flow sensor can be reused as long as it can be calibrated successfully. ● The flow sensor must be disposed of as infectious special waste. It can be incinerated with little pollution at temperatures of more than 800 °C. Care Disinfecting / cleaning / sterilizing Microbial filter 654 St ● Wipe the surface with a disposable cloth. "Only for internal use by Draeger. Not applicable as Instructions for Use!" Do not clean with solvents such as naphtha, alcohol or ether. Do not clean the filter in cleaning and disinfecting machines. Do not immerse the filter in disinfectant solution. ● Sterilize the filter at max. 134 °C in a hot steam sterilizer. Do not use ethylene oxide sterilization! Do not sterilize when connected! ● Mark each sterilization in the corresponding field on the filter housing (e.g. with a water-resistant pen). The filter can be sterilized up to 24 times. The filter must be discarded: – if the pressure rise in the resistance test is greater than 2 mbar. – after being sterilized 24 times at the most. ● The filter must be sterilized once more in hot steam at 134 °C after use and can then be disposed of as plastic with ordinary domestic waste. Note the hygiene regulations of the hospital. All the components are listed in the care list for Juian on pages 106 and 107, together with the corresponding intervals and appropriate means. 105 Care Care list Care list for Julian anaesthetic workstation Only applies for non-infectious patients. When used with infectious patients, all parts in contact with breathing gas must additionally be sterilized after disinfection and cleaning. What How often Components which can be conditioned Conditioning intervals1) Filter on inspiration and expiration port Filter on Y-piece "Only for internal use by Draeger. Not applicable as Instructions for Use!" Julian workstation Front daily, other surfaces weekly Vapor 19.3 / Devapor unit Power cable, compressed gas hoses, equipotential bonding lead Breathing bag with twin connector and hose Breathing hoses Bellows Y-piece Cover of breathing system with APL valve Middle and bottom part of breathing system Container of bellows Valve discs (use a cassette) Expiration port Absorber and insert Water trap (monitoring) Microbial filter 654 St Filter of the measured gas recirculation system Flow sensor AGS housing AGS flow tube (without filter) Container for AGS buffer volume AGS transfer hose Scavenging hose with connector Waste gas connector with tube Hose of sample gas return or hose of sample gas scavenging Emergency breathing bag, its diaphragm, upper and lower valve parts (Dräger Resutator 2000) Silicone sleeve of secretion collecting bottle and rinsing bottle, their lid with float, suction hose and inspection window Without filter Daily Monthly Daily Daily Per patient Daily Weekly Daily Weekly Per patient Weekly Per patient Weekly Per patient Daily Per patient Weekly Weekly Daily Weekly Weekly Weekly Weekly Daily ––– Weekly Weekly Weekly Weekly Weekly Daily Daily Weekly Weekly Daily Daily Daily Daily ––– Weekly Weekly Weekly Weekly Daily Daily Weekly Weekly Weekly Monthly Weekly Weekly After each use As required, but at least daily 1) The conditioning intervals depend on the use and position of the filters. The table is merely intended as a rough guide. The instructions of the hospital's hygiene officer shall prevail! 106 Care Care list The parts should preferably be cleaned and disinfected in a washing machine, otherwise by immersion. Julian and its components must not be treated with formaldehyde vapours or ethylene oxide! How Disinfection and cleaning4) Washing 93 °C 10 minutes no no Wiping3) Immersion3) outside outside no no Sterilization Steam, 134 °C, 10 minutes no no no yes no no yes no possible yes yes yes yes no no no possible possible possible yes yes, max. 25 times yes yes no possible yes yes no possible yes yes yes yes yes yes no no no no no no outside4) possible possible possible possible possible no yes yes yes yes yes yes, max. 24 times no outside no yes, max. 10 times no yes no yes yes yes yes yes outside no yes no no no no no possible 5) possible no possible possible possible possible possible no no no yes no no no yes yes no possible yes yes no possible yes "Only for internal use by Draeger. Not applicable as Instructions for Use!" machine2) 2) Only use cleaning agents, no alkaline or chlorine-releasing substances. Risk of corrosion! 3) Surface disinfectants 5) Disinfect the flow based on aldehydes, sensor in 70% ethanol alcohols and quaternary solution for approx. ammonium compounds, 1 hour and leave such as PaMo dur rapid to dry in air for at least or PaMo sept (Dräger 30 minutes. Parts&More GmbH) can be used to ensure compatibility. 4) Do not use any agents containing alcohol. 107 Care Assembling Assembling Installing the breathing system 1 Place the bottom section on a flat surface. 2 Fit the valve plate on the bottom section. 5 3 Insert both white ceramic valve discs. 5 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 4 Tightly fit the cover. 5 Tighten all five sealing screws a quarter-turn. 5 5 4 5 5 3 2 3 1 6 Hang the breathing system into the slot-in unit. 6 Inserting the flow sensor 7 Insert the flow sensor with the electric connection in the slot. 8 Push in the expiration port with the nose of the port in the slot. ● Tighten the knurled nut by hand. 7 8 108 Care Assembling Installing the bellows ● Hold the breathing system from above to prevent it dropping out and 1 1 uniformly slide the tightly compressed bellows onto the connector. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2 Insert the container in the breathing system from below and turn it clockwise as far as possible. 2 Filling and installing the absorber 3 Push the insert fully into the absorber. ● Fill the absorber with fresh soda lime – up to the MAX mark. Only use Drägersorb 800! MAX 4 3 If the breathing system is to remain unused during the next 24 hours: ● Only fill with soda lime immediately before use! Soda lime dries out when exposed to ambient air and sun for a longer period of time. This reduces the CO2 absorption capacity and the effectiveness of the indicator. 4 Insert the absorber in the breathing system from below and turn clockwise as far as possible. 5 Slot in the breathing system – as far as possible. 6 6 Fold down the writing top. 5 5 109 Care Assembling Installing the breathing hoses "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Fit the microbial filters on the inspiration and expiration ports of the breathing system until they audibly engage. 1 3 2 2 Connect the 2.3 L breathing bag to the breathing hose with a connecting sleeve. Plug the breathing hose onto the angled connector and hang the breathing bag on the hook. 3 Plug the breathing hoses into the microbial filters and connect them to the Y-piece. ● Do not use antistatic or conductive breathing hoses! Fire hazard when using HF electrosurgery. Julian has no components containing latex. For latex-free use: ● Use latex-free breathing bag and breathing hoses. 4 Fit the water trap container from underneath. 5 Screw the sample line onto the Y-piece and water trap. Only use original sample line. Other lines may change the technical data of the device. 5 4 Alcohol and agents containing alcohol must not be allowed to penetrate the sample line! Alcohol distorts the results of the concentration measurement. Preparing the suction system 6 Plug the bacterial filter into the port on the side panel of the Julian. ● Replace the bacterial filter every two weeks. ● The filter must be disposed of as infectious special waste. It can be incinerated with little pollution at temperatures of more than 800 °C. 6 110 5 Care Assembling 1 Press the overflow protection float into the rising pipe until it clicks into place. The float must move freely without falling out. 2 Uniformly button the silicone sleeve onto the cover. 51 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 42 ● Connect the bottle cap to the secretion collecting bottles. ● Place the secretion collecting bottle in the inner sleeve and the rinsing bottle in the outer sleeve. 3 5 3 Fit the vacuum hose to the port on the Julian and to the thin port on the cap. 4 Fit the suction hose to the thick port on the cap. 4 3 5 Fit the secretion inspection window in the suction hose. Connecting the measured gas recirculation system 6 Fit the short hose to the port of the measured gas outlet. 6 7 Fit the long hose to the port of the recirculation system. 7 111 Care Assembling 1 Fitting waste gas connector 1 Push waste gas connector into the aperture all the way to the stop, angle downwards. 2 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2 Fit hose to connector. Sample gas scavenging If the sample gas is not to be recirculated: ● Use hose 11 90 520, connector M 33 151 and sealing cap (optional). 3 3 Connect the hose to the port of the sample gas outlet port. 4 Fit the connector with sleeve to the free end of the hose. Insert the connector in the coupling of the anaesthetic gas scavenging system until it clicks into place. 5 5 Fit the cap to seal the port. 4 112 Care Assembling Fitting emergency ventilation bag "Only for internal use by Draeger. Not applicable as Instructions for Use!" Example: Dräger Resutator 2000 ● Insert the adapter in the bag so that the rubber flange is uniformly located in the groove of the adapter. ● Press the retaining ring together completely with the large eyelet pointing towards the bag and clamp it over the bead on the bag. 1 Place the diaphragm in the bottom part of the valve with the lip facing downwards. Screw the upper part of the valve onto the bottom part. 1 2 Plug the patient valve into the bag adapter. 2 Connecting the anaesthetic gas scavenging system AGS 3 Connect the transfer hose to the excess gas connector and to the port of the scavenging system. 3 4 Connect the suction hose to the port of the scavenging system. 5 Connect the anaesthetic waste gas connector to the suction hose. 3 5 6 Ensure that the second port on the scavenging system is sealed with the sealing screw. ● Note the Instructions for Use of the anaesthetic gas scavenging system AGS. 6 3 4 113 114 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Julian as Wall-mounted Unit Contents Julian as Wall-mounted Unit "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents Features................................................................................................ 116 Preparation............................................................................................ 116 Anaesthetic gas aspiration......................................................................116 115 Julian as Wall-mounted Unit Julian as Wall-mounted Unit Features The wall-mounted unit is fixed to the wall and is available in left or right-hand hinged versions. "Only for internal use by Draeger. Not applicable as Instructions for Use!" The supply lines are permanently connected to the wallmounted unit. The auxiliary power sockets and the grounding pins for earth leads are located on the left and right sides of the lower half of the unit. The AGS anaesthetic gas scavenging line is built into the unit. The on/off switch and display symbols for anaesthetic gas aspiration are located in the lower half of the unit. The bacterial filter for secretion aspiration is located on the left side of the unit. The wall-mounted unit must be installed by qualified personnel only. We recommend DrägerService. Preparation Julian can be swung clear of the wall on its hinges to gain access to the back panel. 1 Pull the handle to swing the unit about 30° clear of the wall. D ● Julian Connect the sampling line for anaesthetic gas measurement to the back panel. After connecting the sample line: ● Swing the unit back against the wall until it latches into place. ● Pull gently to check that Julian is fixed to the wall. ● Always return the device to the wall position in order to save space and avoid damage. 1 Anaesthetic gas aspiration 2 Switch on = switch pointing upwards, symbol lights up green. Switch off = switch pointing downwards, symbol unlit. Operation and Care as per standard Julian model. 116 2 Maintenance Intervals Contents Maintenance Intervals Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Cleaning the cooling air filters..............................................................119 Replacing the water separator............................................................. 119 Replacing the O2 sensor.......................................................................119 Disposing of batteries and O2 sensors................................................ 120 Disposing of the used device............................................................... 120 117 Maintenance Intervals Maintenance Intervals "Only for internal use by Draeger. Not applicable as Instructions for Use!" The workstation and its components must be cleaned and disinfected before every maintenance operation even when returning for repair! Water separator Replace when dirty or when the message CO2 line?! is displayed (if the sample line is correctly installed and free of any blockage). Can be disposed of as domestic waste. O2 sensor Replace when calibration is no longer possible or when the message FIO2 INOP! is displayed. Disposal, see page 120. Flow sensor Replace when calibration is no longer possible or when the message FLOW INOP! is displayed. Can be incinerated with little pollution at temperatures of more than 800 °C. Bacterial filter for secretion aspiration Replace after two weeks. Must be disposed of as infectious special waste. Can be incinerated with little pollution at temperatures of more than 800 °C. Bacterial filter for measured gas recirculation Replace every six months. Can be incinerated with little pollution at temperatures of more than 800 °C. Cooling air filter (set of 3) Should be cleaned and thoroughly dried or replaced every month. Must be replaced after one year at the latest. Can be disposed of as domestic waste. Lithium battery for data backup (set of 2) Must be replaced by professionals after two years. Must be disposed of in accordance with local waste disposal regulations. Lead gel battery in power pack (set of 2) Julian should be used in battery mode without a patient at least every 4 weeks. A fully charged battery should keep the workstation operating for at least 30 minutes. If not, get lead gel battery (set of 2) replaced by professionals. Must be replaced by professionals after 2 years. Must be disposed of in accordance with local waste disposal regulations. Optical measuring set for determining the anaesthetic gas concentration Must be checked by professionals every six months. Time-keeper RAM Must be replaced by professionals after four years. Must be disposed of in accordance with the local waste disposal regulations. Inspection and maintenance Must be carried out by professionals every six months 118 Maintenance Intervals Cleaning the cooling air filters Replacing the water separator Replacing the O2 sensor Cleaning the cooling air filters – clean filters monthly. "Only for internal use by Draeger. Not applicable as Instructions for Use!" 1 Remove all three cooling air filters from their mount. ● Clean in warm water to which a detergent has been added; dry thoroughly. ● Insert the cooling air filters in their mount without creasing. ● Replace the cooling air filters after not more than one year. The filters can be disposed of as domestic waste. 1 1 1 Replacing the water separator – Every two weeks or – When soiled or – When the message CO2 line? ! is displayed (if the sample line is correctly installed and free of any blockage). ● Grip the water separator by its sides and pull it out. ● Push the new water separator into the holder as far as possible. ● The old water separator can be disposed of as domestic waste. Replacing the "Waterlock" water trap: ● See separate Instructions for Use. Replacing the O2 sensor – When the message FIO2 INOP! is displayed or – when the sensor can no longer be calibrated. 2 Remove the screw. 3 Remove the spent O2 sensor from the screw and insert a new O2 sensor in the screw. 2 Refit the screw. ● 3 2 Dispose of the spent O2 sensor, see page 120. 119 Maintenance Intervals Disposing of batteries and O2 sensors Disposing of the used device Disposing of batteries and O2 sensors "Only for internal use by Draeger. Not applicable as Instructions for Use!" Batteries and O2 sensors: ● must not be incinerated or thrown into a fire – risk of explosion! ● must not be opened forcibly – danger of chemical burns! ● must not be recharged. Batteries must be handled as special waste: ● They must be disposed of in conformity with the local waste disposal regulations. Spent O2 sensors can also be returned to Dräger Medizintechnik GmbH. Disposing of the used device – At the end of its useful life. Julian can be returned to Dräger Medizintechnik GmbH for disposal. 120 Fault – Cause – Remedy Contents Fault – Cause – Remedy Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Fault – Cause – Remedy....................................................................... 122 121 Fault – Cause – Remedy Fault – Cause – Remedy "Only for internal use by Draeger. Not applicable as Instructions for Use!" Julian divides the alarm messages into three priority classes identified by exclamation marks: !!! Warning = Message with top priority !! Caution = Message with middle priority ! Advisory = Message with least priority Message The messages are listed below in alphabetical order. The list is intended to help identify the cause of an alarm message and to remedy the fault rapidly. Cause Remedy Anaesthetic gas measurement faulty. Call DrägerService. AGAS MIX ! ! Mixture of more than two anaesthetic agents present. Scavenge system. Check fresh gas setting. 2nd AGAS ! 2nd anaesthetic agent recognized AIR SUPPLY !!! Compressed air supply has failed. Central supply connector not plugged in. Compressed air hose kinked. Scavenge system if necessary. Check fresh gas setting. Wait for transitional phase. Check connection to central supply. AGAS INOP APNEA CO2 APNEA PRESSURE APNEA VOL !!! !!! !!! Air compressor failure. Check compressor. Breathing/ventilation has stopped. No breath detected for 30 seconds. Patient must immediately be ventilated by hand! Check ventilator setting. Ensure it is not disconnected. No breath detected for 60 seconds in the "MAN/SPONT alarm limits" alarm mode. Patient must immediately be ventilated by hand! Check patient's spontaneous breathing ability. Breathing/ventilation has stopped. No change of pressure detected for 15 seconds. Patient must immediately be ventilated by hand! Inadequate supply of fresh gas. Check fresh gas setting. Leak in hose system. Check that hose system is not disconnected. Patient connection open.* Connect patient up correctly. Breathing/ventilation has stopped. No expiratory tidal volume for 15 seconds. Patient must immediately be ventilated by hand! Check patient's spontaneous breathing ability. Check ventilator setting. Inadequate supply of fresh gas. Check fresh gas setting. Tube kinked. Leak in hose system. Check hose system. * In automatic ventilation mode and with PEEP = 0, due to its very low internal breathing resistances, the workstation can display a measured value for the minute volume. This display is irrelevant in conjunction with the message "APNOEA PRESSURE!!!". 122 Fault – Cause – Remedy "Only for internal use by Draeger. Not applicable as Instructions for Use!" Message Cause Remedy If using a breathing gas humidifier: disconnect humidifier. If using heated breathing hoses: remove plug of hose heater. Check sensor lead. Replace sensor. Check patient's condition! Prepare manual ventilation with 100 % O2. AW TEMP > !!! Breathing gas temperature above 40 °C. AW TEMP INOP ! Airway temperature sensor defective. BATTERY LOW !!! The battery capacity of the uninterruptible power supply is almost exhausted. CO2/AGA INOP ! CO2 INOP CO2 LINE? ! ! CO2 / anaesthetic gas measurement faulty, and consequently: aspiratory O2 measurement faulty. CO2 gas measurement faulty. Sample line blocked. COOLING ? ! Internal temperature in apparatus is too high or fan for mixer electronics or DC/DC converter is defective. EMERGENCY O2 OPEN ! O2 emergency metering has opened in normal operation. Upper alarm limit for end-expiratory CO2 concentration has been exceeded for at least two breaths. End-expiratory CO2 concentration has fallen below lower alarm limit for at least two breaths. Upper alarm limit for expiratory MAC value has been exceeded. ET CO2 > !! ET CO2 < !! EXP MAC > > > > > > FI HAL < FI ISO < FI ENF < FI DES < FI SEV < FI O2 < FI HAL FI ISO FI ENF FI DES FI SEV FLOW INOP !! !!! !!! !!! !!! !!! !! !! !! !! !! !!! ! The inspiratory gas concentration of the relevant anaesthetic agent exceeds the upper alarm limit. The upper alarm limit has been exceeded for at least two breaths. Call DrägerService. Call DrägerService. Check sample line, filter in T-piece and watertrap, WaterLock or water separator; replace if necessary. Check that hose to anaesthetic gas scavenging system is not kinked. Clean filter on the back panel. Call DrägerService. Close O2 emergency metering. Check ventilation. Check ventilation. Check Vapor setting. Check fresh gas setting. Check setting of anaesthetic vaporizer. Inspiratory gas concentration of the Check setting of anaesthetic vaporizer. relevant anaesthetic agent is below the lower alarm limit. The value has remained below the lower alarm limit for at least two breaths. Inspiratory O2 concentration is below the lower alarm limit. Flow sensor defective. Check O2 supply. Check O2 concentration in fresh gas flow. Replace flow sensor, page 108. 123 Fault – Cause – Remedy Message Cause Remedy !! Fresh gas setting too low. Increase fresh gas flow. GAS FAILURE !!! Leak Failure of the O2 and AIR supply. INSP CO2 > !! Repair leak. Open backup O2 cylinder. Check connection to central supply. Replace the soda lime in the anaesthetic unit system. "Only for internal use by Draeger. Not applicable as Instructions for Use!" FRESH GAS ? INSP MAC > MV MV < > N2O SUPPLY !! Minute volume below the lower alarm limit. Tube blocked/kinked. Check tube. Leak in breathing system. Seal breathing system. Ventilation volume reduced by pressure limitation. Correct ventilation pattern. Inadequate fresh gas flow. Increase fresh gas flow. !! Minute volume exceeds upper alarm limit. Correct tidal volume or respiration rate. !!! N2O supply has failed. Open the N2O backup cylinder. The central supply connector is not plugged in or the N2O hose is kinked. Check connection to central supply. Restore N2O supply. N2O cylinder empty. Fault on switching over to the external fresh gas outlet. O2 sensor worn or defective Connect a full N2O cylinder. Call Dräger Service. The oxygen supply has failed. Open the O2 backup cylinder. The central supply connector is not plugged in or the O2 hose is kinked. O2 cylinder empty. Airway pressure exceeds upper alarm limit. Ventilation hose kinked. Stenosis. Pressure limit set too high. Inadequate supply of fresh gas. Check connection to central supply. Restore O2 supply. Connect a full O2 cylinder. Check hose system. !! !!! O2 INOP ! !!! PAW > PAW NEGATIVE Upper alarm limit for inspiratory MAC value has been exceeded. !!! !!! Mean pressure pmean less than –2 mbar. Airway pressure PAW less than –7 mbar. 124 Valve discs in breathing system defective. Set sample rate to 200 mL/min due to high frequency and time constant of CO2 sensor. Check Vapor setting. Check fresh gas setting. Check breathing system. Check setting of ventilator. NO FRESHGAS O2 SUPPLY The inspiratory CO2 concentration exceeds the upper alarm limit set. Replace O2 sensor, page 119 Correct pressure limit. Set adequate fresh gas flow on the anaesthetic unit. Fault – Cause – Remedy "Only for internal use by Draeger. Not applicable as Instructions for Use!" Message Cause Remedy P MAX ? ! PCV pressure limit not reached. Seal the leak. Correct pressure limit, inspiratory flow or inspiration time if necessary. POWER FAIL ! Power supply failure. Check battery capacity. Prepare manual ventilation. Remove the device plug from the auxiliary socket. Press the switch on the back panel. Short-circuit in one of the devices connected to the auxiliary sockets. PRESSURE LIMIT !! PRESSURE INOP ! PRESSURE EXP > !!! End-expiratory pressure is more than 10 mbar above the set PEEP. Increase expiration time. Check hose system and microbial filter. Drain water trap. PULSE SPO2 < !!! Pulse rate has dropped below the set alarm limit. Pulse rate exceeds upper alarm limit. Check patient's condition! No pulse signal detected by SpO2 measurement for approx. 10 seconds. Check patient's condition! PULSE SPO2 > !! RS 232 COM ! SPO2 < !!! SPO2 > !! SPO2 INOP ! !!! SPO2 PULSE ? The ventilator is operating in pressurelimited mode. Lung compliance has changed. Tube kinked. Check tube/microbial filter. Microbial filter clogged on the inspiratory If necessary, increase Pmax or reduce side. VT Pressure sensor defective. Call DrägerService. Check patient's condition! Correct alarm limit if necessary. Communication via the RS 232 interface Check the plug connection on Julian COM 2 has been interrupted. and the connected device. Oxygen saturation is below the set lower Check ventilation. alarm limit. Check O2 concentration of the fresh gas. Oxygen saturation exceeds the upper Check O2 concentration of the fresh alarm limit. gas flow. Check ventilation. SpO2 measurement faulty. Call DrägerService. Check SpO2 sensor! SpO2 sensor not plugged in. Check sensor connection. SPEAKER FAIL ! ! No alarm tone, loudspeaker faulty. Call DrägerService. SYSTEM ERROR !!! Internal device error. Automatic switchover to MAN/SPONT. SPO2 SENSOR? Version without rotary knob for O2 emergency metering: Julian automatically delivers an O2 flow of 8 L/min. Immediately ventilate the patient by hand. Version with rotary knob for O2 emergency metering: Set »Safety O2« rotary knob to desired O2 flow. Range 0 to 12 L/min. This O2 flow flows through the Vapor unit. Set »Safety O2« rotary knob for O2 emergency metering to desired O2 flow. Range 0 to 12 L/min. Immediately ventilate the patient by hand. Check Vapor unit setting. Call DrägerService. 125 Fault – Cause – Remedy Message !!! WATER TRAP ! "Only for internal use by Draeger. Not applicable as Instructions for Use!" VENT INOP 126 Cause Remedy The ventilator control unit is performing an internal restart. This restart procedure takes about 30 seconds. The collecting jar of the water trap at the back of the unit is full. After about 30 seconds, Julian is restored to its previous operating mode. The prism of the water trap is misted over with condensation. Wipe the prism dry. Empty the jar. Exchange the watertrap, WaterLock. What's what Contents What's what "Only for internal use by Draeger. Not applicable as Instructions for Use!" Contents Front view............................................................................................. 128 Gas supply panel................................................................................... 129 Screen with user interface......................................................................130 Rear view.............................................................................................. 131 Interface panel....................................................................................... 132 127 What's what What's what Front view 15 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 14 1 13 2 3 12 4 11 5 6 10 7 9 1-36-96 8 1 Screen with user interface 10 Bacterial filter for suction system 2 Rotary knob for selection, setting and confirmation 11 Compact breathing system 3 Main power switch 12 Gas supply panel (see page 129) 4 Writing top 13 Vapors with interlock system 5 Catch to unlock the breathing system 14 Mounting rail for accessories 6 Bellows 15 Shelf for patient monitor 7 Absorber 8 Drawer 9 Suction system 128 What's what Gas supply panel 6 7 8 O2 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 2.5 N2O Air 2.5 6 kPa x 100 bar 2.5 6 kPa x 100 bar 6 kPa x 100 bar 5 Safety-O 2 6 4 2 8 10 Vac. 0 12 O2 + L/min 4 3 2 1 O2 flush 2 Adjustable O2 emergency metering (optional) 3 Secretion aspiration on/off switch 4 Rotary knob for secretion aspiration suction 5 Secretion aspiration pressure gauge 6 Central gas supply O2 pressure gauge 7 Central gas supply AIR pressure gauge 8 Central gas supply N2O pressure gauge 1 129 What's what Screen with user interface 1 2 3 4 5 11 IPPV 12 Pleth "Only for internal use by Draeger. Not applicable as Instructions for Use!" SpO2 etCO2 CO2 40 MV O2 0 PAW 20 N2O Iso. Enf. 0 98 67 13 alarm limits 38 6.0 freq auto set limits 10 Fi Fet alarm info 45 53 0.8 0.6 41 51 0.6 0.5 list .. 12... 14 curves config. 15 1.3 MAC (age: 36) 16 Freshgas O2+N2O O2 % L/min Pmax VT mbar mL TI:TE TIP:TI PEEP % mbar 1/min 35 600 10 1:2.0 10 50 4.00 MAN SPONT AIR N 2O Freq. IPPV 0 PCV 17 18 6 7 8 9 10 1 Status field showing the current ventilation mode 10 Softkeys for setting ventilation 2 Curve field for curves and bar graphs 11 Power supply indicator 3 Alarm field for alarm messages and their priority 12 Alarm indication LEDs 4 Measurement field for numerical values 13 Key for suppressing the acoustic alarm for 2 minutes 5 Softkeys for monitoring functions 14 Key for changing monitoring screen pages 6 Keys for selecting the carrier gas (N2O or AIR) 15 Key for calling up the standard screen 7 Softkeys for setting the fresh gas flow 16 User advisory field 8 Status line for fresh gas 17 Rotary knob for selection, setting and confirmation 9 Keys for selecting the ventilation mode 18 Key for switching to standby mode 130 What's what Rear view 12 1 2 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 3 4 11 5 6 10 7 8 MT-490-98 9 1 Gas supply ports 7 Auxiliary power sockets 2 Sample gas return with filter 8 Pin for earth cable 3 O2 sensor (behind the sealing screw) 9 Anaesthetic gas scavenging system AGS 4 Interface panel 10 Power cable 5 Waste gas connector 11 Cooling air filters 6 Transfer hose to anaesthetic gas scavenging system AGS 12 Connection for sample line with water trap 131 What's what "Only for internal use by Draeger. Not applicable as Instructions for Use!" Interface panel Analog 1 COM 3 2 COM 2 3 COM 1 4 SA-Bus 5 Sync. [ CAN 2 SpO2 m CAN 1 Temp. 6 7 8 9 10 1 Analog Analog output for three curves 2 COM3 RS232 interface for MEDIBUS 3 COM2 RS232 interface for MEDIBUS (additional monitoring) 4 COM1 RS232 interface for printer 5 SA-Bus For DrägerService only 6 CAN1 Interface for PM 8060 vitara (haemodynamic screen), optional 7 CAN2 Interface for parameter box PB 8800, optional 8 Temp Socket for temperature sensor, optional 9 SpO2 Socket for SpO2 sensor, optional 10 Sync 132 Socket for C-Lock-ECG synchronization of the optional SpO2 measurement Technical Data Contents Technical Data Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Ambient conditions...............................................................................134 Fresh gas.............................................................................................. 134 Ventilator...............................................................................................134 Breathing system..................................................................................135 Measuring systems...............................................................................135 Pressure measurement ..........................................................................135 O2 measurement....................................................................................135 Flow measurement................................................................................. 136 Airway temperature measurement....................................................... 136 CO2 measurement................................................................................. 136 Anaesthetic gas measurement................................................................ 137 SpO2 measurement............................................................................... 137 C-Lock-ECG synchronization (optional)..................................................138 Interfaces.............................................................................................. 138 Operating data...................................................................................... 139 133 Technical Data Technical Data Ambient conditions "Only for internal use by Draeger. Not applicable as Instructions for Use!" In operation: Temperature Air pressure Rel. humidity CO2 concentration of ambient air In storage: Temperature Air pressure Rel. humidity 10 to 35 °C 700 to 1060 hPa 20 to 80 % (no condensation) 300 to 800 ppm –20 to 60 °C O2 sensor max. 50 °C 500 to 1100 hPa <98 % (no condensation) Fresh gas (electronic mixer) Settings: O2 concentration 25 to 100% by vol., at least 25% by vol. or 250 mL/min ± 5% of set value Fresh gas flow 0 and 0.5 to 12 L/min ± 10% of set value or max. ±100 mL >35 L/min O2 flush Ventilator (electronically controlled, pneumatically driven bellows in bottle ventilator, fresh gas disconnected) Settings: Pressure limit Pmax for IPPV for PCV Tidal volume for IPPV for PCV 10 to 70 mbar (PEEP+1) to 70 mbar ±10 % of setting or at least ±2 mbar 50 to 1400 mL ± 15% of the setting for inspiration flows ≥ 10 L/min. 20 to 1400 mL (result of the ventilation settings) Ventilation frequency 6 to 60 per minute Tinsp 0.2 to 6.7 seconds Texp 0.33 to 8 seconds Insp/Exp. time ratio TI : TE 1 : 4 to 2 : 1 with automatic ventilation Plateau time ratio TIP : TI 0 to 50 % Inspiratory flow (PCV) 5 to 50 L/min ±10 % Can be set to up to 75 L/min by DrägerService Inspiratory flow (IPPV) (cannot be set directly; depends on the setting for VT, Freq. TI:TE and TIP:TI) 3 to 75 L/min PEEP 0 to 20 mbar at least ±2 mbar 134 Technical Data "Only for internal use by Draeger. Not applicable as Instructions for Use!" Breathing system Total gas volume (without breathing hoses) Approx. 4.5 L enclosed gas volume Compliance with filled absorber container, without breathing hoses Approx. 4.5 mL/mbar Absorber volume 1.5 L Leakage (EN 740) <150 mL at 30 mbar Pressure limiting valve APL Adjustment range 5 to 70 mbar ±15 % of setting Exp. resistance (EN 740) 4,8 mbar at 60 L/min Insp. resistance (EN 740) 4,6 mbar at 60 L/min absorber container filled with DrägerSorb 800 Plus Fresh gas outlet for non-rebreathing system Connection dia. 22 ISO Pressure max. 80 mbar Fresh gas flow 0; 0,5 to 12 L/min Measuring systems Pressure measurement (piezoresistive) Airway pressure Resolution Accuracy –10 to 99 mbar 1 mbar Better than ±4 % of measured value or at least 1 mbar, the larger value applies. O2 measurement (fuel cell in sidestream) Sample rate Delay time for sampling Measuring range Resolution Accuracy 60 mL/min or 200 mL/min Less than 1 second (for a sample rate of 200 mL/min) 5 to 100 vol% 1 vol% Calibration in air: ±3 vol% in the range from 5 to 50 vol% ±5 vol% in the range from 50 to 100 vol% Calibration with 100 % O2: ±3 vol% in the range from 5 to 100 vol% Drift Within the ranges specified above Response time t10...90 at 200 mL/min at 60 mL/min 500 ms 1s 135 Technical Data Flow measurement (hot wire anemometry) "Only for internal use by Draeger. Not applicable as Instructions for Use!" Tidal volume VT Range Resolution Accuracy (under calibration conditions and 1013 hPa) Minute volume MV Range Resolution Accuracy (under calibration conditions and BTPS*) Respiration rate Range Resolution Accuracy 0.02 to 9.99 L 0.01 L Better than ±8 % of the measured value or 0.01 L, the larger value applies 0 to 99.9 L/min 0.1 L/min Better than ±8 % of the measured value 0 to 60 per minute ±1 per minute ±1 per minute Airway temperature measurement (NTC resistance) Measuring range Resolution Accuracy 20 to 50 °C 1K ±0.5 K in the range from 30 to 41 °C CO2 measurement (infrared spectrometry) Sample rate (selectable) Delay time for sampling 60 mL/min or 200 mL/min Less than 1 s (for a sample rate of 200 mL/min) Response time t 10...90 at 200 mL/min at 60 mL/min 300 ms 1s Measuring range Resolution Accuracy 0 to 9.9 kPa (0 to 80 mmHg) 0.1 kPa ±0.2 vol% or 5 % of measured value ___________ * BTPS: Body temperature, current atmospheric pressure, gas saturated 136 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Technical Data Anaesthetic gas measurement (infrared spectrometry) All data in % by volume at 1013 mbar current atmospheric pressure Sample rate (selectable) Delay time for sampling 60 mL/min or 200 mL/min Less than 1 s (for a sample rate of 200 mL/min) Response time t 10...90 at 200 mL/min at 60 mL/min 300 ms 1s Accuracy The measurement accuracy required by DIN ISO 11196 is attained at the latest 4 minutes after switching on the apparatus. The threshold for automatic detection is 0.15% by volume. To check the complete accuracy of Julian, a temperature stabilisation time of 1 hour at 21°C should be observed. The accuracy of the measuring equipment used should be at least 5 times and if possible 10 times higher than that of Julian. Display range for N2O Resolution Accuracy 0 to 100 vol% 0.1 vol% Better than ±2 vol% absolute or ±3 % of measured value Display range for halothane Resolution Accuracy for 0 to 4 vol% >4 to 8.5 vol% 0 to 8.5 vol% 0.1 vol% Display range for isoflurane Resolution Accuracy for 0 to 5 vol% >5 to 8.5 vol% Display range for enflurane Resolution Accuracy for 0 to 54 vol% >4 to 9.9 vol% Display range for sevoflurane Resolution Accuracy for 0 to 6 vol% >6 to 9.9 vol% Display range for desflurane Resolution Accuracy for 0 to 15 vol% >8 to 22 vol% 0.15 vol% or 5 % of measured value ±10 % of measured value 0 to 8.5 vol% 0.1 vol% 0.15 vol% or 5 % of measured value ±10 % of measured value 0 to 9.9 vol% 0.1 vol% 0.15 vol% or 5 % of measured value ±10 % of measured value 0 to 9.9 vol% 0.1 vol% 0.15 vol% or 5 % of measured value ±10 % of measured value 0 to 22 vol% 0.1 vol% 0.15 vol% or 5 % of measured value ±10 % of measured value Automatic anaesthetic gas identification Volatile anaesthetic agents are automatically identified. Manual selection is not necessary and not possible. In the case of a mixture of two volatile anaesthetic agents, the concentration of the secondary anaesthetic agent is displayed from a MAC value of 0.1 MAC. A secondary anaesthetic agent becomes the main anaesthetic agent if its MAC value exceeds the MAC value of the main anaesthetic agent by 0.2 MAC. If a mixture of more than 2 volatile anaesthetic agents is present, the display is blank. Cross-sensitivity None with respect to alcohol, acetone, methane, NO and CO. 137 Technical Data "Only for internal use by Draeger. Not applicable as Instructions for Use!" SpO2 measurement, optional (light absorption) Display range Accuracy (adults) between 70 and 100 % SpO2 between 50 and 70 % SpO2 between 0 and 50 % SpO2 0 to 100 % SpO2 Better than ±2 % SpO2 Better than ±3 % SpO2 Not specified Accuracy (neonates) between 70 and 95 % SpO2 between 0 and 70 % SpO2 between 95 and 100 % SpO2 Better than ±3 % SpO2 Not specified Not specified Actualization time Once per heartbeat Pulse rate Accuracy 20 to 250 per minute ±2 per minute Sensors Type Compatible with Nellcor sensors Oxisensor, Oxiband and Durasensor Wavelengths 660 nm (red) 920 nm (infrared) Acoustic pulse signal A tone is produced for each detected pulse, tone pitch proportional to oxygen saturation C-Lock-ECG synchronization (optional) Requirements for ECG synchronization signal Max. permissible signal delay with reference to current QRS complex Pos. pulse with voltage >4.5 V, >10 ms duration for driving 2 mA 40 ms Ground Socket for 2-pin jack-plug, dia. 3.5 Jack layout Signal isolation from other electronic components Dielectric strength Signal 4 kV Interfaces Analog output Plug connector PAW Flow CO2 Earth 138 9-pin sub-D, electrical isolation 1.5 kV 0 to 100 mbar; 0 to 5 V =; PIN 3 0 to 150 L/min; 0 to 5 V=; PIN 6 0 to 10 kPa; 0 to 5 V=; PIN 9 PIN 1, 4, 7 Technical Data "Only for internal use by Draeger. Not applicable as Instructions for Use!" COM1 record (printer) Connector Pin assignment COM2 (MEDIBUS 1) Connector Pin assignment COM3 (MEDIBUS 2) Connector Pin assignment 9-pin sub-D, electrical isolation 1.5 kV 1 shield 2 TxD 3 RxD 5 GND 9-pin sub-D, electrical isolation 1.5 kV 1 shield 2 TxD 3 RxD 5 GND 9-pin sub-D, electrical isolation 1.5 kV 1 shield 2 TxD 3 RxD 5 GND Operating data Operating voltage 90 – 265 V~ Power input 400 W typically, max. 2.3 kW Uninterruptible power supply with fully charged battery: typically 30 min (auxiliary sockets are not powered!) Mains fuse Automatic circuit-breaker 10 A Auxiliary sockets Each with two fuses 2 A T2L 250V DIN 41662, IEC 127-2/III Medical gas supply O2 N2O AIR 2.7 to 5.5 bar 2.7 to 5.5 bar 2.7 to 5.5 bar Drive gas consumption Operation Standby and MAN/SPONT MV +1 L/min AIR or O2 0 L/min Dimensions of Julian W x H x D 68 cm x 133 cm x 68 cm Dimensions of the storage tray W x D 43 cm x 29 cm Dimensions of the breathing system W x H x D 31 cm x 35 cm x 21 cm Weight of Julian (Ready for operation without Vapor units and gas cylinders) Approx. 90 kg Weight of breathing system without soda lime 4.8 kg Screen Electro-luminescent screen, 10.4" diagonal Protection class Device I, type B conforming to EN 60601-1 SpO2 sensor Type BF electrically isolated from protective earth 139 "Only for internal use by Draeger. Not applicable as Instructions for Use!" Technical Data Electromagnetic compatibility EMC Tested to EN 60601-1-2 Classification according to Directive 93/42/EC Appendix IX Class II b UMDNS Code Universal Medical Device Nomenclature System 10-134 Latex Julian is latex-free. For latex-free use, latex-free breathing bag and breathing hoses should be used with Julian. 140 Abbreviations / Symbols Contents Abbreviations / Symbols Contents "Only for internal use by Draeger. Not applicable as Instructions for Use!" Abbreviations........................................................................................ 142 Symbols ............................................................................................... 143 141 Abbreviations "Only for internal use by Draeger. Not applicable as Instructions for Use!" Abbreviations Abbreviation Meaning Abbreviation Meaning AGas Anaesthetic gas MAC Minimum Alveolar Concentration AGS Anaesthesia Gas Scavenging System MAN/SPONT AIR Compressed air for medical use Manual ventilation / spontaneous breathing APL Adjustable Pressure Limitation MEAN Mean pressure BTPS Measuring condition at body temperature, current atmospheric pressure and saturated gas MV Expiratory minute volume N2O Nitrous oxide (laughing gas) NiBP Non-invasive blood pressure O2 Oxygen Pa Pascal (1mbar = Pa x 100) PAW Airway pressure PCV Pressure Controlled Ventilation PEAK Peak pressure PEEP Positive end-expiratory pressure Plateau Plateau pressure Pleth Plethysmogram Pmax Maximum pressure Sev. Sevoflurane SpO2 Functional O2 saturation Tip:Ti Ratio of inspiratory pause time to inspiration time ç Conformité Européenne Directive 93/42/EC on Medical Products CC-Lock The SpO2 signal is synchronized with the ECG signal Compl. Compliance Des. Desflurane etCO2 End-expiratory CO2 concentration Enf. Enflurane Fet End-expiratory fraction Fi Inspiratory fraction Fi Des Inspiratory desflurane concentration Fi Enf Inspiratory enflurane concentration Fi Hal Inspiratory halothane concentration Fi Iso Inspiratory isoflurane concentration TI:TE Ratio of inspiration time to expiration time Fi Sev Inspiratory sevoflurane concentration USV Uninterruptible power supply FLOW Expiration flow VAC Vacuum (e.g. for secretion aspiration) Fi CO2 Inspiratory CO2 concentration VT Tidal volume Fi O2 Inspiratory O2 concentration ZV Hal. Halothane Piped medical gas supply for O2, N2O, AIR and vacuum HLM Alarm mode for heart-lung machine INOP Function failure IPPV Intermittent Positive Pressure Ventilation Iso. Isoflurane 142 Symbols Symbols Symbol "Only for internal use by Draeger. Not applicable as Instructions for Use!" G Q Meaning Suppress alarm tone for 2 minutes Call up standard page S Call up basic pages in succession E Standby / operation switch ª Pulse rate Fresh gas flowing u Action in progress ✓ Action has been completed successfully ? Repeat calibration _ Upper and lower alarm limits > Upper alarm limit only < Lower alarm limit only _ Alarm monitoring inactive –– Alarm limit deactivated **** Enter 4-digit password ! Advisory message !! Caution message !!! Warning message m m Protection class type B (body) P Connection for equipotential bonding Protection class type BF (body floating) Connection for equipotential bonding z Close menu, back to previous menu Connection for non-rebreathing systems J >XX min Available operating time with uninterruptible power supply UPS 143 Index "Only for internal use by Draeger. Not applicable as Instructions for Use!" Index Abbreviations ......................................................... 142 Absorber, dismantling ............................................. 101 Absorber, filling and installing ................................. 109 Accessories ................................................................ 5 Advisory ........................................................... 63, 122 Airway temperature measurement ............................. 80 Alarm info ................................................................. 64 Alarm limits ............................................................... 61 Alarm sound, setting ........................................... 69, 83 Alarms ............................................................... 55, 60 Alarms, FRESH GAS EXTERNAL ............................ 51 Alarms, IPPV ............................................................ 42 Alarms, MAN/SPONT .............................................. 39 Alarms, PCV ............................................................ 45 Alarms, selecting ................................................ 60, 72 Ambient conditions ................................................. 134 Anaesthetic agent ....................................... 74, 93, 116 Anaesthetic agent scavenging system AGS ....................................... 23, 28, 102, 113 AutoSet .................................................................... 62 Auxiliary devices ....................................................... 24 Auxiliary power socket .............................................. 24 Backup gas cylinders ............................................... 29 Basic configurations ................................................. 89 Basic pages ............................................................. 17 Batteries ................................................................. 120 Battery ..................................................................... 19 Bellows, installation ................................................ 109 Bellows, removal .................................................... 101 Breathing bag ......................................................... 110 Breathing hoses ..................................................... 110 Breathing hoses, installing ...................................... 110 Breathing system .............................................. 28, 135 Breathing system, dismantling ................................. 100 Breathing system, installing ..................................... 108 Breathing system, opening ...................................... 102 C-Lock ECG synchronization ........................... 77, 138 Calibration ......................................................... 75, 93 Care ......................................................................... 98 Care list .................................................................. 106 Carrier gas, selecting ............................................... 36 Caution ............................................................ 63, 122 Checking against checklist ....................................... 26 Checklist .................................................................. 26 Children, ventilating .................................................. 49 Classification .......................................................... 139 Cleaning ................................................................. 104 CO2 alarms on/off .............................................. 64, 72 CO2 unit, setting ................................................ 70, 84 CO2, setting ............................................................. 84 COM1 ..................................................................... 86 COM2 ..................................................................... 86 COM3 ..................................................................... 86 144 Compliance ................................................ 32, 40, 135 Configuring in operation ........................................... 68 Configuring in standby .............................................. 82 Connection ................................................................. 5 Cooling air filter, cleaning ............................... 118, 119 Curves ............................................................... 66, 89 Data page .......................................................... 17, 57 Date ......................................................................... 89 Default alarm limits, setting ....................................... 87 Default setting, fresh gas .......................................... 92 Default setting, IPPV ................................................. 91 Default setting, PCV ................................................. 91 Default values ........................................................... 82 Disinfecting ............................................................ 104 Disposal ................................................................. 120 Disposing of the used device .................................. 120 ECG signal .............................................................. 77 Emergency ......................................................... 33, 52 Emergency metering ................................................. 30 Emergency mode ..................................................... 52 Emergency ventilation bag ........................ 29, 103, 113 End of operation ....................................................... 54 Equipotential bonding ............................................... 24 Explosion hazard areas ............................................... 5 First-time operation .................................................. 20 Flow sensor, installation .......................................... 108 Flow sensor, removal .............................................. 101 For your safety and that of your patients ...................... 5 Fresh gas flow, setting ............................................. 36 Fresh gas metering ........................................... 93, 134 Fresh gas, setting ..................................................... 36 Gas cylinders ........................................................... 23 Gas cylinders ........................................................... 23 Gas failure ................................................................ 53 Gas supply ....................................................... 22, 129 HLM alarm mode ..................................................... 73 HLM mode ............................................................... 73 Intended use .............................................................. 9 Intended use ............................................................... 9 Interfaces ............................................................... 132 Interfaces, configuring ........................................ 86, 87 IPPV ......................................................................... 40 Language ................................................................. 89 Latex-free......................................................... 110, 139 Leakage test ............................................................. 48 Liability ....................................................................... 5 Limits ....................................................................... 60 Limits, adjusting ....................................................... 62 List ........................................................................... 65 Index "Only for internal use by Draeger. Not applicable as Instructions for Use!" MAC .................................................................. 74, 94 Maintenance ....................................................... 5, 118 Maintenance intervals ............................................. 118 Major hardware fault ................................................. 53 MAN/SPONT ........................................................... 37 Manual calibration .............................................. 75, 93 Manual ventilation ..................................................... 37 Measured gas recirculation system, connecting ...... 111 Measured gas, scavenging ..................................... 112 Measuring parameters, setting ............................ 70, 84 Measuring systems ................................................. 135 MEDIBUS ................................................................ 86 Message – Cause – Remedy .................................. 122 Microbial filter ................................................... 99, 105 Microbial filter 654 St ....................................... 99, 105 Mobile telephones ...................................................... 9 Monitor defaults, activating ....................................... 71 Monitoring functions, selecting/setting ...................... 15 Non-rebreathing systems .......................................... 50 Nuclear spin tomography ............................................ 9 O2 concentration, setting ......................................... 36 O2 cylinders ............................................................. 23 O2 emergency metering ........................................... 30 O2 flush ............................................................. 23, 30 O2 sensor, replacing .............................................. 119 Operating characteristics ........................................ 139 Operating concept ................................................... 12 Paediatric hoses ...................................................... 49 Patient, change ........................................................ 47 PCV ......................................................................... 43 Power failure ............................................................ 20 Power failure ............................................................ 52 Power supply ........................................................... 24 Preparation ............................................................... 22 Pulse tone, setting .............................................. 69, 83 Standard screen ....................................................... 89 Standby ............................................................. 47, 54 Starting up ......................................................... 26, 33 Sterilization ............................................................. 104 Suction rate .............................................................. 84 Switch-off time lag .................................................... 54 Symbols ................................................................. 143 System compliance ............................... 32, 39, 40, 135 Technical data ........................................................ 134 Time ......................................................................... 89 Trend memory, deleting ............................................ 59 Trend page ........................................................ 17, 58 UMDNS code ........................................................ 139 Uninterruptible power supply UPS ...................... 20, 52 Vapor ................................................................. 27, 46 Vapor, setting ........................................................... 46 Ventilation mode ....................................................... 37 Ventilation mode IPPV .............................................. 40 Ventilation mode MAN/SPONT ................................. 37 Ventilation mode PCV ............................................... 43 Ventilation parameters for IPPV .......................... 40, 90 Ventilation parameters for PCV ........................... 43, 90 Ventilation parameters, selecting/setting ................... 14 Ventilator ................................................................ 134 Volumeter function .................................................... 67 Wall-mounted unit ................................................... 116 Waste gas connector ..................................... 101, 112 Water separator, replacing .................................... 119 Water trap ................................................................ 27 What‘s what ........................................................... 128 Zoom function .......................................................... 59 Record ............................................................... 71, 86 Safety checks ............................................................ 5 Sample line ........................................................ 79, 98 Scale, selecting .................................................. 69, 83 Screen ergonomics .................................................. 12 Screen layout ........................................................... 16 Secretion aspiration .................................................. 30 Secretion aspiration, dismantling ............................. 100 Secretion aspiration, preparation ............................ 110 Secretion, aspirating ................................................. 46 Self-test .................................................................... 31 Soda lime, changing ................................................. 47 SpO2 alarms on/off .................................................. 72 SpO2 measurement .......................................... 76, 137 SpO2 sensor ............................................................ 76 Spontaneous breathing ............................................. 37 Standard page ................................................... 17, 56 145 146 "Only for internal use by Draeger. Not applicable as Instructions for Use!" 147 "Only for internal use by Draeger. Not applicable as Instructions for Use!" These Instructions for Use apply only to Julian with Serial No.: If no Serial No. has been filled in by Dräger these Instructions for Use are provided for general information only and are not intended for use with any specific machine or device. ç "Only for internal use by Draeger. Not applicable as Instructions for Use!" Directive 93/42/EEC concerning Medical Devices Dräger Medizintechnik GmbH Germany H Moislinger Allee 53 – 55 D-23542 Lübeck T (4 51) 8 82 - 0 X 26 80 70 FAX (4 51) 8 82-20 80 ! http://www.draeger.com 90 37 064 - GA 5132.006 en Dräger Medizintechnik GmbH 2nd edition - May 2000 Subject to alteration