PenlonInterMedPartnership for LifeAV-S VentilatorIntroduction PenlonInterMedPartnership for LifeAV-S VentilatorProduct OverviewIntroductionCharacteristicsConfigurationSub-assemblies PenlonInterMedPartnership for LifeAV-S VentilatorOperationVentilator control settingsOperation workshopPre-operative checkout procedure PenlonInterMedPartnership for LifeAV-S Ventilator!C"#ICAL $!SC%IPIO#AV-S Pneumatic description&AV-S !lectrical description& PenlonInterMedPartnership for LifeAV-S VentilatorPractical'$isassembl(&Planned maintenance&est and calibration procedures&)ault finding& PenlonInterMedPartnership for LifeAV S ventilatorProduct Overview PenlonInterMedPartnership for LifeAims and Ob*ectivesAim'he aim of this module is to give the student a full understanding of the features and characteristics of the AV-S ventilator&Ob*ective'+( the end of this module the student will be able to' $escribe the features of the AV-S& %ecognise user controls& %ecognise AV-S configuration& PenlonInterMedPartnership for LifeAV-S Ventilator Pneumaticall( driven& Software controlled& ,ulti-mode ventilator& ime-c(cled- volume.pressure controlled and pressure limited& Compliance / fresh gas compensated& 0ser ad*ustable sigh / inspirator( pause& PenlonInterMedPartnership for LifeAV-S monitoringIntegrated monitoring'Inspired o1(gen measurement&,easured from inspirator( limb&Airwa( pressure measurement&,easured in the e1pirator( limb&idal.,inute volume measurement&$ual spirometr( s(stem& PenlonInterMedPartnership for LifeAV-S featuresLarge 2&34 high definition colour screen&ouch screen&%otar( control dial&Single. $ual waveform displa(&$esigned to integrate with'PrimaSP5 SP6 and SP7&A899SP5 A699SP& PenlonInterMedPartnership for LifeAV-S featuresPrint outs / interfacing'0S+- Serial Port- Analogue outputs- "PPCL3 printer output&79 minutes batter( back up as standard'Optional :9 minute batter( available& PenlonInterMedPartnership for LifeAV-S featuresL!$ power indicators';ellow when connected .batter( chargingOn/Off SwitchAlarm silence.mute ke(&,enu selection ke(L!$ on.off indicator& 11 PenlonInterMedPartnership for Life,odes of ventilationS"ecial / Su""ort modes#SI,V- S,,V / PSV&hese must be pre-selected&Absorber must be switched to BVentC mode& PenlonInterMedPartnership for Life,odes of ventilationSelectin1 Su""ort Modes#2Standby32S"ecial Modes32Select Mode4s53 PenlonInterMedPartnership for Life,odes of ventilation6sin1 Su""ort Modes#ouch special mode on-screen ke( 16 to select and confirm mode&!nsure absorber is switched to BVentC mode&Ad*ust ventilation parameters as reAuired& PenlonInterMedPartnership for Life,odes of ventilationSI,V.S,,V.PSV are used when a patientCs spontaneous respirator( rate- effort or tidal volume drops' $ue to a deepening of the depth of anaesthesia&A safet( net for a weak spontaneousl( breathing patient&0sed differentl( than in intensive care& PenlonInterMedPartnership for Life,odes of ventilationSynchronised .ntermittent Mandatory Ventilation,andator( breaths delivered at a wide interval&Patient breathes spontaneousl( between mandator( breaths&,andator( breath is s(nchronised with a patient breath&If no patient breath a mandator( breath is still delivered&&11 $ispla(Airway PressureLimitPEEP SelectI:E RatioBreath RateTidal VolumemeasuredSet Tidal Volume PenlonInterMedPartnership for LifeAn( JuestionsK PenlonInterMedPartnership for LifeAV-S VentilatorOperation PenlonInterMedPartnership for LifeAims and Ob*ectives7im#he aim of this module is to familiarise the student with the operation of the AV-S VentilatorOb;ecti-es#+( the end of this module the student will be able to' Operate the ventilator in volume and pressure modes #avigate the menus Set alarm limits %ecognise alarm conditions PenlonInterMedPartnership for LifeOperation;ellow indicator is illuminated whenever power is applied to the unit and internal batter( is being chargedSwitch OnShort internal test seAuenceSwitch OffShort power down seAuence with audible tones869 seconds Alarm silencefor most alarmsSome alarms 79 seconds"igh airwa( pressureLow $rive and 3&9 litres.min& PenlonInterMedPartnership for LifeOperation@ Litres.min&Vt 1 +P, 1 FI L !G H )low rate FL.pmG& PenlonInterMedPartnership for LifeBreath rate of 10 bpm gives a cycle time of 6 secondsI:E ratio of 1:2 gives an inspiratory time of 2 secondsWith a tidal volume of 600 ml and 2 seconds to deliver it the flow rate is 1 l!min1 breath cycleI E600ml ! 2sec " 1 l!min#hanging the $ate% I:E% or &olume will change the inspiratory flow rateMaximum Flow rate = ! l"mi# Mi#imum Flow rate = $ l"mi#'( l!min2 l!min1 2 ) * ( 6'00600(00*00)00200100+ime ,sec-&t ,ml- PenlonInterMedPartnership for LifeOperation7dditional features#Absorber connected indicator&Adult mode indicator Ftedd( bear s(mbol used for paediatric modeG& PenlonInterMedPartnership for LifeOperation6sin1 the menus#,enus can be opened b( pressing the ,enus Select soft-ke( located on the front of the ventilator- or b( touching the relevant area of the touch-screen&0se control dial to select item&Press control dial to confirm selection& PenlonInterMedPartnership for LifeOperationMain menu#Available from stand-b( modeot all subseAuent menus are available for alteration b( the user&o access engineers menu an access code is reAuired&!MI ,!#0SO6 ,O#IO% / SPI%O,!%;L!AN !S ,!#0)%!S" ml.cm"6O&,a1& 82 ml.cm"6O& 0sed in compliance compensation mode&Q!SCAP! )%O, ,!#0SA%.SOP L!AN !SL!AN !S SA0S' !1cellentL!AN L!V!L' 7D ml.min+S;S CO,' >&9 ml.cm"6O PenlonInterMedPartnership for LifeOperation@resh Aas Com"ensation menu#!nsures correct volume deliver( with var(ing fresh gas flows& Automaticall( O)) if Spirometr( is switched off& If B)resh ' lit when I.O board running in test-harness mode L!$-:' flashes to indicate !thernet activit( L!$-@' lit when 899,bit !thernet present L!$-3 to L!$-8' no function currentl( assigned PenlonInterMedPartnership for Life)ront panel2&3V ) colour screen&ouch screen is resistive M-; matri1& Light touch membrane&$irect graphic cable from main board CP0 core&%ibbon cable to !ncoder +oard routes& Serial communications signals for Led=s- ,embrane switches- %otar( encoder and touch screen& @V for ) inverter board&%emote front panel !ncoder board contains LV$S receiver& All signals through LV$S %M board& ,ain board reAuires LV$S M board& PenlonInterMedPartnership for LifeCP0 Core and I ProcessorCP0 Core' ,ounted in removable card slot& "olds main software& ,ain ventilator control& !1ternal communications&LC$ and V3 switch mode converter provides L7&7Vdc L@Vdc L89Vdc PenlonInterMedPartnership for Life$rive @ l.min& Current through valve controlled using )!& )! controlled b( micro-processor through a digital.analogue converter to give 3&@ P 88&@Vdc across valve& Accurate deliver( set using feed back from flow sensor& L 89Vdc suppl(& 9 P @ Vdc output&,icro-processor$.A converter)!Proportioning valveL86Vdc)low sensor PenlonInterMedPartnership for LifePatient Proportional valve 0ses L86V suppl( Initial pressure on diaphragm set according to user settings Current through valve controlled using )! )! controlled b( micro-processor through a digital.analogue converter to give 7&@ P 87&@Vdc across valve $eliver( ad*usted to maintain airwa( pressure 9 P D@ cm"6O Pressure sensor monitors for high pressure condition Outlet blocked,icro-processor$.A converter)!Proportioning valveL86VdcPressure sensor PenlonInterMedPartnership for LifePressure Switches and Sensors Suppl( Pressure switch' ,onitors gas suppl( pressure& Switch is normall( open& 6D2&6 ;ear service&P,N Pt #o P @>6DD&3 ;ear service&P,N Pt #o P @>799& PenlonInterMedPartnership for LifePreventive ,aintenance NitsAll kits come with a data sheet listing components and detailed fitting instructions&One year Eit ,art Fo */2G&Patient +lock Assembl('!1haust diaphragm 799@29One-wa( valve 799@28O-ring @ mm 938693O-ring > mm 93863@O-ring 86 mm 938666Inlet filter 799@:9 PenlonInterMedPartnership for LifeService Procedure - : ,onthl(Check',echanical damage&!lectrical safet( FI!C class 8t(pe + deviceG&Power on5 displa(5 control functions&Suppl( voltages&!rror histor(&+ellows diaphragm valve& Operation in all modes&All alarm functions& PenlonInterMedPartnership for LifeService Procedure - : ,onthl(Calibrate' O6 sensor&899?&Check at 68?&Check Calibration'Spirometer(&& PenlonInterMedPartnership for LifeAn( JuestionsK PenlonInterMedPartnership for LifeAV-S VentilatorCalibrations and Ad*ustmentsPractical Oorkshop PenlonInterMedPartnership for LifePrimar( regulator calibration$(namic measurement' 6:9 kPa L68kPa F72psi L7psiG U @lpm flow&Connect test manometer to self sealing test point&Ad*ust gas flow to @lpm& Set front panel controls to' Vt P @99 ml& %ate P @& I'! P 8'8&,easureduring inspirator( phase'Ad*ust as necessar(& PenlonInterMedPartnership for LifeSecondar( regulator calibration $(namic measurement' Provides 839 cm"6O on diaphragm with bleed flow& Appro1imatel( 6 l.min&Connect test manometer into the 3mm test point 2&Set front panel controls to default settings&,easureduring inspirator( phase' Ad*ust secondar( regulator as necessar( to achieve 839 cm"6O 1&12 PenlonInterMedPartnership for LifeAlternative method of Secondar( regulator calibration $(namic measurement' Provides D@ cm"6O on diaphragm with bleed flow& Appro1imatel( 6 l.min& %emove Patient +lock& Connect test manometer smallest probe from Pneumatic Control ,anifold& Set front panel controls to default settings&,easureduring inspirator( phase'Ad*ust secondar( regulator as necessar( to achieve D@ cm"6O& PenlonInterMedPartnership for Life+arometric Calibration!nsure all tubes disconnected from rear of ventilator&In BPenlon OptionsC menu select BCal PressureC&Ad*ust to current barometric pressure and confirm&Weros all pressure transducers' $rive Valve& Patient Valve& Patient Airwa(& Ambient& PenlonInterMedPartnership for LifeSpirometr( Eero calibration$isconnect fresh gas hose from anaesthesia machine&Set bag vent switch to bag and disconnect bag from bag-arm&%emove breathing circuit from absorber&Select =SPI%O CALI+%AIO#'9 L.min= from menu and confirm&Weros $rive )low sensor and !1ternal Spirometr(&In B$iagnosisC menu spiro values should read appro1 29mV when Eero is good& PenlonInterMedPartnership for LifePatient valve P Wero and CalConnect ventilator to circle s(stem as for normal use with patient ;-piece occluded&Set anaesthesia machine to @ l.min&Select BPV WeroB& Patient valve is slowl( opened& As diaphragm is closed circuit pressure will increase b( @ cm"6O& Lift point of valve measured& ,a1imum diaphragm pressure 7@ cm"6O& ,a1imum PO, @99& Pressure is incremented in steps up to @9 cm"6O& PenlonInterMedPartnership for Life$rive valve - Wero )it Patient +lock' $isconnect drive gas hose and occlude connector&Select B$V EeroB from Cal Valves menu' Patient valve automaticall( closes&$rive valve PO, slowl( incremented until pressure increase detected& PenlonInterMedPartnership for Life$rive valve - ,easureConnect calibrated flowmeter to $rive gas outlet&Select B$V ,easureC&$rive Valve opens until $rive flow sensor reads 69 l.min&Compare with calibrated flowmeter and ad*ust with rim )low&Ad*usting Brim )lowC down reduces output of flow sensor and so increases output of $rive flow& Ad*usting Brim )lowC up increases output of flow sensor and so decreases output of $rive flow& PenlonInterMedPartnership for Life$rive )low Curve Calibration!nsure Leak est is completed successfull(&Connect ventilator- absorber and breathing circuit with re-breathing bag fitted&%emove bellows from canister&Select BTStart.Stop Curve CalQC&+ag is filled at 69 l.min' imed between @ and 79 cm"6O&Process repeated at higher and lower flow rates')ull curve generation from 6 P >@ l.min&akes appro1 @ minutes&Verify flow and use 28rim Cri-e @low3 to ad;ust$ PenlonInterMedPartnership for Life!1ternal Spirometr( calibration!nsure $rive )low has been calibrated&$isconnect fresh gas hose from anaesthesia machine and connect to +ag arm& Close APL valve and set bag vent switch to bag&$isconnect Vent $rive hose from rear of absorber and connect to !1pirator( port Fuse Pt no @697:G&Connect short hose to Inspirator( port&Select B!M& SPI%O ,!#0C - BTStart.Stop Curve CalQC&Verify s"irometry and use 28rim :+t$ S"iros3 to ad;ust$ PenlonInterMedPartnership for LifeAn( JuestionsK PenlonInterMedPartnership for Lifehe !nd