User’s Pocket Guide - mssmem.commssmem.com/wp-content/uploads/2009/08/PB840_Pocket_Guide.pdf · II 840 Ventilator Pocket Guide The 840™ Ventilator System is manufactured in accordance

PURITAN BENNETT

840™ Ventilator SystemUser’s Pocket Guide

© 2002 Nellcor Puritan Bennett Inc. All rights reserved. O.c 0690-0402 VE07000

4280 Hacienda DrivePleasanton, CA 94588Tel 925.463.4000Toll Free 1.800.635.5267www.puritanbennett.com

Tyco Healthcare UK LTD. 154 Fareham RoadGosport, UK PO13 0ASTel +44.1329.224000

O.c 0690 840 pocket guide cover 3/31/03 4:03 PM Page 1

840™

V e n t i l a t o r S y s t e m

U s e r ’ sP o c k e t G u i d e

O.c 0690 840 pocket guide 3/31/03 4:05 PM Page I

II 840 Ventilator Pocket Guide

The 840™ Ventilator System is manufactured in accordance with PuritanBennett proprietary information, covered by one or more of the following U.S.Patents and foreign equivalents: 4,954,799; 5,161,525; 5,271,389; 5,301,921;5,319,540; 5,339,807; 5,368,019; and 5,390,666. 840, Flow-by, DualView,SandBox, SmartAlert and BiLevel are trademarks of Puritan Bennett.

The information contained in this manual is the sole property of PuritanBennett and may not be duplicated without permission. This manual may berevised or replaced by Puritan Bennett at any time and without notice. Whilethe information set forth herein is believed to be accurate, it is not a substitutefor the exercise of professional judgment.

The ventilator should be operated and serviced only by trained professionals.Puritan Bennett’s sole responsibility with respect to the ventilator, and its use,is as stated in the limited warranty provided.

Nothing in this publication shall limit or restrict in any way PuritanBennett’s right to revise or otherwise change or modify the equipment(including its software) described herein, without notice. In the absence ofan express, written agreement to the contrary, Puritan Bennett has noobligation to furnish any such revisions, changes, or modifications to theowner or user of the equipment (including its software) described herein.

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III840 Ventilator Pocket Guide

Table of contents

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1The 840 Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2Connections

Power. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4Air and oxygen supplies . . . . . . . . . . . . . . . . . . . . . . . . . . . 6Patient circuit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8

Patient setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12New patient setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13Apnea settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14Calibrating the oxygen sensor . . . . . . . . . . . . . . . . . . . . . . 14Once patient setup is complete . . . . . . . . . . . . . . . . . . . . . 14Inspiratory pause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Expiratory pause. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15

Alarm settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Main setting changes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22Mode, breath type, and batch (multiple) changes . . . . . . . . . . 23

Previous setup. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Humidification type, humidifier volume, O2 sensor

enable/disable, and disconnect sensitivity (Dsens) . . . . . . 24Constant during rate change . . . . . . . . . . . . . . . . . . . . . . . 25

Alarm handling. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Alarm silence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Alarm reset . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Alarm log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Alarm messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Graphics. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Display. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Color . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Freezing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Plot setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Once graphics are displayed . . . . . . . . . . . . . . . . . . . . . . . 40

The ? key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41BiLevel. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42

Patient setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42Constant during rate change . . . . . . . . . . . . . . . . . . . . . . . 43Using pressure support with BiLevel . . . . . . . . . . . . . . . . . 44Manual inspiration in BiLevel Mode . . . . . . . . . . . . . . . . . 45

Tube Compensation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Ventilator self tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

Running SST . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Safety modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53Preventive maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55

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IV 840 Ventilator Pocket Guide

FiguresFigure 1. 840 Ventilator components. . . . . . . . . . . . . . . . 3

Figure 2. Connecting the ventilator power cord . . . . . . . 4

Figure 3. Connecting the air and oxygen supplies . . . . . . 6

Figure 4. Connecting the patient circuit . . . . . . . . . . . . . . 8

Figure 5. Installing the expiratory filter and collector vial . . . . . . . . . . . . . . . . . . . . . . . . . . 9

Figure 6. Using the collector vial with or withoutdrain bag . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10

Figure 7. Ventilator Startup screen . . . . . . . . . . . . . . . . 12

Figure 8. 840 Ventilator graphic user interface (GUI) . . . 20

Figure 9. Alarm setup . . . . . . . . . . . . . . . . . . . . . . . . . 21

Figure 10. Constant during rate change(inspiratory time selected). . . . . . . . . . . . . . . . 25

Figure 11. Alarm indicators . . . . . . . . . . . . . . . . . . . . . . 26

Figure 12. Alarm log . . . . . . . . . . . . . . . . . . . . . . . . . . . 29

Figure 13. Alarm message format . . . . . . . . . . . . . . . . . . 30

Figure 14. Pressure-volume loop . . . . . . . . . . . . . . . . . . . 38

Figure 15. BiLevel breath timing bar . . . . . . . . . . . . . . . . 43

Figure 16. BiLevel with pressure support. . . . . . . . . . . . . 45

TablesTable 1. Inspiratory pause maneuver displays . . . . . . . . 16

Table 2. Alarm messages . . . . . . . . . . . . . . . . . . . . . . . 31

Table 3. Ideal body weight (IBW) and tube I.D. . . . . . . 47

Table 4. Individual test results in SST. . . . . . . . . . . . . . 50

Table 5. Overall SST results . . . . . . . . . . . . . . . . . . . . . 51

Table 6. Maintenance summary . . . . . . . . . . . . . . . . . . 55

O.c 0690 840 pocket guide 3/31/03 4:05 PM Page IV

1840 Ventilator Pocket Guide

Introduction

This pocket guide gives you a quick overview of how toset up and use the 840 Ventilator System.

As you read through this pocket guide, this symbol:

➪ asks you to take an action

This pocket guide is intended to supplement (not replace)the 840 Ventilator Operator’s and Technical ReferenceManual, which should always be available while using theventilator.

Different versions of the 840 Ventilator can have minorvariations in labeling (e.g., keyboard overlays and off-screen alarm status indicators).

For more detailed information on any of the topics cov-ered in this pocket guide, please see the 840 VentilatorOperator’s and Technical Reference Manual. (Also please see the 840 Ventilator Service Manual.)

O.c 0690 840 pocket guide 3/31/03 4:05 PM Page 1

2 840 Ventilator Pocket Guide

The 840 Ventilator

The 840 Ventilator includes a breath delivery unit (BDU)that controls ventilation, and a graphic user interface(GUI) that monitors and displays ventilator and moni-tored data (see Figure 1). The ventilator supplies manda-tory (pressure or volume controlled) or spontaneousbreaths (inspiratory flows of up to 200 L/min, with orwithout pressure support) with a preset oxygen concen-tration. Breaths can be pressure- or flow-triggered (usingFlow-by®).

DualView™ Touch Screens display monitored data sepa-rately from ventilator settings for easy assessment of yourpatient’s condition. The SandBox™ allows you to previewsettings before applying them to your patient, and theSmartAlert™ Alarm System helps you to quickly determinethe urgency and root cause of alarm conditions.

The optional 806 Compressor provides compressed air tothe BDU, and can be used in place of wall or cylinder air.The standard 802 Backup Power Source (BPS) providesdc power to the BDU and GUI in the event that ac poweris lost. 840 Ventilator mounting options include a cart,pole mount, or wall mount.


Graphic UserInterface (GUI)

Optionalcart

BreathDeliveryUnit (BDU)

802 BackupPower Source(BPS)

Optional 806 Compressor


Figure 1. 840 Ventilator components


Connections

This section tells you how to connect the 840 Ventilator toac power, air and oxygen supplies, and the patient circuit.

Power

➪ Plug the ventilator power cord to ac power (see Figure 2). The power cord retainer protectsagainst accidental disconnection, and must always bein place during operation.

To avoid electrical shock hazard, connect the venti-lator power cord into a grounded ac power outlet.

Figure 2. Connecting the ventilator power cord


Power cordretainer

Power cord

To ac power

WARNING


Normally, the 840 Ventilator System is mains-powered.The mandatory 802 Backup Power Source (BPS) operatesthe ventilator when ac power drops below a minimumlevel. The ventilator recharges the BPS during ac poweroperation.

NOTE:The BPS is designed for short-term use only, and is notintended as a primary alternative power source. TheBPS is intended to power the BDU and GUI only. Incase of ac power loss, no power is available for thecompressor or humidifier.

If you turn on the ventilator after it has been unpluggedfor an extended period, the LOW BATTERY alarm maybecome active. If so, recharge the BPS by leaving it con-nected to an operating ventilator for up to eight hours. Ifthe LOW BATTERY alarm is still active or if the INOP-ERATIVE BATTERY alarm is active, the BPS batterymust be replaced by a qualified service technician.



6

Air and oxygen supplies

➪ Connect air and oxygen supplies to the ventilator (seeFigure 3). The ventilator can use air and oxygen fromcylinder or wall supplies. Supply pressures must be 35to 100 psi (241 to 690 kPa).

Figure 3. Connecting the air and oxygen supplies

Connect only air to the air inlet, and only oxygento the oxygen inlet. Do not attempt to switch airand oxygen or connect any other gas.


Air inletconnector

Oxygeninletconnector

Air hose(from airsupply) Oxygen hose

(from oxygensupply)

Air inletfilter bowl

WARNING


7

To ensure that a constant gas supply is available tothe patient, always connect at least two gassources to the ventilator. (There are three gassource connections: the compressor, air inlet, andoxygen inlet.)

To prevent damage to the ventilator, ensure that the connections to the air and oxygen supplies areclean and unlubricated, and that there is no waterin the air or oxygen supply gas. If you suspectwater in the air supply gas, use an external wallair water trap to prevent water damage to theventilator and its components.


CAUTION

WARNING



Patient circuit

➪ Connect the patient circuit to the ventilator (see Figure 4).

Figure 4. Connecting the patient circuit

(From patient)

(To patient)

Inspiratory filter

Tubing

Expiratory filter

Expiratory limb of patient circuit

Inspiratory limb of patient circuit Humidifier

Collector vial


9

➪ Figure 5 shows you how to install the expiratory filterand collector vial to ventilator. Attach the expiratorylimb of the patient circuit to the filter’s expiratory limbconnection.

Figure 5. Installing the expiratory filter and collector vial


Slide filter rimonto these tracks

Filterhousing

area

Expiratory limb connection

Pull latch upto installfilter, pulldown tohold filterand collectorvial in place



➪ Cap the collector vial drain port if you are not usingthe drain bag (see Figure 6).

➪ If you are using the drain bag, install clamp on tubing.Uncap collector vial drain port and install tubing tocollector vial drain port. Connect other end of tubingto drain bag. If the ventilator is mounted on the cart,place the drain bag in the cart drawer (see Figure 6).The drain bag is designed to lie flat, and is notdesigned to be suspended.

Figure 6. Using the collector vial with or without drain bag

Collector vialdrain port mustbe capped if notusing drain bag

Place drainbag in cartdrawer

Clamp

Tubing

Drain bag



Puritan Bennett recommends that you use one ofthe patient circuits identified by Puritan Bennett(see the 840 Ventilator Operator’s and TechnicalReference Manual for patient circuit testing speci-fications). Using a circuit with a higher resistancedoes not prevent ventilation, but can cause an SSTfault or compromise the patient’s ability tobreathe through the circuit.

NOTE:To ensure optimum compliance compensation, PuritanBennett recommends that you use low-compliancepatient circuits. (For pediatric patients, the compliancecompensation volume limit is four times the set tidalvolume, in addition to the set tidal volume.)

NOTE:To ensure optimum ventilation, use pediatric circuitsfor patients whose ideal body weight (IBW) is 24 kg(53 lbs) or less, and adult circuits for patients whoseIBW is more than 24 kg.

WARNING



Patient setup

Once you turn on the ventilator or run SST, the ventilatorruns POST, then displays the Ventilator Startup screen (see Figure 7) on the lower screen.

NOTEIf TC was used on the previous patient setup, a noteemphasizing tube type and tube I.D. appears below theSAME PATIENT button explanation.

Figure 7. Ventilator Startup screen

➪ Touch SAME PATIENT, then press ACCEPT to continue ventilating with the most recent settings.Ventilation does not begin until a patient is connected.

➪ Touch NEW PATIENT to begin ventilating with newsettings.



NOTE:If you are unsure of the meaning of any symbol forventilator settings, alarms, or monitored data, touchthe symbol on the screen; its definition will appear atthe left bottom corner of the lower screen. (Figure 8shows where symbol definitions appear on the GUI.)

New patient setup

➪ Touch the IBW button, then turn the knob to adjustthe IBW. (Many initial settings and setting limits areautomatically determined based on the IBW.) The pro-posed value is shown in red.

➪ Touch CONTINUE (this button does not appear untilyou touch IBW), or touch RESTART to return to theVentilator Startup screen.

➪ At the New Patient Setup screen, settings for mode,mandatory type (for manual inspirations, if the select-ed mode is SPONT), spontaneous type (if applicable),and trigger type appear. For any setting you want tochange, touch its button, then turn the knob to selectthe value. When you are finished changing settings,touch CONTINUE.

➪ At the New Patient Settings screen, more settingsappear. Touch each setting you want to change, thenturn the knob to select its value. (To cancel a high-lighted change, press CLEAR.)

➪ Press ACCEPT to put all settings into effect. Normalventilation begins once a patient is connected. (Anytime before you press ACCEPT, you can touchRESTART to restart setting changes.)



Apnea settings

Although you aren’t required to change or confirm apneasettings, you should verify that they are appropriate forthe patient. Apnea settings are automatically determinedbased on IBW, but can be changed.

➪ If you selected NEW PATIENT, the Current ApneaSettings screen appears at the end of patient setup.

➪ If you selected SAME PATIENT, touch the APNEAbutton at the bottom of the lower screen to viewapnea settings.

➪ If you change any apnea settings, press ACCEPT toput new settings into effect.

Calibrating the oxygen sensor

Press the 100% O2 / CAL 2 MIN key. This causes theventilator to deliver 100% oxygen (if available) for 2minutes and calibrates the oxygen sensor.

The ventilator’s oxygen monitoring feature is alwaysactive unless you disable the oxygen sensor (see the MoreSettings screen). The oxygen sensor is always enabled whenyou power up the ventilator.

Once patient setup is complete

Once the settings are accepted, you can attach a patientto the ventilator. Ventilation only begins when the ventila-tor senses that a patient is attached. (If you attach apatient before completing setup, the ventilator beginssafety ventilation and declares a PROCEDURE ERRORalarm that resets once patient setup is complete.)



Inspiratory Pause

Pressing the INSP PAUSE key causes the ventilator toschedule an automatic pause maneuver as follows (seeTable 1):• At the next scheduled inspiration, the inspiratory and

expiratory valves close to allow pressure to equilibratebetween the patient and circuit.

• The inspiratory pause continues until a stable pressureis reached or until 2 seconds elapse, whichever comesfirst.

• The graphics screen will automatically be displayed (ifit is not already active). The trace freezes and the val-ues for compliance and resistance are displayed.

• You can extend the pause beyond 2 seconds to a maxi-mum of 7 seconds by holding down the INSP PAUSEkey.

Expiratory Pause

Pressing the EXP PAUSE key causes the ventilator toschedule an automatic expiratory pause maneuver asfollows: • Press EXP PAUSE key to schedule automatic expirato-

ry pause maneuver.• During the next exhalation, the inspiratory and expira-

tory valves close to allow pressure to equilibratebetween the circuit and the patient.

• The expiratory pause continues until a stable pressureis reached or 2 seconds elapse, whichever comes first.

• The graphics screen will automatically be displayed (ifit is not already active). The trace freezes and the val-ues for intrinsic (auto) PEEP and total PEEP are dis-played.

• You can extend the pause beyond 2 seconds to a maxi-mum of 20 seconds by holding down the EXP PAUSEkey.



Table 1. Inspiratory pause maneuver displays

C <

0.1

mL

/cm

H2O

or

pati

ent

flow

< 0

.1L

/min

. Thi

s po

ints

to

ques

tion

able

inpu

tsto

the

C e

quat

ion,

whi

ch w

ould

in t

urn

rend

er R

que

stio

nabl

e. T

he lo

w p

atie

ntfl

ow is

bel

ow t

he t

hres

hold

of

relia

ble

mea

sure

men

t.

The

dif

fere

nce

in p

ress

ure

betw

een

end

plat

eau

and

end

exha

lati

on <

0.1

cm

H2O

.T

his

is b

elow

the

lim

its

of r

elia

ble

reso

luti

on. T

he R

and

C v

alue

s ar

eth

eref

ore

ques

tion

able

.

C ≤

0 m

L/c

mH

2O o

r C

< 5

00 m

L/c

mH

2O.

The

se m

easu

rem

ents

are

out

side

of

phys

iolo

gica

l lim

its.

C (

****

**)

C (

****

**)

C (

0 )

or C (

500)

R (

****

**)

R (

****

**)

R (

)

Mes

sage

as

dict

ated

by

othe

r te

sts

Che

ck t

he b

reat

hing

wav

efor

ms

and

mon

itor

ed p

atie

nt d

ata

for

clue

s ab

out

thes

e qu

esti

onab

lein

puts

.

Che

ck t

he b

reat

hing

wav

efor

ms

and

mon

itor

ed p

atie

nt d

ata

for

clue

s ab

out

thes

e qu

esti

onab

lein

puts

.

Che

ck t

he p

atie

nt-v

enti

lato

rin

tera

ctio

n, t

he b

reat

hing

wav

efor

ms,

and

the

pat

ient

cir

cuit

for

unde

rlyi

ng c

ause

s.

Whe

n yo

u se

eC

ompl

ianc

e (C

):O

r R

esis

tanc

e (R

)(i

f di

spla

yed)

:It

mea

ns:

Do

this

:


R ≤

0 cm

H2O

/L/s

or

R <

500

cmH

2O/L

/s. T

hese

mea

sure

men

ts a

re o

ut-

side

of

phys

iolo

gica

l lim

its.

Sub-

thre

shol

d in

put

valu

e(s)

C <

1/3

of

vent

ilato

r br

eath

ing

syst

em c

ompl

ianc

e(d

eriv

ed f

rom

SST

). B

oth

C a

nd R

are

ques

tion

able

.

Exh

alat

ion

was

not

com

plet

e. T

his

ren-

ders

end

-exp

irat

ory

pres

sure

and

tot

alex

hale

d fl

ow v

alue

s qu

esti

onab

le.

C (

)M

essa

ge a

sdi

ctat

ed b

yot

her

test

s

C (

xxx)

C (

xxx)

Inco

mpl

ete

exha

lati

on

R (

0 )

or

R (

500)

R (

yyy)

R (

yyy)

Inco

mpl

ete

exha

lati

on

Che

ck t

he p

atie

nt-v

enti

lato

r in

ter-

acti

on, t

he b

reat

hing

wav

efor

ms,

and

the

pati

ent

circ

uit

for

unde

rly-

ing

caus

es.

If t

he p

atie

nt’s

IB

W ≤

24 k

g, c

on-

side

r in

stal

ling

a pe

diat

ric

pati

ent

circ

uit.

Che

ck f

or a

n in

suff

icie

nt e

xpir

ato-

ry in

terv

al. I

f po

ssib

le, s

hort

enin

spir

atio

n ti

me

and

redu

ce r

espi

-ra

tory

rat

e.

Whe

n yo

u se

eC

ompl

ianc

e (C

):O

r R

esis

tanc

e (R

)(i

f di

spla

yed)

:It

mea

ns:

Do

this

:


Table 1. Inspiratory pause maneuver displays (continued)




Plat

eau

is n

ot “

flat

” (l

ung

and

circ

uit

pres

sure

s di

d no

t eq

uilib

rate

) or

pau

sepr

essu

re w

as e

xces

sive

ly n

oisy

. The

sepr

oble

ms

rend

er R

and

C q

uest

iona

ble.

C <

1.0

mL

/cm

H2O

. Thi

s re

sult

s fr

omqu

esti

onab

le in

put

data

. Thi

s ou

t-of

-ran

geva

lue

also

ren

ders

R q

uest

iona

ble.

R >

150

cm

H2O

/L/s

. Thi

s re

sult

s fr

omqu

esti

onab

le in

put

data

, pos

sibl

y C

.

C (

xxx)

No

plat

eau

C (

xxx)

Out

of

rang

e

C (

xxx)

Que

stio

nabl

em

easu

rem

ent

R (

yyy)

No

plat

eau

R (

yyy)

Que

stio

nabl

em

easu

rem

ent

R (

yyy)

Out

of

rang

e

If p

late

au c

onti

nues

to

decl

ine,

chec

k fo

r a

leak

in t

he b

reat

hing

circ

uit,

pos

sibl

y ar

ound

the

cuf

f.If

pla

teau

is u

nsta

ble,

che

ck f

orm

oist

ure

cond

ensi

ng in

a “

lazy

”lo

op o

r a

brea

thin

g ci

rcui

t be

ing

jiggl

ed.

Che

ck t

he b

reat

hing

wav

efor

ms

and

mon

itor

ed p

atie

nt d

ata

for

clue

s ab

out

thes

e qu

esti

onab

lein

puts

.

Che

ck t

he b

reat

hing

wav

efor

ms

and

mon

itor

ed p

atie

nt d

ata

for

clue

s ab

out

thes

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The top of the upper screen shows monitored data (dataoutside the normal range flashes). Once normal ventila-tion is in progress, ventilator settings are displayed acrossthe top of the lower screen. (Figure 8 shows how infor-mation is displayed on the GUI.)

Figure 8. 840 Ventilator graphic user interface (GUI)

Upper Screen:monitoredinformation(alarms,patient data)

Lowerscreen:ventilatorsettings

Patient data

Alarm and status

Miscellaneous patientdata, including graphicsand alarm log

Symbol definitions Prompt area

Statusindicators

Off-screen keys Knob

Primary settings

Batch settings, ventilatorsetup, alarm settings,breath timing,miscellaneous settings



Alarm settings

Most alarm settings are initially set based on the patient’sIBW. You should review all alarm settings.

➪ Touch the ALARM SETUP button (lower screen) toview the current alarm setup (see Figure 9).

➪ Touch the alarm you want to change.

➪ Turn the knob to set the value you want. Proposedvalues are shown in red. You can change several alarmsettings in a batch change. To cancel a highlightedchange, press CLEAR.

➪ Review all settings.

➪ Press ACCEPT to apply the new alarm settings. Press the ALARM SETUP button to cancel all alarmchanges.

You can touch the ALARM SETUP button at any timeduring ventilation to show the current limits and moni-tored value for each alarm. If an alarm annunciates, thealarm slider on the Alarm Setup screen will turn colorindicating the urgency of the alarm state, red for highurgency, yellow for medium and low urgency.

Figure 9. Alarm setup

NOTE:The upper limits for the spontaneous exhaled tidal vol-ume and mandatory exhaled tidal volume alarms arealways the same. Changing the upper limit of one alarmautomatically changes the upper limit of the other.



Main setting changes

Main settings are the buttons displayed at the top of thelower screen, and you can only change them individually.Follow these steps to change main settings:

➪ Touch the setting you want to change.

➪ Turn the knob to the set value.

➪ Press ACCEPT to apply the new setting.

Remember: touch, turn, ACCEPT!



Mode, breath type, and batch (multiple) changes

➪ Touch the SETUP button on the lower screen. The Current Vent Setup screen appears.

➪ To change ventilation setup (mode, mandatory breathtype, spontaneous type, or trigger type), touch its but-ton, then turn the knob to set the value. Proposedchanges are shown in red. (Press CLEAR to cancel a change you’ve just made.)

➪ Once you’ve made all the changes you want (you don’thave to make any changes at all), touch CONTINUE.Appropriate settings for the ventilation setup you’veselected appear on the lower screen.

➪ For each of the current ventilator settings you want tochange, touch its button, then turn the knob to set itsvalue. (Press CLEAR to cancel a change you’ve justmade.)

➪ Once you’ve made any changes you want, review thesettings, then press ACCEPT to apply all the new set-tings at the same time. (Touch SETUP to cancel allchanges.)

Previous setup

Once ventilator settings are in effect, the PREVIOUSSETUP button appears at the bottom of the lower screenwhen you press SETUP, and allows you to restore theentire previous setup (including alarm and apnea settings)that was in effect immediately before you made settingschanges using the Ventilator Setup screen.

➪ To restore the previous setup, touch PREVIOUSSETUP, then press ACCEPT.



Humidification type, humidifier volume, O2 sensorenable/disable, and disconnect sensitivity (Dsens)

To view or change:

➪ Touch the OTHER SCREENS button, then touch theMore Settings button.

➪ Touch each setting you want to change (you canchange multiple settings), then turn the knob to set itsvalue. To leave settings unchanged, touch the OTHERSCREENS button again.

➪ Press ACCEPT to apply the new settings.



Constant during rate change

If you selected pressure control (PC), you can select oneof three timing variables (inspiratory time, I:E ratio, orexpiratory time) to be held constant when the respiratoryrate setting changes.

➪ Touch SETUP.

➪ Touch CONTINUE. The breath timing bar appears inthe lower screen (see Figure 10).

➪ Touch one of the lock icons to select TI, I:E, or TE asthe setting that remains constant when the rate settingchanges.

➪ Review settings and change if necessary, then pressACCEPT. The value displayed is the one held constantduring rate changes, and becomes the only setting youcan adjust directly.

Figure 10. Constant during rate change (inspiratory time selected)

NOTE:You can change the value of the constant setting at anytime, but the value does not change as a result ofchanging the rate setting.



Alarm handling

The SmartAlert™ Alarm System offers prioritized alarmannunciation that distinguishes primary alarms from sec-ondary, dependent alarms (that is, alarms that arise dueto the initial alarm condition) and indicates the urgencylevel of each alarm. An alarm log keeps a time-and-date-stamped record of alarms, alarm silences, and resets inorder of occurrence.

Alarms on the 840 Ventilator are classified as high-,medium-, or low-urgency (see Figure 11).

Figure 11. Alarm indicators

NOTE:You can always change an alarm setting even whenalarms are active. You do not need to press ALARMRESET or wait for the alarm to autoreset.

Low-urgency alarmindicator (yellow):Indicates a change in thepatient-ventilator system.

High-urgency alarm indicator(red): Immediate attentionrequired to ensure patient safety.

Medium-urgencyalarm indicator(yellow): Promptattention required.



Alarm silencePressing ALARM SILENCE mutes the alarm sound for twominutes. The key’s LED lights during the silence period, andturns off if the alarm is reset. Every time you press ALARMSILENCE, the two-minute silence period restarts. An on-screen alarm silence notification appears on the display whenalarm silence is active.

Never leave patient unattended when ALARMSILENCE is activated. ALARM RESET will cancelsilence.

Alarm reset

Pressing the off-screen ALARM RESET key resets thedetection algorithms of all active alarms, except for these:

AC POWER LOSS

COMPRESSOR INOPERATIVE

DEVICE ALERT

O2 SENSOR

INOPERATIVE BATTERY

LOW AC POWER

LOW BATTERY

NO AIR SUPPLY

NO O2 SUPPLY

PROCEDURE ERROR

Pressing ALARM RESET has no effect on patient data. If an alarm condition persists, the alarm becomes activeagain, according to the detection algorithm for thatalarm. For example, if the APNEA alarm is active,ALARM RESET resets the apnea detection algorithm to itsinitial state and returns the ventilator to normal ventilation.

WARNING



Pressing ALARM RESET cancels alarm silence if active(this avoids silencing an alarm condition that arises short-ly after pressing ALARM RESET). Pressing ALARMRESET clears any high-urgency alarm that has autoreset(and the steadily lit high-urgency alarm indicator turnsoff).

ALARM RESET gives you a way to return the ventilatorto normal operation if an alarm condition has beenresolved, without waiting for alarm detection algorithmsto reset the alarm.

Alarm log

To view the alarm log, touch the ALARM LOG buttonon the upper screen. The alarm log shows alarm events(including time-and-date-stamped alarms, silences, andresets) in order of occurrence, with the most recent eventat the top of the list (see Figure 12). The alarm log canstore up to 80 of the most recent entries. Completing anew patient setup clears the alarm log.

A question mark in a triangle appears on the ALARMLOG button if the log includes an event that hasn’t beenviewed yet. The question mark in a triangle disappearsafter you’ve viewed the event.

To scroll through the alarm log, move the scroll box upor down and turn the knob to page through the alarmlog. An icon shows your relative position in the log.



Figure 12. Alarm log

Alarm messages

The upper screen displays the two highest-urgency activealarms. Alarms are color coded, both on the Alarm Setupscreen and in the alarm status section on the upperscreen. Red for high urgency; yellow for medium and lowurgency. An alarm icon flashes on the MORE ALARMSbutton if there are other active alarms. Pressing the icondisplays a full screen of up to eight active alarms.

Each alarm message consists of a base message, an analy-sis message (supplementary information that includes anyassociated alarm conditions), and a remedy message thatsuggests corrective actions (see Figure 13).

Alarm logbutton

Indicates thatlog includesunread entries

Touchsymbols tosee definitionat bottom ofscreen

Touch scroll boxand turn rotaryencoder to scrollthrough log



The base messageidentifies the alarm.Touch alarm symbolto view definitionon lower screen.

The analysis messagegives the root cause ofthe alarm. May alsoinclude dependentalarms that have arisendue to the initial alarm.

The two highest-priorityactive alarm messagesare displayed here.

Touch flashing MORE ALARMSbutton to view messages for up tosix additional active alarms.

The remedymessagesuggests howto resolvethe alarmcondition.

Figure 13. Alarm message format

Table 2 lists possible alarm messages.

When more than one alarm is active and the alarmmessages vary in their degree of seriousness, youshould assume that the most serious message isapplicable.

WARNING



The power switch isON, ac power is notavailable, and theventilator is beingpowered by the back-up power source(BPS).

The set apnea intervalhas elapsed withoutthe ventilator, patient,or operator triggeringa breath.

There is a disconnection in thepatient circuit beforethe patient wye orpatient disconnect isdetected followingpower restorationfrom an unintentionalpower loss with thepower switch ON.

Compressor cannotmaintain sufficientsupply pressure.

A background test orpower on self test(POST) has detected aproblem.

Prepare for powerloss. Obtain alter-nate ventilation.Check integrity of ac power source.Contact service ifnecessary.

Check patient and settings.

Check patient.Reconnect patientcircuit. PressALARM RESET.

Check patient.Obtain alternateventilation.Remove ventilatorfrom use and con-tact service.

Check patient. If prompted to doso, obtain alternate ventilation or con-tact service.

Table 2. Alarm messages

AC POWER LOSS

APNEA

CIRCUIT DISCONNECT

COMPRESSORINOPERATIVE

DEVICEALERT

When you see It means: Do this:this message:



Background checkshave detected aproblem with the O2

sensor.

The measured airwaypressure is equal to orgreater than the setlimit. Reduced tidalvolume likely.

The O2% measuredduring any phase of abreath cycle is 7%(12% during the firsthour of operation) ormore above the O2%setting for at least 30seconds. (These per-centages increase by5% for 4 minutes fol-lowing a decrease inthe O2% setting.)

The patient’s exhaledtidal volume for anybreath is equal to orgreater than the setlimit.

The patient’s expira-tory minute volume isequal to or greaterthan the set limit.

O2 sensor is out ofcalibration or hasfailed. Press 100%O2 CAL; replace ordisable the sensor.

Check patient,patient circuit, andendotracheal tube.

Check patient, airand oxygen sup-plies, oxygen analyzer, and ventilator.

Check patient andsettings. Considerwhether thepatient’s compli-ance or resistancehas changed.


Table 2. Alarm messages (continued)

O2 SENSOR

↑PCIRC

(High circuitpressure)

↑O2% (High deliveredO2%)

↑VTE

(High exhaledtidal volume)

↑V.

E TOT

(High exhaledtotal minutevolume)




↑V.

ti SPONTAlarm

↑ fTOT

(High respira-tory rate)

↑PVENT

(High internalventilator pressure)

↑PCOMP

INOPERATIVEBATTERY

INSPIRATIONTOO LONG

Check patient.Check for leaks,tube type/I.D. setting


Check patient.Obtain alternateventilation.Remove ventila-tor from use andcontact service.

Check patient. Check for leaks,tube type/I.D. setting.

Contact service.

Check patient.Check for leaks.

The delivered volume ofany tube compensated(TC) breath is equal toor greater than theinspired tidal volumelimit. Ventilator transi-tions to exhalation.

The breath rate from allbreaths is greater thanor equal to the set limit.

The inspiratory pressuretransducer has mea-sured a pressure of atleast 100 cmH2O.Active only during vol-ume-controlled breaths.Ventilator transitions toexhalation. Reducedtidal volume likely.

The target pressure of atube compensated (TC)breath equals the ↑PCIRC

limit. This limit is equalto the setting of PPEAK.Inspiration pressure islimited during thisalarm.

BPS is installed but notfunctioning.

IBW-based inspiratorytime for a spontaneousbreath exceeds ventila-tor-set limit.





The ventilator powerswitch is on and thereis insufficient powerfrom the ac supplyand the BPS. There may not be avisual indicator forthis alarm, but anindependent audioalarm sounds for atleast 120 seconds.

Mains ac power hasdropped below 80%of nominal voltage forat least one second.Warns that ac powerhas dropped signifi-cantly, and that amore severe powerdrop may be immi-nent. The ventilatorturns off the compres-sor (if installed), andotherwise operatesnormally.

The BPS has less thanapproximately 2 min-utes of operationaltime remaining.

Check integrity ofac power and BPSconnections.

Obtain alternateventilation.

Check integrity of connection to acpower. Check acpower supply.

Replace BPS orallow it to rechargeduring normal ven-tilator operation.


LOSS OFPOWER

LOW ACPOWER

LOW BATTERY




↓O2% (Low delivered O2%)

↓VTE MAND

(Low exhaledmandatory tidal volume)

↓VTE SPONT

(Low exhaledspontaneoustidal volume)

↓V.

E TOT

(Low exhaledtotal minutevolume)

NO AIR SUPPLY

Check patient, airand oxygen sup-plies, oxygen ana-lyzer, and ventilator.Calibrate oxygensensor (press 100%O2 / CAL 2 minkey).

Check patient.Check for leaks orchanges in thepatient’s resistanceor compliance.

Check patient andsettings.

Check patient andsettings.

Check patient and air source.Obtain alternateventilation.

The O2% measured during any phase of abreath cycle is 7% (12%during the first hour ofoperation) or morebelow the O2% settingfor at least 30 seconds,or below 18%. (Thesepercentages increase by5% for 4 minutes following an increase inthe O2% setting.)

The patient’s exhaled mandatory tidal volumeis less than or equal tothe set limit.

The patient’s exhaled spontaneous tidal vol-ume is less than orequal to the set limit.

The minute volume forall breaths is less thanor equal to the set limit.

Air supply pressure isless than the minimumrequired pressure forcorrect ventilator oper-ation throughout itsrange of flows.Accurate O2% deliverymay be compromised.You cannot set or dis-able the NO AIR SUPPLY alarm.





Oxygen supply pres-sure is less than theminimum requiredpressure for correctventilator operationthroughout its rangeof flows. AccurateO2% delivery may becompromised. Youcannot set or disablethe NO O2 SUPPLYalarm.

Patient attachedbefore ventilatorstartup is complete.Safety ventilation isactive.

Patient circuit isseverely occluded.

Check patient and oxygen source.Obtain alternate ventilation.

Provide alternateventilation.Complete ventila-tor startup proce-dure.

Check patient.Obtain alternateventilation if neces-sary. Check patientcircuit for crimps,blocked filter. Ifproblem persists,remove ventilatorfrom use and con-tact service.


NO O2

supply

PROCEDUREERROR

SEVEREOCCLUSION




Graphics

The graphics function displays real-time patient data, including:• Pressure-time curve• Flow-time curve• Volume-time curve• Pressure-volume loop

Display

➪ To display the most recently selected graphics, pressthe graphics button at the bottom of the upper screen.

• If the pressure-volume loop is selected, the loop for the next full breath is displayed, then updatedevery other breath. The inspiratory area is calculatedbased on the area inside the loop to the left of thebaseline (see Figure 14).

• Curves (pressure-time, flow-time, and volume-time)are drawn on the screen at the start of a breath, begin-ning with the last 0.5 second of the previous breath.

Color

Curves and loops are enhanced by color:• Inspiration is green• Expiration is yellow• Spontaneous breaths are orange


Figure 14. Pressure-volume loop

Graphics are automatically displayed when you press theEXP PAUSE or INSP PAUSE key. The measured valuesfor intrinsic and total PEEP are displayed at the end ofthe expiratory pause. The measured values for complianceand resistance (for VC with a square flow pattern) aredisplayed at the end of an inspiratory pause. During boththe expiratory pause and inspiratory pause, the mostrecently selected graphics are displayed and frozen.

Graphics won’t be displayed when:• The ventilator begins apnea ventilation or safety venti-

lation. (However, you can choose to redisplay graphicsby pressing the graphics button.)

• You touch the MORE PATIENT DATA, ALARMLOG, MORE ALARMS, or OTHER SCREENSbutton.


Inspiratory area



Freezing

Follow these steps to freeze graphics on the screen:

➪ Touch FREEZE. The screen flashes the message“FREEZING,” the UNFREEZE button appears, andthe scaling buttons disappear. Plotting continues untilthe screen is full.

➪ Once the screen is filled and frozen, the other onscreenscaling buttons reappear. You can now redo the plotsetup and adjust the scales for the last 48 seconds offrozen data. (The pressure-volume display shows themost recent full breath within the 48-second freezeperiod.)

➪ Press UNFREEZE at any time to resume real-timegraphics display.

Graphics remain frozen even if you switch to anotherscreen (for example, MORE ALARMS).

Plot setup

You can choose to display one or two time curves at atime. (The pressure-volume loop uses the entire screen, sono other waveform can be displayed at the same time.)

➪ Touch the graphics button at the lower left of theupper screen. Graphics appear.

➪ Touch PLOT SETUP at the upper left of the screen.Touch Plot 1, then turn the knob to select any one ofthe waveforms. (If you select pressure-volume, whichuses the entire screen, Plot 2 disappears.)

➪ Touch Plot 2, if applicable. Turn the knob to selecteither of the two remaining waveforms, or none. If you select none, only one enlarged plot (with higherresolution) appears.

➪ Touch CONTINUE to display the graphics you’veselected. (You don’t have to press ACCEPT.)


Once graphics are displayed

Setting baseline pressure:

➪ To move the baseline on apressure-volume loop, touchthe baseline pressure button,then use the knob to positionthe baseline.

The default position of the baseline is the PEEP setting. Ifthe PEEP setting changes, the baseline resets to PEEP.

Adjusting scales:

➪ To adjust vertical and horizontal scales,touch the arrow buttons, then turn theknob to select.




The ? key

The ? key on the GUI displays basic operatinginformation about the 840 Ventilator, including:• A few basics — information about screens, sounds,

keys, and symbols.• Ventilator, alarm, and apnea settings.• New patient setup — how to configure the ventilator

for a new patient.• How to view patient data, including graphics.• Graphics — setting up, viewing, and freezing

waveforms and loops.• Alarm handling — what to do in case of alarm.• Short self test (SST).• Service, including O2 sensor calibration, cleaning, peri-

odic maintenance, and when to call for help.


BiLevel

BiLevel® is a breath mode in which the patient has theability to breathe spontaneously at two levels of PEEP. Itspressure waveform resembles pressure controlled ventila-tion but differs in its ability to allow unrestricted sponta-neous breathing at both the upper and lower pressure lev-els. Therefore, only a minimally necessary degree of venti-latory augmentation needs to be applied.

Patient Setup

To select BiLevel ventilation:

➪ Touch the SETUP button on the lower screen.

➪ Touch the Mode button, then turn the knob to selectBiLevel.

NOTE:Once you have selected BiLevel, the PC mandatorybreath type is selected and cannot be changed.

➪ Select PS or none as the spontaneous type (or TC ifthis option is active), select P-TRIG or V-TRIG as yourtrigger type, then press CONTINUE.

➪ Settings for BiLevel are displayed. For each settingyou want to change, touch its button and turn theknob to set its value.

NOTE:PEEPH must always be set at least 5 cmH2O greaterthan PEEPL. Otherwise, the settings for PEEPH andPEEPL do not affect each other. When you have fin-ished changing settings, press ACCEPT to put all set-tings into effect.

NOTE:Rise time % determines the rise time to reach the pres-sure target in pressure support (PSUPP) or transitionsfrom PEEPL to PEEPH.




NOTE:Expiratory sensitivity (ESENS) applies to all spontaneousbreaths.

Constant during rate change

In BiLevel ventilation as in pressure control, you canselect one of three timing variables: inspiratory time(TH), I:E ratio (TH:TL ratio), and expiratory time (TL) tobe held constant when the frequency setting changes.

➪ Touch SETUP.

➪ Touch CONTINUE. The breath timing bar appears inthe lower screen (see Figure 15).

➪ Touch one of the lock icons to select TH, TH:TL, or TL

as the setting that remains constant when the respira-tory rate changes, and to determine which timing vari-able will be present on the timing button.

➪ Review settings and change if necessary, then pressACCEPT. The value displayed is the one held constantduring rate changes and becomes the only setting youcan adjust directly.

Figure 15. BiLevel breath timing bar



NOTE:You can change the value of the constant setting at anytime, but the value does not change as a result ofchanging the respiratory rate setting.

Using pressure support with BiLevel

Spontaneous breaths in BiLevel mode can be augmentedwith pressure support according to these rules:• Pressure support can assist spontaneous breaths at

PEEPL and PEEPH, and is always relative to PEEPL.• If PSUPP + PEEPL is less than PEEPH, all spontaneous

breaths at PEEPL are augmented by the PSUPP setting,and all spontaneous breaths at PEEPH are augmentedby 1.5 cmH2O.

• If PSUPP + PEEPL is greater than PEEPH, all spontaneousbreaths at PEEPL are augmented by the PSUPP setting,and all spontaneous breaths at PEEPH are augmentedby (PSUPP + PEEPL – PEEPH). For example, if PEEPL = 5 cmH2O, and PEEPH = 15 cmH2O, and PSUPP = 15 cmH20:• All spontaneous breaths at PEEPL are augmented by

15 cmH2O of pressure support (PSUPP + PEEPL) fora total pressure of 20 cmH2O.

• All spontaneous breaths at PEEPH are augmentedby 5 cmH2O of pressure support (PSUPP + PEEPL – PEEPH) for a total pressure of 20 cmH2O (see Figure 16).



Figure 16. BiLevel with pressure support

Manual inspiration in BiLevel mode

Pressing the MANUAL INSP key during BiLevel modecauses the ventilator to:• Switch from PEEPH to PEEPL if pressed during a

PEEPH phase.• Switch from PEEPL to PEEPH if pressed during a

PEEPL phase.

PS = 5 cmH2O

PEEPL = 5 cmH2O

PEEPH = 15 cmH2O

Actual Peak PS Pressure = 20 cmH2O



Tube Compensation

Tube Compensation (TC) assists a patient’s spontaneousbreath by delivering positive pressure proportional to theinspired flow, which overcomes the estimated resistanceof an artificial airway. TC supports all spontaneousbreaths for patients with an ideal body weight ≥ 7.0 kg(15.4 lb), and for endotracheal/tracheostomy tubes withan inside diameter (I.D.) of ≥ 4.5 mm. TC can be usedwithin SPONT, BILEVEL, or SIMV. With the BiLeveloption selected, TC supports spontaneous breaths at bothPEEP levels.

Patient Setup

To select TC option:1. Touch the VENT SETUP button on the lower screen.2. Touch the MODE button and turn the knob to select

either SPONT, BILEVEL, or SIMV, all of which allowfor TC to be selected as the spontaneous type.

3. Touch the SPONTANEOUS TYPE button and turn theknob to select TC.

4. Touch the CONTINUE button. The settings applicableto the selected mode, and for TC, appear on the lowerscreen.

5. Touch the on-screen button for each setting you wishto change, and then turn the knob to set the desiredvalue (see Table 3 for tube I.D. and IBW). Proposedchanges are highlighted. Press the CLEAR key abovethe knob to cancel any changes you’ve just made.Flashing arrows indicate TC settings.

NOTE:If you select an I.D. that does not match the IBW, youmust touch the OK button to continue. The tube typeand tube I.D. indicators flash if TC is a new selection.

8. When you have made the settings you want, press theACCEPT key above the knob to apply the new set-tings, or the CLEAR key to cancel the last change.



IBW (kg) IBW (lb) ET/Trach I.D. ET/Trach I.D.(mm) (low) (mm) (high)

7-10 15-22 4.5 4.5

11-13 23-29 4.5 5.0

14-16 30-35 4.5 5.5

17-18 36-40 4.5 6.0

19-22 41-49 5.0 6.0

23-24 50-53 5.0 6.0

25-27 54-60 5.5 6.5

28-31 61-68 5.5 7.0

32-35 69-77 6.0 7.0

36 78-79 6.0 7.5

37-42 80-93 6.5 7.5

43-49 94-108 6.5 8.0

50-53 109-117 7.0 8.0

54-59 118-130 7.0 8.5

60 131-132 7.0 9.0

61-69 133-152 7.5 9.0

70 153-154 7.5 9.5

71-79 155-174 8.0 9.5

80-100 175-220 8.0 10.0

101-130 221-287 8.5 10.0

131-150 288-330 9.0 10.0

Table 3. Ideal body weight (IBW) and tube I.D.



Ventilator self tests

The 840 Ventilator has three self tests to verify micro-processor, pneumatic, and circuit integrity. The testsinclude: • Power on self test (POST): A several-second test that

automatically checks microprocessor function whenyou power up the ventilator.

• Short self test (SST): A short and simple sequence oftests that verify proper ventilator operation. SSTchecks the patient circuit for leaks and measures cir-cuit compliance.

• Extended self test (EST): A more exhaustive test ofventilator integrity, designed to be run by a qualifiedservice technician.

Running SST

Use SST to check the patient circuit for leaks and to calculate circuit compliance and resistance. Always rerun SST whenever you change the circuit type or thehumidification type, or when you install a new or sterilized exhalation filter.

Incorrectly specifying the patient circuit type orhumidification type (or changing either type afteryou’ve run SST) can affect the accuracy of compli-ance calculation and measured exhaled tidal vol-ume. (You must rerun SST to change the circuittype. You can change the humidification type dur-ing ventilation by touching the OTHER SCREENS,then the More Settings buttons.) HumidifierVolume allows you to mimimize inaccuracies dueto a change in humidifier type.

WARNING



➪ Ensure that the patient is not connected to the circuit and that the patient wye is unblocked.

Disconnect the ventilator from the patient beforerunning SST. Running SST while the ventilator isconnected to the patient can injure the patient.

➪ Turn the power switch (at the front of the ventilator)to the ON position. You can only run SST immediatelyafter you turn on the ventilator.

➪ At the Ventilator Startup screen, touch SST, then pressthe TEST button (on the side of the ventilator) withinfive seconds. (Waiting longer than five seconds cancelsSST.)

➪ At the Current SST Setup screen, select the patientcircuit and humidification type (and humidifiervolume, if applicable), then press ACCEPT.

➪ The ventilator automatically starts the test sequence.Some tests (SST flow sensor, Expiratory filter, andCircuit resistance) require your intervention and willwait indefinitely for your response. Otherwise, youdon’t need to do anything until a test result is ALERTor FAILURE, or SST is complete.

➪ As each test is performed, the SST Status screen showstest results (see Table 4).

To ensure reliable SST results, DO NOT repeat anindividual test with a different patient circuit ifthe test result is FAILURE or ALERT. If you suspect adefective patient circuit, restart SST from thebeginning with a different patient circuit.

WARNING

WARNING


Nothing, unless prompted bythe ventilator.

Touch one of these buttons,then press ACCEPT:

Repeat SST from the beginning.

Repeat the test.

Skip to the next test.


Repeat SST from the beginning.

Repeat the test.


➪ You can touch EXIT SST during SST to halt testing.You can touch EXIT SST again to resume testing, orpress ACCEPT to restart the ventilator (if SST has notdetected an ALERT or FAILURE).

To ensure ventilation that correctly compensatesfor circuit resistance and compliance, do not exitSST and begin normal ventilation until the entireSST has been successfully completed with the cir-cuit to be used attached.

WARNING

Table 4. Individual test results in SST

Passed

ALERT

FAILURE

No problemsfound.

Test results notideaal, but notcritical. SSThalts.

A criticalproblem hasbeen detected,and SST cannotcomplete untilthe ventilatorpasses the failedtest.

If the test It means: Do this:result is:

REPEAT

REPEAT

RESTART SST

RESTART SST

NEXT



When all of the tests in SST are complete, the SST Statusscreen displays all individual test results and SST out-come. Table 5 summarizes overall SST outcomes and howto proceed in each case.

➪ To begin normal ventilation (if SST has not detectedan ALERT or FAILURE), touch EXIT SST, then pressACCEPT. The ventilator reruns POST.

➪ The ventilator displays the Ventilator Startup screen.Confirm or change the last valid settings.

Table 5. Overall SST results


To exit SST and beginnormal ventilation.

To repeat SST from thebeginning.


To repeat SST from thebeginning.

To override the alert, asallowed by your institu-tion’s protocol, touchEXIT SST, then pressACCEPT to begin normalventilation.

Passed

ALERT

All tests passed.

One or morenoncriticalproblems weredetected. Followyour institution’sprotocol foroverriding anALERT.Immediateservice notrequired.


EXIT SST

RESTART SST

RESTART SST

OVERRIDE



Table 5. Overall SST results (continued)

Restart SST with a differentpatient circuit. Touch

then press ACCEPT torepeat SST from thebeginning.

If the failure persists, contacta qualified service technician.

FAILURE One or morecritical problemswere detected.The ventilatorenters a ventilatorinoperative stateand cannot beused for normalventilation until it passes SST.Service required.


RESTART SST



Safety modes

The 840 Ventilator offers these safety modes:Safety ventilation: If you attach a patient before

completing setup, the ventilator alarms and beginssafety ventilation. Safety ventilation delivers pressurecontrol (PC) mandatory breaths with predeterminedsettings and a high pressure limit of 20 cmH2O untilthe setup is complete.

Apnea ventilation: The ventilator monitors the time fromthe start of one breath to the start of the next. If thattime exceeds the operator-set apnea interval, the venti-lator begins apnea ventilation according to operator-determined settings. Apnea ventilation continues untilthe patient initiates two consecutive breaths and theexhaled volume is equal to or greater than 50% of thedelivered volume (autoreset). May also be manuallyreset by the operator.

Occlusion status cycling (OSC): The ventilator checks thepatient circuit for severe occlusions during all modesof breathing to protect the patient from excessive air-way pressures. If the ventilator detects a severe occlu-sion, it opens the safety valve and enters OSC. In OSC,the ventilator periodically attempts to deliver a pres-sure-based breath while monitoring for a severe occlu-sion. Normal ventilation resumes once the occlusion iscorrected.

Idle mode (disconnect detection): Once the ventilatordetects a patient circuit disconnect, it enters idle mode,in which the exhalation valve opens, idle flow (5L/min flow at 100% O2, if available) begins, andbreath triggering is disabled. The ventilator displaysthe length of time that the patient has been withoutventilatory support. Once the ventilator confirms thatthe disconnect has been corrected, normal ventilationresumes.



The 840 Ventilator is also designed to enter emergencystates (ventilator inoperative and safety valve open, SVO)under some circumstances. A ventilator inoperative condi-tion always includes the SVO state, but an SVO statedoes not necessarily indicate a ventilator inoperative con-dition.Ventilator inoperative: The ventilator declares a ventila-

tor inoperative condition if a hardware failure or criti-cal software error that could compromise safe ventila-tion occurs. In case of a ventilator inoperative condi-tion, the ventilator enters the SVO state. To correct aventilator inoperative condition, the ventilator must beturned off, then powered on again; at power on, aqualified service technician must run EST. The ventila-tor must pass EST before normal ventilation canresume.

SVO: The safety valve allows the patient to breathe roomair unassisted when the ventilator is in the SVO state.The ventilator remains in the SVO state until the con-dition that caused the SVO state is corrected or, if theventilator declared a ventilator inoperative condition,POST verifies that power levels to the ventilator areacceptable and that the major electronics systems arefunctioning correctly.

The ventilator enters the SVO state if a hardware or soft-ware failure occurs that could compromise safe ventila-tion, both air and oxygen supplies are lost, or an occlu-sion is detected. In case of a malfunction that preventssoftware from opening the safety valve, there is also ananalog circuit that opens the safety valve if system pres-sure exceeds 100 to 120 cmH2O.



Preventive maintenance

Table 6 summarizes maintenance intervals and procedures.

Table 6. Maintenance summary

Interval

Several timesa day or asrequired byyour institu-tion’s policy

250 hours (or moreoften, ifrequired)

Annually orafter 100autoclavecycles

Every twoyears or asnecessary

Every 10,000hours

Procedure

Check patient circuit for water buildup,empty and clean as necessary.

Inspect and check the resistance across inspi-ratory and expiratory filters before every use,after 15 days of continuous use in the exhala-tion limb, or if you suspect excess resistance.(SST checks the resistance of the expiratoryfilter.)

Collector vial, water traps, and drain bag:check and empty as needed.

Air inlet filter bowl: if cracked, replace bowl.If any sign of moisture is visible, remove ven-tilator from use and contact service or main-tenance.

Clean compressor inlet filter.

Replace reusable inspiratory and expiratorybacteria filters. Sterilize between patients andcircuit changes, or according to your institu-tion’s policy. Sterilize before nondestructivedisposal.

Replace oxygen sensor and BPS internal bat-tery pack. (Must be replaced by a qualifiedservice technician according to instructions inthe 840 Ventilator Service Manual.)

Use appropriate preventive maintenance kit(preventive maintenance must be performedby a qualified service technician according toinstructions in the 840 Ventilator ServiceManual).




PURITAN BENNETT

840™ Ventilator SystemUser’s Pocket Guide

© 2002 Nellcor Puritan Bennett Inc. All rights reserved. O.c 0690-0402 VE07000

4280 Hacienda DrivePleasanton, CA 94588Tel 925.463.4000Toll Free 1.800.635.5267www.puritanbennett.com

Tyco Healthcare UK LTD. 154 Fareham RoadGosport, UK PO13 0ASTel +44.1329.224000

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User’s Pocket Guide - mssmem.commssmem.com/wp-content/uploads/2009/08/PB840_Pocket_Guide.pdf · II 840 Ventilator Pocket Guide The 840™ Ventilator System is manufactured in accordance