VMAX LFT USER MANUAL

Aaron - 25/09/2018

User Manual for

VMAX Lung Function

Machine

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At Heartscope Victoria, prevention of infection transmission to technicians exposed to contaminated

spirometer surfaces is accomplished through proper use of anti-bactericidal sanitizer and use of barrier

devices, such as suitable gloves and masks.

The Mass Flow Sensor will need to be cleaned at least monthly or at an interval of every 50 test subjects

(500 blows). These instructions explain the proper cleaning and decontamination of the Detachable Mass

Flow Sensor.

1. Disconnect Tubing A and Tubing B from the Mass Flow Sensor

2. Detach the Mass Flow Sensor from the Breathing Valve Body

3. Under the Mass Flow Sensor, squeeze the ribbed sides of the connector, and then pull downwards

Infection Control Policy

Mass Flow Sensor

Tubing B

Tubing A

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4. Place the Mass Flow Sensor into the disinfectant solution

The entire Mass Flow Sensor can be safely immersed in liquid disinfectant. The Sensor Cable, however,

cannot be immersed, because the connectors on each end can be damaged by liquids.

5. Allow the Mass Flow Sensor to soak in the disinfectant solution for 5 minutes

6. After disinfecting, rinse and thoroughly dry the sensor.

Make sure that the Mass Flow Sensor is rinsed and dried thoroughly before reconnecting the cable

The newly installed Mass Flow Sensor must successfully pass a Mass Flow Sensor Calibration before being

used for patient testing.

7. Note down the date in the maintenance database

If unaware of the maintenance database, please contact IT for assistance

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This is the timetable for annual, monthly and daily user test hygiene:

Every Test

A new mouthpiece should be used for each test subject.

Daily

If the patient has come into contact with any parts of the spirometer then clean and disinfect accordingly

using the Clinell Disinfectant wipes. This includes the plastic gripper on the Spirometer which the patient

grips when doing the test. Ensure this is cleaned and disinfected at the end of every session.

Perform a visual inspection at the end of testing. If there is visible contamination to the flow head or

elsewhere on the device, clean and disinfect accordingly.

Monthly

The Mass Flow Sensor is disinfected regularly. The frequency of this is dependent on the Facilities’ Risk

Assessment, usage and test environment, but should be cleaned at least monthly or every 50 subjects (500

blows). They should also be replaced in the event of damage, or if visibly contaminated.

Annually

Annual inspection, maintenance and calibration certification should be obtained from the manufacturer or a

qualified service supplier. All these procedures are a part of the manufacturer’s recommended PPM (Planned

Preventative Maintenance) service procedure.

Timetable of Hygiene Procedures

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The following Calibrations must be performed before the first test of every day.

It can also be performed at any time for verification.

1. Turn on the 3 cylinders (always check the level of the gauges)

2. Turn on the Vmax Machine and wait for 5 minutes for the Machine to warm up

3. Select “Flow Sensor Calibration | 1” to open the Flow Volume Calibration screen

4. The Flow Volume Calibration screen will be displayed below.

Calibration

Calibration Procedure

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5. Attach the Calibration Syringe to the Mass Flow Sensor

6. Select “F1” on the Flow Volume Calibration screen to begin the calibration

The Mass Flow Sensor Zero dialog box will be displayed

7. Hold the Calibration Syringe still for approximately 10-15 seconds and then select “Space Continue”

8. A timer will count down to zero seconds before continuing to the Vmax Flow Volume Calibration screen

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9. Perform 5 inspiratory and expiratory strokes within the target ranges shown in yellow on the graph

The bar graph segments on the right turn to green when the mean flow rate of a stroke falls within the

adjacent range, which is what we are aiming for.

* to ensure that the strokes are within the yellow target ranges, turn the knob of the lever first before pulling

in really slow motion IN and OUT making a nice loop. Increase the speed and circular motion each time. Once

the bar graph segments on the right turn green, the screen should look like this:

10. Once the bar graph segments on the right turn to green, the next calibration graph will be displayed:

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11. Perform 5 inspiratory and expiratory strokes within the target ranges shown by the red lines:

Four of the five strokes are displayed and should appear as follows:

• One stroke should reach the lowest red dotted line (0.5 LPS).

• One stroke should reach the highest dotted line (3.0 LPS).

• One stroke should be halfway between the dotted lines (1.5 LPS)

• One stroke (fourth stroke) should include a peak-flow rate near 12 LPS (8 LPS minimum)

This stroke should be created without ‘banging’ the piston at either end of the stroke

12. The Calibration is successful when the time and date are present on the top table

Note that none of the values on the top table should be in red. Click “F3” to store the calibration.

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1. Select “New Study | 2” in the Vmax Program Manager Window

2. The Vmax Demographic Input dialog box will be displayed

To enter the patient demographics, click in each text box and type or select the information.

Press ENTER to move the insertion point to the next text box.

Vmax Overview Create New Patient

Will accept letters, numbers &

symbols

Computer

automatically

enters today’s date

Computer automatically

calculates age from the

date of birth

Can be used if you are unable to measure the patient’s height

Pakenham, St Albans etc.

Reporting Physician

Technician Initials

Clinical Details (SOB etc.)

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3. Select “Other” from the top menu ribbon then select “Additional Parameters”

Type the referring doctor’s details as demonstrated above.

01: Referring Doctor’s Name

02: Clinic Name

03: Clinic Address

04: CC Doctor Name (if applicable)

05: CC Clinic Name (if applicable)

06: CC Clinic Address (if applicable)

Then select “F3” to save the Referring Doctor’s details

3. Select F3 to store the new patient information and return to the Vmax Program Manager

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1. Select “Pulmonary Function | 5” on the Vmax Program Manager

2. The Pulmonary Function Program window will be displayed.

Select Test Level: “Pre” then Select “1 Flow Volume Loop”

Pre-Spirometry

Flow Volume Loop

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Once the 3rd test is done, choose the best result (number), click F4 and then F3 (to store)

3. The Flow Volume Loop Test screen will be displayed

4. Explain the procedure to the patient, and the purpose of the mouthpiece and nose clip

5. Attach the mouthpiece and instruct the patient to sit in front of the Spirometer

Adjust the height of the spirometer accordingly to ensure the patient is comfortable

6. Attach the nose clip onto the patient and instruct them to place their mouth onto the mouthpiece

Ensure that the patient’s mouth is tightly sealed around the mouthpiece

7. Select “F1” on the Flow Volume Loop Test screen to begin the test procedure

8. Normal Breathing: Instruct the patient to do Normal Breathing first (coaching patient repeatedly)

Ensure that you record at least 3 stable tidal breaths

9. Maximal Inspiration/Expiration: Now tell the patient: “on your next breath, [press F1] take a deep breath

and then forcefully exhale and completely empty the lungs.” Coach the patient to “keep exhaling” until the

smaller box on the right side turns green. Then instruct the patient to take a deep breath in and then come

off the mouthpiece.

10. Select “End Test” to check the reference values / outcome

REPEAT STEPS 7 TO 10 AT LEAST 3 TIMES TO OBTAIN REPRODUCIBLE RESULTS

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1. Prepare Ventolin, Spacer and a Timer

2. Set the Timer to 5 minutes and press Start

3. Give the patient the 1st puff

Instruct them to take a deep breath in, *hold for 2 seconds*, then breathe out. Repeat 3 times.

4. After 1 minute, give the patient the 2nd puff

Instruct them to take a deep breath in, *hold for 2 seconds*, then breathe out. Repeat 3 times.

5. After another minute, give the patient the 3rd puff

Instruct them to take a deep breath in, *hold for 2 seconds*, then breathe out. Repeat 3 times.

6. Let the patient rest for a period of 2 minutes to let the Ventolin administer

1. Select Test Level: “Post” then Select “1 Flow Volume Loop” on the Pulmonary Function Program window

Post-Spirometry

Flow Volume Loop

Administering Ventolin

Begin Post-Spirometry Test

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Once the 3rd test is done, choose the best result (number), click F4 and then F3 (to store)

2. The Flow Volume Loop Test screen will be displayed

3. Select “F1” on the Flow Volume Loop Test screen to begin the test procedure

4. Normal Breathing: Instruct the patient to do Normal Breathing first (coaching patient repeatedly)

Ensure that you record at least 3 stable tidal breaths

5. Maximal Inspiration/Expiration: Now tell the patient: “on your next breath, [press F1 during inhalation]

take a deep breath and then forcefully exhale and completely empty the lungs.”

Coach the patient to “keep exhaling” until the smaller box on the right side turns green.

Then instruct the patient to take a deep breath in and then come off the mouthpiece.

6. Select “End Test” to check the reference values / outcome

REPEAT STEPS 3 TO 6 AT LEAST 3 TIMES TO OBTAIN REPRODUCIBLE RESULTS

ENSURE ALL THREE LIGHTS ON THE RIGHT SIDE OF THE SCREEN ARE IN GREEN

ALL THREE MUST BE GREEN (PRE AND POST SPIROMETRY)

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1. Select Test Level: “Post” then Select “Single Breath DLCO | C” on the Vmax Program Manager

2. The Single Breath DLCO Test screen will be displayed

DLCO

Single Breath Diffusing Capacity

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Once the 2 trials are done, choose the best result (number)

3. Select “F1” on the Single Breath DLCO Test screen to begin the test procedure

Face the Spirometer away from the patient’s face

4. Select “Space to Continue” to flush the breathing valve with 100% DLCO gas

Note that you will hear a loud cleaning sound

5. After the calibration is complete, explain the test procedure instructions to the patient

6. Instruct the patient to attach the nose clip and put in the mouthpiece

Ensure the patient’s mouth is tightly sealed around the mouthpiece

Normal Breathing:

7. Instruct the patient to begin with Normal Breathing first (coaching patient)

Maximal Expiration/Inspiration:

8. Instruct the patient to exhale completely; press F1 during the maximal exhalation

9. When “Full Inhalation Then Hold” is displayed on the screen, instruct the patient to inhale completely

Breathe Hold:

10. Coach the patient to hold their breath until the exhalation valve opens

The patient will need to hold their breath for at least 10 seconds (until 2nd vertical green line is reached)

Maximal Expiration:

11. Coach the patient to exhale completely (empty lungs) until the computer ends the test

12. The patient can now come off the mouth piece

REPEAT STEPS 3 TO 12 ONLY 2 TIMES TO OBTAIN REPRODUCIBLE RESULTS

13. Select “Exit” on the top of the Single Breath DLCO Test screen

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1. Select “Reports | F8” on the Vmax Program Manager

2. The Reports screen will be displayed. Select “Heartscope – PW (JT)” from the Reports List drop down box

Reports

Obtaining the Report

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3. Select “F7” to access PFT Comments and Interpretation Edit Box

4. The PFT Comments and Interpretation Edit Box will be displayed

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5. Select “F5 Comments”. Then select one of the “A” to “I” options accordingly

Double click on one of the options to insert the sentence into the comments section

6. Select “F8 Narrative”. Select Category “A – Indications for Evaluation”

The Narrative section should address the following points:

• What was the reason for the test?

• Is the patient a smoker?

• Did the patient have any difficulties with the technique?

Select one of the options accordingly if required, or type inside the Narrative section

Double click on one of the options to insert the sentence into the narrative section

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7. Select “F7 LOGIC Tree”. Then select “F2” to access User LOGIC Paths Manager

8. The LOGIC Pathways Manager window will be displayed

Select “F2” to Generate text using Selected LOGIC Pathway

Copy all of the generated text and select “ESC” to return to the PFT Comments Edit box

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9. Paste the generated text into the LOGIC Tree section

Select “F3” to Store Results and Exit

10. Select “Print PDF” on the top bar

Ensure that all information is correct and all relevant

graphs are displayed in the Report

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The fo

The following is a list of potential problems you may eventually encounter using the Vmax Lung Function

Machine. For problems not covered by this list, or for any questions, contact technical support.

Condition Possible Causes Possible Remedies No power to system (computer, monitor, Vmax modules)

Loose power cable Check all power cable connections

Defective power outlet Try a known, good power outlet

Flow Volume Calibration Failure

Defective calibration syringe Try an alternate calibration syringe Verify the syringe volume setting in Calibration Setup

Defective breathing circuit Check the breathing circuit assembly for incorrect connection, incorrect assembly, or damage

Balloon valve tubing connection Switch tubing connectors

Dirty or defective mass-flow sensor Mass Flow Sensor Zero Check and Mass Flow Sensor Cleaning

Leak in spirometer dry rolling seal Replace seal

Incorrectly assembled spirometer Disassemble and re-assemble

Resistance to breathing during any test

Breathing circuit defective or incorrectly assembled

Check breathing circuit for damage or incorrect assembly

Spirometer incorrectly assembled Disassemble and re-assemble spirometer

Balloon valve tubing incorrectly assembled Switch tubing connectors

Inadequate oxygen or diffusion mix gas pressure

Make sure gas cylinders are completely turned on, contain at least 200 PSI internal pressure, and are set to 50-60 PSI delivered pressure (10-20 PSI above oxygen pressure for Vmax diffusion mix)

Condition Possible Causes Possible Remedies Hardware Check Warning. Check Power, Cables.

Analyzer Module turned off Verify that the Analyzer Module is turned on

Loose or disconnected interface cable between the computer and the Analyzer Module or the spirometer

Verify that the interface cable is securely attached

Hardware lock-up Turn the entire system off and then turn it back on

The Mass Flow Sensor does not respond. Check the Sensor Cable or Substitute Another Sensor

The mass-flow sensor cable is loose or disconnected from the flow signal port on the rear of the Analyzer Module

Verify that the cable is securely attached

Defective mass flow sensor Replace the entire Mass Flow Sensor Assembly

The Sensors are Responding Incorrectly to Calibration Gas. Check Calibration Gas Tank Pressures and Connections

Calibration tank turned off or only slightly opened

Make sure calibration gas is completely turned on

Inadequate gas pressure in calibration tank

Make sure there is at least 200 PSI remaining in the calibration gas cylinders

Hoses from gas tanks are switched or disconnected at the rear of the instrument

Make sure gas hoses are attached correctly

Ensure that the Sample Line is Connected to the Calibration Fitting

The Permapure sample tubing is not connected to the inlet port on the front of the Analyzer Module

Connect the sample tubing to the inlet port

General Problems

Troubleshooting

Warning Messages