Welch Allyn Schiller AT-2plus Manual
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Welch Allyn Schiller AT-2plus Manual

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  • Page 1 Schiller Menu Manuals AT-2plus Spiro Option...
  • Page 2 Welch Allyn Canada Ltd Cubblington Road 160 Matheson Blvd. East, Unit #2 Aston Abbotts HP22 4ND Mississauga, Ontario L4Z 1V4 United Kingdom Canada Tel: 01296-682-140 Tel: (800) 561-8797 Fax: 01296-682-104 Fax: (905) 890-0008 Copyright © 1999 by Welch Allyn Schiller...
  • Page 3 Welch Allyn or it`s authorized distributors or agents. Accessory items such as electrodes, batteries and cables are limited to a warranty of 90 days from the date of purchase from Welch Allyn or its authorized distributors or agents. Welch Allyn will repair or replace any components found to be defective or at variance from manufacturer`s specifications within this time at no cost to the customer.
  • Page 4 This equipment has been tested and found to comply with the limits for a class A digital device, pursuant to both Part 15 of the FCC (Federal Communications Commision) Rules and the radio interference regulations of the Canadian Department of Communications. These limits are designed to provide reasonable protection against harmful interference when the equipment is operated in a commercial environment.
  • Page 5 Power Supply The mains connection is on the rear of the unit. The power supply voltage is set by the factory for100-115V(nom. 110V) or 220-240V (nom. 230V) working. The setting is indicated by the indented metal strip on the fuse panel.
  • Page 6 PHYSICIAN‘S RESPONSIBILITY THE AT-2PLUS AND SP-250 SENSOR ARE PROVIDED FOR THE EXCLUSIVE USE OF QUALIFIED PHYSICIANS OR PERSONNEL UNDER THEIR DIRECT SUPERVISION. THE NUMERICAL AND GRAPHICAL RESULTS FROM A RECORDING MUST BE EXAMINED WITH RESPECT TO THE PATIENTS OVERALL CLINICAL CONDITION. THE RECORDING PREPARATION QUALITY AND THE GENERAL RECORDED DATA QUALITY, WHICH COULD EFFECT THE REPORT DATA ACCURACY, MUST ALSO BE TAKEN INTO ACCOUNT.
  • Page 7 Safety Notices TO PREVENT ELECTRIC SHOCK DO NOT DISASSEMBLE THE UNIT. NO SERVICEABLE PARTS INSIDE. REFER SERVICING TO QUALIFIED PERSONNEL ONLY. DO NOT USE THIS UNIT IN AREAS WHERE THERE IS ANY DANGER OF EXPLOSION OR THE PRESENCE OF FLAMMABLE GASES SUCH AS ANAESTHETIC AGENTS.
  • Page 8 Intended Use The AT-2plus with Spiro Option can be used to measure Forced Vital Capacity (FVC), Forced Expiratory Volume in one second (FEV1), FEV / FVC, FEF , FEF , FEF , PEF, FEF , FEF , FEF 0.2-1.2 25-75% 75-85% FIVC, FIV , FIV...

  • Page 11: Table Of Contents

    Contents Quanjer & Tammeling Comparisons ----------------------------------------- 3 0 --------------------------------------------------------------------- 1 ONTENTS Austrian Standard Values (österreich) ---------------------------------------- 3 1 ---------------------------------------------------------------- 2 NTRODUCTION Swedish Standards (Berglund) --------------------------------------------------- 3 2 Finnish Standards ------------------------------------------------------------------ 3 3 ------------------------------------------------------ 3 ROCEDURE VERVIEW Indian Equations ------------------------------------------------------------------- 3 4 Forced Vital Capacity (FVC) Test ---------------------------------------------- 6 Slow Vital Capacity (SVC) Test ------------------------------------------------- 7 ------------------------------------ 35...

  • Page 12: Introduction

    Introduction The Spirometry function of the SCHILLER AT-2PLUS is automatically available when the SP-250 sensor is plugged into the RS-232 connector on the left hand side of the unit. It features 4 pulmonary function testing modes for the measurement of inspiratory and expiratory values.

  • Page 13: Procedure Overview

    Procedure Overview WARNING ALSE MEASUREMENTS CAN RESULT WHEN THE SENSOR IS NOT HELD VERTICALLY ALWAYS ENSURE THAT THE SESOR IS HELD UPRIGHT AT ALL TIMES Switch unit on, press ON, the introductory screen is displayed: SP-250 Press key `ALT` and `P` to enter the Spiro Mode ALT + C = ECG ALT + P = SPIRO Press the Patient key and enter patient data - see page 11.
  • Page 14 Procedure Overview Key '1' FVC test Key '2' SVC test AUTO Key '3' MVV test Key '4' MV test Key '6' Results 5/10 Key '7' Pre / Post Key '8' Calibration Key '0' Settings Memory AT-2plus User Guide Spirometry Supplement Page 4...
  • Page 15 Procedure Overview If using the option for the first time select the required spiro settings and Spiro Standard. Press '0' to display the Spiro settings - details of all spiro settings are given on the following pages. All these settings are stored when the unit is switched off. Insert new disposable sensor (SP-250).

  • Page 16: Forced Vital Capacity (Fvc) Test

    Procedure Overview Select test: Forced Vital Capacity (FVC) Test For this test the patient must exhale as quickly as possible from the time of starting the test. Note: The FVC test employs the `Back extrapolation` method. If the extrapolated volume is too large (>0.15 litres or 5% of FVC), then a warning appears on the display To carry out the test for Forced Vital Capacity (FVC), press key `1` and the corresponding coordinate presentation appears on the display.

  • Page 17: Slow Vital Capacity (Svc) Test

    Procedure Overview Slow Vital Capacity (SVC) Test MVV Test AUTO The patient should breathe normally 3 times and then The patient should breathe as deeply and as rapidly as possible inhale maximally to total lung capacity and then expire over a period of 6 to 12 seconds. maximally.

  • Page 18: Screen Information

    Procedure Overview Click the Auto (START) key The flow sensor must be held quite still and no air should be breathed into the device for at least one second before and after the START key is pressed. The message ‘’READY FOR MEASUREMENT’’ appears on the display together with a volume counter graph for the value.

  • Page 19: Post-Medication Tests

    Procedure Overview Repeat as many times as required (Best, or Meas. 1). Repeat steps 8 and 9 until three measurements have been taken. Note: If the Start key is again pressed (a fourth or more times), only the best three measurements are stored. When American standards are stipulated, the message ‚`ATS criteria met` appears on the printout if the deviation (as stipulated by the American Thoracic Society) between the best and second best measurements is not greater than 200ml.

  • Page 20: Definition Of Best

    Definition of Best In accordance with the ATS Spirometry Standard (11 November 1994), the best recordings are defined as the highest value from the calculation: Best = FVC + FEV1 The measurement table (on the printout and on the display) gives the highest individual measurements (e.g.

  • Page 21: Entering Patient Data

    Entering Patient Data Each printout is complete with the name and other information concerning the patient. Before beginning a recording, the patient data should be entered. The following parameters have to be entered: Pat-Name: Patient name Pat-No: Patient number Age: Enter age of patient in whole years Sex: Select `M` (male) or `F` (female).
  • Page 22 Displaying the Results in Tabular Form Press the Results option key `6` after a measurement, or series of measurements have been made. A measurement table is displayed. The display gives the measured values and the predicted values* (calculated from the entered patient data).
  • Page 23 Displaying the Results in Tabular Form PRED BEST MEAS1 MEAS2 MEAS3 %PRED 4.31 4.82 FEV 1.0 3.50 4.532 FEV 1/FVC (%) 8.23 9.36 FEF .2-1.2 (l/s) FEF 25-75% (l/s) FEF 75-85% (l/s) (l/s) FEF 25% (l/s) FEF 50% (l/s) FEF 75% (l/s) FMFT FIVC...

  • Page 24: Race Influences On Norm Values

    Race Influences on Norm Values According to the setting of the patients race the predicted values will differ. The differences are (according to ITS recommendations) as follows: All languages except American: W (White): values are calculated according to the given formulas (= 100%) B (Black): 85% of the given formulas...

  • Page 25: Printout

    Printout Click the PRINT (copy) key to obtain a printout. The following is given. The graphs are printed as defined on the following page. ° The patient data. ° The selected norm values. ° The date of last calibration. ° The diagnostic statement (if enabled in Settings menu).

  • Page 26: Spiro Settings

    Spiro Settings This menu option defines all the general settings. Settings made here are remembered when the unit is switched off. For normal use, the settings are made when the unit is first commissioned. However, the settings can be easily changed at any time for comparison purposes or individual preference.

  • Page 27: Printout Graph Setup - Miscellaneous

    Spiro Settings Flow Graph Volume graph Printout Graph Setup - Miscellaneous This defines the miscellaneous print settings as follows: 1s1st key 2nd key 3rd key 4th key 5th key 6 th key Diagnosis on (diagnosis printed) Diagnosis off (diagnosis not printed) PEF (l/m) - Peak Expiratory flow calculation litres/minute PEF (l/s)- Peak Expiratory flow calculation...

  • Page 28: Normals

    Spiro Settings Normals The Normal value standards are given at the end of this section- ‘Diagnosis and Norm Value Tables’. The effect of race on results is detailed previously. 1s1st key 2nd key 3rd key 4th key 5th key 6 th key Knudson / ITS Knudson 76/ ITS Crapo / ITS...

  • Page 29: Measurement/ Report Setup

    Spiro Settingss Measurement/ Report setup The measurement setup defines how the FVC graph is displayed and printed. The report type defines the measurement on which the interpretation is to be based- Best or measurement 1. 1s1st key 2nd key 3rd key 4th key 5th key 6 th key...

  • Page 30: American And Standard English

    Spiro Settings American and Standard English The unit language is set by the software. When English is installed it is possible to select American English or Standard English. The difference is as follows: American Standard English measurements in inches measurements in centimetres temperature in degrees Fahrenheit temperature in degrees centigrade.

  • Page 31: Calibration

    Calibration To calibrate, proceed as follows: THE UNIT MUST BE CALIBRATED WITH THE FIRST PULMONARY FUNCTION TEST OF THE DAY, AFTER EVERY SIGNIFICANT TEMPERATURE CHANGE OR AFTER CHANGING THE SENSOR. Select the Calibration menu option (ALT key then key '8'). The following screen is displayed: then >...
  • Page 32 Calibration Last Calibration date of last calibration BTPS Factor calculated BTPS (=> Body Temperature, Ambient Pressure, Saturated with water vapour) value. This value compensates for the difference in inhaled and exhaled humidity. The unit is set for measuring exhaled volume (100% humidity, Temp 36.8 ), and so when inhaled volume is measured this factor is applied.

  • Page 33: Calibration Procedure

    Calibration Calibration Procedure To calibrate the unit proceed as follows: ° Connect the calibration pump to the sensor. Ensure that there are no air leaks. ° Press key '8' - the menu is displayed as shown on the previous page. °...

  • Page 34: Explanation Of Measured Values

    Explanation of Measured Values Forced (expiratory) Vital Capacity. Volume achieved by the quickest possible exhalation after a maximal inhalation. Forced expiratory volume. Lung volume in litres, measured after 0.5, 1.0 or 3 seconds forced expiration. 0.5/1.0/3.0 Forced Expiratory Flow Respiratory. Flow in terms of differing lung volumes measured in litres per second. flow speed of the expired air by 25 to 75% of the forced vital capacity (FVC).
  • Page 35 Explanation of Measured Values Expiratory Reserve Volume. Possible further expiration starting from the normal expiration level. Inspiratory Reserve Volume. Possible further inspiration starting from the normal inspiration level. Tidal Volume. Expirational and inspirational volumes during normal respiration. Slow Vital Capacity. Lung volume measured from a complete expiration following a deep inspiration. Expired or Minute Ventilation.

  • Page 36: Diagnosis

    Diagnosis The diagnostic interpretation is dependent upon the country. The factors used in the evaluation for diagnosis are automatically included in the respective language software and described in the following chapters. Diagnosis Setting `International` Note: When ‚International‚ is set, diagnostic norms are predicted using the VC value (if taken). If VC values are not recorded, FVC is used.

  • Page 37: Diagnosis Setting `American

    Diagnosis Diagnosis Setting `American` For the USA and Canada, diagnosis of possible respiratory problems is based on the ITS interpretation standard which uses the LLN (Lower Limits of Normal) calculations. These calculations apply to patients between the ages of 5 and 85. The LLN FEV1% value is calculated as follows: Male Female...

  • Page 38: Norm Values

    Norm Values The norm values used for the calculation of predicted values are dependent upon the country. ° For Great Britain, Italy, Spain and Switzerland, the ECCS and Quanjer standards are used. ° For Sweden, the Swedish (Berglund) and Quanjer standards are used. °...

  • Page 39: Norm Values For Countries Outside The Usa

    Norm Values Norm Values for Countries Outside the USA ECCS Values The safety standards of the European Coal and Steel Community Standards (ECCS) are valid for adults of at least 25 years of age. Patients between the ages of 18 and 25 are calculated on the basis of a 25 year old. The calculation equations are as follows: Males Females...

  • Page 40: Quanjer & Tammeling Comparisons

    Norm Values Quanjer & Tammeling Comparisons The Quanjer and Tammeling comparison is valid for children between the ages of 6 and 17 as follows: Boys Girls SVC = FVC 1.00 x H 0.95 x H FEV1 0.84 x H 0.81 x H FEV1/SVC 0.84 0.84...

  • Page 41: Austrian Standard Values (Österreich)

    Norm Values Austrian Standard Values (Österreich) Boys 5 - 17.99 years (1.09 - 1.96m) Males 18 - 90 years (1.44 - 2.00m) In(FVC) = -1.142 + 1.259H + 0.004070A ÖW FVC = - 11.606 + 8.172H - 0.0339A x 1.2869In (A) In(FEV1) = -1.178 + 1.221H + 0.003841A ÖW FEV1 = -8.125 + 6.212H - 0.0300A x H + 0.9770In (A) ÖPEF = 1.798 + 2.311In (H) + 0.0159A - 0.000248A...

  • Page 42: Swedish Standards (Berglund)

    Norm Values Swedish Standards (Berglund) The Swedish (Berglund) standard is valid for adults between the ages of 18 and 75 years as follows: Hommes Femmes FEV% 91.79 -(0.373 x A) 92.11 -(0.261 x A) FVC=SVC 1.09 [ (4.81 x H) -(0.020 x A) -2.81] 1.09 [ (4.04 x H) -(0.022 x A) -2.35] 1.01.09 [ (3.44 x H) -(0.033 x A) -1.00] 1.09 [ (2.67 x H) -(0.027 x A) -0.54]...

  • Page 43: Finnish Standards

    Norm Values Finnish Standards The Finnish standard is valid for adults from the age of 18 years as follows: Males SVC (l) exp [(-0.00833 x A) + (0.6309 x log A) + (-1.4750 / H) + 0.9047] FEV1 (l) exp [(-0.00587 x A) + (0.2756 x log A) + (-1.1655 / H) + 1.0980] FVC (l) exp [(-0.00827 x A) + (0.5860 x log A) + (-1.4468 / H) + 0.9461] FEV1 / SVC (%)

  • Page 44: Indian Equations

    Norm Values Indian Equations The Indian equations are valid for patients from the age of 7 years as follows: Males Females <30 years old: 0.055 x H + 0.019 x A -6.058 0.030 x H + 0.006 x A - 2.284 FEV1 0.039 x H - 0.010 x A -3.266 0.025 x H - 0.011 x A - 1.424...

  • Page 45: Norm Values For Usa And Canada

    Norm Values for USA and Canada Morris Norm Values The Morris equations are valid for women between 56 and 72 inches tall and within the age range of 20 to 90 years, and for men between 58 and 80 inches tall and within the age range of 20 to 90 years as follows: Males Females 0.1480 x H -0.0250 x A -4.241...

  • Page 46: Crapo Norm Values

    Norm Values for USA and Canada Crapo Norm Values The Crapo equations are valid for men between 61 and 77 inches tall and within the age range of 18 to 89 years, and for women between 57 and 71 inches tall and within the age range of 18 to 89 years as follows: Males Females 0.1524 x H -0.0214 x A -4.650...

  • Page 47: Morris And Crapo Norm Values For Children

    Norm Values for USA and Canada Morris and Crapo Norm Values for Children The following equations are valid for children within the age range of 7 to 18 years: BOYS 7 - 17.99 years (1.09 - 1.96m) White GIRLS 7 - 17.99 years (1.09 - 1.96m) White 3.18 2.78 FVC(ml) =...

  • Page 48: Knudson Norm Values

    Males Females Norm Values for USA and Canada H = 44 to 61 inches, A = 6 to 11 yrs H = 42 to 58 inches, A = 6 to 10 yrs 0.1039 x H + 0.0 x A -3.376 0.1092 x H + 0.0 x A -3.749 FVC0.5 0.0760 x H +0.0430 x A -3.050...

  • Page 49: Knudson 76 Norm Values

    Norm Values Males Females Knudson 76 Norm Values Age <25 yrs Age <20 yrs The Knudson 76 equations are valid for both males 0.1270 x H + 0.078 x A -5.508 0.0838 x H + 0.092 x A -3.469 and females in specific age groups as follows: FVC0.5 0.0762 x H +0.043 x A -3.054 0.0483 x H + 0.061 x A -1.738...

  • Page 50: Composite Norm Values

    Norm Values Composite Norm Values Selection of the Composite normals provides selected equations taken from other tables as follows: Value Equation Reference Knudson FEV1 Knudson FEV3 Crapo FEF25 - 75 Knudson FEF75 - 85 Morris FEF.2 - 1.2 Morris Crapo Knudson (same as FVC) AT-2plus User Guide Spirometry Supplement Page 40...

  • Page 51: Polgar Norm Values

    Norm Values Males Females Age under 18 years Age under 18 years Polgar Norm Values *0.0000071 +H *0.00057 -H*0.0123 +0.14 H *0.0000076 +H *0.00048 +H*0.0112 +0.13 The Polgar equations are FVC0.5 H*0.076 +A*0.043 -3.05 valid for both children and FEV1 *0.00000087 +H*0.00035 -H*0.0086 +0.1 *0.0000086 +H *0.00035 -H*0.0086 +0.1...

  • Page 52: Changing The Flow Sensor Sp-250 (Rs-232)

    Changing the Flow Sensor SP-250 (RS-232) AT-2plus User Guide Spirometry Supplement Page 42...
  • Page 53 Changing the Flow Sensor SP-250 (RS-232) WARNING THE DISPOSABLE MOUTHPIECE IS DESIGNED FOR ONE-TIME USE TO ELIMINATE THE DANGER OF CROSS CONTAMINATION - DO NOT USE THE MOUTHPIECE FOR MORE THAN ONE PATIENT. Remove disposable mouthpiece (1) by gently but firmly pulling it away from the handle (2). Discard the complete assembly.

  • Page 54: Care & Maintenance

    Care & Maintenance Self-test Initiate a self-test of the unit as follows by pressing keys ALT > 0 > 3 > 3. A table giving information for the service staff is displayed. To obtain a printout press `P` when the table is displayed. Exit this screen by pressing the ENTER key. 12 Monthly Check The unit should undergo a technical safety check every 12 months.

  • Page 55: Cleaning The Sensor Assembly

    Care & Maintenance WARNINGS: ONLY THE SENSOR HANDLE AND CABLE CAN BE CLEANED - DO NOT ATTEMPT TO CLEAN THE DISPOSIBLE MOUTHPIECE. DISCONNECT THE SENSOR FROM THE UNIT BEFORE CLEANING. DO NOT, UNDER ANY CIRCUMSTANCES, IMMERSE THE APPARATUS INTO A CLEANING LIQUID OR STERILIZE WITH HOT WATER, STEAM, OR AIR. Cleaning the Sensor Assembly Cleaning the Thermal Print Head The sensor casing can be cleaned with a soft damp cloth on...

  • Page 56: Replacing The Recording Paper

    Replacing the Recording Paper The recording paper must be replaced as soon as the end of the paper is indicated by a red stripe on the lower edge. After the indication first appears, there are about 8 pages left. However, we recommend that the paper be replaced immediately. If no paper is left, the printing process is interrupted and a warning is given on the screen.

  • Page 57: Thermal Paper Handling

    Replacing the Recording Paper Thermal Paper Handling • Place fingers under the retaining bar and pull directly upwards. The paper tray cover releases. The thermal paper used in the At-2plus requires slightly different handling to normal paper as it can react with •...

  • Page 58: Technical Data

    Technical Data Technical data subject to change without notice. Safety standard: BF according to IEC and complying with the following: RL 93/42/EEC EN 60601-1:1990 IEC 601-1 pr EN 1441:1994 IEC 513:1994 Protection class: I according to IEC, VDE, SEV IIa according to RL 93/42/EEC Method of Measurement: Pneumotachometer Measurement Ranges:...

  • Page 59: Accessories & Ordering

    Accessories & Ordering The SCHILLER representatives in your country will keep all spirometry parts and accessories. In case of a problem or if you require the address of your local representative, contact the SCHILLER-headquarters in Switzerland. The staff there will be happy to process your order and to supply you with information regarding all SCHILLER products.

  • Page 60: Spirometry Tips - How To Do It And Common Pitfalls And Problems

    Spirometry Tips - How To Do It and Common Pitfalls and Problems How to Do It To ensure an acceptable result, the FVC manoeuvre must be performed with maximum effort immediately following a maximum inspiration; it should have a rapid start and the spirogram should be a smooth continuous curve. To achieve good results, carefully explain the procedure to the patient, ensuring that he/she is sitting erect with feet firmly on the floor (the most comfortable position, though standing gives a similar result in adults, and in children the vital capacity is greater in the standing position).

  • Page 61: Fvc

    Spirometry Tips - How To Do It and Common Pitfalls and Problems Remember, particularly in patients with airflow obstruction, that it may take many seconds to fully exhale. It is also important to recognise those patients whose efforts are reduced by chest pain or abdominal problems, or by fear of incontinence, or even just by lack of confidence.

  • Page 62: Fev1

    Spirometry Tips - How To Do It and Common Pitfalls and Problems FEV1 ° As for FVC ° Take largest FEV1 even if not from the same curve as the best FVC ° „Zero time“ determined by back-extrapolation - extrapolated volume should be <5% of FVC or 0.15 litres, whichever is greatest °...

  • Page 63: Patient-Related Problems

    Spirometry Tips - How To Do It and Common Pitfalls and Problems Patient-Related Problems The most common patient-related problems when performing the FVC manoeuvre are: ° Submaximal effort ° Leaks between the lips and mouthpiece ° Incomplete inspiration or expiration (prior to or during the forced manoeuvre) °...

  • Page 64: Index

    Index Accessories & Ordering 49 ECCS Values_ 29 American English 20 Explanation of Measured Values 24 Austrian Standard Values (österreich) 31 Finnish Standards_ 33 BTPS 22 Flow Impedance: 48 BTPS_ 22 Flow Sensors 42,43 Forced Vital Capacity (FVC) Test 6 FVC E-I Test_ Screen Information_ 8 Calibration 21,22,43...
  • Page 65 Index Measured Values 24 Paper Handling 46,47 Measured Values: 48 Patient Data 11 Measured Volume_ 22 Polgar Norm Values 41 Measurement Ranges: 48 Prediction Equation: 48 Method of Measurement 48 Print Head 45 Morris Norm Values_ 35,37 Procedure Overview 3 MV Test 7 Protection class 48 MVV Test 7...
  • Page 66 Tabular Format 12,13 Technical Data 48 Temperature_ 22 AT-2plus User Guide Spirometry Supplement Page 56...

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