Accessories; Important Information; Provider's Notes; Physician Information - DeVilbiss PulseDose PD1000I Instruction Manual

ACCESSORIES

The accessories below are approved for use with the DeVilbiss unit:
Carry Bags
C Cylinder bag .......................................................................................................................... EX3000D-651
D Cylinder bag .......................................................................................................................... EX3000D-652
M6 Cylinder bag ....................................................................................................................... EX3000D-653
ML6 Cylinder bag ..................................................................................................................... EX3000D-654
Cylinder cart (E Cylinder) .............................................................................................................................CT001
There are many types of oxygen tubing and cannulas that can be used with this device. Certain accessories
may impair the device's performance. Use only standard nasal cannula capable of supporting a minimum flow
rate of 10 LPM with PulseDose delivery. Do not use pediatric (low-flow) nasal cannula or mask with PulseDose
delivery. A mask or any nasal cannula can be used with continuous flow delivery and may be sized according
to your prescription as recommended by your homecare provider who should also give you advice on the
proper usage, maintenance, and cleaning.

IMPORTANT INFORMATION

Physician information

Name: __________________________________________________________________________________
Address: ________________________________________________________________________________
________________________________________________________________________________________
Telephone: _______________________________________________________________________________
Emergency Telephone: _____________________________________________________________________

Prescription Information

Patient's Name: __________________________________________________________________________
Flow Setting (LPM): ________________________________________________________________________
Set-up Information
Name of Person Setting Up: ________________________________________________________________
Oxygen Provider
Emergency Telephone Number: ______________________________________________________________
This instruction guide was reviewed with me and I have been instructed on the safe use and care of the
DeVilbiss PulseDose oxygen conserving device.
________________________________________________________________________________________
Patient or Caregiver Signature

PROVIDER'S NOTES

No routine calibration or service is required provided the device is used in accordance with the manufacturer's
directions. Between patients wipe with a damp cloth having a maximum 5.25% Sodium Hypochlorite (Bleach)
or 3% Hydrogen peroxide solution. Avoid getting fluids or debris such as sand or dirt inside the oxygen
connections. Do not immerse in water.
EN - 12
Date
SE-1000