Dräger Cicero EM Instructions For Use Manual
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Dräger Cicero EM Instructions For Use Manual

Dräger Cicero EM Instructions For Use Manual

Integrated anaesthetic workstation
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Cicero EM
Integrated Anaesthetic Workstation
Instructions for Use
Software-Versionen:
Ventilator: ................. 6.n/7.n
Monitor:.................... 4.n

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Summary of Contents for Dräger Cicero EM

  • Page 1 Cicero EM Integrated Anaesthetic Workstation Instructions for Use Software-Versionen: Ventilator: ....6.n/7.n Monitor:....4.n...
  • Page 2 1 Xxxxxxxxxxx Xxxxxxxxxx xxxxx - Xxxxxxxxxxxxx XXXXXXXXXX cccxxxxxxxxxxxxx xxxxx x 2 Xxxxxxxxxxxxxxxxxx xxxxxxxxx (X xxxxxxxxx). Xxxxxxxxxxxxxxxxxxx Checkliste Cicero EM Xxxxxxxxxxxxxxx xxx Xxxxxxxxxxx xxxxxxxxx xxxxxxxx - Vor jeder Benutzung vom Anwender zu prüfen Xxxxxxxxxx - xxxxxx xxxxxxxxxxxx ! - xxx xxx Xxxxxxxxxx...
  • Page 3 Overall contents For your safety and that of your patients Intended use Emergency Quick-Start Notes Power failure Gas failure Operating concepts Master switch Ventilator operating concept Monitor operating concept Preparing for use Power supply Compressed gas supply Connecting external equipment Checking workstation with checklist Anaesthesia ventilation Spontaneous breathing/manual ventilation...
  • Page 4 For your safety and that of your patients For your safety and that of your patients Strictly follow the Instructions for Use Liability for proper function or damage Any use of the apparatus requires full understanding and The liability for the proper function of the apparatus is strict observation of these instructions.
  • Page 5 ) with the pulse bear the mark of conformity. rate. The conversion kit can also be installed in the »Cicero EM – The plethysmogram. color« even if the unit itself does not bear the symbol, because the conformity evaluation procedure has confirmed the suitability of the product for this type of device.
  • Page 6 Emergency Quick-Start Emergency Quick-Start Press the master switch (1) – The pressure gauges (2) are in the green zone. – All lamps on the ventilator light up. Gas/Power ON / I Press Press a function key on the ventilator Recommendation: Press and hold down key for TEST SPONT...
  • Page 7 Emergency Quick-Start Notes on Quick Start The Quick Start procedure is permitted a maximum of 10 times in succession, and only if the previous (full) self- test was completed without error. Otherwise, the display on the ventilator and the system Self-test screen instruct the user to run through the complete self- test.
  • Page 9 Operating concepts Page Master switch............10 Ventilator operating concept ........10 Monitor operating concept ........12...
  • Page 10 Operating concepts Ventilator operating concept Ventilator operating concept Master switch for power and gas 1 Press to switch on. The switch clicks into position. 2 Turn clockwise to switch off. Gas/Power ON / I Press Hardkeys – for setting the operating modes »MAN / SPONT«...
  • Page 11 Operating concepts Operating concept of ventilator Display window with dialogue function (in combination with the rotary control) Example: adjusting the maximum pressure In the black field, beside the rotary control: 1 The set value appears on the right and left-hand sides of the field when a parameter key (P ) is IPPV...
  • Page 12 Operating concepts Monitor operating concept Monitor operating concept Hardkeys The right-hand side is reserved for operating elements, the left-hand side for displays. This key switches the system screen from standby to measuring mode and vice versa. The system screen mode depends on the ventilator mode: Standby can only be selected on the system screen if the ventilator is also in standby.
  • Page 13 Operating concepts Monitor operating concept Softkeys 1 Beside the screen, on the right-hand side, there is an unmarked touch-sensitive keypad. 2 The function of these keys depends on the software and is indicated on the screen itself. Only those keys which can be activated are actually shown.

  • Page 15: Table Of Contents

    Preparing for use Page Electrical power supply........... 16 Equipotential bonding..........16 Uninterruptible Power Supply......... 17 Compressed gas supply ......... 17 Anaesthetic gas scavenging system ...... 18 Anaesthetic vaporizer ..........19 Connecting external equipment ......19 Parameter box ............20 Checking workstation with checklist...... 21 Manual tests.............

  • Page 16: Electrical Power Supply

    Preparing for use Electrical power supply Equipotential bonding Preparing for use The device must be correctly prepared and checked before every use! Connecting the electrical power supply The mains voltage must be within the voltage range specified on the nameplate on the back panel. 1 Plug the power plug into the wall socket.

  • Page 17: Uninterruptible Power Supply

    1 Plug the Cicero power plug into the socket of the UPS. 2 Plug the UPS mains plug into the mains socket. The UPS can supply the Cicero EM with electrical energy for about 45 minutes. It is activated automatically in the event of a power failure.

  • Page 18: Anaesthetic Gas Scavenging System

    Connecting the transfer hoses lime container. 1 Pass transfer hose from behind through the hole in the Cicero EM and 2 connect the hose to the scavenging connector of the breathing system (only on first installation - the hose then remains on the connector).

  • Page 19: Anaesthetic Vaporizer

    Preparing for use Anaesthetic vaporizer External equipment Anaesthetic vaporizer: Only use the Vapors listed in the list of accessories! – Note the separate Instructions for Use of the Vapor. – Vol. Only use the Vapor intended for each anaesthetic – agent! 1 The fill plug must always be inserted and securely tightened!

  • Page 20: Parameter Box

    2 Fix the blue holder in a suitable position. 3 Connect the cable of the mounting base to the connector on the side of the Cicero EM. 4 Hang the parameter box onto the mount from above. The plug connector must engage.

  • Page 21: Checking Workstation With Checklist

    The equipment must be checked every time, Gas delivery , Air, N O present O flow changes proportionally to O -flush audible flow, breathing bag fills immediately before being used! 06-12-98 11:59 Is the Cicero EM o.k. according to check-list ? Please confirm ! 00:00...

  • Page 22: Check Vapor

    Preparing for use Checking workstation with checklist Check-list Cicero EM Check Vapor: To be verified by the user prior to each use – Set the handwheel to » «. Vapor handwheel set to zero fill - level ok – Filling level OK?

  • Page 23: Check Breathing System

    – Filling level adequate (up to the mark). – The absorber vessel must be screwed in (counter- clockwise) as far as it will go. Emergency ventilation bag: (not shown) – Bag is complete and hung from the side of the Cicero EM. – Bag functions correctly.

  • Page 24: Check Piped Medical Gas Supply

    Preparing for use Checking workstation with checklist Soda ime no co our change Central medical gas supply Emergency breathing bag present, functional – The connectors have been pressed right into the wall Central gas supply all pressures greater than 2.7 bar sockets for O , AIR and N O (not in holding...

  • Page 25: Check Gas Delivery

    The following symbols are used: 06-12-98 11:59 Is the Cicero EM o.k. according to check-list ? Please confirm ! 00:00 ? = Enquires whether an action has been performed or a setting made. = Waiting period. The selected test step is being performed by the machine.

  • Page 26: Self-Test

    Preparing for use Self-test As a basic rule, the general task to be performed is specified in the centre field, and detailed operating instructions to the user are given at the bottom of the screen. The test begins with the question: Fresh gas occluded? Close all delivery valves on the measuring block.

  • Page 27: Automatic Self Test

    Preparing for use Self-test Y-piece occluded? 1 Fit the patient connection of the Y-piece onto the cone provided. Press rotary control to confirm. – Additional internal tests requiring an occluded Y-piece are then conducted by the ventilator. The leakage test includes the measured gas sampling and return lines.
  • Page 28 During the leakage test, the expiration valve is tested for Standby leaks. If a leak is found, the corresponding fault message is generated after the leakage test. leakage Cicero EM The fault must be remedied. The self-test must then be test delete restarted by pressing the rotary control!

  • Page 29: Fresh Gas Outlet (Option)

    1 Fit the hose of the semi-open system (e.g. Mapleson system) to the external fresh gas outlet, and connect the anaesthetic gas scavenging hose. Perform self-test in conformity with the Cicero EM Instructions for Use. 2 Set the desired O...
  • Page 31 Anaesthesia ventilation Page Manual / Spontaneous ........... 32 Spontaneous breathing..........32 Manual ventilation ............. 32 Selecting IPPV mode ..........33 Adjusting ventilation parameters ....... 33 Automatic compliance correction ......34 Ventilation with pressure limitation ......34 Limit settings ............34 Selecting SIMV mode ..........

  • Page 32: Manual / Spontaneous

    Anaesthesia ventilation Manual / Spontaneous Anaesthesia ventilation Select Manual / Spontaneous mode 1 Press key »MAN SPONT« on ventilator for at least one second (or press the key and confirm with the rotary control. Setting by Dräger Service as from software version 7.2).

  • Page 33: Selecting Ippv Mode

    Anaesthesia ventilation IPPV Selecting IPPV mode After switching on, the ventilation parameters set prior to delivery or subsequently programmed by DrägerService are active in IPPV mode. 1 Set the values required for the patient. Default settings upon delivery of new apparatus: (may be altered by DrägerService if requested by customer) Tidal volume...

  • Page 34: Automatic Compliance Correction

    Anaesthesia ventilation IPPV Automatic device compliance correction Only set the desired patient tidal volume! The compliance of the breathing system and of the hoses used are established by the apparatus during the self-test or during a manual leakage test. The reduction in tidal volume due to system compliance is then corrected automatically during ventilation so that the patient actually receives the set tidal volume.

  • Page 35: Selecting Simv Mode

    Anaesthesia ventilation SIMV Selecting SIMV mode In order to prevent the mechanical mandatory ventilation stroke from being applied during the expiratory spontaneous breathing phase, a special trigger ensures that the mandatory ventilation stroke is controlled by the patient and consequently synchronized with spontaneous breathing (this is described in detail on page 180).

  • Page 36: Selecting Pcv Mode (Pcv Ventilator)

    Anaesthesia ventilation Selecting PCV mode (PCV ventilator) After switching on in PCV mode the ventilation parameters originally set by the factory or subsequently TEST SPONT reprogrammed by Dräger Service are applied. IPPV SIMV PEEP IPPV Flow Settings on delivery of a new machine: (can be modified by Dräger Service at the customer’s request).

  • Page 37: Special Features Of Mode Changes

    PEEP set to PEEP + 5 mbar. If the Cicero EM is started up in PCV mode, the preset standby value for P is used. For the Flow, the standby value is always set to 50 l/min. These default settings can be modified by Dräger Service at the...

  • Page 38: Paediatric Use

    Anaesthesia ventilation Paediatric use Paediatric use Infant hose set Infant hoses should be used for ventilation volumes of less than 200 mL. If a breathing gas humidifier is used, water traps should be installed at the lowest points of the breathing hoses (arrows) on both the inspiratory and the expiratory side.

  • Page 39: Anaesthesia Ventilation With The Kuhn System

    Kuhn system. The higher the fresh gas flow, the greater the difference. In case the Cicero EM is equipped with an external fresh gas outlet (see page 29) this should be used.

  • Page 40: Checking Water Separators And Water Traps

    Condensation Check the water trap – Regularly check the water trap on the left-hand side of the Cicero EM. When the level comes close to the »Full« mark, remove the jar by pulling it down and empty it. – Fit the jar firmly back in place!

  • Page 41: Checking Soda Lime

    Anaesthesia ventilation Soda line Anaesthetic Check soda lime The soda lime turns purple from the bottom upwards when saturated with CO . To monitor the amount of CO absorption by the soda lime, the FiCO value can be displayed on the system screen (see page 50). FiCO is monitored during IPPV ventilation (default value: adults 5 mmHg, neonates 8 mmHg;...

  • Page 42: Secretion Aspirator

    Anaesthesia ventilation Secretion aspirator Secretion aspirator Set negative pressure: 1 Set negative pressure switch to » «. 2 Set required negative pressure with rotary control. ON / I Seal the aspiration ports (or fold over the hose) and Press 3 check negative pressure on pressure gauge. 1 Set negative pressure switch to »...

  • Page 43: Changing Patients

    Anaesthesia ventilation Changing patients Changing patients Changing parts: Refer to page 117 and 125 for a schematic overview and description of methods for cleaning and disinfection. Maintenance intervals: page 137. Machine in Standby mode - Vapor: thumbwheel set to » «...

  • Page 44: After Use

    After use After use Set machine to »Standby« In »Standby« mode, – the system can immediately be switched to any operating mode, – gas consumption is zero, – power consumption is marginal and – the piston cylinder unit is in withdrawal position. TEST SPONT 1 Press »Standby«...
  • Page 45 System screen functions Page »Standby« screen ............ 46 Running the leakage test .......... 46 Delete trend ............. 46 Basic screen configuration ........47 Access to Configuration ........... 47 Default values............47 Operating Description ..........48 Operating modes for adults and neonates....49 Alarm limits ..............

  • Page 46: Standby" Screen

    System screen functions »Standby« screen System screen functions »Standby« screen Standby In Standby mode, the Cicero EM is immediately ready for operation. The »Standby« screen contains the following softkeys: leakage test Cicero-EM – the leakage test, delete Ventilator Data Manager...

  • Page 47: Basic Screen Configuration

    System screen functions Basic screen configuration Setting code Basic screen configuration Access to Configuration 1 When you press the »Config« screen key, the screen Standby opposite is displayed: leakage test Cicero-EM delete Ventilator Data Manager Parameterbox trend SW-Version 7.n SW-Version 4.n SW-Version 2.n 06-12-98 06-12-98...

  • Page 48: Operating Description

    System screen functions Basic screen configuration Operating Description Operating Description Standby / Configuration alarms inactive ! Settings Part of screen: Representation: NiBP mode adult neon. Active menu level ....Turquoise alarm limits NiBP iBP locations parameter Inactive menu level....Grey iBP channels screen time interval...

  • Page 49: Operating Modes For Adults And Neonates

    RS 232 (Medibus) – ECG functions (see page 89). record (printer) basic config. Every time the Cicero EM is switched on, it automatically operates in the mode selected in this menu. 06-12-98 11:59 Select the required ventilation mode (adult or neonate). Please confirm !

  • Page 50: Parameters

    System screen functions Configuring the system screen in »Standby« Standby / Configuration alarms inactive ! Parameters Settings The settings for the following parameters are defined with mode adult neon. this menu: NiBP alarm limits iBP locations Electrocardiogram. parameter iBP channels screen NiBP Non-invasive blood pressure.
  • Page 51 System screen functions Configuring the system screen in »Standby« NiBP settings Standby / Configuration alarms inactive ! Settings (see also page 91) mode NiBP adult neon. time interval Sets the time between measure- time NiBP interval alarm limits ments. iBP locations active alarms parameter active alarms...
  • Page 52 System screen functions Configuring the system screen in »Standby« Standby / Configuration alarms inactive ! /Pleth settings Settings (see also page 97): mode adult neon. /Pleth measuring function NiBP alarm limits function Switches SpO measurement on and off. iBP locations parameter pulse iBP channels...

  • Page 53: Configuring Screen Pages With Modules

    System screen functions Configuring the system screen in »Standby« alarms inactive ! Standby / Configuration Configuring screens Settings Three standard screens can be configured and stored mode adult neon. independently of one another. The colour configuration of alarm limits the screen can be defined. The following menu options parameter are available: screen...
  • Page 54 System screen functions Configuring the system screen in »Standby« Examples of the other selectable graph modules: 1. ECG I ECG graph ECG real-time curve. The lead and amplitude are selectable. iBP graphs: iBP 1 Real-time curve of the channel 1 iBP 1 ART invasive blood pressure measurement.
  • Page 55 System screen functions Configuring the system screen in »Standby« Flow graph Real-time curve of the expiratory Flow breathing gas flow. PAW graph Real-time curve of the airway pressure. The alarm limits are shown as dashed lines (only the upper limit in Man/Spont). The curve can also be displayed in a double-height module.
  • Page 56 System screen functions Configuring the system screen in »Standby« Examples of the selectable numerical modules: HR/Pulse module HR / Pulse (ECG) Shows the heart rate/pulse rate, which 1/min can be obtained from the ECG, SpO iBP. The data source is shown in pulse def 4 ST +0.05 descending order of priority.
  • Page 57 System screen functions Configuring the system screen in »Standby« Comb. vent. module etCO Peak Shows the combination of measured values obtained from the measurements Freq PEEP of etCO , AMV, Peak, Freq, V 0.76 PEEP. AMV module Shows the expiratory tidal minute L/min volume, breathing frequency and V Freq.
  • Page 58 System screen functions Configuring the system screen in »Standby« pEEG modules pEEG modules are available for d-Ratio selection in the parameter menu 12.5 10.5 0.5 10.5 (see page 52). Please observe the separate Instructions for Use! SEF / SMF / EMG SMF / d-Ratio / EMG d-Ratio d-Ratio...
  • Page 59 System screen functions Configuring the system screen in »Standby« Econometer module Fresh gas surplus: In IPPV mode, shows the fresh gas balance in the breathing system in the form of a bar graph (see des- none high cription on page 179) Econometer temporarely disabled Tendency: Bar in the right-hand sector: The fresh gas flow is...

  • Page 60: Configuring The Screen Colours

    System screen functions Configuring the system screen in »Standby« Configuring the screen colours Standby / Configuration alarms inactive ! Settings Colour settings always relate to all the settings associated with a particular parameter. The curves and mode adult neon. standard - screen 1 their corresponding numerical modules are always in the standard - screen 2 alarm limits...

  • Page 61: General Settings

    System screen functions Configuring the system screen in »Standby« alarms inactive ! Standby / Configuration Configuring the general settings Settings The following can be switched on (»yes«) or off (»no«): mode adult neon. units Indication of the units. alarm limits parameter Temperature screen...

  • Page 62: Transport Function

    System screen functions Configuring the system screen in »Standby« Transport function The parameter box stores the following data, which can be transferred to the system screen: – Patient data from the list screen, – Alarm limit settings and – Measurement parameter settings. The patient remains connected to the parameter box while in transit.

  • Page 63: External Interfaces (Medibus / Printer)

    System screen functions Configuring the system screen in »Standby« alarms inactive ! Standby / Configuration The following dialogue is then displayed on the system Settings screen: mode adult neon. transport »Do you want to transfer the following data from the function alarm limits parameter box?«...

  • Page 64: Basic Configuration

    System screen functions Configuring the system screen in »Standby« alarms inactive ! Standby / Configuration Record (printer) Settings This menu is used to configure the interface for data mode adult neon. transfer to a logging printer (see Instructions for Use of alarm limits the device to be connected): parameter...

  • Page 65: Calibration, O 2 , Flow

    Standby / Configuration alarms inactive ! Calibration Calibration Since all sensors of the Cicero EM are calibrated fully more automatically, the use of this menu is not required in normal operation. The following functions can be calibrated in this menu: –...

  • Page 66: Testing (O 2 Linearity, Gas Sensor Zero Point)

    System screen functions Configuring the system screen in »Standby« Standby / Configuration alarms inactive ! -sensor 100 Vol.% O Calibration For calibrating the sensor in pure oxygen: -sensor more 21 Vol. % Note the information on the screen; see also page 176. flow-sensor For O concentration above 60 vol%.

  • Page 67: Anaesthetic Agent

    Configuring the system screen in »Standby« alarms inactive ! Standby / Configuration Anaesthetic agent Anesth. Agent Calibration Default values The Cicero EM has an automatic anaesthetic agent selection more mode adult neon. identification system and can therefore recognise the man.

  • Page 68: System Screen Functions During Operation

    System screen functions System screen functions during operation Switching on the system screen The system screen starts up automatically whenever a ventilation mode is invoked on the ventilator. »standard screen 1« is displayed with the monitoring mode corres- ponding to the selected ventilation mode. To start up the system screen alone: 1 Press on the screen.

  • Page 69: Standard Screens

    System screen functions System screen functions during operation Standard screens Data screen Standard screens The three standard screens are preconfigured by the manufacturer. The configuration of these screen pages is described from page 47 ff. onwards. The softkeys are described on page 13. Example of a standard screen: Advisory: Warning:...

  • Page 70: List Screen

    System screen functions System screen functions during operation List screen Advisory: Warning: Caution: List screen IPPV alarm limits list screen - adults Certain measured values which have been automatically HR/Pulse start of ª or manually saved are displayed here for documentation anaesthesia 1/min (to facilitate compilation of the anaesthetic record).

  • Page 71: Trend Screen

    Clearing the list and trend memory: In principle, the trend memory and list of the system monitor are erased by switching off the Cicero EM. The trend memory and list can also be cleared in standby mode. If a parameter box is connected, its list memory will also be cleared.

  • Page 72: Softkeys

    The limit value settings only apply temporarily! They are overwritten by the standard alarm limits when Warning: Caution: Advisory: – the Cicero EM is switched on. IPPV alarm limits standard screen 1- adults – the system screen is switched to »Standby«. HR/Pulse (ECG) 1.
  • Page 73 System screen functions Softkeys Patient alarm AutoSet Advisory: Patient alarm AutoSet Warning: Caution: IPPV alarm limits standard screen 1- adults Alarm limits can also be set automatically once the patient is stable. limits auto set pat. alarm. The user can set a new limit range with new upper and auto set lower alarm limits by pressing the softkey »auto set pat.
  • Page 74 System screen functions Softkeys Ventilation alarm AutoSet Alarm Info Advisory: Ventilation alarm AutoSet Warning: Caution: IPPV alarm limits standard screen 1- adults Prerequisite: The ventilator must be in »IPPV«, »SIMV« or »PCV« mode. limits auto set pat. alarm. The ventilation alarms can be automatically adjusted to auto set the current settings of the ventilator by pressing the vent.
  • Page 75 System screen functions Softkeys Screen structure Parameter Warning: Caution: Advisory: Configuring the screen structure IPPV alarm limits APNOEA CO2 TEMP1 TEMP2 CALIB ! standard screen 1- adults A selection menu is displayed when the softkey HR/Pulse (ECG) 1. ECG 1 »screen config.«...
  • Page 76 System screen functions Softkeys Timer Advisory: Timer Warning: Caution: IPPV alarm limits standard screen 1- adults The timer is started by pressing the softkey »timer start«. limits auto set pat. alarm. The time is shown below the actual time on the auto set screen.
  • Page 77 System screen functions Softkeys Configuring during operation Configuring during operation Warning: Caution: Advisory: IPPV alarm limits standard screen 1- adults This softkey calls up the configuration menu. Refer to the corresponding section from page 47 onwards. limits auto set pat. alarm. The menu for configuring the settings is displayed: auto set vent.

  • Page 78: Alarm Concept

    System screen functions Alarm concept Alarm concept Priority of alarms Hinweis: Alarm: Achtung: IPPV Alarmgrenzen The alarms are arranged in order of priority and assigned Standardbildschirm 1 - Erwachsene to specific tones or tone sequences. Grenzen P. Alarme anpassen The information appropriate to the situation is clearly V.

  • Page 79: Show All Alarms

    System screen functions Alarm concept If several alarms occur simultaneously (in this example: pulse rate), the alarm limits which have been exceeded are shown against a dithered yellow background. When the first alarm has been confirmed (by pressing the rotary control on the system screen), the alarm limit of the alarm with the next lower priority is activated and displayed.

  • Page 80: Alarm Modes

    System screen functions Alarm concept Alarm modes IPPV alarm limits Anesth.Agent Alarms Calibration Settings For adults / neonates: selection default mode iBP 1 adult neon. man. auto iBP 2 alarm sound The device stores two different sets of alarm limits, one 1 2 3 4 5 6 7 8 9 Isoflurane ECG pulse tone...
  • Page 81 System screen functions Alarm concept The MAN/SPONT alarm limits are automatically activated in »MAN/SPONT« mode and the SIMV alarm limits for »SIMV« mode with a ventilation frequency of less than 6 breaths per minute. The currently active alarm limits are Warning: Caution: Advisory:...

  • Page 82: Special Features Of Alarm Signalling

    System screen functions Alarm concept Special alarm features Related parameters are combined so that the user is not disturbed by unnecessary cascade alarms. Combination of Apnea alarms from pressure, flow and CO measurement: Measurement Result Message Special features No breathing APNEA CO2 !!! With indication of the time elapsed Flow...
  • Page 83 System screen functions Alarm concept Combined alarms for no pulse or heart rate: The heart/pulse rate is determined from the ECG, SpO and iBP1 and 2. Measurement Result Message Special features No heart beat ASYSTOLE !!! iBP 1 iBP 2 Heart beat iBP 1 PULSE? !!! Pulse...
  • Page 85 Parameter box Page Function keys and displays........86 Transport function........... 87 Measurement functions .......... 89 ECG / heart rate ............89 ECG display............89 Adjusting settings ..........89 Electrosurgery and ECG ........90 Non-invasive blood pressure (NiBP) ......91 Start monitoring........... 91 Interrupt measurement ........

  • Page 86: Function Keys And Displays

    Parameter box Function keys and displays Parameter box Function keys The parameter box is controlled by the Cicero EM. A number of functions can be accessed quickly and directly via the function keys. Act. Start → ← → ← AUTO Punct.

  • Page 87: Transport Function

    Parameter box Transport function Fixing the parameter box to the unit Transport function The parameter box stores: – the patient data from the list screen – alarm limit settings and – measurement parameter settings. The patient remains connected to the parameter box in transit.
  • Page 88 Parameter box Transport function Data transfer Data transfer After the parameter box has been clipped into place, it exchanges data with the system screen. It will perform as programmed in »Standby« (see page 62). A complete list of the transported data is given in the »Technical Data«...

  • Page 89: Measurement Functions

    Parameter box ECG / Heart rate ECG / Heart rate Act. Start → ← → ← AUTO Punct. ECG display Stop Insert the electrode cable in the ECG input of the parameter box, and attach the electrodes to the patient (for instructions, see »Descriptions« from page 163 onwards).

  • Page 90: Electrosurgery And Ecg

    Parameter box ECG / Heart rate Warning: Caution: Advisory: pulse deficit indication on / off IPPV alarm limits Activates and deactivates the pulse deficit standard screen 1- adults indication derived from the heart rate and HR/Pulse 2. ECG ª 1/min pulse.

  • Page 91: Non-Invasive Blood Pressure (Nibp)

    Parameter box Non-invasive blood pressure (NiBP) Non-invasive blood pressure (NiBP) Start monitoring The main steps can be undertaken at the parameter box. Act. Start → ← → ← AUTO Punct. 1 Plug the hose connectors into the parameter box. Stop The rubber rings on the connectors can be moistened slightly so that they can be inserted more easily.

  • Page 92: Adjusting Settings

    Parameter box Non-invasive blood pressure (NiBP) Advisory: Warning: Caution: Changing settings IPPV alarm limits standard screen 1- adults Press the softkey »parameter«. HR/Pulse (ECG) 2. ECG ª limits 1/min NiBP Move the cursor frame to »NiBP« with the rotary auto set auto pulse def.

  • Page 93: Measuring The Blood Pressure Of Neonates

    Parameter box Non-invasive blood pressure (NiBP) repeated 5 seconds later with a higher cuff pressure. If it is still too NiBP low, the air is released again and the measurement repeated 30 seconds auto later with an elevated cuff pressure. punction Start Stop Punction pressure numerical display...

  • Page 94: Invasive Blood Pressure (Ibp)

    Parameter box Invasive blood pressure (iBP) Invasive blood pressure (iBP) Start monitoring the invasive blood pressure Act. Start → ← → ← AUTO Punct. The invasive blood pressure can be measured on two Stop channels simultaneously. The settings and functions of the channels are identical and are described only once below.

  • Page 95: Adjusting Settings

    Parameter box Invasive blood pressure (iBP) Setting functions function on / off iBP 1 Activates and deactivates the iBP function measuring function. location location The names of the following catheter site AORTA labels are programmed: active Artery alarms AORTA Aorta graph absol.

  • Page 96: Ibp Display

    Parameter box Invasive blood pressure (iBP) active alarms sys / dia Determines whether the systole »sys« or iBP 1 diastole »dia« is to be used for monitoring. function graph absol / morph Absolute: Bottom line equals absolute location AORTA zero. Manual amplitude selection active possible.

  • Page 97: Functional O 2 Saturation (Spo 2 )

    Parameter box Functional oxygen saturation (SpO Warning: Caution: Advisory: Functional oxygen saturation (SpO Man./Spont. alarm limits standard screen 3 - adults Graph ª HR/Pulse limits 1/min 1 Presentation of the plethysmogram as a curve. auto set pulse def 4 pat.alarm IBP1 mmHg auto set...

  • Page 98: Temperature Measurement

    Parameter box Temperature measurement Temperature measurement Start measurement – Use a protective sheath for rectal sensors. – Apply the sensor(s) to the patient and connect with the parameter box (colour-coded green). Correct temperature values are displayed after approx. three minutes. Display: If programmed, the small temperature module is 36.8...
  • Page 99 Message, cause and remedy Page Where messages are displayed......100 Location of valves and subsystems ......101 Messages on the system screen ......102 Warning messages...........102 Caution messages............104 Advisory messages ..........106 Messages on the ventilator........109 Message in the ventilation system......110 Message during the self-test........111 Message during operation ........114...

  • Page 100: Where Messages Are Displayed

    »VENT INOP« on the system screen, TEST manual ventilation with the breathing bag is always dialogue field possible with the Cicero EM. The Ventilator then switches over automatically to »MAN/SPONT« mode. The volume of the breathing system increases rapidly to 1.4 litres, because the pump piston is forced back to its starting position by the gas pressure.

  • Page 101: Location Of Valves And Subsystems

    Message, cause and remedy Location of the subsystems Location of valves in the breathing system Schematic Malfunctions and system faults: Location of the subsystems: Eliminate the cause where possible as indicated by Subsystem 3 Vapor Pneumatic the user prompt on the screen. Inform DrägerService interface if necessary, specifying the malfunction number and software number.

  • Page 102: Messages On The System Screen

    Messages on the system screen (In alphabetical order according to priority) Warning Caution Advisory Alarm messages are assigned to three priority classes (alarm priority) in the system screen of the Cicero EM: – Warning » « Text on red field – Caution »...
  • Page 103 Message, cause and remedy Messages on the system screen (In alphabetical order according to priority) Messages Cause Remedy > Fl HAL The inspiratory anaesthetic concentration exceeds Check setting of anaesthetic > Fl ISO the upper alarm limit in each case. vaporizer.

  • Page 104: Caution Messages

    Message, cause and remedy Messages on the system screen (In alphabetical order according to priority) Messages Cause Remedy Caution messages < Minute volume below lower alarm limit. Check tube and hoses. Tube blocked / kinked? Seal breathing system. Leak in breathing system? Adjust ventilation pattern.
  • Page 105 Message, cause and remedy Messages on the system screen (In alphabetical order according to priority) Messages Cause Remedy < MEAN IBP1 The average invasively measured blood pressure of Check patient's condition! < MEAN IBP2 the displayed channel (1 or 2) is below the set Correct alarm limit if necessary.

  • Page 106: Advisory Messages

    Message, cause and remedy Messages on the system screen (In alphabetical order according to priority) Messages Cause Remedy Advisory messages AGAS MIX !! Gas measurement has detected a mixture of two If necessary, check the anaesthetic agents. The leading agent is anaesthetic agent concentration recognised and quantified.
  • Page 107 Message, cause and remedy Messages on the system screen (In alphabetical order according to priority) Messages Cause Remedy ECG N ? ! ECG electrodes disconnected. Secure electrodes. ECG LA ? ! ECG LL ? ! ECG RA ? ! ECG V ? ! FI O2 CAL ? ! The mainstream FiO sensor has not been...
  • Page 108 Message, cause and remedy Messages on the system screen (In alphabetical order according to priority) Messages Cause Remedy PRESSURE INOP ! Pressure sensor defective. Call DrägerService RS 232 COM ! RS 232 communication interrupted. Check plug connection. SELECT AGAS ! The automatically recognised anaesthetic agent Check the anaesthetic agent does not match the manually selected anaesthetic.

  • Page 109: Messages On The Ventilator

    Message, cause and remedy Messages on the ventilator (In alphabetical order according to priority) Messages during the self-test and leakage test Messages Cause Remedy Complete test Attempt to cancel self-test when Run complete self-test. – a malfunction has been signalled beforehand or Manual ventilation is always –...

  • Page 110: Message In The Ventilation System

    Message, cause and remedy Messages in the ventilation system Messages in the ventilation system display: General advisory messages: These messages are displayed for about 2 seconds for Error Code No. for faults in the breathing system during information. the self-test. See page 164. During the self-test and during operation: Remedy the faults and follow the instructions.

  • Page 111: Message During The Self-Test

    Message, cause and remedy Messages in the ventilation system Message must be acknowledged Messages during the self-test Cause Remedy Breathing sys. defect. • Valve V not closing. Replace breathing system or valve plate. Display »109« in V field Breathing sys. defect. • Additional air valve not opening. Replace breathing system or valve.
  • Page 112 Message, cause and remedy Messages in the ventilation system Message must be acknowledged Messages during the self-test Cause Remedy Leak IPPV = xxx mL • Indicates a leak in the ventilation system. Acknowledge. For leaks greater than 175 mL/min Repair any leak and repeat the test. (at 30 mbar) in subsystem 1/2.
  • Page 113 Message, cause and remedy Messages in the ventilation system Message must be acknowledged Messages during the self-test Cause Remedy Service No. 118 • Incorrect test control pressure. No sealing Call DrägerService. test possible for valve and roller diaphragm. Service No. 119 •...

  • Page 114: Message During Operation

    Message, cause and remedy Messages in the ventilation system Message must be acknowledged Messages during operation Cause Remedy Check monitor No communication between ventilator Switch on airway monitor manually. and airway monitor. Check connectors. Display repeated every 10 minutes. Call DrägerService if necessary. Compliance test Compliance test in progress.
  • Page 115 Message, cause and remedy Messages in the ventilation system Message must be acknowledged Messages during operation Cause Remedy Prohibited Prohibited key sequence. Wait about 2 seconds. Service No. 46 Defective fan Switch off machine after end of anaesthesia due to possible overheating. Call Dräger Service.
  • Page 117 Care Page Stripping down machine.........118 Dismantling parts............119 Disinfection - cleaning - sterilization ......121 Agents and methods ..........121 Care schematic ...........122 Care intervals for individual components....122 Disposing of throw-away articles......123 Wipe-cleaning ............123 Disinfectant cleaning in machines......123 Disinfection with formaldehyde vapour ....123 Steam sterilization (121 / 134 °C) ......124 Tabular summary ............125 Reassembling machine ..........126...

  • Page 118: Stripping Down Machine

    To do so: Press button to unlock hose connector and pull downwards. Hose remains on connector. The anaesthetic gas scavenging system can be removed from the back panel of the Cicero EM as a single unit.

  • Page 119: Dismantling Parts

    Care Dismantling parts Dismantling parts Measured gas: 1 T-piece of measured gas hose (if used): remove filter. Inspiratory O sensor (if used): Must not be disinfected in liquid or autoclaved! Wipe any dirt off housing or lead with damp disposable cloth. Unscrew O sensor and remove O cell.
  • Page 120 Care Dismantling parts Breathing system: Remove flow sensor - Unscrew pressure limitation valve APL - Dismantle breathing valves - valve discs must be handled with care. Replace measured gas return hose if contamination is possible - 1 Release the five quick-release screws by turning through a quarter-turn with a 6 mm hexagon key - Remove upper part - 2 The two valves are only unscrewed if soiled.

  • Page 121: Disinfection - Cleaning - Sterilization

    Care Disinfection / Cleaning / Sterilization Agents and methods Disinfection / Cleaning / Sterilization Agents and methods Only products from the list of surface disinfectants may be used for disinfection. Products based on – aldehydes, – alcohols and – quaternary ammonium compounds ®...

  • Page 122: Care Schematic

    Care Disinfection / Cleaning / Sterilization Care schematic Care intervals Care schematic Stripping down machine Machine without parts in contact Dismantling parts in contact with patient gas with patient gas Manual preliminary In automatic disinfection cleaning unit ANDA / Purfactor In automatic dis- infection unit Aseptor Manual, scrubbing, wipe and...

  • Page 123: Disposing Of Throw-Away Articles

    Care Disinfection / Cleaning / Sterilization Agents and methods Disposal of throw-away articles Throw-away articles and articles with limited service life (e.g. microbial filters, soda lime) can be disposed of as household refuse if used for treating non-infectious patients. Infectious waste must be disposed of in accordance with regulations! Wipe cleaning Cicero parts which can be wipe-cleaned are listed in...

  • Page 124: Steam Sterilization (121 / 134 °C)

    Care Disinfection / Cleaning / Sterilization Agents and methods Steam sterilization at 121 or 134 °C Cicero parts which can be sterilized in this way are listed in the table on page 125. Steam sterilization must be preceded by sterilization with moist heat and/or wipe cleaning.

  • Page 125: Tabular Summary

    Care Disinfection / Cleaning / Sterilization Agents and methods Methode: Disinfection by wiping Cleaning with Formaldehyde Steam sterilization at 121 °C at 134 °C Machine components or immersion automatic cleaners vapour Stripped down basic machine Wipe Parameter box Wipe Rubber parts: Tube / mask Y-piece Breathing hoses...

  • Page 126: Reassembling Machine

    Reassembling machine Reassembling the parts Reassembling machine Reassemble cleaned, disinfected and sterilized parts Assemble the piston pump: Check individual parts: Gaskets: pressure marks? cracks? Diaphragm: cracks? holes? deformation? Defective parts must be replaced! 1 Fit roller diaphragm - production mark visible on the outside (arrow) - 2 Insert piston - carefully place the rolled edge round the edge of the piston - 3 Screw piston into position (not quick-release) -...
  • Page 127 Reassembling machine Reassembling the parts Fit the piston pump Swing up table top 1 Handle in starting position - Do not damage gaskets when fitting pump! Hold piston pump by its handle and insert in machine. 2 Swing handle as far as possible to the left (black). Fit the breathing system 3 Hold breathing system by its handle and insert in machine -...
  • Page 128 Reassembling machine Reassembling the parts Connect fresh gas hose 1 to breathing system from below with plug connector. Connect pressure measuring line with filter 2 Plug pressure measuring line into coupling - until it engages. Fill soda lime container The container can hold approx. 1.5 l soda lime »Drägersorb 800 plus«...
  • Page 129 Connecting the transfer hoses 1 Pass the transfer hose from behind through the hole in the Cicero EM and connect the hose to the scaven- ging connector of the breathing system. 2 Connect the transfer hose to the connector on the receiving system.
  • Page 130 Reassembling machine Reassembling the parts Fit flow sensor: 1 Unscrew expiration nozzle. 2 Slide flow sensor into housing. 1 Screw expiration nozzle back into place. The sensor is automatically calibrated. Fit microbial filter: Fit a microbial filter with 22 mm fittings on both the inspiration and expiration ports.
  • Page 131 Check operational readiness Page Check O shortage signal........132 Check power failure alarm ........132 Run the self-test............132 Check manual ventilation function ......133 Check automatic ventilation function ....... 133 Testing the pneumatic circuit for leaks..... 135 Testing display errors..........135 Disposal of used batteries and O sensors....

  • Page 132: Check O 2 Shortage Signal

    Check operational readiness Check operational readiness Operational readiness of the machine must be restored and checked whenever it has been cleaned, disinfected, sterilized, repaired or serviced! Supplementary equipment must be checked in accordance with the respective Instructions for Use. Note the applicable time limits for filters, maintenance and calibration, e.g.

  • Page 133: Check Manual Ventilation Function

    Check operational readiness Check manual ventilation function Machine in Manual/Spontaneous mode: 1 Press 2 Pressure limiting valve (APL) set to MAN - Connect lung simulator, test thorax or breathing bag to Y-piece - 3 Set fresh gas flow - 2 Set maximum ventilation pressure between 5 and 70 mbar on APL valve - turn valve head for this purpose.
  • Page 134 Check operational readiness Replace cooling air filter of system screen 1 Draw both cooling air filter out of its mount. Fit new filter or wash in warm water with detergent and dry thoroughly. Replace cooling air filter in mount without creasing. P-Box VGA extern VGA intern...

  • Page 135: Testing The Pneumatic Circuit For Leaks

    Check operational readiness Checking the NiBP pneumatic circuit for leaks Pull the supply hose of the sphygmomanometer cuff from Advisory: Warning: Caution: the twin hose and connect it to a pump-ball via a T piece. IPPV alarm limits The cuff (normal size) remains in the measuring circuit, standard screen 1- adults tightly rolled up.

  • Page 136: Disposal Of Used Batteries And O

    Treat as infectious special waste. Can be incinerated at temperatures above 800 °C with low pollutant emissions. Disposal of apparatus – at the end of its useful life. The Cicero EM can be returned to Dräger Medizintechnik GmbH for environmentally sound disposal.

  • Page 137: Maintenance Intervals

    Maintenace intervals Replacement intervals Maintenace intervals Machine and machine parts must be cleaned and disinfected before starting any maintenance work and before returning to manufacturer for repair! Inspection and maintenance* ........Every 6 months by qualified personnel. Pressure reducing valve maintenance ...... Must be serviced every 6 years by qualified personnel.
  • Page 139 What's what Page Overall view of the machine ........140 Operating elements and displays on ventilator ..141 Operating elements and displays on monitor.....142 Operating elements and displays on gas control panel............143 Operating elements and displays on flowmeter bank............144 Operating elements and displays on parameter box ............145 Elements on the rear of the machine ......146 Elements on breathing system ........147...

  • Page 140: Overall View Of The Machine

    What's what Overall view of the machine e r o C i c 1 Hinged arm (optional) 13 Retaining pin 2 Guides for hoses and leads 14 Swivelling transport castor (2 units) 3 Support for NiBP cuff and other items of equipment 15 Locking transport castor (2 units) 4 Plug connection for Dräger Vapors 16 Gas delivery (details on page 144)

  • Page 141: Operating Elements And Displays On Ventilator

    What's what Operating elements and displays on ventilator With PCV: TEST SPONT IPPV SIMV IPPV PEEP Flow 14 15 16 17 18 19 20 Without PCV: TEST SPONT IPPV SIMV IPPV PEEP 1 Pressure limiting valve (APL) with Manual/Spontaneous changeover 2 MAN/SPONT key for manual ventilation/spontaneous breathing 3 Key for automatic ventilation (IPPV) 4 Bar graph of relative piston movement [%]...

  • Page 142: Operating Elements And Displays On Monitor

    What's what Operating elements and displays on system screen 10 11 Warning: Caution: Advisory: IPPV alarm limits standard screen 1 - adults limits auto set pat. alarm. auto set vent. alarm. alarm info screen config. para- meter timer start config. 06-12-98 16:47 00:00...

  • Page 143: Operating Elements And Displays On Gas Control Panel

    What's what Operating elements and displays on gas control panel Gas / Power OFF / O ON / I Press Vac. Fresh gas Frischgas 1 Pressure gauge for oxygen (O 2 Pressure gauge for air (AIR) 3 Pressure gauge for nitrous oxide (N 4 Green area indicating adequate gas pressure 5 Control knob for negative pressure for bronchial aspiration 6 Switch for generating negative pressure...

  • Page 144: Operating Elements And Displays On Flowmeter Bank

    What's what Operating elements and displays on flowmeter bank 1 Key for O flush (O 2 Connection ports for Vapor 3 Vapor plug-in connection system 4 Support block for Vapor 5 Acoustic outlet for O shortage signal (whistle) O / AIR changeover switch 7 Oxygen flow tubes* 8 Air flow tube 9 Nitrous oxide flow tube*...

  • Page 145: Operating Elements And Displays On Parameter Box

    What's what Operating elements and displays on parameter box Act. Start → ← → ← AUTO Punct. Stop NIBP 1 Key for suppressing alarm sound 2 Key for starting automatic NiBP measurement 3 Key for starting and stopping manuall NiBP measurement 4 Key for starting inflation of the NiBP cuff 5 LED lights up when parameter box active 6 Indicator for defibrillator strength...

  • Page 146: Elements On The Rear Of The Machine

    What's what Elements on the rear of the machine 1 Shelf 11 Pressurized gas port for oxygen hose 2 Rear of monitor (details on page 148) 12 Pressurized gas port for air hose 3 Holder for coiled cables and hoses 13 Pressurized gas port for nitrous oxide hose sensor for sampled gas measurement 14 Anaesthetic gas scavenging system (AGSS)

  • Page 147: Elements On Breathing System

    What's what Elements of breathing system 1 Plug-in connection for pressure measurement (P 2 Inspiration valve with mount for O sensor (optional) 3 Inspiration port (ISO cone 22mm) 4 Quick-release coupling for measured gas return line 5 Expiration valve 6 Expiration port (ISO cone 22mm) with mount for flow sensor (screwed in) 7 Pressure limiting valve (APL) with pressure setting (turn), MAN/SPONT changeover (two-way switch) and pressure relief (press) 8 Plug to seal Y-piece for leakage test...

  • Page 148: Connections On The Rear Of The Monitor

    VGA intern Temp. / Spiro Itmes 9 to 20 are accessible after removing the outer back panel of the Cicero EM. 1 Cooling air filter of the system screen 2 Nameplate 3 Connection for level gauge in water trap of measured gas sampling system...

  • Page 149: Basic Screen Settings

    What's what Basic screen settings: The contrast and background brightness of the screen can be set directly with the keys. The keypad is located on the back of the monitor (item 18 on page 148). 1 Keys for adjusting the background brightness of the screen. »+«...

  • Page 150: Dimensions

    What's what Dimensions Trolley version (illustrated) Ceiling version (not illustrated, dimensions apply accordingly) A = 1342 mm A = 1010 mm 708 mm 570 mm 747 mm 745 mm 850 mm incl. transport handle on both sides 840 mm incl. transport handle on both sides 775 mm 805 mm 385 mm...
  • Page 151 Technical data Page Identification / Approval .........152 Power supply ............152 Ambient conditions ..........153 Medical gas supply ..........153 Vacuum pressure............153 Breathing system............153 Ventilator..............154 Gas delivery ............154 System monitor............155 Pressure measurement..........155 measurement, sampling ........155 Flow measurement ...........155 measurement ...........155 Anaesthetic agent measurement .......156 Breathing gas temperature measurement....156 Data communication ..........156 Parameter box ............157...

  • Page 152: Identification / Approval

    Technical data Where tolerances are given in percent and as absolute values, the higher value applies in each case! Identification ......: The serial number and article number of the Cicero EM and the –symbol are located on the rating plate (nameplate) fixed to the back of the machine (ref.

  • Page 153: Ambient Conditions

    Technical data Ambient conditions Temperature ......: + 15 to + 35 °C (operation) – 20 to + 50 °C (storage / transport) Humidity ........: 20 to 90 %, no condensation (operation) 0 to 98 %, no condensation (storage / transport) Air pressure......: 80 to 106 kPa (operation) 50 to 106 kPa...

  • Page 154: Ventilator

    Technical data Pressure relief ......: 90 ± 10 mbar Pressure limiting valve....: Variable between 5 and 70 mbar, ± 15% of set value Patient connections ....: ISO cone 22 mm Anaesthetic gas scavenging..: Nominal socket diameter 27 mm or ISO cone 30 mm EN 1281-1) Leakage ventilation system..: <...

  • Page 155: System Monitor

    Technical data System monitor Test regulations ......: EN 60601-1, EN 60601-1-2, EN 60601-2-27, EN 60601-2-30, EN 60601-2-34, pr-EN 864, pr-EN 865. Pressure measurement Airway pressure, measuring range..: – 10 to 80 mbar Resolution: .......: 1 mbar Accuracy ........: better than ± 4% of measured value or at least 1 mbar sidestream measurement (sampling measurement) Measuring range.......: 5% to 100% by volume Sample rate ......: 60 mL/min or 200 mL/min...

  • Page 156: Anaesthetic Agent Measurement

    Technical data Anaesthetic agent measurement Display range......: 0% to 100% by volume Accuracy ........: ± 2.5% by volume or 4% of measured value Resolution ........: 1 % Halothane and isoflurane Display range......: 0 to 8.5% by volume better than ± 0.2% by volume absolute Accuracy ........: In the range from 0 to 4%: better than ±...

  • Page 157: Parameter Box

    Technical data Parameter box Electrocardiogram (ECG) Input.........: Isolated; IEC type CF; for ECG leads with 3, 4 or 5 electrodes; colour-coded red. Input impedance .......: > 20 MΩ at 10 Hz > 4 MΩ at 40 Hz Leads ........: 1, 2, 3 or I, II, III, AVR, AVL, AVF, V Display ........: Position can be configured as required.

  • Page 158: Non-Invasive Blood Pressure (Nibp)

    Technical data Non-invasive blood pressure (NiBP) Input.........: IEC type CF, floating, Colour-coded purple Measuring method ....: Oscillometric Measuring range.......: Adult mode: 20 to 290 mmHg (3.0 to 38.6 kPa) Neonatal mode: 5 to 150 mmHg (0.6 to 20 kPa) Resolution: .......: 1 mmHg (0.1 kPa) Accuracy ........: 1 mmHG (0.1 kPa) Unit of measure ......: mmHg or kPa Inflation of cuff ......: The cuff is inflated to the preset starting pressure for the first measurement;...

  • Page 159: Oxygen Saturation (Spo 2 )

    Technical data Measuring ranges for graph display .......: 20, 40, 80, 160 and 320 mmHg Max. pressure signal ....: – 10 to 320 mmHg for undistorted display Measured parameters ....: Systolic, diastolic and mean pressure Measuring range.......: – 10 to 320 mmHg Resolution ........: 1 mmHg Unit of measure ......: mmHg Site labels.........: ART, AORTA, APulm, CVP, ICP, ?

  • Page 160: Transport Function, Transferable Data

    The haemodynamic parameters are stored in Parameter Box PB 8800 and transferred between this box and the connected PM 8060 monitors or the Cicero EM Anaesthetic Workstation. The following data can be transferred:...
  • Page 161 Technical data Parameters Setting Measured value for the list General Times at which saved Memory flags Application mode Location name Start and end time of monitoring phase Patient name Data transferred from the anaesthetic unit or ventilation device: Parameters Measured value for the list Alarm limit None None...
  • Page 163 Descriptions Page Flow chart of self-test ..........164 Ventilation with automatic adjustment of rebreathing to match fresh gas flow ......166 Automatic leakage tests IPPV / MAN .....167 Automatic compliance correction......167 Notes on setting fresh gas flow......168 Relationship between fresh gas and gas concentration in the breathing system ....168 Relationship between fresh gas and time constants in the breathing system ......168...

  • Page 164: Flow Chart Of Self-Test

    Description Self-test Flow chart of self-test in anaesthesia ventilator Legend: Subsystem 3 Vapor Pneumatic interface Display in dialogue window of ventilator Indicated faults must be remedied, instructions and advisories observed. Information in dialogue window of ventilator Press rotary control Correspondingly numbered test blocks in VT window Test sequence Start –...
  • Page 165 Description Self-test Flow chart of self-test in anaesthesia ventilator (cont.) Test blocks: Control pressure test Interface Service 118 Service 119 Service 115 Valve and roller diaphragm Valve disc defective test Roller diaphr. defective > 5 L/min Subsystem 1/2 (IPPV) Subsystem 1/2 leak Leak <...

  • Page 166: Ventilation With Automatic Adjustment Of Rebreathing To Match Fresh Gas Flow

    –0.3 mbar. secondly, for fresh gas to escape without first having This shortage of fresh gas is signalled by the Cicero EM been administered to the patient. and the piston pump stops in order to avoid a negative In closed anaesthesia systems, anaesthetic gas cannot pressure in the patient.

  • Page 167: Automatic Leakage Tests Ippv / Man

    Effective leakage = Test leakage x P mean test during the leakage test and saved by the Cicero EM. Effective leakage = 6 mL/min This calculated compliance value is used to calculate the volume stored in the breathing system and hoses for Automatic MAN leakage test each ventilation pressure.

  • Page 168: Notes On Setting Fresh Gas Flow

    Description Notes on setting the fresh gas flow Notes on setting the fresh gas flow Example for estimating the minimum fresh gas flow required in The fresh gas delivered must the steady state: – cover the patient's consumption (uptake) and Body weight 70 [kg]: –...

  • Page 169: Tips For Reducing Condensation

    Moisture generation increases with the proportion of Recommendation rebreathed gas (low-flow mode). If condensate is expected: The Cicero EM is optimised for this low-flow mode: Replace the breathing system and piston/cylinder unit – the electric heater prevents condensation in the daily.

  • Page 170: Tips For Ecg And Heart-Rate Measurement

    Description ECG / Heart rate ECG in the operating theatre Applying electrodes The following measures are necessary to ensure an – Carefully prepare the areas of skin to which the effective ECG, reliable heart rate calculations and patient electrodes are to be applied. safety: –...

  • Page 171: Tips For Nibp Measurement

    Description Non-invasive blood pressure (NiBP) Tips for NiBP measurement Limitations of the method The oscillometric method used here is based on Applying the sphygmomanometer cuff measuring the change of pressure in an inflated cuff Correct application of the cuff and use of the correct due to blood streaming through a partly occluded artery.

  • Page 172: Tips For Spo 2 Measurement

    Description Functional oxygen saturation (SpO Tips for SpO measurement Safety and precautions – The sensor must not be applied to limbs together with Choice of sensor an arterial catheter, infusion or sphygmomanometer Nellcor sensors must be used exclusively! Note the cuff.
  • Page 173 Description Functional oxygen saturation (SpO Tips to avoid artefacts during SpO Coupling with non-invasive pressure measurement measurement Nellcor sensors must be used exclusively and positioned The interlock function should be activated for simulta- correctly in order to avoid the risk of measuring errors neous measurement of SpO and non-invasive blood and tissue damage.

  • Page 174: Measuring Principle Of Spo 2 Measurement

    Description Functional oxygen saturation (SpO Measuring principle The light alternately emitted by the diodes is completely absorbed by the pulsating arterial blood, the skin, finger The light absorption properties of oxygenated arterial nails, muscular tissue, bones and venous blood. blood (oxyhaemoglobin HbO ) differ from those of Except for the pulsating arterial blood, the amount of light unsaturated venous blood (reduced haemoglobin Hb).

  • Page 175: Measurement

    Description Functional oxygen saturation (SpO Pressure measurement saturation 100% O saturation Measuring principle at 660 nm red Piezoresistive change of resistance in a membrane. Determination of PEEP and plateau pressure PEEP (positive end-expiratory pressure) is the airway pressure at the end of expiration. Time (s) The plateau pressure is the airway pressure measured at 920 nm infrared...
  • Page 176 Description measurement Calibrating the inspiratory O sensor with 100% O Calibrating the O sensor for sampling measurement with 100% by volume O volume Required for the monthly linearity check. (Only necessary if sampling O measurement is not used) Prepare a replacement sample line: Remove the O sensor and fit test adapter 68 01 349 Cut a sample line hose into two equal halves.

  • Page 177: Measuring Principle Of Flow Measurement

    The Cicero EM is equipped with an automatic anaesthetic agent recognition system. Mixtures will be identified and Shake the sensor briefly in the ambient air to purge it the main component recognised and quantitatively of any residual breathing system gases.

  • Page 178: Definition Of Low-Flow And Minimal-Flow

    Description Definitions for »low-flow« and »minimal flow« anaesthesia Disturbance variables in sidestream gas Definitions for »low-flow« and »minimal flow« measurement anaesthesia When assessing the measured values, the temperature, Low-flow anaesthesia is performed with a fresh gas flow humidity and pressure conditions during measurement considerably below the minute ventilation.

  • Page 179: Econometer Module

    The qualitative assessment of the econometer reflects the prevailing conditions in the breathing system most In the case of excess fresh gas flow, the Cicero EM accurately when anaesthetic ventilation for adults is ventilator releases the excess gas by actuating the gas carried out with a rate of 6 to 25 strokes per minute.

  • Page 180: Simv Ventilation

    Description Synchronized Intermittent Mandatory Ventilation SIMV Synchronized Intermittent Mandatory Ventilation Mixture of mechanical ventilation and spontaneous breathing. In SIMV mode, the patient can breathe spontaneously at specified regular intervals. Between these intervals, mandatory (i.e. automatically delivered) ventilation strokes ensure a minimum degree of ventilation. The mandatory ventilation strokes are the same as those for IPPV ventilation.
  • Page 181 Description Synchronized Intermittent Mandatory Ventilation Trigger and spontaneous Trigger breathing times for [sec] Spont Spont SIMV mode: Trigger Example ∆T [sec] Maximum pause time Example: = 5 / min = 10 / min IPPV ∆T = –––– – –––– = –––––––– – ––––––––– = 6 s 5 per min 10 per min IPPV...

  • Page 182: Oxygen Ratio Control - S-Orc

    Description Oxygen Ratio Control – S-ORC Oxygen Ratio Control – S-ORC To prevent the setting of hypoxic gas mixtures, Cicero EM has an O ratio control system (SORC = Flow tubes Sensitive Oxygen Ratio Control). in the bank of measuring tubes...

  • Page 183: Safety Features Of Gas Supply

    Description Safety features of gas supply Safety features of gas supply The amplitudes are determined for specific time slots (epochs). Characteristic values are then calculated from Switch-on lock the frequency spectrum. These calculations take place in "real time", i.e. they are performed at the same time as A safety mechanism prevents gas from being delivered the signals are received, so that the results are available if the machine is switched on although there is no O...

  • Page 184: Operation Of The Ceiling Version

    100 cm 50 cm On the rear of the ceiling version of the Cicero EM there is a mounting arm with which the machine is coupled to the mount on the DVE. Both the mounting arm and the mount are equipped with sensors ensuring that the Cicero has been correctly fitted and coupled.
  • Page 185 Description Operation of the ceiling version Backup gas cylinders Backup gas cylinders are not installed. Auxiliary mains sockets The auxiliary mains sockets are not installed on the ceiling version. Articulated arm The articulated arm is attached to the journal of the support at the left-hand side.
  • Page 186 4 Swing supporting flap down again. The DVE can no longer be operated via its own keypad. Plug the mains connector of the Cicero EM into the socket on the DVE. Plug the pipeline probes of the Cicero EM into the corresponding outlets on the DVE.
  • Page 187 Description Operation of the ceiling version 1 Both green LEDs on the touch-sensitive keypads on the Cicero EM mounting arm and on the DVE light up when correctly positioned. The DVE can now be controlled via the keypad on the Cicero EM! 2 Press key until Cicero EM reaches the required working height.
  • Page 188 Description Operation of the ceiling version 1 Move Cicero EM away from the DVE. 2 Swing supporting flap upwards. The DVE can now be controlled via its own keypad again. As from approx. 5 cm above the lower limit position, the DVE can also be moved upwards even when the supporting flap is lowered.

  • Page 189: Abbreviations And Symbols

    Description Abbreviations and symbols Abbreviation Significance Abbreviation Significance Light-emitting diode Compressed air for medical use Minute ventilation LED display 7-segment display with light-emitting diodes Adjustable pressure limitation Man/Spont Manual ventilation or spontaneous AW-Temp Inspiratory breathing gas temperature breathing Connection for breathing bag Mean Mean pressure Calibration has been performed...
  • Page 190 Protection class type BF (DIN IEC 601) Request for action Action has been completed successfully Action is being carried out Warning message Caution message Advisory message – – Alarm limit inactive ç ç ç ç Conformité Européenne Cicero EM conforms to the relevant EC requirements.
  • Page 191 Index Breath volumeter bbreviations Acids, disinfectants Breathing system, assembling Acoustic signals, definition of Breathing system, checking Additional sockets, auxiliary mains sockets Breathing system, dismantling Adults mode Breathing system, heating Advisory messages Breathing system, installation (message - cause - remedy) Breathing system, removal Advisory, definition/display Breathing system, technical data AIR changeover...
  • Page 192 Index Compliance correction, automatic Function keys, parameter box Compliance correction, description Fuses Compressed gas supply, technical data Concept, alarms as control plate, operating controls Condensate, avoiding Gas failure Conductive rubber parts Gas failure, emergency respiration Connecting the ceiling version Gas metering, checking Cooling air filter Gas metering, technical data Cursor frame...
  • Page 193 Index Measuring principle, O measurement Oxygen saturation, calculated/measured Measuring principle, pressure Oxygen saturation, functional/fractional measurement Oxygen-releasing disinfectants Measuring principle, SpO measurement Oxygen... see O Measuring principle, temperature measurement acemaker pulse recognition Measuring tubes, operating controls Pacemaker, ECG Measuring unit, changeover Paediatric application MEDIBUS interface Paediatric hoses...
  • Page 194 Index Screen, Data Switching off, end of operation Screen, List System monitor, technical data Screen, modules, defining/deleting Screen, operating controls echnical data Screen, Standard Temperature measurement, measurement principle Screen, Standby Screen, switching on Temperature sensor, installation Screen, Trend Time, setting Timer setting Tone Selecting IPPV mode...
  • Page 196 These Instructions for Use apply only to Cicero EM with Serial No.: If no Serial No. has been filled in by Dräger these Instructions for Use are provided for general information only and are not intended for use with any specific ç...

Table of Contents