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Dräger Medical Narkomed Mobile Operator's Instruction Manual

Anesthesia system
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Operator's
Instruction
Manual
Part Number: 4115139-001
Rev: F
Date: 30 January 2004
© 2004 Draeger Medical, Inc.
Narkomed Mobile
Anesthesia System
WARNING: For a full understanding of the performance characteristics of this anesthesia
machine, the user should carefully read this manual before operating.

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  • Page 1 Part Number: 4115139-001 Rev: F Date: 30 January 2004 © 2004 Draeger Medical, Inc. Narkomed Mobile Anesthesia System WARNING: For a full understanding of the performance characteristics of this anesthesia machine, the user should carefully read this manual before operating.
  • Page 2 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS...

  • Page 3: Table Of Contents

    Anesthesia Ventilator Operation ............5-12 Part Number: 4115139-001 Narkomed Mobile Operator’s Manual Rev: F...
  • Page 4 Breathing Pressure Monitoring Problem Resolution .........8-6 Appendix: Spare and Replacement Parts Rev: F Part Number: 4115139-001 Narkomed Mobile Operator’s Manual...
  • Page 5 Recommendations ............. 1-4 Purpose of This Manual ............. 1-4 Symbol Definition ............... 1-5 Warnings and Cautions ............. 1-5 Warnings ..............1-6 Moving the Unit ............1-6 Cautions ............... 1-8 Vaporizer Storage ............1-9 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 6: Operator's Responsibility For Patient Safety

    Draeger Medical, disclaims responsibility for the adequacy of the monitoring package selected for use with the anesthesia system. However, Draeger Medical is available for consultation to discuss monitoring options for different applications. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 7: Limitation Of Liability

    Datagrip, DrägerService, Narkomed, Narkomed GS, ORM, Quality Service For Life, Vigilance Audit, Vitalert, and Vitalink are registered trademarks of Draeger Medical, Inc. All other products or name brands are trademarks of their respective owners. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 8: Disclaimer

    For further information concerning these agreements, contact DrägerService at (800) 543-5047. Purpose of This Manual This manual provides operating instructions for the Narkomed Mobile Anesthesia System. It is intended for use by trained clinical professionals familiar with accepted medical procedures, practices, and terminology used in delivery of anesthesia and patient monitoring.

  • Page 9: Symbol Definition

    Warning statements provide important information that, if ignored, could lead directly to personal injury. • Caution statements provide important information that, if ignored, could lead directly to equipment damage and indirectly to personal injury. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 10: Warnings

    Contact DrägerService at (800) 543-5047 for further information. Moving the Prior to moving the Narkomed Mobile unit, the following functions must be Unit performed: 1. Disconnect the power cord from the mains and store properly.
  • Page 11 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS Figure 1-1. Narkomed Mobile Showing Handle Locations. ROTATE MONITOR HANDLE INTO PARKED POSITION (SIDE) HANDLE (REAR) ROTATE ABSORBER, ELEVATE SLIGHTLY, AND INSERT INTO BRACKET OPENING FOR PARKED POSITION...

  • Page 12: Cautions

    Do not insert any additional components into, or modify, the anesthesia system after any checkout procedure is started. Doing so can invalidate the checkout results and could affect the patient's safety. There is a possible explosion hazard if the Narkomed Mobile is used in the presence of flammable anesthetics. Cautions...

  • Page 13: Vaporizer Storage

    There are two additional foam cushions supplied with the machine and are located in the drawer. Figure 1-2. Vaporizer Storage Locations SU00045 ADDITIONAL FOAM PAD (IF NEEDED) VAPORIZER HOLDERS Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 14 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS...
  • Page 15 Adjustable Pressure Limiter (APL) Valve ....2-17 Respiratory Volume Monitor Sensor ......2-17 Oxygen Sensor ............2-18 Positive End-Expiratory Pressure (PEEP) Valve ..2-18 Scavenger System ............2-19 Anesthesia Ventilator ............2-20 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 16 Remote Display and Support Arm ......... 2-24 Monitoring System ............2-25 Monitor Screen and Controls ........... 2-25 Alarm System ..............2-26 Alarm Display ..............2-26 Alarm Annunciation ............2-27 Ventilation Alarms ............2-27 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 17: Overview

    RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS Overview The Narkomed Mobile is a compact, lightweight, continuous flow anesthesia system. All Narkomed Mobile machines are equipped with a monitoring system and pneumatic circuitry for delivering gases and anesthetic vapor for adult and pediatric patients.
  • Page 18 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS The Narkomed Mobile consists of these major systems: • gas delivery • vaporizer • absorber • scavenger • ventilator • power supply • system interface • monitoring/alarms.

  • Page 19: Gas Delivery System

    Each connection, valve, gauge, and flowmeter is labeled and color-coded for the appropriate gas, as shown in the table below. GAS SYSTEM COLOR CODING MARKING COLOR Yellow Nitrous Oxide Blue Oxygen Green Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 20 The gauges are located directly below their corresponding flowmeters and flow control valves. Pressure is indicated in psi and kPa. The pressure gauge and flowmeter arrangements are shown in Figure 2-4 on page 2-7. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 21 O cylinders and deplete their contents (if the cylinder valve is left in the open position). Caution: To ensure gas supplies are adequate, pipeline pressure gauges should show steady pressures of 50—55 psi. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 22 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS Cylinder Gas The Narkomed Mobile is equipped with a two cylinder hanger yoke Entry assembly. The standard combination is one O cylinder and one N cylinder. A factory installed option for the mounting of two O cylinders is available.

  • Page 23: Oxygen Supply Pressure Failure Protection Device

    The specific gas is labeled at bottom of the flowtube. Each flowmeter has a float indicator. To determine the flow rate, read the flowmeter scale at the center of the float. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 24: Minimum Oxygen Flow

    The oxygen dispensing system has a calibrated bypass flow of Oxygen Flow 150 ±50 mL/min (at 50 psi pipeline pressure) that delivers this flow of oxygen even if the oxygen flow control valve is fully closed. 2-10 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 25: Oxygen Flush

    Figure 2-6. Flush Button OP00097 O2 FLUSH FRESH GAS CONTROL OUTLET FRESH GAS LOCKING BAR RELEASE TO LOCK PULL TO INSERT OR REMOVE HOSE FRESH GAS HOSE Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 2-11...

  • Page 26: Oxygen Ratio Controller

    Flowmeter on the left side of the flowmeter bank (Figure 2-6 on page 2-11). This flowmeter can be used when the machine is turned off. 2-12 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 27 RETURN TO CD-ROM TABLE OF CONTENTS Figure 2-7. Fresh Gas Outlet OP00097 O2 FLUSH FRESH GAS CONTROL OUTLET FRESH GAS LOCKING BAR RELEASE TO LOCK PULL TO INSERT OR REMOVE HOSE FRESH GAS HOSE Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 2-13...

  • Page 28: Anesthetic Vaporizer

    RETURN TO CD-ROM TABLE OF CONTENTS Anesthetic Vaporizer The Narkomed Mobile is equipped with a Dräger-Vapor 19.3 vaporizer. This vaporizer enriches fresh gas with precisely metered vapor of liquid anesthetic agent. The vapor is inserted into the fresh gas line. It is connected between the fresh gas metering unit and the fresh gas outlet.

  • Page 29: Absorber System

    The absorber system handles spontaneous, manually assisted, or automatic ventilation. The preferred mode of operation is selected with the manual/ automatic selector valve. The “AUTO” position of the valve enables automatic ventilation. The “BAG” position enables Manual/Spontaneous ventilation. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 2-15...

  • Page 30: Inspiratory And Expiratory Valves

    A cap is tethered to the absorber for plugging into the inspiratory valve dome when the oxygen sensor and pressure sensor hose assembly are not in place. 2-16 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 31: Canister

    Valve absorbent. Respiratory The respiratory volume sensor is an ultrasonic flow sensor that monitors Volume tidal volume, respiratory minute volume, and respiratory frequency. Monitor Sensor Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 2-17...

  • Page 32: Oxygen Sensor

    (lower than –0.5 cmH O) and excessive positive pressure (higher than +10 cmH O) are not possible at the connection point. 2-18 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 33: Scavenger System

    A 19 mm hose connects to the fitting below the hose barb for passive exhaust systems. A relief valve guards against excessive pressure build-up if the exhaust hose is restricted. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 2-19...

  • Page 34: Anesthesia Ventilator

    32 psi. Electrical power is supplied by the AC power source, or, in event of AC power failure, by the backup battery. A fully charged battery can power the ventilator for at least 90 minutes. 2-20 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 35 (PEEP) within the breathing system. For the Narkomed Mobile, the PEEP is approximately 2 cmH The pressure limit control is used to set the peak inspiratory pressure produced by the ventilator to limit the maximum pressure to the patient.

  • Page 36: Power Supply System

    RETURN TO CD-ROM TABLE OF CONTENTS Power Supply System The Narkomed Mobile has a central power supply for the ventilator, alarm system, and monitoring system. When in use, the Narkomed Mobile must be plugged into an active AC outlet. Do not use “cheater” plugs. The term “cheater”...

  • Page 37: Backup Battery System

    The battery test button and indicator located near the system power switch Indicator and are used to determine the backup battery status (Figure 2-13 on page 2-22). Button A detailed testing procedure is included in the checkout procedures in this manual. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 2-23...

  • Page 38: System Interface Panel

    The display can be adjusted up or down to place it in the most convenient position. The support arm below the monitor screen supports an external patient monitor. 2-24 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 39: Monitoring System

    RETURN TO CD-ROM TABLE OF CONTENTS Monitoring System The monitoring system integrates the functions of the electronic monitors and organizes information from these monitors on the monitor screen. The Narkomed Mobile monitors: • oxygen concentration • breathing pressure • respiratory volume •...

  • Page 40: Alarm System

    INSP O2 LOW OXYGEN SUB ATM PRESSURE CAUTION: AC / BATTERY FAIL O2 SUPPLY LOW ADVISORY: SERVICE VENT MON PORT A ERROR TID VOL MIN VOL 0.35 PEAK MEAN PEEP OP87001 2-26 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 41: Alarm Annunciation

    When the ventilator is turned back on, the pressure apnea threshold is restored to its previous set value and the apnea alarms revert to activation after 15 seconds (Caution) and 30 seconds (Warning) of apnea. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 2-27...
  • Page 42 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS...
  • Page 43 Oxygen Monitoring ............3-4 Breathing Pressure Monitoring .......... 3-5 Respiratory Volume Monitoring ......... 3-5 Minute Volume ............. 3-5 Tidal Volume ..............3-5 Respiratory Rate ............3-5 Serial Interface ..............3-6 Serial Ports ..............3-6 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 44: General

    Charging time 12 hours Reserve power time (from full charge) ....90 min Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 45: Gas Delivery System

    ........1.0—8.0 L/min ±5% FS Oxygen (Auxiliary Oxygen) ....0—10 L/min ±5% FS Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 46: Ventilator

    ......≥ 8 months at 25 ° C, Sensor service life ≥ . . . 50% relative humidity, 50% O gas mixture (or 5000% hr CO Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 47: Breathing Pressure Monitoring

    ........whichever is greater Exclusive of hose compliance Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 48: Serial Interface

    Protocols ......... . Vitalink Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 49 APL Valve Verification ..........4-7 Breathing System Leak Test ........4-7 Scavenger System Verification ........4-8 Manual and Automatic Ventilation Systems ....4-9 Monitors ..............4-10 System Flush ............. 4-10 Final Position ............. 4-10 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 50 APL Valve ................. 4-12 Breathing System Leak Test ..........4-13 Scavenger System ............4-14 Manual and Automatic Ventilation Systems ..... 4-15 Monitor ................4-16 System Flush ..............4-16 Final Position ..............4-16 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 51: Daily Checkout Procedure

    RETURN TO CD-ROM TABLE OF CONTENTS Daily Checkout Procedure Before operating the Narkomed Mobile, the following checkout procedure must be performed to make sure the machine is ready for use. This is a recommended procedure. Follow your institution's policies for specific checkout procedures.

  • Page 52: High Pressure System Verification

    Check the flowmeters. Adjust the flow control knob for each gas and Circuit verify the proper operation of the corresponding flowmeters. The float Verification must move freely over the full range of each flowmeter. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 53: Low Pressure System Verification

    Make sure the handwheel is set to 0. Open the oxygen flow control Verification valve to an 8 L/min flow and close all other flow control valves. Sniff the gas coming from the fresh gas common outlet. There should be no noticeable odor. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 54: Absorber System Verification

    Wear a surgical mask to inhale and exhale through the breathing system (each limb individually, if possible). Verify the unidirectional flow in each limb and then reconnect the tubing. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 55: Apl Valve Verification

    Observe the pressure drop at the breathing system pressure gauge. When the pressure is at 50 cmH O, begin counting seconds. The pressure must not drop more than 20 cmH O in 30 seconds. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 56: Scavenger System Verification

    Turn the PEEP valve control knob fully counterclockwise to its lowest setting. Turn the scavenger needle valve fully counterclockwise. k. Push the O flush button to inflate the scavenger reservoir bag. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 57: Manual And Automatic Ventilation Systems

    Occlude the patient side of the Y-piece. Fill the ventilator bellows by pressing the oxygen flush button. Observe the breathing system pressure gauge as the ventilator cycles. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 58: Monitors

    BAG f. all flowmeters indicate 0 (or minimum) g. the breathing system is ready to use (the bag is in place and all hoses are connected properly). 4-10 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 59: Preuse Checkout Procedure

    Make sure the breathing pressure hose assembly is properly connected to the pressure sensor adapter and the system interface panel. g. Make sure the oxygen sensor and respiratory volume sensor are properly installed. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 4-11...

  • Page 60: Apl Valve

    Open the oxygen flow control valve to a flow of 8 L/min. g. Occlude the bag mount opening and watch for a pressure increase on the breathing system pressure gauge. This pressure increase must not exceed 3 cmH 4-12 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 61: Breathing System Leak Test

    Observe the pressure drop at the breathing system pressure gauge. When the pressure is at 50 cmH O, begin counting seconds. Thirty seconds or longer are needed for a pressure drop from 50—30 cmH Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 4-13...

  • Page 62: Scavenger System

    Turn the PEEP valve control knob fully counterclockwise to its lowest setting. Turn the scavenger needle valve fully counterclockwise. k. Push the O flush button to inflate the scavenger reservoir bag. 4-14 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 63: Manual And Automatic Ventilation Systems

    Occlude the patient side of the Y-piece. Fill the ventilator bellows by pressing the oxygen flush button. Observe the breathing system pressure gauge as the ventilator cycles. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 4-15...

  • Page 64: Monitor

    0 (or minimum) f. the patient suction level is adequate g. the breathing system is ready to use (bag is in place and all hoses connected are properly). 4-16 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 65 Using the Manual/ Automatic Selector Valve ....5-8 Using the APL Valve ............ 5-9 Using the PEEP Valve ..........5-10 Scavenger Interface Operation ........5-11 Needle Valve Adjustment for Suction Systems ..5-12 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 66 Setting the Respiratory Frequency ........5-15 Setting the Inspiratory/Expiratory (I:E) Phase Time Ratio 5-15 Setting the Inspiratory Flow Rate ........5-15 Setting the Inspiratory Pressure Limit ......5-15 Selecting the Bellows Drive Gas ........5-16 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 67: Gas Delivery System Operation

    RETURN TO CD-ROM TABLE OF CONTENTS Gas Delivery System Operation The Narkomed Mobile is a continuous flow anesthesia system with pneumatic circuitry for mixing and delivering fresh gas and anesthetic agent vapor. The pneumatic system can deliver up to three gases (oxygen, nitrous oxide, and air) and one anesthetic agent simultaneously.

  • Page 68: Anesthetic Vaporizer Operation

    Using the To use the oxygen flush, press the oxygen flush button, located on the front Oxygen of the Narkomed Mobile. This introduces an unmetered flow of pure oxygen Flush into the breathing circuit at a rate of about 55 L/min.
  • Page 69 Note: Drain the anesthetic agent if the vaporizer will not be used for longer than six months or if the vaporizer will be removed from the anesthesia machine. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 70: Filling The Vaporizer During A Case

    Warning: Because the vaporizer funnel filling system does not limit the type of agent poured into the vaporizer, using an agent monitoring device is recommended to verify the agent. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 71: Absorber System Operation

    • fresh gas hose • manual/automatic ventilation selector valve • an adjustable pressure limiter (APL) valve • respiratory volume sensor • oxygen concentration sensor • a positive end-expiratory pressure (PEEP) valve. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 72: Using The Manual/Automatic Selector Valve

    Warning: Do not use the anesthesia machine if: • The pins in the I E valves or valve body(ies) are bent, damaged, or missing, • The valve disks are missing or damaged. • The valve seat is damaged. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 73: Using The Apl Valve

    Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 74 PEEP. The actual PEEP in the system is indicated on the absorber pressure gauge at the end of exhalation and can be adjusted from about 2—15 cmH 5-10 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 75: Scavenger Interface Operation

    (if necessary) at six month intervals. Warning: Waste gases vented through the positive pressure relief valve enter the operating room. Properly adjusting the needle valve keeps such venting to a minimum. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 5-11...

  • Page 76: Anesthesia Ventilator Operation

    The anesthesia ventilator is a volume preset, time cycled, pressure limited ventilator with electronic timing, pneumatic circuitry and independent controls for frequency, inspiratory to expiratory (I:E) ratio, inspiratory flow rate, tidal volume, and inspiratory pressure limit. 5-12 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 77 The ventilator will not function if this pressure drops below 32 psi. Electrical power is supplied by the Narkomed Mobile's AC power source, or, in event of AC power failure, by the backup battery. A fully charged battery can power the ventilator for at least 90 minutes.

  • Page 78: Activating The Ventilator

    The position of the tidal volume indicator can be calibrated for a specific combination of fresh gas flow and equipment compliance by an authorized representative of DrägerService. 5-14 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 79: Setting The Respiratory Frequency

    15 cmH O. When the control is turned fully clockwise, the peak inspiratory pressure is less than or equal to 120 cmH Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 5-15...

  • Page 80: Selecting The Bellows Drive Gas

    To select air as the drive gas, move the switch to the AIR position. Figure 5-7. Drive Gas Selector Switch DRIVE GAS SELECTOR SWITCH OP00078 VENTILATOR DRIVE GAS FLOWMETER HOUSING 5-16 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 81 Oxygen Monitoring ............6-12 Oxygen Monitoring Display ........6-12 Oxygen Monitor Controls ........... 6-13 Setting Alarm Limits ........... 6-13 Calibrating the Oxygen Sensor ........6-14 Unsucessful Calibration ..........6-15 Oxygen Alarm Messages .......... 6-17 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 82 Manually Setting the Threshold Limit ....... 6-28 Automatically Setting the Threshold Limit ......6-28 Turning the Apnea Pressure Alarm Off ......6-30 Turning the Apnea Pressure Alarm On ......6-30 Breathing Pressure Alarm Messages ......6-31 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 83: Overview

    Power-On Screen When you turn the SYSTEM POWER switch ON, the Narkomed Mobile performs extensive self-tests on its internal hardware. As these diagnostics are performed, each test and its result appear on the screen. The result, PASS or FAIL, indicates the status of the tested component.

  • Page 84: Monitor Screen And Controls

    AC / BATTERY FAIL O2 SUPPLY LOW ADVISORY: SERVICE VENT MON PORT A ERROR TID VOL MIN VOL 0.35 RESPIRATORY VOLUME PEAK MONITOR WINDOW MEAN PEEP BREATHING PRESSURE BREATHING PRESSURE TRACE WINDOW MONITOR WINDOW Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 85 (PEEP). • Breathing Pressure Trace Window—Displays a trace, or waveform, of the patient's breathing pressure, and the anesthesia machine's breathing pressure alarm limits (to the left of the waveform). Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 86: Left Keypad

    You also enter the Alarm Log by way of the Configure screen. These functions are described in detail later in this section. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 87: Right Keypad

    Breathing Pressure High Limit Auto OP87008 Configuring You can configure the following parameters on the Narkomed Mobile: • Trace Speed—Speed of the breathing pressure waveform trace: Anesthesia either FAST or SLOW Machine • Alarm Volume—Volume of annunciated alarms • Current Time—The current hour and minute in 24-hour format ( hour:minute ) •...

  • Page 88: Displaying The Configure Screen

    SELECT Selects a parameter by highlighting it with a box EXIT Exits the Configure screen and returns to the Monitor screen Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 89: Changing Parameter Values

    Screen passes and no keys are pressed. When you exit the Configure screen, the values displayed on the screen are saved. The monitoring system uses these values until they are changed. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 90: Using The Alarm Log

    MINUTE VOLUME LO EXIT Clearing the Alarm Log To delete all of the messages from the Alarm Log, press the CLEAR LOG key. The messages are permanently deleted from the LOG. 6-10 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 91: Exiting The Alarm Log

    Note: All continuous audible alarms are automatically silenced for 2 minutes following power-up. During this period, the occurrence of a new alarm produces a non-repeating tone pattern appropriate for that alarm's level of urgency. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-11...

  • Page 92: Oxygen Monitoring

    AC / BATTERY FAIL O2 SUPPLY LOW HIGH OXYGEN ADVISORY: SERVICE VENT MON PORT A ERROR CONCENTRATION TID VOL MIN VOL ALARM LIMIT 0.35 LOW OXYGEN PEAK CONCENTRATION ALARM LIMIT MEAN PEEP 6-12 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 93: Oxygen Monitor Controls

    3. To save the new value, stop pressing arrow keys until the highlighting box disappears (5 seconds), or press a different alarm Limit key. The new value is saved as the alarm limit. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-13...

  • Page 94: Calibrating The Oxygen Sensor

    Exposure Time 10 seconds > 21% up to 50 seconds 5. When the Narkomed Mobile successfully completes the calibration, pull the inspiratory valve dome plug and reinsert the sensor assembly. 6-14 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 95: Unsucessful Calibration

    Alarm window. If this happens, reconnect the sensor cord to the OXYGEN SENSOR interface beneath the rear panel of the ventilator box and try to calibrate the oxygen sensor again. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-15...
  • Page 96 If the oxygen sensor is improperly calibrated, it can cause inaccurate measurements. When a calibration gas mixture is excessively rich or lean in oxygen, the Narkomed Mobile will not complete an attempted calibration; however, if the calibration gas is rich or lean but is within certain limits, the Narkomed Mobile will complete the calibration.

  • Page 97: Oxygen Alarm Messages

    (Advisory) • the oxygen sensor enters a noncalibrated state • the Narkomed Mobile is unable to calibrate the oxygen sensor • more than 18 hours have elapsed since the last calibration Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 98: Respiratory Volume Monitoring

    RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS SERVICE If the Narkomed Mobile detects an internal electronic failure that would VENT MON prevent proper operation, the Advisory message SERVICE VENT MON (Advisory) appears in the Alarm window. If this happens, contact an authorized representative of DrägerService.

  • Page 99: Respiratory Volume Display

    A blank MIN VOL display area indicates that a full one-minute history of exhaled volume is not available. • Minute Volume Alarm Limit—Indicates the volume below which an alarm condition occurs. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-19...

  • Page 100: Respiratory Volume Monitor Controls

    While the ventilator is off, these alarms are generated at 30 seconds (Caution) and 60 seconds (Warning). The Narkomed Mobile's volume alarms are automatically enabled when the ventilator power switch is turned to the ON position. A disconnected or damaged sensor causes a sensor failure alarm.

  • Page 101: Turning Respiratory Volume Alarms Off

    Alarm Messages APNEA- The Narkomed Mobile continuously monitors the expiratory flow in the VOLUME patient breathing system. By processing the expiratory flow pattern, the (Warning/ monitor can determine whether a “valid” breath has occurred. A “valid”...
  • Page 102 Note: You can disable volume-related alarms by pressing the Breathing Volume Off key. MINUTE Whenever the Narkomed Mobile measures a minute volume less than the VOLUME low minute volume alarm limit, the Caution message MINUTE VOLUME LOW appears in the Alarm window, and an intermittent audible alarm (Caution) sounds.

  • Page 103: Breathing Pressure Monitoring

    To the left of the waveform, in small type, are the pressure high and threshold pressure alarm limits. • Breathing Pressure Monitor Window—This small window on the right contains numerical breathing pressure measurements. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-23...

  • Page 104: Breathing Pressure Monitor Window

    0—20, 0—50, or 0—100 cmH O. If the scale changes, the positions of the waveform and alarm limits also change relative to the new scale. The window below has a scale of 0—20 cmH 6-24 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 105 The following examples illustrate the difference in appearance. (Note that a threshold pressure alarm limit marker is also displayed in these examples.) Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-25...

  • Page 106: Breathing Pressure Monitor Controls

    Limit PRESSURE PRESSURE (cm H O) Breathing Pressure ALARM HIGH ALARM High OFF KEY LIMIT KEY Limit ARROW Auto KEYS THRESHOLD PRESSURE ALARM LIMIT KEY THRESHOLD PRESSURE AUTO SET KEY 6-26 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 107: Setting The Pressure High Alarm Limit

    Warning: The threshold pressure alarm limit should be as close as possible to the sensed peak pressure without exceeding it. For details, see “Threshold Limit Guidelines” and “Sample Threshold Limit Settings” in this section. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-27...

  • Page 108: Manually Setting The Threshold Limit

    If the alarm limit is on or below the upper limit of the scale, a marker appears next to the alarm limit, and a dotted line extends from the alarm limit horizontally across the scale. 6-28 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 109 Sample Figure 6-18 illustrates the effects of correct and incorrect settings of the Threshold threshold pressure alarm limit. Limit Settings Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-29...

  • Page 110: Turning The Apnea Pressure Alarm Off

    Turning the To turn on the apnea pressure alarm, press the Breathing Pressure On key. Apnea Pressure Alarm On 6-30 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 111: Breathing Pressure Alarm Messages

    This alarm condition is cleared when the sensed pressure rises above –10 cmH O. However, the alarm message is extended for 5 seconds to allow the recognition of a momentary subatmospheric pressure condition. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 6-31...
  • Page 112 Standby, the Advisory message APNEA-PALM STBY (Advisory) appears in the Alarm window. SERVICE If the Narkomed Mobile detects an internal electronic failure that would VENT MON prevent proper operation, the Advisory message SERVICE VENT MON (Advisory) appears in the Alarm window.
  • Page 113 Disassembling Parts for Cleaning and Disinfection ..7-14 Disassembling the Oxygen Sensor Ass’ly ....7-14 Disassembling the Ventilator Bellows Ass’ly ....7-14 Disassembling the Flow Housing/Transducer Ass’ly ... 7-14 Disassembling the Inspiratory and Expiratory Valves . 7-15 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 114 Cleaning and Disinfecting the Absorber Assembly ........7-22 Cleaning and Disinfecting the Vaporizer Exterior .......... 7-22 Cleaning and Disinfecting the Scavenger Interface ........7-23 Cleaning and Disinfecting the Scavenger Hoses and Bag ......7-23 Reassembly Instructions ................7-24 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 115: Overview

    Warning: Absorbent is caustic and is a strong irritant to the eyes, skin, and respiratory tract. When replacing the absorbent, take care not to spill its caustic contents. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 116 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS Figure 7-1. Disassembled Canister Assembly TOP ABSORBER GASKET CANISTER CANISTER GASKET DUST CUP O-RING DUST CUP OP00094 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 117: Replacing The Oxygen Sensor Capsule

    If you do not wait, calibration (the next step) will not be successful. 6. Restore power to the machine and calibrate the oxygen sensor. This procedure is provided in “Using the Monitoring System.” Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 118: Clearing Condensation From The Flow Sensor

    3. Lift the flow sensor off the bracket. 4. Press down on the lever under the flow housing and remove the flow housing/transducer assembly from the electronics housing. 5. Pull both transducers out of the flow housing. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 119 12. Connect the patient hose to the expiratory hose terminal on the flow sensor. 13. Install the connector hose assembly between the flow sensor and the expiratory valve, and secure it by turning the ring nut clockwise. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 120: Scavenger Interface Maintenance

    Note: If your facility requires a disinfection process for the scavenger interface and hoses, remove the scavenger and all 19 mm hoses. Refer back to the cleaning instructions under “Scavenger Maintenance” for disassembly instructions. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 121: Removing Parts For Cleaning And Disinfection

    RELIEF VALVE BODY WINGNUT (2X) 5. Disconnect the oxygen sensor connector from the system interface panel. 6. Separate the oxygen sensor housing from the breathing pressure sensor adapter. (It is a press fit.) Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 122 7. Disconnect the breathing pressure sensor quick-connect fitting from the system interface panel. 8. Disconnect the quick-connect fitting from the pressure gauge. 9. Separate the pressure sensor adapter from the inspiratory valve dome. (It is a press fit.) 7-10 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 123 10. Turn the nut that connects the pressure gauge to the gauge mount to the absorber assembly counterclockwise. 11. Lift the pressure gauge assembly off the gauge mount. Be sure to keep the o-ring with the pressure gauge assembly. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-11...
  • Page 124 Take care not to lose the gasket that fits between the expiratory valve and the PEEP valve. 16. Remove the PEEP valve by turning the retaining ring counterclockwise. Take care not to lose the gasket. 7-12 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 125 18. Disconnect the fresh gas hose from the fresh gas outlet. 19. Loosen the wing screw to release the absorber from the absorber pole. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-13...

  • Page 126: Disassembling Parts For Cleaning And Disinfection

    1. Press down on the lever under the flow housing and pull the flow bling the housing/transducer assembly out of the electronics housing. Flow 2. Pull both transducers out of the flow housing. Housing/ Transducer Ass’ly 7-14 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 127: Disassembling The Inspiratory And Expiratory Valves

    (PART OF BREATHING PRESSURE HOSE ASSEMBLY) RING NUT INSPIRATORY VALVE DOME EXPIRATORY VALVE DOME DOME GASKET EXPIRATORY VALVE BODY INSPIRATORY VALVE MOUNT VALVE BODY GASKET PEEP VALVE INSPIRATORY VALVE MOUNT OP00081 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-15...

  • Page 128: General Guidelines For Cleaning And Disinfection

    RETURN TO CD-ROM TABLE OF CONTENTS General Guidelines for Cleaning and Disinfection The frequency, level, and need for disinfection of the Narkomed Mobile is determined by the user facility based on the conditions of use and hospital infection control policy. Draeger Medical recommends using disposable patient breathing circuits that can be replaced after single use.
  • Page 129 D Wet pasteurization at 70° C for 30 minutes after detergent cleaning E Sodium hypochlorite (5.2% household bleach) 1:500 dilution (100 ppm free chlorine) F Ethyl or isopropyl alcohol (70% to 90%) Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-17...

  • Page 130: Cleaning\Disinfecting Exterior Surfaces

    • Wipe any spills and cleanser off the equipment surfaces immediately. Cleaning\Disi Clean painted, plated, and plastic surfaces of the Narkomed Mobile with a nfecting soft lint-free cloth moistened with mild detergent and water. Follow up with Exterior...

  • Page 131: Cleaning And Disinfecting The Y-Piece And Mask

    Allow the assembly to drip dry. Ventilator After cleaning, use an EtO process for disinfection. Follow manufacturer's Bellows Bottom guidelines. Assembly Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-19...

  • Page 132: Cleaning And Disinfecting The Oxygen Sensor Capsule

    After cleaning or disinfecting the inspiratory or expiratory valve assembly, verify that the valve disk and all internal pins are undamaged and that the valve disks are correctly reinstalled. 7-20 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 133: Cleaning And Disinfecting The Peep Valve

    Dust Cup residues for the canister and gasket surfaces. Check the dust cup periodically. Empty and clean it when necessary. Warning: Absorbent is caustic. Avoid contact with the skin and eyes. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-21...

  • Page 134: Cleaning And Disinfecting The Absorber Assembly

    1. Drain the discolored halothane from the vaporizer. 2. Fill the vaporizer with fresh halothane up to the maximum level, then drain completely. 3. Dispose of the drained halothane in accordance with standard practices at your facility. 7-22 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 135 Elbow, and Bag” to select a compatible process. Scavenger Check the hoses frequently for signs of deterioration, including swelling Hoses and tackiness, or cracking. Replace the affected parts when any of these conditions are evident. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-23...

  • Page 136: Reassembly Instructions

    Ensure that the three o-rings on each transducer are not damaged and are properly seated. Slide the flow housing/transducer assembly into the electronics housing. Be sure that it clicks into place. 7-24 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 137 27. Turn the nut that connects the pressure gauge to the gauge mount clockwise. 28. Check the gauge needle’s zero position and adjust it if necessary. 29. Replace the 22 mm hoses and other breathing circuit accessories as illustrated. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-25...
  • Page 138 Figure 7-12. Replacing 22 mm Hoses and Other Breathing Circuit Accessories (1 of 2) OP00233a VENTILATOR Y-PIECE 22MM MASK CORRUGATED ELBOW HOSE 32 IN. LONG INSPIRATORY VALVE 22MM CORRUGATED HOSE 22 IN. LONG 7-26 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 139 APL valve and ventilator relief valve to the scavenger as illustrated on the following pages. 31. Turn the System Switch on. 32. Perform the Daily Checkout procedure provided in this manual before operating the machine. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-27...
  • Page 140 Figure 7-14. Replacing the 19 mm Hoses (1 of 2) VENTILATOR RELIEF VALVE 20 IN. 19 MM SCAVENGER HOSE (MAGENTA COUPLING) SCAVENGER APL VALVE MAGENTA BAND EXHAUST SYSTEM 30 IN. 19MM SCAVENGER HOSE (MAGENTA COUPLING) OP00100 7-28 Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 141 RELIEF VALVE 20 IN. 19 MM SCAVENGER HOSE (MAGENTA COUPLING) SCAVENGER OP00082 APL VALVE MAGENTA BAND HOSPITAL SUCTION LINE 3-LITER RESERVOIR BAG (MAGENTA COUPLING) 30 IN. 19MM SCAVENGER HOSE (MAGENTA COUPLING) Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual 7-29...
  • Page 142 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS...
  • Page 143 Absorber System Problem Resolution ....... 8-2 Ventilator Problem Resolution ........... 8-4 Oxygen Monitoring Problem Resolution ......8-5 Respiratory Volume Monitoring Problem Resolution ..8-6 Breathing Pressure Monitoring Problem Resolution ..8-6 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 144: Absorber System Problem Resolution

    APL valve resistance is set too Adjust APL valve high. counterclockwise. Automatic ventilation Switch to manual ventilation. malfunction. Ventilator relief valve Contact an authorized adjustment set incorrectly. representative of DrägerService to adjust ventilator relief valve. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 145 Replace gauge. Absorbent is purple. Ethyl violet indicator shows Replace with fresh absorbent. absorbent is exhausted. Other indicators exhibit different color changes. High CO levels. Depleted absorbent. Replace with fresh absorbent. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 146: Ventilator Problem Resolution

    Absorber manual/ automatic Place selector valve in AUTO inspiration selector valve in BAG position position. Inspiratory flow control setting Increase inspiratory flow control on ventilator too low setting. Frequency too high Decrease frequency. Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...

  • Page 147: Oxygen Monitoring Problem Resolution

    Defective sensor housing and Replace housing/cable appears in Alarm window during cable assembly. monitoring Sensor cord is disconnected Insert sensor cord connector into Oxygen Sensor receptacle in the system interface panel. Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...

  • Page 148: Respiratory Volume Monitoring Problem Resolution

    Hose is blocked or kinked Make sure that assembly is free of obstructions. Condensation accumulation in Drain and reconnect breathing the hose pressure hose assembly. Erratic readings PEEP valve setting Adjust PEEP valve Narkomed Mobile Operator’s Manual Part Number: 4115139-001 Rev: F...
  • Page 149 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS Spare and Replacement Parts Replacement Parts and Spares Description Part Number Documentation Narkomed Mobile Operator's Instruction Manual....4115139 Absorbent gerSorb (10-liter canister) ..........6750801 ä Absorber System Gasket - Canister Top ...............4105848 Screen - Canister...............1100022 Canister (includes bottom gasket) ...........4105851...
  • Page 150 O-Ring Set ..........4115147 Narkomed Mobile Operator’s Manual...
  • Page 151 Cable Translator Adapter ....... . 4114359 Part Number: 4115139-001 Rev: F Narkomed Mobile Operator’s Manual...
  • Page 152 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS...
  • Page 153 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS...
  • Page 154 RETURN TO THIS MANUAL'S TABLE OF CONTENTS RETURN TO CD-ROM TABLE OF CONTENTS Draeger Medical, Inc. 3135 Quarry Road Telford, PA 18969 Tel: (215) 721-5404 (800) 462-7566 Fax: (215) 721-9561 Web: www.draegermedical.com Printed in the U.S.A.

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