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Heyer iTernIS ADV Operator's Manual

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Operator's Manual
Rev. 1.0 – 07/2011
INNOVATIONS AS A SERVICE TO THE PATIENT

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Summary of Contents for Heyer iTernIS ADV

  • Page 1 Operator’s Manual Rev. 1.0 – 07/2011 INNOVATIONS AS A SERVICE TO THE PATIENT...
  • Page 3 User’s Instruction Manual Rev. 1.0 – 07.2011...
  • Page 4 HEYER Medical AG Carl-Heyer-Str. 1/3 D-56130 Bad Ems - Germany Tel.: +49 2603 791-3 Fax: +49 2603 70424 eMail: info@heyermedical.de...

  • Page 5: Table Of Contents

    6.1 Overall User Interface Management ..........6.2 Selecting the Operative Mode ............6.3 Configuring the Operative Mode ............6.4 Standby ....................6.5 Additional Functions ................6.6 Ventilation Parameters ..............6.10 7. Menu ......................7.1 General Information ................User Instruction Manual | iTernIS ADV...
  • Page 6 11.6 Inop. Vent. Alarm (Inoperative Ventilator) ........11.8 11.7 High Priority Alarms ................11.9 11.8 Medium Priority Alarms ..............11.10 11.9 Low Priority Alarms .................11.11 12. Respiratory Mechanics ................ 12.1 12.1 auto-PEEP ..................12.3 User Instruction Manual | iTernIS ADV...
  • Page 7 17.12 Basic Operation of the Ventilator ..........17.10 17.13 Safety Mechanisms ..............17.11 17.14 Diagram of the Pneumatic Circuit of the Ventilator ....... 17.13 17.15 Lifetime ..................17.14 Appendices ......................A.i Warranty ......................G.i Alphabetical Index .................... I.i User Instruction Manual | iTernIS ADV...
  • Page 8 Table 17-8 Monitored Parameters ..............17.6 Table 17-9 Alarm Adjustment ................17.6 Table 17-10 Data Collection for Control and Monitoring ........17.7 Table 17-11 Electromagnetic Emissions Statement ........17.8 Table 17-12 Electromagnetic Immunity Statement ..........17.8 Table 17-13 Electromagnetic Immunity Statement .........17.9 User Instruction Manual | iTernIS ADV...
  • Page 9 Table 17-14 Recommended Separation Distances between the Ventilator and Mobile/Portable Communications Equipment .......17.10 Table 17-15 Ventilation Parameters in Emergency Ventilation .....17.12 Table 17-16 Lifetime ..................17.14 User Instruction Manual | iTernIS ADV...
  • Page 10 This Page Left Intentionally Blank User Instruction Manual | iTernIS ADV...

  • Page 11: Introduction

    Abbreviations, acronyms and variable names CHAPTER SUMMARY This introductory chapter details the concepts defining iTernIS ADV. These defini- tions provide information about the equipment, and its appropriate use. The infor- mation included in this chapter is to be used as mandatory guidelines for the design and development of iTernIS ADV.
  • Page 12 This Page Left Intentionally Blank 1. 2 Introduction | iTernIS ADV...

  • Page 13: Observed Requirements And Standards

    1.3 | Intended Use The iTernIS ADV ventilator was designed to be used with all types of patients: adult, pediatric, and neonatal infants requiring invasive and noninvasive ventilatory support, for a short or long period, allowing monitoring of the main ventilatory pa- rameters.

  • Page 14: User Support

    Keep upwards. Keep dry. Temperature limits. Fragile. Do not stack more than 5 boxes. Moisture limit. Manufacturer. Not reusable. Marking indicating compliance with the re- quirements of European Council Directive (93/42/EEC) on medical devices. 1. 4 Introduction | iTernIS ADV...
  • Page 15 Connection for the expiration set. Inhaled gas delivery port (to patient). Connection port for the nebulizer. Connection ports for the distal pneumota- chograph hoses. Connection port for the proximal pneumo- Prox tachograph. Connection port for the O cell. Introduction | iTernIS ADV 1. 5...

  • Page 16: Abbreviations, Acronyms And Variable Names

    Screen lock. Proximal pneumotachograph activated. On-screen display for maintenance requi- red. 1.9 | Abbreviations, Concentration of O Acronyms and Variable Names Adult APRV Airway pressure release ventilation Cdin Dynamic compliance Cest Static compliance 1. 6 Introduction | iTernIS ADV...
  • Page 17 Pressure during the first 100 ms Lower hose inlet of expiratory pneu- motachograph Upper hose inlet of expiratory pneu- motachograph Airway pressure Pressure controlled ventilation Pediatric PEEP Positive end expiratory pressure Pimax Maximum inspiratory pressure Introduction | iTernIS ADV 1. 7...
  • Page 18 Volume control ventilation Expired minute volume Spontaneous expiratory minute volu- VE Espont VE Mandat Mandatory expired minute volume Minute volume Vmax Maximum volume Noninvasive ventilation VT or V Tidal volume WOBi Imposed work of breathing 1. 8 Introduction | iTernIS ADV...

  • Page 19: Warnings - Precautions - Notes

    This chapter defines the meaning of the terms warning, caution, and note in the context of this manual, and summarizes some of the most important definitions of each of them. Warnings - Precautions - Notes | iTernIS ADV 2. 1...
  • Page 20 This Page Left Intentionally Blank 2. 2 Warnings - Precautions - Notes | iTernIS ADV...

  • Page 21: Definition Of Terms

    • Operation with internal battery has a limited time. In the event of a dead battery, immediately replace the main power or switch to an alternative method of ventilation. • To avoid risk of electric shock, this equipment must be con- nected to an earthed power source. Neither remove the third pin (earth) of the plug power cord, nor use a two-pin adapter. Keep a distance of NOT less than 3 meters (9.84 feet). Warnings - Precautions - Notes | iTernIS ADV 2. 3...

  • Page 22: Cautions

    8 (eight) hours. If these signals persist, they may indicate the need for a battery replacement. In this case, contact the authorized service. 2. 4 Warnings - Precautions - Notes | iTernIS ADV...

  • Page 23: Notes

    5000 hours, a tool icon appears at the Icons and mes- sages bar. The presence of the icon is deleted by the authorized service after the maintenance protocol is performed. Warnings - Precautions - Notes | iTernIS ADV 2. 5...
  • Page 24 This Page Left Intentionally Blank 2. 6 Warnings - Precautions - Notes | iTernIS ADV...

  • Page 25: Assembly And Installation

    Patient Circuit Sensor CHAPTER SUMMARY This chapter contains the information needed to assemble the ventilator, mount it on the pedestal, connect it to power sources, and prepare it to be put into use. Assembly and installation | iTernIS ADV 3. 1...
  • Page 26 This Page Left Intentionally Blank 3. 2 Assembly and installation | iTernIS ADV...
  • Page 27 Fig. 3-1 Diagram of the ventilator assembly with patient circuit The Y-shaped part has been redrawn to show the optional capnograph connection. The proximal pneumota- chograph may be placed in the same position. Assembly and installation | iTernIS ADV 3. 3...

  • Page 28: Assembly Of The Pedestal

    • Attach the articulated extension arm with hose support, twisting it onto one of the ends of the lateral bars. Fig. 3-3 Rear view of the vertical column while attaching the lateral bars (A). The J- shaped cross section (B) is placed over the lateral bars. 3. 4 Assembly and installation | iTernIS ADV...

  • Page 29: Attachment Of Ventilator To The Pedestal

    • Do not use any device that restricts flow or pressure between the source outlet and the su- pply hoses that feed the ventilator. Therefore, DO NOT USE pressure regulators with shutoff valves or flow meters. • Only use gases (air and O ) that comply with the medical grade requirements of the applica- ble standards. PRECAUTION • The supply pressure for both gases should be in the range of 3.5 to 7.0 bar (approximately 50-100 psi). Assembly and installation | iTernIS ADV 3. 5...

  • Page 30: Connection To The Power Source

    • The responsibility for correctly supplying air and oxygen rests solely with the user, not HEYER • The gas supply source should be capable of pro- viding peak flows of up to 180 L/min and never less than 120 L/min for compressors.

  • Page 31: Patient Circuit

    Each category of patient uses a different sized patient circuit. The tube diameters are: 22 mm for ADL, 15 mm for PED, and 10 mm for NEO-INF. Consequently, the Assembly and installation | iTernIS ADV 3. 7...
  • Page 32 • The patient circuit may have water traps in the middle portion of the inspiratory and/or expira- tory segments. Ensure the airtightness of these devices. Any leak may cause a loss of volume in the circuit. 3. 8 Assembly and installation | iTernIS ADV...
  • Page 33 • Introduce the set into the corresponding connection opening at the lower block of connections, such that the connectors for the hoses that run toward P1 and P2 face to the front. Assembly and installation | iTernIS ADV 3. 9...
  • Page 34 Fig. 3-8 Drawings of the expiratory set Left, front view of the set. Right, same view, but of a cross-section of the front of the set. (A) position of the diaphragm, and (B) position of the internal membrane. 3. 10 Assembly and installation | iTernIS ADV...
  • Page 35 • When a proximal pneumotachograph is used, ve- rify its connections before ventilating the patient. If any of the hoses is incorrectly connected, serious leakage of respiratory gases may result. Assembly and installation | iTernIS ADV 3. 11...

  • Page 36: O Sensor

    (C) the sensor itself. NOTE • When the O sensor is used for the first time, it should be exposed to ambient air for at least 20 minutes before being connected to the ventila- tor. 3. 12 Assembly and installation | iTernIS ADV...

  • Page 37: Front Panel

    This is a descriptive chapter which individualizes the ventilator parts and highlights, in detail, each of their functions. The equipment is divided into three sections, grou- ping the descriptions of related attributes. General description - Sections of the ventilator | iTernIS ADV 4. 1...
  • Page 38 This Page Left Intentionally Blank 4. 2 General description - Sections of the ventilator | iTernIS ADV...
  • Page 39 4.1 | Overview The iTernIS ADV ventilator integrates user interface, connections to the patient circuit, and connections to power sources (electric and pneumatic) into its cabinet. The user interface has a touch screen, fixed keys and a rotary knob which allows for the management of all functions.
  • Page 40 Below some of the monitored parameters lie touch buttons. These buttons allow for direct access to the configuration of the corresponding alarm. These buttons display the limit value of such alarms at all times (see chapter Alarms.) 4. 4 General description - Sections of the ventilator | iTernIS ADV...
  • Page 41 Updating this value is done on a continuous basis. • Oxygen - Oxygen Monitor (%) It indicates the percentage of oxygen in the gas sent to the patient. General description - Sections of the ventilator | iTernIS ADV 4. 5...
  • Page 42 Fig. 4-4 The right-hand toolbar, which identifies touch com- mands for certain functions, and the left-hand toolbar which, among other things, indicates the numeric monitoring of pres- sure, are highlighted. 4. 6 General description - Sections of the ventilator | iTernIS ADV...
  • Page 43 Between the Monitored data and the graphics area there is a space dedicated to 4.2.1.5 | Icons and messages Icons and messages and Onscreen notices of the alarm system. bar and Onscreen alarm notices. General description - Sections of the ventilator | iTernIS ADV 4. 7...
  • Page 44 Maximum inspiratory pressure is found to be active. 4.2.2 | Alarm signals It corresponds to the visual light signals forming part of the alarm system. 4. 8 General description - Sections of the ventilator | iTernIS ADV...
  • Page 45 Fixed key used to block the functions of the touch screen as well as the fixed keys of the right-hand area of the front panel. More informa- tion on using this key can be found in chapter Basic Operations. General description - Sections of the ventilator | iTernIS ADV 4. 9...
  • Page 46 Some specific tasks can also be carried out by using the knob. For example, chan- ges in scale, or the scrolling of the cursor over the graphics. 4. 10 General description - Sections of the ventilator | iTernIS ADV...
  • Page 47 This section only lists the items which form part of the block. Fig. 4-9 Picture of the lower area of the ventilator. References of the Fig. 4-9 Connection for the expiratory set. Connections for pneumotachograph hoses of the expiratory valve. cell. General description - Sections of the ventilator | iTernIS ADV 4. 11...
  • Page 48 On the upper part of the ventilator cabinet, there is the upper light indicator which 4.5 | Upper Panel functions as a visual alarm signal, see Fig. 4-1. A detailed description of this indica- tor can be found in the chapter Alarms. 4. 12 General description - Sections of the ventilator | iTernIS ADV...

  • Page 49: Start-Up And Initial Calibration

    This document contains the information needed for the confi- guration and initial calibration that must be carried out each time the ventilator is turned on. Start-up and initial calibration | iTernIS ADV 5. 1...
  • Page 50 This Page Left Intentionally Blank 5. 2 Start-up and initial calibration | iTernIS ADV...

  • Page 51: Start-Up

    (mL) to be delivered for each kg of set IBW. In the same window it is possible to view the VT resulting from the Start-up and initial calibration | iTernIS ADV 5. 3...
  • Page 52 231-309 309-386 147.3 40.9 164-245 245-327 327-409 149.9 43.2 173-259 259-346 346-432 152.4 45.5 182-273 273-364 364-455 154.9 47.8 191-287 287-382 382-478 157.5 50.1 200-301 301-401 401-501 52.4 210-315 315-419 419-524 5. 4 Start-up and initial calibration | iTernIS ADV...
  • Page 53 84.7 339-508 508-677 677-847 87.0 348-522 522-696 696-870 195.6 89.3 357-536 536-714 714-893 198.1 91.6 366-550 550-733 733-916 Formula for IBW calculation from: ARDS Network. NEJM. May 2000, 342 (18): 1301-08. Start-up and initial calibration | iTernIS ADV 5. 5...
  • Page 54 A plug may be used to cover it as recommended on the screen, or the connector may be placed on the metal conic part which is at one end of the side arms of the pedestal (Fig. 5-4). 5. 6 Start-up and initial calibration | iTernIS ADV...
  • Page 55 Ensure that this value is suitable for the calibrations to be carried out co- rrectly, and for the volume and flow readings to be correct. Start-up and initial calibration | iTernIS ADV 5. 7...
  • Page 56 If a leak less than 10 L/min is accepted, an on-screen message is displayed per- manently showing the magnitude of the recorded leak. The message is placed in the Icons and messages Bar. 5. 8 Start-up and initial calibration | iTernIS ADV...
  • Page 57 Fig. 5-8. Fig. 5-8 On-screen message showing that the patient circuit has lost its airtightness. Start-up and initial calibration | iTernIS ADV 5. 9...
  • Page 58 Y-shaped connector. Take precautions to provide an alternative ventilation method during recalibration, if this were neces- sary. WARNING • It is possible to recalibrate the patient circuit, and the O cell at any time during operation of the ventilator. Accessing from [Menu] >> Tools >> Calibrations both calibrations can be run individually (see Menu chapter). 5. 10 Start-up and initial calibration | iTernIS ADV...
  • Page 59 The ventilator injects known volumes in the tight circuit and records the pressure levels generated by these volumes. In this way, the circuit calculates the patient calculation circuit compliance for the different values of the existing volume. Start-up and initial calibration | iTernIS ADV 5. 11...
  • Page 60 This Page Left Intentionally Blank 5. 12 Start-up and initial calibration | iTernIS ADV...

  • Page 61: Basic Operations

    Ventilation Parameters CHAPTER SUMMARY Upon completing the initial calibration process, iTernIS ADV allows the configura- tion of an interesting variety of ventilation functions. This chapter describes how to configure and program the equipment main functions, such as: selecting an opera- tive mode, its configuration, entering and exiting the Standby mode, and program- ming additional functions for ventilation in specific modes.
  • Page 62 This Page Left Intentionally Blank 6. 2 Basic operations | iTernIS ADV...

  • Page 63: Overall User Interface Management

    6.1 | Overall User Interface The iTernIS ADV user interface combines a 12” touch screen and a series of fixed keys on the front panel of the ventilator. This same front panel has a rotary knob Management that completes the list of control commands.

  • Page 64: Configuring The Operative Mode

    Operative Modes for ADL/PED and Operative Modes for NEO-INF chapters). The Operative Mode parameters that can be configured appear on the lower area of the screen. Section 6.6 Ventilation Parameters describes the ventilation parameters. 6. 4 Basic operations | iTernIS ADV...
  • Page 65 • Configuring Backup Ventilation (see the Menu chapter, which describes this con- figuration). • Press the Accept button. The window for the selected operative mode is shown be- low, but with the message that Backup Ventilation has been correctly configured. Basic operations | iTernIS ADV 6. 5...
  • Page 66 6.3.3 | Configuring Alarm Limits Alarm limits can be modified at any time from the [Alarm Limits] fixed key. When this button is pushed, the ALARM SETTINGS menu is displayed (see Fig. 6-5). 6. 6 Basic operations | iTernIS ADV...

  • Page 67: Standby

    6.5 | Additional Functions There are two types of additional functions. Direct-access functions (using a touch- screen button or fixed key on the panel) and functions that are part of the equip- ment main Menu. Basic operations | iTernIS ADV 6. 7...
  • Page 68 6.5.1.2 | Respiratory Mechanics Fig. 6-6 RESPIRATORY MECHANICS Menu. iTernIS ADV offers the possibility of performing different tests to categorize the res- piratory mechanics of the patient being ventilated. For further information, consult the Respiratory Mechanics chapter, which describes all the tests in detail.
  • Page 69 The frozen screen is saved in memory until the next capture and can be saved as an image file in the computer connected through the ventilator RS232C serial port. The software, developed by HEYER, is used for this; this is a freeware Capture iTernIS ®...

  • Page 70: Ventilation Parameters

    The ad- justment values for these parameters can be found in Table 17-7. For a better understanding of the parameters that iTernIS ADV manages, they are divided into four groups: •...
  • Page 71 The inspiratory will of the patient can be detected using two methods in iTernIS ADV, either by reducing the pressure in the patient circuit or by a certain flow demand.
  • Page 72 The pressure continues to rise until the end of the breath, which coincides with the cessation of the flow. 6. 12 Basic operations | iTernIS ADV...
  • Page 73 APRV mode. They regulate the two values of continuous positive pressure for the upper and lower inspiratory times, respectively. • HIGH AND LOW INSPIRATORY TIME: These two parameters allow adjusting the HIGH and LOW PEEP times, respectively, in the APRV mode. Basic operations | iTernIS ADV 6. 13...
  • Page 74 This Page Left Intentionally Blank 6. 14 Basic operations | iTernIS ADV...

  • Page 75: Menu

    Tools Intra hospital transport CHAPTER SUMMARY This chapter describes the ventilator main menu functions ([Menu] key). The des- cription includes a functional explanation, and the use and configuration instruc- tions for each of them. Menu | iTernIS ADV 7. 1...
  • Page 76 This Page Left Intentionally Blank 7. 2 Menu | iTernIS ADV...

  • Page 77: General Information

    The image for this window was captured during ventilation with a test lung in PSV mode. ETCO and VCO show no values because no capnograph was being used at the time of the capture. Menu | iTernIS ADV 7. 3...
  • Page 78 (inspiration + expiration). It indicates the pressure on the distal end of the endo- Tracheal pressure tracheal or tracheostomy tube. This reading is shown if the Tube compensation has been activated. 7. 4 Menu | iTernIS ADV...
  • Page 79 Continuous flow in NEO-INF. But by accessing to this line on the menu, it is pos- sible to enable/disable the backup for these modes. Fig. 7-3 BACKUP VENTI- LATION menu window. Left for ADL/PED category and right for NEO- INF. Menu | iTernIS ADV 7. 5...
  • Page 80 The length of the pause can be configured in the range of 0.25 to 2.00 s, at 0.25 s intervals. If the NO option is selected (default condition) for the Inspiratory pause line, the pause is disabled. If an inspiratory pause is set, it will be executed for all of the inspirations. 7. 6 Menu | iTernIS ADV...
  • Page 81 Inspiration is controlled according to the estimated intratracheal pressure. This pressure is estimated based on the configuration entered into the TUBE COMPEN- SATION window. The following parameters are configured in this window: • TUBE: Endotracheal or Tracheostomy. Menu | iTernIS ADV 7. 7...
  • Page 82 (and on the pressure/volume loop) that corresponds to the calculated tracheal pressure. Depending on the flow provided or required and the compensation percentage, it will be possible to see that the airway 7. 8 Menu | iTernIS ADV...
  • Page 83 When this option is enabled (YES option), the ventilator compensates for the tidal volume according to the patient circuit compressible volume. In this way, the driven and the monitored tidal volumes reflect a value that represents the value received and exhaled by the patient, respectively. Menu | iTernIS ADV 7. 9...
  • Page 84 If there is a leak, it is measured by the ventilator and used as a point of reference to establish triggering criteria (inspiratory sensitivity). The compensation operates up to certain leak levels (see Table 7-3). 7. 10 Menu | iTernIS ADV...
  • Page 85 They are: • TRENDS: for further details, see the TRENDS chapter. • SAVED LOOPS: for further details, see the Graphics management chapter. • ACTIVATED ALARMS: for further details, see the Alarms chapter. Menu | iTernIS ADV 7. 11...
  • Page 86 The %O enrichment is a value that is added to the O concentration that is present in the current ventilation. For example, if the breaths delivered have a 50% oxygen concentration and an 7. 12 Menu | iTernIS ADV...
  • Page 87 7.6.3 | Calibrations Fig. 7-11 shows the functions included in the CALIBRATIONS window. Fig. 7-11 CALIBRA- TIONS menu. 7.6.3.1 | Oxygen sensor calibration Entering this option displays a submenu like the one found in Fig. 7-12. Menu | iTernIS ADV 7. 13...
  • Page 88 The change is made in the highlighted field (mbar) and the torr value is automati- cally updated. The initial value for this parameter appears in Fig. 7-13. 7. 14 Menu | iTernIS ADV...
  • Page 89 (20% - 100%). Sound volume cannot be completely eliminated. Fig. 7-14 SOUND VOLU- ME window. This window can be accessed from the Sound volume line in MENU Menu | iTernIS ADV 7. 15...
  • Page 90 7.6.4.5 | Language [Menu]>>Tools>>Settings>>Language changes the language of the ventilator program. When the language is changed, all functions and tags displayed on the iTernIS ADV screen will change to the new language. Available options are: • SPANISH • ENGLISH • PORTUGUESE •...
  • Page 91 AIR inlet or when the following is executed: [Menu]>>Intrahospital transport>>NO. While the option is active, the ventilator displays low priority alarm signals to indicate that condition. Menu | iTernIS ADV 7. 17...
  • Page 92 This Page Left Intentionally Blank 7. 18 Menu | iTernIS ADV...
  • Page 93 Graphics management includes instructions to correctly configure pressure, volu- me and flow curve and pressure-volume and volume-flow loop graphs. The chapter descriptions include screen graphic layout configuration, scale management, units, reference loops, etc. Graphics management | iTernIS ADV 8. 1...
  • Page 94 This Page Left Intentionally Blank 8. 2 Graphics management | iTernIS ADV...
  • Page 95 • FIVE CURVES. Pressure, volume and flow; and pressure/volume and flow/volu- me loops. This is the default iTernIS ADV screen. This is the screen displayed at the start of ventilation, and pressing the [Esc] key brings the system back to this screen.
  • Page 96 8.1.1 | Five curves Fig. 8-2 FIVE CURVES screen. 8.1.2 | Two curves Fig. 8-3 TWO CURVES screen. 8.1.3 | Three curves Fig. 8-4 THREE CURVES screen. 8. 4 Graphics management | iTernIS ADV...
  • Page 97 8.1.4 | Loops Fig. 8-5 LOOPS screen 8.1.5 | Patient´s data Fig. 8-6 PATIENT’S DATA screen. 8.1.6 | Capnography Fig. 8-7 CAPNOGRAPHY screen. Graphics management | iTernIS ADV 8. 5...
  • Page 98 Autoscale will adjust the scale to fit again the curve that has changed. When this function is activated, an icon appears on the Icons and messages bar reporting that condition. 8. 6 Graphics management | iTernIS ADV...
  • Page 99 Right, SAVED LOOPS picture. When one of the four saved loops is selected, it will be displayed on the screen as shown in the picture on the left. Graphics management | iTernIS ADV 8. 7...
  • Page 100 This Page Left Intentionally Blank 8. 8 Graphics management | iTernIS ADV...
  • Page 101 Backup Ventilation CHAPTER SUMMARY iTernIS ADV uses the same operative modes for the ADL and PED patient cate- gories. Therefore, a brief description of the modes found in these categories is shown here, with the default values for the ventilation parameters corresponding to ADL and PED, and a list of additional features enabled in each of the described modes.
  • Page 102 This Page Left Intentionally Blank 9. 2 ADL/PED Operative modes | iTernIS ADV...
  • Page 103 (predetermined wave) and a constant wave (rectangular). By choosing one or the other, the ventilator adjusts automatically the calculations necessary to deliver the selected volume (more details in the Basic Operations chapter). ADL/PED Operative modes | iTernIS ADV 9. 3...
  • Page 104 Controlled Ventilation 9.2.1 | Overview In the Controlled Pressure mode (PCV), the iTernIS ADV ventilator functions as a positive pressure controller. In this mode, the pressure is set from the PCV parame- ter, and this value remains unchanged regardless of the patient compliance and re- sistance.
  • Page 105 Fig. 9-5 Image of the PCV-enabled controls, ADL category. Shown with the preset values for each of them Fig. 9-6 Image of the PCV-enabled controls, PED category. Shown with the preset values for each of them ADL/PED Operative modes | iTernIS ADV 9. 5...
  • Page 106 - The inspiration is prolonged up to 3 s in ADL category or 2 s in PED (for NEO-INF patient category, inspiration ends if this is prolonged during 1 s). - Inspiratory pressure exceeds abruptly a value of 14% of the set pressure plus 5 O, for all categories. 9. 6 ADL/PED Operative modes | iTernIS ADV...
  • Page 107 Fig. 9-7 Image of the iTernIS ADV screen in PSV operative mode. 9.3.2 | Inspiratory sensitivity It is important to configure an appropriate value for Inspiratory sensitivity . The va- lue of this parameter determines the effort that the patient must perform to trigger an inspiration on his own.
  • Page 108 It is possible to adjust the rate and inspiratory time for breaths imposed by the ven- tilator. The resulting expiratory time (of the mandatory breaths) has a period during which the patient can start a spontaneous inspiration with the same characteristics 9. 8 ADL/PED Operative modes | iTernIS ADV...
  • Page 109 The predetermined tidal volume values will depend on the configuration of IBW- based VT (see Start-up and Initial calibration chapter). The images of Fig. 9-11 and Fig. 9-12 show the initial values resulting from the preset IBW-based VT configu- ration. ADL/PED Operative modes | iTernIS ADV 9. 9...
  • Page 110 Fig. 9-13 SIMV (PCV) + PSV mode. Captured image during ventilation in ADL category. (A) Mandatory PCV breathing, and (B) spontaneous breathing with support pressure. 9.6.2 | Rise Time Changes to the Rise Time thus affect spontaneous and mandatory breaths. 9. 10 ADL/PED Operative modes | iTernIS ADV...
  • Page 111 Therefore, recurrent differences can be verified between the set minute volume and the monitored volume without causing a malfunction. ADL/PED Operative modes | iTernIS ADV 9. 11...
  • Page 112 The following list contains additional functions that can be selected optionally in MMV + PSV (for further details on their behavior, see the Menu chapter): functions • Nebulization. • O suction %. • Manual inspiration. • Volume compensation. 9. 12 ADL/PED Operative modes | iTernIS ADV...
  • Page 113 Table 9-1 Managing the inspiratory phase in PSV with assured VT Variable Driven VT > Target VT Driven VT < Target VT Control Pressure Volume Limit Pressure Flow Cycling Flow Volume or Time Fig. 9-19 PSV + VT Assured screen image. ADL/PED Operative modes | iTernIS ADV 9. 13...
  • Page 114 (PSV). According to the regulation of the times for upper and lower pressu- re, ventilation may be administered with an inversion of the I:E ratio. The Backup Ventilation configuration is optional for this mode. 9. 14 ADL/PED Operative modes | iTernIS ADV...
  • Page 115 The following list contains additional functions that can be selected optionally in APRV (for further details on their behavior, see the Menu chapter): functions • Nebulization. • %O suction. • Manual inspiration. • Volume compensation. • Leak compensation. • Tube compensation. ADL/PED Operative modes | iTernIS ADV 9. 15...
  • Page 116 Fig. 9-24 Appearance of the graphics in Noninvasive Ven- tilation. 9.10.2 | Enabled ventilatory parameters (preset values) Fig. 9-25 Preset controls for ADL category. Fig. 9-26 Preset controls for PED category. 9. 16 ADL/PED Operative modes | iTernIS ADV...
  • Page 117 Target Volume not reached alarm signals will be activated. WARNING • The maximum pressure limit must be regu- lated accurately, because it is responsible for determining the maximum level of auto- matic pressure regulation. It must not be set below: PEEP + 10 cmH O. The PEEP must not be set above: 10 cmH O below the alarm limit. ADL/PED Operative modes | iTernIS ADV 9. 17...
  • Page 118 PRVC (for further details on their behavior, see the Menu chapter): functions • Nebulization. • %O suction. • Manual inspiration. • Manual inspiratory/expiratory pause. • Volume compensation. • Leak compensation. • Tube compensation. 9. 18 ADL/PED Operative modes | iTernIS ADV...
  • Page 119 It is not strictly an operative mode such as those described in this chapter. This is a safety tool that is used in conjunction with the spontaneous mo- des to provide ventilation in the event of apnea, or decreased ventilatory effort. ADL/PED Operative modes | iTernIS ADV 9. 19...
  • Page 120 This Page Left Intentionally Blank 9. 20 ADL/PED Operative modes | iTernIS ADV...
  • Page 121 ADL/PED patients. On the other hand, modes that are common to all categories have some differences in NEO-INF. These are all reasons to provide the information included in this chapter. NEO-INF Operative modes | iTernIS ADV 10. 1...
  • Page 122 This Page Left Intentionally Blank 10. 2 NEO-INF Operative modes | iTernIS ADV...
  • Page 123 The preset values of the tidal volume will depend on the configuration of the IBW- based VT (see the Start-up and Initial Calibration chapter). Fig. 10-2 shows the initial value that result from an IBW-based VT default configuration. NEO-INF Operative modes | iTernIS ADV 10. 3...
  • Page 124 • The configured pressure is added to the established PEEP level. Therefore, the resulting pressure is obtained by adding the PCV and PEEP values. 10. 4 NEO-INF Operative modes | iTernIS ADV...
  • Page 125 ADL/PED Operative Modes chapter. See that Ventilation / CPAP chapter for specific details regarding the PSV/CPAP mode. That chapter breaks them down into two independent operative modes. Both descriptions apply to this mode in NEO-INF. NEO-INF Operative modes | iTernIS ADV 10. 5...
  • Page 126 Fig. 10-5 iTernIS ADV screenshot ventilating in NEO-INF category and PSV/CPAP mode. 10.3.1 | Enabled ventilation parameters (preset values) Fig. 10-6 Picture of the PSV/CPAP enabled controls, NEO- INF category. Shown with the preset values for each. 10.3.2 | Enabled complementary The following list has complementary functions that can be selected as an option in...
  • Page 127 SIMV (VCV) + PSV (for further details regarding their behavior, see the Menu functions chapter): • %O suction. • Manual inspiration. • Manual inspiratory/expiratory pause. • Programmed inspiratory pause. • Volume compensation. • Leak compensation. • Distal/proximal pneumotachograph. NEO-INF Operative modes | iTernIS ADV 10. 7...
  • Page 128 The following list has complementary functions that can be selected as an option functions in SIMV (PCV) + PSV (for further details regarding their behavior, see the Menu chapter): • %O suction. 10. 8 NEO-INF Operative modes | iTernIS ADV...
  • Page 129 10.6.2 | Enabled complementary The following list has complementary functions that can be selected as an option in APRV (for further details regarding their behavior, see the Menu chapter): functions • %O suction. NEO-INF Operative modes | iTernIS ADV 10. 9...
  • Page 130 In this mode, the programmed pressure determines the maximum limit it can reach. Therefore, the PEEP addition does not change the maximum pressure peak obtai- ned. This way, the TCPL mode in the iTernIS ADV ventilator adheres completely to the classic programming style that this mode has followed for a long time.
  • Page 131 The following list has complementary functions that can be selected as an option 10.8.2 | Enabled complementary in SIMV (TCPL) + PSV (for further details regarding their behavior, see the Menu functions chapter): • %O suction. NEO-INF Operative modes | iTernIS ADV 10. 11...
  • Page 132 NEO-INF patients and the large leaks that usually occur in this ventilation mode, nasal prong disconnection warning conditions may not be detected. NOTE • The tidal volume and minute volume alarms are disabled in this mode. 10. 12 NEO-INF Operative modes | iTernIS ADV...
  • Page 133 These pressure rises or falls do not exceed 3 cmH O per breath. The mechanism that determines the necessary pressure (first breath with VCV and inspiratory pause) will come into play whenever: NEO-INF Operative modes | iTernIS ADV 10. 13...
  • Page 134 10.10.3 | Enabled complementary The following list has complementary functions that can be selected as an option in PRVC (for further details regarding their behavior, see the Menu chapter): functions • %O suction. 10. 14 NEO-INF Operative modes | iTernIS ADV...
  • Page 135 Strictly speaking, it is not an operative mode like those described in this chapter. It is a safety tool used along with the spontaneous modes to ensure ventilation in case of apnea or a ventilation effort decrease. NEO-INF Operative modes | iTernIS ADV 10. 15...
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  • Page 137 CHAPTER SUMMARY The Alarms chapter has the information needed to know and manage the iTernIS ADV alarm system. This includes information about the structure of the alarm system, how to manage its configuration, the notification and message sys- tem, and the specific characteristics of each alarm condition.
  • Page 138 This Page Left Intentionally Blank 11. 2 Alarms | iTernIS ADV...
  • Page 139 11.1 | General All the alarms that are part of the iTernIS ADV alarm system have visual light and audible signals with a screen message that indicates the name of the activated Characteristics alarm condition. The alarm system is organized following an alarm condition priority ranking. There are three alarm priority groups: HIGH PRIORITY, MEDIUM PRIORITY, and LOW PRIORITY.
  • Page 140 In this case, it is on page 33 of 33 available pages. 11.3 | Alarm Signals iTernIS ADV has three different types of alarm signals to indicate the presence of an alarm condition, regardless of priority. • Visual light signals.
  • Page 141 Press the [Esc] key. 11.3.2.1 | Visual light signal In iTernIS ADV light alarm signals have maintained signal characteristics. The sig- nals are maintained with the characteristics indicated on Table 11-4. Table 11-4 Maintained visual signal - Alarm Signals.
  • Page 142 Alarm limit changes are made by first accessing the desired alarm and then selecting the limit to be configured. There are alarms that are not enabled for certain operative modes. In those cases, access to those alarm configurations is not allowed. 11. 6 Alarms | iTernIS ADV...
  • Page 143 Fig. 11-3 Picture where the touch buttons used to access some alarm configurations directly have been highlighted. 11.5.2 | Alarm signal The iTernIS ADV alarm system can deactivate some alarms. A deactivated alarm generates no alarm signals and cannot configure its limits. When an alarm is deac- deactivation tivated, a record of the ACTIVATED ALARMS screen is kept (see 11.2 Alarm event...
  • Page 144 This is because the Inoperative ventilator condition takes place when the signals software of the machine has stopped working. For that reason, the control for this alarm is independent from the software and has to be controlled by other means. 11. 8 Alarms | iTernIS ADV...
  • Page 145 Ventilation con- dition activated as a safety mechanism when there is Always. tilation dition (see Technical software failure or when no options are selected for 30 specifications). s on the previous initial calibration screens. Alarms | iTernIS ADV 11. 9...
  • Page 146 In PRVC and MMV blished pressure limits pressure level limits have been reached and the + PSV. (Cannot be adjus- (max. or min.) having target has not been reached. ted by user) been reached. 11. 10 Alarms | iTernIS ADV...
  • Page 147 Loss of power signal suppression. transfer. activated. Condition during which the machine does not From the start of The ventilator stops ventilating and stays on, maintai- Standby ventilate, but is char- ventilation. ning the last configuration. ged. Alarms | iTernIS ADV 11. 11...
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  • Page 149 PV flex (inflection points) 12.7 máx 12.8 VD/VT Physiologic CHAPTER SUMMARY iTernIS ADV allows testing standards for characterizing the patient’s respiratory mechanics. This chapter describes the concept and how to carry out each test. Respiratory mechanics | iTernIS ADV 12. 1...
  • Page 150 This Page Left Intentionally Blank 12. 2 Respiratory mechanics | iTernIS ADV...
  • Page 151 12.1.2 | Procedure With the iTernIS ADV ventilator, the auto-PEEP measurement is performed through a static maneuver. The patient must be kept in controlled ventilation (volume or pressure). Respiratory efforts may alter the measurement, therefore, if the patient is alert, it is important to instruct him/her on the procedure to obtain maximum re- laxation during the maneuver.
  • Page 152 The calculation takes into account the compliance of the ventilator circuit. Both the compliance and resistance are parameters of respiratory mechanics that are closely linked with the pulmonary volume for which they were measured. This is 12. 4 Respiratory mechanics | iTernIS ADV...
  • Page 153 The compliance measurement is performed through a static maneuver. This means that the patient must be instructed on the procedure to achieve his/her maximum relaxation during the maneuver. Test enabled in the following modes: • VCV • PCV • PRVC Respiratory mechanics | iTernIS ADV 12. 5...
  • Page 154 12.3.2 | Procedure To make the measurement, the iTernIS ADV ventilator performs a static maneuver. The patient must be kept in controlled ventilation (volume or pressure). Respiratory efforts alter the measurement; therefore, if the patient is alert, it is important to ins- truct him/her on the procedure to obtain maximum relaxation during the maneuver.
  • Page 155 Encourage the patient to perform a maximal inspiration and then expire slowly to the maximum extent possible. It should be noted that the maneuver must be slow. Test enabled in the following modes: • VCV • PCV Respiratory mechanics | iTernIS ADV 12. 7...
  • Page 156 At the start of the maneuver, the ventilator analyzes the breathing cycle during two breaths, identifying inspiration and expiration. During the last expiration, inspiratory occlusion of the inspiratory valve occurs, and the expiratory valve is left open. 12. 8 Respiratory mechanics | iTernIS ADV...
  • Page 157 During the implementation of the test, it is possible to cancel the maneuver by pressing [Esc]. Fig. 12-5 Picture of the window and graph of the P0.1 test. At the end of the first breath displayed on-screen, the occlu- sion and measure have been performed. Respiratory mechanics | iTernIS ADV 12. 9...
  • Page 158 Pressure/Volume cur- ve. The method used by the iTernIS ADV ventilator for this analysis, is pulmonary insufflation with low flow. Thus, it is possible to determine the lower inflection point (Lip) and upper inflection point (Uip).
  • Page 159 RESPIRATORY MECHANICS in the test menu, the ventilator continues in the selected mode and removes the PEEP. The maneuver starts by analyzing the breathing cycle during two breaths, identi- fying inspiration and expiration. During the last expiration, an inspiratory occlusion Respiratory mechanics | iTernIS ADV 12. 11...
  • Page 160 After the maneuver, the breathing returns to the original operative mode and the screen freezes showing the value obtained. During the implementation of the test, it is possible to cancel the maneuver by pressing [Esc]. Fig. 12-7 Detail of the Pimax test screen. 12. 12 Respiratory mechanics | iTernIS ADV...
  • Page 161 • By accepting the PaCO value entered, the display shows the calculated VD/VT physiologic value, and the result is saved with date and time, until a new measu- rement is performed (or the unit is turned off). Respiratory mechanics | iTernIS ADV 12. 13...
  • Page 162 Fig. 12-8 VD/VT physiologic test screen. 12. 14 Respiratory mechanics | iTernIS ADV...
  • Page 163 This chapter summarizes the information needed to know the features of the trend system that has been implemented in iTernIS ADV. The trend history system of the monitored parameters can be viewed at any time, and the user can configure the information it shows.
  • Page 164 This Page Left Intentionally Blank 13. 2 Trends | iTernIS ADV...
  • Page 165 The trends module is a tool used to control the value history of the main ventilating parameters during the last 72 h of ventilation. iTernIS ADV has activated the trends feature for the three patient categories: ADL, PED and NEO-INF. The information is presented the same way for all categories, using three graphs on screen that show the evolution of three parameters that can be chosen by the user (see Fig.
  • Page 166 3 trends, and, by pressing the knob, a third window is accessed where it is possible to change the parameters for each line (Fig. 13-3). Fig. 13-3 Trend 1 configuration window. 13. 4 Trends | iTernIS ADV...
  • Page 167 • The trends can be downloaded to a computer through the Visual iTernIS program ® to be filed or analyzed in detail. This program can be requested at no additional charge. Fig. 13-4 TREND screen appearance. Trends | iTernIS ADV 13. 5...
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  • Page 169 The chapter includes information on how to enable the optional module of capno- graphy, how to interpret the information provided by the ventilator, how to manage its menu settings and information about the equipment used to assess data. Capnography | iTernIS ADV 14. 1...
  • Page 170 This Page Left Intentionally Blank 14. 2 Capnography | iTernIS ADV...
  • Page 171 14.1 | Capnograph The iTernIS ADV ventilator accepts the capnography sensor CAPNOSTAT 5 of Res- ® pironics Inc. The capnograph is an optional accessory that is delivered upon demand. NOTE • The capnograph is a maintenance-free device that requires no calibration or use of certified gases.
  • Page 172 Time (under the pressure, volume and flow curves). • Volumetric capnography (on the right, below the box showing the monitored para- meters). 14.3.2 | Derived parameters iTernIS ADV allows continuous monitoring of these parameters on the Capnogra- phy screen: • ETCO : partial pressure of CO at the end of exhalation.
  • Page 173 If the sensor is connected to the ventilator, but the status message is ‘ERROR (Ac- tivate Sensor)’ it should then be activated manually. [Menu]>>Tools>>Calibratio n>>Capnography>>Sensor Initialization. During the activation process, data of barometric pressure is sent as well as oxygen compensation of the mixture. Capnography | iTernIS ADV 14. 5...
  • Page 174 This may appear when a deviation of the source current outside the factory cali- bration occurs or if it is out of the performance specifications. Check if the sensor is properly connected to the ventilator. If the error persists, contact the Authorized Service. 14. 6 Capnography | iTernIS ADV...
  • Page 175 • ‘OVERHEATED SENSOR’ Internal temperature of the sensor is above the operating range. Check to see if the sensor is not exposed to external heat sources (lamps or stoves). In case this persists, contact the Service. Capnography | iTernIS ADV 14. 7...
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  • Page 177 15.4 Alarms Verification 15.5 Operative Verification CHAPTER SUMMARY This chapter lists a series of tests to be performed on the ventilator in order to de- termine whether it is in good operating condition. Operational verification | iTernIS ADV 15. 1...
  • Page 178 This Page Left Intentionally Blank 15. 2 Operational verification | iTernIS ADV...
  • Page 179 15.1 | Necessary Items In order to perform the tests listed below, the following items are necessary: • Ventilator iTernIS ADV with patient circuit for the patient category of ADL, PED or NEO-INF. • Test lung provided with the unit (suitable for verifying the patient category).
  • Page 180 15. 4 Operational verification | iTernIS ADV...
  • Page 181 Operative verification is an automatic control performed by the ven- tilator during the initial calibration. For further information on the nature of these tests, refer to chapter Start-up and Initial Calibration. Operational verification | iTernIS ADV 15. 5...
  • Page 182 This Page Left Intentionally Blank 15. 6 Operational verification | iTernIS ADV...
  • Page 183 This chapter is dedicated to presenting the necessary guidelines on the subject of maintenance, and key points which must be addressed in order to ensure the proper functioning of the ventilator. Cleaning and maintenance | iTernIS ADV 16. 1...
  • Page 184 This Page Left Intentionally Blank 16. 2 Cleaning and maintenance | iTernIS ADV...
  • Page 185 Sterilization 16.1.1 | General instructions The ventilator iTernIS ADV and the parts associated to the patient circuit (hoses, connectors, accessories, etc.) are delivered clean but not sterilized. The parts which come into contact with the patient are easily disassembled for cle- aning and subsequent sterilization, which should be done after every use.
  • Page 186 Do not introduce any sharp or trenchant objects through the openings of the assembly, or objects which, through their improper use, may threaten the internal membrane. The deterioration of this membrane can lead to the inadequate functio- ning of the ventilator. 16. 4 Cleaning and maintenance | iTernIS ADV...
  • Page 187 Assembly and Installation. WARNING • Always use authentic diaphragms. Non- authentic diaphragms may cause the mal- function of the expiratory valve while jam- ming the expiratory pathway. • The positioning of the diaphragm onto the expiratory set is very important for the pro- per functioning of the ventilator. Ensure that it is properly adjusted. Cleaning and maintenance | iTernIS ADV 16. 5...
  • Page 188 (every 5000 hours of usage or every year). • Scheduled maintenance can only be executed by HEYER or personnel authorized by HEYER Medi- cal AG Table 16-1 Suggested preventive maintenance FREQUENCY...
  • Page 189 The following list summarizes the verification of parts, accessories and consuma- bles which are executed during a scheduled maintenance of the equipment. • Expiratory set Cleaning and maintenance | iTernIS ADV 16. 7...
  • Page 190 For all safety-relevant controls a protocol must be prepared containing the date and results of the safety relevant control. This protocol has to be testified and kept with the product book – to be stored five years after final putting out of operation. 16. 8 Cleaning and maintenance | iTernIS ADV...
  • Page 191 Diagram of the Pneumatic Circuit of the Ventilator 17.15 Lifetime CHAPTER SUMMARY This chapter summarizes the technical specifications that characterize iTernIS ADV. Some examples are: physical, electrical, and pneumatic specifications, environ- mental conditions, parameter setting, alarm tables, etc. Technical specifications | iTernIS ADV...
  • Page 192 This Page Left Intentionally Blank 17. 2 Technical specifications| iTernIS ADV...
  • Page 193 Ventilator connectors for gas supply gen: DISS 9/16” - 18 male connector Air: DISS 3/4” - 16 female connector Connectors for gas supply hoses (both ends). Oxygen: DISS 9/16” - 18 female connector (both ends) Technical specifications | iTernIS ADV 17. 3...
  • Page 194 Results of the inspiratory time I:E Ratio 5:1 - 1:599 0,1:0,1 and the initial rate. ADL: 12 ADL: 1 - 100. Respiratory rate PED and NEO-INF: PED: 25 (rpm) 1 - 150. NEO-INF: 30 17. 4 Technical specifications| iTernIS ADV...
  • Page 195 (4) The Minute Volume is programmed only in MMV + PSV. For the rest of the modes, the Minute Volume is the result of other parameters programming (see maximum values by category in Table 17-5). Technical specifications | iTernIS ADV 17. 5...
  • Page 196 Low: 19 – 95 Low: 40 Inadequate oxy- 18 or less (not con- gen (%) figurable) N/A (not configu- Disconnection rable) ADL: 50 Leakage out of N/A (not configu- PED: 30 range (L/min) rable) NEO-INF: 10 17. 6 Technical specifications| iTernIS ADV...
  • Page 197 I:E ratio. ± 1 rpm Internal clock. Concentra- Galvanic cell Concentration of O ±3% Vol. tion of O WARNING 17.11 | Electromagnetic • The replacement of cables (main power su- Compatibility pply or internal cabling) of the equipment by anyone other than those approved by HEYER may result in decreased immunity, or increa- sed emissions reported for iTernIS ADV. Technical specifications | iTernIS ADV 17. 7...
  • Page 198 Table 17-11 Electromagnetic Emissions Statement Statement: iTernIS ADV is intended to be used in the specified electromagnetic environ- ment. The customer and/or user of iTernIS ADV must ensure it is used in an Electromagnetic Emissions electromagnetic environment as stated in this Table.
  • Page 199 RF transmitters, consider conducting a test in situ. If the mea- surement of the field strength where iTernIS ADV is used exceeds the above RF applicable compliance limits, iTernIS ADV must be evaluated to ensure it can operate normally. If abnormal performance is observed, it may be necessary to take additional measures, such as reorienting or relocating the equipment.
  • Page 200 Table 17-14 Recommended Separation Distances Between the Ventilator and Mobile/Portable Communications Devices Statement: Separation iTernIS ADV is intended to be used in an electromagnetic environment in which Distances radiated RF disturbances are controlled. The customer and/or user of iTernIS ADV can help prevent electromagnetic interference by maintaining a minimum...
  • Page 201 Simultaneously, air flow is driven to purge the lines of the expiratory pneumota- chograph, and avoid water deposits and humidity in the measuring element. iTernIS ADV has a complete safety system, which includes the operating system 17.13 | Safety Mechanisms that controls the microprocessor, and various components that act independently of these.
  • Page 202 At each reset, a message is displayed in the Icons and messages bar indicating that this procedure is being performed. 17. 12 Technical specifications| iTernIS ADV...
  • Page 203 • ALARM SYSTEM: iTernIS ADV has an alarm system to warn on situations that pose some degree of risk to the patient or to the unit itself. Some allow preventing the continuation of the condition that triggered it, others just trigger signals to re- port its presence.
  • Page 204 Inspiratory relief valve (anti-suffocation) Nebulizer (optional) Outlet “Towards Patient” Low pressure sensor Expiratory set (expiratory valve and pneumotachograph) Cycling valve PEEP proportional solenoid valve 17.15 | Lifetime Table 17-16 Lifetime Ventilator lifetime 10 (ten) years 17. 14 Technical specifications| iTernIS ADV...
  • Page 205 Appendices CHAPTER CONTENTS Troubleshootings Appendices | iTernIS ADV A. i...
  • Page 206 This Page Left Intentionally Blank A. ii Appendices | iTernIS ADV...
  • Page 207 Power loss. A.I.2 | Inop. Vent. Alarm Table A-2 High Priority Alarms ALARM Possible Causes Suggested Action Contact the authorized Inop. Vent. Microprocessor failure technical service Appendices | iTernIS ADV A. iii...
  • Page 208 Maximum and sor adapter in poor condition (free of dirt). Check minimum ETCO condition. Changes in conditions of the alarm limits and the patient's breathing of the patient mechanics. mechanics. A. iv Appendices | iTernIS ADV...
  • Page 209 Changes Review the pressure alarm li- patient's breathing mits. Check current status of the Volume target not mechanics. Pressure patient for changes in breathing reached alarm limits Incorrectly mechanics. configured. Appendices | iTernIS ADV A. i...
  • Page 210 Check presence of heat sources within proximity of the sensor, Sensor exposed to ex- Sensor overheated such as lamps or stoves. If the ternal heat sources. message persists, contact the authorized technical service. A. ii Appendices | iTernIS ADV...
  • Page 211 Warranty Declaration In addition to the legal warranty acc. to HBG §377, HEYER Medical AG shall grant a warranty of 12 months for the purchase of a new apparatus from the HEYER product range. The warranty period begins with the date of invoice and is subject to the following conditions: 1.
  • Page 212 This Page Left Intentionally Blank G. ii Warranty | iTernIS ADV...
  • Page 213 Compressed air filter 3.4, 16.6 Inop. Vent. 4.8, 5.2, 11.7 Control adjustment 4.3 Inspiratory detection 6.11, 9.6 CPAP 9.6 Adjustments of 17.3 PSV/CPAP 10.4 Continuous flow 10.10 Inspiratory/expiratory CTesp 7.3 Inspiratory/expiratory pause 6.9 Alphabetical index | iTernIS ADV I. i...
  • Page 214 PCV – volume controlled Ventilation parameters Pedestal, assembly 3.3 Adjustment of (table) 17.3 Physiological VD/VT (breathing Description of 6.10 mechanics) 12.12 Changes 6.3 Pimax (breathing mechanics) 12.10 P0.1 12.7 Programmed inspiratory pause 7.5 I. ii Alphabetical index | iTernIS ADV...
  • Page 215 Watchdog 17.9 WOBi 7.3 Y connector or part 3.8 Alphabetical index | iTernIS ADV I. iii...
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