MEDUMAT Transport. Emergency ventilator. Description and Instructions for Use for Devices from Firmware Version 2.17

Transcription

1 MEDUMAT Transport Emergency ventilator Description and Instructions for Use for Devices from Firmware Version 2.17

2 Contents 1. Overview Description Intended use Applications Operator and user qualification Function Safety information Installation Connecting oxygen cylinder Hose system Accessories from other manufacturers Permanent installation of the unit Operation Controls Switching the unit on/self-test Navigating in menus Selecting emergency mode Selecting a ventilation mode Changing the ventilation mode Selecting additional ventilation functions Performing ventilation Monitoring ventilation Alarm signals Ventilation with filters (not supplied with the unit) Ending ventilation Calculating the Oxygen level/ Operating time Alternative ventilation Changing battery during use Battery management Ventilation modes Classification of the ventilation modes Important ventilation parameters Additional functions and safety functions Pressure-controlled ventilation modes Volume-controlled ventilation modes Main menu Automatic alarm limits Alarm Limits Curves Advanced ventilation parameters Apnea ventilation parameters Audio/Video Options Night colors Hygienic preparation MEDUMAT Transport Hose systems Parts and accessories BiCheck flow sensor Fittings Cleaning, disinfection and sterilization Function check Intervals Checking the system for leaks Checking the patient valve (reusable hose system only) Automatic function check Troubleshooting Troubleshooting System alarms Physiologic alarms Maintenance MEDUMAT Transport Batteries Accessories Changing the suction filter Storage Disposal EN Contents

3 12. Product, accessories Standard scope of supply Accessories Replacement parts Technical Data Specifications Block diagram Separation distances O 2 consumption of the unit Possible O 2 concentration with counterpressure Attainable tidal volume with counterpressure Glossary Warranty Declaration of Conformity Contents EN 3

4 1. Overview Connections on MEDUMAT Transport 1 Alarm display 2 USB interface 3 O 2 inlet 4 O 2 inlet/outlet 5 Filter compartment cover, air inlet 6 Ventilation connection terminal 9 External power supply unit 8 DC connection 7 Rechargeable battery 1 Alarm display Glows to indicate alarms. 2 USB interface Means of data transfer for servicing and maintenance purposes. 3 O 2 inlet Connection point, e.g., for an oxygen cylinder. 4 O 2 inlet/outlet At this connection point, oxygen can be extracted, e.g., using an inhalation device, or an oxygen source can be connected. 5 Filter compartment cover, air inlet Covers the filter and ensures it is securely positioned. 6 Ventilation connection terminal The tube system is connected here. 7 Rechargeable battery Provides mobile power supply to the unit. 8 DC connection For DC power supply via an external power supply unit or via the electrical circuit of an ambulance or rescue vehicle. 9 External power supply unit Provides power supply to the unit via a 100V - 240V grid. 4 EN Overview

5 Ventilation connection terminal 1 CO 2 measuring hose connection 2 PEEP control hose connection 3 Pressure-measurement hose connection 5 BiCheck flow sensor connection line connection 4 Ventilation hose connection 1 CO 2 measuring hose connection The CO 2 measuring hose of the patient hose system is attached to this connection via the connection plug. 2 PEEP control hose connection The PEEP control hose of the patient hose system is attached to this connection via the connection plug. 3 Pressure-measurement hose connection The pressure-measurement hose of the patient hose system is attached to this connection via the connection plug. 4 Ventilation hose connection The ventilation hose of the patient hose system is attached to this connection. 5 BiCheck flow sensor connection line connection The BiCheck flow sensor connection line of the patient hose system is attached to this connection. Overview EN 5

6 Controls of MEDUMAT Transport 11Function buttons for emergency ventilation 10 Context-dependent control knobs 9 Navigation knob 1 Context-dependent function button 2 Alarm mute button with LED 3 Context-dependent function button 4 Function button for main menu 5 Context-dependent function button 6 Function button for 100% O 2 7 Function button for inspiratory O 2 concentration 8 On/Standby/Off button 1, 3, 5 Context-dependent function button These buttons are used to set various ventilation parameters, depending on the ventilation mode selected. 2 Alarm mute button with LED With this button, acoustic alarms can be muted briefly (for 2 minutes). If alarms are muted, the LED lights up. Visual alarms are still displayed. 4 Function button for main menu This button calls up the main menu. 6 Function button for 100% O 2 This button calls up the 100% O 2 function to ventilate the patient briefly (for 2 minutes) with 100% O 2 (FiO 2 = 1.0). 7 Function button for inspiratory O 2 concentration This button calls up the O 2 concentration menu. The required inspiratory O 2 concentration in the respiratory gas can be set in this menu. 8 On/Standby/Off button A short press switches the unit on and off. A long press switches it off completely. 9 Navigation knob For navigating in menus and confirming your settings on the unit. During ventilation, this knob is to set the I:E ratio. 10 Context-dependent control knobs For setting various parameters, depending on which ventilation mode is active. Settings made here must be confirmed with the Navigation knob. 11 Function buttons for emergency ventilation These buttons start emergency ventilation. By pressing the buttons, preset parameters for infants, children or adults are activated. 6 EN Overview

7 Display of MEDUMAT Transport 1 Battery/Line operation indicators 9 Info field 10 Mode indicator 8 Numeric measurement display 7 Battery charge status 6 Numeric measurement display 5 Function indicator for contextdependent function buttons 4 Function indicator for contextdependent control knobs 3 Ventilation progress display 2 Function indicator for contextdependent function buttons 1 Battery/Line operation indicators Indicates whether the unit is being operated with the external power supply unit (upper LED) or with the internal battery (lower LED). 2 Function indicator for contextdependent function buttons The currently available function of the contextdependent function buttons is indicated here. 3 Ventilation progress display Displays the ventilation progress according to the presentation version selected. In the case of emergency ventilation, a pressue gauge is displayed. 4 Function indicator for contextdependent control knobs The currently available function of the contextdependent control knobs is indicated here. 5 Function indicator for contextdependent function buttons The three directly selectable emergency ventilation modes (infant, child, adult) are indicated here. 6 Numeric measurement display The current measurements are indicated numerically here. 7 Battery charge status The battery charge status is indicated here. 8 Numeric measurement display Displays the measured inspiratory O 2 concentration (FiO 2 ). 9 Info field Information (error messages, visual alarms) about the state of the patient and the ventilator is displayed here. The time of day is also displayed in this field. 10 Mode indicator The ventilation mode set by the user is indicated here. Overview EN 7

8 Hose system (reusable and disposable versions available) 2 Water filter for CO 2 measurement 3 Connector 12 Tube protection sleeve 11 Pressuremeasurement tube 10 CO 2 measuring hose 1 Ventilation hose 9 Patient valve 1 Ventilation hose The respiratory gas flows through the ventilation hose to the patient valve. 2 Water filter for CO 2 measurement The water filter protects the measuring chamber of the MEDUMAT Transport against moisture and contamination from the patient's respiratory gas. 3 Connector The measurement-tube system is connected to MEDUMAT Transport by means of this connector. 4 PEEP control tube With this tube, MEDUMAT Transport controls the patient valve and the PEEP. 5 BiCheck flow sensor connection line This electric lead transfers the measuring signals from the BiCheck flow sensor to the MEDUMAT Transport. 6 BiCheck flow sensor This sensor supplies monitoring data on flow, MV e, V te and f. 4 PEEP control tube 5 BiCheck flow sensor connection line 6 BiCheck flow sensor 7 Elbow 8 Blanking plug 7 Elbow The mask/tube is connected here. The elbow is removable, i.e., the mask/tube can also be connected to the BiCheck flow sensor itself, depending on the position of the patient. 8 Blanking plug The blanking plug (Luer lock) is used to seal off the CO 2 outlet if your MEDUMAT Transport is not equipped with CO 2 measurement or this is not activated. 9 Patient valve Switchover between inspiration and expiration happens here. 10 CO 2 measuring hose Test gas is removed via this tube if your unit is equipped with the optional CO 2 measurement facility. 11 Pressure- measurement tube For patient-side measurement of ventilation pressure. 12 Tube protection sleeve Protects tubes and leads against soiling and damage. Note Detailed information about the hose systems can be found in the "Patient Hose System" instructions for use WM EN Overview

9 MEDUMAT Transport Main menu Automatic alarm limits No Yes Alarm limits Automatic alarm limits MVe MVe f Apnea etco 2 etco 2 Pressure, flow Pressure, CO 2 Curves Advanced ventilation parameters Pressure, flow, CO 2 Pressure, flow, measurements Pressure, CO 2, measurements Pressure ramp Flow ramp Flow progress Decreasing Constant Plateau time Trigger thresholds Inspiration Expiration Apnea ventilation parameters Audio/Video Options Night colors Activated Apnea mode BiLevel SIMV Settings PEEP pinsp Vt Freq I:E Brightness/Day Brightness/Night Volume CO 2 configuration Date, time Language Device data Bluetooth Suction activated Unit mmhg Vol% kpa Year Month Day Hour Minute Deutsch English Español Italiano Overview EN 9

10 Mode menu NIV Apnea ventilation BiLevel PCV CPAP + ASB PRVC IPPV S-IPPV SIMV Pre-oxygenation 25 l/min 20 l/min 15 l/min 10 l/min 5 l/min Off Symbols used on the display Symbol Meaning Emergency mode - Infant Emergency mode - Child Emergency mode - Adult Battery status indicator 10 EN Overview

11 Symbol Meaning Tick box: option activated Radio button: function selected Navigate upwards Navigate downwards Increase value Decrease value Confirm your selection Navigation knob active Bluetooth connection: Symbol is gray when connection has been activated Symbol is blue during communication Overview EN 11

12 Function of the controls during ventilation Depending on the ventilation mode selected, you can set the following ventilation parameters using the controls: Ventilation mode Control knob 1 Control knob 2 Control knob 3 BiLevel PEEP p insp p max Freq. PCV PEEP p insp p max Freq. CPAP + ASB PEEP - p max - PRVC PEEP Vt p max Freq. IPPV PEEP Vt p max Freq. S-IPPV PEEP Vt p max Freq. SIMV PEEP Vt p max Freq. Control knob 4 Navigation knob 5 I:E and Selection/ Confirmation I:E and Selection/ Confirmation Only Selection/ Confirmation I:E and Selection/ Confirmation I:E and Selection/ Confirmation I:E and Selection/ Confirmation I:E and Selection/ Confirmation Function button 6 Function button 7 Function button 8 pasb Trigger Mode - - Mode pasb Trigger Mode pasb Trigger Mode - - Mode - Trigger Mode pasb Trigger Mode 12 EN Overview

13 Symbols used on the unit MEDUMAT Transport 8 Cover of USB interface 1 MEDUMAT Transport type plate 2 Voltage input 7 Filter compartment cover 6 O 2 inlet Battery 5 O 2 inlet/outlet 4 Ventilation hose connection 9 Rechargeable battery type plate 3 STK and service label 1 Symbol Meaning MEDUMAT Transport type plate Consult instructions for use 1 Date of manufacture 1 Degree of protection against electric shock: type BF device 1 Input 1 DC voltage 1 I min I max Minimum and maximum current Overview EN 13

14 1 1 Symbol Meaning e1 mark (confirms that the device complies with the applicable European EMC Directives on use in vehicles) Do not dispose of the unit in the household waste. 1 Type of protection against electric shock: protection class II device 1 IPX4 Protection against ingress of water 1 1 SN Serial number Other marks 2 CE mark (confirms that the device complies with the applicable European Directives). Input voltage 3 Service label: indicates when the next service is required. 3 4 STK label: (only in the Federal Republic of Germany) indicates when the next safety check in accordance with 6 Medical Device Operator Ordinance (MPBetreibV) is required. Maximum pressure 100 mbar 5 Volume flow rate 6 Input 2.7 bar - 6 bar O 2 14 EN Overview

15 7, 8 Symbol Consult instructions for use Meaning 9 Rechargeable battery type plate Do not dispose of the unit in the household waste. 9 Do not subject the unit to hard knocks or shocks. 9 Do not open the unit using force. 9 Protect the unit against heat. 9 Protect the unit against moisture. Labeling on the packaging Symbol MEDUMAT Transport: SN Serial number of the unit Meaning Permissible storage temperature: -30 C to +70 C 3 RH % 0-95 Permissible humidity for storage: up to 95% relative humidity Overview EN 15

16 Safety information in these instructions for use The safety instructions in these instructions for use are marked as follows: Warning! Warns of risk of injury and possible damage to the unit. Caution! Warns of material damage and possibly incorrect therapy results. Note: Offers useful tips. 16 EN Overview

17 2. Description 2.1 Intended use The MEDUMAT Transport is an automatic oxygen emergency ventilator with additional preoxygenation and monitoring functions (pressure, flow and CO 2 ). MEDUMAT Transport is used for the controlled and assisted, as well as invasive and noninvasive, ventilation of adults, children and infants. In the case of volume-controlled ventilation, respiratory volumes of 50 ml or more are possible. Smaller volumes are also possible in the case of pressure-controlled ventilation. The device is not suitable for the ventilation of neonates. MEDUMAT Transport must only be operated when installed permanently or on approved portable systems. 2.2 Applications MEDUMAT Transport can be used in the following cases for up to 30 days: Emergency for resuscitation at the place of the emergency for longer-tem use in continuing emergency situations for preoxygenation via a ventilation mask Transport in ground, sea and air emergency medical service between hospital rooms and departments between a hospital and other locations (secondary transport) Ventilation in hospitals recovery room intensive care unit surgery preparation and follow-up emergency department Description EN 17

18 MEDUMAT Transport is also suitable for gentle ventilation of anesthetized patients (TIVA: total intravenous anesthesia). 2.3 Operator and user qualification MEDUMAT Transport must only be used by persons who can verify that they have the following qualifications: A medical qualification and training in ventilation techniques Training in the use of the MEDUMAT Transport by a person authorized by Weinmann Improper use may lead to serious physical injury. As the operator or user, you must be fully familiar with the correct operation of this medical device. Observe the statutory requirements for operation and use (in Germany, particularly the German regulations governing owners/operators of medical devices (MPBetreibV)). General recommendation: You should seek instruction on the correct handling, use and operation of this medical device from a person authorized by Weinmann. 2.4 Function The unit MEDUMAT Transport is used to treat apnea and to provide respiratory support. By means of adjustable ventilation parameters, the unit ensures uniform ventilation tailored to the patient. Pressure-controlled and volume-controlled ventilation modes can be selected for optimum patient ventilation. In CPAP + ASB mode, the unit enables assisted spontaneous breathing with continuous positive airway pressure and respiration-controlled oxygen inhalation. In addition, the unit permits O 2 inhalation for preoxygenating the patient. The unit allows the oxygen concentration of the respiratory gas to be adjusted. Depending on the version, the unit's large display can show up to three spirometric curves (pressure, flow and CO 2 ) or two curves and additional measured values. For emergency situations, rapid selection of default types of ventilation is possible. With the data communication option enabled, the device can transmit its application data to an application documentation system via Bluetooth. 18 EN Description

19 Patient Hose System The ventilation gas is supplied to the patient via the Patient Hose System, comprising the ventilation hose and all leads necessary for comprehensive ventilation and monitoring. The Patient Hose System is designed to permit spontaneous respiraton even if the MEDUMAT Transport malfunctions. The following versions of the patient hose system are available: Reusable hose system with CO 2 measuring hose Reusable hose system without CO 2 measuring hose Disposable hose system with CO 2 measuring hose Disposable hose system without CO 2 measuring hose Disposable hose system with reduced dead space with CO 2 measuring hose Disposable hose system with reduced dead space without CO 2 measuring hose Description EN 19

20 3. Safety information Read these instructions for use carefully. It is part of the unit and must be available at all times. For your own safety and that of your patients, and in accordance with the requirements of Directive 93/42/EEC, please observe the following points: General Always carry out a functional check before using the unit (see "9. Function check" on page 88). Please observe the section "8. Hygienic preparation" on page 83 in order to avoid infection or bacterial contamination. Warning! Risk of injury. Only use MEDUMAT Transport if you are a qualified medical professional and have received training in respiration techniques. Improper use may lead to serious physical injury. Risk of injury. Never leave the patient or the ventilator unattended during ventilation. Only then can you respond quickly if the patient's condition deteriorates or in the event of an alarm or malfunction. Delayed response on the part of medical personnel may lead to serious physical injury. Only use MEDUMAT Transport for the designated purpose (see "2.1 Intended use" on page 17). MEDUMAT Transport is not suitable for hyperbaric use (pressure chamber). The unit is not licensed for use in explosive atmospheres. The unit must not be used in combination with flammable gases or anesthetics. The unit is not licensed for use in poisonous or contaminated atmospheres. Only have modifications to the unit carried out by the manufacturer, Weinmann, or by a technician expressly authorized by Weinmann. Caution! Do not place a switched-on cellular phone or radio closer than 1 m from the MEDUMAT Transport, as this could cause malfunctions. Remember that the respiratory resistance of the system as a whole may increase beyond the level specified by the standard when an HME filter 20 EN Safety information

21 (heat and moisture exchanger), a bacterial filter or a combined HME bacterial filter is used. Please also follow the manufacturer's instructions for use for the filter being used. When operating the unit with the power supply unit, always connect the unit to an easily accessible outlet so that it can be unplugged quickly in the event of a malfunction. When operating the unit with the power supply unit, make sure that the power cord cannot cause anyone to trip or cause any obstruction. If necessary, do not use an external power supply, but operate the unit with the battery instead. When operating the unit with the 12 V supply cord, always connect the unit to an easily accessible vehicle electrical system receptacle so that it can be unplugged quickly in the event of a malfunction. When operating the unit with the 12 V supply cord, make sure that the cord cannot cause anyone to trip or cause any obstruction. If necessary, do not use the vehicle electrical system, but operate the unit with the battery instead. An alternative ventilation unit must be kept available in case a unit fails. After using the unit in a dusty environment (e.g., a gravel plant), change the suction filter, as described in the section "11.4 Changing the suction filter" on page 102. Safe handling of oxygen Warning! Risk of explosion! In combination with combustible substances (grease, oil, alcohol etc.), highly compressed oxygen may give rise to spontaneous explosive reactions. Risk of fire! If only the O 2 inlet/outlet is used, close the O 2 inlet on the side with a suitable cap. Otherwise, oxygen will escape from the O 2 inlet on the side. Risk of poisoning! Highly concentrated oxygen can have a toxic effect on the patient if administered for too long and depending on the age of the patient. When ventilating with pure oxygen or an oxygen-air mixture, make sure that oxygen is only administered for an appropriate period. Keep the units and all screwed unions absolutely free from oil and grease. Be sure to wash your hands before working on the oxygen supply. Safety information EN 21

22 Smoking and open flames are strictly prohibited in the vicinity of fittings containing oxygen. Caution! When assembling the unit, and when changing cylinders, tighten all screwed unions on the oxygen cylinder and pressure reducer by hand only. Never use tools. Overtightening damages the threads and seals, resulting in leaks. Secure the oxygen cylinders so that they cannot fall over. If a cylinder falls on the pressure reducer or valve, these could break off, causing a violent explosion. Risk of insufficient oxygen supply Two oxygen sources can be connected to this unit simultaneously. Make sure that only one oxygen source is open at any given time and that there is no gas reflux. Otherwise, one of the oxygen sources may empty itself unnoticed. Sufficient oxygen supply to the patient can then no longer be guaranteed when the unit is in use. Always open the cylinder valve slowly to prevent pressure hammer on the fittings. Do not empty oxygen cylinders completely, as this may allow moist ambient air to enter and cause corrosion. Ventilation/Handling Caution! The unit's USB interface should only be serviced by the manufacturer or an authorized technician. Do not connect equipment of any sort to the USB, in case this interferes with operation of the unit, putting the patient at risk. Patient and emergency ventilator must be kept under continuous observation during ventilation. Prolonged ventilation can lead to atrophy of the muscles (dependency of the patient on ventilation). Prolonged ventilation may lead to the airway drying out. Ensure adequate conditioning of the respiratory gas. Only apply high ventilation pressures for short periods and only if medically indicated. Permanently applied high ventilation pressures can be injurious to the patient. Make sure that the patient valve is not covered or its function impaired, e.g. by the patient's position. 22 EN Safety information

23 The patient hose systems for the device have different dead spaces. Please take the dead space into consideration when selecting the ventilation parameters, particularly when ventilating infants with very small tidal volumes. Otherwise, there is a risk of insufficient ventilation. Do not place the patient valve of the disposable hose system with reduced dead space near the O 2 inlet of the MEDUMAT Transport, in order to prevent the device sucking in CO 2. Please note that the inspiratory resistance of a disposable hose system with reduced dead space increases during adult ventilation. Please bear in mind that the use of a humidifier or a nebulizer will increase the dead space. Patient Hose System Software Warning! Risk of injury. Only use the Patient Hose System if you are a qualified medical professional and have received training in respiration techniques. Improper use may lead to serious physical injury. The Patient Hose System must be subjected to a functional check and visual inspection by the user before use. For this, refer to the instructions for use for the Patient Hose System. When connecting the patient valve, check that the direction of flow of the respiratory gas is correct. Make sure that the expiration opening of the patient valve is not covered or prevented from functioning, e.g., by the patient's position. Only use the Patient Hose System for the purpose described. For this, refer to the instructions for use for the Patient Hose System. The Patient Hose System is not suitable for hyperbaric use (pressure chamber). Also refer to the instructions for use for the Patient Hose System. Risks due to software errors have been minimized by means of extensive qualification measures. Accessories/Repairs/Replacement parts Caution! Protect silicone/rubber parts against UV light and prolonged direct exposure to sunlight to prevent them becoming brittle. Safety information EN 23

24 We recommend that work such as inspections and repairs should be carried out by the manufacturer, Weinmann, or by a technician expressly authorized by Weinmann. If third-party items are used, functional failures may occur and fitness for use may be restricted. Biocompatibility requirements may also not be met. Please note that in such cases, any claim under warranty and liability will be voided if neither the accessories nor genuine replacement parts recommended in the instructions for use are used. This product may contain disposable items. Disposable items are intended to be used only once. So use these items only once and do not reprocess them. Reprocessing disposable items may impair the functionality and safety of the product and lead to unforeseeable reactions as a result of ageing, embrittlement, wear, thermal load, the effects of chemical processes, etc. 24 EN Safety information

25 4. Installation As a rule, MEDUMAT Transport only has to be installed for stationary use in rescue vehicles, helicopters or aircraft. In this case, fastening sets can be supplied as accessories. If MEDUMAT Transport is supplied complete on a portable system, the unit is ready for operation and no further installation work is required. There are separate instructions for use for the portable systems. Warning! After installation, you must perform a functional check (see "9. Function check" on page 88) to ensure reliable operation. 4.1 Connecting oxygen cylinder Warning! Risk of explosion! Wash your hands thoroughly before doing any work on the oxygen supply. Hydrocarbon compounds (e.g. oil, grease, cleaning alcohol, hand cream or adhesive plasters) can cause explosive reactions if they come into contact with highly compressed oxygen. Never use wrenches or other tools to tighten or unscrew the union nuts. Note! Use the OXYWAY Fast II High Flow pressure reducer. Foreign pressure reducers can impair the unit's efficiency. Removing the empty cylinder 1. Close the valve on the oxygen cylinder. Switch on MEDUMAT Transport at the On/Standby/Off switch. This allows the remaining oxygen to escape and the unit is pressure-free. Only when the contents gauge on the pressure reducer indicates 0 bar, can the screwed union be undone by hand. 2. Switch MEDUMAT Transport off again. 3. Undo the screwed union at the cylinder by hand. Installation EN 25

26 Connecting a new cylinder 1. Briefly open the valve of the new oxygen cylinder, then shut it again. This is to blow away any particles of dust. Caution! Make sure that the patient is not connected up to the MEDUMAT Transport when you are establishing the gas supply. Otherwise, the unit's automatic self-test can lead to incorrect results. When doing this, hold the valve opening away from your body in such a way that any flying particles cannot injure yourself or other people! 2. Screw the pressure reducer to the cylinder valve using the knurled union nut. Tighten the union nut by hand. 3. Screw the pressure hose onto the outlet of the pressure reducer (if not already connected) using the G 3/8 union nut. 4. Screw the other end of the pressure hose to the compressed gas connection of the MEDUMAT Transport (if not already connected). Connecting a second oxygen source Caution! Risk of insufficient oxygen supply Two oxygen sources can be connected to this unit simultaneously. Make sure that only one oxygen source is open at any given time and that there is no gas reflux. Otherwise, one of the oxygen sources may empty itself unnoticed. Sufficient oxygen supply to the patient can then no longer be guaranteed when the unit is in use. If desired or if foreseen in your establishment, you can connect a second oxygen source, e.g., an oxygen cylinder or a CGC to the O 2 inlet/outlet (quick connector to the front of the unit). Note: If your unit is equipped with a DIN quick connector, no oxygen can be fed into the unit with the associated DIN gas probe. With this combination it is only possible to draw off oxygen. 26 EN Installation

27 4.2 Hose system A reusable hose system is supplied with the MEDUMAT Transport. Alternatively, a disposable hose system and a disposable hose system with reduced dead space are also available. Information on the disposable hose system with reduced dead space can be found in the instructions for use for the patient hose system WM To connect reusable and disposable hose systems, proceed as follows: 1. Press the ventilation hose onto the corresponding connection on the unit. 2. Attach the connector of the BiCheck flow sensor connection line to the corresponding connection on the unit. Elbow Connector 3. Press the connector (contains PEEP control line, CO 2 measuring hose, pressure-measurement tube) onto the corresponding connection on the unit. Make sure that the connected tubes are not kinked. Caution! Only grip the ventilation hose by its ends. Otherwise the hose may be damaged. 4. Connect the patient valve with BiCheck flow sensor to the hose following intubation. If performing mask ventilation, attach the ventilation mask to the patient valve with the BiCheck flow sensor (identical to tube connection). Note! You can remove the elbow to reduce the dead space or to adapt the hose routing to suit the patient's position. Elbow Installation EN 27

28 Tube protection sleeve The tube protection sleeve is pulled over the ventilation hose with connected BiCheck flow sensor. It prevents the hose system from tangling on other items of equipment and being damaged. Water filter for CO 2 measuring hose Note: Always operate the unit with a water filter when CO 2 suction is activated. Otherwise particles that have been sucked in can damage the CO 2 module. The water filter WM loses efficiency after approx. 8 hours of continuous operation, depending on the temperature, humidity and any coarse particles such as mucus. Change the filter after eight hours at the latest. The filter's decreasing efficiency is indicated by the alarm message "CO 2 occlusion" on the display. This message is accompanied by a low-priority audible alarm. 4.3 Accessories from other manufacturers Caution! The unit's USB interface is intended exclusively for use by the manufacturer or an authorized technician for servicing work. Do not connect equipment of any sort to the USB, as this will interfere with operation of the unit, putting the patient at risk. Accessories Assembly Special features HME filter Bacterial filter Combined HME bacterial filter If a filter is used, install it between the patient connection of the BiCheck flow sensor (with elbow if desired) and the tube or mask. Follow the manufacturer's instructions. 28 EN Installation

29 Ventilation mask Laryngeal mask Accessories Assembly Special features Laryngeal tube Gooseneck Endotracheal tube Tracheostomy tube Humidifier* Nebulizer** Onto the BiCheck flow sensor If a humidifier is used, install it between the patient connection of the BiCheck flow sensor and the tube/mask. If a nebulizer is used, install it between the patient connection of the HME filter, bacteria filter or the combined HME bacterial filter and the tube/mask (with elbow if desired) Requires standard connection as per ISO Requires standard connection as per ISO Follow the manufacturer's instructions for use Requires standard connection as per ISO Follow the manufacturer's instructions for use *Not all types of humidifiers are suitable for use with MEDUMAT Transport. Always ensure that all products are compatible. **Not all types of nebulizers can be used effectively with MEDUMAT Transport. Always ensure that all products are compatible. Installation EN 29

30 Assembling the nebulizer Caution: When assembling the nebulizer, observe the correct order of the individual components. Always install a HME filter, bacteria filter or a combined HME bacterial filter between the BiCheck flow sensor and the nebulizer. If the filter is not installed correctly, or no filter is used, the membranes may become stuck together in the patient valve and cause the BiCheck flow sensor to deliver faulty measurements. 1. Attach the mask/tube (with elbow if desired) to the nebulizer. 2. Connect the open end of the nebulizer to the HME filter, bacteria filter or the combined HME bacterial filter. 3. Attach the HME filter, bacteria filter or the combined HME bacterial filter to the BiCheck flow sensor of the patient hose system. Supplying oxygen to external units You can use the O 2 inlet/outlet to connect the units, modules or inhalation devices to the MEDUMAT Transport (quick connector on the front of the units). When doing so, bear in mind that the outlet gas flow reduces the efficiency of the gas supply (see "13.5 Possible O 2 concentration with counterpressure" on page 116). 30 EN Installation

31 4.4 Permanent installation of the unit If you wish to install the unit on a portable system or permanently install it in a vehicle or aircraft, you require the fastening set WM The following diagram shows the method of installation. Back panel of MEDUMAT Transport Portable system Installation EN 31

32 5. Operation 5.1 Controls Display The display provides the following information while the unit is in use. Progress of the current ventilation Current measurements Ventilation parameters set/to be set Current assignment of the context-dependent function buttons and control knobs Alarms and error messages Function buttons with fixed assignment Function buttons with fixed assignment The fixed-assignment function buttons enable you to carry out the following functions directly: Mute acoustic alarms Call up the main menu Activate the "100% O 2 " function Call up the "O 2 concentration" menu 32 EN Operation

33 Context-dependent function buttons Function buttons for emergency ventilation Contextdependent buttons Contextdependent buttons Contextdependent buttons On both sides of the display there are context-dependent function buttons for calling up the following functions: Left side of the display: Selecting emergency modes (available in every ventilation mode): Infant (approx. 10 kg) Child (approx. 25 kg) Adult (approx. 75 kg) Right side of the display: Calling up menus during ventilation: Button 1: Selecting a ventilation mode (see "6. Ventilation modes" on page 54) Button 2: Setting trigger thresholds in BiLevel, CPAP + ASB, PRVC, S-IPPV and SIMV modes (see "Trigger thresholds" on page 77) Button 3: Setting ASB (Assisted Spontaneous Breathing) pressure support in BiLevel, CPAP + ASB, PRVC and SIMV modes Navigating in a menu: Button 1: Up Button 2: Down Button 3: Confirm selection Alternatively, these settings can also be made with the navigation knob (dual navigation). Setting a parameter: Button 1: Increase value Button 2: Decrease value Button 3: Confirm selection Alternatively, these settings can also be made with the navigation knob (dual navigation). Operation EN 33

34 Navigation knob Navigation knob When a menu is open, you can use the navigation knob to navigate as follows: Turn anticlockwise: moves the selection bar upwards in the menu Turn clockwise: moves the selection bar downwards in the menu Press the navigation knob: confirms selection When no menu is open, you can carry out the following functions: Confirm setting parameters that have been set with the context-dependent control knobs Set and confirm the I:E ratio Context-dependent control knobs Depending on the ventilation mode selected, you can set the following parameters using the control knobs (see "Function of the controls during ventilation" on page 12): Control knob 1: PEEP Control knob 2: Vt, P insp ; in some ventilation modes, this knob has no function Control knob 3: P max (alarm limit) Control knob 4: Respiratory rate (no function in some modes) Navigation knob 5: I:E (no function in some modes) If you change the ventilation parameters with the control knobs, the corresponding parameters and the symbol above the navigation button will flash for 5 seconds. If you do not confirm the changed parameters with the navigation button or the contextdependent button within 5 seconds, they will not be applied. 34 EN Operation

35 Above the navigation knob the unit also displays values dependent on the ventilation parameters: I:E Freq. Vt Ventilation parameters Additionally displayed values T i T i and MV I:E and MV (with Freq. of 5/min) MV If certain values fall above or below the ventilation parameters, the corresponding ventilation parameter flashes red (see "6.2 Important ventilation parameters" on page 55). 5.2 Switching the unit on/self-test 1. Open the valve on the oxygen cylinder slowly. The contents gauge now indicates the cylinder pressure. On/Standby/Off button 2. Calculate the remaining operating time if necessary (see "5.13 Calculating the Oxygen level/operating time" on page 48). You should change the cylinder in good time, e.g., when the pressure falls below 50 bar, to ensure a sufficiently long operating time. 3. To switch on MEDUMAT Transport, press the On/ Standby/Off button. An automatic self-test runs which includes the following sequence of steps: Alarm LED flashes briefly Alarm buzzer emits a series of five audible sounds Loudspeaker emits a series of two audible sounds Ventilator checks its own functions internally Operation EN 35

36 The self-test is successful when all the steps have been completed. Check that all the steps are successfully completed. Do not operate the unit if: one of the first three steps has not been successfully completed the last part has not been successfully completed ("Fault" message appears in the display) Caution! The automatic self-test is not a substitute for a function check. Before using the unit, always carry out a function check as described in section"9. Function check"on page 88. This is the only way to ensure that the unit is fully functional. 4. The "Start menu" appears in the display. You now have the following options: Press one of the emergency buttons (Infant, Child, Adult): The unit immediately begins ventilation with the preset parameters. Do not make any selection: After 20 seconds the "Start menu" will disappear. The unit begins ventilation in the mode that was last selected and with the parameters last set. Press the "Previous patient" button: The unit immediately begins ventilation in the last mode selected. Press the "New patient" button: Select the "Adult", "Infant" or "Child" button. The "Mode" menu appears. Select the appropriate ventilation mode and confirm your selection. Use the control knobs to set the parameters for ventilating the patient. Then use the context-dependent buttons to select "Start ventilation" if you want to start ventilation, "Alarm Limits" if you want to determine the alarm limits in the "Alarm Limits" menu (see "7.2 Alarm Limits" on page 74) or "back" if you want to change any settings. 36 EN Operation

37 Note: As soon as you select a new patient, you can use the menu button to change over to the main menu. Select "Function check" menu: The unit will begin the automatic function check (see "9.4 Automatic function check" on page 91). Note: As a precaution you can mute the alarms immediately after the unit starts up. 5. When the self-test has finished and the ventilation mode has been set, connect the patient. 6. Adjust the ventilation values if necessary during ventilation. 5.3 Navigating in menus The vast majority of functions of the MEDUMAT Transport are accessed via menus. MEDUMAT Transport offers two methods of navigating in these menus: using the navigation knob using the context-dependent function buttons on the right of the display You can close menus at any time by pressing the Menu button again. If you do not change any parameters, the menus close automatically after 20 seconds. Parameter changes will not be implemented unless they are confirmed with the navigation knob or context-dependent button. Operation EN 37

38 Navigating with the navigation knob Navigation knob 1. Use the function buttons to select a menu (here: Alarm Limits). 2. Select a menu item by turning the navigation knob clockwise (the selection bar moves downwards) or anticlockwise (the selection bar moves upwards). 3. Confirm your selection by pressing the navigation knob. 4. To exit a menu, use the navigation knob to select the menu item "back" and confirm your selection by pressing the navigation knob. Proceed in the same way when making numeric settings (here: Alarm Limits) Turn the navigation knob clockwise to raise the value, and anticlockwise to lower it. Press the navigation knob to confirm the newly set value. If you wait or set another ventilation parameter by mistake, a set value will be rejected. 5. To switch from a sub-menu directly to the ventilation screen, press the "Main menu" function button again. 38 EN Operation

39 Navigating with the context-dependent function buttons Other symbols used in the menus: 1. First use the function buttons to select a menu (here: Main menu). 2. Select a menu item by pressing the function button (the selection bar moves downwards) or the button (the selection bar moves upwards). 3. Confirm your selection by pressing the button. 4. To leave a menu, select the menu item "back", using the or button, and confirm your selection by pressing the button. Proceed in the same way when making numeric settings (here: Alarm Limits) Press the button to raise the value and the button to lower it. Press the button to confirm the newly set value. If you wait or set another ventilation parameter by mistake, a set value will be rejected. 5. To switch from a sub-menu directly to the ventilation screen, press the "Main menu" function button. Radio button: If a menu contains functions which have a so-called "Radio button", only one function at a time can be selected in these menus. Tick box: If a menu contains functions which have a so-called Tick Box, these functions can be activated in addition to other functions. Operation EN 39

40 5.4 Selecting emergency mode Emergency ventilation function buttons Three modes with preset ventilation parameters are available for emergency ventilation. You can select these directly at any time during ventilation by pressing one of the function buttons twice or by pressing one of the function buttons once and then confirming with the navigation knob. Button 1: Infant Button 2: Child Button 3: Adult A pressure gauge is displayed in emergency mode. Exit the emergency mode as follows: Select a mode in the "Mode" menu Select the menu item "Curves" in the main menu. All three emergency modes are based on the IPPV ventilation mode (see "IPPV" on page 67). This mode is activated automatically when you call up an emergency mode from another ventilation mode. IPPV ventilation is started with preset parameters. These are optimized for the following patient groups: Infant (approx. 10 kg body weight) Child (approx. 25 kg body weight) Adult (approx. 75 kg body weight) Factory settings of the unit: Parameter Adult Child Infant PEEP 0 mbar 0 mbar 0 mbar P max 30 mbar 25 mbar 20 mbar I:E 1:1.7 1:1.7 1:1.7 Frequency 12/min 20/min 30/min Vt 600 ml 200 ml 100 ml 40 EN Operation

41 5.5 Selecting a ventilation mode To select a different ventilation mode, proceed as follows: 1. First, use the "Mode" function button to select the "Mode" menu. 2. Use the navigation knob or the context-dependent function buttons on the right of the display to select the ventilation mode you require. If necessary you can: also activate the NIV function, also activate Apnea ventilation or activate pre-oxygenation with 100% O Confirm your selection by pressing the navigation knob or the corresponding context-dependent function button. Note: In combined ventilation modes, breaths triggered by the patient within a time slot of 20% (depending on the rate) or 100% (S-IPPV mode) of the expiration time before the mandatory breath is initiated. You will find a detailed description of all the ventilation modes in the "Mode" menu in section "6. Ventilation modes"on page Changing the ventilation mode If you change from one ventilation mode to another, the unit will respond as follows: Ventilation parameters which are also available in the new ventilation mode are retained unchanged. Ventilation parameters which are not available in the new ventilation mode are saved, but have no influence on current ventilation progress. The saved values become available again as soon as the previous ventilation mode is reactivated. When changing from volume-controlled ventilation to pressurecontrolled ventilation, the preset inspiratory pressure is 15 mbar. Operation EN 41

42 5.7 Selecting additional ventilation functions The ventilation functions "O 2 concentration" and "100% O 2 " are available for all the ventilation modes. You can call up and set these functions at any time using the fixedassignment function buttons on the right of the display. Warning! Risk of poisoning! Highly concentrated oxygen can have a toxic effect on the patient if administered for too long, depending on the age of the patient. When ventilating with pure oxygen or an oxygen-air mixture, make sure that oxygen is only administered for an appropriate period. Setting the O 2 concentration To save oxygen, ventilation is normally carried out with an oxygen/air mixture. The administered oxygen concentration can be selected between 40% and 100%. The currently measured value is shown in the info field on the display. If you switch from oxygen/air mixture (40% O 2 ) to pure oxygen (100% O 2 ), the respiratory minute volume changes within the preset tolerances (see "13. Technical Data" on page 110). To set the O 2 concentration, proceed as follows. 1. Use the FiO 2 button to call up the "O 2 concentration" menu. 2. Select the required inspiratory O 2 concentration using the navigation knob or the function buttons. 3. Press the button or the navigation knob to confirm your selection. 42 EN Operation

43 Activate the 100% O 2 function To raise the oxygen concentration to 100% briefly (two minutes maximum), you can use the "100% O 2 " function. 1. Press the "100% O 2 " button to activate the function. The message "100% O 2 " appears in the display. 2. Press the "100% O 2 " button again to end the function. Ventilation is continued with the originally set O 2 concentration. The function is ended automatically after two minutes. 5.8 Performing ventilation Endotracheal tube As a rule, the patient is intubated before the tube is connected to the patient valve. 1. Set the desired ventilation mode and the associated ventilation parameters. 2. Attach the patient valve to the endotracheal tube connector. 3. During ventilation, check the respiratory parameters on the display. This will enable you to determine whether ventilation is adequate. Note: If your unit is equipped with the optional CO 2 measurement, you can check the tube position on the basis of the capnogram and correct it if necessary. Ventilation mask 1. If necessary, use the elbow supplied with the hose system to allow you to optimize the route of the hose system, depending on the patient's position. Caution! Using the elbow increases the dead space of the hose system. Take this into account when setting the ventilation parameters. Otherwise the success of treatment may be compromised. 2. Attach the mask to the hose system. 3. If necessary, introduce a Guedel oropharyngeal tube to keep the patient's airways free. 4. Place the ventilation mask over the patient's mouth and nose. Operation EN 43

44 5. Tilt back the patient's head and, at the same time, hold the mask tight against the patient's face with the C grip. 5.9 Monitoring ventilation General During ventilation, you must monitor the patient continuously. You can follow the progress of ventilation on the display. You can select various display formats. High airway resistances, e.g., due to obstructions of the airway or during external cardiac massage, may change the respiratory minute volume, depending on the ventilation mode. If lung compliance decreases, the unit responds as follows: With volume-controlled ventilation, the ventilation pressure rises until the set pressure limit is reached, while the ventilation volume remains constant. Then the applied volume drops. With pressure-contolled ventilation, the applied volume drops while the pressure remains constant. Example of ventilation progress before and after decrease in compliance during volume-controlled ventilation Note: All the displayed measurements for flow, volume, or MV relate to ambient temperature and ambient air pressure. 44 EN Operation

45 Displayed measurements During ventilation, the following parameters are displayed as numbers: O 2 i: inspiratory O 2 concentration measured by the unit Vt e : expiratory tidal volume/breath volume f/(f sp ): respiratory rate/number of spontaneous breaths per minute MV e : expiratory minute volume etco 2 : end-tidal CO 2 concentration (only with units equipped with optional CO 2 measurement). If you deactivate CO 2 suction in the Options CO 2 suction menu, the CO 2 display is crossed out in red. If you select two curves and measurements for your curve display, you will be shown the following measurements in the display: ppeak: Peak pressure in mbar pplat: Plateau pressure in mbar pmean: Mean pressure of all measurements in mbar Vleak: Leakage in % Vt i Ventilation progress curves For the purpose of monitoring ventilation, the standard unit displays the following parameters as curves: Pressure, flow Pressure, flow, measurements Operation EN 45

46 If you have a unit equipped with CO 2 measurement, you can vary the display as follows: Pressure, flow Pressure, CO 2 Pressure, flow, CO 2 Pressure, flow, measurements Pressure, CO 2, measurements 5.10 Alarm signals Alarm priority MEDUMAT Transport classifies alarms into the following priority levels: high priority medium priority low priority If two or more alarms occur simultaneously, alarms with the currently highest priority are displayed cyclically. You can set limit values for alarms relating to respiratory physiology (see "7.2 Alarm Limits" on page 74). Display of alarms MEDUMAT Transport displays alarms as follows: High priority LED flashes red "High priority" alarm sounds every 8 seconds Info field Alarm text appears in info field; info field flashes red Medium priority LED off "Medium priority" alarm sounds every 15 seconds Alarm text appears in info field; info field flashes yellow 46 EN Operation

47 Low priority LED off "Low priority" alarm sounds every 30 seconds Alarm text appears in info field; info field has turquoise background Set alarms are displayed in the "Alarm Limits" menu in their priority color (see "7.2 Alarm Limits" on page 74). Muting the alarm You can use the alarm mute button at any time to mute the alarm signal for 120 s. During this time, the yellow LED of the alarm mute button flashes. Pressing the button again reactivates the acoustic alarm. The visual alarm continues to remain active. Visual and acoustic alarms are reset automatically as soon as the cause of the alarm has been removed Ventilation with filters (not supplied with the unit) For hygiene purposes, and to condition the air for breathing, you can equip the patient valve with commercially available filters (HME, bacterial or combined HME/bacterial filters) with standard 15/22 mm connections. This increases both inspiratory and expiratory resistance. Therefore you should monitor the ventilation pressure and volume with special care. Allowance must be made for the larger dead space, especially with children. Always follow the filter manufacturer's instructions for use Ending ventilation Caution! Never empty the oxygen cylinder completely. Always ensure that there is a certain residual pressure in the cylinder when you return it for filling, since this prevents moist ambient air from entering and causing corrosion. Operation EN 47

48 1. Check the remaining oxygen content on the contents gauge of the pressure reducer. If the contents gauge indicates 50 bar or less, the cylinder must be refilled or a reserve cylinder obtained to ensure that the unit remains ready for use. 2. Close the valve on the oxygen cylinder. 3. Hold down the On/Standby/Off button for 2 seconds to switch the unit to standby. Note: The unit still uses up electricity in standby mode. If the unit does not need to be used for a long time or is not connected to the power supply, we recommend switching it off completely. To do so, hold down the On/Standby/Off button until the LED alarm goes out (approx. 10 seconds) Calculating the Oxygen level/operating time Caution! When calculating the oxygen level in the cylinder, take into account the unit's O 2 consumption (see "13.4 O 2 consumption of the unit" on page 115). Otherwise you may miscalculate how long the cylinder will last, which may impair the success of treatment. Oxygen level in the cylinder Oxygen volume = cylinder volume x cylinder pressure Cylinder volume x Cylinder pressure = Oxygen content Example 1 10 l x 200 bar = 2000 l Example 2 10 l x 100 bar = 1000 l Ventilation operating time Vt (tidal volume) x f (respiratory rate) = MV (minute volume) Oxygen supply (l) Ventilation operating time (min) = Vt x f + O 2 consumption O 2 concentration 48 EN Operation

49 Example 1: O 2 supply = 1000 l; Vt x f = 11 l/min; 100% O 2, O 2 consumption 0.3 l (see "13.4 O 2 consumption of the unit" on page 115). This gives: 1000 l 100 Ventilation operating time (min) = = 88 min = 1 h 28 min 11.3 l/min 100% If MEDUMAT Transport is operated with an O 2 concentration less than 100%, the operating time will increase correspondingly Alternative ventilation In the event of the MEDUMAT Transport breaking down during ventilation, you have the following alternatives: Ventilation bag 1. Pull the patient valve off the tube or mask. 2. Attach the ventilation bag, e.g., COMBIBAG WM from Weinmann and perform manual ventilation. Ventilation aid Alternatively, you can use the LIFEWAY WM from Weinmann to perform mouth/ mask ventilation. Oxygen failure In exceptional situations, when there is no oxygen supply, the MEDUMAT Transport can also be operated with sterile compressed air. Note: If the NIV function is not activated, the unit sounds the "FiO 2 not achievable" alarm continuously during ventilation with sterile compressed air Changing battery during use You should change a battery with low capacity in good time. Always keep a fully charged replacement battery ready for use. Operation EN 49

50 Proceed as follows: 1. Have the fully charged battery ready to hand. 2. Switch off the device. Caution! Do not remove the battery whilst the device is in operation, as this prevents the settings for the last patient being safely stored. Always switch off the device first. 3. Pull the low battery currently in use out of the unit's battery compartment. 4. Insert the replacement battery into the compartment. 5. Switch on the device. 6. To adopt the settings entered before changing the battery: Click on "Previous patient" in the Start menu to call up the settings. 7. Continue with ventilation Battery management MEDUMAT Transport has an internal power supply with a rechargeable battery. Two battery versions are available: BATTERY pack Plus WM for internal and external charging; can be recharged either in the unit or using an external charger WM 28305; charge level can be checked on the battery. BATTERY pack WM for internal charging; can only be recharged in the unit; charge level can be checked on the battery. For recharging the battery, an external DC power supply with V (internal charging) or 15 V (external charging) is required. Use only the vehicle/aircraft on-board electrical power supply or, if charging from the mains, use charger WM MEDUMAT Transport can be operated from an external power supply when the battery is empty. The battery is charged while the unit is in operation but charging takes longer than when the unit is switched off. Caution! Never operate the unit without a battery because any voltage dips in the power supply cannot then be bridged. This would mean that uninterrupted ventilation of the patient could not be guaranteed. 50 EN Operation

51 Battery-operated medical devices have a limited operating period. MEDUMAT Transport can be operated for at least 4.5 hours without an external power supply, provided that the battery is fully charged. You should therefore ensure that the battery is always as fully charged as possible, or that you have a spare battery ready for use. Battery charge level indicator (MEDUMAT Transport) empty half full full At the top left of the display you will find the symbol indicating the battery charge level. This is displayed in five levels. The picture opposite shows examples of a full, halffull and empty battery. Charge level indication on the battery itself Capacity indicator Accu-Pack Plus MEDUMAT Transport WM Button Status LED When the battery is removed from the unit, you can also check the charge level on the battery itself. The charge level is indicated by 4 green LEDs. Press the button on the battery (see drawings opposite). Capacity indicator Battery charge level 4 LEDs 100% 3 LEDs 75% 2 LEDs 50% 1 LED 25% 1 LED flashing less than 10 minutes charge left The battery's charge level is indicated by the status LED Status LED LED glows green LED flashes green LED glows red Battery status Battery fully charged Battery is being charged Battery faulty. Do not use. Charging status indicator The charging status is only indicated when the external power supply is connected, since only then is it possible to actually charge the battery. When MEDUMAT Transport is off, the charging status is shown by the charging indicator. Operation EN 51

52 When MEDUMAT Transport is on, the charging status is shown by both the charging indicator and the capacity indicator. Key to charging status and capacity indicator: Battery is being charged Unit off Charging indicator flashes green Unit on Charging indicator Capacity indicator flashes green (current charge level) Battery full green green Problem during charging Battery is being discharged Battery missing or faulty red off off red off red (full) (current charge level) (current charge level) (current charge level) Charging batteries MEDUMAT Transport starts charging the battery automatically, as soon as the following conditions are met: External power supply with at least 12 V DC is connected The battery is not full (<95% charge) Battery temperature not above 45 C or below +5 C Note: The battery WM has its own charging interface, so it can also be charged outside the MEDUMAT Charging indicator Transport. Only use the mains and charger WM If charging cannot be started, e.g., because the battery temperature is outside the permitted range (+ 5 C - 45 C), the charging indicator glows red. It only goes out once all the conditions for starting charging are met. While the battery is being charged, the charging indicator flashes green. 52 EN Operation

53 Ending battery charging MEDUMAT Transport automatically determines the optimum point at which to end charging by measuring and evaluating the charging curve and battery temperature. As soon as charging has ended, the charging indicator glows green continuously. Interrupting battery charging Battery charging is continuously monitored by MEDUMAT Transport. Faults which cause charging to be interrupted are: Battery temperature rises above 45 C, e.g., due to high ambient temperature, or falls below +5 C Charging current is too high (>3 A) e.g., due to a short-circuit If one of these problems occurs, charging is automatically interrupted and the charging indicator glows red. Charging is also interrupted if there is no external power supply, e.g., because the unit, which is mounted on a portable system, is removed from the wall mounting. The charging indicator does not light up in this case because this is not a fault, but a normal operating situation. As soon as the external power is restored, e.g., when the portable system is put back into the wall mounting, charging continues immediately. Operation EN 53

54 6. Ventilation modes You can select different ventilation modes in the "Mode" menu (see "5.5 Selecting a ventilation mode" on page 41). This section describes: Classification of the ventilation modes (see "6.1 Classification of the ventilation modes" on page 54) Important ventilation parameters (see "6.2 Important ventilation parameters" on page 55) Additional functions and safety functions (see "6.3 Additional functions and safety functions" on page 56) Pressure-controlled ventilation modes (see "6.4 Pressure-controlled ventilation modes" on page 59) Volume-controlled ventilation modes (see "6.5 Volume-controlled ventilation modes" on page 67) 6.1 Classification of the ventilation modes Breathing effort 100% Patient Emergency ventilator 0% controlled respiration assisted ventilation Spontaneous respiration 54 EN Ventilation modes

55 The following ventilation modes are available in the unit: Control parameter Controlled ventilation Assisted ventilation Spontaneous respiration Pressure PCV BiLevel CPAP + ASB Pressure + Volume PRVC Volume IPPV S-IPPV SIMV Setting ventilation parameters can cause the classification of the ventilation modes to change. 6.2 Important ventilation parameters Ventilation parameter Explanation Unit behaviour/ Special features Vt Tidal volume (breath volume) In certain circumstances it may no longer be possible to achieve breath volume with volume-controlled ventilation. If airway pressure reaches the set limit P max, it will be limited to the value P max (pressurelimited ventilation). P insp Inspiration pressure >30 mbar = red light flashes PEEP Positive end-expiratory pressure (CPAP) >15 mbar = red light flashes Freq Respiratory rate <5/min = red light flashes I:E P max Ratio of inspiration time to expiration time Maximum inspiratory pressure Inverse ratio = red light flashes Pressure is limited to this value by the unit. Can be set from 3 mbar - 65 mbar. P max is displayed as a red line in the pressure curve in all ventilation modes. Ventilation modes EN 55

56 Note: Choose values which only cause the red light to flash in the case of special indications. 6.3 Additional functions and safety functions NIV NIV: Non-Invasive Ventilation (Mask ventilation) This additional function can be activated in all the ventilation modes. The leakage alarm is deactivated. The unit uses optimized trigger algorithms for non-invasive ventilation. If non-invasive ventilation is activated, the symbol for mask ventilation appears in the "Mode" function indicator. Caution! If the NIV function is not activated during ventilation with leakage, the patient can only trigger the unit by greatly increasing his/her respiratory efforts. This may endanger the success of treatment. In certain circumstances, the required O 2 concentration may not be achieved during ventilation with leakage. This is for technical reasons and does not indicate a malfunction. When the NIV mode is activated, the alarm limit for "FiO 2 not achievable" is therefore automatically set to 20 Vol%. Apnea ventilation Apnea ventilation is a safety function which causes the unit to take over and continue ventilation if the patient stops breathing (Apnea). If the patient is no longer breathing spontaneously and the set Apnea time (see "7.2 Alarm Limits" on page 74) in the "Alarm Limits" menu has elapsed, the unit will ventilate the patient (mandatorily) with a preset ventilation mode. A high-priority alarm sounds and the mode function indicator flashes red. 56 EN Ventilation modes

57 The ventilation mode which the unit reverts to for Apnea ventilation is indicated by a selected option in the "Mode" menu. The originally selected ventilation mode and the menu item Apnea ventilation are marked in red. You can make the following settings: Accept ventilation mode for Apnea ventilation Reactivate the ventilation mode set originally Change ventilation parameters on the display and then adopt set ventilation mode You can activate or deactivate Apnea ventilation in the "Mode" menu (see "5.5 Selecting a ventilation mode" on page 41) or in the "Apnea ventilation parameters" menu (see "7.5 Apnea ventilation parameters" on page 78). Apnea ventilation is always activated by default. In the "Apnea ventilation parameters" menu, you can decide which ventilation mode the unit should revert to during Apnea ventilation: BiLevel (pressure-controlled) SIMV (volume-controlled) In this menu, you can also set the ventilation parameters for Apnea ventilation. If you do not set any ventilation parameters, the unit adopts the presettings for these ventilation modes according to the patient (infant, child, adult). Ventilation modes EN 57

58 Pre-oxygenation Pre-oxygenation is a function which enables the oxygen content in a patient's lungs to be increased quickly, e.g., in preparation for intubation. The unit applies a flow of 100% O 2 which can be set in the menu item "Pre-oxygenation". Pressure is limited to 10 mbar for safety reasons. You can select pre-oxygenation in all ventilation modes. The function overrides the set ventilation mode and must be deactivated before ventilation with the set ventilation mode can resume. 58 EN Ventilation modes

59 6.4 Pressure-controlled ventilation modes BiLevel Caution! Ventilation pressure is limited to P max in the pressure-controlled modes (pressure limitation). A high-priority alarm is triggered when this pressure limit is reached. BiLevel: ventilation at two pressure levels You can set the following ventilation values using the control knobs: Ventilation mode Control knob Control knob 2 Control knob 3 BILEVEL PEEP P insp P max Freq. Control knob 4 Navigation knob 5 I:E and Select/ Confirm Function button 6 Function Function button 7 button 8 pasb Trigger Mode You can find more setting options under the menu item "Advanced ventilation parameters" in the main menu (see "7.4 Advanced ventilation parameters" on page 75). Ventilation modes EN 59

60 Pressure P max automated ventilation assisted respiration P insp PEEP Pressure ramp dp dt dt dp DpASB Time TI=T insp 1/Freq. (spontaneous) 1/Freq. (set) The BiLevel mode is used for pressure-controlled ventilation combined with free spontaneous respiration at pressure levels P insp and PEEP during the entire breathing cycle and for adjustable pressure support at PEEP level. This mode is used on patients who have no spontaneous respiration or on spontaneously breathing patients. The BiLevel ventilation mode is also used as the mode for Apnea ventilation (see "Apnea ventilation" on page 56). The patient can trigger a mandatory, pressure-controlled mechanical breath during a predetermined trigger time slot. The trigger time slot is 20% of the expiration time T e before the anticipated mandatory mechanical breath. For the rest of the time, the patient can breathe spontaneously or with the aid of pressure support (see "CPAP + ASB" on page 63). Tidal volume and minute volume are determined by the set P insp, lung compliance and the set inspiration time T i. 60 EN Ventilation modes

61 PCV PCV: Pressure Controlled Ventilation You can set the following ventilation values using the control knobs: Ventilation mode Control knob Control knob 2 Control knob 3 PCV PEEP P insp P max Freq. Control knob 4 Navigation knob 5 I:E and Select/ Confirm Function button 6 Function Function button 7 button Mode You can find more setting options under the menu item "Advanced ventilation parameters" in the main menu (see "7.4 Advanced ventilation parameters" on page 75). Ventilation modes EN 61

62 Pressure P max P insp Pressure ramp PEEP dt dp Time 1/Freq. (set) 1/Freq. (set) PCV mode is used for mandatory pressure-controlled ventilation with fixed pressure levels. This mode is used on patients who have no spontaneous respiration. However, a spontaneously breathing patient can breathe deeply and freely during expiration. The set maximum pressure limitation (P max ) ensures the safety of the patient. 62 EN Ventilation modes

63 CPAP + ASB CPAP: Continuous Positive Airway Pressure ASB: Assisted Spontaneous Breathing You can set the following ventilation values using the control knobs: Ventilation mode Control knob Control knob 2 Control knob 3 CPAP + ASB PEEP - P max - Control knob 4 Navigatio n knob 5 Select/ Confirm only Function button 6 Function Function button 7 button 8 pasb Trigger Mode You can find more setting options under the menu item "Advanced ventilation parameters" in the main menu (see "7.4 Advanced ventilation parameters" on page 75). Ventilation modes EN 63

64 Pressure P max CPAP without pressure support CPAP with pressure support ASB DpASB CPAP / PEEP Time 1/Freq. (spontaneous) 1/Freq. (spontaneous) The CPAP + ASB mode can be separated into its individual elements: The set value CPAP/PEEP is used to increase the pressure level of respiration in order to raise the functional residual capacity (FRC) of a spontaneously breathing patient. The ASB mode is used for pressure support of insufficient or exhausted spontaneous respiration. The patient is able to breathe spontaneously without any restriction, but is supported in his breathing effort by MEDUMAT Transport. The CPAP + ASB mode is used exclusively on patients with adequate spontaneous respiration. In principle, the pressure is set at the end of expiration (PEEP). In addition, pressure support ( pasb) can be switched on if needed. Ventilation can be individually adjusted to suit the patient with the aid of the inspiratory and expiratory triggers. The inspiratory trigger indicates a sensitivity for triggering pressure support. The expiratory trigger determines when the unit should switch off pressure support, which enables the administered volume and the inspiration time to be set indirectly. The set maximum pressure limitation (P max ) ensures the safety of the patient. 64 EN Ventilation modes

65 PRVC PRVC: Pressure Regulated Volume Controlled Ventilation You can set the following ventilation values using the control knobs: Ventilation mode Control knob Control knob 2 Control knob 3 PRVC PEEP Vt P max Freq. Control knob 4 Navigation knob 5 I:E and Select/ Confirm Function button 6 Function Function button 7 button 8 pasb Trigger Mode You can find more setting options under the menu item "Advanced ventilation parameters" in the main menu (see "7.4 Advanced ventilation parameters" on page 75). Ventilation modes EN 65

66 Pressure P max P Plateau P insp (variable) Safety margin 5 mbar Increments max. 3 mbar PEEP Time volume-controlled mechanical breath pressure-controlled mechanical breath pressure-controlled mechanical breath 1/Freq. (set) 1/Freq. (set) The controlled ventilation mode PRVC combines the advantages of both pressurecontrolled ventilation and volume-controlled ventilation. The set tidal volume is applied with the minimum ventilation pressure possible. Ventilation begins with three volume-controlled breaths with the set tidal volume and decreasing flow. The volume-controlled breaths have a plateau time of 50% of the configured inspiration time T i. The unit selects the measured plateau pressure as starting value for the inspiratory pressure P insp of the following pressure-controlled ventilation. It measures the administered volumes and adjusts the ventilation pressure accordingly. If the lung parameters change during ventilation, the unit alters the inspiratory pressure P insp in increments of a maximum of 3 mbar in order to achieve the set tidal volume again and thereby automatically compensate for changes in the patient. Measuring the applied volume is improved by compensating hose compliance. This enables precise control of the required tidal volume, in particular of small tidal volumes under high airway pressures. The set maximum pressure limitation (P max ) ensures the safety of the patient. For safety reasons inspiratory pressure P insp is 5 mbar below the set maximum pressure limitation (P max ). Once maximum ventilation pressure (P max - 5 mbar) is achieved, the unit administers as much volume as possible. If this volume deviates from the set tidal volume, the unit triggers the low-priority alarm "Vt not achievable". 66 EN Ventilation modes

67 6.5 Volume-controlled ventilation modes IPPV Warning! Risk of inconsistent volume once pressure limitation P max is reached! Monitor the patient continuously throughout volume-controlled ventilation modes and change the setting parameters if necessary. Once the pressure limitation is reached, a highpriority alarm (airway pressure ) guarantees the safety of the patient. IPPV: Intermittent Positive Pressure Ventilation You can set the following ventilation values using the control knobs: Ventilation mode Control knob Control knob 2 Control knob 3 IPPV PEEP Vt P max Freq. Control knob 4 Navigation knob 5 I:E and Select/ Confirm Function button 6 Function Function button 7 button Mode You can find more setting options under the menu item "Advanced ventilation parameters" in the main menu (see "7.4 Advanced ventilation parameters" on page 75). Ventilation modes EN 67

68 Pressure P max automated ventilation automated ventilation P Plateau PEEP Time 1/Freq. (set) 1/Freq. (set) The IPPV mode is used for mandatory volume-controlled ventilation with a fixed tidal volume. This mode is used on patients who have no spontaneous respiration. However, a spontaneously breathing patient can breathe deeply and freely during expiration. The set maximum pressure limitation (P max ) ensures the safety of the patient. Note: If you select a PEEP > 0 in this mode, the name of the mode changes from IPPV to CPPV (Constant Positive Pressure Ventilation). 68 EN Ventilation modes

69 S-IPPV S-IPPV: Synchronized Intermittent Positive Pressure Ventilation Warning! Risk of hyperventilation! Continuously monitor the patient's measured respiratory rate and measured minute volume in order to prevent hyperventilation. To this end, set a narrow alarm limit for the f alarm, in order to recognize the risk of hyperventilation in good time. Risk of air trapping! Continuously monitor the airway pressure in order to prevent air trapping. Risk of intrinsic PEEP! An expiration that is too short can cause the pressure to increase slowly at the end of the expiration. Monitor the sensitivity of the inspiratory trigger. Once the set PEEP is exceeded, a high-priority alarm (PEEP ) guarantees the safety of the patient You can set the following ventilation values using the control knobs: Ventilation mode Control knob Control knob 2 Control knob 3 S-IPPV PEEP Vt P max Freq. Control knob 4 Navigation knob 5 I:E and Select/ Confirm Function button 6 Function Function button 7 button 8 - Trigger Mode Ventilation modes EN 69

70 You can find more setting options under the menu item "Advanced ventilation parameters" in the main menu (see "7.4 Advanced ventilation parameters" on page 75). Pressure P max automated ventilation snychronized automated ventilation P Plateau PEEP Time 1/Freq. (current) DT 1/Freq. (set) Synchronized time slot The S-IPPV mode is used for volume-controlled ventilation with a variable mandatory minute volume MV. Throughout the entire expiratory phase, a trigger is active which enables the patient to trigger a new breath. This means the patient has the option of increasing the respiratory rate and therefore the minute volume MV, and adapting these to his/her needs. As a rule this mode is used on patients who have inadequate spontaneous respiration. Ventilation in the S-IPPV mode corresponds to ventilation in the IPPV mode with the difference that it is possible to synchronize ventilation with the patient's efforts to inhale. Since the setting for the respiratory rate is lower, the patient can trigger mandatory mechanical breaths spontaneously. A trigger time slot extending throughout the expiration time is available for this synchronization. 70 EN Ventilation modes

71 SIMV SIMV: Synchronized Intermittent Mandatory Ventilation You can set the following ventilation values using the control knobs: Ventilation mode Control knob Control knob 2 Control knob 3 SIMV PEEP Vt P max Freq. Control knob 4 Navigation knob 5 I:E and Select/ Confirm Function button 6 Function Function button 7 button 8 pasb Trigger Mode You can find more setting options under the menu item "Advanced ventilation parameters" in the main menu (see "7.4 Advanced ventilation parameters" on page 75). Ventilation modes EN 71

72 Pressure P max automated ventilation P Plateau Spontaneous respiration assisted spontaneous respiration synchronized automated ventilation DpASB PEEP Time 1/Freq. (current) DT 1/Freq. (set) Synchronized time slot The SIMV mode is used for volume-controlled ventilation with a fixed mandatory minute volume MV. The patient can breathe spontaneously between the mandatory mechanical breaths and thereby increase the minute volume. During spontaneous respiration, the mandatory mechanical breath is synchronized with the patient's breathing. The mandatory minute volume and the mandatory respiration rate remain unchanged. The set maximum pressure limitation (P max ) ensures the safety of the patient. The SIMV ventilation mode is also used as the mode for Apnea ventilation (see "Apnea ventilation" on page 56). The patient can trigger a mandatory, pressure-controlled mechanical breath during a predetermined trigger time slot. The trigger time slot is available in the final 20% of expiration time T e. For the rest of the time, the patient can breathe spontaneously or with the aid of pressure support (see "CPAP + ASB" on page 63). 72 EN Ventilation modes

73 7. Main menu In the main menu, you can optimize the unit's settings to suit the particular operating conditions. The main menu can be called up at any time using the "Main menu" function button. To navigate in the menu, you can use either the navigation knob or the context-dependent function buttons on the right of the display (see "5.1 Controls" on page 32). 7.1 Automatic alarm limits General When the "Automatic alarm limits" function is activated, the unit automatically determines limits for the alarms relating to respiratory physiology. Crucial for determining the limits are the respiratory values measured at the moment when the function is activated (Vt e, MV e, f, if necessary etco 2 ). In the "Alarm Limits" menu (see "7.2 Alarm Limits" on page 74), you can set the amount of deviation (in %) from the current respiratory value, which should trigger an alarm. Note: This overwrites the values set in "Alarm Limits" (see "7.2 Alarm Limits" on page 74). Automatic alarm calculation for the Apnea alarm Depending on the set percentage, the Apnea alarm is set to 4 (10%), 5 (20%) or 6 (30%) respiratory periods. The length of a respiratory period is 60/f in seconds, i.e., with a measured respiratory rate of, for example, 15/min, the increments for the Apnea alarm limit are 16 s, 20 s, and 24 s. Main menu EN 73

74 7.2 Alarm Limits You can set limit values for alarms relating to respiratory physiology. Once the limit values are reached, the unit triggers an alarm. You can set the following: Alarm Automatic alarm limits Setting range 10%, 20% or 30% deviation from the respiratory values at the moment of activation. MVe 1 l l MVe 0.1 l l f 1/min - 150/min Apnea 4 s - 60 s Only for units equipped with CO 2 measurement: etco 2 et CO 2 20 mmhg - 75 mmhg 2.6 Vol% Vol% 2.6 kpa - 10 kpa 0 mmhg - 40 mmhg 0 Vol% Vol% 0 kpa kpa If the unit triggers a set alarm, the alarm in this menu is displayed in the color of its priority (see "5.10 Alarm signals" on page 46). The alarm limit for the CO 2 i alarm is set at 5 mmhg. 74 EN Main menu

75 7.3 Curves In this menu, you can vary the display for monitoring ventilation. You can make the following settings: Parameters Pressure, flow Setting range Curves (Units equipped with CO 2 measurement) Curves (Units without CO 2 measurement) Pressure, CO 2 Pressure, flow, CO 2 Pressure, flow, measurements Pressure, CO 2, measurements Pressure, flow Pressure, flow, measurements If you select a display with measurements, the following measurements will be displayed: Measurement Explanation Unit P Peak Peak pressure mbar P Plat Plateau pressure mbar P Mean Mean pressure of all measurements mbar V leak Leakage % Vt i 7.4 Advanced ventilation parameters To achieve optimum results during transport ventilation, you can configure settings in the "Advanced ventilation parameters" menu, depending on the particular mode selected. The non-selectable functions in a particular ventilation mode are shown in gray letters. Main menu EN 75

76 Pressure ramp With this function you can set how quickly the inspiratory ventilation pressure should be reached. You can make the following settings: Parameters Flat ramp Medium ramp Steep ramp Setting range slow pressure rise medium pressure rise fast pressure rise Note: How quickly the set pressure is actually reached depends on the patient, any possible leakage (NIV) and the set ventilation parameters. Flow ramp With this function you can set how fast the inspiratory flow should be reached. You can make the following settings: Parameters Setting range Flat ramp slow flow rise Medium ramp medium flow rise Steep ramp fast flow rise Note: How quickly the set flow is actually reached depends on the patient, any leakage (NIV) and on the set ventilation parameters. 76 EN Main menu

77 Flow progress With this function you can set the flow progress. You can make the following settings: Parameters Setting range decreasing Flow progress constant Plateau time (0% T i - 50%T i ) If you select a plateau time (see "Plateau time" on page 119) for the flow progress, for the duration of the plateau time, no gas will be administered to the patient and at the same time expiration will be prevented. Trigger thresholds With this function you can set the inspiratory and expiratory trigger threshold. You can make the following settings: Parameters Setting range Inspiration Expiration 1 l/min - 15 l/min 5% Flow max - 50% Flow max Alternatively, you can also set the trigger thresholds on the right in the display, using the trigger thresholds function button. Use the control knob to navigate straight to the "Trigger thresholds" menu item. Main menu EN 77

78 7.5 Apnea ventilation parameters In this menu you can both specify the presettings for the Apnea ventilation (see "Apnea ventilation" on page 56) and activate Apnea ventilation. You can select the following ventilation modes for Apnea ventilation: BiLevel SIMV You can make the following settings: Parameters Setting range PEEP 0 mbar - 30 mbar P insp (BiLevel only) 3 mbar - 60 mbar Vt (SIMV only) 50 ml ml Freq 1/min - 60/min I:E 1: :1 7.6 Audio/Video In this menu, you can set the brightness of the display for the day colors and night colors separately. You can also set the alarm volume. You can make the following settings: Parameters Setting range Brightness/Day 10% - 100% Brightness/Night 10% - 100% Volume 50% - 100% 78 EN Main menu

79 7.7 Options CO 2 configuration In this menu, you can activate CO 2 suction. You can only access this menu if you have a unit equipped with CO 2 measurement. If you activate CO 2 suction, the current end-expiratory CO 2 concentration is shown bottom left in the display. If you deactivate CO 2 suction, this is shown bottom left in the display. In the menu, you can select which unit of measurement the CO 2 concentration should be displayed in. You can make the following settings: Parameters Setting range Unit mmhg Vol% kpa Main menu EN 79

80 Date, time In this menu, you can set the current date and time. You can make the following settings: Parameters Setting range Year Month Date, time Day Hour Minute Note: The date and time are also used for the unit's internal operations. Therefore they should both be checked regularly and corrected if necessary. Language In this menu, you can set the language in which the display should be shown. 80 EN Main menu

81 You can make the following settings: Parameters Setting range German English Spanish Italian Dutch Portuguese Brazilian Portuguese Russian Language Swedish Greek French Polish Turkish Thai Chinese Danish Romanian Note: Depending on the status of the firmware, additional languages may be available. Device data In this menu you can see the software version of your device (with date) and the date and time of the most recent function check passed. Main menu EN 81

82 Bluetooth This menu enables you to activate or deactivate a Bluetooth connection. With the Bluetooth connection activated, an application documentation system can connect to MEDUMAT Transport in order to retrieve application data. This menu only appears if the data communication option has been enabled. You can choose the following settings: Parameters Bluetooth Activated Deactivated Setting range 7.8 Night colors To ensure optimum readability of the display during nighttime use, you can activate the night colors. The readings are displayed on a black background. This prevents glare. You can set the brightness of the night colors in the Audio/ Video menu (see "7.6 Audio/Video" on page 78). 82 EN Main menu

83 8. Hygienic preparation The MEDUMAT Transport and the accessories used must be hygienically prepared after each use. Please refer to the instructions supplied with the disinfectant used. We recommend using gigasept FF (new) for immersion disinfection and terralin protect for wipe disinfection. Always carry out a functional check after the hygienic preparation (see "9. Function check" on page 88). 8.1 MEDUMAT Transport Warning! Never immerse the MEDUMAT Transport or the BiCheck flow sensor lead in disinfectant or other liquids. Otherwise the unit may be damaged, causing a hazard to users and patients. Keep MEDUMAT Transport and the BiCheck flow sensor connecting lead clean by wiping with disinfectant. Please refer to the instructions supplied with the disinfectant used. We recommend using terralin protect for wipe disinfection. 8.2 Hose systems Depending on the hose system used, the hose system may contain disposable articles. Do not reuse. For preparing the other components, follow the instructions for use supplied with the hose systems. Hygienic preparation EN 83

84 8.3 Parts and accessories Masks and all silicone parts must be cleaned in a disinfectant solution: 1. All surfaces must be wetted, free of bubbles, inside and outside. Allow the disinfectant to act for the full time specified by the manufacturer. 2. After disinfection, rinse the parts thoroughly with distilled water to avoid residues of the disinfectant solution causing problems. 3. Always allow parts to dry in the air. 4. Carry out a visual inspection and replace any damaged parts immediately. The reusable ventilation tube, reusable patient valve (see previous section), reusable BiCheck flow sensor and ventilation masks with silicone cushion can also be autoclaved. 8.4 BiCheck flow sensor Observe the following instructions for hygienic preparation to avoid damage to the BiCheck flow sensor: Caution! Never rinse off the BiCheck flow sensor under running water. Ingress of a water stream or jet may damage the BiCheck flow sensor. Take particular care to avoid a water stream or jet directly entering the CO 2 outlet. To rinse the BiCheck flow sensor after hygienic preparation, swirl it carefully in distilled water. Never dry the BiCheck flow sensor with compressed gas, as this may damage the measuring wires in the BiCheck flow sensor. Leave the BiCheck flow sensor to drip dry for a sufficient length of time. Alternatively, you can connect the patient hose system, without the testing bag, to the MEDUMAT Transport and actuate several mechanical breaths. For the purpose of thermal disinfection or sterilization, place the BiCheck flow sensor in a fine-meshed small parts tray with a lid to prevent the BiCheck flow sensor coming into direct contact with streams or jets of liquid. 84 EN Hygienic preparation

85 8.5 Fittings Warning! Risk of explosion! Never immerse the fittings in disinfectant or other liquids. Only carry out wipe disenfection. Liquid must not be allowed to enter the pressure reducer. Otherwise there is a risk of explosion. If it is absolutely necessary to clean the fittings (e.g., pressure reducer, valve), use a clean cloth. The cloth may be dry or moistened with clean water. 8.6 Cleaning, disinfection and sterilization Warning Risk of explosion! If wipe disinfection is required, make sure that no liquid enters the connections. Cleaning agents containing alcohol or grease become flammable when combined with compressed oxygen and can cause explosions. Carry out hygienic preparation of the MEDUMAT Transport and the accessories used, as described in the following table. Refer to the instructions supplied with the hose system and with the disinfectant used. We recommend using gigasept FF (new) for immersion disinfection and terralin protect for wipe disinfection. You are advised to use suitable gloves for disinfection work (e.g., household or disposable gloves). Note: Further instructions on hygienic preparation and a list of all suitable cleaning agents and disinfectants can be found in a brochure on the internet at Hygienic preparation EN 85

86 Reusable components Parts Cleaning Disinfection MEDUMAT Transport BiCheck flow sensor lead BiCheck flow sensor (5) Reusable patient valve Reusable ventilation mask Reusable ventilation hose Reusable measuring hose system PEEP control hose Pressure-measurement hose Connector measuring hose system Blanking plug Protective cap Reusable tube protection sleeve Oxygen fittings Elbow Wipe down with a moist cloth Wipe down with a moist cloth In hot water with a mild household detergent In hot water with a mild household detergent In hot water with a mild household detergent In hot water with a mild household detergent In hot water with a mild household detergent Wipe down with a moist cloth With a dry or moist cloth: use clean water In hot water with a mild household detergent Wipe disinfection Wipe disinfection Immersion disinfection Immerse in gigasept FF (new) solution (1) Immersion disinfection (1) Immersion disinfection (1) Immersion disinfection (1) 30 C washing cycle, without spinning Not permitted Immerse in gigasept FF (new) solution (1) Not permitted Not permitted Clean at 95 C, as instructed in the disinfector instructions. Dry thoroughly Thermodisinfector Sterilization Not permitted Not permitted Steam sterilization (3) Washing cycle up to Steam sterilization 95 C (2) (3) Washing cycle up to Steam sterilization 95 C (2) (3) Washing cycle up to Steam sterilization 95 C (2) (3) Washing cycle up to Steam sterilization 95 C (2) (3) Possible during the washing cycle Not permitted Not permitted Not permitted Washing cycle up to Steam sterilization 95 C (2) (4) (1) After disinfecting, rinse all parts thoroughly with distilled water and then leave them to dry. Follow the instructions on 86 EN Hygienic preparation

87 hygienic preparation of the BiCheck flow sensor (see "8.4 BiCheck flow sensor" on page 84). (2) Thermal disinfection in a washer (3) Steam sterilization at 134 C with devices which comply with EN 285; holding time up to 18 minutes. (4) Material is autoclavable up to 121 C. (5) Follow the instructions on hygienic preparation of the BiCheck flow sensor (see "8.4 BiCheck flow sensor" on page 84). Disposable components Parts Cleaning Disinfection Disposable measuring tube system comprising: PEEP control line Pressure-measurement tube CO 2 measuring hose Connector Water filter Y-piece (Luer lock) Luer lock connector Dispoable Patient Hose System Thermodisinfector Sterilization These are disposable parts and must not be reused. Use new parts instead. Hygienic preparation EN 87

88 9. Function check The user must carry out a function check on the unit before each use and after each disassembly, but at least every 6 months. For the function check, connect the ventilation hose, the patient valve, and a testing bag to the MEDUMAT Transport. Warning! If this function check reveals any faults or deviations from the specified values, you must not use the MEDUMAT Transport. Have the unit repaired by Weinmann or an authorized dealer. You should first try to rectify the fault with the aid of the information provided in section "10. Troubleshooting"on page 95. If this is not possible, have the unit repaired by the manufacturer Weinmann or by a technician specifically authorized by the manufacturer. A full function check comprises: Visual inspection for mechanical damage Visual inspection of the display "9.2 Checking the system for leaks"on page 89 "9.3 Checking the patient valve (reusable hose system only)"on page 90 "9.4 Automatic function check"on page 91 We recommend that you always keep the following spare parts available: Spare seals for the unit connections A replacement dust filter PEEP control diaphragm for patient valve Check-valve diaphragm for patient valve Measuring tube system, including water filter, for CO 2 measuring Note: Carry out a visual inspection of the testing bag. The testing bag must not be damaged. 88 EN Function check

89 9.1 Intervals Before each use: Perform a function check. After each use or disassembly: Clean, disinfect and sterilize the unit and the components (see "8. Hygienic preparation" on page 83). Perform a function check. At least every 6 months: Perform a function check. Check the suction filter for dirt. Unscrew and remove the filter cover. Never reinstall used filters. 9.2 Checking the system for leaks 1. Open the valve on the oxygen cylinder slowly. You can now read the cylinder pressure on the contents gauge of the pressure reducer. For example, a reading of 200 bar means that the cylinder is full; a reading of 100 bar means that it is still half full. You should change the cylinder in good time, e.g., when the pressure falls below 50 bar, to ensure a sufficiently long operating time. 2. Close the cylinder valve again. 3. Watch the needle of the contents gauge on the pressure reducer for approx. 1 minute. If the position of the needle stays constant, the system is free from leaks. If the needle falls steadily, there is a leak in the system. Function check EN 89

90 Repairing leaks Note: Always keep a stock of replacement seals for the connections. 1. Prepare a soapy solution using unperfumed soap. 2. Wet all the screw and hose connections with the solution. If bubbles form, this indicates a leak. 3. Release the pressure in the system: Close the oxygen cylinder valve. Switch MEDUMAT Transport on briefly until the contents gauge on the O 2 cylinder indicates "0". Then switch MEDUMAT Transport off again. Caution! The screwed unions of the oxygen tubes must only be tightened by hand. 4. If there is a leak, change the faulty parts. 5. Then check for leaks again. 6. If the leak cannot be corrected, the unit must be repaired. 9.3 Checking the patient valve (reusable hose system only) Caution! Also observe the "Function check" section in the instructions for use of the "Patient Hose System" WM Never use torn, wavy, distorted or sticky diaphragms for ventilation. Otherwise considerable malfunctions are to be expected. When assembling the patient valve, it is essential you make sure that the PEEP control diaphragm is correctly positioned and the right way up (the letters TOP on the PEEP control diaphragm must face upwards). Otherwise the patient valve may malfunction, putting the patient at risk. 90 EN Function check

91 1. Pull all the tubes and cables off the patient valve. 2. Dismantle the patient valve Control cover PEEP control diaphragm 3 Main body of the patient valve 3 4 Check valve diaphragm 5 Holder for check valve diaphragm 3. Visually inspect all parts for cracks or other mechanical damage. 4. Change any diaphragms that are torn, wavy, distorted or sticky. 5. Reassemble the patient valve. 9.4 Automatic function check MEDUMAT Transport has an automatic function check feature for testing the unit's sensors, actuators and controls. To start the automatic function check, proceed as follows. Start automatic function check 1. Connect the device to the oxygen supply. 2. Connect the device to the power supply. 3. Switch the unit on. 4. Check that the alarm display lights up briefly during the self-test. 5. Check that the alarm buzzer emits a series of five audible sounds and the loudspeaker then emits two audible sounds during the self-test. 6. Select the "Function check" item on the start screen. Function check EN 91

92 7. Follow the instructions on the display: Check for leaks (see "9.2 Checking the system for leaks" on page 89) and check the hose system (see "9.3 Checking the patient valve (reusable hose system only)" on page 90). Open the valve of the oxygen cylinder. Connect the patient hose system. Connect a testing bag. Do not touch the patients tube and the testing bag after this. 8. Start the function check by selecting "Start function check" in the menu. This starts the automatic function check, which takes approximately one minute. The unit tests the sensors and actuators. While this is happening, you can start testing the controls (see "Testing the controls" on page 92). Do not touch/move the testing bag or the patient hose system. The testing bag is filled and emptied according to a specific paradigm during testing. Touching or moving it could distort the results of the function check. Note: Among other things, this check ensures that, in the event of a malfunction during patient ventilation, physiological alarms are triggered correctly. If a fault in the device occurs during the function check, check that the hose system and the testing bag are OK. Switch the device off and then on again. Repeat the function check. If the fault reoccurs, have the unit repaired by Weinmann or an authorized dealer. Testing the controls While the sensors/actuators are being tested, the function buttons and control knobs are shown in red on the display. To check that these controls function correctly, proceed as follows: 1. Press each of the controls on the unit (do not press the controls on the screen), as described in section "5. Operation" in these instructions for use. 92 EN Function check

93 A control is functioning correctly if the corresponding control on the screen is shown in green. If a control is found to have a fault, the corresponding control on the display is shown in red. In this case, exit the test by pressing the menu button. Note: Do not press the On/Standby/Off button during the test. You can exit the function check at any time by pressing the menu button twice. If all the fields are green or you have exited the function check, the unit will display a status report. This displays the status for each component individually: Green tick: function check passed Red cross: function check failed Gray exclamation mark: function check exited Every six months, the unit asks you to change the suction filter (see "11.4 Changing the suction filter" on page 102) before it displays the status report. 2. Press "OK" to confirm the status report. The window is closed. 3. Switch off the device. 4. Close the oxygen cylinder valve. Testing the power-failure alarm 1. Once the automatic function check has finished, switch to ventilation mode. 2. Pull out the battery and disconnect the charger or remove the portable system from the wall mounting (for not more than 30 seconds). If the red alarm LED flashes and an acoustic signal sounds, the power failure alarm is functioning. 3. Reconnect the power supply. 4. If you wish to use the unit, switch it on again. Function check EN 93