Operator s Manual. TBird Series Ventilators

Transcription

1 Operator s Manual TBird Series Ventilators L1580 Revision D Copyright Bird Products 2002

2 2 Operators Manual

3 Revision History Date Revision Pages Changes May 2001 B All Initial Release December 2002 C Cover, 2, 4, 5, 20, 26, 65-67, 98, 100 Update, copy write, CE mark, sensitivity range, and parts list March 2003 D 5 Tracking Notice

4 4 Operators Manual Warranty TBird ventilation systems are warranted to be free from defects in material and workmanship and to meet the published specifications for two (2) years or 8,000 hours, whichever occurs first. The liability of Bird Products under this warranty is limited to replacing, repairing or issuing credit, at the discretion of Bird Products, for parts that become defective or fail to meet published specifications during the warranty period; Bird Products will not be liable under this warranty unless (A) Bird Products is promptly notified in writing by Buyer upon discovery of defects or failure to meet published specifications; (B) the defective unit or part is returned to Bird Products, transportation charges prepaid by Buyer; (C) the defective unit or part is received by Bird Products for adjustment no later than four weeks following the last day of the warranty period; and (D) Bird Product's examination of such unit or part shall disclose, to its satisfaction, that such defects or failures have not been caused by misuse, neglect, improper installation, unauthorized repair, alteration or accident. Any authorization of Bird Products for repair or alteration by the Buyer must be in writing to prevent voiding the warranty. In no event shall Bird Products be liable to the Buyer for loss of profits, loss of use, consequential damage or damages of any kind based upon a claim for breach of warranty, other than the purchase price of any defective product covered hereunder. Bird Products warranties as herein and above set forth shall not be enlarged, diminished or affected by, and no obligation or liability shall arise or grow out of the rendering of technical advice or service by Bird Products or its agents in connection with the Buyer's order of the products furnished hereunder. Limitations of Liabilities This warranty does not cover normal maintenance such as cleaning, adjustment or lubrication and updating of equipment parts. This warranty shall be void and shall not apply if the equipment is used with accessories or parts not manufactured by Bird Products or authorized for use in writing by Bird Products or if the equipment is not maintained in accordance with the prescribed schedule of maintenance. The warranty stated above shall extend for a period of two (2) years from date of shipment or 8,000 hours of use, whichever occurs first, with the following exceptions: 1. Components for monitoring of physical variables such as temperature, pressure, or flow are warranted for ninety (90) days from date of receipt. 2. Elastomeric components and other parts or components subject to deterioration, over which Bird Products has no control, are warranted for sixty (60) days from date of receipt. 3. Internal and optional external batteries are warranted for ninety (90) days from the date of receipt. The foregoing is in lieu of any warranty, expressed or implied, including, without limitation, any warranty of merchantability, except as to title, and can be amended only in writing by a duly authorized representative of Bird Products.

5 TBird Series Ventilators 5 Notices Copyright Notice Copyright 2002 Bird Products Corporation, a subsidiary of VIASYS Healthcare, Palm Springs, California. This work is protected under Title 17 of the U.S. Code and is the sole property of Bird Products Corporation. No part of this document may be copied or otherwise reproduced, or stored in any electronic information retrieval system, except as specifically permitted under U.S. Copyright law, without the prior written consent of Bird Products Corporation. For more information, contact: World Headquarters European Office Bird Products Corporation Bird Products Corporation 1100 Bird Center Drive Rembrandtlaan 1b Palm Springs, CA BG Bilthoven U.S.A. P.O. Box 299, 3720 AG Bilthoven Phone: (760) The Netherlands (800) Phone: (31) Fax: (760) Fax: (31) or Trademark Notices TBird is a registered trademark of Bird Products Corporation, a subsidiary of VIASYS Healthcare, in the United States and some other countries. All other brand names and product names mentioned in this manual are trademarks, registered trademarks, or trade names of their respective holders. EMC Notice MRI Notice This equipment generates, uses, and can radiate radio frequency energy. If not installed and used in accordance with the instructions in this manual, electromagnetic interference may result. The equipment has been tested and found to comply with the limits set forth in EN for Medical Products. These limits provide reasonable protection against electromagnetic interference when operated in the intended use environments described in this manual. This equipment contains electromagnetic components whose operation can be affected by intense electromagnetic fields. Do not operate the ventilator in an MRI environment or in the vicinity of high-frequency surgical diathermy equipment, defibrillators, or short wave therapy equipment. Electromagnetic interference could disrupt the operation of the ventilator.

6 6 Operators Manual Intended Use Notice The TBird Ventilator Series of ventilators are intended to provide continuous or intermittent ventilatory support for the care of individuals who require mechanical ventilation. The ventilator is a restricted medical device intended for use by qualified, trained personnel under the direction of a physician. Specifically, the ventilator is applicable for adult and pediatric patients weighing at least 10 kg (22 lbs.), who require the following general types of ventilatory support, as prescribed by an attending physician: Positive pressure ventilation Assist/Control, SIMV, or CPAP modes of ventilation The TBird AVS Series, VSO2 and VS ventilators are intended for institutional use. The TBird Legacy Series is suitable for use in both institutional and home settings. Regulatory Notice Federal law restricts the sale of this device except by or on order of a physician. Important Notice (Legacy only) The US Food and Drug Administration has issued Tracking Orders for the TBird Legacy Ventilator in accordance to 21CFR821. Distributors are required to have a tracking system in place to track the transfer of the TBird Legacy Ventilator device to the person for whom the device is indicated. Distributors are required by Federal Law to make available upon request tracking records. Bird Products Corporation will conduct an audit utilizing statistical sampling every six months for the first three years and once each year thereafter as required by FDA regulations. The audit may be in the form a formal audit survey or through an onsite visit. If the distributor ceases distributions of the tracked device, that person continues to be responsible for compliance to FDA tracking regulation unless another person affirmatively and in writing, assumes responsibility for continuing the tracking of devices previously distributed. Failure of compliance of the above warning constitutes misbranding by persons distributing the device. Declaration of Conformity Notice This medical equipment complies with the Medical Device Directive, 93/42/EEC, and the following Technical Standards, to which Conformity is declared: EN EN ISO 9001, EN MDD-Annex II EU Notified Body: 0086 BSI (Reg. No. 0086) Type of Equipment: Medical Equipment, Lung Ventilator Trade names: TBird AVS, TBird AVS II, TBird AVS III, TBird VS, TBird VSO2, TBird Legacy If you have a question regarding the Declaration of Conformity for this product, please contact Bird Products.

7 TBird Series Ventilators 7 IEC Classification The AVS, VSO2 and VS ventilators are suitable for use in institutional and transport environments. The Legacy is suitable for home and institutional environments. Ordinary equipment not protected against the ingress of liquids. Not protected/not suitable for use in the presence of flammable anesthetic gases. Class I / Internally Powered, Type BF Safety Information Terms Please review the following safety information prior to operating the ventilator. It lists warnings, cautions, and notes pertinent to the safe operation of the ventilator. Attempting to operate the ventilator without fully understanding its features and functions may result in unsafe operating conditions. If you have a question regarding the installation, set up, operation, or maintenance of the ventilator, contact Bird Products Technical Support as shown in Appendix A Contact & Ordering Information. WARNINGS CAUTIONS NOTES identify conditions or practices that could result in serious adverse reactions or potential safety hazards. identify conditions or practices that could result in damage to the ventilator or other equipment. identify supplemental information to help you better understand how the ventilator works. Warnings The following warnings apply any time you work with the ventilator. To avoid explosion, do not operate the ventilator in the presence of flammable anesthetics or in an atmosphere of explosive gases. Operating the ventilator in flammable or explosive atmospheres may result in fire or explosion. To avoid personal injury and the risk of electric shock, as well as damage to the ventilator, do not operate the ventilator with its covers or panels removed. Refer all servicing to a Bird Certified Service Technician. All electromechanical systems are subject to malfunction or failure from both internal and external causes. Although the ventilator has been designed to detect and notify you of various conditions by means of alarms, and to shut down in case of possible unsafe operating conditions, anyone operating the ventilator should be trained to respond with a well-rehearsed procedure to provide emergency ventilation in case the ventilator ceases to operate. Care should be taken to ensure that the patient does not disconnect from the patient breathing circuit. Such disconnections could be hazardous to the patient. Use an accurate oxygen analyzer having high and low alarms to monitor oxygen concentrations. This is required to ensure the desired fraction of inspired oxygen (FiO2) is

8 8 Operators Manual being delivered to the patient. Consult a physician to determine the desired concentration of inspired oxygen to be delivered. Do not attach a one-way check valve to the outlet of the exhalation valve. Doing so may adversely affect the operation of the ventilator and may be harmful to the patient. Do not operate the ventilator without setting the adjustable alarms. All adjustable alarms must be set to ensure safe operation. Ensure that all critical alarms, such as the Low Pressure alarm, have been set. Operating an improperly functioning ventilator may be harmful to the patient or operator. If the ventilator does not start up properly, or fails to pass the User Verification Tests (described in Chapter 7), remove it from service and contact your Bird Certified Service Technician. Do not operate the ventilator unless you are trained to do so. The ventilator is a restricted medical device intended for use by qualified, trained personnel under the direction of a physician. Operation by untrained personnel may result in unsafe operating conditions. Do not operate the ventilator unless qualified personnel are in attendance to promptly respond to alarms, inoperative conditions, or sudden malfunctions. Patients on life-support equipment should be visually monitored at all times. Qualified personnel should be prepared to provide an alternate form of ventilation, if needed. Lower air density at higher altitudes will effect tidal volume delivery and exhaled tidal volume measurements. Please refer to Chapter 6, Special Functions, for details on how to compensate for higher altitudes. Do not ignore audible alarms occurring at the ventilator. Alarms indicate conditions that require your immediate attention. Do not try to service or repair an improperly functioning ventilator yourself. Contact your Bird Certified Service Technician for all repairs and service. Do not use parts, accessories, or options that have not been authorized for use with the ventilator. Using unauthorized parts, accessories, or options may be harmful to the patient or damage the ventilator. Do not connect the ventilator to a patient without first pressure testing the patient breathing circuit (see Chapter 7, User Verification Tests). Failing to pressure test the patient breathing circuit may result in injury or inadequate therapy. If using a heated humidifier be sure to include it in the circuit when pressure testing. Check the exhalation valve diaphragm daily. A worn or damaged exhalation valve diaphragm may result in improper patient ventilation. Replace the diaphragm as necessary. Check all audible and visual alarms daily to make sure they are operating properly. If an alarm fails to activate, contact your Bird Certified Service Technician. Although the system will continue to ventilate with a XDCR FAULT alert, the accuracy of the tidal volume, minute volume, and pressure measurements may be reduced. Remove the ventilator from service and contact your Bird Certified Service Technician. Make sure the High Pressure alarm limit is not set above the Over Pressure Relief setting. Otherwise, a HIGH PRES alarm will not occur and the patient may be subjected to sustained high pressures. Although the system continues to ventilate when a NO CAL DATA alert is present, the accuracy of the volume and pressures may be reduced. The system may generate pressures and volumes that are inconsistent with the front panel settings. Remove the ventilator from service and contact your Bird Certified Service Technician.

9 TBird Series Ventilators 9 Cautions Disconnect the patient prior to accessing the UVTs. The ventilator does not deliver gas during the UVTs. Delivered percentage oxygen may be higher than set at elevations above 5000 feet. The following cautions apply any time you work with the ventilator. A protective ground connection by way of the grounding conductor in the power cord is essential for safe operation. Upon loss of protective ground, all conductive parts, including knobs and controls, which may appear to be insulated, can render an electric shock. To avoid electrical shock, plug the power cord into a properly wired receptacle, use only the power cord supplied with the ventilator, and make sure the power cord is in good condition. To avoid fire hazard, use only the fuse specified in the ventilator s parts list and is identical in type, voltage rating, and current rating to the existing fuse. (See the TBird Ventilator Series Service Manual, P/N L1314, for more information). Fuses should only be changed by a Bird Certified Service Technician. To minimize the potential for electrostatic shock, do not use anti-static or electrically conductive hoses and tubing with the ventilator. Run the User Verification Tests (described in Chapter 7) prior to clinical application, at least once a month (or as specified by your department guidelines), and any time you suspect the ventilator is not operating properly. Do not store the ventilator in hot areas for prolonged periods of time. Temperatures above 80 F (27 C) can shorten battery life. Failing to charge the ventilator while in storage may also shorten battery life. When the integrity of the external power earth conductor arrangement is in doubt, operate the ventilator from its internal battery or the optional external battery. The maximum voltage that can be applied to the Patient Assist Call modular connector is 25 volts rms or 31 VDC. The following cautions apply when cleaning the ventilator or sterilizing ventilator accessories. For more information, see Chapter 9, Cleaning And Sterilization. Do not clean or dry the ventilator with a high-pressure air gun. Applying high-pressure air to the ventilator may damage the internal components of the pneumatic circuit and render the ventilator inoperable. Do not over clean the ventilator. Repeated use of a cleaning agent can cause residue build-up on critical components. Excessive residue build up can affect ventilator performance. Do not wash, rinse, soak, pasteurize, ethylene-oxide sterilize, or immerse the Bird Products main flow bacteria filter in liquid sterilizing agents. Use a steam autoclave to sterilize the main flow bacteria filter. Do not sterilize the ventilator. Standard sterilization techniques may damage the ventilator. Do not use cleaning agents that contain phenols, ammonium chloride, chloride compounds, or more than 2% glutaraldehyde. These agents may damage the ventilator s plastic components and front panel overlay. When cleaning the ventilator:

10 10 Operators Manual o Do not use harsh abrasives. o Do not immerse the ventilator in liquid sterilizing agents or liquids of any kind. o Do not spray cleaning solution into the exhalation valve or directly onto the front panel. o Do not allow cleaning solution to pool on the front panel. The exhalation valve assembly is a delicate precision assembly. Exercise care when removing, replacing, or cleaning the assembly: Do not insert cleaning instruments (cloth, brush, pipe cleaner, and so on) into the exhalation valve body. Do not use a high-pressure gas nozzle to dry the exhalation valve body. High-pressure gas may damage the differential pressure ports in the exhalation valve body. Using a low flow gas source (less than 10 lpm) ensures the differential pressure ports are free of moisture and debris. To avoid possible damage to elastometric components, the peak temperature for Bird Products accessories should not exceed 131 F (55 C) for gas (ETO) and 275 F (135 C) for steam autoclave. Be sure to check with the manufacturer of these chemicals and sterilizing equipment to ensure safe handling procedures are followed. It is not necessary to remove the four screws to remove the fan inlet filter. To do so will cause mounting hardware to become loose within the ventilator, which may result in electrical damage.

11 TBird Series Ventilators 11 Symbols The following symbols may be used on the instrument or in accompanying documentation. Symbol Compliance Meaning Symbol #03-02 IEC Indicates ATTENTION, consult ACCOMPANYING DOCUMENTS Symbol #5016 IEC This symbol indicates a FUSE. Symbol #5034 IEC Symbol #01-36 IEC This symbol indicates INPUT. Symbol #5035 IEC Symbol #01-37 IEC This symbol indicates OUTPUT Symbol #5019 IEC Symbol #01-20 IEC Symbol #5021 IEC Symbol # IEC Symbol # 5333 IEC Symbol #02-03 IEC Symbol #5032 IEC Symbol #01-14 IEC Symbol# 5049 IEC Symbol #5007 IEC Symbol #01-01 IEC This symbol indicates protective EARTH (ground). This symbol indicates the EQUIPOTENTIAL connection used to connect various parts of the equipment or of a system to the same potential, not necessarily being the earth (ground) potential (e.g., for local bonding). This symbol indicates TYPE BF equipment, which indicates equipment that provides a particular degree of protection against electric shock, particularly with regards to allowable leakage current and reliability of the protective earth connection. This symbol is located on the rating plate. It indicates the equipment is suitable for alternating current. This Symbol indicates the ON condition for a part of the equipment. When pressed the ventilator will operate from the MAINS voltage (if connected) or internal or external batteries if the battery charge is within operating specifications. Indicates ON (Power) Symbol #5008 IEC Symbol #01-02 IEC Indicates OFF (Power)

12 12 Operators Manual Table of Contents Revision History... 3 Warranty... 4 Notices... 5 Copyright Notice... 5 Trademark Notices... 5 EMC Notice... 5 MRI Notice... 5 Intended Use Notice... 6 Regulatory Notice... 6 Declaration of Conformity Notice... 6 Safety Information... 7 Terms... 7 Warnings... 7 Cautions... 9 Symbols Table of Contents...12 Chapter 1 Introduction...15 TBird Series Models, Options & Configurations Requirements to Operate a TBird Ventilator What to Do if the Ventilator Fails Operator Replaceable Components Chapter 2 Controls and Displays...19 How To Set a Control Front Panel - Monitor Section Front Panel - Alarm Section Front Panel - Control Section Front Panel - Power Section Front Panel - Special Control Section Front Panel - Patient Connectors Rear Panel Chapter 3 Monitored Parameters...37 Chapter 4 Alarms and Alerts...39

13 TBird Series Ventilators 13 Definitions Alarms Alerts Chapter 5 Unpacking, Setup and Operation Unpacking the Ventilator How to Attach a Patient Breathing Circuit Adjusting Alarm Volume Attaching Oxygen Lines Attaching to a Patient Assist Call System To Turn the Ventilator ON To Turn the Ventilator OFF Performance Checks TBird Series Ventilator Performance Checklist Setting a Mode Chapter 6 Special Functions How to Access the Special Functions Ventilator Setup Group Alarm Setup Group Transducer Data Group Transducer Test Group Event Codes Group Chapter 7 User Verification Tests Accessing the UVTs Running the UVTs Chapter 8 Basic Troubleshooting If the Ventilator Does Not Turn ON If a Vent Inop Occurs If a UVT Fails If a Malfunction Occurs Chapter 9 Cleaning and Sterilization How to Clean the Ventilator To Clean, Sterilize, or Disinfect the Exhalation Valve Assembly To Clean, Sterilize or Disinfect the Patient Breathing Circuit Cleaning & Sterilization Compatibility Recommendations, Exhalation Valve and Patient Circuit To Clean, Sterilize, or Disinfect Ventilator Accessories To Clean, Sterilize, or Disinfect the Air Intake Filter... 94

14 14 Operators Manual How to Clean and Replace the Fan Filter Appendix A Contact & Ordering Information...97 How to Call for Service Ordering Information Approved Accessories and Part Numbers Part Number Appendix B Ventilator Specifications...99 Physical Specifications Performance Specifications and Tolerances Electrical Specifications Environmental Specifications Appendix C Ventilator Illustrations Illustrations Appendix D Oxygen Computer Chart (VS & Legacy) To Find O2 Input Flow To Find O2 Concentration Appendix E Operator Instruction Checklist Appendix F Event Codes Glossary Index...121

15 Chapter 1 Introduction This chapter covers the following material: TBird series ventilators models, options & configurations What you will need to operate the ventilator. What to do in case the ventilator ceases to operate properly. Which components are operator-replaceable. TBird Series Models, Options & Configurations Table 1.1 TBird Series Ventilator Models & Options OPTION LEGACY VS VSO2 AVS AVS II AVS III % O2 X X X X 100% O2 X X X X Assist/Control X X X X X X Breath Rate X X X X X X CPAP X X X X X X Expiratory Hold X X Flow Cal X X X X X X High Breath Rate X X X X X High Pressure X X X X X X Inspiratory Hold X X X X X X Inspiratory Pause X X X Inspiratory Time X X X Low Pressure X X X X X X Manual Breath X X X X X X MIP/NIF X X Peak Flow X X X X X X PEEP X X X X X X Pressure Control X X X Pressure Support X X X X X X Sensitivity X X X X X X Sigh X X X X X X SIMV X X X X X X Square Waveform X X X Tidal Volume X X X X X X VAPS X The TBird Ventilator systems are easy to use, self-contained systems that combine an advanced pneumatic system with microprocessor-based technology. The result is a ventilation system providing excellent ventilation and patient monitoring.

16 16 Operators Manual The AVS Series Ventilator is available in three configurations: AVS, AVS II and AVS III. The AVS and AVS II can easily be upgraded in the field using Configuration Memory Cards. The VS and VSO2 ventilators are excellent for critical care and sub-acute care environments. The TBird Legacy ventilator completes the family as a homecare capable version. Packaged in a compact, lightweight unit, the TBird Ventilators provide all the features you would expect in larger ventilators. Compressor-less technology, allowing uninterrupted ventilation. A broad range of operating modes including Control, Assist/Control, SIMV, and CPAP. Volume Control, Pressure Control, Pressure Support, and VAPS ventilation. Automatic Apnea Backup ventilation. Adjustable and lockable front panel controls with integrated displays. A comprehensive monitoring package, including PIP, MAP, Breath Rate, I:E Ratio, Tidal Volume (Vt e ), Minute Ventilation (VE), Inspiratory Time (Ti), and PEEP. Integrated real-time digital airway pressure manometer with adjustable high and low-pressure alarms. Special Functions for viewing and setting parameters. Self-testing at power-up and background testing during normal operation. Internal and optional external battery. For ordering information on upgrades, see Appendix A or contact your Bird Products representative. Requirements to Operate a TBird Ventilator Power Source. The ventilator operates from a standard 100, 110, 220, or 240 VAC power source, the internal battery or an optional external battery. The factory equipped internal battery is capable of providing power during short-term patient transports or AC power interruptions. The optional external battery can be used for longer periods of support. Pressurized Oxygen (for AVS models or VSO2). The oxygen source must provide clean, dry, medical grade oxygen at a line pressure of 40 to 60 PSIG (2.8 to 4.2 bar). Low Flow Oxygen (for VS or Legacy). The low flow oxygen source must provide clean, medical grade oxygen not to exceed 80 lpm at 0.5 PSIG (0.035 bar). What to Do if the Ventilator Fails If a TBird ventilator detects a condition that could possibly prevent it from continuing to operate safely, it stops delivering gas and opens all valves so the patient can breathe spontaneously from room air. It also generates a vent inop alarm. (For more information, see Chapter 4, Alarms and Alerts.) If a vent inop occurs, provide an alternate means of ventilating the patient, take the ventilator out of service and contact your Bird Certified Service Technician. WARNING Do not operate the ventilator unless qualified personnel are in attendance to promptly respond to alarms, inoperative conditions, or sudden malfunctions. Patients on life support equipment should be visually monitored at all times. Qualified personnel should be prepared to provide an alternate form of ventilation, if needed.

17 TBird Series Ventilators Chapter 1 Introduction 17 Operator Replaceable Components The following components are operator replaceable: Air intake filter Patient breathing circuit Exhalation valve body Exhalation valve diaphragm External battery Main flow bacteria filter Fan filter Contact your Bird Certified Service Technician to replace all other parts, including the internal battery. See Appendix A, Contact & Ordering Information for information on how to order replaceable components and request a service call.

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19 Chapter 2 Controls and Displays This chapter describes the function and operation of your TBird ventilator s controls and displays. It covers the following points: How each control operates. Why some controls may flash when you attempt to set them. Why some controls are dimmed in certain modes. For more information on where controls are located, see Appendix C, Ventilator Illustrations. Table 2-1 List of Controls and Displays %O2 Control External Battery Power Indicator ON Indicator 100% O2 3-Minute Button Flow Cal Button Over Pressure Relief Valve AC Power Indicator High Breath Rate Alarm Control Peak Flow Control Airway Pressure Manometer High Pressure Limit Alarm Control PEEP/CPAP Control Alarm Silence Button Inspiratory Hold Button Power Switch Alarm Window Inspiratory Pause Control Pressure Control, Control Altitude Compensation Inspiratory Time Control Pressure Support, Control APNEA Interval Setting Assist/Control Mode Selection Button Internal Battery Charge Status Indicator Internal Battery Power Indicator Remote Alarm Button Sensitivity Control Bias Flow Setting Low Minute Volume Alarm Sigh Button Breath Rate Control Low Pressure Alarm Control SIMV Mode Selection Button Control Knob/Lock Manual Breath Button Square Waveform Button CPAP Mode Selection Button MIP/NIF Button Tidal Volume Control Effort Indicator Monitor Select Button VAPS Button Expiratory Hold Button Monitor Window Vent Inop Indicator External Battery Charge Status How To Set a Control The front panel contains several types of controls, including variable controls, mode select buttons, and pushbuttons. Variable Controls These controls are used to set ventilation parameters and alarms. Set the control by pressing the button located below its display. While the control is selected, all other control displays are dimmed. Turn the front panel control knob until the desired setting appears in the control s display. The new setting takes effect upon the next breath. The other controls will illuminate again when the operator either: Presses the button again, or Presses a button for another variable control, or

20 20 Operators Manual Allows five (5) seconds to elapse. Table 2-2 shows you the controls available in each mode and the non-limited range of settings allowed in that mode. Table 2-3 shows the available controls by breath type. Table 2-2 Ranges of Variable Controls by Mode Function Control & Assist Control Modes SIMV Mode CPAP Mode Breath Rate 2-80 bpm 2-80 bpm Dimmed High Breath Rate OFF, bpm OFF, bpm Dimmed High Pressure cmh2o cmh2o cmh2o Limit Inspiratory Pause OFF, sec OFF, sec Dimmed Inspiratory Time sec sec Dimmed Low Min Volume L L Dimmed Low Pressure OFF, 2-60 cmh2o OFF, 2-60 cmh2o Dimmed O2% % % % Peak Flow L/min L/min Dimmed PEEP/CPAP 0-30 L/min 0-30 L/min 0-30 lpm Pressure Control OFF, cmh2o OFF, cmh2o Dimmed Pressure Support Dimmed OFF, 1-60 cmh2o OFF, 1-60 cmh2o Sensitivity OFF, 1 20 L/min OFF, 1 20 L/min OFF, 1 20 L/min Tidal Volume ml ml Dimmed Table 2-3 Availability of Variable Controls by Breath Type Function Volume Control 1 Pressure Control 2 VAPS 3 Breath Rate Active Active Active High Pressure Active Active Active Limit Inspiratory Pause Active Dimmed Active Inspiratory Time Dimmed Active Dimmed Low Min Volume Active Active Active Low Pressure Active Active Active O2% Active Active Active Peak Flow Active Dimmed Active PEEP/CPAP Active Active Active Pressure Control Dimmed Active Active Pressure Support Active Active Active Sensitivity Active Active Active Tidal Volume Active Dimmed Active 1 Volume Control Breath = Pressure Control OFF, VAPS OFF 2 Pressure Control Breath = Pressure Control ON, VAPS OFF 3 VAPS Brea h = Pressure Control ON, VAPS ON

21 TBird Series Ventilators Chapter 2 Controls & Displays 21 Mode Select Buttons These buttons allow you to select a mode of ventilation 1. The buttons are mutually exclusive. Selecting one mode automatically deselects the others. To select a mode, press the button once: the integrated LED begins to flash. This flashing lasts for five seconds, indicating the system is ready to make the transition from one mode to another. Press the button again while the LED is flashing to enable the mode. If you do not press the button while the LED is flashing, the mode select operation is canceled and the ventilator continues to operate in the previous mode. Pushbuttons These buttons allow you to perform a front panel action, such as delivering a manual breath, or turning a feature, such as the sigh breath feature, on or off. When the button is on, the integrated LED illuminates. To toggle the button on or off, just press and release the button. Dimmed Controls A control dims when it is not available in the currently selected mode. Although dimmed, the control retains its setting so you can switch modes without having to reset the control. You can also set a dimmed control prior to switching to a mode in which the control will be active. Flashing Controls A control may flash for several reasons: 1. There is a pre-set limit on the range of possible settings for the control, and you have reached that limit. The ventilator monitors all control settings and will automatically limit the range of certain controls to prevent incompatible settings. This is to ensure the following: A minimum exhalation time of 250 msec for all breaths. A minimum inhalation time of 30 msec for all breaths. A minimum high pressure alarm setting of at least 5 cmh2o above PEEP for all modes. A maximum inverse I:E ratio of 4:1. A peak flow > bias flow. 2. A required control has not been set. If a control is required in a particular mode, the ventilator flashes the control until you set it. When you set the Low Peak Pressure alarm limit to OFF, for example, the setting flashes to remind you to set the alarm before leaving the machine. 3. An alarm is active. When an alarm occurs, the associated display will flash. This enables you to identify the cause of the alarm at a glance. 4. An alternate exhalation criteria has been met for a Pressure Support or Pressure Control breath. In Pressure Support, ordinarily a Termination Flow (TERMSENS) ends the inspiratory phase. If the Time Limit (VARITIME) has been reached first, the Pressure Support control will flash. In Pressure Control, ordinarily the Inspiratory Time control ends the inspiratory phase. If Flow Termination (FLOWTERM) is set and is reached first, the Pressure Control display will flash. 1 The Assist/Control button selects both the Control and Assist Control modes of ventilation. To select the Control mode, set the Sensitivity to OFF.

22 22 Operators Manual Front Panel - Monitor Section Effort Indicator Display only. Illuminates briefly when the patient s inspiratory effort meets or exceeds the Sensitivity setting and the breath is patient initiated. Airway Pressure Manometer Display only. Shows the patient s real-time, airway pressure. Ranges from - 20 cmh2o (- 2 kpa) to 120 cmh2o (12 kpa) in increments of 2. The two amber LEDs indicate the currently set high and low pressure alarm limits. Monitor Window (AVS models only) Display only. Displays alerts, monitored parameters, Special Functions and User Verification Tests (UVTs). Alarm Window (AVS models only) Display only. Alarm messages appear in the alarm window. When the alarm is cleared, the alarm message disappears. Alarm/Monitor Window (VS, VSO2 & Legacy) Display only. Displays alarms, alerts, monitored parameters, special functions, and User Verification Tests (UVTs). Alarm messages temporarily overwrite any parameters, special functions, or UVTs displayed in the alarm/monitor window. When the alarm is cleared, the alarm message disappears and the previously displayed item is redisplayed. Front Panel - Alarm Section Low Pressure Alarm Control Sets the alarm threshold for low circuit pressure during the inspiratory phase of machine and assist breaths. Press the button and turn the control knob to set the alarm to any value between 2 and 60 cmh2o or OFF. The setting is indicated on the manometer by an amber LED. If set to OFF, the display will flash, indicating the alarm is disabled. The new setting takes effect on the next machine or assist inspiration. Once set, the ventilator generates a LOW PRES alarm if the circuit pressure fails to exceed the set value. Note The alarm is disabled in the CPAP mode and during spontaneous and Pressure Support breaths. The alarm is enabled in CPAP mode when a manual or sigh breath is delivered.

23 TBird Series Ventilators Chapter 2 Controls & Displays 23 High Pressure Alarm Control This sets the maximum allowable pressure in the patient breathing circuit to any value between 5 and 120 cmh2o. The limit cannot be set less than 5 cmh2o above PEEP. The setting is indicated on the manometer by an amber LED. New settings take effect immediately. A HIGH PRES alarm is generated if the patient breathing circuit pressure (measured by the exhalation valve pressure transducer) reaches the set value. If a HIGH PRES alarm occurs, the ventilator immediately terminates inspiration and cycles into the exhalation phase so pressure can return to PEEP. If the circuit pressure does not fall back to PEEP +5 cmh2o within three seconds, the ventilator terminates all flow. Once the patient breathing circuit pressure falls to within PEEP +5 cmh2o, the ventilator clears the audible alarm, restarts the flow, and attempts to deliver another breath. During a sigh breath, the alarm limit is automatically increased by 50% to a maximum of 120 cmh2o. This temporary increase does not appear on the High Pressure display. Low Minute Volume Alarm Control Sets the minimum threshold for the exhaled minute volume alarm. The volume is calculated by averaging the previous eight exhaled Tidal Volumes, multiplying the resulting average by the total breath rate, and then dividing by 1,000 to convert from milliliters to liters. New settings take effect immediately. To accommodate different institutions policy, two ranges are available: OFF to 99.9 liters and 0.1 to 99.9 liters. These ranges are accessed in the Special Functions, Alarm Setup Group (see Chapter 6). If the exhaled minute volume falls below the set value, the LOW VOLUME alarm occurs. High Breath Rate Alarm Control (AVS models, VSO2, Legacy) This sets the maximum threshold for total breath rate alarm between 3 and 150 breaths per minute or OFF. New settings take effect immediately. If the total breath rate exceeds the alarm setting, a HIGH BREATH RATE alarm occurs. Alarm Silence/Reset Button Silences and resets any active alarms. If the audible alarm is sounding, press the button once to silence the alarm for 60 seconds. If you correct the condition causing the alarm within the silence period, press the button again to clear the alarm message. If the audible alarm is not sounding, but there is an alarm message displayed in the alarm window and the red silence-period indicator is turned off, press the button once to clear the display. If no alarm is sounding or displayed, press the button once to silence any alarms that might occur in the next 60 seconds. To cancel the preemptive silence period, press the button again. When silenced, the red LED above the button illuminates for 60 seconds. At the end of the silence period, the LED turns off and the audible alarm sounds again unless the condition causing the alarm has been corrected. If a vent inop occurs, turn the ventilator off before pressing Alarm Silence/Reset.

24 24 Operators Manual Vent Inop Indicator Display only. Illuminates when a Ventilator Inoperative (Vent Inop) condition is detected. A Vent Inop occurs whenever a condition develops that could affect the continued safe operation of the ventilator. Because safe operation cannot be guaranteed in the presence of these conditions, the ventilator ceases to operate and activates the Vent Inop alarm. The ventilator will default to a safe operating condition, opening all valves, so the patient can breath spontaneously from room air. If a Vent Inop occurs, remove the ventilator from service, provide an alternate means of ventilation and have it evaluated by your Bird Certified Service Technician. Front Panel - Control Section Monitor Select Button Selects monitored parameters, Special Functions, and User Verification Tests (UVTs). This button is also used to clear some alerts. To operate, press and release the button. For information on how to use the Monitor Select button when working with monitored parameters, see Chapter 3, Monitored Parameters. For information on clearing alerts, see Chapter 4, Alarms and Alerts. For information on how to use this button with the Special Functions, see chapter 6, Special Functions. For information on how to use this button with the UVTs, see Chapter 7, User Verification Tests. Mode Select Button Selects desired mode. Modes available are Assist/Control, Control, SIMV and CPAP. Press the button once to select the mode. The built-in LED will flash to indicate a transitional state. To activate the mode, press the button again within five seconds, otherwise the mode remains unchanged. All modes are mutually exclusive. Selecting one mode automatically disables the others. Controls that are not active in this mode are dimmed. Control: To operate the ventilator in a pure Control mode, set the Sensitivity setting to OFF. If Sensitivity is not set to OFF, the breath rate timing is reset whenever a breath is delivered in response to patient effort to avoid breath stacking. Control Knob/Lock Used to set variable controls (e.g., Breath Rate, Tidal Volume), select Special Functions, and run User Verification Tests (UVTs), this control allows you to dial through a range of values or a sequence of selections. Also allows you to lock and unlock the front panel. To set a variable control, press the control s button and turn the Control Knob clockwise to increase the setting or counter-clockwise to decrease the setting. The faster you turn the knob the faster the setting will change. To lock or unlock the front panel controls, press the Control Knob. When locked, the green LED next to the lock icon illuminates. Locking or unlocking the front panel has no effect on the actual setting of the controls. Locking the front panel s controls prevents unauthorized personnel from changing the ventilator s settings. All controls except the Monitor Select, Manual Breath, 100% O2 3 Min (VSO2, AVS, II, III) and Alarm Silence/Reset button are secured when locked.

25 TBird Series Ventilators Chapter 2 Controls & Displays 25 To access the Special Functions, press and hold the Control Knob until VENT SETUP appears in the monitor window (approximately two seconds). Release the control Knob. When working with the Special Functions, you can back out of the functions by pressing the Control Knob. The control lock itself can only be disabled using the Control Lock Enable function in the Ventilator Setup Group Special Functions (see Chapter 6). When disabled, pressing the control lock has no affect on the front panel controls: they remain unlocked. Note When operating in CPAP mode, certain controls must be set to clinically appropriate levels even though they are dimmed and inactive. Should the patient become apneic, the ventilator uses these settings when providing Apnea Backup ventilation. The TBird Ventilator Series can provide Apnea Backup ventilation in Volume Control, Pressure Control or Volume Assured Pressure Support (VAPS), depending on the current settings. Refer to Chapter 5, for more information. Tidal Volume Control Sets the total volume of gas delivered to the patient during a Volume Control breath. During a VAPS breath this control sets the minimum volume gas delivered to the patient. The Tidal Volume can be set to any value between 50 and 2,000 ml. New settings take effect on the next Volume Control or VAPS breath. For Volume Control Breaths, the Tidal Volume is delivered in a decelerating waveform (except AVS models offering a choice of square or decelerating). WARNING Lower air density at higher altitudes will effect tidal volume delivery and exhaled tidal volume measurements. Please refer to Chapter 6, Special Functions, for details on how to compensate for higher altitudes. Breath Rate Control This control sets the minimum number of machine breaths delivered to the patient each minute between 2 and 80 bpm. New rate settings take effect immediately. This control is active in Control, Assist/Control mode, SIMV mode, and Apnea Backup ventilation. The system uses the Breath Rate setting to compute the breath period. Note When operating in CPAP mode, certain controls must be set to clinically appropriate levels, even though they are dimmed and inactive. If the patient becomes apneic, the ventilator will use these settings to provide Apnea Backup ventilation. The TBird Ventilator Series can provide Apnea Backup ventilation in Volume Control, Pressure Control or Volume Assured Pressure Support (VAPS), depending on the current settings. Refer to Chapter 5, Unpacking, Setup and Operating Procedures, for more information. Peak Flow Control In a Volume Controlled breath, the Peak Flow control sets the maximum inspiratory flow rate in Control, Assist/Control, and SIMV mode.

26 26 Operators Manual In a VAPS breath, the Peak Flow Control sets the minimum flow generated and determines the exhalation criteria. It also sets the flow at which VAPS breaths guarantee the set minimum Tidal Volume. The flow rate can be set between 10 and 140 L/min. The new flow rate takes effect on the next machine or assist inspiration. The inspiratory flow is delivered in either a square or decelerating waveform and is measured in liters per minute (L/min) delivered at Body Temperature Pressure Dry (BTPD). Note The ventilator can deliver up to 180 lpm for patient breaths (spontaneous and pressure support). Sensitivity Control Sets the threshold below baseline flow at which the patient can flow trigger a breath between 1 and 20 lpm or OFF. New settings take effect immediately. Breaths can be flow triggered any time during the exhalation phase following the minimum exhalation time. When the patient begins to inhale, flow is diverted from the bias flow into the patient s lungs. If the rate of this patient flow exceeds the Sensitivity setting, the ventilator triggers a breath. The lower the Sensitivity level, the lower the patient effort required to trigger the breath. If Sensitivity is set to a value, the patient is allowed to flow trigger breaths. If Sensitivity is turned OFF, the ventilator provides a pure Control Mode Ventilation (CMV), prohibiting the patient from triggering breaths. WARNING Make sure the Sensitivity is set to an appropriate value (1-20 L/min). If set to OFF, the patient will be unable to trigger breaths. PEEP/CPAP Control Figure 2.1 Sensitivity & Breath triggering Sets the PEEP/CPAP pressure level between 0 and 30 cmh2o. New settings take effect immediately.

27 TBird Series Ventilators Chapter 2 Controls & Displays 27 Pressure Support Control Sets the Pressure Support level above PEEP for all Pressure Support breaths between 1 and 60 cmh2o or OFF. This control is only active in SIMV and CPAP modes. New settings take effect on the next pressure support inspiration. The total Peak Inspiratory Pressure (PIP) will equal the sum of the PEEP/CPAP and Pressure Support settings. Figure 2.2 Pressure Support Waveforms When the patient initiates a breath, the ventilator raises the inspiratory flow to meet the patient s demands until the target pressure level is reached. The ventilator then maintains the patient breathing circuit pressure at the target pressure, allowing flow to decrease as pressure equalizes between the circuit and the patient s lungs. When flow drops to the set percentage of that breath s peak inspiratory flow, the ventilator cycles into the exhalation phase. The clinician determines this value and sets it in the Special Functions (see Chapter 6), Vent Setup, Termination Sensitivity (TERMSENS). If the inspiratory flow is unable to drop to the established percentage of peak flow (e.g., as a result of a leak), within the set inspiratory time (Variable Time Termination) or two breath periods, whichever occurs first, the ventilator terminates inspiration. When a breath is terminated because of time rather than flow, the Pressure Support control flashes. % O2 Control (AVS models & VSO2) Sets the percentage of oxygen in the inspiratory flow from 21% to 100% in increments of 1%. The time required for the oxygen level in the gas flow to reach the %O2 setting depends on the bias flow and patient s minute volume demands. The set percentage is typically reached before the first two liters of gas are delivered. WARNING Delivered percentage oxygen may be higher than set at elevations above 5,000 feet. Pressure Control Control (AVS III, VSO2 & Legacy Only) Sets the inspiratory pressure above the baseline (PEEP) when setting up a Pressure Control or VAPS (AVS III only) breath to any value between 1 and 100 cmh2o or OFF. New settings take effect on the next Pressure Control or VAPS inspiration. When setting up a Volume Control breath, set this control to OFF. The total Peak Inspiratory Pressure (PIP) will equal the sum of the PEEP/CPAP and Pressure Control settings. For Pressure Control breaths, the ventilator raises the inspiratory flow to meet the patient s demands until the target pressure level is reached. The ventilator then maintains the patient breathing circuit pressure for the time specified by the Inspiratory Time control setting. The clinician may also choose to

28 28 Operators Manual set a Flow Termination threshold for Pressure Control. The clinician determines this value and sets it in the Special Functions (see Chapter 6), Vent Setup, Flow Termination (FLOWTERM). If this value is set, the breath will terminate when either the set Inspiratory Time or the set FLOWTERM is reached, whichever occurs first. When a breath is terminated because of flow rather than time, the Pressure Control setting flashes. For VAPS breaths, this control sets the inspiratory pressure above baseline (PEEP) for the pressure supported portion of the breath. Inspiratory Time Control ( AVS III, VSO2 & Legacy only) Sets the inspiratory time for Pressure Control breaths between 0.3 and 10.0 seconds. The inspiratory time determines the length of the inspiratory phase of the breath unless flow termination is reached first. New inspiratory time settings take effect on the next Pressure Control inspiration. Inspiratory Pause Control (AVS models only) This control sets the inspiratory pause time for Volume Controlled and VAPS breaths to any value between 0.1 and 2.0 seconds (in 0.1 second increments), or OFF. New settings take effect on the next Volume Control or VAPS breath. This control is only available for Volume Control or VAPS breaths. At the end of the inspiration, the circuit pressure will be maintained for the set inspiratory pause period. At the end of this interval, exhalation will begin. Front Panel - Power Section On Indicator Display only. Indicates the ventilator is turned ON and has power. This indicator is normally green. If it is yellow or red, a problem has developed with the internal power supplies or software. Discontinue using the ventilator and contact your Bird Certified Service Technician. Power Source Indicators Display only. Indicates the power source the ventilator is using. AC Indicator This indicator remains on as long as sufficient AC power is present. It turns off if AC power fails or falls below acceptable limits. If this occurs, the ventilator automatically switches to battery power and generates a BATTERY ON alert. Internal Battery Indicator Illuminates when the ventilator is operating on internal battery power. Color of the LED indicates the power level of the internal battery when in use. See below for color code. As the battery level drops from full to medium power, the ventilator generates an audible LOW BATTERY alarm (a chirp every three seconds) which can be cleared by pressing the Alarm Silence/Reset button twice. When the battery drops from medium to low power, a non-silencable audible alarm will occur (continuous tone).

29 TBird Series Ventilators Chapter 2 Controls & Displays 29 The time remaining on the battery depends on the current front panel settings and the patient s demands. Table 2-4 shows typical times expected for normal and heavy demands. Table 2-4 Internal & External Battery Typical Operating Times Internal Battery - When Indicator Is: Normal Load Heavy Load Green 40 mins 7 mins Yellow 14 mins 5 mins Red 10 mins 4 mins External Battery - When Indicator Is: Normal Load Heavy Load Green 3.5 hours 55 mins Yellow 1.5 hours 20 mins Settings Normal Load Heavy Load Tidal Volume 500 ml 1500 ml Breath rate 12 bpm 30 bpm Peak Flow 40 lpm 140 lpm Sensitivity 2 lpm 2 lpm PEEP 5 cmh2o 30 cmh2o Lung Compliance 50 ml/cmh2o 17.5 ml/cmh2o Lung Resistance 6 cmh2o/l/sec 3 cmh2o/l/sec External Battery Indicator Illuminates when the ventilator is operating on external battery power. Color of the LED indicates the power level of the external battery when in use. See below for color code. As the external battery gets low, the indicator changes from green to yellow. If the battery becomes fully discharged, the ventilator automatically switches to internal battery power and activates the EXT BATTERY alarm. The time remaining on the battery depends on the current front panel settings, battery condition and the patient s demands. Table 2-4 shows typical times expected for typical normal and heavy demands from a fully charged battery. Color code for battery power source indicators: If green, the battery is at full power. If yellow, the battery is at medium power. If red, the battery is at low power. If off, the ventilator is either running on AC or the other battery source. Battery Charge Status Indicators Display only. Shows the status of the internal and external batteries while being charged. When the ventilator is plugged into an AC source, it automatically charges both batteries (if present). The color of the indicator indicates the battery s charge status: If off, the battery is not present or properly connected. If green, the battery is between 90 and 100% fully charged.

30 30 Operators Manual If yellow, the battery is being charged. If red, a battery fault exists. Contact your Bird Certified Service Technician. The typical amount of time required to recharge the batteries is as follows: Internal battery: If the external battery is fully charged or not present and the internal battery is depleted, the charge time for the internal battery is approximately six (6) hours. If both the internal and external batteries are depleted, the charge time for the internal battery is approximately seven (7) hours. External battery: If the internal battery is fully charged and the external battery is depleted, the charge time for the external battery is approximately seventeen (17) hours. If both the internal and external batteries are depleted, the charge time for the external battery is approximately twenty-four (24) hours. Front Panel - Special Control Section Sigh Button Turns sigh breath feature ON or OFF. To operate, press the button. When ON, the green LED illuminates. A sigh breath is a Volume Control breath in which the Tidal Volume is equal to 1.5 times the Tidal Volume setting. When you press this button, the ventilator delivers a sigh breath on the next assist or machine breath regardless of how that breath is initiated. The ventilator then delivers a sigh breath once every seven (7) minutes or 100 breaths, which ever occurs first. When a sigh breath is delivered: The Tidal Volume is increased by 50%. The effective breath period is increased by 50%. The inspiratory time is increased by 50% (not to exceed a maximum of 5.5 seconds). If the Tidal Volume cannot be delivered in 5.5 seconds, the maximum possible Tidal Volume is delivered for the current flow setting. The preset high pressure alarm limit is increased by 50% (not to exceed a maximum of 120 cmh2o). Sigh breaths are not available in Pressure Control Manual Breath Button This control delivers a single machine breath to the patient. Press and release the button. When breath delivery begins, the integrated LED turns on and stays on while the breath is being delivered. When this control is activated, the ventilator delivers a breath according to the current ventilator settings (Tidal Volume and Peak Flow or Pressure Control and Inspiratory Time). If you press this button during the inspiratory phase or before the minimum exhalation time has elapsed, the ventilator ignores your request.

31 TBird Series Ventilators Chapter 2 Controls & Displays 31 Remote Alarm Button Future option. Square Waveform Button (AVS models only) Changes the waveform from decelerating to square when setting up a Volume Control breath. Press the button to toggle between a square and decelerating waveform. The LED illuminates when you select a Square Wave. This waveform controls how gas flow is delivered to the patient for Volume Control breaths. VAPS Button (AVS III only) This control activates Volume Assured Pressure Support (VAPS). Press the button to enable VAPS, the LED illuminates. Be sure to set the Pressure Control, Tidal Volume and Peak Flow controls to appropriate settings. When turned ON, the ventilator delivers a VAPS breath using the Pressure Control setting for the target pressure. The Pressure Control setting determines the circuit pressure above baseline to be delivered. The Tidal Volume setting determines the minimum guaranteed Tidal Volume to be delivered. The Peak Flow setting determines the minimum delivered flow until the minimum volume is reached. Inspiratory Hold Button (AVS models, VSO2 & Legacy only) Performs an inspiratory hold maneuver to measure static compliance. Press and hold this button prior to the delivery of a mechanical breath. The LED illuminates and the first parameter Paw xxx cmh2o appears in the monitor window, where xxx is the real-time airway pressure. At the end of inspiration, Paw xxx will change to Pplat xxx cmh2o, where xxx represents the plateau pressure. The Inspiratory Hold maneuver will end when the button is released or after six (6) seconds. At this time, Palvd xxx cmh2o Cst xxx ml/cmh2o is displayed where Palvd is the alveolar distending pressure and Cst is static compliance. The green LED now turns off and normal ventilator operation is resumed. The maneuver fails if the Inspiratory Hold button is released too soon or a stable plateau could not be obtained. To clear the display from the monitor window, press the Monitor Select Button. Note The HIGH PRES alarm will automatically cancel the Inspiratory Hold maneuver. Expiratory Hold Button (AVS II & AVS III only) Performs an expiratory hold to measure AutoPEEP. To activate, press and hold this button to initiate the Expiratory Hold maneuver. When the next machine breath would occur, the ventilator occludes inspiratory and expiratory flow, the built-in LED turns on and the following parameters will appear in the monitor window: Paw nn Pex mm AUTOPEEP pp cmh2o

32 32 Operators Manual where nn is the real time airway pressure, mm is the ending exhalation pressure and pp is the measured AutoPEEP. AutoPEEP characterizes the patient s end expiratory alveolar pressure. This value is continuously updated until six (6) seconds has elapsed or the button is released. At the end of the maneuver, AutoPEEP is calculated as the difference between Pex and Paw. Normal ventilation resumes at the end of the maneuver. Note The HIGH PRES alarm will automatically cancel the Expiratory Hold maneuver. MIP / NIF Button (AVS II & AVS III only) Performs a MIP/NIF maneuver to measure the patient s inspiratory effort. To operate, press and hold. The built-in LED turns on and the following parameters are displayed: Starting pressure (Pstart), airway pressure (Paw), and maximum inspiratory pressure (MIP). They are displayed as follows: Pstart --- Paw --- MIP --- cmh2o Continue to hold the button until the dashes are replaced by values. The ventilator computes MIP by measuring the difference between the airway circuit pressure at the start of the maneuver and the maximum negative pressure achieved during the maneuver. When you press and hold the button, the ventilator locks out all front panel controls, displays the labels, and waits for the exhalation flow to end. Once this occurs, the inspiratory and exhalation flows are blocked and the circuit pressure is displayed next to Pstart. The ventilator then displays the current airway pressure next to Paw Each time a new maximum negative pressure is detected, the MIP value is updated with the computed difference between Paw and Pstart. This value is continuously updated until you release the button, or 30 seconds have elapsed. Once the MIP period ends, the highest value is retained as the MIP and ventilator returns to normal operation. Note The HIGH PRES alarm will automatically cancel the MIP/NIF maneuver. 100% O2 3 Min Button (AVS models & VSO2 only) Delivers 100% oxygen to the patient for a maximum of three minutes without having to change the % O 2 setting. Press the button to turn 100% oxygenation ON or OFF. The LED illuminates and the % O 2 display flashes 100 while 100% oxygen is being delivered. The percentage of oxygen increases to 100% for three minutes or until you turn 100% O2 OFF. The length of time required to actually reach the 100% oxygen level depends on the currently set bias flow and the patient s minute volume demands. The 100% level is typically reached before the first two liters of gas are delivered. After three minutes the unit returns to the previous Oxygen setting.

33 TBird Series Ventilators Chapter 2 Controls & Displays 33 Flow Cal. This button allows you to override the automatic flow cal program and perform a manual flow calibration. It will turn on the automatic flow cal program after a manual flow calibration has been performed. When the ventilator is turned ON, the Flow Cal. LED will flash while the software is establishing the flow calibration. Once this is reached the LED will be illuminated continuously. Flow calibration determines the bias flow exiting the Exhalation Valve Flow transducer which may differ from the set bias flow. If the LED continues to flash, the ventilator is unable to establish the calibration and the clinician can perform a manual flow calibration. To perform a manual flow calibration, press and hold the Flow Cal button during the exhalation phase of a breath. The following message appears: FC nn.n Where nn.n is the current volume of gases moving through the exhalation valve sensor. Continue to hold the button until the flow calibration value nn.n stabilizes within 3 L/min of the set bias flow. The display will appear as: FC nn.n OK Note Although the system continues to ventilate without an established flow cal value, indicated by the flashing LED, the accuracy of the exhaled tidal volume and minute volume measurements and the sensitivity may be reduced. Front Panel - Patient Connectors Patient Outlet. 22mm OD outlet for patient circuit. Exhalation valve Connector for exhalation valve body and tubing from patient. Over Pressure Relief Valve Sets the maximum pressure allowed in the system. Provides a safety backup for the high-pressure alarm. To set the Over Pressure Relief Valve, do the following: 1. Attach a Bird test lung (P/N or equivalent) to the patient breathing circuit 2. Set the High Pressure Limit Control to 120 cmh2o. 3. Set the Tidal Volume and Peak Flow to achieve at least 100 cmh2o as displayed on the manometer 4. Monitor PIP 5. Adjust the valve until the pressure shown on the manometer reaches the desired pressure.

34 34 Operators Manual 6. Lower the High Pressure Limit Control to 5-15 cmh2o (or to the value dictated by hospital protocol) below the Over Pressure Relief setting. This control must be set 5-15 cmh2o above the high-pressure limit WARNING Make sure the high-pressure alarm limit is not set above the Over Pressure Relief setting. Otherwise, a HIGH PRES alarm will not occur and the patient may be subjected to sustained high pressures. Rear Panel Figure 2.3 Over Pressure Relief Power Switch Switches the ventilator between STANDBY and ON. Press the upper half of the switch to turn the ventilator ON. Press the lower half of the switch to return the ventilator to STANDBY. When ON, the ventilator will operate on AC, internal battery, or optional external battery power, depending on the power source available. When in STANDBY position and plugged into an AC power source, the ventilator charges the internal battery and optional external batteries. Fan Intake Filter Filters air drawn into the ventilator. Alarm Volume Control Enables you to set the sound level of the audible alarm. Typically would be set to far clockwise position. Fiberoptic Interface Port Allows attachment of the optional Bird Graphics Monitor. Patient Assist Call Connector Allows connection to an existing Patient Assist Call system in an institution.

35 TBird Series Ventilators Chapter 2 Controls & Displays 35 Fuses Oxygen Inlet Port, Low Flow (Legacy, VS) Allows entrainment of oxygen into the gas flow. Low flow oxygen (up to 80 lpm) can be attached from an oxygen concentrator or regulated oxygen source. Two (2) DISS high pressure connectors for oxygen. High pressure oxygen (40 to 60 psi) sources can be attached. Air Inlet Filter Filters air drawn into the turbine.

36 36 Operators Manual

37 Chapter 3 Monitored Parameters The ventilator features a comprehensive package that continually monitors breath parameters. These parameters include: Total Breath Rate (f) I:E Ratio (I:E) Minute Volume (VE) Spontaneous Minute Volume (sve) Machine Minute Volume (mve) Peak Inspiratory Pressure (PIP) Mean Airway Pressure (MAP) Inspiratory Time (Ti) Positive End Expiratory Pressure (PEEP) Exhaled Tidal Volume (Vte) These parameters are displayed singularly on the TBird VS, VSO2 and Legacy models and in sets of two or three on the TBird AVS models. As each set of parameters is monitored, the values appear in the monitor window. If autoscanning is turned on, the system automatically advances through the parameters, displaying each set for approximately four seconds. You can hold the scan at a particular set of parameters by pressing the Monitor Select button. If autoscanning is turned off, you can manually advance through the list by pressing the Monitor Select button. The selected parameters will be displayed until you press the Monitor Select button again to advance to the next parameter. To enable or disable autoscanning, use the Autoscan function described in Chapter 6, Special Functions. When autoscan is enabled, a rising arrow ( ^ ) appears in the far right of the monitor window. Table 3-1 describes each of the monitored parameters and shows the range of values displayed. Table 3-1 Monitored Parameters Monitored Parameter Display Range Description Breath rate f 0 to 250 bpm Shows the total number of breaths per minute including both spontaneous and machine breaths. The displayed value is based on an eight breath moving average and is updated at the beginning of each inspiration. I:E Ratio I:E 99:1 to 1:99 Shows the ratio of inspiratory to expiratory time for all breaths including spontaneous breaths and is updated at the end of every breath. Inverse I:E ratios are displayed as well as regular I:E ratios Minute Volume VE 0 to 99.9 L/min Shows the average volume delivered to the patient each minute, it is updated at the end of each exhalation. The minute volume is a moving average calculated by multiplying the breath rate by the average of the previous eight tidal volumes. Spontaneous breaths are included. Spontaneous Minute Volume sve 0 to 99.9 L/min The average volume delivered to the patient during a

38 38 Operators Manual Monitored Parameter Display Range Description minute for spontaneous breaths only. Machine Minute Volume mve 0 to 99.9 L/min The average volume delivered to the patient during a minute for machine breaths Peak Inspiratory Pressure PIP 0 to 140 cmh2o Shows the highest circuit pressure to occur during inspiration as measured at the exhalation valve. The display is updated at the end of inspiration. PIP is not updated for spontaneous breaths. Mean Airway Pressure MAP 0 to 99 cmh2o Shows the MAP over the last minute and is based on a one minute moving average. The display is updated every 10 seconds Inspiratory time Ti sec Displays the Inspiratory Time for all breath types and is updated at the end of every breath. Positive End Expiratory Pressure PEEP 0 to 99 cmh2o Shows the measured end expiratory pressure. The display is updated at the end of the exhalation phase. Machine exhaled Tidal Volume mvte 0-4,000 ml Shows the average exhaled volume for machine type breaths as measured by the exhalation flow transducer. The default average is for the previous 8 breaths and is updated at the end of each exhalation. Spontaneous exhaled Tidal Volume svte 0-4,000 ml Exhaled Tidal Volume of the previous spontaneous breath

39 Chapter 4 Alarms and Alerts This chapter describes the various alarms and alerts that can occur while operating the ventilator. The following topics are covered: How alarms and alerts are generated. How to respond to each alarm or alert. Definitions Alarms Alerts Alarms When the ventilator detects an operating condition that requires your immediate attention, it activates the audible alarm, flashes a message in the alarm window, and flashes any dedicated indicators or controls associated with the alarm. The audible and visual components of the alarm remain active for as long as the condition causing the alarm exists. Once the condition no longer exists, the audible component automatically clears itself. The visual component may or may not be automatically cleared, depending on the nature of the alarm. If the visual component is not automatically reset, press the Alarm Silence/Reset button. To clear the audible portion of an alarm, press the Alarm Silence/Reset button. The volume of the audible alarm can be physically adjusted using the alarm volume control on the back panel. When the ventilator detects an operating condition that needs to be addressed, it flashes an alert message in the monitor window to signal you to the condition. After addressing an alert, press the Alarm Silence/Reset button to clear the alert. APNEA Alarm Cause The elapsed time between inspiratory starts has exceeded the current apnea interval. The elapsed time is measured from the start of one inspiration to the start of the next, regardless of breath type (machine, assist, or patient). Ventilator Response The ventilator: Switches to Apnea Backup ventilation, which is delivered in the Assist/Control mode. Sounds the audible alarm. Displays APNEA xx BPM in the alarm window, where xx is the apnea ventilation breath rate.

40 40 Operators Manual Resets the breath rate to 12 bpm if the set rate is less than 12 bpm. Highlights the controls used for breaths given during Apnea Backup ventilation. Note You cannot switch modes when the ventilator is providing Apnea Backup ventilation. Corrective Action The audible portion of this alarm clears itself automatically whenever two successive breaths are initiated by the patient. To clear the visual portion, press the Alarm Silence/Reset button. To manually silence and reset the alarm, and cancel Apnea Backup ventilation, press the Alarm Silence/Reset button twice. AC Power Lost Alarm Cause This alarm occurs when the ventilator is operating on AC power and the AC power either fails or AC power is removed. Ventilator Response The ventilator: Immediately switches to battery backup (without interrupting ventilation). Sounds the audible alarm. Turns the AC indicator OFF. Illuminates the Ext. Bat power indicator, if the optional external battery is present. Illuminates the Int Bat power indicator, if the optional external battery is not present. Displays BATTERY ON in the alarm window. Corrective Action To clear the alarm, press the Alarm Silence/Reset button twice. When the ventilator is operating on battery power, the front panel lamps are turned OFF to conserve power. They will illuminate whenever front panel activity is detected. If an alarm message is displayed in the alarm window, the window will stay illuminated. The Airway Pressure Manometer remains illuminated at all times. Internal Operations Check Alarm Cause This alarm occurs when the ventilator s on-going self-tests detect an anomaly. The ventilator reinitializes itself to invoke the more sophisticated Power-On Self Tests (POST).

41 TBird Series Ventilators Chapter 4 Alarms & Alerts 41 Ventilator Response The ventilator: Records the events in EEPROM. Performs a self-start. Sounds the audible alarm. Displays CHECK EVENTS in the alarm window. During the self-start, the ventilator runs the Power-On Self Tests (POST). If the POST detects a problem that could interfere with the continued safe operation of the ventilator, it generates a vent inop condition. Otherwise, the ventilator resumes operation at the previous settings. Corrective Action Press the Alarm Silence/Reset button twice to clear the audible and visual alarm. Note Although the ventilator continues to operate normally when this alarm is present, contact your Bird Certified Service Technician. Circuit Fault Alarm Cause This alarm occurs when the patient breathing circuit becomes kinked, occluded, or disconnected. It also occurs if a problem is detected with one of the internal transducers used to measure the patient breathing circuit pressure. The ventilator checks the patient breathing circuit in all modes, except during the inspiratory phase of pressure support breaths. Ventilator Response The ventilator: Sounds the audible alarm. Displays CIRC FAULT in the alarm window. Cycles into the exhalation phase. When this condition occurs, the ventilator stops flow and opens the exhalation valve. Corrective Action The audible alarm automatically clears itself when the problem is corrected. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset button.

42 42 Operators Manual Default Settings Alarm Cause The ventilator is shipped from the factory with built-in default settings for all operational parameters. Once you set a front panel control, the corresponding default value for that control is overridden by the new setting. The new setting is then stored in EEPROM so that it can be retained even when the ventilator is turned off. When you turn the ventilator on, the retained settings are automatically restored If something happens that prevents the ventilator from retrieving the retained settings from EEPROM, the ventilator restores the original factory default settings, allowing the ventilator to continue to operate safely. This alarm notifies you that the ventilator is operating on the default settings. Ventilator Response The ventilator: Sounds the audible alarm. Displays DEFAULTS in the alarm window. Table 4-1 Default Settings Control Default Altitude Compensation 500 ft APNEA Interval 20 sec Assist Control ON Bias Flow 10 L/min Breath Rate 12 bpm Control Lock Enabled CPAP OFF High Pressure 30 cmh2o Inspiratory Pause OFF Inspiratory Time 0.3 Language English Low Minute Volume Alarm 0.1 Peak Flow 35 L/min Control Default PEEP/CPAP 0 cmh2o Pressure Control OFF Pressure Support OFF Remote Alarm OFF Sensitivity 2 lpm Sigh OFF SIMV OFF Square Waveform OFF Termination Sensitivity 25% Tidal Volume 500 ml VAPS OFF Variable Time Termination 3.0 sec Flow Termination OFF Corrective Action To clear the alarm, press the Alarm Silence/Reset button twice and set the front panel controls to the desired settings. Note If this alarm occurs frequently, contact your Bird Certified Service Technician.

43 TBird Series Ventilators Chapter 4 Alarms & Alerts 43 Low External Battery Alarm Cause This alarm occurs when the ventilator switches from external battery power to internal battery power. Ventilation is continued without interruption. Ventilator Response The ventilator: Sounds the audible alarm. Displays EXT BATTERY message in the alarm window. Corrective Action To clear the alarm, press the Alarm Silence/Reset button twice. The audible alarm automatically clears itself when you plug the ventilator into an AC source. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset button. Fan Fault Alarm Cause This alarm occurs when the speed of the cooling fan drops below acceptable limits. Ventilator Response The ventilator: Sounds the audible alarm. Displays FAN FAULT in the alarm window. Corrective Action Press the Alarm/Silence Reset button twice to clear the audible and visual alarm Remove the ventilator from service as soon as possible and contact your Bird Certified Service Technician. High Breath Alarm (AVS models, VSO2 & Legacy only) Cause This alarm occurs when the total breath rate meets or exceeds the High Breath Rate alarm setting. Ventilator Response When total breath rate exceeds the alarm setting the ventilator: Sounds the audible alarm. Flashes the High Breath Rate control. Displays the HIGH BREATH in the alarm window.

44 44 Operators Manual Corrective Action This alarm stays in effect until the total breath rate falls below the High Breath Rate alarm setting. The audible alarm automatically clears itself when the total breath rate falls below the High Breath Rate alarm setting. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset Button. High Oxygen Inlet Pressure Alarm (AVS models & VSO2) Cause This alarm occurs when the % O2 is set to a value greater than 21 and inlet pressure at the oxygen inlet exceeds 65 PSIG (4.3 bar). Ventilator Response The ventilator: Sounds the audible alarm. Displays HIGH O2 in the alarm window. Corrective Action The audible alarm resets itself when the inlet pressure falls back into range. To manually clear the alarm: Reconnect the ventilator to a known good oxygen source. Adjust the oxygen inlet pressure to between PSIG ( bar). Press the Alarm Silence/Reset button. High PEEP Alarm Cause This alarm occurs when the patient breathing circuit pressure fails to return to the set PEEP +15 cmh2o during exhalation. Ventilator Response The ventilator: Sounds the audible alarm. Displays HIGH PEEP in the alarm window. Corrective Action To clear the alarm, correct the condition causing the alarm and press the Alarm Silence/Reset button twice. The audible alarm automatically clears itself when the PEEP returns to within 15 cmh2o of PEEP. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset button.

45 TBird Series Ventilators Chapter 4 Alarms & Alerts 45 High Pressure Alarm Cause This alarm occurs when the patient breathing circuit pressure exceeds the High Pressure Limit alarm setting by at least 1 cmh2o during any portion of a breath. Ventilator Response The ventilator: Sounds the audible alarm. Flashes the High Pressure Limit control. Displays HIGH PRES in the alarm window. Immediately terminates inspiration and cycles into the exhalation phase. By immediately cycling into the expiratory phase, the ventilator allows the pressure in the patient breathing circuit to return to the baseline pressure. It also allows the exhalation valve to regulate the pressure at the currently set PEEP level. Corrective Action The audible alarm automatically clears itself if patient breathing circuit pressure falls to within 5 cmh2o of PEEP. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset button. If the patient breathing circuit pressure does not fall back to PEEP + 5 cmh2o within three (3) seconds after entering the exhalation phase, the ventilator stops the flow, and the exhalation valve opens. Flow restarts when PEEP + 5 cmh2o is reached. Hardware Fault Alarm Cause This alarm occurs when the ventilator s on-going self-tests have detected a problem with the ventilator hardware, or the internal temperature of the ventilator has exceeded acceptable limits. Ventilator Response The ventilator: Sounds the audible alarm. Displays HW FAULT message. Corrective Action To clear the alarm, press the Alarm Silence/Reset button twice. Ensure that the fan filter is free from obstruction. If the alarm reoccurs, this indicates that there is an internal hardware fault. Remove the ventilator from service and contact your Bird Certified Service Technician.

46 46 Operators Manual Low Internal Battery Alarm Cause This alarm occurs when the ventilator is being powered from the internal battery and the battery s remaining power drops to the medium or low power level. Ventilator Response This alarm occurs when battery power drops to medium power. The ventilator: Chirps the audible alarm every three seconds Turns the Int Bat Power Source indicator from green to yellow. Displays the LOW BATTERY message. The alarm can be cleared by pressing the Alarm Silence/Reset button twice. This alarm occurs again when battery power drops to low power. The ventilator: Sounds the audible alarm continuously. Turns the Int Bat Power Source indicator from yellow to red. Displays the LOW BATTERY message. This alarm cannot be cleared unless you plug the ventilator into an AC source or connect the external battery. Corrective Action Find another power source. The audible alarm automatically clears itself when you attach an external battery or plug the ventilator into an AC source. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset button. Low Oxygen Inlet Pressure Alarm (AVS models & VSO2) Cause This alarm occurs when the % O2 control is set to a value greater than 21 and the pressure at the oxygen inlet falls below 35 PSIG (2.4 bar). Ventilator Response If the pressure becomes too low, the ventilator: Sounds the audible alarm. Displays the LOW O2 message. Corrective Action The audible portion of the alarm resets itself when the inlet pressure comes back into range. Reconnect the ventilator to a known good oxygen source. Adjust the oxygen inlet pressure to PSIG ( bar).

47 TBird Series Ventilators Chapter 4 Alarms & Alerts 47 Press the Alarm Silence/Reset button. Low Pressure Alarm Cause This alarm occurs when the patient breathing circuit pressure fails to exceed the Low Pressure Alarm setting during the inspiratory phase of a machine or assist breath. Ventilator Response The ventilator: Sounds the audible alarm. Flashes the Low Pressure Alarm control display. Displays the LOW PRES message. Corrective Action The audible alarm automatically clears itself when a subsequent machine or assist breath exceeds the currently set Low Pressure Limit. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset button. Note This alarm is disabled in CPAP mode and during spontaneous and Pressure Support breaths. The alarm is enabled in CPAP mode when a manual or sigh breath is delivered. Low Minute Volume Alarm Cause This alarm occurs when the patient s exhaled minute volume fails to exceed the Low Minute Volume alarm setting. The ventilator calculates the exhaled minute volume based on information received from the exhalation valve flow transducer. Ventilator Response When the calculated value falls below the front panel setting, the ventilator: Sounds audible alarm. Flashes the Low Minute Volume display. Displays the LOW VOLUME message. Corrective Action Check the humidifier assembly and patient circuit for leaks. The alarm stays in effect until the patient s exhaled minute volume exceeds the Low Minute Volume alarm setting.

48 48 Operators Manual The audible alarm automatically clears itself when the patient s exhaled minute volume exceeds the Low Minute Volume alarm setting. The visual portion of the alarm remains in effect until you press the Alarm Silence/Reset button. If the alarm activates continuously, consult the ordering physician to evaluate the alarm and ventilator settings. Transducer Fault Alarm Cause This alarm occurs when a transducer s zero point has drifted out of range. Ventilator Response The ventilator: Sounds the audible alarm. Displays the XDCR FAULT message. Corrective Action To clear the alarm, press the Alarm Silence/Reset button twice. If this does not clear alarm, replace the exhalation valve body and reseat the diaphragm. Perform a manual flow cal and press the Alarm Silence/Reset to clear the alarm. WARNING Although the system will continue to ventilate with a XDCR FAULT alarm, the accuracy of the tidal volume, minute volume and pressure measurements may be reduced. Remove the ventilator from service and contact your Bird Certified Service Technician. Vent Inop Alarm Cause A condition has developed that could affect the continued safe operation of the ventilator. Ventilator Response The ventilator: Sounds the audible alarm. Illuminates the Vent Inop indicator. Ceases operation. Returns to a safe state so the patient can breathe spontaneously from room air. Corrective Action Provide an alternate means of ventilation for the patient. Turn the power switch to the STANDBY position and press the Alarm Silence/Reset button to silence the audible alarm. Then remove the ventilator from service and contact your Bird Certified Service technician.

49 TBird Series Ventilators Chapter 4 Alarms & Alerts 49 Alerts Note A Vent Inop alarm occurs normally when the ventilator is placed in the STANDBY position. APNEA Alert Cause BIAS Alert This alert occurs immediately following the POST and informs the user as to the current Apnea Interval setting. To adjust the Apnea Interval, see Apnea Setting in Chapter 6, Special Functions. Ventilator Response Informational only. This is normal in the power-up procedure. Corrective Action To clear the alert, press the Monitor Select button. Cause This alert occurs following the Power On Self Tests (POST) and informs the user of the current Bias Flow setting. To adjust the Bias flow, see Bias Flow in Chapter 6, Special Functions. Ventilator Response Informational only. This is normal in the power-up procedure. Corrective Action To clear the alert, press the Monitor Select button. Check Apnea Backup Settings Alert Cause This alert occurs when the ventilator powers up in CPAP mode or when CPAP mode is selected. This is a reminder to check ventilator settings that will be used during Apnea Backup ventilation. Ventilator Response Informational only

50 50 Operators Manual Corrective Action When operating in CPAP mode, certain controls must be set to clinically appropriate level even though they are dimmed and inactive. Should the patient become apneic, the ventilator uses these settings when providing Apnea Backup ventilation. A CHECK BKUP alert will be displayed as a reminder to verify that Apnea Backup ventilation parameters are appropriately set. Check the following settings to ensure that they are clinically appropriate: Tidal Volume Inspiratory Time Peak Flow Inspiratory Pause Breath Rate VAPS Pressure Support Square Waveform Pressure Control Apnea Interval To clear the alert, press the Monitor Select button. Check Filter Alert Cause This alert occurs every 500 hours to remind you to check the air intake filter on the back panel to see if it needs to be cleaned or replaced. Ventilator Response When this alert occurs, the FILTER message appears in the monitor window. Corrective Action Remove and clean or replace the air intake filter (refer to Chapter 9, Cleaning and Sterilization) Press the Monitor Select button to clear the alert. Controls Locked Alert Cause This alert occurs when you attempt to change a control setting while the front panel controls are locked. Ventilator Response The ventilator displays the LOCKED message in the monitor window. Corrective Action To clear the alert, press the Monitor Select button or unlock the controls.

51 Control Setting Limits Alert Cause This alert occurs when you attempt to set a control to a value that is incompatible with other control settings. This alert will occur: If Tidal Volume, Breath Rate, Peak Flow, Inspiratory Pause, and Inspiratory Time are set to values which would cause the minimum inspiratory time to be less than 300 ms or minimum exhalation time to be less than 250 ms, regardless if they are active or inactive. If Tidal Volume, Breath Rate, Peak Flow, Inspiratory Pause, and Inspiratory Time are set to values which would cause an inverse I:E ratio of greater than 4:1. If High Pressure is decreased to within 5 cmh2o of PEEP, or PEEP is increased to within 5 cmh2o of the High Pressure setting. If Peak Flow is set to a value which is below Bias Flow. Ventilator Response The ventilator will not allow these parameters to be exceeded and will flash the affected controls. The ventilator displays LIMITED in the monitor window. Corrective Action To clear the alert, deselect the control or set the affected controls to compatible settings. If a limited alert occurs during a ventilator parameter change, carefully review all of the new parameter settings. Flow Sensor Alert (AVS models only) Cause This alert occurs when the ventilator cannot detect the presence of an AVS exhalation valve body. Ventilator Response The ventilator: Displays FLOW SENSOR in place of Vte and VE in the monitor window. Corrective Action This alert remains in effect until the ventilator detects an AVS exhalation valve body. To clear the alert, ensure that an AVS exhalation valve body is installed: Reseat the exhalation valve body, or Replace the exhalation valve body with a new one.

52 52 Operators Manual Invalid Calibration Values Alert Cause This alert occurs when the Power On Self Tests (POST) detect a problem with the transducer calibration data stored in the EEPROM. Ventilator Response The ventilator: Replaces the current calibration data with the default values. Displays the NO CAL DATA message. The message cannot be cleared and remains in the window until the problem is corrected by a Bird Certified Service Technician. Any alert or special function messages that occur while this message is active temporarily overwrite the message. Monitored parameters do not overwrite the message. Corrective Action Although the system continues to operate, remove the ventilator from service and contact your Bird Certified Service Technician. WARNING Although the system continues to ventilate when a NO CAL DATA alert is present, the accuracy of the volume and pressures may be reduced. The system may generate pressures and volumes that are inconsistent with the front panel settings. Remove the ventilator from service and contact your Bird Certified Service Technician. New Sensor Alert (AVS Models Only) Cause This alert occurs while the ventilator is processing data from a newly installed AVS exhalation valve body. Ventilator Response The ventilator: Displays NEW SENSOR in place of Vte and VE in the monitor window. Corrective Action None is required. This is a temporary event that occurs when a new valve body is installed. The alert will clear automatically. Invalid Calibration Values Alert Cause This alert occurs when the Power On Self Tests (POST) detect a problem with the transducer calibration data stored in the EEPROM.

53 TBird Series Ventilators Chapter 4 Alarms & Alerts 53 TermSens Varitime Ventilator Response The ventilator: Replaces the current calibration data with the default values. Displays the NO CAL DATA message. The message cannot be cleared and remains in the window until the problem is corrected by a Bird Certified Service Technician. Any alert or special function messages that occur while this message is active temporarily overwrite the message. Monitored parameters do not overwrite the message. Corrective Action Although the system continues to operate, remove the ventilator from service and contact your Bird Certified Service Technician. WARNING Although the system continues to ventilate when a NO CAL DATA alert is present, the accuracy of the volume and pressures may be reduced. The system may generate pressures and volumes that are inconsistent with the front panel settings. Remove the ventilator from service and contact your Bird Certified Service Technician. Cause This alert occurs during the course of power up. It alerts the clinician to the existing setting in Special Functions for the Termination Sensitivity, as a % of Peak Flow, for a Pressure Supported breath. Ventilator Response Informational only. This is normal in the power-up procedure. Corrective Action Press the Monitor select button to clear. Cause This alert occurs during the course of power up. It alerts the clinician to the existing value in Special Functions for the Variable Time termination, maximum inspiratory phase for a Pressure Supported breath. Ventilator Response Informational only. This is normal in the power-up procedure. Corrective Action Press the Monitor select button to clear.

54 54 Operators Manual

55 Chapter 5 Unpacking, Setup and Operation This chapter shows you how to unpack, set up, and check out the ventilator prior to putting it into clinical use. It also covers basic operating procedures. Instructions are included demonstrating how to: Unpack the ventilator. Attach a patient breathing circuit. Set the audible alarm. Connect oxygen lines (optional). Connect to a Patient Assist Call System (optional). Turn the ventilator ON Turn the ventilator OFF Unpacking the Ventilator Check the ventilator performance. Set up Control Mode Set up Assist/Control Mode Set up SIMV Mode Set up CPAP Mode Set up Pressure Control Breaths Set up Volume Assured Pressure Support (VAPS) Breaths Prior to unpacking the ventilator, check the outside of the shipping carton for physical damage or water stains. If you find damage or water stains, contact the freight carrier and your local Bird Products Customer Care representative. To unpack the ventilator, do the following: 1. Remove the ventilator from its box and remove all packing materials. 2. Inspect the ventilator for damage. Check the covers, connectors, power cord, and front panel. If you find any damage, do not operate the ventilator. Contact the freight carrier and your local Bird Products Customer Care representative. 3. Check the contents of the carton against the packing slip. If any parts are missing, contact the freight carrier and your local Bird Products Customer Care representative. 4. Save the shipping container and packing materials for future storage or shipment. How to Attach a Patient Breathing Circuit The TBird Series ventilators are compatible with reusable and disposable patient breathing circuits meeting the ISO 22 mm standard taper connections regulation. Patient breathing circuit compliance varies widely. Contact the original equipment manufacturer for circuit compliance information to calculate distensible volume loss. The clinician will use this information to determine potential clinical impact. Patient breathing circuit compliance for the Bird Products reusable circuit is available in Appendix B of this manual. How you attach the patient breathing circuit depends on what devices are to be used in the circuit. This procedure assumes you are using a heated humidifier. The TBird Series ventilators are compatible with Heated Humidification systems meeting or exceeding the ANSI Z standard or its locally mandated equivalent. See Appendix A of this manual for a partial list of approved optional Heated Humidification devices and accessories. Heated Humidification devices provide for a full compliment of reusable and disposable accessories, including chambers, circuits, probes, and adapters. A complete

56 56 Operators Manual list of Heated Humidification devices and accessories is located in the Bird Products Hospital Price List. L1332. If you are not using a heated humidifier, ignore the steps that reference it. If using optional components, refer to the installation instructions provided with those components. To attach the patient breathing circuit, refer to Figure 5.1 and do the following: 1. Install the exhalation valve diaphragm and exhalation valve body into the ventilator. The exhalation valve body is properly installed when the safety release latch engages: you will hear it click into place. 2. Attach one end of the short circuit tubing to the patient outlet port. 3. Attach the other end of the circuit to the main bacteria filter and connect the outflow end of the bacteria filter to the humidifier s inlet port. Make sure the airflow through the bacteria filter is in the proper direction. The humidifier can be attached to either side rail of the ventilator, or if you are using a Bird Products ventilator stand, to the dovetail bracket on the stand. 4. Connect the inspiratory leg of the patient airway circuit tubing to the outlet of the heated humidifier. 5. Connect the exhalation leg of the patient breathing circuit to the exhalation valve body. 6. Connect the two water traps, the patient wye, and the remaining circuit components 7. Relieve stress on the patient connections by using the Bird Products Circuit Support Arm. Before using the ventilator, check the ventilator s performance as described later in this chapter. Figure 5.1 Attaching the Patient Breathing Circuit. Adjusting Alarm Volume The alarm volume control is located on the back panel. It allows you to adjust the loudness of the audible alarm upwards from a minimum of 70 dba ± 5dBa (measured at one meter.) To adjust the volume of the audible alarm, refer to Figure 5.2 and do the following:

57 TBird Series Ventilators Chapter 5 Unpacking, Set-up & Operation Turn the control clockwise to increase the volume. 2. Turn the control counterclockwise to decrease the volume. Attaching Oxygen Lines Figure 5.2 Adjusting the Audible Alarm Volume WARNING Introduction of oxygen into the TBird Legacy and VS ventilator may increase delivered tidal volumes. Tidal volumes should be monitored to ensure the desired volume is delivered. Legacy and VS Systems The TBird Legacy and VS series ventilators have a barbed fitting that allows for the introduction of oxygen. The oxygen source should not exceed 80 lpm or 0.5 PSI. To attach a low flow oxygen source, refer to Figure 5.3 and do the following: 1. Attach one end of standard ¼ I.D. oxygen tubing to the barbed fitting on the back of the ventilator. 2. Attach the other end of the tubing to the flow meter.

58 58 Operators Manual AVS and VSO2 systems Figure 5.3 Attaching a Low Flow Oxygen Source (Legacy and VS). The TBird AVS and VSO2 have two threaded connectors to supply the unit with oxygen. Each connector has an internal check valve that allows you to change oxygen sources without interrupting the gas supply to the ventilator. The oxygen inlet pressure must be between 40 and 60 PSIG (2.8 to 4.2 bar). To attach oxygen lines to the connectors, refer to Figure 5.4 and do the following: 1. Screw one end of an appropriate oxygen hose to the connector on the back of the ventilator. 2. Attach the other end of the oxygen hose to a pressurized oxygen source. 3. A second connector is provided to facilitate switching from piped O2 to bottled O2 when preparing to move the patient. Leaving both ports connected to oxygen sources continuously is not recommended. Figure 5.4 Attaching oxygen AVS and VSO2

59 TBird Series Ventilators Chapter 5 Unpacking, Set-up & Operation 59 Attaching to a Patient Assist Call System The ventilator can be connected to a Patient Assist Call System through the Patient Assist Call modular jack located on the back panel. Before connecting to the system, however, you must determine whether your patient call system is configured as Normally Open (NO) or Normally Closed (NC). For NO systems you need cable part # For NC systems you need cable part # CAUTION The maximum voltage that can be applied to the Patient Assist Call modular connector is 25 volts rms or 31 volts DC. Connect the ventilator to the Patient Assist Call System by plugging into the Patient Assist Call jack shown in Figure 5.5. Patient Assist Connection To Turn the Ventilator ON Figure 5.5 Connecting to the Patient Assist Call System. Prior to placing a patient on the ventilator, plug the power cord into a live AC power source for 24 hours to fully charge the batteries. A ventilator check must be performed using a breathing circuit and a test lung. To turn the ventilator ON, do the following: 1. Connect the ventilator to a valid power source (AC line or optional external battery). If you do not connect the ventilator to an external power source it will operate on the internal battery when turned on. 2. Move the AC power switch to the ON position. The ventilator responds as follows: The power source LED illuminates. The ON LED illuminates green. The Power ON Self-Tests (POST) run. During these tests, the alarm sounds and the front panel lamps illuminate briefly.

60 60 Operators Manual Upon successfully completing the POST, the ventilator begins operating using retained settings or defaults. The Flow Cal LED flashes. The LED will continue to flash until the Auto Flow Cal software obtains a valid value or until a manual Flow Cal maneuver is performed. The ventilator exhibits a flashing Apnea Interval setting. 3. Press the Monitor Select button to clear the display. The current Bias Flow setting is displayed. 4. Press the Monitor Select to clear the display. The current Termination Sensitivity setting is displayed. 5. Press the Monitor Select to clear the display. The current Variable Time Termination setting is displayed. 6. Press the Monitor Select button to clear the display. The system begins to display the monitored parameters. To Turn the Ventilator OFF 1. Disconnect the patient from the ventilator. 2. Move the power switch to the STANDBY position. The audible alarm sounds and the Vent Inop indicator begins to flash. 3. Press the Alarm Silence/Reset button to silence the audible alarm. The Vent Inop indicator continues to flash for several minutes. This flashing operates from an internal capacitor, not from the battery and has no effect on battery life. 4. While plugged into an AC source, the AC and charge indicators will remain illuminated. When turned OFF, the ventilator is on STANDBY as long as it is plugged into an AC source. While on STANDBY the ventilator charges the internal battery and the optional external battery, if present. Performance Checks Note If any portion of the following performance check fails and you are unable to correct the problem, contact your Bird Certified Service Technician. After setting up the ventilator, check its performance as follows: 1. Plug the ventilator s power cord into a properly grounded electrical outlet. 2. Perform the User Verification Tests (UVTs). See Chapter Exit the UVTs and attach a Test Lung to the patient breathing circuit. 4. Press the Assist/Control mode button to operate the ventilator in Assist/Control mode. 5. Set the ventilation controls as follows:

61 TBird Series Ventilators Chapter 5 Unpacking, Set-up & Operation 61 Control Setting Tidal Volume 500 ml Peak Flow 60 L/min Breath Rate 12 bpm PEEP/CPAP 5 cmh2o Sensitivity OFF Pressure Support OFF % O2 21 Pressure Control OFF Inspiratory Time 0.3 sec Inspiratory Pause OFF Sigh OFF Square Waveform OFF Bias Flow 10 Autoscan ON Altitude 500 ft. Low Minute Volume DIS LMV OFF Alarm Range Termination Sensitivity 25% Variable Time 3.0 sec Termination Flow Termination OFF 6. Set the alarm controls as follows: Alarm Control High Pressure Low Pressure Low Minute Volume High Breath Rate Apnea Interval Setting 5 cmh2o above peak pressure reading on the manometer 10 cmh2o below peak pressure reading on the manometer. 4 L 15 bpm 20 sec Note Refer to Chapter 6, Special Functions, for instructions on setting these controls. 7. Check monitor performance as follows: Note Approximate numbers and values depend on test set-up.

62 62 Operators Manual Note Allow the ventilator to operate for two minutes. View the monitored parameters. The values should appear as follows: Parameter Value Minute volume 6 L L Tidal Volume 500 ml ml I:E Ratio 1: % Breath Rate 12 bpm + 2 bpm PIP Should equal manometer display + 5 cmh2o MAP N/A PEEP 5 cmh2o + 2 cmh2o Inspiratory Time 0.68 seconds +.05 seconds The values presented in the table above are reasonable approximates. Your values may differ slightly due to variances in testing set-up and equipment. 8. Check the alarms as follows: Power Fail Check: Remove the power cord from the wall. The ventilator should do the following: Switch to battery power. Sound the audible alarm. Turn the AC Power Source indicator OFF. Display the BATTERY ON message in the alarm window. LED for internal or external battery will light. Press the Alarm Silence/Reset button twice to clear the alarm. Plug the AC power cord back into the wall socket. High Pressure Limit Check Lower the High Pressure Alarm setting to 5 cmh2o below the Peak Inspiratory Pressure (PIP). When the ventilator cycles to inspiration and the high pressure limit is violated, the high pressure alarm should occur. When this happens the ventilator should: Immediately cycle into the expiratory phase. Sound the audible alarm. Display the HIGH PRES message in the alarm window. Flash the High Pressure control display. Return the High Pressure Alarm setting to 5 cmh2o above PIP, and press the Alarm Silence/Reset button twice to clear the alarm. This completes the performance check. The following Ventilator Performance Checklist may be used to document each Performance Check for your records.

63 TBird Series Ventilators Chapter 5 Unpacking, Set-up & Operation 63 TBird Series Ventilator Performance Checklist This checklist is for use during the TBird Operational Verification Procedure. Model: VS VSO2 AVS AVSII AVSIII Legacy Serial Number Hours Date Verification Steps Verification Step 1. Inspect the ventilator and components for appearance and cleanliness. Confirm the Exhalation valve, diaphragm, and air intake filter are correctly installed. Wipe the ventilator clean if needed using a cloth moistened with an approved cleaning solution. 2. Enter the User Verification Test (UVT). Depress the Monitor Select button to clear the "REMOVE PT" message. (For detailed information on conducting the UVT see Chapter 7 in the Operator's Manual)" 3. Test the alarm volume. Adjust as required. 4. Confirm the proper functioning of the front panel lamps. 5. Confirm the proper functioning of the front switches. 6. Complete the internal filter performance check. 7. Attach the patient breathing circuit to the ventilator and conduct a leak test. Make sure all needed components are firmly attached in the circuit. 8. Exit the UVT and begin conducting a brief performance test. Set the variable controls to the following recommended settings: Check & Initial Mode A/C Inspiratory Pause OFF Tidal Volume 500ml Sigh OFF Peak Flow 60 L/min Square Waveform OFF Breath Rate 12 bpm Bias Flow 10 PEEP/CPAP 5 cmh2o Autoscan ON Sensitivity OFF Altitude 500 ft. Pressure Support OFF Low Minute Volume Alarm Range DIS LMV OFF % O2 21 Termination Sensitivity 25% Pressure Control OFF Variable Time Termination 3.0 sec Inspiratory Time 0.3 sec Flow Termination OFF

64 64 Operators Manual Verification Step Check & Initial 9. Set the variable alarm controls as follows: Alarm Control High Pressure Low Pressure Low Minute Volume High Breath Rate Apnea Interval Setting PIP plus 5 cmh2o PIP minus 10 cmh2o 4 L 15 bpm 20 sec 10. After at least two minutes of operation compare the displayed readings to the following: Display Minute Volume 6L +/- 1.2L Reading Tidal Volume 500ml +/-100ml I:E Ratio 1:6.1 +/-10% Breath Rate 12 bpm +/-2 bpm PIP Equal to Manometer +/- 5 MAP NA PEEP 5 cmh2o +/-2 cmh20 Inspiratory Time 0.68 sec +/-0.5 sec 11. Check alarms A. Power Fail Check B. High Pressure Limit Check Signature: Procedure Complete WARNING Do not release the ventilator for use if it does not pass all of the verification procedures specified in this checklist. For detailed information on performing a User Verification Test, see the appropriate Operator's Manual. Contact a Bird Products Corporation Certified Service Technician to perform all needed service or calibration.

65 TBird Series Ventilators Chapter 5 Unpacking, Set-up & Operation 65 Setting a Mode Before selecting a mode, do the following: 1. Perform the User Verification Tests (UVTs) described in Chapter Perform a performance check as described in this section. 3. Set the Apnea Interval using the Special Functions described in Chapter Set the Bias Flow using the Special Functions described in Chapter Set the Over Pressure Relief valve. 6. Set the mode characteristics as described in the rest of this chapter. 7. Set the volume of the audible alarm (see the back panel). 8. Connect the Patient Assist Call System, if desired. Control Mode SIMV Mode To set up the ventilator to operate in Control mode with Volume Control Breaths, do the following: 1. Press the Assist/Control button twice. 2. Set the Tidal Volume, Breath Rate and Peak Flow to the desired settings. 3. Set the Sensitivity to OFF. 4. Set the PEEP/CPAP, if desired. 5. Set Pressure Support to OFF. 6. Set desired % O2 (AVS models & VSO2). 7. Set Pressure Control to OFF. 8. Set the Inspiratory Pause, if desired (AVS models). 9. Set the alarm limits for High Pressure, Low Pressure, Low Min Volume and High Breath Rate (Legacy, VSO2, AVS models) alarms 10. Set Sigh, if desired. 11. Set the Square Waveform, if desired (AVS III). To set up the ventilator to operate in SIMV mode with Volume Control Breaths, do the following: 1. Press the SIMV button twice. 2. Set the Tidal Volume, Breath Rate and Peak Flow to the desired settings. 3. Set the Sensitivity to an appropriate value from 1 to 20 lpm. 4. Set the PEEP/CPAP, if desired. 5. Set Pressure Support to OFF. 6. Set desired % O2 (AVS models & VSO2). 7. Set Pressure Control to OFF. 8. Set the Inspiratory Pause, if desired (AVS models). 9. Set the alarm limits for High Pressure, Low Pressure, Low Min Volume and High Breath Rate (Legacy, VSO2, AVS models) alarms.

66 66 Operators Manual 10. Set Sigh, if desired. 11. Set the Square Waveform, if desired (AVS III). CPAP Mode To set up the ventilator to operate in CPAP mode, do the following: 1. Press the CPAP button twice. 2. Set the Tidal Volume, Breath Rate and Peak Flow for apnea ventilation. 3. Set the Sensitivity to an appropriate value from 1 to 20 lpm. 4. Set the PEEP/CPAP, to the desired level. 5. Set Pressure Support, if desired. 6. Set desired % O2 (AVS models & VSO2). 7. Set Pressure Control to OFF. 8. Set the Inspiratory Pause for apnea ventilation, if desired (AVS models). 9. Set the alarm limits for High Pressure, Low Pressure, Low Min Volume and High Breath Rate (Legacy, VSO2, AVS models) alarms. 10. Set Sigh, if desired. 11. Set the Square Waveform for apnea ventilation, if desired (AVS III). NOTE In CPAP, Tidal Volume, Peak Flow, Inspiratory Pause, Breath Rate and the Low Pressure Alarm are dimmed. These controls should be set to clinically appropriate values should Apnea occur and Volume Control Apnea Backup Ventilation is desired. The ventilator will use these settings when delivering Apnea Backup Ventilation. Pressure Control Ventilation (AVS III, VSO2 & Legacy only) To set up the ventilator to operate in Pressure Control, do the following: 1. Press the desired mode of ventilation button (Assist/Control or SIMV ) twice.. 2. Set the Breath Rate. 3. Set the Sensitivity to an appropriate value from 1 to 20 lpm (if Control Mode is desired, set to OFF). 4. Set the PEEP/CPAP, if desired. 5. Set Pressure Support, desired (not available in Control or Assist/Control). 6. Set % O2. 7. Set Pressure Control. 8. Set the Inspiratory Time. 9. Set the alarm limits for High Pressure, Low Pressure, Low Min Volume and High Breath Rate (Legacy, VSO2, AVS models) alarms.

67 TBird Series Ventilators Chapter 5 Unpacking, Set-up & Operation 67 VAPS Ventilation (AVS III only) To set up the ventilator to operate in VAPS, do the following: 1. Press the desired mode of ventilation button (Assist/Control or SIMV) twice. 2. Set the Tidal Volume, Breath Rate and Peak Flow to desired settings. 3. Set the Sensitivity to an appropriate value from 1 to 20 lpm (if control Mode is desired, set to OFF). 4. Set PEEP/CPAP, if desired. 5. Set Pressure Support, if desired (not available in Control or Assist/Control). 6. Set desired % O2. 7. Set Pressure Control. 8. Set the Inspiratory Pause, if desired. 9. Set the VAPS button. 10. Set Sigh, if desired Set the alarm limits for High Pressure, Low Pressure, Low Min Volume and High Breath Rate (Legacy, VSO2, AVS models) alarms.

68 68 Operators Manual

69 Chapter 6 Special Functions This chapter describes the software functions available through the ventilator s Special Functions.: Ventilator setup functions Alarm setup functions Transducer test functions Transducer data functions Event codes listing User Verification Tests (UVT) Service Verification Tests (SVT) Tables 6-1 through 6-7 give a brief overview of each group of Special Functions. Table 6-1 Special Functions Ventilator Setup Group Function Description Control Lock Enable Enables/disables the control lock. Autoscan Enables or disables automatic scanning of monitored parameters. BGM Interface Switches ventilator interface with Bird Graphics Monitor. Bias Flow Sets the bias flow from 10 to 20 L/min. Termination Sensitivity Sets the inspiratory termination point in a Pressure Support breath from 5 to 30 percent of peak flow. Variable Time Termination Sets the maximum duration for the inspiratory phase of a Pressure Support breath from 0.3 to 3.0 seconds. Flow Termination Sets the inspiratory flow termination point in a Pressure Control breath from OFF, 5 to 30 percent of peak flow. Display Language Selects the display language. Selector Software Versions Shows the software version numbers. Hour Meter Shows the total hours of operation. Turbine Shows the turbine serial number. Altitude Sets the current elevation from 1,000 feet (-305m) to 10,000 feet (3,048m).

70 70 Operators Manual Table 6-2 Special Functions Alarm Setup Group Function Apnea Interval Low Minute Volume Alarm Range Remote Alarm Status Description Sets the apnea interval from 10 to 60 sec. Enables/Disables the Low Minute Volume Alarm from accepting a range of OFF to 99.0L. Displays the remote alarm ID. Table 6-3 Special Functions Transducer Data Group Function XP Exhalation Gauge Pressure TD Turbine Differential Pressure XD Exhalation Differential Pressure XF Exhalation Flow TF Turbine Flow TS Turbine Speed TT Turbine Case Temperature OP Oxygen IB Internal Battery XB External Battery FC Flow Cal Description Shows the real-time pressure at exhalation valve. Shows the real-time differential pressure across the turbine. Shows the real-time differential pressure across the exhalation flow transducer. Shows the real-time exhalation flow across the exhalation flow transducer. Shows the real-time inspiratory flow. Shows the real-time turbine speed. Shows the turbine case temperature. Shows the oxygen inlet pressure. Shows Internal Battery Voltage. Shows External Battery Voltage. Shows the current Flow Cal valve. Table 6-4 Special Functions Transducer Tests Group Function XP Exhalation Gauge Pressure TD Turbine Differential Pressure Autozero XD Exhalation Differential Pressure Autozero Description Autozeroes the exhalation pressure transducer. (N/A on Legacy) Autozeroes the turbine differential pressure transducer. Autozeroes the exhalation differential pressure transducer. Table 6-5 Special Functions Event Codes Group Function Events Codes Group Description Lists the most recent 256 event codes. Table 6-6 Special Functions User Verification Tests Function User Verification Tests Description Cannot be accessed through the Special Functions. See Chapter 7, User Verification Tests. Table 6-7 Special Functions Service Verification Tests Function Service Verification Tests Description Cannot be accessed through the Special Functions. See the TBird Ventilator Series Service Manual (L1314).

71 TBird Series Ventilators Chapter 6 Special Functions 71 How to Access the Special Functions Accessing the Special Functions does not interfere with ventilation. You can access the Special Functions at any time except when an alarm is displayed. If an alarm occurs while you are in Special Functions, the alarm will be displayed. After you clear the alarm, the display returns to the currently active special function. To access the Special Functions, do the following: 1. Press and hold the control knob until VENT SETUP appears in the monitor window (approximately two seconds). 2. Release the control knob. Turning the control knob clockwise will display the Special Functions in the following order: VENT SETUP ALARM SET UP TRANSDUCER DATA TRANSDUCER TESTS EVENT CODES UVT OFF SVT OFF Note The User Verification Tests (UVT) and Service Verification Tests (SVT) appear after Event Codes but are set to OFF because they cannot be selected while the ventilator is being used in treatment. See Chapter 7, User Verification Tests, for more information on the UVTs. The SVTs are reserved for use by Bird Certified Service Technicians. When working with the Special Functions, you can back out of the functions by pressing the control knob. (The control knob acts like the escape key on a computer.) Ventilator Setup Group See table 6-1. Control Lock Enable Turns the front panel control lock feature ON or OFF. After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. Since LOCKS is the first function in this group, the current lock setting appears: LOCKS: ON or LOCKS: OFF

72 72 Operators Manual Autoscan 3. Press the Monitor Select button to toggle the setting ON or OFF. 4. Press the control knob to accept this setting and to exit the function and return to VENT SETUP. Turns the monitored parameters autoscan feature ON (enabled) or OFF (disabled). After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until the AUTOSCAN setting appears: AUTOSCAN ON or AUTOSCAN OFF 4. Press the Monitor Select button to toggle the setting ON or OFF. 5. Press the control knob to accept this setting and to exit the function and return to VENT SETUP. Bird Graphics Monitor Interface Changes the ventilator interface status within the Bird Graphics Monitor (BGM) to either standard (OFF) or enhanced (ON). After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until the BGM MECH setting appears: BGM MECH ON (Enhanced Bird Graphics Monitor) or BGM MECH OFF (Standard Bird Graphics Monitor) 4. Press the Monitor Select button to toggle the setting On or OFF. 5. Press the control knob to accept these setting and to exit the function and return to VENT SETUP. Bias Flow Control Sets the bias flow level in the patient breathing circuit to any value between 10 and 20 lpm. Note Because the ventilator retains setting between applications, always check the Bias Flow before applying the ventilator to a new patient to make sure the Bias Flow is set appropriately. After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until BIAS appears.

73 TBird Series Ventilators Chapter 6 Special Functions Press the Monitor Select button. The current bias flow setting appears: BIAS xx LPM Where xx is the current bias flow setting. 5. Turn the control knob to display the desired setting (10 to 20 L/min). 6. Press the Monitor Select button to accept the setting. BIAS reappears in the window, without showing the new setting. Note Be sure to press the Monitor Select button to accept the setting. Otherwise the bias setting reverts to the previous setting. 7. Press the control knob to exit the function and return to VENT SETUP. Termination Sensitivity Sets the inspiratory termination point in a Pressure Support breath from 5 to 30 percent of the peak flow. Note Because the ventilator retains setting between applications, always check the Termination Sensitivity before applying the ventilator to a new patient to make sure the Termination Sensitivity is appropriate. After Accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until TERMSENS appears. 4. Press the Monitor Select button. The current value for the termination point as a percent of peak flow appears: TERMSENS XX % Where XX % is the current termination point as a percent of peak flow 5. Turn the control knob to display the desired setting (5% to 30%, in increments of 5%). 6. Press the Monitor Select button to accept the setting. TERMSENS reappears in the window, without the new setting. Note Be sure to press the Monitor Select button to accept the setting. Otherwise the Termination Sensitivity reverts to the previous setting. 7. Press the control knob to exit the function and return to VENT SETUP. Variable Time Termination Sets the maximum duration for the inspiratory phase of a Pressure Support breath from 0.3 to 3.0 seconds.

74 74 Operators Manual Note Because the ventilator retains setting between applications, always check the Variable Time Termination before applying the ventilator to a new patient to make sure the Variable Time Termination setting is appropriate. 1. After Accessing the Special Functions: 2. Turn the control knob until VENT SETUP appears. 3. Press the Monitor Select button. The LOCKS setting appears. 4. Turn the control knob until VARITIME appears. 5. Press the Monitor Select button. The displayed value represents the maximum duration of the Inspiratory Phase. VARITIME XX Where XX is the maximum duration of the Inspiratory Phase. 6. Turn the control knob to display the desired setting (0.3 to 3.0 seconds, in increments of 0.1). 7. Press the Monitor Select button to accept the setting. VARITIME reappears in the window, without the new setting. Note Be sure to press the Monitor Select button to accept the setting. Otherwise the Variable Time Termination reverts to the previous setting. 8. Press the control knob to exit the function and return to VENT SETUP. Flow Termination Sets the inspiratory termination point in a Pressure Control breath from OFF to 5 to 30 percent of the peak flow. Note Because the ventilator retains setting between applications, always check the Flow Termination before applying the ventilator to a new patient to make sure the Flow Termination is appropriate. After Accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until FLOWTERM appears. 4. Press the Monitor Select button. The current value for the termination point as a percent of peak flow appears: FLOWTERM XX % Where XX % is the current termination point as a percent of peak flow 5. Turn the control knob to display the desired setting (OFF, 5% to 30%, in increments of 5%). 6. Press the Monitor Select button to accept the setting. FLOWTERM reappears in the window, without the new setting.

75 TBird Series Ventilators Chapter 6 Special Functions 75 Note Be sure to press the Monitor Select button to accept the setting. Otherwise the Flow Termination reverts to the previous setting. 7. Press the control knob to exit the function and return to VENT SETUP. Display Language Selector Sets the display language to English, French, German, Italian or Spanish. After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until LANGUAGE appears. 4. Press Select. The currently selected language appears. 5. Turn the control knob to display the desired language: DEUTSCH ENGLISH ESPANOL FRANCAIS ITALIAN 6. Press the Monitor Select button to accept the displayed language LANGUAGE reappears in the window, without showing the new setting. Note Be sure to press the Monitor Select button to accept the setting. Otherwise the language reverts to the previous setting. 7. Press the control knob to exit the function and return to VENT SETUP. Software Version Allows you to view the version number of the following installed software and firmware: MSP - Main Ventilator Software IOP - Input/Output Processor Software RMT - Remote Alarm Transmitter Software WDG - Hardware Watchdog Timer Firmware After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until VERSION appears. 4. Press the Monitor Select button. The MSP version number appears:

76 76 Operators Manual Hour Meter Turbine MSP x.xx where x.xx is the installed software version number. 5. Turn the control knob to display the remaining software version numbers. 6. Press the control knob twice to exit the function and return to VENT SETUP. Allows you to view the number of hours the ventilator has been in operation (has been turned on). Standby hours are not counted. After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until the hour meter reading appears. HOURS xxx Where xxx represents the number of hours the ventilator has been in operation. 4. Press the control knob to exit the function and return to VENT SETUP. Shows the turbine serial number. This number is used in servicing the ventilator. After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until the TURBINE appears. 4. Press the Monitor Select button to display the turbine serial number. 5. Press the control knob twice to exit the function and return to VENT SETUP. Altitude Compensation For proper functioning of the TBird volume monitoring system, it is necessary to set the correct elevation. The default setting is 500 feet and should be changed to the operating elevation. The altitude should be set when the ventilator is initially set up and when there is a change in altitude. The operating elevation for the ventilator can be set between 1,000 and 10,000 feet or 305 to 3,048 meters. WARNING Lower air density at higher altitudes will effect tidal volume delivery and exhaled tidal volume measurements. After accessing the Special Functions: 1. Turn the control knob until VENT SETUP appears. 2. Press the Monitor Select button. The LOCKS setting appears. 3. Turn the control knob until ALTITUDE appears. 4. Press the Monitor Select button. FEET is displayed. 5. Turn the control knob to select FEET or METERS.

77 TBird Series Ventilators Chapter 6 Special Functions Press the Monitor Select button. The current altitude is displayed. 7. Turn the control knob to display the desired setting (-1,000 to 10,000 ft or 305 m to 3,048 m). 8. Press the Monitor Select button to accept the setting. Note Be sure to press the Monitor Select button to accept the setting. Otherwise the altitude reverts to the previous setting. 9. Press the control knob two times to exit the function and return to VENT SETUP. This table defines the variances that may occur in delivered and monitored Tidal Volumes, when the system is operating in a high altitude environment and the altitude compensation has not been set. Percentage adjustments in the following table are approximate values. Ventilators are calibrated at 500 ft. above sea level (Palm Springs, California). Table F-1 Tidal Volume Altitudes Variables Altitude Set Vt to Delivered Vt Delivered Vt to Monitored Exhaled Vt Set Vt to Monitored Exhaled Vt 500 ft ,550 ft. -3.0% -2.5% -5.5% 2,500 ft. -6.0% -5.0% -11.0% 3,500 ft. -9.0% -7.5% -16.5% 4,500 ft % -10.0% -22.0% 5,500 ft % -12.5% -27.5% Example: 3,500 ft. above sea level, Vt 800 ml: Delivered Vt = 800 ml 9.0% = 728ml Measured Exhaled Vt = 728ml 7.5% = 673ml Alarm Setup Group See table 6-2. Apnea Interval Sets the Apnea Interval the length of time between two consecutive inspirations that, when elapsed, triggers an Apnea alarm. Setting the Apnea Interval tells the ventilator how much time to allow between successive breaths before generating an Apnea alarm. The interval is measured from the start of one breath to the start of the next. If an inspiration is not initiated during this interval, the ventilator automatically switches to Apnea Backup Ventilation. The ventilator continues to provide Apnea Backup Ventilation until the patient initiates two successive breaths. Apnea Backup Ventilation is then terminated and the ventilator reverts to its previous mode of

78 78 Operators Manual ventilation. Apnea Backup Ventilation can also be canceled by pressing the Alarm Silence/Reset button twice. Note Because the ventilator retains settings between applications, always check the Apnea Interval before applying the ventilator to a new patient to make sure the Apnea Interval is set appropriately. After accessing the Special Functions: 1. Turn the control knob until ALARM SETUP appears. 2. Press the Monitor Select button. APNEA appears. 3. Press the Monitor Select button again. The current apnea setting appears. xx sec APNEA where xx is the currently set Apnea Interval. 4. Turn the control knob to display the desired setting (10, 20, 30, 40, 50, or 60 seconds. 5. Press the Monitor Select button to accept the setting. APNEA reappears in the window without showing the new setting. Note Be sure to press the Monitor Select button to accept the setting. Otherwise the Apnea Interval reverts to the previous setting. 6. Press the control knob to return to ALARM SETUP. Low Minute Volume Alarm Range Enables or disables the Low Minute Volume Alarm to range from OFF to 99.9 L. After accessing the Special Features Functions: 1. Turn the control knob until ALARM SETUP appears. 2. Press the Monitor Select button. APNEA appears. 3. Turn the control knob until ENAB LMV OFF or DIS LMV OFF appears. 4. Press the Monitor Select button to cycle between settings. ENAB LMV OFF (Low Minute Volume Alarm range OFF to 99.9 L) or DIS LMV OFF (Low Minute Volume Alarm range 0.1 to 99.9L) 5. Press the control knob twice to return to ALARM SETUP. Remote Alarm Status This function allows you to display the identification number of the optional remote alarm. After accessing the Special Functions: 1. Turn the control knob until ALARM SETUP appears. 2. Press the Monitor Select button. APNEA appears. 3. Turn the control knob until REMOTE ALARM appears.

79 TBird Series Ventilators Chapter 6 Special Functions Press the Monitor Select button. The current remote alarm ID and status (ON/OFF) appears. RA xx N OFF or RA xx N ON Where xx is the remote alarm s station ID, N is the ventilator address and OFF or ON tells you whether the ventilator is transmitting or not. This message appears even if the optional remote alarm transmitter is not installed. 5. Press the control knob twice to return to ALARM SETUP. Transducer Data Group Shows the real-time readings generated by various transducers in the gas flow delivery system. This group is typically used by technical personnel. See table 6-3. After accessing the Special Functions: 1. Turn the control knob until XDCR DATA appears. 2. Press the Monitor Select button. The first transducer reading appears: XP xx.x where XP identifies the transducer and xx.x is the reading. 3. Turn the control knob to view the real-time readings of the other transducers in the group. The transducer readings appear in the following order: XP cmh2o Exhalation Gauge Pressure TD cmh2o Turbine Differential Pressure XD cmh2o Exhalation Differential Pressure XF L/min Exhalation Flow TF L/min Turbine Flow TS rpm Turbine Speed TT C Turbine Case Temperature OP PSIG Oxygen Inlet Pressure IB volts Internal Battery Voltage XB volts External Battery Voltage FC L/min External Battery Voltage 4. Press the control knob to return to XDCR DATA Transducer Test Group This Special Functions group allows you to autozero the exhalation pressure transducer, exhalation flow transducer and turbine differential pressure transducer. These functions are typically used by technical personnel. See table 6-4. After accessing the Special Functions: 1. Turn the control knob until XDCR TESTS appears.

80 80 Operators Manual 2. Press the Monitor Select button. The exhalation pressure test appears: XP xxx PASS or XP xxx FAIL 3. Where XP identifies the test and xxx is a reference number used by the service technician, and PASS or FAIL shows the results of the previous test. 4. Press the Monitor Select button, if desired, to perform a manual autozero function. The autozero will be performed on the next breath. The status of the test (pass or fail) is cleared until the test ends. If the test fails, remove the ventilator from service and contact your Bird Certified Service Technician. 5. Turn the control knob to view the exhalation differential pressure transducer and turbine differential pressure transducer tests. 6. Press the Monitor Select button, if desired, to perform the test. 7. Press the control knob to exit the test and return to XDCR TESTS. Event Codes Group Shows the previous 256 event codes. See Appendix F, Event Codes, for a description of each code. After accessing the Special Functions: 1. Turn the control knob until EVENTS appears. 2. Press the Monitor Select button. The most recent event code appears: nnn: xxx where nnn is the sequential order in which the event occurred and xxx is the event code. 3. Press the Monitor Select button again to display the hour meter reading when the event occurred: nnn: xxxxxh where xxxxh is the hour meter reading. 4. Press the Monitor Select button to return to the event code. 5. Turn the control knob counterclockwise to view earlier event codes or clockwise to view later events. 6. Press the control knob to return to EVENTS.

81 Chapter 7 User Verification Tests Table 7-1 This chapter shows you how to run the User Verification Tests (UVTs) to ensure the ventilator is working properly. The following points are covered: Accessing and running the UVTs. Audible alarm test. Lamp test. Switch test. Filter test. Leak test. Table 7-1 shows the tests included in the UVTs and the order in which they are run. Each test is described in detail in the remaining sections of this chapter. If any test fails, refer to Chapter 8, Basic Troubleshooting. To rerun a test, use the control knob to dial to the test and run the test as described in this chapter. To exit the UVT, select EXIT. When you exit the UVTs, the system begins normal operation. UVT Audible alarm Test Lamp Test Switch Test Filter Test Leak Test Exit Description Allows you to check the audible alarm Allows you to check the front panel LEDs to make sure they are working properly Allows you to check the front panel controls to make sure they are working properly. Displays the name of each control as it is activated. Allow you to check the differential pressure across the turbine s inlet filter. PASS or FAIL result shown. Allows you to test the patient breathing circuit for leakage. Exits UVTs. Accessing the UVTs WARNING Disconnect the patient prior to accessing the UVTs. The ventilator does not deliver gas during the UVTs. To access the User Verification Tests (UVTs), do the following 1. After disconnecting the patient, turn the ventilator OFF (i.e., STANDBY). 2. Press and hold the Monitor Select button. 3. While holding the Monitor Select button, turn the ventilator ON. Continue to hold the button until the ventilator completes the Power On Self Tests (POST). 4. Release the Monitor Select button when the following message appears in the monitor window: UVT ON

82 82 Operators Manual The Audible Alarm sounds. Press Alarm/Silence Reset to clear Press the Monitor Select button again. The following message appears: REMOVE PT This is a reminder to remove the patient from the ventilator prior to accessing the UVTs if you have not already done so. 6. Press the Monitor Select button again to clear the message and display the UVTs. Running the UVTs Alarm Lamp Switch The UVTs appear in the following order as you turn the control knob: ALARM LAMP SWITCH FILTER LEAK EXIT Run this test to check the audible alarm. 1. Press the Monitor Select button to start the test. The audible alarm sounds. 2. Press the Monitor Select button again to silence the audible alarm, exit the test, and advance to the next test. Run this test to check the front lamps to make sure they are functioning properly. 1. Press the Monitor Select button to start the test. The ventilator illuminates all displays, windows, and green LEDs. 2. Press the Monitor Select button again to illuminate the displays, windows, and red LEDs. 3. Press the Monitor Select button again to exit the test and advance to the next test. 4. The AC, ON, Ext Bat Charge Status, Int. Bat Charge Status, and Vent Inop LEDs are not affected by this test. Run this test to check the front panel controls to make sure they are working properly. 1. Press the Monitor Select button. The word SELECT appears in the monitor window. 1 If you would like to access the Special Functions described in Chapter 6, you may do so at this point. Just turn the control knob until VENT SETUP appears, then refer to Chapter 6, Special Functions.

83 TBird Series Ventilators Chapter 7 User Verification Tests Activate any front panel control. Watch for the name of the control to appear in the monitor window. Table 7-2 lists, in alphabetical order, the label displayed when you activate the corresponding control. 3. Press the Monitor Select button to exit the test and advance to the next test. Table 7-2 Switch Test Response Labels Switch Alarm Silence/Reset button Assist/Control Mode Select button Breath Rate control Control Knob (Clockwise) Control Knob (Counterclockwise) Control Lock CPAP Mode Select button Expiratory Hold button Flow Cal button High Breath Rate Alarm control High Pressure Alarm control Inspiratory Hold button Inspiratory Pause control Inspiratory Time control Low Minute Volume Alarm Low Pressure Alarm Manual Breath button Label SILENCE ASSIST/CTRL BREATH RATE DIAL RIGHT DIAL LEFT CONTROL LOCK CPAP EXP HOLD FLOW CAL HIGH BREATH HIGH PRES INSP HOLD IPAUSE INSP TIME LOW MIN VOL LOW PRES MANUAL BRTH Switch Label MIP/NIF button MIP NIF Monitor Select button SELECT Peak Flow control PEAK FLOW PEEP/CPAP control PEEP Pressure Control PRES CONTROL Pressure Support PRES SUPPORT Remote Alarm button * REMOTE ALARM Sensitivity control SENSITIVITY Sigh Breath button SIGH SIMV Mode Select button SIMV Spare button or control SPARE Square Waveform button SQUARE WAVE Tidal Volume control TIDAL VOLUME VAPS button VAPS 100% O2 3 Min button 100% O2 % O2 control FIO2 * If the Remote Alarm option is not installed, pressing this button will display SPARE Note Be sure to press the Monitor Select button; otherwise the test will not start. Filter Run this test to check the differential pressure across the turbine inlet filter. A high differential pressure may indicate a dirty or occluded filter. This test cannot be run until the ventilator has been ON for 60 seconds. 1. Press the Monitor Select button. The turbine accelerates flow to 140 lpm and checks the differential pressure to make sure it is within range. At the end of the test, the ventilator displays a pass or fail message. If the test passes, the following message appears: FILTER x.x P where x.x is the average turbine differential pressure and P indicates the test passed. If the test fails, the following message appears: FILTER x.x F where x.x is the average turbine differential pressure and F indicates the test failed:

84 84 Operators Manual Leak 2. If the test fails, clean or replace the air filter (see Chapter 9, Cleaning and Sterilization) and run the test again. If the test fails again, contact a Bird Certified Service Technician. 3. Press the Monitor Select button to exit the test and advance to the next test. Note This test should be performed with all circuit accessories installed (e.g., humidifier, water traps, and so on.) Make sure al connections are secure and all openings occluded before beginning the test. Exit Run this test to make sure the patient breathing circuit is not leaking. 1. Attach a test lung to the breathing circuit wye. 2. Press the Monitor Select button to run the test. The test begins by increasing the pressure in the patient breathing circuit to 60 cmh2o. The ventilator then measures the pressure and displays it as follows: XP xx.x where xx.x is the internal airway pressure. 3. The ventilator then waits eight seconds and measures the circuit pressure again. If the difference between the starting and ending measurements is less than or equal to 6 cmh2o, the test passes and the ventilator displays the following message: XP xx.x PASS where xx.x is the ending measurement. 4. Otherwise, if the difference is more than 6 cmh2o, the test fails and the ventilator displays the following message: XP xx.x FAIL 5.. If the test fails, refer to Chapter 8, Basic Troubleshooting. 6. Press the Monitor Select button to exit the test and advance to the EXIT selection. To exit the UVTs and begin normal ventilator operation, press the Monitor Select button until EXIT appears in the monitor window, otherwise turn the control knob to rerun any of the UVTs.

85 Chapter 8 Basic Troubleshooting This chapter shows you how to troubleshoot the ventilator. The following points are covered: The ventilator does not power up properly. A vent inop occurs. A User Verification Test fails. A malfunction occurs. If the Ventilator Does Not Turn ON If you turn the power switch ON and the ON indicator does not illuminate, perform the troubleshooting procedures given in Table 8-1. Table 8-1 Troubleshooting Power Up Problems Problem Possible Cause Action Ventilator plugged into an AC source, but it does not power up. Ventilator is connected to an external battery but will not power up. Ventilator is not connected to an external battery or AC power source and will not power up. Ventilator powers up but does not ventilate. No power at AC outlet and discharged internal battery Discharged internal and external battery Discharged internal battery Vent inop condition Try connecting to a known good AC source. If the ventilator still does not power up, try operating from an optional external battery, if available. If the ventilator still does not power up, contact your Bird Certified Service Technician. Try plugging the ventilator in. If the ventilator starts, the internal and external batteries are discharged. Plug the ventilator into an AC source for twenty-four (24) hours to charge both batteries. The ventilator can be used while the batteries are being charged. Unplug the ventilator and attempt to power it up again. If the ventilator does not power up, contact your Bird Certified Service Technician. Try plugging the ventilator into an AC source. If the ventilator starts, the battery is discharged. Plug the ventilator into an AC source for seven (7) hours to charge the battery. Unplug the ventilator and attempt to power it up again. If the ventilator does not power up, contact your Bird Certified Service Technician. Make sure the power source is good. If it is, contact your Bird Certified Service Technician.

86 86 Operators Manual If a Vent Inop Occurs When you turn the ventilator ON, the Power On Self Test (POST) run. These tests check the internal circuitry to make sure everything is functioning properly. As each test executes, a message appears in the alarm window to identify the internal component being tested. Since the entire POST only takes five (5) seconds, the messages appear rapidly. If any test fails, the ventilator terminates the power up procedure and generates a Vent Inop condition. The ventilator: Sounds the audible alarm. Illuminates the Vent Inop indicator. Retains the last message in the monitor window so you can identify the test that failed. Records both the Vent Inop and the hour meter reading for later reference. If a Vent Inop occurs, turn the ventilator OFF, unplug it, and contact your Bird Certified Service Technician. If a UVT Fails Table 8-2 lists suggested corrective actions if a User Verification Test fails. Table 8-2 UVT Troubleshooting ALARM UVT Problem Corrective Action 1. Audible alarm too loud or too low. 2. No alarm 1. Adjust the alarm Volume Control located on the back panel. 2. Contact your Bird Certified Service Technician. LAMP 1. A Lamp, LED, or display does not illuminate. 2. Contact your Bird Certified Service Technician. SWITCH 1. The correct label does not appear when you 1. Contact your Bird Certified Service Technician. activate a front panel switch. FILTER 1. The test fails. 1. Clean or replace the air intake filter (see Chapter 9, Cleaning and Sterilization). 2. Run the test again. 3. If the test still fails, contact your Bird Certified Service Technician. LEAK 1. The test fails. 1. Check the patient breathing circuit connections. Make sure all inline circuit components are connected properly. 2. Make sure the over pressure relief valve is set to the maximum setting. 3. Check the exhalation valve diaphragm to make sure it is seated properly and free from excessive wear.

87 TBird Series Ventilators Chapter 8 Troubleshooting 87 If a Malfunction Occurs Table 8-3 lists suggested corrective actions for various malfunctions that might occur. In all cases, make sure the ventilator is set up properly and the exhalation valve body, exhalation valve diaphragm, and patient breathing circuit are properly assembled and undamaged. Table 8-3 Basic Troubleshooting Problem Monitored exhaled tidal volumes are low. Monitored exhaled tidal volumes are high. Delivered tidal volumes are low. Delivered tidal volumes are high. Sensitivity appears to be inaccurate or erratic. Ventilator is autotriggering with PEEP applied. Corrective Action 1. Check the patient breathing circuit connections. Make sure all inline circuit components are securely connected, 2. Check the passages in the exhalation valve body to make sure they are not occluded. 3. Ensure that the altitude compensation value corresponds with the current elevation. See Special Functions, Chapter Perform a Manual Flow Cal maneuver described under the Flow Cal control in Chapter 2, Controls and Displays. Allow the monitored exhaled volumes to stabilize. Compare the monitored volumes using each Flow Cal method. Leave the ventilator in the Manual Flow Cal mode only if a substantive improvement in monitored exhaled volume is produced. Otherwise, return the ventilator to the Automatic Flow Cal mode by depressing the Flow Cal button. 5. Replace the exhalation valve body with a known good one. 6. Contact your Bird Certified Service Technician. 1. Check the patient breathing circuit connections. Make sure all inline circuit components are securely connected, 2. Check the passages in the exhalation valve body to make sure they are not occluded. 3. Ensure that the altitude compensation value corresponds with the current elevation. Refer to Special Functions, Chapter Perform a Manual Flow Cal maneuver described under the Flow Cal control in Chapter 2, Controls and Displays. Allow the monitored exhaled volumes to stabilize. Compare the monitored volumes using each Flow Cal method. Leave the ventilator in the Manual Flow Cal mode only if a substantive improvement in monitored exhaled volume is produced. Otherwise, return the ventilator to the Automatic Flow Cal mode depressing the Flow Cal button. 5. Replace the exhalation valve body with a known good one. 6. Contact your Bird Certified Service Technician. 1. Check the patient breathing circuit for leaks. Be sure to check the connections of all components installed in the circuit. 2. Check the setting of the Over Pressure Relief valve. 3. Check the exhalation valve body, diaphragm, and housing to make sure they are not damaged. 4. Ensure that the altitude compensation corresponds with the current elevation. Refer to Special Functions, Chapter Contact your Bird Service Technician. 1. Ensure that the altitude compensation corresponds with the current elevation. Refer to Special Functions, Chapter Contact your Bird Certified Service Technician. 1. Check the patient breathing circuit connections. Make sure all inline circuit components are connected properly. 2. Check the exhalation valve diaphragm to make sure it is installed properly and free from damage. 3. Replace the exhalation valve body with a known good one. 4. Perform a Manual Flow Cal maneuver described under the Flow Cal control in Chapter 2, Controls and Displays. Carefully assess the patient s effort. Compare the patient effort produced by each Flow Cal method. Leave the ventilator in the Manual Flow Cal mode only if a substantive improvement in sensitivity is produced. Otherwise, return the ventilator to the Automatic Flow Cal mode by depressing the Flow Cal Button. 5. Contact your Bird Certified Service Technician. 1. Check the patient breathing circuit connections. Make sure all inline circuit components are connected properly. 2. Check the exhalation valve diaphragm to make sure it is installed properly and free from damage. 3. Reevaluate the current Sensitivity setting.

88 88 Operators Manual Problem High and low pressure alarms do not appear to be accurate. Peak flow does not appear to be accurate. The ventilator is inoperative and there are no audible or visual indications FLOW SENSOR in monitored window parameters for VE and Vte (AVS Models) NEW SENSOR in monitored window parameters for VE and Vte Corrective Action 4. Perform a Manual Flow Cal maneuver described under the Flow Cal control in Chapter 2, Controls and Displays. Leave the ventilator in the Manual Flow Cal mode only if auto-triggering is eliminated. Otherwise, return the ventilator to the Automatic Flow Cal mode by depressing the Flow Cal Button. 5. Replace the exhalation valve body with a known good one. 6. Contact your Bird Certified Service Technician.. 1. Check the setting of the Over Pressure Relief Valve. 2. Contact your Bird Certified Service Technician. 1. Ensure that the altitude compensation corresponds with the current elevation. Refer to Special Functions, Chapter Contact your Bird Certified Service Technician. 1. Turn the ventilator ON. 2. Check the AC power source. 3. Check the power cord. 4. Replace or reseat the external battery, if present. 5. Contact your Bird Certified Service Technician. 1. Ensure that an AVS Flow Sensor is installed. 2. Reseat the Exhalation Valve Body. 3. Replace Exhalation Valve Body. 4. Contact your Bird Certified Service Technician. 1. This is a temporary event that occurs when a new flow sensor is installed. This message will automatically clear when the processing of flow sensor data is completed. If this persists more than one (1) minute, perform steps 1 and 2 from the FLOW SENSOR corrective action above.

89 Chapter 9 Cleaning and Sterilization This chapter contains the recommended cleaning, sterilization, and disinfection techniques to be used with the TBird series. It describes how to clean the ventilator and how to clean, sterilize, or disinfect the exhalation valve, exhalation valve diaphragm, air intake filters, and patient breathing circuit components. CAUTION Do not sterilize the ventilator. Standard sterilization techniques may damage the ventilator. Note The disinfecting method described below results in a high-level of disinfection, as defined by a 1:1,000,000 reduction in bacteria infection during laboratory testing. How to Clean the Ventilator To clean the ventilator, use a clean cloth dampened with an appropriate bactericidal or germicidal agent. CAUTION Do not use cleaning agents that contain phenols, ammonium chloride, chloride compounds, or more than 2% glutarealdehyde. These agents may damage the ventilator s plastic components and front panel overlay. Clean all external panels and surfaces before and after each patient use and as often as necessary to keep it clean. Use only those cleaning materials that have been approved by your department. CAUTION When cleaning the ventilator: Do not use harsh abrasives. Do not immerse the ventilator in liquid sterilizing agents or liquids of any kind. Do not spray cleaning solution into the exhalation valve or directly onto the front panel. Do not allow cleaning solution to pool on the front panel. After cleaning the ventilator, be sure to wipe off all cleaning agents to prevent residue buildup. The exhalation valve assembly is a delicate precision assembly. Exercise care when removing, replacing, or cleaning the assembly: Do not insert cleaning instruments (cloth, brush, pipe cleaner, and so on) into the exhalation valve body. Do not use a high-pressure gas nozzle to dry the exhalation valve body. High-pressure gas may damage the differential pressure ports in the exhalation valve body.

90 90 Operators Manual To Clean, Sterilize, or Disinfect the Exhalation Valve Assembly To Remove the Exhalation Valve Assembly for Cleaning Refer to Figure 9-1 and do the following: 1. Press and hold the release latch on the lower left of the exhalation valve housing. 2. Grasp the exhalation valve body, rotate it counter-clockwise until the alignment slots line up, and then gently pull it free from the housing. 3. Grasp the exhalation valve diaphragm by the center and remove it from the exhalation valve body. 4. Using a clean soft cloth and an evaporative solution (e.g., alcohol), wipe all exposed surfaces around the exhalation valve housing. Do not allow cleaning fluid to spill into the opening in the exhalation valve housing. To Disinfect the Exhalation Valve Assembly: 1. Clean the external surfaces only with a soft bristle brush using Ultra Ivory or an equivalent detergent. Do not insert cleaning instruments (cloth, brush, pipe cleaner, and so on ) into the exhalation valve body. Pay particular attention to crevices and hard to clean areas. Dry with a soft cloth. After cleaning the surfaces, make sure all excess cleaning solution is completely removed to prevent reside buildup. 2. To disinfect, immerse in boiling water for 15 minutes. To Sterilize the Exhalation Valve Body and Diaphragm: 1. After cleaning the surfaces, make sure all excess cleaning solution is completely removed to prevent reside buildup. 2. Sterilize the exhalation valve body and diaphragm using steam autoclaving or a liquid agent. Figure 9.1 Exhalation Valve Assembly

91 TBird Series Ventilators Contact & Ordering Information 91 Note In Homecare ventilator applications it is recommended to have at least two (2) complete circuits and exhalation valve assemblies and clean every other day. If a pulmonary infection is present, then clean and disinfect daily. CAUTION The exhalation valve assembly is a delicate precision assembly. Exercise care when removing, replacing, or cleaning the assembly: Do not insert cleaning instruments (cloth, brush, pipe cleaner, and so on) into the exhalation valve body. Do not use a high-pressure gas nozzle to dry the exhalation valve body. High-pressure gas may damage the differential pressure ports in the exhalation valve body. 3. Using a low flow gas source (less than 10 lpm) ensure the differential pressure ports are free of moisture and debris. 4. To avoid possible damage to elastomeric components, the peak temperature for Bird Products accessories should not exceed 275 F (135 C) for steam autoclave. 5. Ultrasonic cleaning is not recommended. Liquid sterilizing agents containing more than 2% glutaraldehyde are also not recommended. If such agents must be used, be sure to thoroughly rinse and dry the assembly to prevent residue buildup. Residue buildup in the differential pressure ports can cause inaccurate pressures and volume readings. 6. Prior to replacing the exhalation valve diaphragm, inspect it for excessive wear. If signs of damage are found, obtain a new diaphragm. 7. Insert the diaphragm. Hold it by the center and set it into the exhalation valve-housing receptacle. Gently tap around the perimeter until the diaphragm is firmly seated. 8. Line up the tabs of the exhalation valve body with the alignment slots on the exhalation valve housing. Gently push the exhalation valve body into place and rotate it clockwise until he release latch pops out. You will hear the exhalation valve body click into place. 9. Gently pull on the exhalation valve body to make sure it is securely attached to the ventilator. CAUTION Be sure to check with the manufacturer of these chemicals and sterilizing equipment to ensure safe handling procedures are followed. Note Bird recommends no more than 50 cycles cleaning/sterilization. To Clean, Sterilize or Disinfect the Patient Breathing Circuit If you are using a Bird Products reusable patient breathing circuit, use the instructions below. When using other reusable patient breathing circuit refer to the original equipment manufacturer s cleaning instructions. If Single Patient Use (disposable) circuits are in use follow your infection control policy to determine usable cycle or life.

92 92 Operators Manual Removing the Bird Patient Circuit for Cleaning 1. Disconnect the circuit from the ventilator and exhalation valve housing. 2. Disconnect the circuit tubing from all inline components such as a heated humidifier or bacteria filters. Note If using a heated humidifier, Bird Products recommends that the heated humidifier meets ANSI Z or equivalent standard. CAUTION Do not submerge bacteria filters in liquids of any kind. Instead, use a steam autoclave to sterilize the filters. To avoid possible damage to elastomeric components, the peak temperature for Bird Products accessories should not exceed 275 F (135 C) for steam autoclave. Disinfecting the Bird Patient Circuit 1. First clean with a soft bristle brush using Ultra Ivory or an equivalent detergent. Pay particular attention to crevices and hard to clean areas. Dry with a soft cloth. After cleaning the patient breathing circuit, make sure all excess cleaning solution is completely removed to prevent residue buildup. 2. To disinfect, immerse in boiling water for 15 minutes. 3. Prior to reinstalling the patient breathing circuit, inspect it for excessive wear. If signs of damage are found, obtain a new patient breathing circuit. To order a replacement for a worn or defective patient breathing circuit, refer to Appendix A, Contact Information. Note In Homecare applications It is recommended to have two (2) complete circuits and exhalation valve assemblies and clean every other day. If pulmonary infection exists, then clean and disinfect daily. Figure 9-2 Circuit Disassembly. Part No. Quantity Description mm I.D. Cuff Adapter Tapered Plug, 7.5mm Male

93 TBird Series Ventilators Contact & Ordering Information Degree Elbow Adapter Wye Connector Water Trap, Natural, Autoclavable Circuit Tubing, 30 Smooth Bore Circuit Tubing, 18 Smooth Bore Main Flow Bacteria Filter Exhalation Valve Body (AVS models) Exhalation Valve Body (Legacy, VS & VSO2 models) 10384D 1 Exhalation Valve Diaphragm and Poppet (Pk. of 10) Cleaning & Sterilization Compatibility Recommendations, Exhalation Valve and Patient Circuit Clean with an Enzymatic Cleaner such as KlenZyme (part # 33775) in a warm bath (over 95 F [35 C], under 150 F [65.5 C]) for 10 minutes. Gently rinse 1 to 2 minutes. Dry with a gently air flow to clear all passages of water. Then sterilize by any of the following methods: Autoclave at 20 psig, 275 F [135 C], moist heat for 7 minutes or 0 PSIG [gravity] 135 C moist heat, for 15 min. at 135 C. Or Bathe in a Glutaraldehyde such as Cidex [2%] for 30 minutes or according to the manufacturer s specifications. Then gently rinse completely and allow to dry. Or Clean with a soft bristle brush using Ultra Ivory or an equivalent detergent per manufacturer s recommendations. Pay particular attention to crevices or hard to clean areas. Dry with a soft cloth. Immerse in boiling water for 15 minutes to disinfect. Note The main flow Bacteria Filter, P/N 09534, is compatible with steam autoclave ONLY. To Clean, Sterilize, or Disinfect Ventilator Accessories When cleaning ventilator accessories such as Heated Humidifiers, Nebulizers, Gas Sampling components and so on, follow the original equipment manufacturer s instructions or superseding institutional policies.

94 94 Operators Manual To Clean, Sterilize, or Disinfect the Air Intake Filter To clean the air intake filter, refer to Figure 9-3 and do the following: 1. Gently pinch the filter and remove it from the ventilator. 2. Hand-wash the filter using warm water and a mild, liquid detergent. 3. Thoroughly rinse the filter in warm water to remove all traces of the cleaning solution. 4. Dry the filter thoroughly. 5. Inspect the filter for damage and replace it if necessary. Figure 9.3 Removing the Air Intake Filter