The magic of active NCPAP

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Lindsey Parsons
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1 The magic of active NCPAP

2 Making technology serve mankind

For illustration only Experience and innovation ARABELLA System Since the advent of the microprocessorcontrolled ventilator, HAMILTON MEDICAL has been mastering the art of respiratory support for

As an ISO 9001 certified firm, we strictly adhere to quality assurance procedures, for our customers and patients good.

3 For illustration only Experience and innovation ARABELLA System Since the advent of the microprocessorcontrolled ventilator, HAMILTON MEDICAL has been mastering the art of respiratory support for your intensive care patients. We are part of the HAMILTON Group, with over 1000 employees world wide. As an ISO 9001 certified firm, we strictly adhere to quality assurance procedures, for our customers and patients good. Today s respiratory products combine the experience gleaned from our users and research partners with world-renowned Swiss engineering. The result: practical applications based on leading-edge medical device technology. Instruments that are as precise as they are easy to use. Systems for active nasal CPAP (NCPAP) have been used in neonatal intensive care in the United States since Today, with practitioners and practical experience to guide development, HAMILTON MEDICAL introduces the ARABELLA with a unique design for the delivery of active NCPAP. The ARABELLA is an easy to operate system proven to effectively and safely deliver NCPAP therapy. The noninvasive Universal Generator and Prongs reduce the work of breathing while maintaining a stable NCPAP level throughout the respiratory cycle for greater comfort for your very small patients. When used in conjunction with early extubation and NCPAP first strategies, the ARABELLA minimizes the need for intubation and mechanical ventilation.

The magic of ARABELLA ARABELLA Monitoring Gas Mixer History of NCPAP The ARABELLA system provides safe, effective delivery of NCPAP to infants, including those with very low birth weight (VLBW).

4 The magic of ARABELLA ARABELLA Monitoring Gas Mixer History of NCPAP The ARABELLA system provides safe, effective delivery of NCPAP to infants, including those with very low birth weight (VLBW). The advantages of the system include no moving parts, small size, minimum deadspace, quiet operation, and decreased impedance to respiration. The Monitoring Gas Mixer is used with a Universal Generator Set with interchangeable silicone prongs, a heated wire Delivery Circuit, and an ARABELLA Cap. The ARABELLA Monitoring Gas Mixer provides precise control of flow, pressure, and FiO 2 for safety and effectiveness. The integral monitoring system and special alarms are built in to ensure the highest level of patient safety. Continuous positive airway pressure (CPAP) was first introduced in the 1930 s as a "continuous distending pressure and used as treatment for pulmonary edema and asthma. It was rapidly replaced, as mechanical ventilation became a reliable modality. In 1968, Gregory and associates reintroduced continuous distending pressure therapy as an adjunct for the management of newborn respiratory distress syndrome and renamed it CPAP. In the late 1980 s, reports suggested that the use of nasal CPAP (NCPAP) without intubation could produce excellent results and reduce the incidence of chronic lung diseases. Although nasal CPAP (NCPAP) should prevent many infants from intubation and mechanical ventilation, the use of conventional NCPAP has been less successful due to an inability to maintain a proper seal at the infant s nares and the high imposed work of breathing. Many cases of failed NCPAP are more closely related to the devices used for delivery than by the infant s inability to breathe spontaneously.

Eliminates the need to intubate Innovative mounting technique Supports breathing of the tiniest infant The Universal Generator Set allows NCPAP to be delivered noninvasively.

5 Eliminates the need to intubate Innovative mounting technique Supports breathing of the tiniest infant The Universal Generator Set allows NCPAP to be delivered noninvasively. The Generator incorporates dual injector jets to maintain constant pressure throughout the respiratory cycle. The Universal Generator accommodates comfortable, soft silicone prongs, which fit easily into the infant s nares. The ARABELLA utilizes an innovative mounting technique for the Universal Generator Set and Delivery Circuit they are mounted on the Cap that allows for free movement of the baby for nursing care and for infant/maternal bonding. VELCRO fasteners and extra long ties are built into the Cap to allow for quick and easy securing of the Generator to the infant. The unique design of the Universal Generator and Prongs reduces the work of breathing while maintaining stable NCPAP. This allows for precise therapy delivery, greater patient comfort, less fatigue, and faster recovery. For illustration only Unique nasal prong design The Prongs come in four sizes (S, M, L, XL) and are contoured to conform to the natural shape of the infant s nares and septum. Each Generator Set includes the KNOSOMETER for correct measurement of the nares to ensure proper fit. Complete system A complete line of heated-wire Delivery Circuits has been developed to integrate with the nursery s specific brand of heated humidifier. Using the correct heated-wire Delivery Circuit ensures compatibility with your heated humidifier and minimizes rainout in the circuit. Expanded application of Monitoring Gas Mixer Specifically designed with the clinician in mind, the ARABELLA incorporates a blender, oxygen analyzer, graduated flowmeter, and an alarm package, for the delivery of oxygen therapy. An integral 330 kpa (50 psi) outlet for an additional flowmeter permits the delivery of blended gases, with active FiO 2 alarms, and for flow delivery by a low-flow cannula, manual resuscitator, oxygen hood, or for nebulizer therapy.

A flow of mixed gas emerging from a short injector tube in the Universal Generator produces a jet of

6 The magic of physics How the Universal Generator works With its unique design, the ARABELLA system delivers active NCPAP to the infant through its Universal Generator. A flow of mixed gas emerging from a short injector tube in the Universal Generator produces a jet of air with an amount of kinetic energy that is converted to pressure. This flow/pressure relationship ensures a comfortable infant with low work of

Bernoulli Effect: (Daniel Bernoulli, 1700-1782) The Venturi Principle (Giovanni Venturi, 1746-1822) Coanda Effect (Henri Coanda, 1885-1972) The Bernoulli effect demonstrates that in rigid tubes,

7 Bernoulli Effect: (Daniel Bernoulli, ) The Venturi Principle (Giovanni Venturi, ) Coanda Effect (Henri Coanda, ) The Bernoulli effect demonstrates that in rigid tubes, static pressure downstream from a restriction P b is lower than upstream P a. This effect is due to increased velocity v b compared to v a while flow is constant (V a =V b ). The Venturi principle is based on the Bernoulli effect. At high enough flows, the subambient pressure in the restriction draws in gas (V q ) just past the restriction, and the increased outflow (V c > V a ) is accommodated by the widened distal passage to assure P a =P c. This phenomenon is caused when an air stream passes by a wall and turbulent gas flow causes an attachment of the stream to the wall. As gas travels faster over a pocket formed by turbulent air, the air stream is "pulled closer to the wall. Bernoulli Coanda V a v a v b V b Venturi V a v a V c V q Inhalation Exhalation An air jet in motion remains steady for a certain distance before dispersing the kinetic energy into the atmosphere (Bernoulli). The ARABELLA incorporates this effect utilizing individual injector jets directed at each nasal passage to maintain a constant NCPAP pressure throughout the respiratory cycle. During the inspiratory cycle, the flow of gas to the injector jets provides inspiratory flow for the patient. At high inspiratory demand, additional flow is entrained by the venturi action of the injector jets. Upon exhalation, flow beyond the portals (into the passageway) enters a low-pressure area with minimal back-pressure and therefore results in a decrease in the velocity of the airflow. The decrease in velocity allow for a reverse or flip of the flow and exhalation to occur. The unique pressure flow stalling characteristics of the dual injector jets allows the patient to passively exhale without additional imposed work. A residual gas pressure is provided by the constant gas flow to assure stable NCPAP delivery throughout the respiratory cycle.

Technical specifications ARABELLA Monitoring Gas Mixer ARABELLA Universal Generator ARABELLA Delivery Circuit ARABELLA Caps ARABELLA five-leg stand ARABELLA Monitoring Gas Mixer Controls Flow 0 to 10

alarm High and low Oxygen ±5% of set Oxygen level Alarm silence 30 s Internal pop-off valve 150 cmh 2 O Safety limit valve and alarm Terminates flow if pressure exceeds 11 cmh 2 O (reinitiates gas

supplies Air/oxygen supplies 207 to 510 kpa (2 to 5 bar, 30 to 75 psi) Electrical power 110 to 240 V ac, 50/60 Hz, 22 VA Physical characteristics Dimensions (W x D x H) 214 x 175 x 145 mm (8.4 x 6.

8 Technical specifications ARABELLA Monitoring Gas Mixer ARABELLA Universal Generator ARABELLA Delivery Circuit ARABELLA Caps ARABELLA five-leg stand ARABELLA Monitoring Gas Mixer Controls Flow 0 to 10 l/min Oxygen 21 to 100% Monitoring NCPAP 0 to 12 cmh 2 O Oxygen 21 to 100% Alarms High pressure 3 cmh 2 O above set NCPAP level Low pressure 2 cmh 2 O below set NCPAP level Independent zero pressure alarm High and low Oxygen ±5% of set Oxygen level Alarm silence 30 s Internal pop-off valve 150 cmh 2 O Safety limit valve and alarm Terminates flow if pressure exceeds 11 cmh 2 O (reinitiates gas flow after 3 s) Gas supply Pressure difference between air and oxygen Electronic displays Brightness Auto-dimming Pressure resolution ±1 cmh 2 O Oxygen resolution ±1% Pneumatic and electrical supplies Air/oxygen supplies 207 to 510 kpa (2 to 5 bar, 30 to 75 psi) Electrical power 110 to 240 V ac, 50/60 Hz, 22 VA Physical characteristics Dimensions (W x D x H) 214 x 175 x 145 mm (8.4 x 6.9 x 5.7 in.) Weight 7.1 kg (15.6 lb) Environment Operating temperature 10 to 40 C at 0 to 75 relh, noncondensing Storage temperature -10 to 60 C at 0 to 75 relh, noncondensing Atmospheric pressure 700 to 1060 hpa (10 to 15 psi) Standards IEC / EN , IEC / EN ARABELLA Universal Generator Prongs sizes XL, L, M, S ARABELLA Delivery Circuit Voltages 16, 21, and 28 V Compatibility of 21 V version Fisher & Paykel MR600, MR620, MR630, MR700, MR720, and MR730; Hudson RCI Compatibility of 16 V version Hudson RCI Compatibility of 28 V version Marquest SCT2000 and SCT3000 ARABELLA Caps Cap size 1 Lemon yellow Cap size 2 Blueberry Cap size 3 Raspberry Cap size 4 Lime Green Cap size 5 Strawberry ARABELLA five-leg stand Pole mount for ARABELLA Monitoring Gas Mixer Note: 1 hpa = 1 mbar 1 cmh 2 O /02 Specifications are subject to change without notice. ARABELLLA and KNOSOMETER are trademarks of HAMILTON MEDICAL AG. All rights reserved. Printed in Switzerland. ISO 9001 EN TÜV-certified Manufacturer: HAMILTON MEDICAL AG, Via Nova, CH-7403 Rhäzüns, Svizzera, Tel.: (+41) , Fax: (+41) USA: HAMILTON MEDICAL Inc., 505 Edison Way, P.O.Box 30008, Reno, NV 89520, Tel.: (800) HAM-MED 1, Fax: (775) Great Britain: HAMILTON (G.B.) Limited, Unit 18 Field Farm Business Centre, Launton, Bicester, Oxon OX6 0EL, Tel.: , Fax: Germany: HAMILTON Deutschland GmbH, Daimlerweg 5a, D Darmstadt, Tel.: , Fax: France: HAMILTON France, Parc de Haute Technologie, 1 Rue Georges Besse, Silic N o 18, ANTONY CEDEX, Tel.: , Fax: For all other countries, contact Switzerland or our local distributor.

CATALOGUE. Adult and Infant Respiratory Care Catalogue

CATALOGUE. Adult and Infant Respiratory Care Catalogue CATALOGUE Adult and Infant Respiratory Care Catalogue TABLE OF CONTENTS F&P 850 System Adult Care Adult Invasive Ventilation Adult Noninvasive Ventilation Adult Optiflow and Oxygen Therapy 6 F&P 850 System