MÁY 4 GraphNET - Service Manual (EN) Rev1 [PDF]

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GraphNet ventilator



Technical manual (review 01)



MAY 2009



CONTENT CHAPTER I GENERAL AND OPERATION FEATURES TECHNICAL DATA AND SPECIFICATIONS CONTROL PANEL SAFETY MECHANISMS CHAPTER II MAINTENANCE INSTRUCTIONS CHAPTER III TROUBLE SHOOTING CHAPTER IV SENSOR VERIFICATION CHAPTER V EQUIPMENT OPENING AND CLOSURE CHAPTER VI DETAIL OF ASSEMBLIES CHAPTER VII ELECTRONIC BOARDS: DETAIL CHAPTER VIII CALIBRATION CHAPTER IX FINAL CONTROL



CHAPTER I



GENERAL AND OPERATION FEATURES



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



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GraphNet Ventilator Features and Principles of Operation Generic definition It is a continuous use ventilator intended to help or mechanically control patients´ breathing by delivering a preset percentage of oxygen in the respiratory gas with an adjustable volume or pressure.



Intended use Purpose and function of the GraphNet Ventilator:  Lung ventilator of medical application intended to provide mechanical ventilation. It is electrically and pneumatically powered and controlled by microprocessor.  The device is intended to be used in a wide range of patients, from infant to adult patients, and for a wide range of clinical conditions.  The device is intended to be used in hospitals and within their specialized units for intensive treatment with continuous ventilatory/respiratory support, for short- or long-term use.



Classification Class: Class III, MERCOSUR/GMC/RES. No. 40/00. Class IIb, Council Directive 93/42. Active therapeutical device intended to administer or exchange energy in a dangerous manner (life support). Operating mode: continuous operation. Type: active medical device. Risk level: Class "C" (High/Moderate) Useful lifetime: 5 years with planned maintenance. WARNING: do not use this ventilator in the presence of flammable anaesthetic gases. Explosion or fire hazard may occur.



Description The GraphNet ventilator consists of a system of related elements, designed to alter, transmit and apply energy directly, and by a preset manner, to replace or contribute with patient’s muscular capacity during respiratory work in order to obtain an efficient gas exchange. This function of mechanical support rise provided to the patient can be explained as follows:



1. Control mechanism. It explains how the device can operate to increase or supplement the patient’s respiratory effort.



2. Circuit control. It defines what type of components is used to carry out this task. 3. Control variables. It defines which dynamic elements control any stage during the respiratory cycle. 4. Respiratory phases variables. It explains how the ventilator responds to the changes that cause the beginning, maintenance and end of respiratory cycle.



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1. Control mechanism In order to understand how the machine can control the replacement or supplementation of the breathing natural function, it is necessary to give a brief explanation about respiratory mechanics. Specifically, about the pressure to be exerted for a flow to enter into the airway and for the lung volume to increase. Pressure, volume and flow change during an inhalation and expiration. This change is described by a mathematical model called Movement Equation of the respiratory system.



Movement equation



muscular pressure + ventilator pressure =



volume



+ resistance x flow



compliance Muscular pressure: force generated by respiratory muscles during inhalation. Ventilator pressure: Transrespiratory pressure generated by ventilator during inhalation (e.g.: airway pressure minus body surface pressure).



Either by muscular action, mechanical action or both, there is pressure powering volume and flow to patient. Pressure and flow, with changes over time, are the variables the ventilator participates with. Compliance and resistance are the constants maintained by the respiratory system. This is so from the mechanical ventilatory point of view. But also, an appropriate oxygen concentration gas shall be administered. The GraphNet ventilator is capable of controlling pressure wave forms as well as flow wave forms. Even this control can be made in a single inhalation.



2. Circuit control The GraphNet ventilator uses a circuit with an electronic control. The critical components of this system include the microprocessor, the pressure sensors and the proportional valves.



3. Control variables As above mentioned, the GraphNet ventilator control variables are pressure and flow.



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Movement equation states that if pressure is selected as the control variable, then the ventilator is a pressure controller. Therefore, the left side of the equation shall be determined by choices made on ventilator, and they shall not be affected by those changes made on the right side (compliance and resistance). As it can be seen, pressure control ventilation (PCV) and pressure support ventilation (PSV) modes use pressure as a control variable. If volume change (VT) is kept stable when compliance or resistance change and flow is directly measured (pneumotachograph), then, the ventilator is classified as a flow controller. The Volume Control Ventilation (VCV) mode of the GraphNet ventilator uses flow as a control variable. The pressure support ventilation with fixed volume mode is capable of changing from pressure controller to flow controller in a same inspiratory phase.



4. Respiratory phase variables In every ventilation phase (inhalation and expiration), a particular variable is measured and used to begin, continue and finish the phase. In this context, pressure, volume, flow and time are referred as phase variables. These actions will be described on “Principles of operation”.



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Principles of operation Definition The GraphNet ventilator is a pressure or flow controller. Inhalation is triggered by pressure, flow or time, or it is manually triggered. It is limited by pressure, volume or flow, and it is cycled by pressure, volume, flow or time. Patient’s gas flow is regulated by two proportional valves, one for air and the other for oxygen. During every breathing, valves operate simultaneously by combining gases in order to obtain the regulated oxygen concentration.



The microprocessor receives airway pressure and inspiratory flow signals, and controls the orders for the adjusted variables and the outlet signals. The airway pressure sensor is connected at the beginning of patient circuit. The sensor also controls feedback signals that are used for triggering by pressure, cycling and alarm levels, and for controlling pressure wave in the pressure control ventilation, pressure support ventilation and mandatory minute ventilation modes. Flow information is obtained through two differential sensors related to the inner outlet pneumotacograph and the expiratory pneumotacograph. The outlet pneumotacograph is of louver-type. The expiratory pneumotacograph is of variable-hole type. Signals from the former are used to control the flow wave form and the regulated tidal volume as reference.



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Control valves Gas flow to the patient is regulated by the above-mentioned proportional valves. Flow control is capable of sending flows up to 180 L/min when gases supply is of central installation and of 120 L/min when air is supplied by a portable compressor. The expiratory valve is governed by two solenoid valves, one for closure and for opening (beginning and end of inspiratory phase). The other one is a low flow proportional valve regulating the expiratory valve partial closure to produce positive pressure at the end of exhalation (PEEP). The activity of these valves is coordinated by the microprocessor, synchronizing their actions. The valve system also has five solenoid valves acting synchronically every 15 minutes for resetting the differential and pressure sensors (atmospheric pressure). At the same time, another solenoid valve allows a compressed air calibrated flow to pass through for draining the lines of the expiratory pneumotachograph and avoiding water and humidity to enter into the sensors.



Programming and monitoring panel The panel consists of the keys, the selection button to select different functions and the display where results are shown, in numerical data as well as in graphic representations.



The display shows graphics, numerical values and texts. Real-time graphics are of pressure, flow, volume, pressure/volume loops and flow/volume loops. Airway pressure is dynamically represented by an analog bar graph located on the right side of the display. The numerical values exhibited on the lower side of the display are those programmed by the operator. The ones on the upper side and on the left are resultant values. Some values have smaller characters, as the VT alarm maximum and minimum limit indication. Others are more outstanding, as the maximum and minimum pressure limit. The mode in use is indicated on the left upper side. On the information bar, below the mode in use, the sigh and/or inspiratory pause indication appears (when activated). Likewise, the display shows messages indicating an alarm state or for executing an action. 8



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Respiratory cycle The gas insufflation process into the lungs through mechanical ventilation with the GraphNet ventilator consists of four stages: 1) beginning of inhalation 2) course of inhalation 3) end of inhalation 4) expiratory phase



Beginning of inhalation The beginning of inhalation may be initiated automatically (by respiratory rate control selection) or by an initial inspiratory effort from patient. In the first case, ventilation shall be controlled and in the second, it may be either assisted or spontaneous.



Respiratory pressure curve indicating the beginning and end of the inspiratory phase. For controlled and assisted ventilation, volume control ventilation (VCV) and pressure control ventilation (PCV) modes are used. In this ventilator, spontaneous ventilation consists of pressure support ventilation (PSV) and its combinations, where patient begins and ends inhalation as required. The inspiratory effort triggering this inspiratory phase modifies the pressure within the respiratory circuit or produces variation of a continuous flow of the same circuit. In both cases, the system is regulated through the control of inspiratory sensitivity called by pressure or by flow, respectively. From the mechanic point of view, this stage is characterized by the expiratory valve closure and the gasmixture flow opening towards the respiratory circuit and the patient.



Course of inhalation The duration of this stage depends on the time during which flow comes out from ventilator towards the respiratory circuit and the patient. The form in which flow is administered depends on the selected ventilatory mode and the flow wave. In VCV mode, the flow wave may be selected in two ways: descending ramp (decelerated) or rectangular ramp (continuous). In pressure modes (PCV and PSV), the flow wave is decelerated, except in PSV with fixed volume where both decelerated flow wave and continuous flow wave are combined.



Drawings of pressure curves (above) and flow curves (below). From left to right: descending ramp flow (decelerated), rectangular (continuous). Note the modifications of pressure curves according to the flow used. 9



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End of inhalation The suspension of inspiratory flow coming out from ventilator depends on the inspiratory time selected in VCV and PCV modes. In PSV mode, it depends on the inhalated flow drop up to a derived percentage of initial flow from this same inhalation. This expiratory sensitivity may be regulated from a 5% to a 80% of initial flow. The default percentage is of 25%.



Flow curve during pressure support ventilation (PSV). In this case, the inhalation ends when the flow has reduced by a 25% of the initial flow (default value).



Expiratory phase It begins when the expiratory valve opens, letting the patient’s expired flow escape. This action is passive and is carried out by the lung elastic retraction itself and the thoracic cavity. Generally, the expiratory flow curve shows an inverted peak that returns with variable delay to the zero flow line. Delay in reaching zero may be due to expiratory difficulty caused by obstructive lung disease or by failure in the respiratory circuit. When the obstructive disease is associated with respiratory rate increase, it can be observed that, before the expiratory flow returns to zero line, another respiratory cycle is initiated. This phenomenon may produce the intrapulmonary gas trapping called Auto-PEEP.



Auto-PEEP: a) normal return of the expiratory flow curve to the base line; b) abrupt “stepped” return of the expiratory flow curve to the base line. There is incomplete lung expiration before initiation of the next inhalation (dynamic hyperinflation). 10



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The expiratory phase may be modified by adding positive end-expiratory pressure (PEEP). The GraphNet ventilator produces this positive pressure through digital regulation of the strength of diaphragm closure of the expiratory valve.



Pressure curve during ventilation with 5 cm H2O PEEP.



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Specifications Definition The GraphNet ventilator is a pressure or flow controller that may be triggered by pressure, flow or time or it may be manually triggered, and it is limited by pressure, volume or flow. It can also combine pressure and flow control in a single breathing.



Controls Inspiratory time: 0.1-3 seconds. (30sec.– Aprv.) I:E ratio: 5:1, 1-1:199 Ventilator rate: 1-150 rpm. Tidal volume: 10 to 2500 mL. Pressure control ventilation (PCV): 2-70 cm H2O (Adjustable Rise Time). Pressure support ventilation (PSV): 0-70 cm H2O (Adjustable Rise Time). Inspiratory sensitivity (compensated PEEP): By flow: 0.5 to 15 L/min. By pressure: –0.5 to –20 cm H2O. Expiratory sensitivity (in PSV): adjustable in 5, 10, 15, 20, 25, 30, 35, 40, 45, 50, 55, 60, 65, 70, 75 or 80% of initial flow. Default value is 25%. Automatic stop after 3 seconds or when pressure exceeds 2 cm H 2O of regulated pressure. PEEP/CPAP: 0-50 cm H2O FIO2: 0.21-1.0 Menu Key to access to different functions or data: • Backup ventilation • Ventilation adjuncts - inspiratory pause (VCV) - sighs (VCV) - volume compensation (NEO) - Humidifier • Trends • Activated alarms List of activated alarms in the last 24 hours. • Tools - Pressure units - Suction period - time of use and software version - Sound volume - Oxygen sensor calibration - Breathing circuit calibration - Date and time setting - Mean ambient pressure Nebulization: synchronized with Inhalation. Inspiratory flow:



In VCV: automatic regulation. In PCV and PSV: up to 180 L/min. Continuous flow in Neonatology: 2-30 L/min.



Sigh (only in VCV mode) with selection of:



- number: 1,2 or 3 - Rate: 5, 10, 15 or 20 per hour - Volume: from +10% to +100% - High pressure



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Inspiratory pause (in VCV mode): 0.25-2 seconds. Inspiratory/expiratory pause Manual trigger: for one inhalation or sigh. O2 100%: for pre- and post- inhalation oxygenation. Time of operation: 140 seconds. Flow wave form: In VCV: rectangular and descending ramp. In PCV and PSV: descending ramp. Stand-by: To keep programming without cycling. Help: key to access to explanatory displays. Printing: in PC file for RS232 communication. Serial outlet: for external communication.



Outlet parameters - peak inspiratory flow. - airway pressure: peak, plateau, mean, base. - expiratory time. - inspiratory time and I:E ratio of spontaneous breathing. - exhaled tidal volume. - exhaled minute volume. - percentage of inhalated oxygen.



Alarms • maximum and minimum airway pressure. • high and low exhaled tidal volume. • high and low exhaled minute volume. • oxygen percentage to the patient, maximum and minimum. • continuous pressure in the airway. • apnea with adjustable time. • maximum respiratory rate. • PEEP loss. • gas supply. • lack of main electric power. • low battery. • technical failure. Alarms are activated following a priority order with a light signal, an audible signal and a message on the display indicating the cause and the possible solution. Electronic circuit set up as a “watchdog” system with preset emergency ventilation.



Respiratory mechanics • Auto-PEEP. • dynamic and static compliance. • inspiratory and expiratory static resistance. • trapped volume. • slow vital capacity. • P0.1



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• P/V Inflex. • PImax.



Monitor control • selection of graphics with pressure, volume and flow curves, and pressure/volume loops and flow/volume loops. • frozen Image. • change of vertical and horizontal scales of the graphics. • trends of pressure, tidal volume, peak flow, minute volume, dynamic compliance. • printing in PC file.



Inhalated oxygen monitor With sensor connected to the first portion of the respiratory circuit for measuring the oxygen content of the gas sent to patient. Concentration result is shown on the display of the ventilator. It also includes alarms of maximum and minimum concentration.



Altitude compensation In order to increase volume measurement accuracy, the ventilator includes a procedure for adjusting altitude in the place of use.



Pressure unit conversion Selection of units in cm H2O, mbar, hPa.



Power requirement • 100 to 240 volts (automatic switching). • Built-in internal battery with automatic recharge.



Pneumatic requirementoxygen (DISS 9/16"-18 connector): Pressure 3.5 to 7 kg/cm air (DISS 3/4"-16 connector): Pressure 3.5 to 7 kg/cm



2



2



Within these limits, gases may have different pressure levels, but they must provide an up to 180 L/min flow.



Regular accessories • expiratory valve with exhaled flow meter. • articulated support for patient circuit. • air and oxygen pressure hoses. • water trap for compressed air input. • test lung. • power supply cable. • rolling pedestal. • instruction manual.



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Operating modes According to the described functional characteristics as well as the controls and the limits assigned to this device, the following operating modes have been established. These modes coincide with the description of the classical global reference material, which is partly mentioned in the “Bibliography” section. The purpose of the division into three parts is to separate groups according to predominant variable, volume, pressure or combined modes. Combined modes consist of forms including participation of the two modalities and others where the objectives of tidal volume or minute volume must be achieved. There is a definition and description of every operating mode action below.



Volume Mode with specific regulation of tidal volume.



Assisted/Controlled VCV Definition and action: It consists of the mode with specific regulation of tidal volume (volume of one inhalation). In this mode, the inspiratory pressure is variable and depends on the respiratory impedance in relation to the regulated volume. On the course of this mode, the ventilator shall operate as a flow controller where the selected flow wave is maintained in the presence of lung compliance/ resistance variations. In this mode, switching from inhalation to exhalation shall be usually regulated by time (inspiratory time-cycling). If maximum limit of safety pressure is reached, switching shall be by pressure. Inspiratory flow is calculated and regulated automatically. This means that, for a given volume, inspiratory flow variations shall be obtained through regulation of inspiratory time where the end of inhalation shall be marked by a rapid drop in pressure without inspiratory pause, except this pause is specifically regulated. In the mode by volume, generation form of inspiratory flow may be varied via the flow wave modification control. The different flows will be: in descending ramp (decelerated), rectangular (continuous). This mode operates with the assisted/controlled feature, switching from one to the other according to the response to the patient’s inspiratory effort. In the first form, inhalation is time-triggered (machine rate), flow-controlled and time-cycled. The patient’s inspiratory effort does not initiate inhalation. In the second form, the assisted one, the patient’s inspiratory effort must be capable of initiating the inspiratory phase. Triggering sensitivity shall be regulated by variation of continuous flow generated by the ventilator or by variations of pressure in the respiratory circuit. In any case, a basic rate is also regulated in order to ensure ventilation if inspiratory effort is reduced.



Specific controls for VCV mode operation: 



VT: regulation of gas volume propelled by the ventilator in every inhalation.







wave form: to change flow wave.



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Pressure It consists of modes with specific regulation of inspiratory pressure. It has two submodes: 1) pressure control ventilation (PCV), Assisted/Controlled 2) pressure support ventilation (PSV) and/or CPAP. In both submodes, pressure rise slope may be varied with the rise time control.



Assisted/Controlled PCV Definition and action: In the pressure control ventilation (PCV) mode, the ventilator shall operate as a positive pressure controller since pressure wave form must be maintained when patient’s compliance or resistance varies. Switching from inhalation to exhalation is generally regulated by time (inspiratory time-cycling) or by pressure if maximum limit of safety pressure is reached. As in all modes controlled by pressure, during PCV, the ventilatory volume is variable and depends on lung size, of the pressure gradient existing at the beginning of inhalation between the upper airway and the alveolus, of compliance of respiratory system and of the available inspiratory time. The pressure wave form developed during inhalation is rectangular and flow is in descending ramp (decelerated flow). It cannot be modified. Ventilation is activated with the assisted/controlled feature. It is controlled when inspiratory phase is initiated by the regulation of rate selected in the ventilator. In other words, this form belongs to controlled mandatory ventilation where inhalation is time-triggered (machine rate), flow-controlled and time-cycled. On the other hand, ventilation is assisted when the patient’s inspiratory effort can initiate the inspiratory phase before the ventilator executes initiation. Triggering sensitivity may be regulated by variation of continuous flow generated by the ventilator or by variations of pressure in the respiratory circuit. In any case, a basic rate is also regulated in order to ensure ventilation if inspiratory effort is reduced. In PCV, pressurization may also be regulated, that is to say, the pressure climb rate until reaching the selected pressure limit. Pressurization is regulated by two keys, one for increasing and the other one for reducing speed. This command is called “rise time”.



Specific controls for PCV mode operation:  PCV: regulates pressure control ventilation level.  Rise time: two keys for rising or lowering pressurization time.



Pressure support ventilation Definition and action: The pressure support is a spontaneous ventilation mode in which patient initiates and ends the inspiratory phase. This means that it keeps control of rate, inhalation duration and tidal volume. As in every mode limited by pressure, tidal volume (VT) is variable, depending on regulated pressure in relation to impedance of the respiratory system as well as patient’s demand. Patient initiates inspiratory phase according to his/her inspiratory effort and to inspiratory sensitivity regulation (by pressure or flow). The end of inhalation depends on expiratory sensitivity and is primarily flow-cycled (80, 40, 33, 25, 15, 10 or 5% of initial peak flow). As a safety measure, it can cycle by pressure (3 cm H2O above adjusted pressure) or maximum inspiratory time (3 seconds). 17



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Specific controls for PSV mode operation:  PSV: regulates pressure support ventilation level. 



Rise time: two keys for rising or lowering pressurization time.



Continuous positive airway pressure (CPAP) Definition and action: In this mode, the ventilator must generate, by means of expiratory valve partial closure, continuous positive pressure in the respiratory circuit. When patient inhales, the proportional solenoid valves will open and provide flow in accordance with patient’s demand. This being so, flow varies to maintain the positive pressure value adjusted. It can be programmed with or without pressure support ventilation. During this inspiratory phase, the airway pressure lowers proportionally to demand. In the expiratory phase, the airway pressure is higher than the regulated base pressure.



Specific controls for operating CPAP mode:  PEEP/CPAP: regulates the level of the airway base positive pressure. 



Rise time: two keys for rising or lowering pressurization time.



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Combined modes Group of modes in which patient presents spontaneous ventilation with mandatory inhalations inserted synchronically. It also includes modes with spontaneous ventilation and objectives of tidal volume or minute volume.



Intermittent mandatory ventilation synchronized by volume with pressure support ventilation (SIMV [VCV] + PSV) Definition and action: This mode is a combination of spontaneous breathing inserted in mechanical breathing which has a preset rate with synchronized initiation according to patient’s demand. In this form of synchronized ventilation, during mandatory breathing (forced), patient receives a preregulated volume sent together with a pre-established rate and inspiratory time. During spontaneous breathings, patient can breathe with pressure support ventilation. As in mode by volume (VCV), the flow wave of mandatory inhalations may be modified in the course of ventilation.



Specific controls for operating the SIMV (VCV) + PSV mode:  VT: regulation of volume propelled by the ventilator in every inhalation.  Wave form: for changing the flow wave during VCV between flow with descending ramp, constant, sinusoidal and ascending ramp.  PSV: regulates pressure support ventilation level. 



Rise time: for rising or lowering pressurization time.



Intermittent mandatory ventilation synchronized by pressure with pressure support ventilation (SIMV [PCV] + PSV) Definition and action: Similar to the previous mode. In this form of synchronized ventilation, during mandatory breathings, patient receives inhalations with controlled pressure with flow in descending ramp (decelerated), sent together with a pre-established rate and inspiratory time. During spontaneous breathings, patient can breathe with pressure support ventilation.



Specific controls for operating the SIMV (PCV) + PSV mode:   



PCV: regulates the pressure control ventilation level of mandatory inhalations. Rise time: two keys for rising or lowering pressurization time during PCV and PSV. PSV: regulates pressure support ventilation level.



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Mandatory minute ventilation with pressure support ventilation (MMV + PSV) Definition and action: It is a spontaneous ventilation mode with pressure support ventilation. It differs from standard pressure support ventilation in the automatic control over pressure level. In the MMV, the initial level of pressure support ventilation is adjusted by the operator. You need to select the target minute volume value you want to maintain. The ventilator shall gradually adjust the level of inspiratory pressure of every breathing with a quantity enough to reach the target minute volume.



Pressure support ventilation with fixed tidal volume (PSV + VT fixed) Definition and action: In this mode, the purpose is to achieve a preselected tidal volume. The operator regulates the pressure support ventilation level and target tidal volume. During inhalation, if target tidal volume has not been reached when flow has been reduced to the chosen criterion percentage (5, 10, 15, 25, 33, 40 %), the ventilator switches the descending ramp flow wave to rectangular wave (constant flow). As a result, inspiratory pressure increases until volume is reached and, finally, inhalation ends.



Airway pressure release ventilation (APRV) Definition and action: It is a ventilation mode applying two adjustable level of continuous positive pressure (CPAP) during regulated periods of time. This mode is programmed, in adult category (ADL) and pediatric (PED), on the Options line from Combined modes section. The two positive pressure levels, alternating in time intervals selected by the operator, produce passive and intermittent inflation and deflation of the lungs. At the same time, in the upper or lower level, patient can breathe spontaneously with or without pressure support ventilation.



Support ventilation Compulsory and programmable mode to ensure ventilation in case of inspiratory weakness or apnea in modes with spontaneous ventilation. Warning, while apnea alarm is activated, is an audible signal repeating every ten seconds during five seconds. This signal is accompanied by a message on the display and the activation of the apnea alarm light. This mode is of compulsory programming when any spontaneous ventilation form is selected, for example, pressure support ventilation, SIMV in both of its forms, MMV and PSV with fixed VT. The objective is to provide patient with safety in case ventilator does not detect the pressure or flow signal to initiate an inspiratory phase. However, in SIMV you can opt for deactivation of the backup function. Since the device does not recognize a difference between reduction of effort or apnea, this last term in generally used. By default, apnea time is established in 15 seconds, but it may be modified while running by 5, 10, 30 or 60 seconds (Menu). Support ventilation for ADULTS and PEDIATRICS is obtained through mode by volume or pressure. In NEONATOLOGY, it is obtained through assisted/controlled pressure (PCV).



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Capnography The Capnography function allows the monitoring of PCO2/Time curves and Volumetric Capnography through continuous display on the screen. In addition, other paremeters are shown such as ETCOw, VD/VT ratio, serial dead space (VD), alveolar current volume (VA), alveolar minute volume (VA min), CO2 current volume and CO2 (VCO2) elimination. All the results are shown on the screen and permanently updated. Implementation: Canostat 5® (Respironics Inc.) should be used as a data gathering instrument, which is an optional accesory provided upon request. It is a free of maintenance device, which requires neither calibration nor use of titled gases. Zero calibration is performed with ambient air each time the adapter connecting the sensor between the airway and the ventilator is changed. Capnograph components: 1. CO2 Sensor 2. Connector from the capnograph to the ventilator 3. Connector of the capnograph wire. 4. Adapter



Other functions of the Capnography Menu The Capnography menu shows other less frequently used options. Sensor activation: if the sensor is plugged while the ventilator is operating, a status message will come up: Sensor ERROR. In this case, it must be activated. In order to do so, move to the Sensor Activation option and press the knob. As a result, the sensor activation is performed following the the steps considered by the manufacturer. If the activation is correct, the sensor status will change to: Sensor OK; on the contrary, the message will still remain as ERROR. When the sensor is connected to the device but the status is ERROR, the activation is required. In the activation process, the barometric and oxygen compensation mix (FIO2) data are also sent.



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Controls common to all modes 



f: regulation of respiratory rate initiated by ventilator. Disabled in PSV and CPAP.







Vtr: regulation of sensitivity for inspiratory triggering by flow required by patient.







Ptr: regulation of sensitivity for inspiratory triggering by pressure required by patient.







FIO2: regulation of fraction of oxygen inhalated in the gas mixture.







PEEP/CPAP: for regulation of continuous positive pressure in the respiratory circuit.







Manual trigger: key to initiate inhalation.







Stand-by: to discontinue ventilator operation without deleting regulated data.







Nebulization: key to initiate flow period for nebulizer.







Alarm limits:



1.



VT maximum / minimum: regulates limits of alarm of tidal volumen delivered by ventilator.



2. 3. 4. 5. 6.



maximum inspiratory pressure: regulates maximum limit of inspiratory pressure. minimum inspiratory pressure: regulates minimum limit of inspiratory pressure. max f: regulates the alarm limit of maximum respiratory rate permitted. PEEP loss: 2, 4, 6 cm H2O. apnea time: 5, 10, 15, 30, 60 seconds.







silence: to eliminate the alarm sound up to 60 seconds.







selection and enter: Keys used to increase or lower and accept a selected value.







reset: key to abort any action in course.







Ctrl: all-purpose key for combining functions with two keys.







inspiratory/expiratory pause.



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Alarms and safety mechanisms The equipment has an alarm system with simultaneous messages to alert conditions that, if they persist, may or do put at risk patient’s state and may require immediate assistance. Safety mechanisms are equipment intrinsec functions consisting of assigned limits per program for every ventilatory parameter and of automatic switching actions of operating modes.



Alarms Some alarms, when activated, have audible and luminous signals (sound and light from intermittent lights) accompanied by messages on the display indicating the cause and the solution suggested. Alarm luminous signals have a dedciated section including a name which identifies the alarm priority. In addition, every luminous signal has two lights in case one of them burns. Activation of other alarms is evidenced by sound and message on the display. Alarms have activation priority and present an order which complies with such priority. This means that if two or more events take place simultaneously, the appropriate lights are on, but the message on the display is the one of highest hierarchy. In every case, the maximum inspiratory pressure alarm is considered as the one of highest hierarchy. Several alarms, in addition to signals and warnings, produce actuation of other devices that replace the lack or malfunction so that ventilation is maintained or danger is reduced to a minimum. For example, the ones activated by maximum limits of pressure or volume produce instant opening of the expiratory valve with patient’s system decompression. The alarm section has the alarms, strictly speaking, and related commands. Some alarms have programmable limits of maximum and minimum values (pressure, volume, rate). Others are automatically activated after a certain time the cause has been presented. While the equipment is on, all alarm events are recorded in memory and shown on the activated alarm display including date and time in a 600-line maximum sequence. If the number of events is higher, when adding the last one, then the first one will disappear. The ventilator alarm signals are grouped in four categories: 1) High priority, 2) mid priority, 3) low priority and 4) information.



High priority signals (emergency signal) They are those requiring immediate action. They are characterized by instant activation. The following alarms activate with high priority signals:



• maximum inspiratory pressure (adjustable by user) Definition: maximum pressure limit permitted in airway. Selection: in all modes. Action: 1) activated immediately when inspiratory pressure reaches the regulated limit. 2) instant opening of the expiratory valve with decompression of respiratory circuit up to PEEP level. signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. regulation limits: from 10 to 120 cm H2O 23



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default values: according to patient’s category: ADL: 40 cm H2O PED: 30 cm H2O NEO: 25 cm H2O value change: with (maximum] key of “inspiratory pressure”. message on display: MAXIMUM PRESSURE REASONS: OBSTRUCTION IN THE RESPIRATORY CIRCUIT OR IN THE AIRWAY HIGH TIDAL VOLUME LOW ALARM LIMIT HIGH PEAK INSPIRATORY FLOW LOW TI PATIENT-VENTILATOR ASYNCHRONY The alarm audible signal is replaced automatically when pressure returns to a value lower than the limit. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



• minimum inspiratory pressure (adjustable by user) Definition: minimum pressure limit permitted in airway. Selection: in all modes. Action: it is activated when inspiratory phase pressure of ventilator is kept below the regulated limit for more than 10 seconds. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. regulation limits: from 3 to 99 cm H2O (from 0 in PCV). default value: 5 cm H2O for all patient’s categories. value change: with (minimum] key of “inspiratory pressure”. message on display: MINIMUM PRESSURE CAUSES: DISCONNECTION LEAKS IN THE CIRCUIT HIGH ALARM LIMIT DISCONNECTION OF UPPER HOSE FROM FLOW SENSOR The alarm audible signal is replaced automatically when pressure returns to a value higher than the limit. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



• low gas supply (not adjustable by user) Definition: it acknowledges an inappropriate lowering of pressure in one or both supply gases (oxygen or air). Action: When supply air or oxygen pressure is below 2.7k cm2, it is immediately activated. Simultaneously, the gas with higher pressure replaces the absent gas. Signal type: auditive, luminous and warning on display. silence: It cannot be kept silent. 24



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message on display: AIR – OXYGEN LOW PRESSURE CORRECTIVE ACTION: REGULATE GAS PRESSURE BETWEEN 3.5 AND 7 bar Automatic resetting if pressure returns to a value exceeding the limit. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



• lack of electric power (not adjustable by user) Definition: main power supply cutoff. it is activated when the voltage master key of the equipment is on and the following events take place: 1) lack of main electric power, 2) cable for connection to main electric power is unplugged and 3) inlet fuse is blown. Action: instant switching to power supply of the internal battery. The indicator light on the panel turns on and the sound is continuous. Signal type: auditive, luminous and warning on display. silence: It cannot be kept silent. message on display: ALARM POWER LOSS CORRECTIVE ACTION: RESET ELECTRIC POWER Automatic resetting if electric power is reset. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



• low battery (not adjustable by user) Definition: it indicates that the estimated time of operation using battery is short. Action: there is no direct action. Signal type: luminous and warning on display. message on display: LOW BATTERY



Continuous pressure (not adjustable by user) Definition: Maintenance of 5 cm H2O above PEEP/CPAP in the respiratory circuit for more than 15 seconds. ventilator action: decompression of respiratory circuit up to the regulated base pressure. Signal type: light and warning on display. silence: It cannot be kept silent. Mesage on display [Ctrl] + [Alarm Settings]: CONTINUOUS PRESSURE SEARCH FOR BRANCH PIPE OCCLUSION



technical failure (not adjustable by user) Definition: important alteration of the electronic circuit or software. Action: ventilator stops operation. Display turns off. The continuous luminous and audible signal is activated. Signal type: auditive and luminous. silence: it cannot be kept silent. 25



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results: failure indicates a serious alteration situation, therefore, the equipment must not be used. Specialized service assistance must be requested.



Mid priority signals (danger signal) They are activated within a delay time. In some of them, time is adjustable by operator, in others, time is fixed. The following alarms activate with mid priority signals:



• VTmax (adjustable by user) Definition: maximum limit permitted of current volume propelled by ventilator. Selection: in all modes. Action: it is activated after 10 seconds when tidal volume of consecutive breathings is kept above the regulated limit. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. regulation limits: from 0.050 L to 3.0 L. default values: according to patient’s category: ADL: 0,600 L PED: 0,300 L value change: by pressing once the [VT] key of “alarm limits”. The audible signal is discontinued when pressure is reset to accepted levels. The luminous signal turns off by pressing [Reset].



message on display: MAXIMUM TIDAL VOLUMEN CAUSES: LOW ALARM LIMIT CHANGES IN IMPEDANCE OF THE RESPIRATORY SYSTEM (PRESSURE MODES) DISCONNECTION OF UPPER HOSE FROM FLOW SENSOR The alarm is automatically reset if volume returns to a value lower than the limit. The alarm audible signal is discontinued if pressure returns to a value lower than the limit. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



• VTmin (adjustable by user) Definition: minimum limit permitted of current volume propelled by ventilator. Selection: in all modes. Action: it is activated after 10 seconds when tidal volume of consecutive breathings is kept below the regulated limit. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. regulation limits: from 0.001 L to a value below the maximum VT. default values: according to patient’s category: ADL: 0,200 L PED: 0,100 L value change: by pressing twice the [VT] key of “alarm limits”. message on display: 26



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MINIMUM TIDAL VOLUME CAUSE: DISCONNECTION LEAKS IN THE CIRCUIT DISCONNECTION OF LOWER HOSE FROM FLOW SENSOR OBSTRUCTION OF THE UPPER OR LOWER HOSE FROM FLOW SENSOR HIGH ALARM LIMIT CHANGES IN IMPEDANCE OF THE RESPIRATORY SYSTEM (PRESSURE MODES) The alarm audible signal is discontinued if pressure returns to a value higher than the limit. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



High/low O2 concentration (adjustable by user) Definition: Maximum or minimum limit permitted of O2 concentration of gas mixture coming out from ventilator. Selection: in all modes. ventilator action: the alarm is activated when oxygen concentration is kept out of the regulated limit for more than 30 seconds. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. default value: 10% above and 10% below the regulated FIO2. value change: by entering Menu. Mesage on display [Ctrl] + [Alarm Settings]: HIGH/LOW O2 CONCENTRATION



• apnea (adjustable by user) Definition: it is the condition where ventilator considers a lack of breathing during ventilation with spontaneous modes after an adjustable period of time. Selection: in pressure support ventilation, continuous positive pressure and combined modes (in SIMV is optional). Action: it changes a spontaneous mode by the selected one as support after 5, 10, 15, 30, 60 seconds depending on regulation. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. default value: 15 seconds in all categories: value change: by pressing the [support ventilation] key. message on display: APNEA ALARM ACTIVATED SUPPORT VENTILATION IN USE The alarm is automatically reset if patient returns to spontaneous ventilation. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



Low priority signals (warning) They are activated within a delay time. In some of them, time is adjustable by operator, in others, time is fixed. The following alarms activate with low priority signals: 27



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• f max (adjustable by user) Definition: regulates the limit of maximum spontaneous respiratory rate. It is also activated if the respiratory rate is regulated with a value higher than that of the alarm limit. Selection: in all modes. Action: The alarm is activated with a luminous and audible signal after 20 seconds the regulated limit has been exceeded. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. default value: 30 rpm for all categories. message on display: ALARM: MAXIMUM RATE CAUSES: AUTO-CYCLING LOW ALARM LIMIT LEAKS IN THE CIRCUIT DISCONNECTION The alarm is automatically reset if rate returns to a value lower than the limit. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



• PEEP loss (adjustable by user) Definition: lowering of base pressure below the selected value during ventilation with expiratory positive pressure at the end of exhalation or continuous positive pressure (PEEP/CPAP). Selection: in all modes. Action: audible, luminous signal and message on display after 15 seconds of alteration persistence. Signal type: auditive and warning on display. silence: it may be temporarily kept silent. regulation limits: 2, 4, 6 cm H2O below PEEP limit. While OFF, it is disabled. default value: 4 cm H2O message on display: ALARM: PEEP LOSS CAUSES: LEAKS IN THE CIRCUIT LOW ALARM LIMIT Automatic resetting if pressure returns to a value exceeding the limit. The luminous signal from the alarms section does not disappear until the [Reset] key is pressed.



• high exhaled minute volume (adjustable by user) Definition: exhaled minute volume higher than the one selected in mandatory minute ventilation (MMV). Action: warning with audible, luminous signal and message on display after 10 seconds of alteration persistence. It generally indicates loss in the respiratory circuit or disconnection. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. 28



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regulation limits: from 1 to 50 L/min. message on display: ALARM MAX MINUTE VOLUME CAUSES: LOW ALARM LIMIT CHANGES IN THE PATIENT’S RESPIRATORY MECHANICS DISCONNECTION OF UPPER HOSE FROM FLOW SENSOR



• low exhaled minute volume (adjustable by user) Definition: exhaled minute volume lower than the one selected in mandatory minute ventilation (MMV). Actuated after 10 seconds. It generally indicates loss in the respiratory circuit or disconnection. Signal type: auditive, luminous and warning on display. silence: it may be temporarily kept silent. regulation limits: from 1.0 L/min. message on display: ALARM MAX MINUTE VOLUME CAUSES: HIGH ALARM LIMIT CHANGES IN THE PATIENT’S RESPIRATORY MECHANICS DISCONNECTION OF LOWER HOSE FROM FLOW SENSOR OBSTRUCTION OF UPPER OR LOWER HOSE FROM FLOW SENSOR



• fan failure (not adjustable by user) Definition: blower operation is stopped with possible overheating of the electronic circuit. Signal type: auditive and warning on display. silence: it cannot be temporarily kept silent. message on display: ALARM BLOWER FAILURE



Alarm complements • Silence 30/60 seconds It discontinues audible signal of some alarms. It does not discontinue alarm sound of lack of electric power and technician.



• Reset has several functions: it resets the main display, it aborts changes of unaccepted values.



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Safety mechanism The ventilator safety mechanisms, in addition to the alarm system, consist of specific devices actuated in cases of risk and the protection of the operating system governing the electronic system. The purpose of this system is to preserve integrity of the procedure, making it safe and reliable.



Ventilator components Safety valve. It is located at the beginning of the respiratory circuit. It is factory-precalibrated. It opens when pressure within patient circuit reaches, for any reason, 120 cm H2O. Gas passes through a gas collector to be expelled to the outside. Inspiratory relief valve (anti-suffocation). It is located at the beginning of the respiratory circuit. It opens when there is lack of electric power or inoperative state of the equipment, allowing patient to breathe in ambient air. Escape of operating gases. Operating gases normally escaping from some internal mechanisms are directed to a common collector from which they are expelled to the outside. Lack of compressed air pressure. Lack of compressed air pressure (command gas) is replaced by compressed oxygen through a communication system. Lack of pressure is alerted by the corresponding alarm through a different device. Lack of compressed oxygen pressure. Lack of compressed oxygen pressure is compensated by compressed air. Lack of pressure is alerted by the corresponding alarm through a different device. Airway pressure monitoring. The system has two pressure sensors. One is located at the beginning (proximal pressure) and the other, at the end of patient circuit (distal pressure). The proximal sensor commands the pressure in the pressure control ventilation (PCV) and pressure support ventilation (PSV) modes, the limits of airway maximum and minimum pressure and the expiratory pressure (PEEP). It also originates the values of airway peak, plateau and mean pressure. The distal sensor participates in the representation of pressure curves and in the airway base pressure. Protection of electronic circuit and display. The motherboard must have a fuse for protection against electric overload that may damage the electronic circuit and display. When, by any reason, this fuse is blown, the electronic system and the display lack electricity. This state is alerted by a continuous sound and light of one of the lights indicating Inop vent from the panel alarms section.



Operating system The operating system regulating the microprocessor functions is designed with algorithms that impede or prevent execution of maneuvers which may result in unfavourable effects. Memory check. Every time the equipment is turned on, RAM and EPROM memories are checked. This guarantees the operating system integrity. Parameter limits. Every parameter participating in ventilation has minimum and maximum limits that cannot be exceeded. Value acceptance. Every selected and changed value must be accepted by pressing the selection key, within a 5 second maximum. Alarm limits. Every alarm has preregulated or programmed limits. When they are exceded, in some cases, instant suppression of action is produced (for example, pressure maximum limit) Or, in other cases, they have a delay time for activation (for example, PEEP loss), depending on the alarm hierarchy. Alarm activation warnings. When an alarm is activated, it has a luminous and audible signal and the display shows a message indicating the name of the activated alarm, potential cause and suggestions for solution.



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Bibliography 1.



Abraham E, Yoshihara G. Cardio-respiratory effects of pressure control ventilation in severe respiratory failure.Chest 1989; 96:1356.



2.



Amato MB, Barbas CS, Bonaza J. Volume- Assured Pressure Support Ventilation: a new approach for reducing muscle work load during acute respiratory failure. Chest 1992; 102:1225.



3.



Ashbaugh DG, Petty TL. Positive end-expiratory pressure: Physiology, indications and contraindications. J Torac Cardiovasc Surg 1973; 65:165.



4.



Branson R.D., Hess D.R., Chatbrum R.L.: Respiratory care equipment. Philadelphia: J.B. Lippincot; 1995.



5.



Brochard F; Rua F; et all. Inspiratory pressure support compensates for additional work of breathing caused by the endotracheal tube. Anesthesiology 1991; 75:739.



6.



Brochard L, Pluskawa F, Lemaire F. Improved efficacy of sponteneous breathing with inspiratory pressure support. Am Rev respir Dis 1987; 136:411.



7.



Cairo J.M., Pilbeam S.P.: Respiratory care equipment. St. Lous: Mosby; 1999.



8.



Chatburn RL. A new system for understanding mechanical ventilators.Resp Care 1991;36:1123.



9.



Chatburn RL. Classification of mechanical ventilators. Resp Care 1992;37:1009.



10. Downs JB, Klein EF, Desaultels E. Intermitent mandatory ventilation: a new approach to weaning



patient from mechanical ventilation. Chest 1973; 64:331. 11. Goldsmith J.P., Karotkin E.H.: Assisted ventilation of the neonate. Philadelphia: W.B. Sauders; 1996. 12. Hewlett AM, Platt AS, Terry VC. Mandatory minute volume. Anaesthesia 1977; 32:163. 13. MacIntyre N, Nishimura M, Usada Y et al. The Nagoya conference on system design and patient



interactions during pressure support ventilation. Chest 1990; 97:1463. 14. Murphy DF, Dobb G, Effect of pressure support ventilation on sponteneous breathing during



intermitent mechanical ventilation. Crit care Med 1987; 15:612. 15. Sanborn WG Microprocesor-based mechanical ventilation. Resp Care 1993;38:7. 16. Sassoon C. Mechanical ventilator design and function: The trigger variable. Resp Care 1992; 37:1056. 17. Tharatt RS, Allen RP,Albertson TE. Pressure controlled inverse ratio ventilation in severe adult



respiratory failure. Chest 1988; 94:755. 18. Thompson JD. Computerized control of mechanical ventilators: closing the loop. Resp Care



1987;32:440. 19. Tobin M.J.: Principles and practice of intensive care monitoring. New York: McGraw Hill; 1998. 20. Tobin M.J.: Principles and practice of mechanical ventilation. New York: McGraw Hill; 1994.



31



CHAPTER II



MAINTENANCE INSTRUCTIONS



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MAINTENANCE INSTRUCTIONS



MAINTENACE PROCEDURE FOR 5000 HOURS:



1- External review, cleaning and disinfection of the device. 2- Functional control of the equipment when servicing. 3- Display sensor verification. 4- Software update verification. 5- LED turn on verification. 6- Functional verification of keys and selection switch (encoder). 7- Alarm sound control. 8- Back lid removal and cleaning of the fan and surrounding area. 9- Auxiliary battery state control. 10- Verification and cleaning of the porous metal filters and of the water trap. 11- Visual verifications of the internal tubes (general state, bends, pinching, absence of water, etc.) 12- Cleaning of contacts and internal connections in the CPU board, sensor board and key board. 13- Pneumotacograph cleaning (in case of obstruction, change mesh). 14- Regulator pressure control. 15- Pneumatic unit recalibration (includes calibration of air/oxygen proportional valves). 16- Check cabinet closing gasket (change if alligatoring). 17- Expiratory valve replacement. 18- Equipment, logging and document update. 19- Equipment functional control. 20- 24 hour operation testing.



32



CHAPTER III



TROUBLE SHOOTING



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



PROBLEM



Equipment does not pass through initial calibration



POTENTIAL CAUSE



Review : 01 Date : 05/04/09



CORRECTIVE ACTION



1. Leak in the patient circuit. 2. Supply gases closed. 3. Pneumatic ways occlusion.



1. Check the patient circuit. 2. Open the supply gases power supply key. 3. Check inlet filters and supply hoses.



4. Check expiratory valve.



4. Check the diaphragm of the expiratory valve and control that the connections are correct.



5. Internal circuit hose clogged or disconnected.



6. Pressure leak or loss. 7. Internal electrical connections.



5. Check the equipment internal connections.



6. Check the tightness of the pneumatic unit up to 100cm of water. To do this, connect the supply gases to the equipment and apply a 100cm water pressure through the outlet of the inner pneumotacograph. If the pressure falls rapidly, then there is a leakage inside the pneumatic unit. Check the Security Valve and the Antisuffocation valve.



7. Check the cable of proportional valves and the valve connection. Check voltage in CPU connectors. Low flow



1. Faulty pressure regulators. 2. Occlusion in the pneumatic ways or internal pneumatic leaks. 3. Leakages in the patient circuit. 4. Water in the pneumotacograph system.



5. Changed flow sensors.



1. Verify and recalibrate the pressure of air and oxygen regulators to 2.8Kg/cm2. Verify and recalibrate the pressure of the 10PCI regulator. 2. Check filters or bent or lose hoses. 3. Check patient circuit. 4. Take the same measures as when water gets in the equipment. (Explained later on). 5. Check the flow sensors operation and calibrate them.



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PROBLEM



High flow



POTENTIAL CAUSE



Review : 01 Date : 05/04/09



CORRECTIVE ACTION



1. Faulty pressure regulators. 2. Flow calibration wrongly implemented.



1. Verify the pressure of air and oxygen



3. Changed pneumotacographs



2. Check the absence of water inside the equipment and recalibrate the pneumotacograph and the valves.



4. Changed flow sensors.



5. Extremely high Electromagnetic Interference (EMI).



regulators and recalibrate them to 2.8Kg/cm2.



3. Check that there is no water inside the equipment. Check flow sensors operation and then recalibrate equipment.



4. Verify flow sensors operation. 5. Verify that there is no other electrical equipment nearby that gives out electromagnetic waves and alters the normal operation of the equipment.



Low Tidal volume



1. Wrong initial calibration of the patient circuit.



1. Go over the circuit initial calibration once more.



2. Damaged expiratory valve or expiratory pneumotacograph. 3. Disconnection of the lower hose of the expiratory pneumotacograph.



2. Check expiratory valve and pneumotacograph.



4. P1 Obstruction.



3. Verify connections in the expiratory pneumotacograph. 4. Verify P1 permeability.



5. Verify flow sensors.



5. Damaged flow sensors. High Tidal volume



1. Wrong initial calibration. 2. Damaged expiratory pneumotacograph. 3. P2 obstruction. 4. Inverted P1 and P2 connection.



1. 2. 3. 4.



Go over initial calibration once more. Check pneumotacograph. Verify P2 permeability. Verify that P1 and P2 are correctly connected, not inverted.



5. Verify operation of the flow sensors.



5. Damaged flow sensors. High Inspiratory Pressure



1. Patient circuit occlusion. 2. High volume. 3. High Rise Time. 4. High inspiratory flow.



1. Verify patient circuit. 2. Verify volume. 3. Regulate Time Rise to patient’s resistance.



5. Flow sensor lost calibration.



4. Calibration of the entire equipment. 5. Verify the calibration of the entire equipment.



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TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



PROBLEM



Low Inspiratory Pressure



POTENTIAL CAUSE



1. Disconnection of the upper hose of the expiratory pneumotacograph. 2. Internal disconnection of the flow sensor



Review : 01 Date : 05/04/09



CORRECTIVE ACTION 1. Check expiratory pneumotacograph connections.



2. Check internal pneumatic circuit connections.



3. Check flow sensor.



3. Damaged flow sensor. High minute volume



1. Disconnection of the upper hose of the pneumotacograph.



1. Verify connections in the expiratory pneumotacograph. 2. Verify P2 permeability.



2. P2 obstruction.



3. Verify that P1 and P2 are correctly connected, not inverted.



3. Inverted P1 and P2 connection.



4. Verify flow sensors.



4. Damaged flow sensors. Low minute volume



1. P1 or P2 obstruction. 2. Damaged flow sensors.



1. Verify P1 and P2 permeability. 2. Check flow sensors.



3. Changed pneumotacograph.



3. Verify that there is no water inside the equipment and fully recalibrate the equipment.



No PEEP



1. Damaged expiratory valve. 2. Leakages in the patient circuit. 3. Defective PEEP electricallyoperated valve.



4. Water in the PEEP electrically-operated valve. High PEEP



1. Stuck expiratory valve diaphragm. 2. Patient circuit obstruction.



3. Defective PEEP electrically-



1. Check expiratory valve. 2. Check patient circuit. 3. Verify the PEEP electrically-operated valve operation in the sensor board.



4. Check whether there is water in the pneumatic box and, in case there is water in the valves, replace the PEEP electrically-operated valve. 1. Replace expiratory valve diaphragm. 2. Verify patient circuit.



3. Verify electrically-operated valve operation.



operated valve. Low PEEP



1. Leakages in the patient circuit. 2. Damaged expiratory valve. 3. Leakages in the internal pneumatic circuit.



1. Check patient circuit. 2. Check expiratory valve. 3. Check internal pneumatic circuit.



4. Verify electrically-operated valve operation.



4. Defective PEEP electricallyoperated valve.



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TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



PROBLEM



No flow in the nebulizer



POTENTIAL CAUSE



1. Inspiratory flow below 7L/min. 2. Disconnection in the internal pneumatic circuit. 3. Obstruction in the nebulizer. 4. Damaged solenoid valve



FiO2 different to the measurement % FIO2



1. Air or oxygen proportional valves lost calibration. 2. Pressure regulators lost calibration.



3. Oxygen analyzer lost calibration.



Review : 01 Date : 05/04/09



CORRECTIVE ACTION 1. Rise the inspiratory flow. 2. Check internal pneumatic circuit. 3. Check nebulizer stem permeability.



4. Verify solenoid valve operation.



1. Calibrate once more the proportional valves and then recalibrate the equipment measurement parameters.



2. Verify calibration of the pressure regulators. Then recalibrate the entire equipment. 3. Calibrate the oxygen analyzer.



Fan’s failure



1. Back fan disconnected or blocked. 2. Damaged back fan.



Low battery



1. Low Battery. 2. Damaged battery. 3. Battery disconnection.



4. Electric failure.



1. Check fan and connections.



2. Replace ventilator for another one with the same characteristics. 1. Keep the battery charging over 12h and, if it does not charge, replace it. 2. Replace the battery with a new one. 3. Check the battery connections. 4. Verify charging voltage (13



Display does not function



1. Burnt display.



1. Replace the display for a new one.



2. Wrong contact in the display



2. Check and clean the contacts in the



connections. Emergency ventilation or technical failure



0.5 V).



different display connection plugs.



1. Failure of an electronic component. 2. Wrong contact of an electrical component or cable. 3. The interior of the equipment is dirty.



1. Check the status of the electrical components of the sensor, annex and CPU boards. 2. Check the welding of cables and electrical components. 3. Clean the interior of the entire equipment and the plugs contacts.



4. Extremely high



4. Verify nearby electrical equipments.



Electromagnetic Interference (EMI).



36



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



PROBLEM Water in the equipment



Review : 01 Date : 05/04/09



POTENTIAL CAUSE



CORRECTIVE ACTION



1. Water entered into the



1. Open the equipment and clean all the pneumatic components (2.8Kg/cm2 pressure regulators, proportional valves, nonreturn valves, 10PSI regulator, pneumotacograph, pneumotacograph meshes).



equipment through the air or oxygen supply.



Then, recalibrate the entire equipment. Equipment autocyclying



1. Wrong initial calibration. 2. Leak in the patient circuit. 3. Extremely high Electromagnetic Interference (EMI).



4. Inadequate sensitivity.



1. Repeat initial calibration. 2. Check the patient circuit. 3. Check whether there is a high electromagnetic emission equipment nearby that can be interfering with the equipment. 4. Set the adequate sensitivity.



Irregular base flow



1. Equipment lost calibration.



2. Proportional valves lost calibration.



1. Recalibrate Pneumotacographs, proportional valves and F02.



2. Recalibrate proportional valves and FO2.



Pressure reading transient failure, volumes with autocycling.



1. Extremely high Electromagnetic Interference (EMI).



1. Check whether there is a high electromagnetic emission equipment nearby.



37



CHAPTER IV



SENSOR VERIFICATION



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Review : 01 Date : 05/04/09



SENSOR VERIFICATION CALIBRATION MENU ACCESS With the equipment off, press the “Reset” key and turn it on again by holding the key. On display, there will appear the “Enter Password:” message. At that moment, press any key four times. Then, there will appear a message announcing that the entered password is incorrect. To continue, press any key. At that moment, the calibration menu appears on display. Turn the selections know to select the “Analog inputs” option and enter by pressing the knob. In this window, we can see the sensor readings and we can also open and close manually the air and oxygen proportional valves. OPENING AND CLOSURE OF PROPORTIONAL VALVES Select the “Analog Inputs” window from the calibration menu and press the selection knob to enter. Analog inputs display:



In the center of the “Analog inputs” window there is an 8 row column; the first four ones correspond to the air, oxygen, suffocation and PEEP valves respectively. The following four ones are not used. Shown values correspond to the opening value of the corresponding valve. Cero value corresponds to the closed valve. With the selections Knob, the opening value of the selected valve can be either increased or lowered. This opening value can vary from 0 (closed valve) up to a maximum of 4095 (valve completely opened). The “Reset” key can close all the valves (Opening value = 0).



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AIR AND OXYGEN VALVES When increasing the opening value between 0 and 4095, you will note that the valve remains closed while the opening value is lower than 900 units, approximately. When the opening exceeds this value, the valve starts to open progressively (air starts to flow through the inspiratory outlet) up to a maximum (higher than 180L/min) when the opening value reaches 4095 units. Then, the valve can be closed with the “Reset” key. SENSOR VERIFICATION On the left top of the window, there is a 10 row column, with each row showing the digitized reading of the flow and pressure transducers in the following order:



Air flow O2 flow PCtrl Pgraf Exhaled flow Not used Air supply O2 supply O2 Sensor Battery



Air flow Oxygen flow Inspiratory side pressure Expiratory side pressure Expiratory flow Not used Air supply pressure Oxygen supply pressure Oxygen sensor reading Battery energy reading



These readings will vary according to the flows or pressures applied over the sensors. When there are no supply gases connected to the equipment, the readings these sensors provide are the ones showed in the following chart:



Air flow O2 flow PCtrl Pgraf Exhaled flow Not used Air supply O2 supply O2 Sensor



MIN. 180 180 420 420 180 32 32 65



TYPICAL 250 250 450 450 250 35 35 70



MAX. 320 320 480 480 320 38 38 75



AIR FLOW SENSOR 1) Close valves (“Reset” key). Disconnect supply gases from the equipment. Verify that the air flow reading is a stable value which corresponds to the one indicated in the previous chart. 39



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



2) Connect supply gases to the equipment. Select air valve. Progressively, open the air valve. When the air starts flowing through the inspiratory outlet, the air flow reading starts rising and it will continue until the opening value reaches the maximum (maximum flow). Verify the maximum value the air flow reading reaches; generally it is higher than 800 units. OXYGEN FLOW SENSOR 1) Close valves (“Reset” key). Disconnect supply gases from the equipment. Verify that the oxygen flow reading is a stable value which corresponds to the one indicated in chart 1. 2) Connect supply gases to the equipment. Select oxygen valve. Progressively, open the oxygen valve. When the air starts flowing through the inspiratory outlet, the oxygen flow reading starts rising and it will continue until the opening value reaches the maximum (maximum flow). Verify the maximum value the oxygen flow reading reaches; generally it is higher than 800 units. EXPIRATORY FLOW SENSOR 1) Close valves (“Reset” key). Disconnect supply gases from the equipment. Verify that the expiratory flow reading is a stable value which corresponds to the one indicated in the previous chart. 2) With a pressure over P2 of 2 (positive two) cm of H2O and of -6 (negative six) cm of H2O you must obtain a 0 (zero) and a 900 (nine hundreds) readings, approximately. 3) With a pressure over P1 of -2 (negative two) cm of H2O and of 6 (positive six) cm of H2O you must obtain a 0 (zero) and a 900 (nine hundreds) readings, approximately.



40



CHAPTER V



EQUIPMENT OPENING AND CLOSURE



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



OPENING AND CLOSING THE DEVICE Withdraw the rear panel of the device by removing the eight screws shown in the picture below.



Disconnecting the cables rear panel Lean the device on foam with the front panel facing downwards. Lift the rear panel in order to disconnect the cables.



The cables to be disconnected off the board are shown on the label on the upper panel, which must also be considered when connecting the cables and placing the panel back. - Battery - RS-232 - Speaker - Fan



41



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Remove the six screws indicated in the two photos below in order to separate the front body from the rear one.



Separate the two bodies in order to disconnect them electrically and pneumatically. Remove the closing gasket.



The cables and hoses to be disconnected are shown in the photos below.



42



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Once the bodies have been separated, remove the four screws holding the frame together in order to be able to remove the pneumatic system.



These are the hoses to be disconnected in order to remove the pneumatic system and the MOLEX connector of the proportional valves cable. In addition, disconnect the silicone corrugated tube at the end connecting to the multiple T connector.



43



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Remove the two screws holding the power source casing and then take it out. To do so, remove the 15mm-screw shown on the second photo and slide the power source upwards.



In order to remove the power source stand, remove the screw at the base and the one holding it through an aluminum insert, from within the enclosure.



44



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



To remove the pneumatic enclosure and the multiple, disconnect the hose connecting them and remove all screws from within the enclosure.



Once the pneumatic enclosure has been removed, withdraw the base board by removing the bolts holding it together and sliding it upwards in order to loosen the casing inserts. Or, withdraw the casing, with the board and remove the four screws at the ends.



45



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



If you wish to withdraw the whole panel, remove the seven screws fixing it to the front body. Or, remove the keyboard plate and the display without having to withdraw the panel.



To withdraw the display, remove the four bolts holding it at the ends. In case it is required to remove the keyboard plate, the encoder bolt will have to be removed as well as the bolds holding it together.



As the device is assembled back, do not forget to connect any cable or hose and do not change their location.



46



CHAPTER VI



DETAIL OF ASSEMBLIES



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2478 A1 V



Date: 05/04/09



Designation: AIR INLET



Designation



Nº.



Code



1



0659 M2 V



¾” CONNECTOR



2



2206 C1 O



2-214 O`RING



3



0206 C1 V



POROUS METAL FILTER



4



1199 Q1 T



M4x0,7x10 SCREW



5



2852 M1 V



PROPELLER GAS INLET BODY WITH 6 PERFORATIONS



6



1781 D1 V



PROPELLER GAS INLET BODY



47



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2479 A1 V



Date: 05/04/09



Designation: OXYGEN INLET



Designation



Nº.



Code



1



0319 Q2 V



9/16" CONNECTOR



2



2206 C1 O



2-214 O`RING



3



1199 Q1 T



M4x0,7x10 SCREW



4



2852 M1 V



PROPELLER GAS INLET BODY WITH 6 PERFORATIONS



5



0206 C1 V



POROUS METAL FILTER



6



1781 D1 V



PROPELLER GAS INLET BODY



48



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 3346 A1 V



Date: 05/04/09



Designation: GRAPHNET EXPIRATORY VALVE



1



2



3



4



Designation



Nº.



Code



1



1227 C0 O



2-010 O´RING



2



3249 M1 V



EXPIRATORY VALVE LID



3



1111 G0 V



EXPIRATORY VALVE DIAPHRAGM



4



3345 M1 V



EXPIRATORY VALVE BODY



49



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 0554 A5 V



Date: 05/04/09



Designation: 0,7 Kg/cm2 REGULATOR



50



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 0554 A5V



Date: 05/04/09



Designation: 0,7 Kg/cm2 REGULATOR



Designation



Nº.



Code



1



0491 M1 V



REGULATOR LID



2



0480 M1 T



REGULATOR SPRING PRESS SCREW



3



0490 M13 V



REGULATOR BODY WITH A THREE-OUTLET CORE (1/8"-M5)



4



0226 M1 V



D.5 M5x0,8 HOSE-CONNECTION



5



0563 C0 T



M4x0,7x40 ALLEN SCREW



6



0560 C0 O



D. 4x10mm ALUMINIUM FLAT WASHER



7



0253 C0 U



M4x0,7 ROUND HEXAGONAL NUT



8



0217 C0 O



2-020 0´RING



9



0475 M2 V



REGULATOR SHUTTER



10



0281 C0 O



2-007 0´RING



11



1147 M1 V



SPRING BUFFER GUIDE PLATE



12



1325 M1 V



D. 8,2 REGULATION SPRING CONIC SUPPORT



13



1324 M1 V



D. 8,2 REGULATION SPRING FLAT SUPPORT



14



0511 G0 V



DIAPHRAGM



15



1141 M1 T



4x0,7x7 ROUND HEADED SCREW



16



1140 M1 V



MIXER DIAPHRAGM FASTENING PLATE



17



0476 M1 V



REGULATING MIXER 1ST STAGE PIN



18



2628 M1 V



D.3,2 M5x0,8x4,5 HOSE-CONNECTION



19



0477 M1 V



REGULATING MIXER 1ST STAGE SEAT



20



0483 M1 R



REGULATION SPRING



21



0484 M1 R



REGULATOR AND CELL SPRING



22



2868 M1 V



REGULATING SUPPORT FRAME 51



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 0554 A6/A7 V



Date: 05/04/09



Designation: 2,8 Kg/cm2 AIR/OXYGEN REGULATOR



52



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code:



Date: 05/04/09



Designation: 2,8 Kg/cm2 AIR/OXYGEN REGULATOR



Designation



Nº.



Code



1



0490 M14 V



REGULATING BODY WITH CORE



2



0491 M1 V



REGULATOR LID



3



0480 M1 T



REGULATOR SPRING PRESS SCREW



4



0484 M1 R



REGULATOR AND CELL SPRING



5



0217 C0 O



2-020 0´RING



6



0475 M2 V



REGULATOR SHUTTER



7



0476 M1 V



REGULATING MIXER 1ST STAGE PIN



8



0281 C0 O



2-007 0´RING



9



0477 M1 V



REGULATING MIXER 1ST STAGE SEAT



10



1141 M1 T



4x0,7x7 ROUND HEADED SCREW



11



0511 G0 V



DIAPHRAGM



12



1140 M1 V



MIXER DIAPHRAGM FASTENING PLATE



13



1147 M1 V



SPRING BUFFER GUIDE PLATE



14



0482 M1 V



REGULATING SPRING FLAT SUPPORT



15



0483 M1 R



REGULATION SPRING



16



0481 M1 V



REGULATING SPRING CONIC SUPPORT



17



0560 C0 O



D. 4x10mm ALUMINIUM FLAT WASHER



18



0253 C0 U



M4x0,7 ROUND HEXAGONAL NUT



19



0563 C0 T



M4x0,7x40 ALLEN SCREW



20



2214 C1 V



QSL 1/8-6 FESTO CONNECTOR



21



2628 M1 V



D. 3,2 M5x0,8x4,5 HOSE-CONNECTION



22



2776 M1 V



PNEUMOTACOGRAPH CONNECTOR



23



2722 C1 T



M4x0,7x45 ALLEN SCREW



53



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2925 A1 V



Date: 05/04/09



Designation: INNER PNEUMOTACOGRAPH



Designation



Nº.



Code



1



2772 M1 V



PNEUMOTACOGRAPH BODY



2



2773 M1 V



PNEUMOTACOGRAPH PERFORATED LID



3



2781 M1 V



PNEUMOTACOGRAPH BLIND END



4



2770 C1 T



M3x0,5x8 BUTTON HEAD ALLEN SCREW



54



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2545 A1 V



Date: 05/04/09



Designation: FULL PROPORTIONAL VALVE



Designation



Nº.



Code



1



2530 M1 V



PROPORTIONAL VALVE BODY



2



2538 A2 V



EXTERNAL REEL HOLDER TUBE



55



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2493 A1 V



Date: 05/04/09



Designation: SAFETY VALVE



Designation



Nº.



Code



1



2487 M1 V



SAFETY VALVE SHUTTER



2



2489 M1 R



SAFETY VALVE SPRING



3



2774 M1 V



SAFETY VALVE BODY



4



2488 I1 V



SAFETY VALVE SPRING PRESS



5



0515 C0 O



2-013 O´RING



56



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2306 A1 V



Date: 05/04/09



Designation: AIR NONRETURN VALVE



Designation



Nº.



Code



1



2138 M1 V



LINE DIRECTIONAL VALVE BODY



2



2137 M1 V



LINE DIRECTIONAL VALVE LID



3



0211 C0 O



2-009 O´RING



4



2305 G1 V



LINE DIRECTIONAL VALVE SHUTTER



57



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2306 A2 V



Date: 05/04/09



Designation: OXYGEN NONRETURN VALVE



Designation



Nº.



Code



1



2138 M1 V



LINE DIRECTIONAL VALVE BODY



2



2137 M1 V



LINE DIRECTIONAL VALVE LID



3



0211 C0 O



2-009 O´RING



4



2305 G1 V



LINE DIRECTIONAL VALVE SHUTTER



5



2465 M1 R



DIRECTIONAL VALVE THICK SPRING



58



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2454 A1 V



Date: 05/04/09



Designation: FULL ANTISUFFOCATION VALVE



1 2



3



Designation



Nº.



Code



1



2496 I1 V



ANTISUFFOCATION VALVE LID



2



2495 A1 V



ANTISUFFOCATION VALVE BODY WITH CORE



3



2710 A1 V



ANTIBLOCKING VALVE BODY



59



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2457 A1 V



Date: 05/04/09



Designation: FULL GASES CONTROL



1



2



6 2



4



1



4 3



5



60



TECHNICAL AND MAINTENANCE MANUAL Review: 01 NV-GraphNet VENTILATOR Code: 2457 A1 V



Date: 05/04/09



Designation: FULL GASES CONTROL Designation



Nº.



Code



1



0554 A6 V



2,8Kg/cm2 AIR REGULATOR



2



0554 A7 V



2,8Kg/cm2 OXYGEN REGULATOR



3



2925 A1 V



INNER PNEUMOTACOGRAPH



4



2545 A1 V



FULL PROPORTIONAL VALVE



5



2493 A1 V



SAFETY VALVE



6



2454 A1 V



FULL ANTISUFFOCATION VALVE



61



CHAPTER VII



ELECTRONIC BOARDS: DETAIL



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



ELECTRONIC BOARDS: DETAIL Code: 2923 A1 V



Designation: Complete GraphNet CPU board rev. 00



62



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



63



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



LIST OF CPU BOARD COMPONENTS Ite m



Code:



Quantity



1



2931E1V



1



2



2932E1V



3



3



2933E1V



2



4



2934E1V



1



5



2935E1V



2



6



2936E1V



1



7



2937E1V



1



8



2938E1V



1



9



2939E1V



2



10



2940E1V



1



11



2941E1V



1



12



2942E1V



77



Description 5pF 50V Capacitor 10pF 50V Capacitor 15pF 50V Capacitor 33pF 50V Capacitor 47pF 50V Capacitor 470pF 50V Capacitor 680pF 50V Capacitor 1nF 50V Capacitor 1, 5nF 50V



2943E1V



156



14



2944E1V



1



C9 C5,C8,C12 C10,C11 C6 C25,C26 C2 C16 C269 C287,C293



Capacitor 4,7nF 50V Capacitor 5,6nF 50V Capacitor 10nF 50V Capacitor



0,1uF 50V Capacitor



13



Location



0,47uF 50V Capacitor



C3 C15 C13,C17,C20,C28,C30,C32,C34,C36, C44,C48,C52,C54,C56,C58, C62,C64,C66,C70,C72,C74,C77,C79,C81,C84,C86,C89, C90,C92,C95,C97,C99,C101,C103,C104,C108,C110,C112,C114,C115, C122,C124,C126,C128,C130,C132,C134,C136,C138,C140,C142,C144, C146,C148,C150,C181,C183,C187,C206,C224,C229,C230,C231,C232, C241,C291,C303,C315,C330,C345,C157,C233,C234,C235,C237, C4,C7,C14,C18,C19,C21,C22,C23,C24,C27,C29,C31,C33, C35,C38,C39,C41,C43,C45,C46,C47, C51,C53,C55,C57,C61, C63,C65,C69,C71,C73,C76,C78,C80, C82,C85,C87,C88,C91,C93,C94,C96, C98,C100,C102,C105,C107,C109,C111 C113,C117,C118,C119,C121,C123,C125,C127,C129,C131,C133,C135, C137,C139,C141,C143,C145,C147,C149,C153,C180,C182, C186,C194,C196,C205,C207,C208,C213,C214,C215,C216, C217,C218,C219,C220,C221,C222,C223,C226,C228,C236, C238,C240,C243,C244,C246,C249,C252,C253,C254,C255, C257,C258,C259,C260,C261,C263,C265,C266,C268,C271, C275,C276,C279,C280,C284,C285,C289,C294,C297,C298, C301,C305,C307,C309,C310,C313,C317,C318,C321,C322,C323 C324,C325,C328,C333,C334,C335,C336,C337,C338,C340,C342,C343,C 344 C346,C349,C350, C151, C158,C173,C184,C185,C188, C189,C191,C116 C193



64



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



15



2945E1V



21



16



2946E1V



13



17



2947E1V



2



18



2948E1V



4



19



2949E1V



12



20



2950E1V



5



21



2951E1V



8



22



2952E1V



13



23



2732E1V



1



24



2551E1V



2



25



2871E1V



2



26



2872E1V



1



27



2554E1V



1



28



2953E1V



1



29



2954E1V



1



30



2955E1V



1



31



2956E1V



3



32



2556E1V



4



33



2557E1V



1



34



1



35



1



36



2245E1V



1



37



2957E1V



1



Review : 01 Date : 05/04/09



1uF 25V Capacitor



C49,C50,C59,C60,C245,C250,C251,C262,C264,C267,C270,C272,



1uF 35 V Tantalum Capacitor 2,2uF 35V Tantalum Capacitor 4,7uF 35V Tantalum Capacitor 10uF 20V



C190,C192,C197,C199,C200,C201,C202,C203,



Tantalum Capacitor 10uF 35V Tantalum Capacitor 180uF 16V Capacitor 180uF 20V Capacitor 2200uF 25V Capacitor IDC 10pin Connector IDC 16pin Connector IDC 20pin Connector IDC 26pin Connector USB Type A Connector USB Type B Connector D-Sub 9 female Connector DF13 Series 6 pin Connector (.156") Pitch Connector (.156") Pitch Connector (.156") Pitch Connector (.156") Connector Vertical Nickel JACK LCD Board Connector



C274,C278,C281,C283,C332,C351,C352,C353,C354 C204,C209,C210,C347,C348 C195,C198



C239,C242,C247,C248 C1,C37,C67,C68,C75, C83,C120,C179,C225, C227,C273,C306 C106,C256,C277,C282,C319 C288,C290,C292,C295,C296,C300,C302,C304 C286,C299,C311,C312, C314,C316,C320,C326,C327,C329,C339,C341,C331 C308 CON1,CON19 CON6,CON8 CON2 CON11 CON5 CON3 CON4



CON9,CON10,CON16 CON18, CON23, CON24, CON27 CON25 CON26 CON12 CON22 CON20



65



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



38



3310E1V



1



39



2959E1V



1



40



3169E1V



2



41



8



42



2960E1V



2



43



2961E1V



19



44



2962E1V



5



45



2963E1V



46



2964E1V



3



47



2965E1V



4



48



2966E1V



5



49



2967E1V



1



50



2968E1V



2



51



2969E1V



1



52



2970E1V



2



53



2971E1V



2



54



2972E1V



12



55



2973E1V



2



56



2974E1V



2



57



2975E1V



6



58



2976E1V



3



59



2977E1V



1



1



Cable to board Connector D-Sub HD- 22 Connector Backlight Connector AmpMODU Test Point BAT54 Diodes 1N4148 Diodes MRA4003 1A 200V Diodes LM385-1,2 Reference diode BAV99L Diodes STPS340 Diodes MBRS540 Diodes 3,3V 1,5W Diode STPS1L30 Diodes 3,3V 1/2W Diode 5,1V 1/2W Diodes 20ºC 0,50A-1,0A Polyswitch 20ºC 0,30A-0,60A Polyswitch 3A 125V Fuse carrier and fuse 3A 125V Fusible Suppression Filter Ferrite EMI Suppression Filter 10µHy Power Inductor



Review : 01 Date : 05/04/09



CON20(LCD y Placa) CON21 CON28, CON29 TP1,TP2,TP3,TP4,TP5 TP6,TP7,TP8 D1,D53 D2,D3,D4,D5,D6,D7,D8,D9,D10,D11, D12,D13, D17,D19,D20,D50,D52,D55,D56 D14,D15,D16,D18,D21



D22 D32,D33,D34 D40,D41,D45,D54 D38,D43,D44,D47,D48 D39 D42,D46 D57 D49,D51 F1,F16



F2,F3,F4,F5,F6,F7,F8,F9,F10,F11, F12,F13



F14,F15



Fusibles sueltos L3,L7,L8,L9,L16,L18



L4,L5,L6



L14



66



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



60



2978E1V



2



61



2979E1V



2



62



2980E1V



2



63



2981E1V



2



64



2982E1V



6



65



2983E1V



7



66



2984E1V



7



67



2985E1V



1



68



2986E1V



4



69



2987E1V



8



70



2988E1V



4



71



2989E1V



1



72



2990E1V



5



73



2991E1V



1



74



2992E1V



1



75



2993E1V



3



76



2994E1V



1



77



2995E1V



4



78



2996E1V



1



79



2997E1V



4



80



2998E1V



1



CDRH125 22µHy Power Inductor CDRH125 47µHy Power Inductor CDRH125 220µHy Power Inductor MMBT2222A Transistor BCP69T1 Transistor Transistor BSP52T1 Transistor MJD32C Transistor MJD31C Transistor BC817-40 Transistor BC807-40 Transistor Si4410DY MOSFET IRF7425 Transistor 47W 1% 1/4 W Resistor 140W 1% 1/4 W Resistor 150W 1% 1/4 W Resistor 200W Preset 470W 1% 1/4 W Resistor 910W 1% 1/4 W Resistor 1KW 1% 1/4 W Resistor 1270W 1% Resistor



Review : 01 Date : 05/04/09



L10,L15



L13,L17



L11,L12



Q1,Q39



Q5,Q9,Q10,Q18,Q19, Q20,Q50 Q6,Q7,Q8,Q11,Q12, Q13,Q14 Q21 Q24,Q25,Q29,Q33 Q26,Q27,Q30,Q31,Q32, Q41,Q42,Q52 Q23,Q28,Q51,Q53 Q40 Q46,Q47,Q48,Q49,Q54 R323



R229



R224,R225,R226 R317 R239,R240,R266,R273



R315



R228,R302,R307,R310 R22



67



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



81



2999E1V



3



82



3000E1V



1



83



3001E1V



4



84



3002E1V



3



85



3003E1V



4



86



3004E1V



4



87



3005E1V



1



88



3006E1V



1



89



3007E1V



3



90



3008E1V



2



91



3009E1V



4



92



3010E1V



12



93



3011E1V



21



94



3012E1V



1



95



3013E1V



6



96



3014E1V



3



97



3015E1V



4



1,5KW 1% 1/4 W Resistor 1960W 1% 1/4 W Resistor 2,2KW 1% 1/4 W Resistor 6,98 KW 1% 1/4 W Resistor 10 KW 1% 1/4 W Resistor 33 KW 1% 1/4 W Resistor 68KW 1% 1/4 W Resistor 82 KW 1% 1/4 W Resistor 91 KW 1% 1/4 W Resistor 1,5MW 1% 1/4 W Resistor 3,3MW 1% 1/4 W Resistor 0W 5% 1/4 W Resistor 0,1 5% 1/4 W Resistor 2,2W 5% 1/4 W Resistor 4,7W 5% 1/4 W Resistor 10W 5% 1/4 W Resistor 27W 5% 1/4 W



Review : 01 Date : 05/04/09



R21,R23,R227



R16



R232,R234,R263,R268



R87, R293, R312



R246,R304,R313,R342



R235,R236,R264,R271



R292



R247



R341,R251,R308



R316,R305



R233,R238,R265,R274 R1,R6,R8,R10,R20,R59,R188,R215, R325,R343, R344,R345 R261,R276,R279,R280,R282,R285,R286,R287,R289,R290, R291,R294,R296,R329,R330,R339,R340,R298,R333,R335,R336



R281



R34,R35,R37,R50,R51,R53



R124,R125,R126



R18,R19,R26,R28



Resistor



68



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



98



3016E1V



1



99



3017E1V



1



100 3018E1V



1



101 3019E1V



6



102 3020E1V



1



103 3021E1V



15



104 3022E1V



3



105 3023E1V



34



106 3024E1V



2



107 3025E1V



2



108 3026E1V



17



109 3027E1V



1



110 3028E1V



55



111 3029E1V



10



112 3030E1V



4



113 3031E1V



6



100W 5% 1/4 W Resistor 180W 5% 1/4 W Resistor 470W 5% 1/4 W Resistor 560W 5% 1/4 W Resistor 910W 5% 1/4 W Resistor 1KW 5% 1/4 W Resistor 1,5KW 5% 1/4 W Resistor 2,2KW 5% 1/4 W Resistor 2,7KW 5% 1/4 W Resistor 3,3KW 5% 1/4 W Resistor 4,7KW 5% 1/4 W Resistor 5, 6KW 5% 1/4 W Resistor 10 KW 5% 1/4 W Resistor 15KW 5% 1/4 W Resistor 22KW 5% 1/4 W Resistor 47KW 5% 1/4 W Resistor



Review : 01 Date : 05/04/09



R100



R122



R33 R36,R38,R40,R52,R54, R56



R283 R29,R30,R74,R75,R85, R86,R88,R89,R90,R94, R96,R99,R249,R253,R314 R300,R309,R318 R39,R41,R42,R43,R44,R45,R46,R47,R48,R49, R55,R57,R58,R60,R61,R62,R63,R72,R73,R78, R83,R84,R112,R113,R222,R231,R241,R303, R351,R352,R353,R354,R355,R356 R284,R357



R213,R250 R76,R77,R91,R92,R93, R95,R107,R108,R110, R117,R121,R194,R257, R262,R277,R324,R288 R245 R3,R11,R12,R13,R14,R15,R25,R27, R64,R65,R66,R67,R68, R69,R70,R71,R79,R80,R81,R82,R101,R103,R104,R105,R106, R115,R116,R119,R191,R193,R221,R230,R237,R242,R243, R244,R248,R252,R254,R259,R260,R272,R275,R297,R301, R306,R311,R319,R320,R321,R322,R223,R328,R348,R358 R9,R31,R32, R195,R196,R200,R209, R210,R218,R198



R17,R114,R346,R347



R24,R299,R207,R212, R216,R217



69



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



114



3032E1V



3



115



3033E1V



1



116



3034E1V



3



117



3035E1V



1



118



3036E1V



2



119



3037E1V



1



120



3038E1V



1



121



3039E1V



1



122



3040E1V



1



123



3041E1V



2



124



3042E1V



1



125



3043E1V



1



126



3044E1V



1



127



3045E1V



1



128



3046E1V



4



129



3047E1V



1



130



3048E1V



1



131



3049E1V



1



132



3050E1V



1



133



3051E1V



1



134



3052E1V



1



135



3053E1V



1



136



3054E1V



1



137



3055E1V



1



100KW 5% - 1/4W Resistor 220KW 5% 1/4W Resistor 1,8W 2W Resistor 10W 2W Resistor 33W 5W Resistor FM24CL64S I. Circuit AT45DB321C I. Circuit LH28F128BFHTPTTL75A I. Circuit AT91RM9200 I. Circuit MT48LC8M16A2 I. Circuit MAX3232 I. Circuit EPM7128 I. Circuit ATtiny2313 I. Circuit ULN2001D I. Circuit SN74LVTH541 I. Circuit MAX6909 I. Circuit OP200 I. Circuit MAX5253 I. Circuit EPM7064 I. Circuit MAX3241E I. Circuit MAX9850 I. Circuit MAX9700 I. Circuit SED13506 I. Circuit IS41LV16100 I. Circuit



Review : 01 Date : 05/04/09



R111,R258,R269



R118 R102,R109,R120 R123 R255,R256 U1 U2 U3 U4 U5,U6 U7 U9 U10 U11 U12,U27,U29,U30 U13 U14 U15 U17 U22 U23 U24 U25 U26



70



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



138



3056E1V



1



139



2585E1V



1



140



3057E1V



3



141



3058E1V



1



142



3059E1V



1



143



3060E1V



1



144



3061E1V



2



145



3062E1V



1



146



3063E1V



3



147



3064E1V



1



148



3065E1V



1



149



3066E1V



1



150



3067E1V



1



151



3068E1V



1



152



3069E1V



1



153



3070E1V



1



154



3071E1V



2



155



2926E1V



1



156



1643E1V



1



157



3074E1V



2



158 159



3075E1V 3072E1V



1 1



160



3073E1V



4



161



2801E1V



1



CD4066 I. Circuit MAX1202 I. Circuit OP400 I. Circuit LM20 I. Circuit 74HC4051 I. Circuit MC33063 I. Circuit MAX1626 I. Circuit TPS77618 I. Circuit MAX1627 I. Circuit LM324 I. Circuit SG8002JC I. Circuit SG8002JC I. Circuit SG8002JC I. Circuit E1950 I. Circuit MAX5478EUD I. Circuit 18,432MHz Cristal 32768Hz Cristal 3,6V 1200mAh Battery 12VDC 12MM Buzzer 12VDC 13.7MM Buzzer 12W 50mW Speaker SWITCH KEY User Reset D-Pack Heat Sink Sink PCB



Review : 01 Date : 05/04/09



U28 U32 U33,U34,U37 U35 U36 U38 U39,U40 U41 U42,U43,U47 U44 U31 U45 U49 U46 U48 Y1 Y2,Y3 BT1 BZ2 BZ3,BZ4 BZ1 S1 Disipador (Sink) 2801E1V



71



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Code: 3133 A1 V



Review : 01 Date : 05/04/09



Designation: GraphNet sensor board Rev.00



72



Review : 01



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Item



Code



Qua ntity



1



1653E1V



2



2



2113E1V



3



3



2309E1V



2



4



3086E1V



1



5



2802E1V



1



6



2939E1V



2



7



2942E1V



1



8



2943E1V



50



9



2945E1V



20



10



2948E1V



7



11



2949E1V



6



12



2951E1V



2



13



2963E1V



1



14



2968E1V



26



15



2980E1V



2



16



2986E1V



1



17



2993E1V



3



18



2996E1V



1



19



3019E1V



3



20



2998E1V



3



21



2999E1V



3



22



3002E1V



2



Description MOTOROLA PRESSURE SENSOR HONEYWELL PRESSURE SENSOR MOTOROLA PRESSURE SENSOR A/D CONVERTER IC GRAPHNET SENSORS BOARD SMD MULTILAYER CAP. SMD MULTILAYER CAP.



SMD MULTILAYER CAP.



SMD MULTILAYER CAP. SMD TATALUM CAP. SMD TATALUM CAP. 16V ELECTR. CAPACITOR LM385 SMD REFERENCE DIODE



Additional description



Location



MPX 10DP



U10, U12



163PC01D75



U3, U5, U8



MPX 5700 MAX 1149BEUP



U16, U17 U9



PCB 1,5nF/50V



C16, C18



10nF/50V



C60



0,1uF/50V



1uF/25V



C1,C2,C3,C4,C5,C6,C7,C8,C9,C10, C11,C12,C13,C14,C17 C19,C23,C26,C27,C28,C29,C32,C33,C38,C39,C40 C41,C42,C43,C46,C49,C51,C52,C54, C57,C58,C59,C62,C64,C70, C71,C74,C77,C80,C81,C82,C84,C86,C89,C92 C15,C24,C25,C30,C35,C36,C47,C48,C53,C56 C66,C69,C76,C78,C79,C83,C85,C87,C88,C90



4,7uF/35V



C31, C45, C50, C55, C61, C63, C91



10uF/20V



C37, C67, C68, C72, C75, C93



180uF LM385M3X-1.2



30V/1A SCHOTTKY STPS1L30 DIODE 220uHy SMD INDUCTOR SMD TRANSISTOR 1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR



Date : 05/04/09



CDRH125NP-221 MJD31CT4G



C21, C22 D13 D1, D2, D3, D4, D5, D6, D7, D8, D9, D10, D11, D12 D14, D15, D16, D17, D18, D19, D20, D21, D22, D23 D24, D25, D26, D27 L1, L2 Q1



150 Ohm



R43, R62, R78



910 Ohm



R8



560 Ohm



R5, R16, R26



1,27 K



R2, R12, R21



1,5 K



R41, R61, R77



6,98 K



R84, R87



73



Review : 01



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



23



3003E1V



18



24



3004E1V



6



25



3010E1V



9



26



3012E1V



1



27



3023E1V



1



28



3024E1V



1



29



3026E1V



2



30



3028E1V



1



31



3030E1V



1



32



3032E1V



6



33



3033E1V



1



34



3048E1V



1



35



3057E1V



3



36



3060E1V



1



37



3079E1V



6



38



3080E1V



10



39



3082E1V



6



40



3083E1V



1



41



3084E1V



1



42



3087E1V



1



43



3113A1V



44



3114A1V



45



3327E1V



6



46



3328E1V



3



47



3085E1V



1



1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR 1/4W - 5% SMD RESISTOR IC OPERATIONAL AMPLIFIER IC OPERATIONAL AMPLIFIER IC INVERSER SWITCH 1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR 1/4W - 1% SMD RESISTOR 5V VOLTAGE REGULATOR SMD IC OPERATIONAL AMPLIFIER IC VOLTAGE REGULATOR SENSORS CABLE (14cond.) ELCTRONICALLYOPERATED VALVE CABLE. (26cond) 1/4W - 1% SMD RESISTOR SMD MULTILAYER CAP. 6V VOLATGE REGULATOR



Date : 05/04/09



10 K



R34, R35, R51, R52, R70, R71, R72, R39, R40 R59, R60, R75, R76, R45, R64, R80, R81, R86



33 K



R3, R13, R14, R22, R24, R33



0 Ohm



R9, R19, R29, R31, R42, R49, R50, R69, R85



2,2 Ohm



R1



2,2 K



R57



2,7 K



R10



4,7 K



R23, R55



10 K



R53



22 K



R58



100 K



R6, R7, R17, R18, R27, R28



220 K



R65



OP200



U15



OP400HSZ MC33063ADR2G



U2, U7, U11 U1



22 K



R38, R44, R56, R63, R74, R79



56 K



R3, R4, R11, R14, R15, R20, R24, R25, R32 R68



470 K



R36, R47, R54, R67, R73, R83



MC78M05CDTRK G



U18



AD8512BRZ



U13



TPS77633D



U6



SENSORS BOARD SENSORS BOARD 27 K 68nF/50V MC78M06CDT



R38, R44, R56, R63, R74, R79 C20, C34, C44 U4



74



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Code: 3207 A1 V



Review : 01 Date : 05/04/09



Designation: Complete GraphNet key board



COMPONENTS LIST Item



Code



Qua ntity



1



2897 E1 V



1



D590984 DER170 KEYBOARD CHIP



2



2898 E1 V



1



D590985 IZQ2 KEYBOARD CHIP



3



2896 E1 V



1



D590986 INF30 KEYBOARD CHIP



4



3314 E1 V



3



GREEN SMD LED



5



3315 E1 V



4



RED SMD LED



6



3316 E1 V



2



YELLOW SMD LED



D4, D5 (D590984)



SWITCH TACT KEY



S1 (D590985)



Description



Location



D1, D2, D3 (D590986) D1, D2, D3, D6 (D590984)



S1,S2,S3,S4,S5 (D590984) 777



2928 E1 V



28



8



3359 A1 V



2



KEY BOARD CABLE (16cond.)



9



3311 E1 V



1



PUSHBUTTON ENCODER



S1,S2,S3,S4,S5,S6,S7,S8,S9, S10,S11,S12,S13,S14,S15,S16, S17,S18,S19,S20,S21,S22 (D590986) CON1, CON4 (D590986) CON5 (D590986)



75



CHAPTER VIII



CALIBRATION



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Measuring, inspection and testing equipment 1- Flow meter (TSI Certifier)



2-Oximeter 3-Medical air 4-Adult reusable respiratory circuit 5-Pressure regulator 5 Kg./cm2 6-Pressure regulator 100 cm. H2O



Remarks: -The measuring and inspection equipment must be periodically calibrated by an official entity and such operation must be recorded and filed. -The used air must be free from oil, humidity, and particles higher than 0,3 m



Neumovent GraphNet Equipment: Calibration and Initial Configuration Procedure Operation



Description



10



With the equipment turned off, verify: 1-When the equipment is plugged-in, verify that the “Power source” is on 2-Verify that the high pressure gas supply is connected. 3-Verify that the equipment outlets (P2, P1, nebulizer, Patient, etc.) do not have connected hoses.



20



Calibration process start: Press the "Esc” key and then turn the equipment on holding the key. When hearing the first sound of the pressed key, release the “Esc” key. This caption will appear on the display: ENTER PASSWORD: 1-For saving the changes made on memory, the following key must be entered: ???? This caption will appear: CORRECT ENTERED KEY PRESS A KEY The CALIBRATION MENU is accessed pressing any key 76



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description 2- If the changes are not to be saved on memory, press any key four times instead of entering the correct password. This caption will appear: INCORRECT PASSWORD PRESS A KEY Pressing any key, it is possible to access to the CALIBRATION MENU without modifying the values saved on memory.



30



Calibration and configuration menu: The calibration and configuration menu shows a list on display in the following order: 1 - Clock adjustment 2 - Ambient pressure 3 - Air flow 4 - Oxygen flow 5 - Air valve 6 - Oxygen valve 7 - Pressure sensors 8 - PEEP valve 9 – Comp. Neumo 10 - Analog inputs 11 - Start options 12 - Serial number 13 - Board monitoring 14 - Sensor monitoring -For entering each item, press "Control Knob" (Encoder). For returning, press “Esc”.



77



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



40



1 - Clock adjustment: -For modifying the date and time values, select the corresponding field moving with the encoder. Enable the field pressing the “Control Knob”.



The field enabled to be modified will change the color and, by rotating the encoder, the value changes. -By pressing the “Control Knob”, the field is enabled again. -Once all the modifications in the date and time fields are made, press “Menu” and this caption will appear:



EXIT SAVE. Select the option and confirm pressing the “Control knob”. Select the desired option.



78



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



50



2 - Ambient pressure Modify the value with the encoder. Press “Menu” and this capti on will appear:



EXIT SAVE Select the option and confirm pressing the“Control knob”.



Select the desired option. Return to the main menu with “Esc”.



79



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



60



3 - Air flow



70



Connect the equipment patient outlet to a pattern flow meter Fig: 1-A (end of chapter). Connect both gas supply inlets to a compressed air supply.



80 Select the target value with encoder and enable pressing the “Control Knob”. The valve opening bar becomes yellow and, with encoder, the valve opens or closes. By pressing "Fine", it changes to slow opening and pressing “Coarse”, it changes to quick opening.



80



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



90



When the flow value shown by the external meter coincides with the target value selected, save pressing “Control Knob”. The curve is modified with the new value saved and the next objective is automatically preselected, which allows continuing with the valve opening.



100



Repeat the operations until finishing all the target values. If the flow does not reach 150 or 160, save the highest possible value in these positions.



110



Check that the shape of the calibration curve reached is uniform and that all the values are calibrated. Press “Menu” and this caption will appear:



EXIT SAVE Select the option and confirm with “Control Knob”. -If EXIT is selected and the values were modified, this caption will appear: EXIT WITHOUT SAVING CHANGES? [ Control knob ] Accept [ Esc ] Cancel Select the desired option. Return to the main menu with “Esc”.



81



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



120



5 - Air valve



130



If the valve does not have a previous calibration, this caption will appear: CALIBRATE SAVE EXIT If it has a previous calibration, press “Menu”.



140



Select calibrate and press the “Control knob” to start the autocalibration.



150



Check that the shape of the calibration curve reached is uniform and that all the values are calibrated.



160



Press “Menu” and this caption will appear: EXIT SAVE Select the option and confirm pressing the “Control knob”. -If EXIT is selected and the values were modified, this caption will appear: EXIT WITHOUT SAVING CHANGES? [ Control knob ] Accept [ Esc ] Cancel Select the desired option. Return to the main menu with “Esc”.



82



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



170



6 - Oxygen valve



Follow the same steps of the Air valve calibration (operations 130 to 160). 180



7 - Pressure sensors



On the display, it appears a list of the calibration values saved in memory which correspond to the pressures shown on the following chart: (Lo pressure) (Control sensor) (Graphics sensor) (Air sensor) (Oxygen sensor)



190



0 0 0 0



(Hi pressure) 100 cmH2O 100 cmH2O 5 kg/cm2 (71 PSI) 5 kg/cm2 (71 PSI)



Disconnect the inlet gas supply checking on the display that the reading of O2 and air in “real time” is zero.



83



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



200



The values shown on the left column (“Lo”) correspond to the zero value pressure of the sensors, both of low and high pressure. Select the field to be saved with encoder and press the “Control Knob” to capture the zero value in each of the 4 sensors.



210



Control sensor maximum value (Pctrl) 1-Connect the supply gases 2-With encoder, select the corresponding field 3-Make a pressure of 100 cm H2O to take place on the patient outlet, controlling this pressure with a calibrated manometer. 4-Capture the value pressing the “Control Knob”.



220



Graphic sensor maximum value (Pgraf) 1-With encoder, select the corresponding field 2-Make a pressure of 100 cm H2O to take place on the P1 y P2 inlets simultaneously with a “Y”shaped connector. 3-Capture the value pressing the “Control knob”.



230



Air and oxygen high pressure sensor maximum value 1-With encoder, select the corresponding field 2-Make a pressure of 5 Kg/cm2 to take place on the air and O2 inlets, controlling this pressure with a calibrated manometer. 3-Capture the value pressing the “Control Knob”.



240



Reset pressing the key ZERO and check the reading of every sensor.



250



Press “Menu” and this caption will appear: EXIT SAVE Select the option and confirm pressing “Control Knob”. -If EXIT is selected and the values were modified, this caption will appear: EXIT WITHOUT SAVING CHANGES? [ Control Knob ] Accept [ Esc ] Cancel Select the desired option. Return to the main menu with “Esc”. 84



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



260



8 - PEEP valve 1-Connect the entire expiratory valve. 2-Patient circuit with the plug in place. 3-Press “Menu” and select “Calibrate” CALIBRATE SAVE EXIT Select the option and confirm pressing “Control Knob”.



270



Once the autocalibration is finished, press “Menu” and select “Save” CALIBRATE SAVE EXIT Select the option and confirm pressing the “Control Knob”. Return to the main menu with “Esc”.



280



9 – Comp. Neumo. 1-Connect the entire expiratory valve. 2-Patient circuit with the plug in place. 3-Press “Menu” and select “Calibrate” CALIBRATE SAVE EXIT Select the option and confirm pressing the “Control Knob”.



290



Once the autocalibration is finished, press “Menu” and select “Save” CALIBRATE SAVE EXIT Select the option and confirm pressing the “Control Knob”. Return to the main menu with “Esc”.



300



10 - Analog inputs. There are no data to calibrate On this display, the digital values of the analog inputs (sensors), running time, fan status are shown. It allows opening valves and activating the LEDs. 85



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Operation



Description



310



11 -Start options Adult category: ADULT Language: English



320



-Press “Control Knob” to enable “Category” or “Language” -Modify the field enabled with the encoder. -Press “Control Knob” to disable.



330



Press “Menu” and this caption will appear: EXIT SAVE Select the option and confirm pressing the “Control Knob”. -If EXIT is selected and the values were modified, this caption will appear: EXIT WITHOUT SAVING CHANGES? [ Control Knob ] Accept [ Esc ] Cancel Select the desired option. Return to the main menu with “Esc”.



340



12 - Serial number



350



13 – Board monitoring



360



14 - Sensor monitoring



86



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure



Connection for calibrating flows Fig.1 A (pattern flow meter)



87



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Neumovent Graph Net Equipment: Calibration and Initial Configuration Procedure Connection for autocalibrating valves Fig 2 A FREE WITHOUT CONNECTION



Connection for calibrating the PEEP valve Fig. 3 A



88



CHAPTER IX



FINAL CONTROL



TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



Review : 01 Date : 05/04/09



Final control ITEM 1 2 3 4



NECESSARY ELEMENTS: DESCRIPTION VENTILATOR ADULT PATIENT CIRCUIT, EXPIRATORY VALVE, 2 PATIENT LINES, “Y” CONNECTOR AND PLUG TEST LUNG (QUICK LUNG): COMPLIANCE OF 50 ml/cmH2O AND RESISTANCE OF 5 cmH2O/L/S TSI FLOW METER 4071 A MODEL



Objectives The purpose of these instructions is to provide the necessary information to carry out the final control of the operation of the GraphNet ventilators.



Op.



Description



10



Turn the equipment on.



20



Connect the line to the plug, expiratory valve, P1 and P2.



30



Carry out the initial calibration (instructions on the equipment)



40



Select the VCV mode (Volume Control Ventilation mode). Remove the plug and connect the Quick Lung



50



Program (initial parameters) Vt= 400 ml. FiO2=0,50 f= 10 (per minute) Peep=0 Ti= 1 sec. Sensitivity=1 l/min Inspiratory pause: 0,50 sec. Square flow wave Confirm the rest pressing the



60



Volume control:



70



Flow wave control: Control the Flow Wave Shape on the display.



80



Sensitivity control: operation with initial parameters Check the Flow trigger. Program the sensitivity in 1 l /min With the SENS (V8) key Control: a) Avoid auto-trigger. b) Trigger by handling the test lung. Check the pressure trigger: Program: 1) Peep= 5 cm H2O 2) Sensitivity by Pressure – 1,5 cm H2O with SENS (V8) key Control:



Exhaled VT Reading= 400 ml +/- 10% (360–440) Reading of the Plateau pressure= 9 cm H2O +/- 1 cm H2O



a) Autocycling b) Trigger by handling the test lung. Return sensitivity= Flow 3 liters/min x Flow Peep= 0



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Review : 01 Date : 05/04/09



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Control peep: Regulate the maximum pressure alarm to 50 cm of H2O with the Alarm Setting key and Control Knob. If you wish to exit, Reset twice. Program 5 – 10 – 15 cm H2O. For each one of these values, control: Correct reading ((+/- 1 cm H2O) regarding the programmed value. Return to Peep= 0 Return to the maximum pressure alarm= 40 cm H2O



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Accessories: THIS MENU CAN ONLY BE ACCESSED IF IT IS CYCLED



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Typical audio volume and quality test 50%



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Manual trigger: Operation control with Manual Trigger



Nebulizer: Control the operation. Connect the TSI, press Nebul and verify the reading between 7 and 9 l/min. Then, disconnect the TSI and disable NEBUL O2 100%: Operation control with O2 100% key and pressing the “Control Knob” to confirm 1 min at 100%, 20 sec. at the FIO value and then 1 min at 100% should appear.



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Review : 01 Date : 05/04/09



Alarms: with the Alarm Sett key and select with the Control Knob. High Pressure Reduce the alarm limit to the level of the peak pressure read. Check the alarm activation Return the alarm limit to 40 cm H2O Low Pressure Increase the alarm limit of low pressure to the level of the peak pressure read. Check the alarm activation Return the alarm limit to 5 cm H2O High VT Reduce the limit of High VT to 400 ml using the initial parameters. Observe the alarm activation. Return the limit to 600 ml.



Low VT Increase the Low VT alarm limit to 450 ml. Observe the alarm activation. Return the limit to 200 ml. Fmax Reduce the alarm limit to 10 per minute. Check the alarm activation. Return the alarm limit to 30 per minute.



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Review : 01 Date : 05/04/09



Gas supply First, they are supplied separately and then together since they have individual and joint activation alarms. Air Close the main supply key. Check the alarm activation. Open the supply key again. Oxygen Do the above again with the air supply Air and Oxygen Do the above again for air and oxygen, but this time simultaneously. Power supply Disconnect the equipment running from the 220 V grid a) Check the continuity of the operation. b) Alarm activation. c) Battery LED activation. d) Reconnect the equipment to the 220 V grid



e) Check the normal operation restart. 130



PCV Mode (Pressure Control) Select PCV Programming:



PCV= 15 cm H2O Increase Ti (sec) until getting inspiratory flow= 0 Peep= 0



Check: Peak Pressure Reading= 15 ± 2 cm H2O Exhaled VT Reading= 750 ml ± 10% (675-825)



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Review : 01 Date : 05/04/09



PSV Mode Select PSV a) Program PSV. Pressure= 15 cm. H2O Peep= 0 Confirm pressing the “Control Knob” b) Program Backup (Support Ventilation). Apnea= 15 sec. SIMV = ON Press “Rest” to start ventilation in PSV c) Trigger the test lung. Check the mode operation (with the graphic created on the display). Check the Peak Pressure= 15 cm +/- 2 cm H2O



150



Apnea Alarm Do not trigger the test lung. After 15 sec., the Apnea alarm must be activated. The ventilator goes to backup ventilation. Trigger the test lung. Check that it returns to PSV ventilation.



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SIMV VCV Mode (Combined) Programming: f= 6 per minute. Inspiratory time: 1 sec. PSV 15 cm H2O The other parameters remain like the initial programming. Trigger the test lung. Check the ventilatory mode operation.



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SIMV PCV Mode Programming: f= 6 per minute.



Inspiratory time: 1 sec.



PCV= 20 cm H2O



PSV= 15 cm H2O



Trigger the test lung. Check the mode operation.



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TECHNICAL AND MAINTENANCE MANUAL GraphNet VENTILATOR



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MMV Mode Programming:



Review : 01 Date : 05/04/09



VE= 7 L / min. VE min alarm= at minimum value PSV= 10 cm H2O



Trigger the test lung at a low frequency to get a VE lower than the one programmed. Observe: a) The Peak Pressure must increase breathing by breathing.



b) VT must increase breathing by breathing.



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PSV + VT Assured Mode Programming: Accept default parameters (CTRL + ENTER). Trigger the test lung. Control the continuous flow phase activation. Control: Expected VT (display)= Target VT with Vt.



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Carry out the following controls and operations: a) Charge control of the internal battery. Check when the battery charge indicator shows “Bat full” and the battery has reached its full charge and when the battery charge led “charging” turns off. Control that it has the orange “OK Bateria” label.



b) Reset the alarms. Do this with \\. Turn the equipment on and off, access in calibration mode with the correct password and enter the Analog Inputs menu. TURN OFF, RESET, Turn on, V5, Freeze, Graphics,V7. Press the keys: 1ª Silence () 2ª O2 100% Turn the equipment off.



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