ARJO HUNTLEIGH citadel User manual

Citadel Patient Therapy System
Instructions for Use
...with people in mind
830.238 Rev D • 12/2015

2Citadel Patient Therapy System
Design Policy and Copyright
® and ™ are trademarks belonging to the ArjoHuntleigh group of companies
unless otherwise stated.
© ArjoHuntleigh 2015
As our policy is one of continuous improvement, we reserve the right to
modify designs without prior notice. The content of this publication may not
be copied either wholly or in part without the consent of ArjoHuntleigh.

3
Citadel Patient Therapy System
Table of Contents
General Warnings............................................................................................5
•Safety Information ......................................................................................6
Introduction......................................................................................................8
Clinical Applications.........................................................................................8
•
Intended Use ..............................................................................................8
•
Indications ..................................................................................................9
•Contraindications........................................................................................9
•General Product Information ......................................................................9
•
Risks and Precautions................................................................................9
•
Precautions...............................................................................................10
Installation .....................................................................................................11
•
Attach Air Mattress Control Unit ...............................................................11
•Attach Integrated Air Mattress ..................................................................14
•Testing ......................................................................................................17
•
Mattress Length Adjustment .....................................................................18
•
To extend the deck ................................................................................18
•
Air Mattress Length Extension..................................................................19
•
X-Ray Sleeve............................................................................................19
Control Panel.................................................................................................20
•Citadel Patient Therapy System Control Panel ........................................20
•
Air Pressure Adjustment Controls.............................................................21
•
Height / Weight Presets.........................................................................21
•
Pressure Zone Indicators ......................................................................22
•
Turning......................................................................................................22
•
Continuous Patient Turn Hold Time Button (optional conguration)......23
•Pulsation / Alternating Pressure Therapy (optional conguration).........23
Patient Placement / Transfer .........................................................................24
•Preparation for Patient Placement / Transfer ...........................................24
•
Patient Placement ....................................................................................24
•
Patient Transfer from the Citadel Patient Therapy System.......................24
•
Patient Transport ......................................................................................25
Nursing Care .................................................................................................26
•CPR ..........................................................................................................26
•Alarms ......................................................................................................26
•
Audible Tone Indicators ............................................................................28
•
Patient Bathing .........................................................................................28
Care and Cleaning.........................................................................................29
•General Recommendations......................................................................29
•Decontamination.......................................................................................29
•
Cleaning ...............................................................................................29
•
Disinfection ...........................................................................................29
•
Cleaning the Citadel Patient Therapy System While in Use.....................30

4Citadel Patient Therapy System
•Cleaning and Maintenance Between Patients..........................................30
•Care And Cleaning Mattress Cover Fabrics .............................................31
Operating Instructions ...................................................................................33
•
Normal Therapy Mode ..............................................................................33
•
Nurse Assist Functions .............................................................................33
•
Therapies..................................................................................................34
•
Alternating Pressure / Pulsation ...............................................................34
•Power Off Citadel Patient Therapy System ..............................................35
Warranty and Service ....................................................................................36
EMC Information............................................................................................37
Troubleshooting.............................................................................................41
Explanation of Symbols Used........................................................................42
Specications ................................................................................................44
Questions and Contact Information...............................................................45

5
Citadel Patient Therapy System
GENERAL WARNINGS
The following warnings should be considered prior to using this product:
Prior to activating any positioning function assess the security
of all patient support lines and tubes to accommodate the
desired angle of articulation and minimize the risk of binding,
disconnecting or dislodging. Tubes and lines should always have
sufcient slack for articulation and patient movement.
Before patient transfer to or from the Citadel Bed Frame System,
all brakes should be engaged.
Always unplug the Citadel Bed Frame System from wall outlet
before cleaning. Failure to do so could result in equipment
damage and / or electric shock.
Assembly, operations, extensions, re-adjustments, modications,
technical maintenance or repairs must be performed by qualied
personnel authorized by ArjoHuntleigh. Contact ArjoHuntleigh for
information regarding maintenance and repair.
All accessories added to the system reduce the safe working
load of the frame by the same amount.
If the power supply cord or plug is damaged, the cord must be
replaced.
Make sure the power supply cord is not stretched, kinked or
crushed.
Make sure the power supply cord does not become entangled
with moving parts of the bed or trapped between the bed frame
and head board.
Presets are provided for reference only. Individual patient
needs should be assessed and the pressure settings should be
adjusted to meet each patient’s individual needs.
Monitor patient airway and position during ination / deation
of mattress. Ensure patient and any patient support lines are
properly supported at all times.
Rotation therapies are not available when fowler angle is above
30˚ or any side rail is down. It is recommended that turning only
be initiated when bed is level and thigh and calf sections are
down.
Do not allow uid to penetrate the Citadel Patient Therapy
System control panels.

6Citadel Patient Therapy System
Safety Information
General Protocols – Follow all applicable safety rules and institution
protocols concerning patient and caregiver safety.
Brakes – Set all caster brakes before transferring patient.
Bed Height – To minimize risk of falls or injury, the bed should always be in
the lowest practical position when the patient is unattended.
Fluids – Avoid spilling uids on unit controls. If spills do occur, unplug unit,
clean uid from unit, wearing rubber gloves to avoid any possibility of shock.
Once uid is removed, check operation of components in area of spill.
Fluids remaining on controls can cause corrosion, which
may cause components to fail or to operate erratically,
possibly producing hazards for patient and staff.
Oxygen Use - Ensure that the unit is not contained in an oxygen
enriched environment. Possible re hazard when bed is used with oxygen
administering equipment other than the nasal prongs, mask or half bed
length tent type. Oxygen tent should not extend below mattress support level.
Lock-Outs – Lock-outs for air mattress system functions should be used at
staff’s discretion to ensure against unintentional operation of Citadel Patient
Therapy System.
Disposal – At the end of useful life, dispose of waste according to local
requirements or contact the manufacturer for advice. There may be special
requirements for disposal of batteries, leaded foam and / or angle sensors (if
present in this product). Improper disposal of any component may result in
regulatory non-compliance.
Moving Parts - Keep all equipment, tubes and lines, loose clothing, hair and
parts of the body away from moving parts and pinch points.
Patient Entrance / Exit – Caregiver should always aid patient in exiting the
bed. Make sure a capable patient knows how to get out of bed safely (and, if
necessary, how to release the side rails) in case of re or other emergency.
Side Rails / Patient Restraints - Whether and how to use side rails or
restraints is a decision that should be based on each patient’s needs and
should be made by the patient and the patient’s family, physician and
caregivers, with facility protocols in mind. Caregivers should assess risks and
benets of side rail / restraint use (including entrapment and patient falls from
bed) in conjunction with individual patient needs, and should discuss use or
non-use with patient and / or family. Consider not only the clinical and other
needs of the patient but also the risks of fatal or serious injury from falling
out of bed and from patient entrapment in or around the side rails, restraints
or other accessories. In the US, for a description of entrapment hazards,
vulnerable patient prole and guidance to further reduce entrapment risks,
refer to FDA’s Hospital Bed System Dimensional and Assessment Guidance
To Reduce Entrapment. Outside the US, consult the local Competent
Authority or Government Agency for Medical Device Safety for specic local

7
Citadel Patient Therapy System
guidance. Consult a caregiver and carefully consider the use of bolsters,
positioning aids or oor pads, especially with confused, restless or agitated
patients. It is recommended that side rails (if used) be locked in the full
upright position when the patient is unattended. Make sure a capable patient
knows how to get out of bed safely (and, if necessary, how to release the
side rails) in case of re or other emergency. Monitor patients frequently to
guard against patient entrapment.
Skin Care – Monitor skin conditions regularly and consider adjunct or
alternative therapies for high acuity patients. Give extra attention to skin
over any raised side bolster and to any other possible pressure points
and locations where moisture or incontinence may occur or collect. Early
intervention may be essential to preventing skin breakdown.
Maximum Recommended Patient Weight - Total patient weight capacity
should not exceed 227 kg (500 lb). The use of accessories on the bed may
decrease the patient weight capacity of the bed. Contact ArjoHuntleigh
Customer Service for questions concerning the use of accessories and see
the Questions and Information section of this guide for contact information.
I.V. and Drainage Tubes – Prior to activating any positioning or rotation
function assess the security of all invasive lines and tubes to accommodate
the desired angle of articulation and minimize the risk of binding,
disconnecting or dislodging. Tubes and lines should always have sufcient
slack for articulation and patient movement.
Turning - CAUTION: Prior to engaging any mattress turn feature, ensure that
all side rails are fully engaged in their full upright and locked position.

8Citadel Patient Therapy System
INTRODUCTION
These instructions contain information for the installation, use and
maintenance of the ArjoHuntleigh Citadel™ Patient Therapy System.
The Citadel Patient Therapy System provides an integrated pressure
redistribution surface for the Citadel™ Bed Frame System. The Citadel
Patient Therapy System can only be used with the
Citadel Bed Frame System.
All Citadel Patient Therapy Systems (C100 and C200 models) have the
following standard features:
• Four-zone pressure adjustment
• Patient height and weight presets
• Patient turn
•Head deate
•Seat deate
•Firm mattress
•Patient transport mode
The following features are additionally included in the C200 model:
•Continuous patient turn
•Alternating pressure
•Pulsation
CLINICAL APPLICATIONS
Intended Use
The Citadel Patient Therapy System is intended for the acute and post-acute
care environments. It is not intended for use in the homecare environment.
When used with the Citadel Bed Frame System, the Citadel Patient Therapy
System is intended for the prevention and treatment of pressure ulcers, to
treat burns and to aid circulation.
The addition of Skin IQ™ Family (Skin IQ Family) can aid in the prevention
and treatment of skin breakdown and pressure ulcers (stages I-IV)1for
patients who require microclimate management of the skin.
1 National Pressure Ulcer Advisory Panel, European Pressure Ulcer Advisory Panel and Pan Pacific
Pressure Injury Alliance. Prevention and Treatment of Pressure Ulcers: Quick Reference Guide. Emily
Haesler (Ed.) Cambridge Media: Perth, Australia; 2014.

9
Citadel Patient Therapy System
Indications
Patient conditions for which the Citadel Patient Therapy System is indicated
are:
• Prevention and treatment of pressure ulcers (stages I-IV) in high-risk
patients.
Contraindications
Patient conditions for which the Citadel Patient Therapy System is
contraindicated are:
• Cervical traction
• Unstable vertebral fracture
• Patient weight >227 kg (500 lb)
General Product Information
Citadel Bed Frame System safe working load (SWL).........270 kg (595 lb)
Citadel Patient Therapy System:
Integrated air mattress and air mattress control unit...........43 kg (94.5 lb)
Remaining safe working load of the bed frame .................227 kg (500 lb)
Expected Service Life.........................................................Five years
All accessories added to the system reduce the safe working
load of the frame by the same amount.
The recommended patient height is between 146 cm (58 in) and 190 cm
(75 in). At the discretion of the caregiver, patients taller than 190 cm
(75 in) may be accommodated by extending the frame and mattress. Ensure
that the patient’s height does not exceed the in-bed length.
Risks and Precautions
Patient Migration – Specialty surfaces have different shear and support
characteristics than conventional surfaces and may increase the risk of
patient movement, sinking and / or migration into hazardous positions of
entrapment and / or inadvertent bed exit. Monitor patients frequently to guard
against patient entrapment.
Side Rails and Restraints – WARNING: Use or non-use of restraints,
including side rails, can be critical to patient safety. Serious or fatal injury can
result from the use (potential entrapment) or non-use (potential patient falls)
of side rails or other restraints. See related Safety Information section of this
guide.
Skeletal Traction or Unstable Fracture (if not contraindicated) – With
skeletal traction, unstable pelvic fracture or any other unstable fracture
(to the extent not contraindicated), maintain physician directed angle of
articulation and guard against risks of patient migration or inadvertent
deation of surface.

10 Citadel Patient Therapy System
Electromagnetic Interference – Although this equipment conforms with the
intent of electromagnetic compatibility, all electrical equipment may produce
interference. If interference is suspected, move equipment away from
sensitive devices or contact the manufacturer.
Shock Hazard – Electrical shock hazard; do not remove electrical
compartment covers. Refer to qualied service personnel.
Precautions
Precautions may need to be taken when using this product with certain
patient conditions, including, but not limited to:
• Hemodynamic instability
• Severe agitation
• Uncontrollable claustrophobia or fear of connement
• Uncontrollable diarrhea
• Pregnancy
• Extensive facial trauma
• Any other unstable fracture
• ICP monitoring or intracranial drainage devices

11
Citadel Patient Therapy System
INSTALLATION
Attach Air Mattress Control Unit
Unit should only be installed by qualied personnel.
A second person may be needed for the lifting of the air mattress
control unit.
1. Ensure the Citadel Bed Frame System mains power is unplugged
from the wall outlet.
2. Remove the existing mattress, if applicable.
3. The air mattress control unit is provided with the following items
(contact ArjoHuntleigh if the items are missing or damaged):
Item Description Quantity
Air Mattress Control Unit 1
Citadel Patient Therapy System IFU 1
Citadel Patient Therapy System QRG 1
Storage Bag 1
Philips Pan Head Screws 4
Hex Head Screws 3
Grounding Screws 2
4. Pull the foot extension handle (see gure 1, item 1), slide the frame
extension out (3) and remove the foot board (2).
1
2
3
4
Figure 1: Foot board and foot extension

12 Citadel Patient Therapy System
5. Locate the foot extension cover plate (see gure 1, item 3), with
air hoses (gure 2, item 1) and electrical connectors (2) attached,
under the foot end of bed. Disconnect the air hoses and electrical
connectors from the foot extension cover plate.
6. Remove cover plate by unscrewing two Philips Pan head screws (see
gure 1, item 4) on the underside of the cover. Place cover plate and
hardware in storage bag in case air mattress control unit is removed
later. The foot extension cover plate will need to be reinstalled to
secure air hoses and electrical connectors.
Electrical connectors must be connected to the air mattress
control unit when installed, or attached to the foot extension
cover plate if the air mattress control unit is not installed.
7. If not already installed, Install the air mattress control unit mounting
bracket (see gure 3, item 1) to the back of the air mattress control
unit (2), using the six hex head ush mount screws (4).
Figure 2: Foot extension cover plate with air hoses and electrical connections
1
2
Figure 3: Air mattress control unit and mounting bracket
1
3
5
6
7
2
4

13
Citadel Patient Therapy System
8. Lift air mattress control unit and slightly tilt the air mattress control
unit forward and then gently lower it onto the frame. Carefully align
holes on top of mounting bracket with holes on frame. As air mattress
control unit sits onto the frame, gently tilt to full upright position while
observing that the communication connector (see gure 3, item 7) on
control unit aligns to hole in frame. Be careful not to damage the air
connectors.
9. Gently slide air mattress control unit from side to side to align holes on
top and on front of mounting bracket with holes on extension frame.
10. Loosely install four Philips Pan Head screws through the top of
mounting bracket (gure 3, item 3) (Do not tighten at this time).
11. Install three hex socket screws through the holes on the front of
mounting bracket. These pass through the mounting bracket / frame
extension and screw into the mattress control unit. Torque screws to
10 Nm.
12. Now tighten the four Philips Pan head screws started earlier on top of
the mounting bracket. Torque screws to 10 Nm.
13. Install two pan-head Philips screws (gure 3, item 6), on the back of
the control unit, RH / LH lower corners.Torque screws to 10 Nm.
14. Connect air hoses (gure 4, item 1) to air mattress control unit (2);
ensure O-rings are on connection ports. Air hoses attach straight
across from the dump valve assembly over the foot extension
crossbar to the air mattress control unit in order from left to right / right
to left. A distinct click will be heard when the air connectors are fully
attached.
15. Connect AC power cable (gure 4, item 3), CPR cable (4) and
communication cable (5).
Figure 4: Connect air hoses to mattress control unit
1
2
3
4
5

14 Citadel Patient Therapy System
Attach Integrated Air Mattress
1. Remove air mattress from its packaging and roll out on the bed.
Notice air connectors on bottom of air mattress ( gure 5). These
should be placed at the foot end of the bed. Locate the dump valve
/ air connectors incorporated into the foot end of the air mattress
support deck. Ensure all packaging materials are removed from air
connectors on bottom of air mattress.
2. Unzip the bottom zipper of the air mattress and lift foot end of air
mattress to access the air connectors under the air mattress cushions
and mattress base.
3. Look at the air connectors under the mattress and ensure O-rings
( gure 5, item 1) are in place on each connector.
4. Lift cushions ( gure 6) and visually guide air connectors on the air
mattress into connection ports.
Figure 5: Air connectors under mattress
Figure 6: Air connectors under cushion inside mattress
1

15
Citadel Patient Therapy System
5. To fully draw down and secure the air connections:
• Use a rocking motion while pressing down on the top of the
connectors.
• While  rmly pressing down on the connectors, screw the knobs
down until they are slightly tight.
• Repeat steps 1 and 2 until the knobs are fully tightened. This will
ensure a robust air seal.
6. Use mattress straps ( gure 8, item 1) located on bottom of mattress to
secure mattress to frame. There are three straps located on each side
of the frame for a total of six straps at the head and foot ends (see
 gure 8). Two Skin IQ straps are also available. Make sure mattress is
secured to an articulated section of the frame (see  gure 8).
Figure 7: Press  rmly on air connectors
1
Figure 8: Mattress straps head to foot view

16 Citadel Patient Therapy System
7. Place strap 1 and strap 2 through the opening in the backrest deck
section and draw together as show in Figure 9. Secure them together
with their buckles. Wrap both ends of strap 3 around the frame cross-
member and secure with the buckle. Repeat for other side of the
mattress.
8. Replace foot board.
9. Before using the mattress system, test the product using the
procedure listed below.
Figure 9: Attach mattress straps to articulated section of frame
1
2

17
Citadel Patient Therapy System
Testing
Prior to patient placement, the following test procedures should be performed
to make sure air mattress control unit and air mattress installation are
complete:
1. Plug the power cord into power outlet.
2. Turn the air mattress control unit on by pressing and holding the
power button on the control panel and allow the mattress to inate.
The mattress should fully inate in no more than three minutes. The
mattress section LEDs on the control unit panel will blink whilst the
mattress inates. When the mattress is fully inated the LEDs will stop
blinking.
3. If the mattress does not inate or an air leak is heard, check that the
CPR valves are closed. Check for a leak at the mattress to frame
connection point. Refer to Attach Integrated Air Mattress Section,
gure 7, to tighten this connection.
4. At one of the bed control panels, raise the backrest angle to above
30°as indicated on the weigh panel display. Verify that the >30°
indicator is lit on the Air Mattress Control unit.
5. Raise all of the side rails. Put the head right side rail into the lowered
position and verify that the appropriate side rail down indicator
is lit on the Air Mattress Control unit. Raise the side rail. Repeat
this procedure for the other three side rails. Lower backrest to
approximately 15°.
6. Press the patient turn right button. Wait a few seconds to verify the
mattress has begun to turn. Put one of the right side rails into the
lowered position and verify that the alarm is heard and the mattress
starts to return to a level position. Verify the side rail down and alarm
indicators are both lit and the nurse turn right indicator is blinking.
Press the alarm silence button to acknowledge and clear the alarm.
7. Press and hold the CPR button on the attendant control panel. Verify
that the bed deck attens (if in an articulated position), the CPR
valves open, the air mattress deates and the Air Mattress Control
unit turns off.
8. Press the power button on the Air Mattress Control Unit and allow the
mattress to ll.
9. Raise backrest to approximately 15°, pull CPR handle on the side
of the bed frame. Verify that the backrest attens (if in an articulated
position), the CPR valves open, the air mattress deates and the Air
Mattress Control unit turns off.

18 Citadel Patient Therapy System
Mattress Length Adjustment
1. To extend the bed frame: rotate the blue extension locking handle (1)
located under the foot end of bed and pull out the bed frame (2) to the
required position and release the handle.
Figure 10: Extending the bed frame
To extend the deck:
2. Lift the blue extension locking handles on either side of the bed (1)
pull out the deck (2) to the required position and release the handles.
Figure 11: Extending the deck
After extending the deck make sure the calf extension sheet is
clipped over the end of the deck frame.
3. To shorten the bed: Reverse the above procedure.
1
2
1
2

19
Citadel Patient Therapy System
Air Mattress Length Extension
1. Locate the extension  ap at the patient’s right foot end of the
mattress. Unsnap and lift the  ap ( gure 12, item 2) to access the two
sets of connectors (1) on the air mattress.
2. Connect the connectors to in ate the extension cushion in the leg
section. This will lengthen the mattress.
X-Ray Sleeve
An X-ray sleeve is provided in the mattress in order to place an X-ray
cartridge under the patient without having to take the patient off of the
mattress.
The sleeve is located at the head end at the shoulder and chest section
on the patient’s right side. Lower the side rails and lift the outer  ap of the
mattress to access the sleeve located above the zipper on the mattress.
It is not necessary to unzip the mattress to access the X-ray
sleeve.
1
2
Figure 12: Extension  ap
Figure 13: X-ray sleeve
X-ray Sleeve

20 Citadel Patient Therapy System
CONTROL PANEL
min
min
min
Citadel Patient Therapy System Control Panel
Power On / Off Button - Press and hold for two seconds to
turn Citadel Patient Therapy System on or off. LED will light
and an audible tone will sound. Bed must be plugged into AC
power for control unit to turn on.
Lock Out Button - Press and hold for two seconds to
activate or deactivate lockout of all control unit functions.
Pressing the CPR button overrides all lockouts.
Side Rail Down Indicator - Lights up when the left or right
side rails are down.
Fowler Angle Indicator - Lights up when fowler angle is
greater than 30°.
Alarm Indicator - Lights up when an alarm or alarm
condition exists in the Citadel Patient Therapy System. The
icon will turn off when all alarm conditions are no longer
present and the alarm has been acknowledged by pressing
the Alarm Silence / Clear Button.
Alarm Silence / Clear Button - Press to acknowledge an
alarm. Pressing this button will clear an alarm indicator for a
condition that has been resolved. If the alarm condition has
not been resolved, pressing the button will mute the alarm
for ten minutes. If the condition causing the alarm is not
corrected within ten minutes the alarm tone will resume.
Seat Deate Button - Press to activate or deactivate seat
deate. Use seat deate to reduce the air pressure in the
cushions of the body section in order to assist with patient
exit and bedpan placement. An audible tone will sound to
indicate when the pressure in the seat section has dropped
by 50%. Periodically an audible tone will sound to remind the
user that the function is still active.