Arjo Citadel User manual

Citadel
INSTRUCTIONS FOR USE
Patient Therapy System
830.238-EN Rev 10 • 11/2021

Design Policy and Copyright
® and ™ are trademarks belonging to the Arjo group of companies.
© Arjo 2021
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 Arjo.

3
Citadel Patient Therapy System
Table of Contents
General Warnings ................................................................................................... 5
•Safety Information .............................................................................................. 7
Introduction.............................................................................................................. 9
Clinical Applications................................................................................................. 9
•Intended Use ..................................................................................................... 9
•Indications ........................................................................................................ 10
•Contraindications.............................................................................................. 10
•General Product Information ............................................................................ 10
•Risks and Precautions...................................................................................... 11
•Precautions....................................................................................................... 11
Installation ............................................................................................................. 12
•Attach Air Mattress Control Unit ....................................................................... 12
•Attach Integrated Air Mattress .......................................................................... 15
•Testing .............................................................................................................. 18
•Mattress Length Adjustment ............................................................................ 19
•To extend the deck: ....................................................................................... 19
•Air Mattress Length Extension.......................................................................... 20
•X-Ray Sleeve.................................................................................................... 20
Control Panel......................................................................................................... 21
•Citadel Patient Therapy System Control Panel ...............................................21
•Air Pressure Adjustment Controls..................................................................... 23
•Height / Weight Presets................................................................................. 23
•Pressure Zone Indicators .............................................................................. 24
•Turning............................................................................................................. 24
•Continuous Patient Turn Hold Time Button (optional con¿guration)..............25
•Pulsation / Alternating Pressure (AP) Therapy (optional con¿guration).........25
Patient Placement / Transfer ................................................................................. 26
•Preparation for Patient Placement / Transfer ................................................... 26
•Patient Placement ............................................................................................ 26
•Patient Transfer from the Citadel Patient Therapy System.............................. 27
•Patient Transport .............................................................................................. 27
Nursing Care ......................................................................................................... 28
•CPR .................................................................................................................. 28
•Alarms .............................................................................................................. 28
•Audible Tone Indicators .................................................................................... 30
•Patient Bathing ................................................................................................. 30

4Citadel Patient Therapy System
Care and Cleaning................................................................................................. 31
•General Recommendations.............................................................................. 31
•Decontamination............................................................................................... 31
•Cleaning ........................................................................................................ 31
•Disinfecting.................................................................................................... 32
•Cleaning the Citadel Patient Therapy System While in Use............................ 32
•Cleaning and Maintenance Between Patients.................................................. 33
•Care And Cleaning Mattress Cover Fabrics ..................................................... 33
Operating Instructions ........................................................................................... 35
•Nurse Assist Functions ..................................................................................... 35
•Therapies.......................................................................................................... 37
•Power OႇCitadel Patient Therapy System ..................................................... 38
Warranty and Service ............................................................................................ 39
Electromagnetic compability (EMC) ...................................................................... 40
Troubleshooting..................................................................................................... 43
Explanation of Symbols Used................................................................................ 44
Explanation of Symbols Used Continued .............................................................. 45
Speci¿cations ........................................................................................................ 46

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 su௻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 Arjo. Contact Arjo 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.

6Citadel Patient Therapy System
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 inÀation / deÀation 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 30Ûor
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 Àuid to penetrate the Citadel Patient Therapy System
control panels.
If a serious incident occurs in relation to this medical device, a௺ecting
the user, or the patient then the user or patient should report the serious
incident to the medical device manufacturer or the distributor. In the
European Union, the user should also report the serious incident to the
Competent Authority in the member state where they are located.

7
Citadel 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 Àuids on unit controls. If spills do occur, unplug unit, clean
Àuid from unit, wearing rubber gloves to avoid any possibility of shock. Once Àuid
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 staႇ.
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 staႇ’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.

8Citadel Patient Therapy System
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 guidance. Consult a caregiver and carefully consider the use of bolsters,
positioning aids or Àoor 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 Arjo 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 suႈcient 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.

9
Citadel Patient Therapy System
INTRODUCTION
These instructions contain information for the installation, use and maintenance of
the Arjo 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 deÀate
• Seat deÀate
• 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.

10 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....................................................Frame – 10 years
Air Mattress Control Unit – 5 years
Air Mattress – 2 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.

11
Citadel Patient Therapy System
Risks and Precautions
Patient Migration – Specialty surfaces have diႇerent 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 deÀation of surface.
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

12 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
Arjo 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

13
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 Àush 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

14 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

15
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

16 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

17
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 straps 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

18 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. If the device will not start working automatically, turn the air mattress
control unit on by pressing and holding the power button on the control
panel. Allow the mattress to inÀate. The mattress should fully inÀate in
approximately three minutes. The mattress section LEDs on the control
unit panel will blink while the mattress inÀates. When the mattress is fully
inÀated the LEDs will stop blinking and based on the control panel version:
• C100: the air mattress control unit enters Normal Therapy Mode,
• C200: the air mattress control unit enters Alternating Pressure
Therapy with a 10-minute timer setting.
3. If the mattress does not inÀate 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 Àattens (if in an articulated position), the CPR valves open,
the air mattress deÀates and the Air Mattress Control unit turns oႇ.
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 Àattens (if in an articulated position), the
CPR valves open, the air mattress deÀates and the Air Mattress Control
unit turns oႇ.

19
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

20 Citadel Patient Therapy System
Air Mattress Length Extension
1. Locate the extension Àap at the patient’s right foot end of the mattress.
Unsnap and lift the Àap (¿gure 12, item 2) to access the two sets of
connectors (1) on the air mattress.
2. Connect the connectors to inÀate 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 oႇof the mattress.
The sleeve is located at the head end at the shoulder and chest section on both
sides of the patient. Lower the side rails and lift the outer Àap 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 Àap
Figure 13: X-ray sleeve
X-ray Sleeve