Breas Medical Nippy Junior+ User manual

DOC 0915
INSTRUCTION MANUAL
FOR THE NIPPY JUNIOR +
POSITIVE PRESSURE
VENTILATOR
B & D Electromedical
Units A1-A2
The Bridge Business Centre
Timoth ’s Bridge Road
Stratford Enterprise Park
Stratford–upon-Avon,
Warwickshire. CV37 9HW
Tel: [phone] Sales
01789 721577 Technical Support
Fax: [phone]
www.nipp ventilator.com
Version 1, September 2007

NIPPY JUNIOR +
INSTRUCTION MANUAL INDEX
Page
Operation
Description 2-4
Intended Use 5
Features 6
Explanation of Controls
Fascia Buttons 7-8
Fascia Displa 9
Outlets 10
Rear Panel La out 11
Explanation of S mbols Used 12
Getting Started
The Main Screen 13
How to Adjust The Nipp Junior + 13
The Menu Window 14
How to use the on-screen Menu 14
Structure of the Main Menu 15
Breath Anal ser 16
How to use the on-screen help 17
Using Help with the Settings Locked 18
Breathing circuits and masks 18
Using the Nipp Junior + Invasivel 19
Using a Humidifier with the Nipp Junior + 19
Setting Up
Setting up the Nipp Junior + in CPAP Mode 20
Setting up the Nipp Junior + in Pressure Support Mode 21
Setting up the Nipp Junior + in Pressure Control Mode 22
Setting up the Nipp Junior + in IPPV Mode 23
Setting up the Alarms
Auto Set 24
Manual Set 24
Alarm Conditions/Tests
High Flow 25
Low Flow 25
Mains Fail 25
High Pressure 25
Fault 25
Running on Batter Power 26-27
Internal batter 28
External batter 29
Batter Care 30
Connecting Auxiliar Equipment 31
Pneumatic Diagram 31
Specifications 32
International Standards 32
Operation Under Extreme Conditions 33
Accessories and Spares 33
Warnings and Cautions 34
Maintenance
User Maintenance 35
Servicing 36
Warrant /Transportation 36
Factor Service / Repair 36
Locking t e Settings 37

2
NIPPY JUNIOR + Positive Pressure Ventilator
The Nipp jnr+ is a pressure controlled, positive pressure ventilator. It compresses
ambient air and delivers it to the patient through a close fitting nasal mask or a
tracheotom . The output pressure, timing and alarms can be adjusted b controls on
the fascia panel. The Pressure, estimated Tidal Volume, Rate and all settings are
displa ed on a colour LCD(Liquid Cr stal Displa ) screen.
The screen can be set to dim after a pre-set time (accessed via the user preferences
in the main menu). To restore the displa , press an button once.
The basic ventilator settings can be achieved using the four buttons to the left of the
displa . The four buttons to the right of the displa adjust the alarms and provide
access to more advanced features and adjustments (accessed via a menu).
For greater safet and convenience the Nipp jnr+ is equipped with an internal
batter . The ventilator is capable of recharging both the internal batter and an
external batter when running from the mains electrical suppl .
There are 4 modes of ventilation:-
CPAP (Continuous Positive Airwa Pressure) Constant positive
pressure is applied via the mask. No respirator support is
given in this mode.
Pressure Support IPAP (Inspirator positive airwa pressure) and EPAP
(Expirator positive airwa pressure) are set b the
ph sician. The ventilator augments the patient’s
spontaneous breathing. Ti is limited to half of the back-up
period, up to a maximum of 1.2 seconds and minimum of 0.5
seconds.
If the patient’s breathing rate falls to the back-up rate, a
timed breath (Ti back-up) is initiated at the back-up rate.
Pressure Control IPAP, EPAP and Ti are set b the ph sician. A timed
inspiration is c cled b the patients inspirator effort.
Adjustable back-up rate takes over in the absence of
inspirator trigger.
IPPV IPAP and Ti are set b the ph sician. A timed inspiration is
c cled b the patient’s inspirator effort. Patient exhales to
atmosphere via an exhale valve fitted in the breathing circuit.
EPAP is not used in this mode. Adjustable back-up rate
takes over in the absence of inspirator trigger.

3
Alarms
Power Fail If the electrical power to the ventilator is interrupted, an audible
alarm will sound. This alarm will run for 5 minutes unless cancelled with the mute
button. Once cancelled the power fail alarm will not re-activate.
Low Internal Battery When running on its internal batter , the alarm will operate when
the batter is almost depleted
The user cannot replace this batter . Refer to qualified technical personnel for
batter replacement.
Low External Battery When running on an external batter , the alarm will operate
when the batter is almost depleted. Machines fitted with an internal batter will
automaticall switch to internal batter power without alarming.
Low Pressure A pre-set low pressure alarm is provided. If the control pressure falls
to below 50% of the set IPAP level for 10 seconds an audible and visual alarm will
operate.
Hig Pressure A pre-set high-pressure alarm is provided. If the pressure rises above
120% of the working pressure, an audible and visual alarm will operate after a 2
second dela .
Breat ing Circuit Disconnect A disconnect alarm is provided. This is
activated b anal sis of the inspirator and expirator flow waveform. An audible
and visual alarm will operate.
Breat ing Circuit Malfunction This alarm warns of a malfunction of the
exhale valve in the IPPV mode circuit.
Hig Flow alarm An adjustable alarm is provided to warn of excess
inspirator flow. This is activated when the inspirator flow exceeds the set high
flow alarm level for 5 seconds. An audible and visual alarm will operate.
Low Flow alarm An adjustable alarm is provided to warn of insufficient
inspirator flow. This is activated when the inspirator flow fails to achieve the
set low flow alarm level for 10 seconds. An audible and visual alarm will operate.
Fault The alarm ma also be operated b an internal fault. In this case the fault will
be displa ed on screen.
These alarms ma be muted for approximatel 2 minutes to allow for setting up
of the ventilator.
Low Internal Alarm/Memory Battery An intermittent alarm (short beep) with no
onscreen message indicates a depleted mains fail alarm batter . If the ventilator has
been stored for more than a few weeks the internal batter will self discharge. In this
case the alarm will stop after the batter has recharged.
The user cannot replace this batter . Refer to qualified technical personnel if the
alarm operates when the ventilator is in dail use.

4
Estimated Tidal Volume
The estimated tidal volume is a calculated value, based on time and calibrated flow
values. The constant leak through the breathing circuit exhalation port is subtracted
from this calculation to give a reasonabl accurate estimation of tidal volume. The
estimated tidal volume is displa ed above the bargraph displa .
Inspiratory Trigger
The Nipp jnr+ emplo s flow triggering, detecting the start of the patients inspirator
effort when the flow rate exceeds the level set b the Inspirator Trigger sensitivit .
Expiratory Trigger
The expirator trigger is used in Pressure Support mode onl . Towards the end of
inspiration, when the inspirator flow rate drops to the baseline (standing flow
caused b exhale port leak) minus the expirator trigger sensitivit the ventilator will
c cle into the expirator phase.
The inspirator and expirator effort required to c cle the ventilator can be adjusted
via the Trigger option in the Menu.
For simplicit the trigger sensitivit is scaled 1 – 10, with 10 being the most difficult.

5
Intended Use
The Nipp jnr+ is designed to augment ventilation in children with acute or chronic
t pe 2 respirator failure.
Patients who suffer form nocturnal h poventilation are chiefl those with failure of the
respirator pump, though an concomitant lung disease is also deleterious. The
main groups of patients who develop this problem are: -
Patients with respirator muscle weakness. E.g. diaphragm paresis, m opathies, old
polio, motor neurone disease.
Patients with skeletal deformit e.g. scoliosis, thoracoplast
Improvement of ventilation during sleep b non-invasive techniques in these patients
will correct the diurnal abnormalities of blood gases.
Adjustment is carried out b medical staff. The patient onl needs to fit the headset
and nasal mask and switch on the machine. Patients with special needs, such as
disabled or elderl persons, ma require assistance when fitting the headset. The
medical staff would assess the level of assistance required.
The ventilator is placed b the bedside and plugged into the domestic electricit
suppl .
Providing that a suitable socket outlet exists near the bed, no installation is required.
Nipp junior+ ma be used to treat patients via:-
 Trac eotomy
 ET Tube
 Full Face Mask
 Nasal Mask / Nasal Pillows
IMPORTANT!
Batteries used for power fail back up must be kept in good condition and
fully c arged at all times.
Nippy Junior + must be prescribed by, and used only under t e supervision of
a qualified p ysician.

6
FEATURES
1. Lightweight, compact full self-contained unit
2. Internal batter operation
3. Comprehensive, auto setting, alarms with mute facilit
4. Can be used with Nasal mask, Full face mask or tracheotom .
5. User friendl intuitive software
6. Easil understood alarm messages displa ed onscreen
7. 4 modes of ventilation
8. Emplo s state of the art microprocessor control
9. Universal mains input, operates an where in the world without transformers
10. Adjustable flow triggers with trigger indicators
11. Large, colour LCD displa , clearl shows all settings
12. 28 da s stored, On-screen compliance data
13. Comprehensive event log stores all adjustments, settings, alarm events
and user interventions, for download to PC.
14. Breath anal ser displa , showing pressure and flow waveforms
15. Fast trigger response
16. Ver low maintenance requirements, therefore maintenance costs are
extremel low.
17. Twelve months parts and labour warrant
18. Auto switching to internal or external batter .
19. Automatic service reminder.

7
EXPLANATION OF CONTROLS
1
2
3
4
5
6
7
8
9
1
0
1
1
1
2
1
3
1
4
15
16
17
Fascia Buttons
1. IPAP - Selects the Inspirator Positive Airwa Pressure
adjustment (scaled in cm H2O). Value is displa ed
on screen adjacent to the switch.
2. EPAP - Selects the Expirator Positive Airwa Pressure
adjustment (scaled in cm H2O). Value is displa ed
on screen adjacent to the switch.
3. Ti - Selects the inspirator time adjustment (scaled in
Seconds). Value is displa ed on screen adjacent to
the switch.
4. Back up - Selects the Back-up Rate adjustment (scaled in
Breaths Per Minute). Value is displa ed on screen
adjacent to the switch.
5. Mode - Displa s the mode selection screen
6. - Starts and Stops the ventilator
7.
◄- - Decrements the selected parameter or moves the
selection bar down the menu.

8
8. Set - Selects the current menu function displa ed b the
selection bar. OR double press for batter run time
and hours till next service.
9.
+► - Increments the selected parameter or moves the
selection bar up the menu
10. Mute - Silences the alarm for 2 minutes. Press and hold
for 2 seconds to cancel alarm mute.
11. Menu - Displa s the menu screen
12. Help - Displa s context sensitive help messages.
13. Lo Alarm - Selects the Low Flow Alarm adjustment (scaled in
litres/minute). Value is displa ed on screen
adjacent to the switch. Changes colour to red in
alarm condition.
14. Hi Alarm - Selects the High Flow Alarm adjustment (scaled in
litres/minute). Value is displa ed on screen
adjacent to the switch. Changes colour to red in
alarm condition.
15. Ext. Batt - Indicates that ventilator is running on batter
power. This ma be internal or external
16. Power - Indicates that external power is connected.
Ext Batt OFF and Power ON = Batter charging
17. Start - Indicates that the ventilator is running.

9
Fascia Display
4
4
1
2
3
4
5
6
7
8
9
10
11
12
1 . Mode - Displa s current mode of ventilation.
2 . Pressure Display - Indicates airwa pressure (scaled in cm H
2
O).
Changes colour to red in under / over pressure
alarm condition.
3 . Rate Display - Indicates patient breath rate (scaled in Breaths Per
Minute).
4 . Volume Display - Indicates estimated inspirator tidal volume (scaled
in millilitres).
5 . Flow Display - Indicates airwa flow (scaled in litres/minute)
Changes colour to red in flow alarm condition.
6. Settings locked symbol - This s mbol shows that the settings are locked.
7. Alarm Muted symbol - This s mbol shows that the audible alarm has been
temporaril silenced.
8. I Trigger indicator - “Flashes” each time the inspirator c cle is initiated
b the patient.
9. E trigger indicator - “Flashes” each time the expirator c cle is initiated
b the patient.
10. External battery - Indicates external batter state of charge, when
connected.
11. Internal battery - Indicates internal batter state of charge.
12. Service Reminder - major service due

10
Ventilator Outlets
22
2
1
1. Outlet - Main Air Outlet to breathing circuit
2 . EVC Port - Exhale Valve Control outlet
Connected to t e Ex alation valve in IPPV
mode
Leave disconnected in any ot er mode

11
Rear Panel Layout
1. Aux. Power -
24 Volt connection for external batter . Connect onl
recommended batteries, part no 0910
2. RS232 Port - For connection to remote alarm or personal
computer. Isolated to 1500 Volts.
3. Power Inlet - Input mains power connector. Double fused and
fitted with connector retaining clip.
0086
100 - 240V
0.4 - 1.0 Amperes
47 - 63Hz
Fuse 2 x T1.6A
SN
RS 232
Cooling Vent
1
2
3

12
Explanation of Symbols used on Nippy jnr+ and Accessories
- T pe B Applied parts to EN 60601-1
- Alternating Current
- Direct Current
T - Time Dela Fuse
SN - Serial Number
- Date of Manufacture
- Attention. Consult Accompan ing Documents
- Switch ON /OFF
+► - Increase Button
◄- - Decrease Button
- Locked / Unlocked, Purple = total lock, Black = settings locked
- Alarm Muted
- Batter charged
- Batter Discharged
- Service Reminder
- Dispose of in Line with Local Authorit Guidelines
- Rec cle
- Do Not Reuse
- Batch code

13
Getting Started
To Switc On
Place the Nipp jnr+ on a clean, smooth, hard surface. (NOT carpet)
Connect the power lead to the mains power connector on the rear panel. Plug into
the mains power suppl .
Press the Start/Stop button.
To Switc Off
Press the Start/Stop button. The “Switch Ventilator Off” message will appear
onscreen. Press the Start/Stop button again after 2 seconds. There must be a dela
of 2 seconds before each push, to prevent accidental operation.
T e Main Screen
The Main Screen is divided into 3 areas
The left-hand side shows the basic ventilator settings, IPAP, EPAP, Ti, BACK-UP,
and Mode, adjacent to its setting button.
The centre section shows the airwa pressure, flow, estimated tidal volume and
breath rate.
The right-hand side shows the alarm settings and s mbols for alarm mute and
locked settings.
Clear
+
How to adjust t e Nippy jnr+
Select the desired parameter with the relevant button.
The reading adjacent to the button will be highlighted b a purple flashing box.
Alter it with the
◄- or +► buttons.
When ou have finished, move on to the next adjustment or wait a couple of
seconds for the flashing box to disappear.
E.g. Press IPAP.
IPAP setting will be surrounded b a purple flashing box.
Press
+► to increase the pressure setting.

14
Menu Window
The Main Menu gives access to further adjustments and allows ou to view
information relating to the ventilator usage.
How to use t e on-screen menu
Press the MENU button. The menu window will be displa ed in front of the main
screen.
Move the selection bar up or down the menu with the
◄- or +► buttons to highlight
the desired function and press the SET button.
Follow the on-screen instruction at the bottom of the window
Press MENU at an time to exit and return to the main screen.
Eg.
Press MENU.
Press
◄- button to move the selection bar over “User Preferences”.
Press SET. Press SET again to move the
◄- and +► s mbols either side of
“Displa Contrast”
Press
+► to increase contrast - Press MENU to exit.

15
Structure of t e Main Menu
1. Adjust Trigger I Trig View / Adjust
E Trig View / Adjust
2. User Preferences Alarm Volume View / Adjust
Displa Brightness View / Adjust
Displa Contrast View / Adjust
Displa Dimming View / Adjust
(Sets time in minutes until displa dims, to night time level)
3. Compliance Data Total Hours View onl
Compliance Hours View onl
Average Dail Use View Onl
Use + or – button to scroll through the data.
Press and hold + and – buttons to reset compliance data
4. Clear Patient Settings Resets machine to default settings and
clears the compliance data, read for a new
patient.
5. Warnings & Cautions Safet information View onl
6. Breath anal ser Displa s Waveforms Enable/Disable
View Pressure and Flow in graphical
form. Press Menu button to return to
standard displa .
7. Service Menu Service Information Restricted
Access

16
Breat Analyser
The breath anal ser changes the displa to a graphical format, like an oscilloscope.
This can be useful to evaluate a patient’s breathing pattern and to assess the
effectiveness of the triggering.
The pressure and flow waveforms are stored then displa ed on the screen.
• The screen displa ed shows the stored information from the previous breath.
• The width of the trace is the period of the back up rate, displa ed in seconds
on the X axis. E.g. if back up rate is set to 10BPM, the trace width represents
3 seconds.
• The pressure in cm H
2
O is displa ed on the left Y-axis and relates to the RED
trace.
• The flow in litres/minute is displa ed on the right Y-axis and relates to the
BLUE trace.
• The insp trigger (IT) and exp trigger (ET) points are marked along the X-axis
as the occur.
• The displa ma be “frozen” b pressing the ◄ - button. Press the + ►
button to restart the displa .

17
How to use t e On-screen Help
Press the HELP button at an time for a list of help topics. Follow the simple on-
screen instructions.
Press HELP again to exit.
If during setting up, ou require a description of a particular parameter, select it then
press HELP. Press HELP again to clear.
Using Help wit settings locked.
When the settings have been locked, help is limited to a list of more common
problems that ma arise during use and advice on how to deal with them.
Follow the on-screen instructions

18
Breat ing Circuits
Always use a 22mm bore breat ing circuit w en t e Hig Flow alarm is set
above 80 lpm.
Always use a 15mm bore breat ing circuit w en t e Hig Flow alarm is set
below 80 lpm.
The t pe of breathing circuit used will depend on the mode of ventilation selected:-
Breathing circuits to be assembled in the order A-B-C-D from the ventilator end.
In
CPAP , Pressure Support and Pressure Control modes, a single limb circuit with
an exhalation port will be required.
DO NOT USE THIS TYPE OF CIRCUIT FOR
IPPV MODE
22mm circuit, Part Number 0792
Breathing circuit volume = 570 ml including filter.
---------------------------------------------------------
In
IPPV mode a single limb circuit with an exhalation valve will be required. This
t pe of circuit will have a 22mm diameter main tube and a small tube to connect the
exhalation valve to the EVC (exhale valve control) port on the Nipp Junior+.
THIS
IS THE ONLY TYPE OF CIRCUIT RECCOMMENDED FOR USE IN IPPV MODE
22mm circuit, Part Number 0793
Breathing circuit volume = 600 ml including filter.
---------------------------------------------------------

19
Using t e Nippy Junior+ Invasively
The Nipp Junior+ is safe for use with a tracheotom or endotracheal tube.
An exhalation port must be fitted between the breathing circuit and the tracheotom
fitting.
DO NOT USE THIS TYPE OF CIRCUIT FOR IPPV MODE
15mm dry circuit, Part Number 0806
Breathing circuit volume = 470 ml including filter.
---------------------------------------------------------
Using a Humidifier wit t e Nippy Junior+
15mm Heated circuit, Part Number 0809 for use with a Fischer and Pa kel
Humidifier
Breathing circuit volume = 1140 ml including filter and water bath.
Heated breathing circuits are available for use with water bath humidifiers.
Follow the instructions supplied with the humidifier.
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