Care Fusion PrinterNOx User manual

1
PrinterNOx
Operating Manual – English
Gebrauchsanweisung - Deutsch

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Contents
I. Important sa ety in ormation – English ................................ 3
Introduction ..................................................................... 4
Medical Use ...................................................................... 5
NO
2
Production ................................................................. 6
Environmental Sa ety ........................................................ 6
Operation......................................................................... 7
1. Measurement ............................................................10
2. Calibration ................................................................17
3. Set Alarms................................................................23
4. Report to printer........................................................24
5. Status ......................................................................24
6. Setup .......................................................................25
7. Calculate Flow ...........................................................26
Battery operation.............................................................27
Paper Loading..................................................................28
Battery Maintenance.........................................................29
Cleaning Procedure...........................................................31
Servicing.........................................................................31
Symbols..........................................................................32
Electrical Environment ......................................................32
Speci ications ..................................................................32
II. Wichtige Sicherheitshinweise – Deutsch ..............................36
Einleitung........................................................................37
Medizinische Anwendung...................................................38
NO
2
Produktion ................................................................39
Umweltschutz ..................................................................40
Betrieb............................................................................40
1. Messung ...................................................................44
2. Kalibration ................................................................52
3. Alarmeinstellungen ....................................................58
4. Bericht an den Drucker...............................................59

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5. Status ......................................................................59
6. Setup .......................................................................60
7. Durch luss berechnen.................................................61
Batteriebetrieb ................................................................62
Papier einlegen ................................................................63
Batterie wartung ..............................................................64
Reinigung........................................................................66
Wartung..........................................................................67
Symbole .........................................................................67
Elektrische Umgebung ......................................................68
Technische Daten.............................................................68
Customer Contact In ormation ...........................................70

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PrinterNOx
Operating manual
I. Important safety information - English
Nitric oxide is a highly toxic gas, exposure to levels as low as 200
parts per million (ppm) may be atal even a ter very short
exposures, and prolonged exposure to much lower levels may be
harm ul. All users o nitric oxide must amiliarise themselves with
the appropriate sa ety regulations. When calibrating the PrinterNOx
monitor it is important to ensure that calibration gas is adequately
vented and sa ely exhausted. Nitric oxide reacts with oxygen in air
to orm nitrogen dioxide, an extremely toxic gas with a maximum
allowable industrial ambient level o 5ppm.
The PrinterNOx nitric oxide/nitrogen dioxide monitor has been
designed to the highest standards and incorporates many inbuilt
sel -checks. As with any measurement device, however,
mal unction is possible. When used in the administration o nitric
oxide the PrinterNOx must not, there ore, be incorporated as a
primary part o the NO delivery system, but rather as a sa ety check
on the delivery system. The delivery system should be constructed
in such a way as to minimise possible errors. CareFusion Ltd does
not accept any liability or injury resulting rom mal unction and
ailure to ollow these guidelines. Failure to ollow instructions in the
remainder o this manual may also result in dangerously inaccurate
measurements being obtained.

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Introduction
The PrinterNOx is a combined Nitric Oxide / Nitrogen Dioxide
monitor based on electrochemical uel cells and may be operated
directly rom the mains power or rom the internal rechargeable
NiCad battery pack. Fuel cells work through the reaction o the
target gas with an electrolyte at one electrode and oxygen ( rom
ambient air) at the other. This reaction generates an electrical
current proportional to gas concentration. In comparison with other
technologies (such as chemiluminescent detectors) electrochemical
sensors are compact, inexpensive and much easier to use with zero
warm up time and simple calibration. The PrinterNOx is designed to
monitor delivered NO used as a therapy or adult respiratory distress
syndrome and pulmonary hypertension on ventilated patients. The
more toxic and non therapeutic by-product, NO
2
, is also monitored.
The NO measurement has a resolution o 0.05 parts per million
(ppm) with a ull scale o 100ppm and the NO
2
measurement has a
resolution o 0.05ppm with a ull scale o 20ppm. The gas to be
monitored is sampled using a constant low (250ml/min), low dead
space, sidestream system. The system includes a water trap, with
integral hydrophobic ilter, and humidity conditioning circuit to
protect the uel cells against extremes o humidity and particulate
contamination. The measurements are displayed on a large graphic
liquid crystal display and can be printed as a chart, on the integral
thermal printer, together with calibration due date and alarm
settings. The last 24 hours o NO and NO
2
measurements taken are
recorded and stored in the internal battery backed memory and can
be printed or uploaded on the RS232 inter ace or computer storage.
The PrinterNOx includes a number o sa ety eatures and alarms.
These include upper and lower alarms or NO and an upper alarm or
NO
2
. An external alarm cable is available, and when connected to a
NO delivery system, is used to trigger an alarm or initiate a sa e
operating mode i high concentrations o gas are detected. This
concentration is 100ppm or NO, 9ppm NO
2
or alarm level whichever

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is the greater. The low o gas in the sampling line is continuously
monitored and an alarm sounded i the line is occluded or the water
trap is ull. A low battery condition is also alarmed.
The PrinterNOx has been designed with ease o use and reliability as
o oremost importance. To ensure accurate results, however, it is
essential to amiliarise yoursel with the contents o this short
manual.
Medical Use
Nitric oxide (NO) is evolving as a novel therapy used to reduce
pulmonary arterial pressure and improve gas exchange in paediatric
and adult intensive care settings. The NO is usually added to the
ventilator circuit rom a cylinder o NO in nitrogen with a
concentration up to 1000ppm and diluted in the circuit to between 1
and 40ppm.
Therapeutic concentrations must be well controlled as levels as low
as 100ppm may cause lung injury.
For sa ety reasons sources with greater than 1000ppm NO should
not be used. Lower concentrations carry less risk either to the
patient in the case o accidental overdose, or to the hospital sta in
the case o leakage. However, i moderately high doses o NO are to
be administered then the decrease in the maximum FiO
2
must be
considered and is given by the relationship:
FiO
2
(max. = (1 - Required NO Conc./Source NO Conc. X
100%
There ore, i 40ppm is required rom a source o 500ppm NO in
nitrogen then the maximum oxygen available would be:
FiO
2
(max. = (1 - 40 / 500 X 100% = 92%

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Methods or therapeutic administration o nitric oxide depend on the
exact type o ventilator and ventilator circuit to be used and have
not yet been standardised. It is there ore the responsibility o the
user to pay due regard to current medical practice when using the
unit to monitor concentrations o inhaled nitric oxide and nitrogen
dioxide.
NO
2
Production
Nitric oxide in the presence o oxygen undergoes the ollowing
chemical reaction to orm nitrogen dioxide, (a more toxic gas than
nitric oxide):
2NO + O
2
→
→→
→ 2NO
2
The rate o conversion is highly dependent on the NO concentration
and this has some important implications or the NO delivery
system.
Firstly, sources o NO with excessively high concentrations should be
avoided.
Secondly, the administered concentration should be kept as low as is
clinically acceptable.
Finally, the administration system should mix the incoming NO
quickly and e ectively to rapidly reduce its concentration to the
therapeutic level where NO
2
production will proceed at a much
slower rate.
Environmental Safety
To eliminate environmental pollution with NO and NO
2
the
PrinterNOx is supplied with two NOxSORB chemical scavengers or
removing these gases rom the exhaust. The NOxSORB works by
converting NO to NO
2
, which is then chemically absorbed.

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Connect a NOxSORB to the exhaust o the PrinterNOx, as shown
overlea , orientated such that the arrow is pointing away rom the
instrument. The NOxSORB should be replaced a ter 24 hours or
when the mauve spheres turn dark brown. When re-ordering please
quote 36-SORB100 or a box o 10 o 36-SORB200 or a box o 20.
Environmental pollution with NO and NO
2
may also arise when leaks
are present in the connections to the source o NO.
Operation
Be ore operating the PrinterNOx, ensure that the unit has been ully
charged using the AC adapter supplied. (See Charging Procedure.)
The PrinterNOx may also be operated with the internal rechargeable
batteries.
Connect the water trap with integral hydrophobic PTFE ilter and
sampling line to the PrinterNOx as shown below:
Sampling
Line
Water
Trap
Micro
Medic al
Water trap
retaining
screws
Exhaust
port
1
Alarm
PAPER
6
42 3 5
9
7
C AN C EL
8
CH A R GIN G
0
EN T ER
PrinterNOx
NOxSORB
Switch on the PrinterNOx. Please note that the water trap must
be used at all times during measurement to avoid
contamination of the fuel cells.

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The on/o switch is located at the rear o the unit:
An introductory screen giving the so tware version will be displayed
brie ly:
MICRO MEDICAL
PrinterNOx
V X.XX
During this time the ollowing in ormation will be printed:
12/04/95 16:14
NO calibration due : 01/01/96
NO2 calibration due : 07/01/96
NO upper alarm : 15
NO lower alarm : 5
NO2 upper alarm : 4
AC Adapter
socket
500mA
Power Input
Contrast
Display contrast
adjustment
O
12V 1
On/O
switch
RS232/
Analogue
Output
RS232
socket
External
Alarm
External
alarm
socket