Dräger Medical Narkomed 6400 User manual

Narkomed 6400
Anesthesia System
Date: 7 February 2003
© 2003 Draeger Medical, Inc.
Instruction
Manual
Operator’s
Part Number: 4117965-001
Rev: A
RETURN TO CD-ROM TABLE OF CONTENTS
RETURN TO THIS MANUAL'S TABLE OF CONTENTS

RETURN TO CD-ROM TABLE OF CONTENTS
RETURN TO THIS MANUAL'S TABLE OF CONTENTS

Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
Contents
Section 1. Introduction
Operator's Responsibility for Patient Safety . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2
Limitation of Liability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-2
Restriction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
Copyright . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
Trademark Notices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
Disclaimer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
Recommendations. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-3
Purpose of This Manual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4
How This Manual Is Organized . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-4
Conventions Used in This Manual. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-5
General Warnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-5
Symbols and Abbreviations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-8
Equipment Symbols. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-9
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1-10
Section 2. System Description
Narkomed 6400 Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-2
Gas Delivery System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-4
Oxygen Gas Supply Special Features. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-9
Vaporizer Mounts and Interlock Systems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-11
Ventilator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-15
Scavenger Systems (CUSTOMER OPTION) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-34
Power Supply System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-36
Monitoring System. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-39
Auxiliary Video Output (CUSTOMER OPTION) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-48
Measurement Subsystems . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-48
Breathing System Interface Panel . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-50
Strip Chart Recorder (SCR) (CUSTOMER OPTION) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-51
Patient Suction System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2-52
Section 3. System Configuration
Initial Warm-up . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-2
System Setup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-7
Ventilator Information Notebook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-30
Low Flow Wizard . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-34
Calculations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-36
Timers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-37
Alarm Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-39
Software Pressure Gauge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-42
Fresh Gas Information. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-45
Printing Patient Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-47
Alarm Window . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-53
Controlling Individual Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-54
Effects of Ventilator Modes on Alarm Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .3-56
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ii Part Number: 4117965-001
Narkomed 6400 Operator’s Manual Rev: A
Section 4. Configuration and Settings - Gas Analysis
Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-2
Configuring Nitrous Oxide and Agent Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-2
Nitrous Oxide and Agent Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-5
Configuring Carbon Dioxide Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-12
Carbon Dioxide Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-13
Gas Analysis Pod Zero Calibration and Delay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .4-17
Section 5. Configuration and Settings - Volume, Pressure, and Oxygen
Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2
Configuring Breathing Pressure Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-2
Breathing Pressure Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-7
Configuring Respiratory Volume Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-14
Respiratory Volume Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-16
Configuring Oxygen Displays . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-18
Oxygen Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .5-18
Section 6. Configuration and Settings - Ventilator
Default Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-2
Adjusting Ventilator Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-3
Selecting Operating Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-8
Preparation to Ventilate Pediatric Patients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .6-14
Section 7. Checkout Procedures
Daily Checkout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-2
Preuse Checkout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .7-13
Section 8. Operation Summary
Typical Operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-2
Service Interruptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-18
Putting the System in Ventilator Standby . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-19
Replacing Absorbent Between Cases . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-20
Ventilator Safe State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-21
Ventilator Override. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-21
Operating during a Power Failure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-22
Use of Suction with the Narkomed 6400 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-22
Operation during Cardiac Bypass . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .8-23
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iii
Part Number: 4117965-001 Rev: A Narkomed 6400 Operator’s Manual
Section 9. Messages/Problem Resolution
Alarm Structure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-2
Pressure Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-3
Volume Monitoring. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-7
Nitrous Oxide and Agent Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-10
Carbon Dioxide Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-11
Oxygen Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-13
Machine Input Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-16
System Communications Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-16
Miscellaneous Alarms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-16
Ventilator Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-18
Hint Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-28
Negative Pressure Dialog Box. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-32
Breathing Hose Compliance Limit Dialog Box. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .9-33
Section 10. General Care and Maintenance
Powering Down the Narkomed 6400 for Cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-2
General Care Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-2
Inspecting the System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-3
Ventilator Cleaning, Disinfection, and Sterilization . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-3
Ventilator Routine Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-5
Ventilator Disassembly Instructions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-6
Ventilator Reassembly Instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-10
Removing the Piston Assembly. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-15
Replacing the Oxygen Sensor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-17
Clearing Condensation from the Flow Sensor. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-17
Disinfecting the Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-19
Cleaning and Disinfecting the Breathing System Pressure Gauge . . . . . . . . . . . . . . . . . . . . . . . . . .10-22
Open Reservoir Scavenger Maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-22
Maintenance for Passive Systems Scavenger Interface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-24
Water Trap Reservoir Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-25
Care of Vaporizer . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-28
Replacing the Strip Chart Recorder Paper . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-28
Removing the Footrest (Narkomed 6000 machines). . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-29
Replacing the Gas Analysis Pod (GAP-2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .10-30
Section 11. Specifications
Physical Dimensions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-2
Environmental . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-2
Electrical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-2
Touch Screen Display . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-3
Auxiliary Video Output . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-3
Gas Delivery System . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-3
Ventilator, Divan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-4
Breathing System Specifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-5
Ultrasonic Flow Sensor . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-5
Monitoring . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11-6
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RETURN TO THIS MANUAL'S TABLE OF CONTENTS

iv Part Number: 4117965-001
Narkomed 6400 Operator’s Manual Rev: A
Appendix 1: Tables
Self-Diagnostic Tests. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1-2
Factory Default Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1-3
Alarm Management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1-6
Alarm Displays. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1-10
Summary of Alarm Messages and Indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1-13
Summary of Ventilator Control Panel Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1-17
Flow Sensor Failure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . A-1-17
Appendix 2: User-Replaceable Parts
Appendix 3: Optional Accessory Mounting Systems
Appendix 4: Divan Ventilator Self-Test Flow Chart
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Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
1 Introduction
This section describes the operator’s responsibility for patient safety,
limit of liability, and general warnings and cautions relating to the
Narkomed 6400 with Divan ventilator. Abbreviations and terms used
throughout the manual are also described.
Operator's Responsibility for Patient Safety ..................... 1-2
Limitation of Liability ......................................................... 1-2
Restriction ......................................................................... 1-3
Copyright .......................................................................... 1-3
Trademark Notices ........................................................... 1-3
Disclaimer ......................................................................... 1-3
Recommendations ............................................................ 1-3
Purpose of This Manual .................................................... 1-4
How This Manual Is Organized ........................................ 1-4
Conventions Used in This Manual .................................... 1-5
Typefaces ............................................................................ 1-5
Warnings and Cautions ....................................................... 1-5
General Warnings ............................................................. 1-5
Symbols and Abbreviations .............................................. 1-8
Equipment Symbols .......................................................... 1-9
Glossary ........................................................................... 1-10
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1Introduction
Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
Operator's Responsibility for Patient Safety
Draeger Medical anesthesia products are designed to provide the greatest
degree of patient safety that is practically and technologically feasible. The
equipment design, the accompanying literature, and the labeling on the
equipment take into consideration that the purchase and use of the
equipment are restricted to trained professionals, and that certain inherent
characteristics of the equipment are known to the trained operator.
Instructions, warnings, and caution statements are limited, therefore, to
the specifics of the Draeger Medical design. This publication excludes
references to hazards which are obvious to a medical professional, to the
consequences of product misuse, and to potentially adverse effects in
patients with abnormal conditions. Product modification or misuse can be
dangerous. Draeger Medical disclaims all liability for the consequences of
product alterations or modifications, as well as for the consequences which
might result from the combination of Draeger Medical products with
products supplied by other manufacturers if such a combination is not
endorsed by Draeger Medical.
The operator of the anesthesia system must recognize that the means of
monitoring and discovering hazardous conditions are specific to the
composition of the system and the various components of the system. It is
the operator, and not the various manufacturers or suppliers of components,
who has control over the final composition and arrangement of the
anesthesia system used in the operating room. Therefore, the responsibility
for choosing the appropriate safety monitoring devices rests with the
operator and user of the equipment.
Patient safety may be achieved through a variety of means depending on
the institutional procedures, the preference of the operator, and the
application of the system. These means range from electronic surveillance of
equipment performance and patient condition to simple, direct contact
between operator and patient (direct observation of clinical signs). The
responsibility for the selection of the best level of patient monitoring belongs
solely to the equipment operator. To this extent, the manufacturer, Draeger
Medical, disclaims responsibility for the adequacy of the monitoring
package selected for use with the anesthesia system. However, Draeger
Medical is available for consultation to discuss monitoring options for
different applications.
Limitation of Liability
Draeger Medical’s liability, whether arising from or related to the
manufacture and sale of the products, their installation, demonstration,
sales representation, use, performance, or otherwise, including any liability
based upon Draeger Medical’s product warranty, is subject to and limited to
the exclusive terms of Draeger Medical’s limited warranty, whether based
upon breach of warranty or any other cause of action whatsoever, regardless
of any fault attributable to Draeger Medical and regardless of the form of
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1-3
Introduction 1
Part Number: 4117965-001 Rev: A Narkomed 6400 Operator’s Manual
action (including, without limitation, breach of warranty, negligence, strict
liability, or otherwise).
Draeger Medical shall in no event be liable for any special,
incidental, or consequential damages (including loss of profits)
whether or not foreseeable and even if Draeger Medical has been
advised of the possibility of such loss or damage. Draeger Medical
disclaims any liability arising from a combination of its product
with products from another manufacturer if the combination has
not been endorsed by Draeger Medical. Buyer understands that the
remedies noted in Draeger Medical’s limited warranty are its sole
and exclusive remedies.
Furthermore, buyer acknowledges that the consideration for the
products, equipment, and parts sold reflects the allocation of risk
and the limitations of liability referenced herein.
Restriction
Federal law restricts this device to sale by, or on the order of, a physician.
Copyright
Copyright 2003 by Draeger Medical, Inc. All rights reserved. No part of this
publication may be reproduced, transmitted, transcribed, or stored in a
retrieval system in any form or by any means, electronic or mechanical,
including photocopying and recording, without written permission of
Draeger Medical, Inc.
Trademark Notices
Datagrip, DrägerService, Narkomed, Narkomed GS, ORM,
Quality Service For Life, Respitone, Vigilance Audit, Vitalert, and Vitalink
are registered trademarks of Draeger Medical, Inc. All other products or
name brands are trademarks of their respective owners.
Disclaimer
The content of this manual is furnished for informational use only and is
subject to change without notice. Draeger Medical, Inc. assumes no
responsibility or liability for any errors or inaccuracies that may appear in
this manual.
Recommendations
In the interest of patient safety, Draeger Medical strongly advocates the use
of an oxygen analyzer, pressure monitor, and either a volume monitor or an
end-tidal CO2monitor in the breathing circuit at all times.
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1-4
1Introduction
Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
Because of the sophisticated nature of Draeger Medical anesthesia
equipment and its critical importance in the operating room setting, it is
highly recommended that only appropriately trained and experienced
professionals be permitted to service and maintain this equipment. Please
contact DrägerService at [phone] for service of this equipment.
Draeger Medical also recommends that its anesthesia equipment be
serviced at three-month intervals. Periodic Manufacturer's Service
Agreements are available for equipment manufactured by Draeger Medical.
For further information concerning these agreements, contact
DrägerService at [phone].
Purpose of This Manual
This manual provides operating instructions for the Narkomed 6400
Anesthesia Workstation equipped with the Divan ventilator. It is intended
for use by trained clinical professionals familiar with accepted medical
procedures, practices, and terminology used in delivery of anesthesia and
patient monitoring.
How This Manual Is Organized
All users of this equipment must read this manual completely before using
the equipment.
To make this document more convenient for future reference, it has been
divided into several independent sections. Each section contains either
general information about the Narkomed 6400 or instructions on how to
use it.
Introduction provides restriction and liability statements, discusses
organization of the manual, and provides system warnings and cautions.
System Description describes the main components of the system and some
theory of operation.
System Configuration describes overall customization of the monitoring
system, including alarm management.
Configuration and Settings - Gas Analysis describes clinical customization
of the analytical data collected by the gas analysis pod.
Configuration and Settings - Volume, Pressure, and Oxygen describes
clinical customization of the analytical data collected by the volume,
pressure, and oxygen (VPO) monitor.
Configuration and Settings - Ventilator describes clinically-determined
adjustments that may be made to the ventilator for each mechanical
breathing mode.
Checkout Procedures describes the full procedure for daily checkout of the
Narkomed 6400, as well as an abbreviated preuse checkout between cases.
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Part Number: 4117965-001 Rev: A Narkomed 6400 Operator’s Manual
Operation Summary describes how to start and end a case, as well as
operator response to some irregular situations.
Messages/Problem Resolution describes the system alarm structure and a
summary of warning, caution, and advisory messages that may be
encountered during patient monitoring.
General Care and Maintenance lists general cleaning and maintenance
procedures, including some disassembly and reassembly procedures
required for access.
Specifications lists the technical specifications for all system components.
Appendices include general information about system messages and
components.
An extensive index is provided for ease in learning about and efficiently
using the Narkomed 6400 features.
Conventions Used in This Manual
This manual has been set up with several conventions to help organize the
information contained in it. Please read about these conventions carefully so
that you understand their significance in the manual.
Typefaces A different typeface is used throughout the manual to differentiate between
narrative information and machine messages and labels.
Warnings and
Cautions
All parts of this manual contain warning and caution statements about the
Narkomed 6400.
•Warning statements give important information that, if ignored,
could lead directly to a patient's or operator's injury.
•Caution statements give important information that, if ignored,
could lead directly to equipment damage and, indirectly, to a
patient's injury.
General Warnings
The following warnings apply to general operation and maintenance of the
Narkomed 6400 anesthesia machine, equipped with the Divan Ventilator
and Narkomed Ultrasonic Flow Sensor. Warnings specific to subsystems
appear in later sections.
Examples:[O2 CAL] ventilator or monitor control button
label; tab label in parameter notebook
REVERSE FLOW monitor or ventilator message
MAN toggle switch position.
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1Introduction
Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
Warning: Any person involved with the setup, installation, operation or
maintenance of the Narkomed 6400 anesthesia system must
be thoroughly familiar with this instruction manual.
However, instructions in this manual in no way supersede
established medical procedures for patient care.
Warning: This anesthesia system will not respond automatically to
certain changes in patient condition, operator error, or failure
of components. The system is designed to be operated under
the constant surveillance and control of a qualified operator.
Warning: No third-party components shall be attached to the
anesthesia machine, ventilator, or breathing system (except
for certain approved exceptions). Contact DrägerService for
further information.
Warning: Do not apply unregulated suction to the patient circuit when
using this device.
Warning: The Narkomed 6400 anesthesia system must be serviced only
by an authorized representative of DrägerService.
Warning: A test for leakage current must be performed by qualified
biomedical engineering personnel before use if the Narkomed
6400 is interfaced with other equipment.
Warning: A preuse checkout procedure must be performed immediately
before each use of the Narkomed 6400. A recommended
procedure is provided in this manual.
Warning: To avoid electrical shock hazard:
•Due to the risk of electric shock, do not remove any
component cover. Refer any servicing to DrägerService.
•Use only hospital-grade grounded electrical outlets and
power cord.
•Make sure the external equipment is hospital-grade
grounded before connecting the equipment.
•Disconnect the power supply from the electrical outlet
before cleaning. Let it dry completely before reconnecting
it to the electrical outlet. Always ensure that the
clamp for the power cord, at the power supply end,
is tight thus preventing an accidental disconnect
from the unit.
•Do not connect additional external equipment other than
equipment specified by Draeger Medical.
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Part Number: 4117965-001 Rev: A Narkomed 6400 Operator’s Manual
Warning: To ensure patient safety:
•This device must be used by, or on the order of, a
physician.
•Constant attention by a qualified professional is needed
whenever a patient is under anesthesia or connected to a
ventilator. Some equipment malfunctions may pass
unnoticed in spite of the monitor alarms.
•Always make sure that alarm limits are set and alarms
are active when monitoring a patient. Do not rely
exclusively on the audible alarm system for patient
monitoring. Adjusting the alarm volume to a low level
during patient monitoring can jeopardize the patient.
•If the accuracy of any value display is in doubt, first
determine the patient’s vital signs by alternate means
before verifying that the monitor is working correctly.
•If the display loses patient data, it is possible that active
monitoring is not being performed. Close patient
observation or alternate monitoring devices should be
used until monitor function is restored.
Warning: If fluids are accidentally spilled on the equipment, take the
Narkomed 6400 out of service. Turn the power switch to
STANDBY and unplug the main power cord from the AC
outlet.
Warning: When moving the anesthesia machine, remove all monitors
and equipment from the top shelf, and use only the machine
handles. The anesthesia machine should only be moved by
people who are physically capable of handling its weight.
Draeger Medical recommends that two people move the
anesthesia machine to aid in its maneuverability. Exercise
special care so that the machine does not tip when moving up
or down inclines, around corners, and across thresholds (for
example, in door frames and elevators). Do not attempt to
pull the machine over any hoses, cords, or other obstacles on
the floor.
Warning: Only configure the Narkomed 6400 for optional accessory
mounting systems using one of the permitted combinations
listed in Appendix 3 of this manual. Use of any other
configuration may create a tip hazard.
Caution: Although designed to minimize the effects of ambient radio-
frequency interference, the Narkomed 6400 may be adversely
affected by the operation of electrosurgical equipment or
shortwave/microwave diathermy equipment in the vicinity.
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1Introduction
Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
Caution: Do not place more than 100 pounds on top of the Narkomed
6400 top shelf.
Caution: Do not place more than 30 pounds on top of the Divan
ventilator.
Symbols and Abbreviations
The following symbols and abbreviations appear throughout this
manual.
inspiratory inlet
expiratory outlet
bag symbol
gas return symbol
important note symbol
APL adjustable pressure limiter (pop-off valve)
BAG connection for breathing bag
cmH2O centimeters of water pressure
CO2carbon dioxide
Cpat patient compliance
Csyst system compliance
DISS diameter-indexed safety system
% I.P. ratio of inspiratory pause time/inspiration time
kPa kilopascals
Manual/Spont. manual ventilation or spontaneous breathing
MAC minimum alveolar concentration
N2O nitrous oxide
O2oxygen
OFPD oxygen failure protection device
ON/OFF switched on, activated/switched off, de-activated
ORC oxygen ratio controller
!
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Equipment Symbols
These symbols appear on the label on the back of the Narkomed 6400:
This symbol can be seen under the ventilator when the table top is raised
and the compact breathing system removed:
Pmax maximum allowable breathing pressure
PMC Periodic Manufacturer’s Certification
Pset pressure setpoint
PEEP positive end-expiratory pressure
psi pounds per square inch, pressure measurement unit
Rate breath rate in Volume and Pressure Modes
SIMV synchronized intermittent mandatory ventilation
SIMV Rate breath rate in SIMV Mode
I:E ratio of inspiration time to expiration time
VPO Volume, Pressure, Oxygen
Vt tidal volume
CAUTION:
ATTENTION:
Refer to accompanying documents before
operating equipment.
Consulter les documents ci-joints avant de faire
fonctionner l’appareil.
CAUTION:
ATTENTION:
Risk of electrical shock. Do not remove cover.
Refer servicing to qualified service personnel.
Danger d'électrocution, ne pas enlever le
couvercle. Aucune réparation ne doit entre
entreprise par une personne nonqualifiée.
CAUTION:
ATTENTION:
Surface may be hot. Do not touch.
Peut-être que c’est très chaud. Ne touchez pas la
surface.
!
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Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
Glossary
Alarm
Standby
operator has touched bell icon for an operator-controlled
alarm in parameter box on main screen, or operator has
selected [STBY] at [Alarm Control] setting in volume,
agent, or carbon dioxide parameter notebook. In both
cases, the bell icon is grayed out.
Interlock a device that automatically prevents or requires a specific
following action.
Example 1: vaporizer interlock prevents the use of
more than one anesthetic by closing one vaporizer
source when the other is opened.
Example 2: oxygen failure protection device (OFPD)
interlock decreases pressure of other gases when
oxygen pressure is restricted, in proportion to the
decreased oxygen pressure.
Key general term for control button; may be ventilator control
button, monitor selection button, or monitor command
button, depending upon context. See associated text.
Mean Breathing Pressure: an average of all of the instantaneous
pressure values recorded during each breath
Agent/Nitrous Oxide/Carbon Dioxide Concentration:
derivative of "running averages" of real-time data over a
period of 5 seconds. Although continuously calculated,
mean data is displayed on the monitor only when carbon
dioxide respiration cannot be accurately detected.
Monitor
Control
Buttons
Command: initiate an action by pressing them once.
Example: [Threshold Pressure Autoset]
Selection: positioned next to a text box or window, that
indicates the current setting. The setting is selected by
touching the button repeatedly until the preferred value
appears next to it.
Example: [Alarm Control] or [Set GAP Delay Period]
Monitor
Standby
operator has touched [Monitor Standby] control button on
monitor touch screen. The monitor standby screen replaces
the main screen on the monitor.
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System
Standby
operator has selected STANDBY position for Narkomed
6400 system power switch.
Ventilator
Standby
operator has pressed control button [Standby] on Divan
ventilator control panel; VENT STANDBY appears as an
advisory on the monitor.
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Part Number: 4117965-001 Rev: A
Narkomed 6400 Operator’s Manual
2 System Description
This section describes and illustrates the Narkomed 6400
components and provides relevant theory of operation.
Narkomed 6400 Overview ................................................ 2-2
Gas Delivery System ........................................................ 2-4
Pipeline Gas Supply to the Narkomed 6400 ....................... 2-5
Cylinder Gas Supply ........................................................... 2-5
Flowmeter Bank .................................................................. 2-6
Electronic Fresh Gas Measurement ................................... 2-7
Fresh Gas Outlet ................................................................. 2-8
Oxygen Gas Supply Special Features .............................. 2-9
Auxiliary Oxygen Flowmeter ............................................... 2-9
Oxygen Flush ...................................................................... 2-9
Oxygen Supply Pressure Failure Protection Device ........... 2-10
Oxygen Low Pressure Alarm .............................................. 2-10
Minimum Oxygen Flow ....................................................... 2-10
Oxygen Ratio Controller ...................................................... 2-10
Vaporizer Mounts and Interlock Systems ......................... 2-11
Ventilator ........................................................................... 2-15
Overview ............................................................................. 2-15
Respitone (Customer Option) ............................................. 2-19
Power-Up Diagnostic Tests ................................................. 2-19
Mechanical Ventilation Modes ............................................ 2-20
Tidal Volume Compensation ............................................... 2-20
Fresh Gas Decoupling ........................................................ 2-20
Low-Flow Technique ........................................................... 2-21
Leak Detection .................................................................... 2-21
Compact Breathing System ................................................ 2-21
Piston Assembly ................................................................. 2-26
Ventilator Control Panel ...................................................... 2-27
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2System Description
Part Number: 4117965-001 Rev: A
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Ultrasonic Flow Sensor .................................................... 2-32
Breathing System Pressure Gauge (CUSTOMER OPTION) 2-33
Scavenger Systems (CUSTOMER OPTION) ................ 2-34
Open Reservoir Scavenger .............................................. 2-34
Scavenger Interface for Passive Systems ....................... 2-35
Power Supply System ................................................... 2-36
System Power Switch ...................................................... 2-36
Convenience Outlet ......................................................... 2-37
Circuit Breakers ............................................................... 2-37
Reserve Power System ................................................... 2-37
Machine Functions on Reserve Power ............................ 2-38
Monitoring System ......................................................... 2-39
Main Screen ..................................................................... 2-40
Alarm Window .................................................................. 2-46
Auxiliary Video Output (CUSTOMER OPTION) ............ 2-48
Measurement Subsystems ............................................ 2-48
Breathing System Interface Panel ................................. 2-50
Strip Chart Recorder (SCR) (CUSTOMER OPTION) .... 2-51
Patient Suction System ................................................. 2-52
Connections and Switch .................................................. 2-52
Patient Suction System (CUSTOMER OPTION) ............. 2-53
Narkomed 6400 Overview
The Narkomed 6400 anesthesia workstation consolidates a number of
functions formerly executed by several pieces of equipment. As a stand-
alone anesthesia workstation, it directs many tasks automatically,
including:
•anesthetic gas and agent delivery
•automatic ventilation
•ventilation monitoring, including pressure and volume
monitoring
•inspired and expired gas monitoring, including concentrations of
anesthetic agent, nitrous oxide (N2O), carbon dioxide (CO2) and
oxygen (O2)
•anesthetic agent identification in both inspired and expired
gases.
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