Dräger Cicero EM User manual

Cicero EM
Integrated Anaesthetic Workstation
23529278
Instructions for Use
Software-Versionen:
Ventilator: ................. 6.n/7.n
Monitor:.................... 4.n

Each page is organized according to the following
principles:
At the top – the subject ...
of the main chapter as listed in the Overall Contents
on page 3.
It is always contained in a headline and printed in
bold type at the beginning of the chapter.
Left-hand column – the text ...
contains explanations, prompts the user to do
something and describes the machine's response.
The dots and numbers refer to actions, while the
numbers also draw attention to details in the
illustrations supplementing the text.
The numbering starts anew on each page.
Right-hand column - the illustrations ...
make it easier to locate the various parts of the
equipment.
Details mentioned in the text are highlighted in
bold type or coloured black.
Working with these Instructions for Use
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O2-Xxxxxxx
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Pleth
XYZ
Cicero nach Checkliste o.k ? Bitte bestätigen
Checkliste Cicero EM
Vapor Nullstellung
Füllung
Zeit seit letzter Inspektion 6<Monate
Sicherheitsfüllvorrichtung Verschlußschieber
eingeschoben und festgezogen
Stecksystem Adapter liegt gleichmäßig auf
Verriegelt
Narkosegasfortleitung Schauzeichen grün
Atemsystem Fester Sitz und vollständig
Atemkalk Kalk erneuert, kein Farbumschlag
Notbeatmungsbeutel Funktion gewährleistet
Zentralversorgung (ZV) Druck O2, Air, N2O > 2,7 bar
Reservegasflaschen Druck O2, Air > 50 bar
Sekretabsaugung Unterdruck vorhanden
Gasversorgung Flow O2, Air, N2O vorhanden
Funktion Umschalter Air/N2O gewährleistet
ORC Flow N2O sinkt proportional mit Flow O2
O2-Flush Strömungsgeräusch, Beutel füllt sich
Test-
Abbruch
11:59
00:00
06.12.98
Vor jeder Benutzung vom Anwender zu prüfen
2
1
3
4

3
Overall contents
For your safety and that of your patients 4
Intended use 5
Emergency Quick-Start 6
Operating concepts 9
Preparing for use 15
Anaesthesia ventilation 31
System screen functions 45
Parameter Box 85
Messages - Cause - Remedy 99
Care 117
Checking readiness for operation 131
What's what 139
Technical data 151
Descriptions 163
Abbreviations and symbols 189
Index 191
Master switch
Ventilator operating concept
Monitor operating concept
Power supply
Compressed gas supply
Connecting external equipment
Checking workstation with checklist
Spontaneous breathing/manual ventilation
IPPV mode
SIMV mode
PCV mode
Paediatric use
Changing patients
After use
Basic screen configuring
Monitoring functions in operation
Alarm concept
Function keys and indicators
Measurement functions
Location of valves and subsystems
Warning, caution and advisory messages
Stripping down machine
Disinfection, cleaning and sterilization
Disposing of throw-away articles
Re-assembling machine
Checking machine functions
Maintenance intervals
Machine functions
Operation of the ceiling version
Notes
Power failure
Gas failure

For your safety and that of your
patients
Strictly follow the Instructions for Use
Any use of the apparatus requires full understanding and
strict observation of these instructions. The apparatus is
only to be used for purposes specified here.
Maintenance
The apparatus must be inspected and serviced regularly
by trained service personnel at six monthly intervals (and
a record kept).
Repair and general overhaul of the apparatus may only be
carried out by trained service personnel.
We recommend that a service contract be obtained with
DrägerService and that all repairs also be carried out by
them. Only authentic Dräger spare parts may be used for
maintenance.
Observe chapter "Maintenance Intervals".
Accessories
Do not use accessory parts other than those in the order
list.
Not for use in areas of explosion hazard
This apparatus is neither approved nor certified for use in
areas where combustible or explosive gas mixtures are
likely to occur.
Safe connection with other electrical equipment
Electrical connections to equipment which is not listed in
these Instructions for Use should only be made following
consultations with the respective manufacturers or an
expert.
Liability for proper function or damage
The liability for the proper function of the apparatus is
irrevocably transferred to the owner or operator to the
extent that the apparatus is serviced or repaired by
personnel not employed or authorized by DrägerService
or if the apparatus is used in a manner not conforming to
its intended use.
Dräger cannot be held responsible for damage caused by
non-compliance with the recommendations given above.
The warranty and liability provisions of the terms of sale
and delivery of Dräger are likewise not modified by the
recommendations given above.
Dräger Medizintechnik GmbH
For your safety and that of your patients
4

5
Intended use
Intended Use
Integrated anaesthetic workstation
»Cicero EM« with system monitor
Universally applicable, integrated anaesthetic workstation
for
– Inhalation anaesthesia for adults, children and
neonates.
– Inhalation anaesthesia in semi-closed to virtually
closed systems with »low flow« and »minimal flow«
techniques (for minimum gas and anaesthetic
consumption).
– Automatic ventilation (IPPV).
– Synchronized intermittent mandatory ventilation
(SIMV).
– Pressure-controlled breathing (PCV) in the PCV
ventilator.
– Manual ventilation (MAN).
– Spontaneous breathing (SPONT).
– Automatic anaesthetic agent recognition.
The following information is displayed in colour on the
system monitor:
– Airway pressure and temperature
– Inspiratory O2concentration
– Expiratory tidal volume
– Patient compliance
–CO2and anaesthetic concentration at the Y-piece
– Fresh gas balance
together with the main haemodynamic parameters
monitored with the parameter box:
– ECG curve with heart rate and ST segment analysis.
– The real-time curve of the invasive blood pressure
(iBP) in two channels, with the systolic, diastolic and
mean pressure values.
– The values of the non-invasive blood pressure (NiBP)
with the systolic, diastolic and mean pressure values.
– The body temperature in two channels.
– The functional O2saturation (SpO2) with the pulse
rate.
– The plethysmogram.
Other accessories (optional)
Vapor*)
Anaesthetic vaporizer for enflurane, isoflurane, halothane
and sevoflurane.
Connection for two Vapor vaporisers*)
Devapor*)
Anaesthetic vaporizer for desflurane.
Anaesthetic gas scavenging system*)
Uninterruptible power supply*)
Passive air conditioning*)
Heated breathing hoses.
pEEG*)
Notes on operation
Only non-flammable anaesthetic agents conforming to
EN 740 may be used. Risk of fire!
Since this apparatus is not approved for use with
inflammable anaesthetics (ether, cyclopropane, etc.),
it is not necessary to use antistatic (conductive) breathing
hoses or face masks.
Conductive breathing hoses and face masks may cause
burns during high-frequency surgery and are therefore
not recommended for this apparatus.
Any additional electrical equipment which is latched
onto the top of the workstation must also be con-
nected to the base unit by means of an equipotential
bonding conductor!
Electromagnetic fields exceeding the limits specified
in EN 60601-1-2 may interfere with the operation of
the device and therefore put patients at risk.
Mobile radio telephones must not be used within
10 metres of the workstation!
Cicero EM must not be used with magnetic resonance
tomography (MRT, NMR, NMI).
The workstation should only be moved by the handles!
Always operate the device under the supervision of
qualified medical personnel in order to obtain prompt
assistance in the event of malfunction.
Retrofitting in different devices
The software described in these Instructions for Use, in
combination with the »Cicero EM«, has passed a conformity
evaluation procedure conforming to 93/42/EEC (medical
appliances); the corresponding conversion kits therefore
bear the C mark of conformity.
The conversion kit can also be installed in the »Cicero EM
color« even if the unit itself does not bear the C symbol,
because the conformity evaluation procedure has confirmed
the suitability of the product for this type of device.
*) Refer to the separate Instructions for Use for this equipment.

Emergency Quick-Start
Press the master switch (1)
– The pressure gauges (2) are in the green zone.
– All lamps on the ventilator light up.
Press a function key on the ventilator
Recommendation: Press and hold down M key for
longer than 1 second.
– The message »Test interrupted« is displayed.
For devices without PCV mode (software 6.n):
Deliver fresh gas
– With the delivery valve buttons (3) under the
measuring tubes
– If necessary fill the system rapidly with the O2
flush (4).
– The manual ventilation bag should fill.
Set the APL pressure limiting valve (5) to »MAN«
Set maximum pressure
– Turn the valve head (6) until the disc is at the
desired maximum pressure.
Emergency Quick-Start
6
Gas/Power
ON / I
Press
I
O
D
1
2
Pmax
PPCV
PCV VTfIPPV TI:TEfIMV
TIP:TI
Flow PEEP
MAN
SPONT
IPPV
TEST
SIMV
O
Lecktest ?
O2AIR
MAN
SPONT
IPPV
Pmax
PPCV
SIMV PCV VTfIPPV TI:TEfIMV
TIP:TI
Flow PEEP
TEST
4
5
3
6
001292780022927800329278

Emergency Quick-Start
7
Notes on Quick Start
The Quick Start procedure is permitted a maximum of
10 times in succession, and only if the previous (full) self-
test was completed without error.
Otherwise, the display on the ventilator and the system
screen instruct the user to run through the complete self-
test.
Manual ventilation remains possible under all condi-
tions!
●Quick Start can also be triggered by the »Cancel
Test« softkey.
●Quick Start can be triggered at any time, even during
a self-test.
If there is a power failure (manual ventilation is
possible)
Make sure that the master switch is pressed down
– The acoustic power failure warning is muted after
30 seconds.
Deliver fresh gas - set APL valve
– If required, press the O2flush button (»O2 +«).
Note: If there is a power failure, the piston of the
ventilator is pushed to its end position by the
airway pressure. This increases the system volume
by a maximum of 1.4 litres.
If there is a gas failure
In case of AIR failure (medical air)
– The system automatically switches over to O2
supply.
In case of O2failure
– The system automatically switches over to the
AIR supply. An acoustic alarm is sounded (O2
shortage signal). The supply of N2O is disabled.
If both O2and air fail
The patient must immediately be ventilated with the
separate emergency ventilation bag!
Self-test
16:47
00:00
cancel
test
Self-test cancelled
06-12-98
00429278

8

Page
Master switch.......................................................... 10
Ventilator operating concept .................................. 10
Monitor operating concept ..................................... 12
9
Operating concepts

Ventilator operating concept
Master switch for power and gas
1Press to switch on. The switch clicks into position.
2Turn clockwise to switch off.
Hardkeys –
for setting the operating modes
»MAN / SPONT« key
for manual ventilation or spontaneous breathing.
»IPPV« key
for IPPV mode.
»SIMV« key
for SIMV mode (see illustrations for the specific
ventilator versions)
»PCV« key
for PCV mode (for PCV ventilator).
»TEST« key
for leakage test and compliance measurement.
A
Standby key.
for setting ventilation parameters
Below the display window:
»Pmax / PPCV« key
for setting the maximum pressure for IPPV and
SIMV ventilation.
The same key is used in PCV mode to set the
plateau pressure.
»VT« key for setting the tidal volume.
»IPPV« key
for setting the ventilation frequency in IPPV
mode.
»TI: TE« key
for setting the time ratio between inspiration
and expiration.
»TIP : TI / Flow«key
for setting the relative inspiratory pause for
IPPV and SIMV ventilation.
The same key is used in PCV mode to set the
inspiratory flow.
»PEEP« key
for setting the PEEP pressure for IPPV mode.
»fIMV« key
for setting the ventilation frequency in SIMV
mode.
Operating concepts
Ventilator operating concept
10
D
Gas/Power
ON / I
Press
I
O
D
1
2
MAN
SPONT
IPPV
TEST
Pmax
PPCV
SIMV PCV VTfIPPV TI:TEfIMV
TIP:TI
Flow PEEP
O
005292780062927800729278
MAN
SPONT
IPPV
TEST
SIMV
O
Pmax VTfIPPV TI:TEfIMV
TIP:TIPEEP
00729278
Ventilator with PCV
Ventilator without PCV

Operating concepts
Operating concept of ventilator
11
Display window with dialogue function
(in combination with the rotary control)
Example: adjusting the maximum pressure
In the black field, beside the rotary control:
1The set value appears on the right and left-hand sides
of the field when a parameter key (Pmax, VT,fIPPV) is
pressed. Here: »23«.
2The value on the right-hand side is changed by
turning the rotary control. Here: »28«.
The old and new values are consequently always
displayed together.
3The value on the right (»28«) is confirmed as the
definitive value by pressing the control.
If the rotary control is not pressed and not turned again,
the machine is reset after 10 seconds without changing
the setting.
●This dialogue window also displays advisory
messages (see page 100) –
Example »Infant hoses«:
Display window without dialogue function
Top left:
Continuous indication of the relative piston movement
(in % referred to the set stroke volume VT).
The set operating parameters correspond with the keys
below:
– Indication of the maximum pressure Pmax in mbar.
– Indication of the tidal volume VTin mL or L.
– Indication of the ventilation frequency fIPPV in
breaths per minute.
23 Pmax / mbar 28
Infant hoses
MAN
SPONT
IPPV
TEST
SIMV
O
Pmax
PPCV
PCV VTfIPPV TI:TEfIMV
TIP:TI
Flow PEEP
Kinderschlaeuche
2
1
3
0% 100%
Pmax
PPCV
23
VT
600
fIPPV
12
mbar ml/L 1/min
0082927800929278010292780112927801229278

Monitor operating concept
Hardkeys
The right-hand side is reserved for operating elements,
the left-hand side for displays.
E This key switches the system screen from standby
to measuring mode and vice versa.
The system screen mode depends on the
ventilator mode:
Standby can only be selected on the system
screen if the ventilator is also in standby.
The system screen starts up when the ventilator is
started.
G This key is used to deactivate the alarm tone for
two minutes. It is reactivated by pressing the key
again. The yellow LED in the key lights up while
alarms are suppressed (see page 79).
During this period, any new advisory and caution
messages will not be audibly signalled but will
appear as text in the alarm fields. Only new
warnings will be signalled once by the appropriate
tone sequence.
Inside the dark area, there are four keys acting directly on
the screen contents:
S This key is used to call up a menu of the available
display options on the system screen. Selection is
made by turning and pressing the rotary control
(see page 68).
Q This key always calls up the last standard screen
used (see page 68).
s This key is used to »freeze« the curves on the
display so that they can be viewed in more detail.
U This key is used to generate a manual entry in the
list screen (see page 70).
Indicators
Above the G key are two bar-shaped indicators that
indicate the alarm status even when the acoustic alarm
has been switched off.
Red (upper) flashing lamp Warning !!!
Yellow (lower) flashing lamp Caution !!
Yellow lamp constantly lit Advisory !
Operating concepts
Monitor operating concept
12
0132927801429278

12
3
Operating concepts
Monitor operating concept
13
Softkeys
1Beside the screen, on the right-hand side, there is
an unmarked touch-sensitive keypad.
2The function of these keys depends on the software
and is indicated on the screen itself.
Only those keys which can be activated are actually
shown.
Pressing some of the softkeys or the screen selector
key
S
will open a menu.
The area where selections can now be made is
turquoise, and the cursor is a yellow rectangle.
●To select: Turn rotary control.
The cursor moves within the turquoise
area.
●To confirm: Press rotary control.
The selected function appears.
All menu levels are displayed in staggered arrangement.
Inactivated menus are grey. The selected menu item is
highlighted in black and white.
Configuring the colours
3Press the »Config« softkey.
4Under »Settings«, select the option »Colours«.
●Select the desired parameter in the colour menu and
confirm.
●Turn the rotary control until the desired colour is
displayed and then confirm
Anesth. Agent Alarms Calibration Settings
11:59
00:00
Wählen Sie mit dem Drehknopf einen Parameter aus. Bestätigen !
Wählen Sie die gewünschte Farbe. Bestätigen !
IPPV alarm limits
mode adult neon.
alarm sound 1 2 3 4 5 6 7 8 9
pulse tone 0 1 2 3 4 5 6 7 8 9
pulse tone
source ECG Pleth.
colours
curve speed 12,5 25 50
mm/s
call standard
ART
AORTA
A.Pulm
ZVD
ICP
iBP ?
NiBP
EKG
SpO
2
/Pleth
Temp.
pEEG
CO
2
Flow
Paw
Hintergrund hell dunkel
Module
farbig ja nein
06-12-98
Settings
11:59
00:00
Select a menu position. Please confirm !
Change the settings. Please confirm again !
ECG
NiBP
iBP locations
iBP channels
SpO2/ Pleth
CO2/ O2
pEEG
Standby / Configuration alarms inactive !
iBP 1 function OFF ON
location ART
sensitivity 42.5 50
iBP 2 function OFF ON
location CVP
sensitivity 42.5 50
mode adult neon.
alarm limits
parameter
screen
acoustic
list entry
transport
RS 232 (Medibus)
record (printer)
basic config.
015292780162927801729278
4

14

15
Page
Electrical power supply........................................... 16
Equipotential bonding............................................. 16
Uninterruptible Power Supply................................. 17
Compressed gas supply ......................................... 17
Anaesthetic gas scavenging system ...................... 18
Anaesthetic vaporizer ............................................. 19
Connecting external equipment ............................ 19
Parameter box ........................................................ 20
Checking workstation with checklist...................... 21
Manual tests............................................................. 21
Check Vapor....................................................... 22
Check anaesthetic gas scavenging...................... 22
Check breathing system...................................... 23
Check soda lime ................................................. 23
Check emergency ventilation bag ........................ 23
Check piped medical gas supply ......................... 24
Check reserve cylinders (optional)....................... 24
Checking the secretion aspiration system ............ 24
Check gas delivery.............................................. 25
Check Oxygen Ratio Control (ORC).................... 25
Check O2flush ................................................... 25
End of manual test according to checklist ................. 25
Self-test................................................................... 26
Semi-automatic part of the self-test........................... 26
Automatic self test.................................................... 27
Fresh gas outlet (option).......................................... 29
Preparing for use

Preparing for use
The device must be correctly prepared and checked
before every use!
Connecting the electrical power supply
The mains voltage must be within the voltage range
specified on the nameplate on the back panel.
1Plug the power plug into the wall socket.
Auxiliary mains sockets:
2Sockets for additional devices that are switched on
and off with the master switch.
(3 sockets. Maximum current per socket: 2 A)
The sum of the derived current in the mains line must not
exceed 500 µA (IEC 601/1).
Equipotential bonding
(e.g. for intracardial or intracranial operations)
3Connect one end of the earthing cable to the terminal
stud on the back panel.
●Connect the other end to the equipotential bonding
stud, e.g. on the operating table or ceiling lamps.
Preparing for use
Electrical power supply
Equipotential bonding
16
P
3
1
2
01829278

g
USV - Ein / On
manuell
S 3 S 4
S 5
S 6
I
0
F2 F2 F3 F4
Uninterruptible Power Supply (optional, see
Instructions for Use of the UPS)
When the machine is powered by the UPS battery
during a mains power failure, no power is supplied to
the auxiliary sockets!
The Desflurane Vapor unit is powered by the side
connector for non-heating apparatus (No. 9 on page 140)
and will therefore continue to run as normal.
1Plug the Cicero power plug into the socket of the
UPS.
2Plug the UPS mains plug into the mains socket.
The UPS can supply the Cicero EM with electrical energy
for about 45 minutes. It is activated automatically in the
event of a power failure.
In the case of a ceiling unit, the auxiliary sockets are
not fitted.
Connecting the compressed gas supply
3Screw hoses for O2, AIR and N2O into the rear of the
apparatus and plug connectors into the wall sockets.
Switch-on lock:
If the machine is switched on without pressure on the
O2line, it is impossible to meter the other gases for
safety reasons!
»Pressure supply« appears on the ventilator.
●Connect O2supply and confirm.
●Check that the supply pressure is adequate on the
pressure gauges on the front (pointers must be in the
green area).
4Holder for anaesthetic gas scavenging. See next page
and separate Instructions for Use.
●If the machine is equipped with a vacuum bronchial
aspirator (option), a vacuum supply system must be
connected.
Preparing for use
UPS
Compressed gas supply
17
1
2
3
4
0192927802029278

Installing the anaesthetic gas scavenging
system:
●Hook the collecting system to the mount on the back
of the Cicero:
Place the slots of the receiving system over the
holders and slide the receiving system down.
See also "What's what" on page 146, No. 14.
Connecting the transfer hoses
1Pass transfer hose from behind through the hole in
the Cicero EM and
2connect the hose to the scavenging connector of the
breathing system (only on first installation - the hose
then remains on the connector).
3Connect the transfer hose to the connector on the
receiving system.
●Make sure the connection is secure!
4Make sure that the connector for the second transfer
hose is sealed with a screw plug.
Do not plug the openings of the receiving system, other-
wise the breathing system could be drained.
5Connect the scavenging hose to the output connector
of the scavenging system.
6Plug the connector of the scavenging hose into the
wall socket. The visual indicator shows »green«.
18
Preparing for use
AGS-system
Bronchial aspirator
D
1
5
3
D
21
Detailed view
from below after
removing soda
lime container.
4
6
021292780222927802329278

0
Vol. %
Anaesthetic vaporizer:
–Only use the Vapors listed in the list of accessories!
–Note the separate Instructions for Use of the Vapor.
–Only use the Vapor intended for each anaesthetic
agent!
1The fill plug must always be inserted and securely
tightened!
2The thumbwheel must always be set to zero when
there is no fresh gas flow.
3Vapor must always be secured by means of the
locking lever (set to the left-hand limit).
Connecting external equipment
Connection via the printer interface:
4with a data cable for printers with serial interface,
such as:
Deskjet (made by Hewlett-Packard)
This connector may also be used as an
RS 232 MEDIBUS interface.
●Equipment plugs must be secured with screws!
For interface configuration, see page 64.
Connection via the Dräger RS 232 MEDIBUS interface:
5with data cable for standard PCs or other monitors.
●Equipment plugs must be secured with screws!
For interface configuration, see page 63.
After removing the outer back panel, the following
connections are accessible:
External screen
6Any S-VGA-compatible screen can be connected.
External O2sensor for inspiratory measurement:
7Connect to the socket marked »O2«.
Airway temperature sensor
8Connect to the socket marked »Temp«.
19
mP
Paw
RS 232 C
Vent.
RS 232 C
CAN P-Box VGA extern VGA intern O2Temp. / Spiro *
Preparing for use
Anaesthetic vaporizer
External equipment
4
5
67 8
1
2
3
0242927802529278

Fitting the parameter box
The parameter box can be operated either in the blue
holder or in the slot-in housing. The slot-in housing can
be mounted by Dräger Service on the left-hand side of
the Cicero EM.
The blue holder can be mounted by the user in any
position on a standard rail (10 x 25 mm).
In the blue holder, the parameter box can be tilted up and
down. In the slot-in housing its position is rigidly fixed.
In both cases, the synchronising output for an
external defibrillator is accessible from the rear.
Slot-in housing:
1Push the parameter box straight into the slot-in
housing. The parameter box locks into position, and
the electrical connections are made.
To remove the parameter box, pull the blue handle on
the box to release the locking lever. The parameter
box can then be simply pulled out of the housing.
Blue holder:
2Fix the blue holder in a suitable position.
3Connect the cable of the mounting base to the
connector on the side of the Cicero EM.
4Hang the parameter box onto the mount from above.
The plug connector must engage.
5To remove, pull the blue handle on the parameter box.
The parameter box is released and can be taken out
of the blue holder.
6Defibrillator connection.
Tilting the parameter box:
7The parameter box can be swivelled up and down.
The parameter box is the central component of the
Dräger transport function. See the separate section in
these Instructions for Use, page 86.
Preparing for use
Parameter box
20
2
4
7
3
D
Cicero EM
5
6
1
0262927802729278025290940262909402729094