Dräger Julian User manual

Julian
Anaesthetic Workstation
Instructions for Use
Software 2.n
1-36-96
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

How to use these Instructions for Use
In the header is the subject…
of the main chapter.
Underneath is the title of the subchapter, to help you
find your way around quickly.
On each page…
the instructions for use
combining text with illustrations. The information is
translated directly into actions to enable the user to
learn „hands-on“ how to use the workstation.
Left-hand column: the text…
provides explanations and guides the user clearly and
ergonomically with brief directions on the use of the
product.
Bullet points indicate the steps to be followed, and
where there are several steps, numbers refer to the
illustration and indicate the sequence.
Right-hand column: the illustration…
provides the link with the text and serves as a guide
to the workstation. Points mentioned in the text are
emphasised and non-essential information is omitted.
Screen displays guide the user and confirm the steps
to be followed.
How to use these Instructions for Use
2
1Press the »MAN/SPONT« key,
2and confirm with the rotary knob.
Display (example):
O2flush
– For flushing and rapidly filling the breathing
system and breathing bag with O2while
bypassing the Vapor unit.
3Press the »O2+« button.
O2flows into the breathing system without
anaesthetic gas as long as the button is held
down.
Julian
12
Operation
Selecting the ventilation mode
MAN/SPONT
Julian
D
3
MAN/SPONT
Pleth
40
0
CO2
40 36
0.8 0.6
58 56
38
98 67
5.2 8
4.0030
Volumeter starten: Bestätigen!
O2
SpO2
N2O
Hal.
Fi Fet
et
CO2
AMV
Freq
Grenzen
CO2-Al.
aus/ein
Alarm
Info
Liste
Kurven
Konfig.
Frischgas O2+ N2O
O2
%L/min
VT
0.35
0
Volumeter --s
--
0510
0.5 1
Frischgas
intern
extern
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Contents
3
Contents
Index 142
For Your Safety and that of Your Patients 5
Intended Use 7
Operating Concept 11
Before Using for the First Time 19
Preparation 21
Starting Up 25
Operation 35
Monitoring 55
Configuring in Standby Mode 81
Care 95
Julian as Wall-mounted Unit 113
Maintenance Intervals 115
What's what 125
Technical Data 131
Fault – Cause – Remedy 119
Abbreviations / Symbols 139
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

4
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

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
5
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Contents
Intended Use............................................................................................. 9
7
Intended Use
Contents
Intended Use
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

8
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Intended Use
Julian Anaesthetic Workstation for patients with a body
weight of 5 kg and over with the use of IPPV ventilation.
For the use of:
– Inhalation anaesthesia in rebreathing systems
– Inhalation anaesthesia in semi-closed to virtually
closed systems with "low flow" and "minimal flow"
techniques (for minimal gas and anaesthetic agent
consumption).
– Inhalation anaesthesia in non-rebreathing systems,
with separate fresh gas outlet for the connection of
e.g. the Bain system or Magill system
with a fresh gas flow of 0.5 to 12 L/min.
Ventilation modes:
– Automatic ventilation (IPPV)
and
pressure-controlled ventilation (PCV).
– Manual ventilation (MAN).
– Spontaneous ventilation (SPONT).
The following measured values are displayed:
– Peak pressure, mean pressure, plateau pressure and
PEEP
– Expiratory minute ventilation
Tidal volume VT
Breathing rate
Patient compliance
– Inspiratory and expiratory concentration of O2, N2O,
anaesthetic gas and CO2
optional:
– Functional oxygen saturation (SpO2) and pulse rate.
The following parameters are displayed as curves:
– Airway pressure
– Expiratory flow
– Inspiratory and expiratory concentration of O2, CO2
and anaesthetic gas
optional:
– Plethysmogram
Trend curves and measured value lists are also available.
Monitoring
by means of adjustable alarm limits that are automatically
adapted to the ventilation mode.
The workstation may only be used under the
supervision of qualified medical personnel, so that
assistance can be provided immediately in the event
of any malfunctions.
Explosive anaesthetics, such as ether or cyclo-
propane, must not be used due to the risk of fire.
Mobile radio telephones must not be used within
10 metres of the workstation!
Mobile telephones may interfere with the operation of
electrical and electronic medical equipment.
Julian must not be used with nuclear spin
tomography (MRT, NMR, NMI)!
Operation of the apparatus may be impaired.
Intended Use
9
Intended Use
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

10
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Contents
Screen ergonomics.................................................................................12
Selecting / setting ventilation parameters..................................................14
Selecting / setting monitoring functions.....................................................15
Screen layout..........................................................................................16
Three basic screens for monitoring...........................................................17
The standard screen.................................................................................17
The data screen....................................................................................... 17
The trend screen......................................................................................18
Operating Concept
Contents
11
Operating Concept
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Operating Concept
Screen ergonomics
All the settings required for
– Fresh gas delivery
– Ventilation
– Monitoring
are entered on the system screen using the appropriate
keys and the rotary knob.
The keys are grouped in function fields:
Left-hand field
Fresh gas delivery
Right-hand field
Ventilation
Middle field
Monitoring
The main functions for anaesthesia, e.g. selection of
N2O or AIR, or selection of ventilation modes, can be
selected directly by keys with permanently defined
functions ("hardkeys"):
1Left-hand block
The »N2O« or »AIR« keys are used to select the gas
to be mixed with O2for the fresh gas mix.
2Right-hand block
The »MAN SPONT«, »IPPV«oder »PCV«
keys select the ventilation mode.
These function keys are located in the bottom row on the
control panel.
Left-hand block for fresh gas setting
Right-hand block for ventilation
Operating Concept
Screen ergonomics
12
.
12...
.
NO
2AIR MAN
SPONT IPPV PCV
Monitoring
Ventilation
Fresh gas
delivery
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
_
CO2
Ve
.
12...
.
NO
2AIR MAN
SPONT IPPV PCV
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
12
_
CO2
Ve
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Complementary "softkeys" with variable functions are
provided at the bottom edge of the screen, above each
group of hardkeys. These softkeys are used to set the
fresh gas delivery parameters and ventilation parameters.
1Left-hand block:
The keys for setting the O2concentration and fresh
gas flow.
2Right-hand block:
The keys for setting the parameters for the relevant
ventilation mode. The example shows the parameters
for IPPV controlled ventilation.
These softkeys have different functions, depending on
the operating status or ventilation mode.
The current parameter values are displayed in the softkey
field.
In a prominent position at the bottom right-hand side:
The "turn-and-push" rotary knob
is the main operating control of the apparatus and has the
following functions in all setting operations:
3select = turn
4confirm = press
– to confirm the selected carrier gas or a ventilation
mode,
– to set and confirm the parameters for fresh gas and
ventilation modes,
– to set and confirm the monitoring functions.
Beside the rotary knob:
The standby key Efor switching over to standby mode.
5Press standby key Eand confirm by pressing the
rotary knob.
13
Operating Concept
Screen ergonomics
.
12...
.
NO
2AIR MAN
SPONT IPPV PCV
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
1 2
_
CO2
Ve
.
12...
.
NO
2AIR MAN
SPONT IPPV PCV
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
3
5
4
_
CO2
Ve
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Operating Concept
Screen ergonomics
14
Selecting / setting ventilation parameters
Example: PEEP ventilation parameter
1Press the softkey »PEEP«.
2Select the PEEP value = turn the rotary knob.
3Confirm the PEEP value = press the rotary knob.
The keys for the various monitoring functions are located
on the right-hand side of the screen.
These keys also have different functions = softkeys,
depending on the monitoring screen required.
Julian
12
3
.
12...
.
NO
2AIR MAN
SPONT IPPV PCV
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
_
CO2
Ve
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

15
Operating Concept
Screen ergonomics
Selecting / setting monitoring functions
For example, to change the lower alarm limit of the end-
tidal CO2concentration.
1Press the »alarm limits« softkey. The alarm limits
menu is displayed on the screen.
●Select the alarm limit value = turn the rotary knob.
Confirm the selection = press the rotary knob.
The limit value is highlighted.
Example: lower alarm limit etCO2: <30
●Set the alarm limit value = turn the rotary knob.
●Confirm the new alarm limit = press the rotary knob.
The cursor returns to the zsymbol.
Julian
1
Pleth
IPPV
CO2
40
0PAW
600 10 1:2 10 0251.0050
98
67
38
6.0
29
0.8
--
95
3.0
--
20
1.0
0.0
40
8
120
50
--
Select limit: Turn and confirm ! !
42
30
0
20
FiO2
FiHal.
PAW
SpO2
etCO2
MV
alarm
limits
auto set
limits
alarm
info
list
curves
config.
O2
%L/min PEEP
mbar
Freq.
1/min
VT
mL TI:TETIP:TI %
Pmax
mbar
Freshgas O2+ N2O
Pleth
IPPV
CO2
40
0
600 10 1:2 10 0251.0050
98
67
38
6.0
29
0.8
--
95
3.0
--
20
1.0
0.0
40
8
120
50
--
Adjust limit value: Turn and confirm !
42
30
PAW
0
20
FiO2
FiHal.
PAW
SpO2
etCO2
MV
alarm
limits
auto set
limits
alarm
info
list
curves
config.
O2
%L/min PEEP
mbar
Freq.
1/min
VT
mL TI:TETIP:TI %
Pmax
mbar
Freshgas O2 + N2O
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Operating Concept
Screen ergonomics
Screen layout
16
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
_
CO2
Ve
➀ ➁ ➂ ➃
➄ ➅ ➆ ➇
Exit the alarm limits menu:
1Press the rotary knob
or
2Press the Qkey.
The function keys for standard functions are located on
the right-hand side of the control panel.
GSuppress the acoustic alarm for 2 minutes.
SSelect the screen page.
QBack to standard page.
Screen layout
➀Status field:
Displays information on the current operating mode
➁Graphics field:
For curves and bargraphs
➂Alarm field:
Displays information on the alarms, warnings, etc.
and their priority
➃Numerical value field:
For numerical values
➄Lower softkeys – for fresh gas parameters
➅Prompt field:
For user guidance
➆Lower softkeys – for ventilation parameters
➇Right-hand softkeys – for monitoring:
For rapid selection of the desired monitoring function
.
12...
.
NO
2AIR MAN
SPONT IPPV PCV
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
_
CO2
Ve
Julian
2
1
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

17
Operating Concept
Screen layout
Three basic screens for monitoring
To call up the standard screen, data screen and trend
screen in succession:
1Briefly press the Skey until the desired screen is
displayed.
Back to the standard screen:
2Press the Qkey.
The fresh gas and ventilation parameters can be set by
means of the softkeys in each of the three basic screens.
The standard screen
with three selectable curves.
The most important numerical values are displayed in
groups on the right-hand side of the screen.
The data screen
contains all the numerical values with their units of
measure.
Julian
2
1
Pleth
IPPV
alarm
limits
auto set
limits
alarm
info
list
curves
CO2
40
0
PAW
0
20
config.
O2
SpO2
N2O
Hal.
40 36
0.8 0.6
58 56
Fi Fet
etCO2
38
98 67
6.0 10
MV
freq
600
VT
mL
10 1:2 10 0
PEEP
mbar
Freq.
1/min TI:TETIP:TI %
25
Pmax
mbar
Freshgas O2+N2O
4.00
O2 %L/min
30
_
CO2
Ve
IPPV
PAW
40
20
0
600 10 1:2 10 0251.0050
O2
%
N2O
%
Hal.
%
036
40 33
0.8 0.6
58 56
Fi Fet
CO2
mmHg
98 67
6.0
0.60
10
27
20
5
15
65
MV
VT
freq
peak
plat.
PEEP
mean
compliance
mbar
mL/mbar
L/min
L
34
AW-temp. °C
1/min 01. Nov. 98
sys. comp. 6.40 mL/mbar
leckage 10 mL/min 01-10 8 : 00
12 : 00
SpO2
% 1/min alarm
limits
auto se
t
limits
alarm
info
list
config.
Freshgas O2+ N2O
O2
%L/min PEEP
mbar
Freq.
1/min
VT
mL TI:TETIP:TI %
Pmax
mbar
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Operating Concept
Screen layout
18
The trend screen
displays the recorded progress of the numerical values
over time since measurement started. The current
measured values are displayed on the right-hand side.
Display (example):
Trends for CO2and minute ventilation MV
IPPV
40 36
0.8 0.6
58 56
38
98 67
6.0 10
600 10 1:2 10 0251.0050
PAW
40
20
0
11:00 12:00 13:00
60
30
0
15
10
5
0
Select zoom area:
Turn ! Zoom in: Press !
CO2
MV
O2
SpO2
N2O
Iso.
Fi Fet
etCO2
MV
freq
alarm
limits
AGas
N2O
CO2
MV
O2
compl.
SpO2
pulse
full
trend
O2
%L/min PEEP
mbar
Freq.
1/min
VT
mL TI:TETIP:TI %
Pmax
mbar
Freshgas O2+ N2O
_
CO2
Ve
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Contents
Charging the battery for emergency operation......................................20
When Julian is not in use........................................................................ 20
19
Before Using for the First Time
Contents
Before Using for the First Time
"Only for internal use by Draeger. Not applicable as Instructions for Use!"

Before Using for the First Time
Fit the enclosed O2sensor,
page 117 "Replacing O2sensor"
Fit the flow sensor, page 106
Charging the battery for emergency
operation
Julian has a built-in uninterruptible power supply UPS
which maintains the power supply for 30 minutes in the
event of a mains failure, provided that the battery is
charged.
The switch-over to the battery-powered UPS is automatic
and is indicated on the screen by the message:
POWER FAIL!
The battery recharges automatically when the workstation
is plugged into the mains.
The battery must be charged for 10 hours before using
the Workstation for the first time.
●Plug the mains plug of the Julian workstation into the
mains socket. The mains voltage must correspond to
the voltage specified on the nameplate.
1The green LED NN
NN
lights up.
●Leave Julian connected to the mains for 10 hours.
The workstation does not have to be switched on.
The devices connected to auxiliary power sockets will
not be powered by the UPS in the event of a power
failure.
When Julian is not in use
●Charge battery at least every 4 weeks.
Allowing it to run down can lead to damage.
If Julian is out of use for an extended period:
●Leave the workstation connected to the mains at all
times.
1The green LED NN
NN
is lit.
20
Before Using for the First Time
Charging the battery for emergency operation
When Julian is not in use
1
"Only for internal use by Draeger. Not applicable as Instructions for Use!"