Drager Medical Evita 4 User manual

Evita 4
Instructions for Use
Software 4.n
MT-159-99
Intensive Care Ventilator

2
Working with these Instructions for Use
Header line – the title...
of the main chapter
The title of the specific sub-section is printed underneath the
main header – to help you find your way quickly from subject to
subject.
Page body...
the Instructions for Use
in combined text/illustrations. The information is expressed in
the form of practical actions, giving the user direct hands-on
experience in learning how to use the machine.
Left-hand column – the text...
provides explanations and instructs the user step-by-step in the
practical use of the product, with short, clear instructions in
easy-to-follow sequence.
Bullet points indicate separate actions. Where several actions
are described, numbers are used both to refer to the relevant
details in the illustrations and to specify the sequence of
actions.
Right-hand column – the illustrations...
provide the visual reference for the text and make it easier to
locate the various parts of the equipment. Elements mentioned
in the text are highlighted. Unnecessary details are avoided.
Screen displays prompt the user to proceed and confirm
correct actions.
Starting up
90
Calibrating
Calibrating
The last calibration/zeroing values remain stored until the next
calibration/zero calibration, even when the machine is
switched off.
Calibration of the pressure sensors for measuring the airway
pressure is automatic.
The flow sensor and O
2
sensor are automatically calibrated
once per day.
Manual calibration of the flow sensor can be performed at any
time, even during ventilation.
Manual calibration of the O
2
sensor can be performed at any
time, even during ventilation. The applied O
2
concentration is
not affected by calibration.
The calibration of the CO
2
sensor can be checked during
ventilation.
Calibrating the O
2
sensor
— Before operation, during the device check.
—After replacing the O
2
sensor (wait for the 15-minute warm-
up time of the O
2
sensor).
—If the measured value and set value deviate from each other
by more than 2 Vol.%.
The O
2
sensor can be calibrated during ventilation.
Start calibration:
●
Press »
Calibration
« key.
Display (example):
●
Touch the »
O
2
« screen key.
The »LED« in the screen key changes colour to yellow.
Message in the help line at the bottom of the screen:
»
O
2
-calibration
«
After calibration is complete, the yellow »LED« in the
screen key goes out.
134

3
What's new in Evita 4 software 4.n*
Specification of the humidifier used
— »Active humidifier«
or
— »HME/Filter« (artificial nose)
— for more accurate measurement of the volume parameters
Apnoea ventilation On/Off
— can be selected as starting configuration
Extended range of settings for the alarm time TApnoea >
— from 5 to 60 seconds
(formerly 15 to 60 seconds)
Frequency can be reduced to 0
— for BIPAP and SIMV, for weaning without transitions
Ventilation mode BIPAPAssist
— for pressure-controlled assisted ventilation
Patient mode »prev. patient« can be selected
—to adopt the settings, including alarms, which were effective
before switching off the equipment
Leakage compensation On/Off
— for activation and deactivation of the automatic leakage
compensation function
Extended logbook entries
— Evita 4 4.n identifies alarms which are active but not
displayed with an asterisk
Monitoring of tube blockages
— new alarm message »Tube blocked !!!«
*See page 180 onwards for new features in software
versions 2.n and 3.n
Additional weaning parameters
available as software version 4.n plus upgrade
in addition to the parameter occlusion pressure P 0.1 Evita 4.n
also determines the parameters
— RSB Rapid Shallow Breathing index
and
— NIF Negative Inspiratory Force index
External flow source
available as software version 4.n plus upgrade
— The amount of external flow is calculated by Evita 4 4.n
(e.g. for additional tracheal gas insufflation) and adjusts the
volume monitoring tolerances in order to avoid inadvertent
alarms
Extended use of loop presentations
available as software version 4.n plus upgrade
— Loops can be zoomed and frozen
— Loops can be displayed permanently in the upper part of
the screen
Evita Remote (Remote Pad)
optionally available
— Remote control pad for parallel remote operation of
function keys on Evita 4
NIV
optionally available
— Application mode to support non-invasive ventilation
therapies
Nurse call
optionally available
— Connection for transmitting alarm signals to a central
hospital alarm station

4

Contents
5
Contents
For Your Safety and that of Your Patients 6
Intended Medical Application 8
Operating Concept 9
Preparation 23
Starting up 43
Configuration 101
Troubleshooting 119
Preparing 127
What is what 139
Technical Data 145
Description 155
Parts List 176
Order List 178
Index 182

For Your Safety and that of Your Patients
6
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.
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 Medical AG & Co. KGaA

7
For Your Safety and that of Your Patients
Safe Use of the Equipment
Safe Use of the Equipment
This equipment must only be used under the supervision of
qualified medical staff, so that help is available
immediately if any faults or malfunctions occur.
This equipment must not be used with flammable gases
or anaesthetic agents. Danger of fire!
Do not use mobile telephones within 10 metres of
ventilators!
Mobile telephones may impair the functioning of
electromedical equipment and endanger the patient.*
* Dräger medical equipment meets the requirements for immunity to
interference in accordance with the specific product standards and
EN 60601-1-2 (IEC 601-1-2). Depending on the type of mobile
telephone used and on the application situation, however, field
strengths exceeding the values specified in the applicable
standards may develop in the immediate vicinity of the mobile
telephone and therefore lead to faults and malfunctions.
Unit must not be tilted more than 5oon the trolley,
otherwise it may tip over.
Appropriate ventilation monitoring
The built-in monitoring facilities of Evita 4 ensure appropriate
monitoring of ventilation therapy and there-fore detect any
undesirable changes in the following ventilation parameters:
— Airway pressure, Paw
— Expiratory minute volume, MV
— Inspiratory O2concentration, FiO2
— Inspiratory breathing gas temperature, T
—Expiratory CO2concentration, etCO2(optional)
— Inspiratory breathing volume, VTi
— Apnoea time
— Tachypnoea monitoring
Changes in these parameters may be caused by:
— Acute changes in the patient's condition
— Incorrect settings and faulty handling
— Equipment malfunctions
— Failure of power and gas supplies
If a fault occurs in this equipment, separate measuring
instruments should be used.
Back-up ventilation with an independent manual
ventilation device
If a fault is detected in Evita 4 so that its life-support functions
are no longer assured, ventilation using an independent
ventilation device must be started without delay – if
necessary with PEEP and/or increased inspiratory O2
concentration (e.g. with the Dräger Resutator 2000).

8
Intended Medical Application
Intended Medical Application
Long-term ventilator for intensive care.
For adults, children and neonates.
For premature babies with the "NeoFlow" option.
With the following ventilation modes:
IPPV (Intermittent Positive Pressure Ventilation)
controlled and assisted constant-volume ventilation.
With the options:
— CPPV (Continuous Positive Pressure Ventilation)
— PLV (Pressure Limited Ventilation)
— AutoFlow®
for automatic regulation of inspiration flow
— IRV (Inversed Ratio Ventilation)
SIMV (Synchronized Intermittent Mandatory Ventilation)
procedure for weaning patients off the ventilator after they
have started spontaneous breathing.
With the options:
— PLV (Pressure Limited Ventilation)
— AutoFlow®
for automatic regulation of inspiration flow
MMV (Mandatory Minute Volume Ventilation)
spontaneous breathing with automatic adjustment of
mandatory ventilation to the patient's minute volume
requirement.
With the options:
— PLV (Pressure Limited Ventilation)
— AutoFlow®
for automatic regulation of inspiration flow
SB (Spontaneous Breathing)
spontaneous breathing at ambient pressure.
CPAP (Continuous Positive Airway Pressure)
spontaneous breathing with positive airway pressure.
ASB (Assisted Spontaneous Breathing)
pressure-assisted spontaneous breathing.
BIPAP* (Biphasic Positive Airway Pressure)
pressure-controlled ventilation combined with free
spontaneous breathing during the complete breathing cycle,
and adjustable pressure increase to CPAP level.
*Registered trade mark
BIPAPAssist (Biphasic Positive Airway Pressure Assisted)
Pressure-controlled assisted ventilation
APRV (Airway Pressure Release Ventilation)
Spontaneous breathing on two pressure levels with long time
ranges – independently adjustable.
Special modes:
Apnoea Ventilation
For switching over automatically to volume-controlled
mandatory ventilation, if breathing stops.
If apnoea occurs, Evita 4 emits an alarm after the preset alarm
period (TApnoea >) and starts volume-controlled ventilation.
ILV (Independent Lung Ventilation)
Separate, differentiated, synchronised ventilation with two
Evita units.
Diagnostics:
Intrinsic PEEP-measurement
for determining intrinsic PEEP and measuring trapped volume
Occlusion pressure measurement
for evaluating breathing drive during spontaneous breathing
With monitoring for
airway pressure, Paw
expiratory minute volume, MV
inspiratory O2concentration, FiO2
inspiratory breathing gas temperature, T
expiratory CO2concentration, etCO2
inspiratory breathing volume, VTi
apnoea time
tachypnoea monitoring to detect rapid, shallow spontaneous
breathing
Automatic gas switch-over.
In the event of a gas failure, the change-over to another gas is
automatic.

Operating Concept
9
Operating Concept . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Structure of the Control Unit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
The Power Switch . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
On-Screen Controls . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Screen Keys for Selecting Functions without Confirmation . . . . . . . . . . . . . . . . . . . 12
Screen Keys for Function Selection, Adjustment and Confirmation . . . . . . . . . . . . 13
Screen Knobs for Setting Parameters . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
Screen Pages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Standard Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
»Settings« Screen . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
»Alarm Limits« Screen Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
»Measured Values« Screen Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
Display Logbook . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19
»Special Procedures« Screen Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
»Calibration« Screen Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
»Configuration« Screen Page . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Control Unit Location . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Operating Concept

Operating Concept
10
Structure of the Control Unit
Operating Concept
Structure of the Control Unit
The main components of the control unit are the screen, a set
of fixed function keys and the central rotary dial-knob.
The function keys are used to call up the screen pages
appropriate to the application.
In addition to curves, measured values and status displays, the
screen contains, in a separate field, touch-sensitive keys and
touch-sensitive rotary knobs for parameter setting.
The touch-sensitive screen keys and the screen knobs are
used in a similar way to ordinary keys and knobs:
Touching with the fingertip is equivalent to pressing a key or
taking hold of a knob.
The display always contains only the screen keys and screen
knobs required for function selection and/or adjustment.
Settings and confirmations are made by turning and pressing
the central, rotary knob.
The keys for routine functions are placed to the right and left
on the outside of the front panel.
Frequently used function keys are placed on the right, e.g. the
key »??
??« for selecting the standard page or the »Alarm Reset«
key for resetting or confirming messages.
Less frequently used function keys are placed on the left-hand
side of the front panel,
e. g. the key » « for switching the medicament nebuliser
on/off,
or the »O2Ysuction« key for bronchial suctioning.
Do not cover the black plastic frame around the screen
and do not place any objects in the frame.
The touch-sensitive screen keys and knobs will no longer
function correctly.
00137206
DEvita 4
21437206
DEvita 4
00237206
DEvita 4

11
Operating Concept
The Power Switch
The Power Switch
for switching the device on/off.
The power switch is located on the back panel and has a
pivoting cover to protect against being inadvertently switched
off.
0033720600437206

Operating Concept
12
On-Screen Controls
On-Screen Controls
The lower half of the screen contains touch-sensitive coloured
screen keys and screen knobs.
Touching these controls with the fingertip is equivalent to
pressing key or taking hold of a knob.
The colour displays the status of the "control" and "LEDs":
green = usable
white = not usable
yellow = adjust/confirm
black = effective function/display
Screen Keys for Selecting Functions without
Confirmation
e.g.for paging through the system on-screen
for changing the menu
for switching over displays.
Example:
●Press the »Table« key = select display.
The key goes black to show that the function is active.
005
1
2
3
FiO221
Ppeak 33 >50
Pplat 27
MV 5.3 _7.0
4.0
IPPV
BIPAP
SIMV
ASB
Extra
settings
Basic
settings
IPPV Assist A m
21
O2 [%]
.500
VT
1.7
Tinsp
21
f
60
Flow
5
PEEP
60
40
20
0
-10
0246 8t [s]
Paw [mbar]
006
1
2
3
FiO221
Ppeak 33 >50
Pplat 27
MV 5.3 _7.0
4.0
Table
Trends
Loops
Logbook
Zoom out
Zoom in
IPPV Assist A m
60
40
20
0
20
10
0
-10
0246
11:03 12:03
8t[s]
Paw [mbar]
MV 11:06 total 1.5
spon 0.0
40
20
0
11:03 12:03
f 11:06 total 1.5
spon 0.0
007
Table Table

13
Operating Concept
Screen Keys for Function Selection, Adjustment and Confirmation
Screen Keys for Function Selection,
Adjustment and Confirmation
Display (example):
1Touch the relevant screen key for the alarm limits,
e.g.:
MV 2.3 L/min
The colour changes from green to yellow = setting function
is set.
2Turn the rotary knob = adjust the alarm limit. The value is
displayed in the screen key.
3Press the rotary knob = the colour changes from yellow to
green, and the set alarm limit is confirmed and effective.
To cancel the setting:
●Touch the screen key again
or
●touch another screen key.
008
1
2
3
FiO221
Ppeak 33 >50
Pplat 27
MV 5.3 _7.0
4.0
Limits
Logbook
Monitoring
IPPV A m
MV 5.3 L/min
fspn 0.0 bpm
TApnoea s
etCO2– – mmHg
VTi .497 L
Paw 33 L/min
60
40
20
0
-10
0246 8t [s]
Paw [mbar]
4.0 _7.0
_30
_15
0 _100
_780
_50
20037206
2
3
1
MV 2.3 L/min
9.3
3.1

Operating Concept
14
Screen Knobs for Setting Parameters
Screen Knobs for Setting Parameters
Display (example):
e.g. »PEEP« screen knob.
1Touch the »PEEP« screen knob:
It changes colour from green to yellow = setting function
selected.
2Turn rotary knob = Adjust setting. The value is displayed in
the knob.
3Press rotary knob = Confirm. The knob changes colour
from yellow to green, and the setting is validated and takes
effect.
While pressure values, such as Pmax, are being set, they are
displayed in the Paw (t) curve as a dashed black line.
To cancel the setting:
●Press the screen knob again
or
●press another screen knob.
005
1
2
3
FiO221
Ppeak 33 >50
Pplat 27
MV 5.3 _7.0
4.0
IPPV
BIPAP
SIMV
ASB
Erweit.
Einstell.
Basis-
einstell.
IPPV Assist E m
21
O2 [%]
.500
VT
1.7
Tinsp
21
f
60
Flow
5
PEEP
60
40
20
0
-10
0246 8t [s]
Paw [mbar] 1
2
3
FiO221
Ppeak 33 >50
Pplat 27
MV 5.3 _7.0
4.0
IPPV
BIPAP
SIMV
ASB
Extra
settings
Basic
settings
IPPV Assist A m
21
O2 [%]
.500
VT
1.7
Tinsp
21
f
60
Flow
5
PEEP
60
40
20
0
-10
0246 8t [s]
Paw [mbar]
00937206
PEEP
5
10
PEEP [mbar]
PEEP [mbar]
1
3
2

15
Operating Concept
Screen Pages
Screen Pages
All the screen pages have the same structure, i.e. their
contents are always arranged in the same positions on the
screen:
Messages indicating ventilation modes and alarms, displays of
measured values and curves, and help functions, always
appear in the same position on the screen:
➀The active ventilation mode/patient mode is displayed on
the left-hand side of the top line.
The ventilation mode is indicated by its abbreviation,
e.g. BIPAP.
The patient mode is indicated by a symbol:
A m for adults
P mfor paediatric
In the case of spontaneous breathing activity by the patient,
a lung symbol ⁄is briefly displayed as indicator.
➁Curves are displayed in the upper left-hand quarter of the
screen.
➂The lower half of the screen shows curves and measured
values or screen keys and screen knobs – depending
which screen page is selected.
➃Alarms are displayed on the right of the top line.
➄Measured values are displayed in the upper right-hand
quarter of the screen.
➅Help functions appear in the bottom line of the screen. On
the right, Evita 4 provides setting instructions. On the left,
Evita 4 provides information on the current status – this
information can be accessed by pressing key » «.
The solid function keys to the right of the screen are used to
select the screen pages for the following specific application
situations:
—Settings
—Alarm limits
—Measured values
—Special measurement procedures
—Calibration
—Configuration
010
Curves Measured
values
Curves or screen knobs Measured
values or
screen keys
Current ventilation mode/patient mode Alarms
Help functions
➀
➁
➄
➃
➂
➅
01137206
DEvita 4

Operating Concept
16
Standard Page
Standard Page
For displaying the ventilation status
●Press »?« key.
Display (example):
The standard page shows the ventilation situation at a
glance – reduced to the most important measurement
parameters and curves.
Four measured values are shown on the right, and two curves
on the left.
Other measured values and curves can be selected in the
standard page and all subsequent screen pages.
To select other measured value combinations:
●Touch screen key » « repeatedly.
To select other curves:
●Touch key » « and touch the screen key corresponding
to the desired curve.
»Settings« Screen
For displaying the setting parameters
The bottom right-hand side of the screen contains the screen
keys for selecting the ventilation modes.
The screen key displayed in black (IPPV in the example)
represents the currently activated ventilation mode.
The bottom left-hand side of the screen contains the on-screen
rotary control knobs.
The values of the setting parameters are displayed in the
screen knobs relevant to the ventilation mode.
The user-definable start-up settings are marked by an
arrow (j) on the scales of the screen knobs. See
"Configuration" on page 101 onwards.
Changing the settings of an active ventilation mode
●Touch the appropriate screen knob, which will change
colour from green to yellow = setting function enabled.
●Turn the rotary knob on the control unit = adjustment of the
value of setting in the screen knob.
●Press the rotary knob: the screen knob changes colour
from green to yellow = the setting is confirmed (validated)
and active.
012
1
2
3
013

17
Operating Concept
»Settings« Screen
Selecting another ventilation mode and setting its
parameters
●Touch the appropriate screen key, e.g. »BIPAP«. The key
changes colour from green to yellow, and the parameter
setting page for BIPAP is displayed.
To set the parameters for BIPAP:
●Touch the screen knob, which changes colour from green
to yellow = adjustment function selected.
●Turn rotary knob = adjust value displayed in screen knob.
●Press rotary knob: the screen knob changes colour from
yellow to green = setting validated and effective.
If the indicator "LED" next to a screen knob is illuminated
white, the knob setting will only be effective after the new
ventilation mode has been switched on (example: »PASB«
knob).
If the indicator "LED" is illuminated yellow, the relevant knob
setting is already active in the existing ventilation mode
(example: »O2« knob).
The start-up values effective on switching on the ventilator are
marked on the relevant knob-scale with an arrow (j)
Example: PASB = 0 mbar
●Press the rotary knob: the screen key changes colour from
yellow to black = the ventilation mode is active.
For detailed instructions on setting the ventilation modes,
please refer to page 48 onwards.
Cancel selection of ventilation mode:
●Press the black screen key for the effective ventilation
mode again
or
●touch another screen key for selecting ventilation modes.
Cancel parameter setting:
●Touch screen key or screen knob again
or
●press another screen key or another screen knob.
To quit a screen page:
1Press »?« key = return to standard page
or
2press any of the function keys next to the screen on the
right.
01401537206
PEEP +
10
PASB
PEEP +
10
PASB
01637206
DEvita 4
21
DEvita 4
21

Operating Concept
18
»Alarm Limits« Screen Page
»Alarm Limits« Screen Page
Displaying the measured values and the corresponding alarm
limits.
Setting the alarm limits.
Setting the monitoring function.
Displaying the logbook.
The alarm limits are grouped together in a field and combined
with a curve and four measured values.
Limits, monitoring and logbook are selected by the screen
keys on the right of the screen.
The currently activated screen key is highlighted in black.
Displaying/Setting Alarm Limits
●Touch the »Limits« screen key. The screen key will change
to black.
The monitored measured values will be displayed, together
with their alarm limits.
Example:
MV 5.4 L/min
Left-hand screen key = lower alarm limit.
Right hand screen key = upper alarm limit.
Set the alarm limit:
●Touch the relevant screen key.
The key changes colour to yellow = adjustable.
●Turn the rotary knob = adjust value displayed in the key.
●Press the dial-knob. The screen key changes colour to
green = setting confirmed.
The alarm limit is now effective.
For detailed operating instructions, please refer to page 70.
017
7.5
5.5

19
Operating Concept
»Measured Values« Screen Page
»Measured Values« Screen Page
This page is used to display:
— the measured values in table format
— the trend curve
— loops
— logbook.
Tables, trend, loop and logbook are selected by the right-hand
block of screen keys.
Example table of measured values »Table 1«
For detailed operating instructions, please refer to page 74.
Display Logbook
●Touch the »Logbook« screen key.
●Turn the dial-knob = select alarm events.
For detailed operating instructions, please refer to page 78.
018019

Operating Concept
20
»Special Procedures« Screen Page
»Special Procedures« Screen Page
This page is used to display and perform the following special
measuring procedures:
— Intrinsic PEEP
and
— Occlusion pressure P 0.1
The desired special procedure is selected by the appropriate
screen key on the right. The result of the last special
procedure is displayed.
Example: Intrinsic PEEP
To start the special procedure:
●Touch the »Start« screen key.
For detailed operating instructions, please refer to page 86
and page 87.
»Calibration« Screen Page
This page is used for calibrating
— the O2sensor
— the Flow sensor
— the CO2sensor
●Select the desired sensor with the »O2«, »Flow« or »CO2«
screen keys.
Evita 4 provides the necessary calibration instructions in the
Help Function line at the bottom of the screen.
For detailed operating instructions, please refer to
page 90 onwards.
020021
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