Hospira Symbiq User manual

SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
System Operating Manual
For List Number 16026-04 (One-Channel Infuser)
The SYMBIQ™ Infusion System is designed for use by health care professionals. The Hospira
Customer Support hotline is available 24 hours a day (in the USA) to provide consultation and
technical assistance regarding the SYMBIQ™ Infusion System.
F
Refer to the Device Development Document for complete specifications and restrictions.
Hospira Technical Support Operations
1-800-241-4002
To order additional copies of this manual
(P/N 430-10599-001), call 1-877-946-7747
LOAD / EJECT
STOP
A
C
P
O
W
E
R
Emergency
Stop
On/Off
09:57 AM
Press Tab A to display Near Viewing Delivery screen.
A
13.1 mL / hr
13.1
mL / hr
103 mL
103
mL
VTBI
[ 400 mg / 250 mL ]
DOPamine
Rate
Settings Logs Lock
Mode
ICU
Alarm
DOPamine

SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)

SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 1
Contents
WHAT IS IN THIS BOOK 5
CHAPTER 1: INTRODUCTION 7
Intended Audience . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Document Conventions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Warnings and Cautions. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Warnings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
General Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8
Epidural Administration. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9
Administration Sets and Delivery Cautions. . . . . . . . . . . . . . . . . . . . . . . . . 9
Battery Operation Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10
Unintended Bolus Delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
Cleaning Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11
US FCC (Federal Communications Commission) Statement. . . . . . . . . . .11
FCC Interference Statement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Radio Frequency Exposure Statement . . . . . . . . . . . . . . . . . . . . . . . 12
Electrical Artifacts in Clinical Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
CHAPTER 2: INFUSER OVERVIEW 15
Infuser Layout—Front . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15
Infuser Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Touchscreen Buttons . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Touchscreen Button Appearance. . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
Touchscreen Icons and Symbols . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Infuser Layout—Rear . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20
Rear Infuser AC Power Outlet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
Wireless Communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Infuser Layout—Underside . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Infuser Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
Channel Level Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Channel Feature Availability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
Program Level Features Options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25
Device Level Features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Settings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
Date and Time Settings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28
Program Lock . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
CHAPTER 3: INFUSER OPERATIONS 33
Infuser Operations Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Power Modes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
AC Power . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33
Channel LEDs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
Battery Power. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
A/C Power LED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Touchscreen Visibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Power Off . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Programming Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
Program (Basic) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40

2 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Contents
Delivery Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
Stop Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42
General Programming Guidelines. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Calculated Values . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Invalid Value Handling . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
Value Rounding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46
Biomed Mode . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
CHAPTER 4: INFUSER PREPARATION 49
Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Attaching an Infuser to an I.V. Pole. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Infuser Configurations on an I.V. Pole . . . . . . . . . . . . . . . . . . . . . . . . . . . 49
Administration Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
Preparing Administration Sets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Fluid Container Compatibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Loading an Administration Set . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
To load a cassette:. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62
Removing a Cassette . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66
Ejecting a Cassette in an Emergency. . . . . . . . . . . . . . . . . . . . . . . . . . . . 67
CHAPTER 5: PROGRAM (BASIC) THERAPY 71
Programming a Basic Program. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71
Specifying Medication Concentration . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76
End of Infusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80
Titrating an Infusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81
CHAPTER 6: PIGGYBACK 83
Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83
CHAPTER 7: ADVANCED THERAPIES 87
Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87
Intermittent Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95
CHAPTER 8: PROGRAM OPTIONS 105
Deliver at End of Infusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
KVO Rate. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105
Power Priming a Set. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106
Delayed Start . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109
Standby Mode. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .110
Alarm Options. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .112
Distal Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112
Proximal Occlusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114
Infusion Complete Callback . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117
Air-In-Line. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118
Nearing End Of Infusion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120

Contents
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 3
CHAPTER 9: BOLUS 123
Overview. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
Bolus. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123
CHAPTER 10: ALARM AND SYSTEM MESSAGES 127
Alarm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Alarm Urgency . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127
Alarm Appearance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128
Minimized Alarm Tabs. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Alarm Silencing. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129
Multiple Alarms. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130
System Messages. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131
Exceeded Soft Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132
Exceeded Hard Limits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133
Invalid Entry . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135
CHAPTER 11: STORED DATA 137
Patient Information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Clinical Care Areas. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
Changing CCAs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138
To display Program Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Clearing Program Totals. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141
Shift Totals Data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142
Clearing Shift Totals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Event Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144
Alarm Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145
Rule Set Alert Override Log . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146
Current Program . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
Default Drug Library . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147
High-Risk Medications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148
Using the Hospira MedNet® Service Suite (MMS) . . . . . . . . . . . . . . . . . . . . 149
Programming a Soft Outside limits Message . . . . . . . . . . . . . . . . . . . . . 150
Programming a Hard Limit Outside Limits Message . . . . . . . . . . . . . . . 150
CHAPTER 12: CLEANING, MAINTENANCE, AND STORAGE 151
Cleaning the Infuser . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151
Cleaning Cautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Battery Maintenance. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Battery Disposal . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152
Storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Infuser Maintenance and Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
Product Handling and Disposal. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153
CHAPTER 13: PRODUCT SPECIFICATIONS 155
Flow Rate Accuracy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Flow Continuity. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Trumpet Curves. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158
Sample Trumpet Curve. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159

4 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Contents
APPENDIX A: SYSTEM MESSAGES AND TROUBLESHOOTING 161
APPENDIX B: ALARM MESSAGES AND TROUBLESHOOTING 171
APPENDIX C: ACCESSORIES, ADMINISTRATION SETS, AND COMPONENTS 179
APPENDIX D: GLOSSARY 181
APPENDIX E: DEFAULT DRUG LIBRARY (DDL) 187
INDEX 189
SYMBIQ™ INFUSION SYSTEM LICENSE & WARRANTY 195

SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 5
What is in this book
Table 1 outlines the chapters and chapter contents of this manual.
Table 1: SYMBIQ™ Infusion System Operating Manual Contents
Chapter/Section Chapter Contents
Chapter 1 Introduction, warnings, and cautions.
Chapter 2 Infuser layout, features, and touchscreen icons and symbols.
Chapter 3 Clinical modes including Power, Programming, Delivery, and Stop.
Chapter 4 Attaching infusers to an I.V. pole, administration sets, and fluid container compatibility.
Chapter 5 Basic infusion therapy.
Chapter 6 Advanced infusion therapies.
Chapter 7 Supplemental deliveries and program options.
Chapter 8 Piggyback
Chapter 9 Bolus
Chapter 10 Alarm messages, alarm urgency, and system messages.
Chapter 11 Data storage and instructions on accessing data.
Chapter 12 Cleaning and service guidelines.
Chapter 13 Product technical specifications, flow rate accuracy.
Appendix A System messages, message criteria, and troubleshooting suggestions.
Appendix B Alarm messages, alarm criteria, and troubleshooting suggestions.
Appendix C Hospira accessories, administration sets, components, and list numbers.
Appendix D—Glossary Acronyms, expressions, terms, and their definitions.
Appendix E Default Drug Library (DDL) in tabular form.

6 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
What is in this book
NOTES:

SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 7
Chapter 1: Introduction
The SYMBIQ™ Infusion System is a general purpose infuser designed to deliver fluids,
solutions, medications, agents, nutritionals, electrolytes, blood and blood products for parenteral,
enteral, intravenous, intra-arterial, subcutaneous, epidural, or irrigation routes of administration.
The SYMBIQ™ Infusion System is available as a one-channel system.
A cassette-based, multi-function device, the SYMBIQ™ Infusion System is powered by either
AC mains power or can be powered by the enclosed rechargeable battery. The SYMBIQ™
Infusion System delivers Basic therapy or Advanced therapies such as Multistep and Intermittent.
The SYMBIQ™ Infusion System is intended for use primarily in a hospital setting. Other care
areas where the infuser can be used include: Home Care, Nursing Homes, Mobile Intensive Care,
Ambulatory Infusion Centers, Hospice, Subacute Facilities, Outpatient/Surgical Centers, Long
Term Care, Urgent Care, Transport, and Physician Offices.
Intended Audience
The SYMBIQ™ Infusion System is intended for use at the direction of or under the supervision of
licensed physicians or certified healthcare professionals who are trained in the use of infusers and
the administration of parenteral, enteral, and epidural fluids and medications. Training should
emphasize preventing I.V. related complications including appropriate precautions to prevent
accidental infusion of air. Use the SYMBIQ™ Infusion System according to established hospital
or institution guidelines, policies, and procedures.
CAUTION: Federal (USA) law restricts this device to sale by or on the order of
physicians or other licensed health practitioners.
Document Conventions
Throughout this manual, the following conventions are used to call attention to warnings,
cautions, notes, and tips:
WARNING: A warning message contains special safety emphasis and must
be observed at all times. Failure to observe a warning message is
potentially life threatening.
CAUTION: A caution appears in front of a procedure or statement. It contains
information that could prevent product damage or hardware failure.
Failure to observe a caution could result in patient or user injury.
Note: A Note highlights information that helps explain a concept or procedure.
Tip: A Tip contains useful information, hints, and shortcuts that make the product easier to use.
Figures and graphics are rendered as representations to approximate the actual product.
Therefore, figures and graphics may not exactly reflect the product.

8 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 1: Introduction Warnings and Cautions
Warnings and Cautions
The SYMBIQ™ Infusion System is designed and manufactured to be safe, reliable, and easy to
use. This section describes possible hazards and explains how to prevent these hazards.
Warnings
• When infusing at low delivery rates (5.0 mL/hr or less), use microbore sets to reduce the
amount of the fluid bolus that may be delivered when a distal line occlusion is released.
• To ensure low-flow continuity at rates less than 1 mL/hr, use SYMBIQ™ administration sets
with microbore tubing.
• DO NOT use medications incompatible with silicone rubber or PVC plastic or medications
not stable under infusion conditions.
• Always prime the administration set to remove air from the cassette, tubing, and injection
sites prior to connecting to the patient. Always disconnect the administration set from the
patient prior to priming or purging.
• Arrange tubing, cords, and cables to minimize the risk of patient strangulation or
entanglement.
• Consult medication labeling to confirm medication compatibility, concentration, delivery
rates, and volumes are all suitable for desired delivery mode.
• When using the infuser for secondary deliveries (piggyback), ensure the fluids being infused
are both chemically and physically compatible.
• When an administration set is loaded in the infuser, a small amount of fluid is expelled each
time the cassette carriage is opened or closed. If potent medications are being used,
disconnect the administration set from the patient to prevent over medicating the patient.
• Delayed respiratory depression following continuous epidural administration of
preservative-free morphine sulfate has been reported.
• Administer only anesthetics and analgesics approved for epidural administration (as
indicated by the medication’s FDA approved labeling). Epidural administration of
medications other than those indicated for epidural use could result in serious patient injury.
General Cautions
• Federal (USA) law restricts this device to sale by or on the order of physicians or other
licensed health practitioners.
• DO NOT place the SYMBIQ™ Infusion System in service if it fails any of the diagnostic
self-tests.
• Before use, inspect the AC cord to check for defects.
• Before use, ensure the infuser has a functional battery installed. Use of a properly installed
and functional battery helps ensure the infuser operates properly.
• Only qualified biomedical technicians should access the infuser’s Biomed mode.

Warnings and Cautions Chapter 1: Introduction
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 9
• To prevent product damage, use proper care during unpacking and installation. DO NOT use
a SYMBIQ™ Infusion System if it appears damaged in any way.
• When a primary infuser is connected to an AC power main, never connect more than one
additional infuser in a series to the rear infuser AC power outlet; connecting more than one
additional infuser in a series may cause an electrical safety hazard (see “Rear Infuser AC
Power Outlet” on page 19 for more information).
• To prevent personal injury or product damage, make sure the pole clamp is tightened
properly and the infuser is securely attached.
Epidural Administration
Recommended use of the epidural route is to provide anesthesia or analgesia for periods up to 96
hours.
• This device can be used to administer only those anesthetics/analgesics approved for epidural
administration (as indicated or allowed by the medications’ FDA approved labeling).
Epidural administration of medications other than those indicated for epidural use could
result in serious injury to the patient.
• For epidural administration, the use of Hospira catheters, SYMBIQ™ sets without Y-sites,
and "epidural" stickers indicating ongoing epidural administration are recommended.
• Administration of medications via the epidural route should be limited to personnel familiar
with associated techniques and patient management problems. Proper epidural placement of
the catheter is essential since catheter migration could result in intravascular or intrathecal
administration. Facilities practicing epidural administration must be equipped with
resuscitative equipment, oxygen, naloxone, and other resuscitative medications. Adequate
monitoring equipment (e.g., Oximetry) is recommended for continuous monitoring of the
patient during epidural administration. Patients must be observed frequently for side effects
in a fully-equipped and staffed environment for at least 24 hours following completion of
medication administration by the epidural route. DELAYED RESPIRATORY
DEPRESSION FOLLOWING CONTINUOUS EPIDURAL ADMINISTRATION OF
PRESERVATIVE-FREE MORPHINE SULFATE HAS BEEN REPORTED.
• The epidural space has 58 openings through which fluid can exit. Pressure buildup during
administration is transient. However, if a large volume of fluid is administered over a short
time period, the pressure will take longer to return to normal. If overdelivery occurs during
administration, observe the patient closely for signs of spinal cord compression
(disorientation, headache, transient neuralgias) and medication overdose.
Administration Sets and Delivery Cautions
• USE ONLY SYMBIQ™ administration sets with the SYMBIQ™ Infusion System. Use of
unauthorized sets may result in injury to the patient or damage to the infuser.
• To prevent contamination, use aseptic techniques with all fluid-path connections. Remove
protective coverings as administration set assembly progresses.
• When priming is complete or when finished loading a cassette, ensure no fluid flows at the
distal end of the administration set. If fluid flow is observed, DO NOT use the administration
set.

10 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 1: Introduction Warnings and Cautions
• Before using a CLAVE®connector, ensure administration set and fluid compatibility. Do not
use needles to access the CLAVE®connector.
• To help prevent fluid flow, close ALL slide clamps before removing the cassette from the
infuser.
• In vitro studies suggest packed red blood cells with unusually high hematocrit be diluted with
blood-compatible fluids like 0.9% sodium chloride injection to decrease hemolysis and
increase flow rate.
• Before disconnecting a syringe from the CLAVE®, pull the plunger up slightly to avoid
spilling fluid. For rigid containers, close the upper slide clamp, open the cassette carriage,
remove and invert the cassette (ports down).
• Air bubbles may form in the administration set as result of normal outgassing of dissolved air
in the fluid. This may occur if using a chilled solution, if the infuser is mounted significantly
above the patient, when set is used for more than 24 hours, or when using certain fluids
known to routinely outgas. In these cases, an air eliminating filter may be used.
• Repeatedly opening and closing the cassette carriage may defeat the proximal air-in-line
alarm and may cause a distal alarm requiring repriming.
• The infuser screen displays the VTBI (volume to be infused) in whole numbers when a value
is above 99.9. Any fraction of a milliliter delivered is not displayed; however, it is retained in
memory.
• SYMBIQ™ administration sets with integral non-blood filters are not for administration of
blood, blood products, emulsions, suspensions, or any medications not totally soluble in the
solution being administered. These medications may be administered through the lower Y-
injection site below the filter or via SYMBIQ™ administration sets with blood filters.
• Administration sets should be changed per CDC guidelines or hospital policy. Ensure
administration sets are properly discarded per CDC guidelines or hospital policy.
• USE ONLY SYMBIQ™ administration sets with the SYMBIQ™ Infusion System. Use of
unauthorized sets may result in injury to the patient or damage to the infuser. Hospira
Gemstar®administration sets are not compatible with the SYMBIQ™ Infusion System.
• DO NOT push the cassette carriage closed. Use the LOAD/EJECT button to open and close
the cassette carriage.
• If a cassette is manually ejected, the channel must not be used until it is reset in Biomed
mode.
• The Callback alarm activates if the amount of time between key presses are made exceeds
the No Keypress time limit configured for the current CCA or DDL.
• If patient information is stored, the infuser uses this information for default weight, height,
and BSA values when specifying dose rate parameters.
Battery Operation Cautions
• The battery may not be fully charged upon receipt. Connect the infuser to AC mains power
for at least six hours prior to initial use. Failure to fully charge the battery may significantly
reduce battery life.

Warnings and Cautions Chapter 1: Introduction
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 11
• Before connecting a patient to the infuser, ensure the infuser has a fully charged battery
installed for continuous infuser operation.
• If the low-battery alarm activates, connect the infuser to AC power immediately.
• Use AC power as the primary power source whenever possible. Before use, inspect the AC
cord to check for defects. Connect to AC power during storage to ensure a fully charged
battery for emergencies. If the quality of the earth grounding source is in doubt, do not use
the infuser, use only battery power.
Unintended Bolus Delivery
• To avoid delivering a bolus when a distal occlusion occurs, disconnect tubing from the
patient while eliminating a distal occlusion.
Cleaning Cautions
• To avoid mechanical or electronic damage, DO NOT immerse the SYMBIQ™ Infusion
System in fluids or cleaning solutions. DO NOT spray cleaning solutions in or near infuser
openings. DO NOT allow cleaning solutions to saturate the air-in-line detectors or enter the
infuser when cleaning the air-in-line detectors.
• USE ONLY the recommended cleaning solutions and follow the manufacturer’s
recommendations. Using cleaning solutions not recommended by Hospira may result in
product damage. The disinfecting properties of cleaning solutions vary; consult the
manufacturer for specific information. See “Chapter 12: Cleaning, Maintenance, and
Storage” on page 151.
• DO NOT use compounds containing combinations of isopropyl alcohol and dimethyl benzyl
ammonium chloride.
• NEVER use sharp objects such as fingernails, paper clips, or needles to clean any part of the
infuser.
• DO NOT sterilize by heat, steam, ethylene oxide (ETO), or radiation.
US FCC (Federal Communications Commission) Statement
This device complies with part 15 of the FCC Rules. Operation is subject to the following two
conditions: (1) This device may not cause interference, and (2) This device must accept any
interference, including that may cause undesired operation of these devices.
FCC Interference Statement
• This equipment has been tested and found to comply with the limits for a Class B digital
device, pursuant to Part 15 of the FCC Rules. These limits are designed to provide reasonable
protection against harmful interference in a residential installation. This equipment
generates, uses, and can radiate radio frequency energy. If not installed and used in
accordance with the instructions, it may cause harmful interference to radio communications.
However, there is no guarantee that interference will not occur in a particular installation. If

12 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 1: Introduction Warnings and Cautions
this equipment does cause harmful interference to radio or television reception, which can be
determined by turning the equipment off and on, the user is encouraged to try and correct the
interference by one or more of the following measures:
- Reorient or relocate the receiving antenna.
- Increase the distance between the equipment and the receiver.
- Connect the equipment to an outlet on a circuit different from that to which the receiver is
connected.
- Consult the dealer or an experienced radio/TV technician for help.
• Changes or modifications not expressly approved by Hospira could void the user's authority
to operate the equipment.
Radio Frequency Exposure Statement
• The Wireless LAN radio device in the Connectivity Engine peripheral board with this
infusion device has been evaluated and found compliant to the requirements of the following
Radio Frequency exposure standards:
- Federal Communications Commission, OET Bulletin 65 (Edition 97-01), Supplement C
(Edition 01-01), Evaluating Compliance with FCC Guidelines for Human Exposure to
Radio frequency Electromagnetic Fields, July 2001.
- Industry Canada, Evaluation Procedure for Mobile and Portable Radio Transmitters with
respect to Health Canada's Safety Code 6 for Exposure of Humans to Radio Frequency
Fields, Radio Standards Specification RSS-102 Issue 1 (Provisional): September 1999.
• The radiated output power of this Wireless LAN device is far below the FCC radio frequency
exposure limits. The Wireless LAN device has been evaluated with zero inches separation of
human body from the antenna and found to be compliant with FCC RF exposure limits.
Electrical Artifacts in Clinical Settings
The SYMBIQ™ Infuser has been tested and found to comply with EMC/EMI limits in
accordance with:
• The use of portable and mobile RF equipment may have an impact on this and other pieces of
medical equipment
• Nonhazardous, low-level electrical potentials commonly occur when fluids are administered
using infusion devices. These potentials are well within accepted safety standards but may
create artifacts on voltage-sensing equipment such as ECG, EMG, and EEG machines. If the
monitoring equipment is not operating correctly or has loose or defective connections to its
sensing electrodes, these artifacts may be accentuated to the point of simulating actual
physiological signals. To determine if the abnormality in the monitoring equipment is caused
by the infusion device instead of some other source in the environment, temporarily suspend
fluid delivery (a therapy should only be suspended if doing so does not pose a clinical risk to
the patient). Disappearance of the abnormality indicates it was probably caused by the
electronic noise generated by the infusion device. Proper setup and maintenance of the
monitoring equipment should eliminate the artifact. Refer to the appropriate monitoring
equipment system documentation for setup and maintenance instructions.

Warnings and Cautions Chapter 1: Introduction
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 13
• The SYMBIQ™ Infusion System is designed to operate around normally encountered
electromagnetic interference (EMI) conditions. If extreme levels of interference like that
produced by an electrosurgical generator are encountered, normal operation of a sensor or
microcomputer might be disrupted.
• This equipment has been tested and found to comply with EMC/EMI limits in accordance
with IEC/EN 60601-1-2 (2001). These limits are designed to provide reasonable protection
against harmful interference in a typical medical installation. The equipment generates, uses,
and can radiate radio frequency energy and, if not installed and used in accordance with the
instructions, may cause harmful interference to other devices in the vicinity. However, there
is no guarantee that interference will not occur in a particular installation. If this equipment
does cause harmful interference with other devices, which can be determined by turning the
equipment off and on, the user is encouraged to try to correct the interference by one or more
of the following measures:
- Reorient or relocate the receiving device
- Increase the separation between the equipment
- Connect the equipment into an outlet on a circuit different from that to which the other
device is connected
- Consult the manufacturer or field service technician for help
• The use of portable and mobile RF equipment may have an impact on this and other pieces of
medical equipment.
• Use of radio frequency emitting devices (other than the wireless communication module if
installed in the SYMBIQ™ Infuser) such as cellular telephones and 2-way radios in close
proximity of this device may affect its operation. Take the following measures to correct
interference caused by these devices:
- Relocate or re-orient other radio frequency emitting devices
- Increase the distance between the infuser and other radio frequency emitting devices
- Do not connect other radio frequency emitting devices to the same AC power source used
by the infuser

14 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 1: Introduction Warnings and Cautions
NOTES:

SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 15
Chapter 2: Infuser Overview
Chapter 2 describes the SYMBIQ™ Infusion System layout (front, rear, and bottom), infuser
buttons and touchscreen buttons, touchscreen icons and symbols, and the features that control the
infuser.
Many features of the SYMBIQ infuser system are configurable through the Hospira MedNet®
software. For details on facility-defined configuration, contact the facility software administrator.
Infuser Layout—Front
Figure 1 depicts the front of a one-channel SYMBIQ™ Infusion System and the infuser
touchscreen.
Figure 1: Front View and Touchscreen of the SYMBIQ™ Infusion System
Table 2 outlines the buttons and touchscreen elements that correspond to the numbers in Figure 1
above.
Table 2: Item Number and Corresponding Feature
Graphic # Feature Graphic # Feature
1Distal tubing guide 8SILENCE button
2Cassette carriage 9Emergency Stop button
3Cassette loader housing 10 CCA/Patient Information button
4Channel Identifier tab 11 Channel-level therapy buttons
5Proximal tubing guide 12 Programming screen
6Cassette LOAD/EJECT button 13 Help/status text area
7On/Off button 14 Battery indicator/AC power indicator
10
11
12
13
14
STOP
P
O W
E
R
EmergencyStop
o
delete all entries. Options to
to continue.
Advanced
kg / min
1
3
5
1
mL/hr
mL
hh:mm
i
ne
CU
L
ogs Lock
Alarm
400 mg / 250 mL ]
Piggyback
Next
Cancel
Titration
7
610
4
11
12
13
14
2
3
9
5
1
8
LOAD / EJECT
STOP
A
C
P
O W
E
R
EmergencyStop
On/Off
11:24 AM
Press fields to edit. Clear to delete all entries. Options to
edit program settings. Next to continue.
A
Program
Rate
(Calculated)
Dose
Advanced
Infusion
5mcg/kg/min
13.1
103
07:51
VTBI
Time
(Calculated)
mL/hr
mL
hh:mm
DOPamine
ICU
Settings Logs Lock
Mode
Options
Clear
Alarm
[ 400 mg / 250 mL ]
Piggyback
Bolus
Next
Cancel
Titration
0mL /hr
0mL

16 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 2: Infuser Overview Infuser Layout—Front
Infuser Buttons
Buttons on the infuser casing function in the following manner:
•LOAD/EJECT—opens and closes the cassette carriage
•On/Off—turns power on and off
•SILENCE—silences a silenceable alarm for a specified period of time, usually two minutes
•Emergency Stop—stops all channels, generates high urgency alarm
•Cleaning Lock (located on the rear of the infuser)—activates and deactivates the
touchscreen
Touchscreen Buttons
The SYMBIQ™ Infusion System touchscreen allows you to access and use on-screen buttons and
keypads. A membrane covers the LCD display so a single keypress does not cause significant
infuser pole movement nor is it mistaken for a double keypress. When an active touchscreen
button is pressed, the infuser sounds an audible valid key tone. The touchscreen also
accommodates a keypress whether you are wearing wet gloves, dry gloves, or no gloves.
Note: A triple-beep will sound when making entries that are touchscreen errors.
Touchscreen Button Appearance
The appearance of touchscreen buttons varies depending on their status. A touchscreen button can
be either active, depressed, selected, or unavailable. Table 3 depicts how touchscreen buttons
appear based on their status.
Note: Basic Program refers to functionality accessed by pressing the Program channel level
button.
Note: Document copies should be printed in color to differentiate between button statuses.
Table 3: Touchscreen Button Appearance
Touchscreen Button Status Touchscreen Button Appearance
Active
Depressed
Selected
Unavailable
Bolus

Infuser Layout—Front Chapter 2: Infuser Overview
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 17
Touchscreen Icons and Symbols
Table 4 describes and illustrates the various touchscreen icons and symbols.
Table 4: Touchscreen Icons and Symbols
On-Screen Item Description On-Screen Item Illustration
Horizontal navigation arrow buttons
Vertical short scroll bar (up and down
arrows scroll a list by one item)
Vertical hot scroll bar (white interior
arrows scroll a list by one item; each
yellow arrow increases the scrolling
increment by one item more than the
previous arrow)
Drop-down list field
End-of-list indicator (for drop-down
lists)
CCA/Patient information button
Select
ICU

18 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 2: Infuser Overview Infuser Layout—Front
Infusion running drip icon
Basic program icon
Multistep therapy icon
Intermittent therapy icon
Piggyback icon
Bolus icon
Upper hard limit icon (displays on a
channel tab when an upper hard limit
is overridden, and the program
confirmed on that channel)
Lower hard limit icon (displays on a
channel tab when a lower hard limit is
overridden, and the program
confirmed on that channel)
Upper soft limit icon (displays on a
channel tab when an upper soft limit is
overridden, and the program
confirmed on that channel)
Table 4: Touchscreen Icons and Symbols
On-Screen Item Description On-Screen Item Illustration