Maquet FLOW-I User manual

MAQUET FLOW-I COVID-19 QUICKGUIDE
TWO RULES OF FLOW-I
1. Make sure it is switched on
2. READ THE SCREEN
FLOW-I
Screen with touch
display area for
ventilatory functions
Rotary knob for selecting, changing
and confirming values on the screen.
Membrane buttons for quick access
to special windows on screen eg
trends, silence alarms etc
HEPA filter
CO2
absorber
(sodalime)
Power button
Emergency ventilation allows
patient to be manually ventilated in
the case of system failure. When the
emergency switch is set to ‘ON’ the
anaesthetic system will shut down.
Fresh gas flow is replaced by 100%
O2 and a manual APL valve under the
flap
Water trap
needs to be
changed
when half
full (or every
17 hours
even if it
isn’t half
full)

PERFORMING SELF CHECK
- Follow the on-screen instructions
- A full system check usually needs to be completed every 24 hours (but this can be bypassed
in an emergency)
- Getinge have confirmed that the machine will run continuously for 12 days without a self-
check
If a system check is required:
- The system check takes at least 8 minutes (provided the machine passes all checks at the
first attempt)
- It will take much longer if consumables need to be replaced and the checkout has to be
repeated
- An anaesthetist and an ODP should be immediately available before starting
- The patient will need to be settled on an alternative ventilator (eg Oxylog) before starting
- Change the water trap when half full or every 17 hours (whichever is soonest)
Adjustable Pressure-Limiting (APL) valve
• Relieves the patient circuit of excess
pressure at user-defined values
• Only used during manual ventilation
(i.e. squeezing the bag)
• Can be set between spontaneous
breathing (SP i.e. fully open) and 80
cmH2O
Manual breathing bag and
tubing
• Used during manual
ventilation to
administer breaths
O2 flush
• Pressing the O2 flush supplies
an additional 50 l/min O2 to the
breathing circuit
• Beware barotrauma!
MAN/AUTO ventilation switch
Sets the status of the
ventilation to either
manual (i.e. bag) or auto
(controlled on the screen)

INITIAL SET UP
- Enter patient demographics
(age, weight, height, gender)
- Fresh gas flow 4 l/min
- O2 concentration 60%
- Select PRVC (pressure
regulated volume control
- Tidal volume 6 ml/kg
predicted body weight
- PEEP 10
- Resp rate 15
- Set alarm limits
(only visible on auto / PRVC)
Ppeak: max 40
MVe: min 4 / max 15
PEEP: min 8 / max 14
RR: min 8 / max 30
ETCO2: min 3 / max 10
FiO2: 5% less than target
- Set alarm volume
o Suggest 60%
o Adjust as required

USING THE MACHINE
- Fresh gas flow should be set to 4l min.
The is a compromise between low flow (which conserves oxygen, heat and moisture)
and high flow (which conserves soda-lime and reduces the build-up of condensation
in the circuit)
- In the case of sudden desaturation, set O2 to 100%
o Note that the O2 concentration selected may differ slightly from the inspired fraction
of oxygen (FiO2) measured at the patient end of the circuit (see next point)
- The inspired oxygen concentration is measured here. This is the FiO2 that should be
documented. Please note that it may differ slightly from the ‘O2 concentration’ selected on
the control screen

DAILY CHECKLIST
- Back up cylinder (mounted on the back of the
machine)
- Alternative means of ventilation (Bag Valve
Mask) must be kept with every machine
- Tube clamp
- A HEPA filter should always be present at the
machine end of the breathing circuit on the
expiratory limb of the circle breathing circuit.
- A second HEPA filter should be present at the
patient end of the breathing circuit.
- Both HEPA filters should be changed every 12
hours
- Soda lime
o Check colour – deepening of
colour to purple indicates
exhausted soda lime
o Soda lime cannister needs to
be changed if inspired CO2 >
0.2
o Ventilation will need to be
paused whilst changing,
therefore remember to pre-
oxygenate and clamp tube
before pausing the ventilator
o If in any doubt, ask an ODP
for assistance with changing
the cannister

VENTILATION MODE
- Patients should be ventilated using Pressure regulated Volume Control (PRVC) unless
otherwise specified by an intensivist
- Triggering of breaths by the patient can be seen by a red line on either the pressure or flow
waveforms, or both
CONDENSATION
PAY PARTICULAR ATTENTION TO THE BUILD-UP OF CONDENSATION IN THE BREATHING
CIRCUIT. Large amounts of condensation could damage the internal components of the machine
and stop it from working
- A build-up of condensation in the breathing circuit can mimic triggering (as above).
- The pressure and flow waveforms may have a saw-tooth appearance as the ventilator
compensates for the vibration of fluid in the breathing circuit.
- Condensation should be emptied from the breathing circuits (remembering to increase flow
and FiO2 before clamping the ET tube and pausing the ventilator before emptying the
breathing circuit).
SUCTIONING
- Increase fresh gas flow to 8l/min before suctioning

PAUSING
- If a pause of longer than 60 seconds is required then either:
(a) Press new pause
(b) Select manual ventilation (NB PEEP will be lost – consider clamping the tube)
DOCUMENTATION
Ensure the following are documented in the ICU records
- Last machine check (date and time)
- Last soda lime change (date and time) – chance when inspired CO2 > 0.2
- Last water trap change (every 17 hours)
- Last HEPA filter change (every 12 hours)
- The following must also be recorded on the ICU observation chart:
o Ventilation mode
o FiO2
o Tidal volume
o Respiratory rate
o Inspiratory pressure
o PEEP
o End tidal CO2