NoxBox NOxBOXi User manual

NOxBOXiOperating Instructions
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Bedfont Scientic Ltd, Station Road, Harrietsham, Maidstone, Kent, ME17 1JA
[phone] [phone] [email protected] www.noxboxltd.com
Issue 6.0 (Software V.17.1) September 2015. Part No: LAB636
© NOxBOX Ltd NOxBOX Limited reserves the right to change or update this literature without prior notice. Registered ofce: England and Wales. Registered No: 9563860
ISO 9001:2008
Cert No. FM 31664
ISO 13485:2003
Cert No. MD 502905
Set- Up
Before you use the Bedfont NOxBOXiintelligent Nitric Oxide delivery and monitoring system it is important to follow these steps:
Ensure the device does not require maintenance (monthly) and that the maintenance is not due during the expected duration of the therapy such as:
• NO sensor high calibration
• NO2 sensor high calibration
• Pump calibration
• Vent calibration
Checklist
• Ensure the device is clean and free from damage
• Ensure the water trap is empty and has been cleaned from previous use
• Ensure all single use items from previous patient have been discarded
Equipment you will need for set-up:
• A NOxBOxi system test kit (NOXBOX-I TEST)
• A NOXKIT (inspiratory limb size dependant)
• Two cylinders of delivery gas
• A 22mm one-way valve for HFO ventilator circuits (FXS555)
Additional items
• NOxAIR Environmental monitors
• Manual bagging kit
NOTE: If you do not have the parts listed above or the device has not been maintained the NOxBOXimay not be suitable for use and you may be unable to
set-up the device. Failure to follow these procedures may result in harm to to the operator or the patient.

NOxBOXiOperating Instructions
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Setup
Engage trolley brakes to
stabilise system prior to use.
To attach monitor to trolley,
carefully drop the monitor
over the attachment plate.
Connect power supply to
suitable rated mains outlet.
Press power button to start
system.
Once zero test is complete,
follow instructions on
screen to set-up system.
Experienced users may
choose to skip directly to
system tests or skip to dose.
System test circuit set-up:
NOxFlowTM arrow points in
direction of ow. 1m vent
tubing between sample
point and NOxFlowTM.
Perform system
test to ensure correct system
functionality prior to
connecting to patient.
Connect to patient circuit;
sample near patient Y-piece.
Retain NOxFlowTM
orientation for ow and 1m
distance from sample point.
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Performaleaktest:openthe
cylindervalvethenclose.
Observegaugefor30
seconds,needleshould
remainsta>onary.
Engage trolley brakes to
stabilise system prior to
changing cylinder.
Check cylinder concentration
matches the setting for the
system.
Check regulator surfaces and
O rings are damage free. Do
not use damaged equipment.
Attach regulator to cylinder.
Screw rmly by hand. Attach
supply line to regulator.
Apply supply line to port on rear
of monitor
12 3
5
Slowly open cylinder valve.
Read gauge. If needle in red
zone, replace cylinder before
starting treatment.
Perform a leak test: open the
cylinder valve then close.
Observe gauge for 30
seconds, needle should
remain stationary.
4
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Cylinder setup
7
Load cylinders onto trolley.
Secure with straps.
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System tests
System test circuit set-up:
NOxFlow arrow points in
direction of ow. 1m vent
tubing between sample
point and NOxFlow.
Re-open NO cylinder.
Connect O2supply to
NOxFlowTM inlet. Set O2 ow
to 10 L/min. Press“Next” on
system screen to run test.
System test takes approx.
5 minutes to run. This purges
NO2and ensures correct
NOxBOXioperation.
System test passed. Stop O2 ow
and disconnect from NOxow.
Ready to connect to patient.
System test failed. Check:
NOxFlow orientation; O2
ow at 10 L/min, NO cylinder
connected and valve open.
Re-run test.
If not using in next 10 mins: Unit
may time out and may require
you to repeat step 4.
Connect to patient circuit.
Enter dose and check alarm
levels before commencing
treatment.
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Ventilator connections
The NOxFlowTM is single
patient use. Unwrap and
carefully uncoil the lines.
Push and click-to-lock twin
sensor line to unit.
Twist dose line luer to unit.
Select a vent connector with
luer port from the NOXKITTM.
Connect the male luer of the
sample line.
12 3 4
NOxFlowTM is situated in the inspiratory limb,
before the humidier.
The sample line is up to 30cm from patient to the patient Y-piece.
NOxFlow should be approx. 1 metre back from the sample
point. Ideal range 0.7 m – 1.3 m.
For system test, high frequency and manual bagging circuit
diagrams please refer to Technical Guide.
5
Change sample line and
hydrophobic iter.

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Dose setting & main screen features
The navigation tabs access the alarm history and user settings screens.
Alarm history: shows last 10 alarms for current treatment. Unresolved
alarms are listed at the top.
User settings: change user settings, access Manual Override
calculator, Sensor Zero and Service Engineer area.
To set or change dose press ‘edit
dose’ . The NOxBOXi will then
guide you through setting the
dose and high/low alarms. Once
conrmed the delivery and
monitoring will adjust
accordingly.
Maximum dose - 80ppm
Minimum dose - 0.1ppm
dose setting
edit dose
monitored gas
units
upper alarm
adjustment
upper alarm value
lower alarm
adjustment
lower alarm value
mute button (inactive)
monitored
value
supply
indicator
(depleated)
cylinder 2
supply concentration
supply
indicator
(gas available)
cylinder 1
time at
current dose
days:hours:mins
second timing marker
total treatment
time
days:hours:mins

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Cylinder replacement
Engage trolley brakes to
stabilise system prior to
changing cylinder.
Fully close cylinder valve.
Check regulator gauge
pressure is relieved and
remove regulator from
depleted cylinder.
Remove depleted cylinder from
trolley and replace with new
supply cylinder. Check the
concentration matches the value
displayed on-screen.
Check O rings and attach
regulator to new
cylinder.
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5
Perform a leak test: Slowly open
the cylinder valve then close.
Observe gauge for 30 seconds,
needle should remain
stationary.
Purge pressure from hose, then
reconnect the hose to inlet port
monitor. Open valve on cylinder
fully.
7 8
34
Performaleaktest:openthe
cylindervalvethenclose.
Observegaugefor30
seconds,needleshould
remainsta>onary.
6
Detach hose from monitor and
depressurise on purge needle.

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Conrm on-screen that
shutdown is required. Follow
on-screen instructions.
Fully close each cylinder and
depressurise the supply lines
using the purge needle.
Check regulator gauge
pressure is relieved and
remove regulator from each
cylinder and stow on system
trolley.
Remove all single patient use
devices from monitor and
dispose of according to local
regulations.
Drain water trap and dispose of
drainage syringe.
On completion of last
instruction screen, system will
purge and shutdown safely
ready for storage.
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Shutdown
Remove power supply and
store on trolley for transport.
Ensure system is attached to
suitable mains supply whilst in
storage.
8
When ready to shutdown the
system, briey press the power
button on the monitor.
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Troubleshooting Guide
ALARMS TROUBLESHOOTING
The NOxBOXiis equipped with audible and visible alarm notications; this chapter is a guide to the alarm conditions that can occur and common actions for alarm resolution. All alarms
are graded into high priority or medium priority alerts.
NOTE: In all instances of alarms sounding, the health and condition of the patient must be ensured before attempting to resolve any issue with the NOxBOXisystem.
Alarm Priorities
The system alarms are colour coded to help identify priority of detected issue. Additionally, the two alarm priorities each have an audible warning to help dierentiate them.
Priority Colour & Tone Meaning
High Red
5 tone pattern & Red L.E.D.
alarm strip.
Critical problem detected. Condition poses immediate threat to patient health or correct
functioning of the NOxBOXi monitor. Alarm condition should be diagnosed and resolved
immediately.
Medium Amber
3 tone pattern
Problem detected. Condition may impair the functioning of the NOxBOXi. If left unresolved, problem may
worsen and cause a high priority alarm condition.

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Notications at Switch on
The below are a series of notications which may be seen at start-up (before the home screen) if an issue is detected with the NOxBOXi.
Troubleshooting Guide
Notication Priority Possible Cause Recommended
NOxBOXi System
Diagnostics
High The NOxBOXi performs self-tests at start-up and during operation
to ensure safe performance is maintained. In the event that a
critical test fails, the system will display a full-screen notice
indicating that the system can no longer be used safely.
Press the on screen reset button.
Sensor Bias Lost High The Nitric Oxide sensor requires a constant very low trickle charge
to maintain its calibration. In the event that the system is not stored
on mains power charge, after an extended period of time the
battery may completely discharge and the sensors will lose their
calibration bias.
In the event of power loss, connect the unit to mains power and allow
6 hours for the unit to charge before
calibrating the NO sensor and re-commissioning the unit.
If another system is not readily available and patient
requires therapy, engage the manual override mode, replace the
system as soon as practically possible and alert the Service Engineer.
The Nitric Oxide sensor is sensitive to extreme
temperature variation, contact with VOCs (such as
alcohol based cleaning products), strong fragrances, direct contact
with moisture or vibrations (such as during transit in a vehicle).
Follow setup steps as normal, if sensor zero fails re
attempt until the unit passes, this can take up to 30
minutes in some cases.
The NO sensor may require replacing. If another system is not readily available and patient
requires therapy, engage the manual override mode, replace the
system as soon as practically possible and alert the Service Engineer.

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High Priority Alarms during therapy
The below are a series of alarms which may be seen during therapy (once the device has been setup) if an issue is detected with the NOxBOXi.
Troubleshooting Guide
Alarm Priority Possible Cause Recommended Action
NO Low High Monitored levels of NO gas being delivered to
the patient have dropped below the alarm
setting boundary. NOxBOXidelivery system
cannot maintain correct dose setting.
Check sample line is correctly attached to ventilator circuit and NOxBOXiwater trap inlet.
Check sample line for blockages.
Check water trap (including barrel thread) for damage and/or leaks.
Check no ventilator circuit breaks or leakages have occurred.
Check supply cylinder is connected, open; there are no leaks and the concentration matches the
system settings.
Check correct orientation of NOxFLOW.
Check NOxFLOW dose line and connection is connected and there are no blockages or leaks.
Check NOxFLOW ow detection lines and connection (including O rings) are connected and there
are no blockages or leaks.
The ventilator minute volume may be too low. Check ventilator minute volume (see NOxBOXitechnical guide for ow specications), you may
need to increase the ventilator bias ow.
The NO low alarm may be inappropriately set
by user.
Check NO low alarm value and reduce value if ventilator settings deem necessary.
The NO sensor may require replacing. If another system is not readily available and patient requires therapy, engage the manual
override mode, replace the system as soon as practically possible and alert the Service Engineer.
NO High High Monitored levels of NO gas being delivered to
the patient have risen above the alarm setting
boundary. NOxBOXi delivery system cannot
maintain the correct dose setting.
Check supply cylinder concentration matches the system settings. If possible, change the NO
supply cylinder for the correct concentration. If not, call Service Engineer to resolve.
Check no ventilator circuit break/leakage has occurred that may cause build-up of NO
concentration due to lack of ventilator ow.
Check correct orientation of NOxFLOW.
Check NOxFLOW connection (and O rings) to NOxBOXi.
The NO high alarm may be inappropriately set
by user.
Check NO high alarm value and increase value if ventilator settings deem necessary.
The NO sensor may require replacing. If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the Service
Engineer.

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NO2High Monitored levels of NO2gas being
delivered to the patient have risen
above the alarm setting boundary.
High NO dose settings on low ventilator ows with High O2content may cause higher NO2build-up than
expected. Increase ventilator bias ow to help reduce stagnation in delivery.
Poor quality NO cylinders can
contain high levels of NO2.
Connect a second supply cylinder to the alternate inlet port. Open the cylinder and
disconnect the previous cylinder, forcing a cylinder changeover to see if this resolves the issue.
The NO2 high alarm is set to a default
value of 1.0ppm. NO2 is extremely
toxic and poses risk to patient health.
The alarm value can be increased to a maximum of 5.0ppm if required. Please see INO guidelines for more
information on maximum NO2values during INO therapy.
Incorrect placement of
NOxFLOW and sample line.
See ventilator circuit diagram for correct placement of NOxFLOW and sample line.
Whilst in standby mode NO2can build
up in supply lines.
Purge supply lines (see cylinder change procedure).
Stagnant gas in manual bag circuit
causing NO2.
Purge manual bag circuit before connecting to
patient (see manual bagging procedure).
The NO2sensor may require
replacing.
If another system is not readily available and patient requires therapy, engage the manual override mode,
replace the system as soon as practically
possible and alert the Service Engineer.
O2Low High Monitored levels of O2 gas being
delivered to the patient have fallen
below the alarm setting boundary.
Check sample line for blockages.
Check water trap (including barrel thread) for
damage and/or leaks.
Check sample line is correctly attached to ventilator circuit and NOxBOXi water trap inlet.
Check no ventilator circuit breaks or leakages have occurred.
The NO gas is balanced in N2, this is
an asphyxiant gas. At high NO dose
levels for low concentration cylinders
(e.g. 200 ppm) the level of gas
delivered into the ventilator stream
can reduce the % v/v of O2being
delivered to the patient.
Check O2concentration setting at ventilator.
Adjust O2 alarm value if deemed necessary.
The O2sensor may require
replacing.
If another system is not readily available and patient requires therapy, engage the manual override mode,
replace the system as soon as practically possible and alert the Service Engineer.
Troubleshooting Guide

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NO2High Monitored levels of NO2gas being
delivered to the patient have risen
above the alarm setting boundary.
High NO dose settings on low ventilator ows with High O2content may cause higher NO2build-up than
expected. Increase ventilator bias ow to help reduce stagnation in delivery.
Poor quality NO cylinders can
contain high levels of NO2.
Connect a second supply cylinder to the alternate inlet port. Open the cylinder and
disconnect the previous cylinder, forcing a cylinder changeover to see if this resolves the issue.
The NO2 high alarm is set to a default
value of 1.0ppm. NO2 is extremely
toxic and poses risk to patient health.
The alarm value can be increased to a maximum of 5.0ppm if required. Please see INO guidelines for more
information on maximum NO2values during INO therapy.
Incorrect placement of
NOxFLOW and sample line.
See ventilator circuit diagram for correct placement of NOxFLOW and sample line.
Whilst in standby mode NO2can build
up in supply lines.
Purge supply lines (see cylinder change procedure).
Stagnant gas in manual bag circuit
causing NO2.
Purge manual bag circuit before connecting to
patient (see manual bagging procedure).
The NO2sensor may require
replacing.
If another system is not readily available and patient requires therapy, engage the manual override mode,
replace the system as soon as practically
possible and alert the Service Engineer.
O2Low High Monitored levels of O2 gas being
delivered to the patient have fallen
below the alarm setting boundary.
Check sample line for blockages.
Check water trap (including barrel thread) for
damage and/or leaks.
Check sample line is correctly attached to ventilator circuit and NOxBOXi water trap inlet.
Check no ventilator circuit breaks or leakages have occurred.
The NO gas is balanced in N2, this is
an asphyxiant gas. At high NO dose
levels for low concentration cylinders
(e.g. 200 ppm) the level of gas
delivered into the ventilator stream
can reduce the % v/v of O2being
delivered to the patient.
Check O2concentration setting at ventilator.
Adjust O2 alarm value if deemed necessary.
The O2sensor may require
replacing.
If another system is not readily available and patient requires therapy, engage the manual override mode,
replace the system as soon as practically possible and alert the Service Engineer.
Water Trap
Full
High Water trap is lled with condensate from sample line.
If the water trap is allowed to overow, the sample
path will block and water ingress to the NOxBOXi
system could damage the internal mechanisms and
gas sensors. Delivery accuracy is compromised and
patient safety could be put at risk.
Use disposable male-luer lock syringe contained in NOXKIT to empty uid from
water trap via the self-sealing drain tap located at the bottom of the water trap.
Dispose of entire syringe and contents according to local directives (e.g. sharps waste).
The water trap uses a small oat to activate the alarm, if no
moisture is present gently tap the barrel to see if the alarm oat is
in the o position.
If issues persist, remove the barrel and check position of alarm oat.
Removing the water trap barrel will dilute NO sample causing inaccurate dose and readings.
Take care not to damage/cross thread the water trap thread when
replacing the barrel.
Sample Line
block
High Sample line to monitor has become blocked, pinched
or occluded. Sample monitoring is
aected which may compromise deliveryaccuracy
and patient safety.
Check sample line for any pinch/crush points from external bodies, or blockages that may have
occurred.
Check water trap does not require emptying.
Change sample line and hydrophobic lter.
If another system is not readily available and patient requires therapy, engage the manual
override mode, replace the system as soon as practically possible and alert the Service Engineer.
Battery
Critical
High NOxBOXiis running from internal battery and battery
charge level has been detected as critical. System
power could fail within the next 10
minutes. Power failure will stop automatic
intelligent delivery of NO.
Reconnect the NOxBOXisystem to the mains using the NOxBOXipower supply. This will ensure
continued powered operation of the NOxBOXi and will start to recharge the internal battery.
Check green (mains power) L.E.D on mains power plug is lit indicating mains supply OK. If not,
try a dierent mains power socket/supply.
Disconnect power supply and reconnect, check blue (charging) L.E.D is lit indicating mains
supply OK. If not, try a dierent mains power/supply.
If possible replace NOxBOXipower supply and alert service engineer.
Troubleshooting Guide

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Troubleshooting Guide
In the event that no mains power can be restored to the device, be prepared to engage the
manual override mode.
Cylinder
Supply
Critical
High NOxBOXidetects that available NO gas
supply is running low, and no alternate
cylinder supply is detected. Without action to
replenish the NO gas supply treatment
delivery will cease.
Install a new gas cylinder supply and connect to the alternate gas inlet port at the rear of
NOxBOXi.
If a new gas cylinder is already installed, ensure the cylinder valve is fully open and
connected to inlet port at rear to allow the device to use the supply for delivery.
Check the supply cylinder regulator gauges indicate adequate cylinder pressure (>20bar). If
regulator gauge indicates adequate pressure, check for leaks. If issues persist, replace regulator and
alert service engineer.
Vent Flow
Idle
High The NOxFLOW has not detected any vent ow
activity for an extended period of time (typically
over 30 seconds) during delivery.
Check correct orientation of NOxFLOW; the green arrow printed on the NOxFLOW should be
pointing towards the patient in the direction of the ventilator ow.
Check NOxFLOW ow detection lines and connection (including O rings) are connected and there
are no blockages or leaks.
Check there is not a serious leak or break in the ventilator circuit. Attend to the ventilator circuit
requirements.
Check the ventilator is connected and supplying sucient ow.
Critical
Delivery
Fault
High The NOxBOXihas detected a critical fault within
the intelligent delivery system, and can no
longer guarantee safe delivery function.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
Occlusion on NO outlet. Check for occlusions on the NO outlet, delivery line or NOxFLOW. Once resolved, reset the dose to
resume delivery.
Touch screen
won’t
respond.
High The NOxBOXihas detected a critical fault within
the intelligent delivery system, and can no
longer guarantee safe delivery function. NO
delivery to the patient may have stopped.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.

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Troubleshooting Guide
Medium Priority Alarms during therapy
Alarm Priority Possible Cause Recommended Action
Zero
Calibration
Medium Every 24 hours during use the NOxBOXi prompts
the user to perform a sensor zero. This operation
ensures the most accurate system performance by
checking the gas sensor
reading performance.
NOTE: This test takes up to 2 minutes to perform.
During this time the monitored patient gases will
be oine. The NOxBOXicontinues to deliver NO
during this time.
No special connections are required; the zero calibration is fully automatic.
Press the tick to start the zero calibration.
The zero calibration can be delayed if the system is not currently in a stable dose delivery state:
e.g. If the patient dose has recently been changed and the system is still stabilising to the new
dose level, dismiss this alarm message and perform the zero when the notice next appears.
Zero
Calibration
Fail
Medium One or all of the sensors have failed the zero (low)
calibration.
Ambient conditions may be aecting the zero
sample.
Check ambient NOxAIR monitor for high levels of NO. If high levels are detected, check the
regulator(s) and supply line(s) for leaks.
A sensor may have become unstable or residual
gas may be present in the system.
Repeat zero calibration.
Check the zero port (rear) has not been blocked.
If another system is not readily available and patient requires therapy, engage the manual
override mode, replace the system as soon as practically possible and alert the Service Engineer.
Cylinder Low Medium This will appear when an alternate viable gas
supply is detected, but the current feed cylinder is
nearly depleted.
Replace the cylinder with a fresh supply to resolve this alarm.
Alternatively, once the cylinder is empty, close the cylinder valve fully, remove the feed hose from
the rear of the system and release the pressure using the purge needle on the monitor. Please
note, once the second cylinder begins to deplete, if this rst cylinder has not been
replaced in the interim period, the‘cylinder supply critical’ alarm will be triggered.

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Troubleshooting Guide
High
Calibration
Overdue
Medium To keep the NOxBOXifunctioning accurately, it is
important that the system sensors be fully calibrated by
a suitably qualied Service Engineer once a month.
The system records the last date of each successful
calibration in the service engineer section.
This action may be performed whilst the system is in use via the service
engineer area. However Bedfont strongly recommend that the sensor high
calibrations are not performed during therapy to minimise risk to the patient.
To resolve, the system sensors must be calibrated by the appointed Systems Engineer using
calibration gases.
Manual
Override
Medium Manual Override mode is engaged.
The system alarms to alert the user that the system is not
delivering in intelligent mode. Changes to the ventilator
setting or patient demand cannot be automatically
corrected on the system. A specic dose setting cannot
be dialled in and achieved.
The patient must be closely monitored and ensure the
gas alarms are correctly set to alert for any
abnormal gas delivery behaviour.
This alarm will resolve when the system is returned to normal Intelligent
Delivery Mode.

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General Troubleshooting
Issue Possible Cause Recommended Action
NOxBOXiturns on and o
immediately. NOxBOXi
attempts to start up but shuts
down.
NOxBOXiwon’t turn on at all.
Low battery power. Connect NOxBOXito mains power and turn on NOxBOXi.
Check mains power is connected and battery is charging (see battery critical).
An internal fault has occurred; the system shuts
down to protect integral components.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
Zero Calibration Fail One or all of the sensors have failed the zero (low)
calibration.
Ambient conditions may be aecting the zero
sample.
Check ambient NOxAIR monitor for high levels of NO. If high levels are detected, check the
regulator(s) and supply line(s) for leaks.
One or all of the sensors may have become unstable
or residual gas may be present in the system.
Repeat zero calibration.
Check the zero port (rear) has not been blocked.
If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
System Test Fail The NOxBOXihas failed the safety test and
cannot accurately deliver and monitor Nitric Oxide
inintelligent mode.
Check the Oxygen source is owing.
Check the NOxFLOW is connected to the Oxygen source and the NOxBOXi-TEST kit.
Check the correct orientation of NOxFLOW.
Check the NOxFLOW is connected to the NOxBOXi.
Check NOxFLOW ow detection lines and connector O rings for damage.
Check sample line is connected to the water trap and the NOxBOXi-TEST kit.
Check water trap (including barrel thread) for damage.
Repeat the system test.
If second test fails, replace the NOxFLOW and sample line.
One or all of the sensors may have become unstable. If another system is not readily available and patient requires therapy, engage the
manual override mode, replace the system as soon as practically possible and alert the
Service Engineer.
Fluctuations/ Oscillations in
excess of 3ppm.
May be due to noxow. Ensure O-ring and NOxFLOW are present and connected.
Mass ow sensor due for service. Contact Service Engineer.
HFO frequency. Adjust the frequency slightly based upon your clinical judgement.

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Conventional ventilator circuit
NOTE: To improve accuracy it is recommended to have up to 30cm between the patient Y-Piece (8) and the sample line (7).
1. Ventilator
2. Ventilator Inspiratory Port
3. NOxFLOWTM (use 22F or 15M to vent tube adaptors)
4. Humidier
5. 0.7m-1.3m Corrugated Tubing (15mm or 22mm)
6. NOxBOXi Sample Line
7. 10M - 10F, 12M - 12F, 15M - 15M luer port or 22M-22F luer port connector
8. Patient Y-piece
9. Expiratory limb
10. NOxBOXi

NOxBOXiOperating Instructions
®
19
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Manual override
NOTE: All dose information for the Manual Override are
approximations. Monitoring must be used to ensure the
patient is receiving the correct dose.
B
If Manual Override is required:
First check suitable ow rate is set.
Then engage mode selection valve to the
position seen on right hand side image.
2
A
A
B
B
Using on-screen
calculator access the
manual override
calculator from Settings.
Adjust vent ow to best match
patient settings. Table displays
approx. dose per valve setting.
Use the look-up tables in this
guide. To set ow rate, nd the
table matching NO
supply concentration.
Find the vent ow setting to
best match patient settings.
The column lists the approx.
dose per valve setting.
A
AB
To set ow rates
1
OR
600
B

NOxBOXiOperating Instructions
®
20
www.noxboxltd.com
All dose information shown in these tables is for guidance only. The patient monitored gas levels should be used for actualy dose delivery information. All nitric oxide (NO) doses shown in parts per million
(ppm) when introduced to continuous ow rates indicated. Doses of NO above 40 ppm are not recommended. Doses above 20ppm are considered clinically high.
Flow valve setting Minute ow volume
Clinder Concentration (ppm)
800
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50 73 38 26 20 16 13 11 9.9 8.8 7.9 7.2 6.6 6.1 5.7 5.3 5 4.7 4.4 4.2 4 3.8 3.6 3.5 3.3 3.2 3.1 3 2.8 2.7 2.7 2.6 2.5 2.4 2.3 2.3 2.2 2.2 2.1 2 2
100 133 73 50 38 31 26 22 20 17 16 14 13 12 11 11 9.9 9.3 8.8 8.3 7.9 7.5 7.2 6.9 6.6 6.3 6.1 5.9 5.7 5.5 5.3 5.1 5 4.8 4.7 4.5 4.4 4.3 4.2 4.1 4
200 229 133 94 73 59 50 43 38 34 31 28 26 24 22 21 20 18 17 16 16 15 14 14 13 13 12 12 11 11 11 10 9.9 9.6 9.3 9 8.8 8.6 8.3 8.1 7.9
300 300 185 133 104 86 73 63 56 50 45 41 38 35 33 31 29 27 26 24 23 22 21 20 20 19 18 17 17 16 16 15 15 14 14 13 13 13 12 12 12
400 356 229 168 133 110 94 82 73 65 59 54 50 46 43 41 38 36 34 32 31 29 28 27 26 25 24 23 22 21 21 20 20 19 18 18 17 17 16 16 16
500 400 267 200 160 133 114 100 89 80 73 67 62 57 53 50 47 44 42 40 38 36 35 33 32 31 30 29 28 27 26 25 24 24 23 22 22 21 21 20 20
600 436 300 229 185 155 133 117 104 94 86 79 73 68 63 59 56 53 50 48 45 43 41 40 38 37 35 34 33 32 31 30 29 28 27 27 26 25 24 24 23
1000
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50 91 48 32 24 20 16 14 12 11 9.9 9 8.3 7.6 7.1 6.6 6.2 5.8 5.5 5.2 5 4.7 4.5 4.3 4.1 4 3.8 3.7 3.6 3.4 3.3 3.2 3.1 3 2.9 2.8 2.8 2.7 2.6 2.6 2.5
100 167 91 63 48 38 32 28 24 22 20 18 16 15 14 13 12 12 11 10 9.9 9.4 9 8.6 8.3 7.9 7.6 7.4 7.1 6.8 6.6 6.4 6.2 26 5.8 5.7 5.5 5.4 5.2 5.1 5
200 286 167 118 91 74 63 54 48 43 38 35 32 30 28 26 24 23 22 21 20 19 18 17 16 16 15 15 14 14 13 13 12 12 12 11 11 11 10 10 9.9
300 375 231 167 130 107 91 79 70 63 57 52 48 44 41 38 36 34 32 31 29 28 27 25 24 23 23 22 21 20 20 19 18 18 17 17 16 16 16 15 15
400 444 286 211 167 138 11 8 103 91 82 74 68 63 58 54 51 48 45 43 40 38 37 35 34 32 31 30 29 28 27 26 25 24 24 23 22 22 21 21 20 20
500 500 333 250 200 167 143 125 111 100 91 83 77 71 67 63 59 56 53 50 48 45 43 42 40 38 37 36 34 33 32 31 30 29 29 28 27 26 26 25 24
600 545 375 286 231 194 167 146 130 118 107 98 91 85 79 74 70 66 63 59 57 54 52 50 48 46 44 43 41 40 38 37 36 35 34 33 32 31 31 30 29
WARNING: Dose >40 ppm Dose over 20ppm
Minute Volume (L/Min)
Minute Volume (L/Min)
Dial
Dial
Minute Volume (L/Min)
Dial
500
0.5 1 1.5 2 2.5 3 3.5 4 4.5 5 5.5 6 6.5 7 7.5 8 8.5 9 9.5 10 10.5 11 11.5 12 12.5 13 13.5 14 14.5 15 15.5 16 16.5 17 17.5 18 18.5 19 19.5 20
50 45 24 16 12 9.8 8.2 7 6.2 5.5 5 4.5 4.1 3.8 3.5 3.3 3.1 2.9 2.8 2.6 2.5 2.4 2.3 2.2 2.1 2 1.9 1.8 1.8 1.7 1.7 1.6 1.6 1.5 1.5 1.4 1.4 1.3 1.3 1.3 1.2
100 83 45 31 24 19 16 14 12 11 9.8 8.9 8.2 7.6 7 6.6 6.2 5.8 5.5 5.2 5 4.7 4.5 4.3 4.1 4 3.8 3.7 3.5 3.4 3.3 3.2 3.1 3 2.9 2.8 2.8 2.7 2.6 2.6 2.5
200 143 83 59 45 37 31 27 24 21 19 18 16 15 14 13 12 11 11 10 9.8 9.3 8.9 8.5 8.2 7.9 7.6 7.3 7 6.8 6.6 6.4 6.2 6 5.8 5.6 5.5 5.3 5.2 5.1 5
300 188 115 83 65 54 45 39 35 31 28 26 24 22 21 19 18 17 16 15 15 14 13 13 12 12 11 11 10 10 9.8 9.5 9.2 8.9 8.7 8.4 8.2 8 7.8 7.6 7.4
400 222 143 105 83 69 59 51 45 41 37 34 31 29 27 25 24 22 21 20 19 18 18 17 16 16 15 14 14 13 13 13 12 12 11 11 11 11 10 10 9.8
500 250 167 125 100 83 71 63 56 50 45 42 38 36 33 31 29 28 26 25 24 23 22 21 20 19 19 18 17 17 16 16 15 15 14 14 14 13 13 13 12
600 273 188 143 11 5 97 83 73 65 59 54 49 45 42 39 37 35 33 31 30 28 27 26 25 24 23 22 21 21 20 19 19 18 18 17 17 16 16 15 15 15
Dial
Minute Volume (L/Min)
Dose look-up table
1000ppm, 900ppm, 800ppm, 500ppm