O-Two Equinox Advantage User manual

Made in Canada by O-Two Medical Technologies Inc.
Part Number: 15PL2183 Rev.15 Feb, 2021
USER MANUAL
Equinox® Advantage
NITROUS OXIDE/ OXYGEN
ADMINISTRATION SYSTEM
01EQ2000

3
Equinox® Advantage - User manual
TABLE OF CONTENTS
1. Introduction 4
1.1. Indications for Use 4
1.2. Contraindications 4
1.3. Product Description/Principles of Operation 4
1.4. Warranty Information 5
1.5. Safety Precautions 6
1.6. Performance Specifications 7
2. Preparation for Use 8
2.1. Component List 8
2.2. Pre-Use Functional Checks 8
3. Operating Instructions 10
3.1. Connection of Hoses 10
3.2. On/O Selector 12
3.3. Gas Mixture Selection 12
3.4. Demand Valve 13
3.5. 100% Oxygen Enrichment Supply 13
3.6. Low Input Pressure Alarms 13
3.7. Low Input Pressure Shut O 14
4. Preventive Maintenance And Servicing 14
4.1. Routine Maintenance 14
4.2. Cleaning 16
5. Schematic Flow Diagram 17
6. Replacement Parts & Accessories 18

4Equinox® Advantage - User manual
1. Introduction
1.1. Indications for Use
The Equinox® Advantage N2O/O2Analgesic Gas Mixing and
Delivery System is intended to administer an adjustable mixture
of Nitrous Oxide analgesic gas and Oxygen, on demand, to a
conscious, spontaneously breathing patient.
The device is suitable for use in:
• Pre-hospital (emergency medical) use, and
• In-hospital use (ER, Labor and Delivery etc.)
1.2. Contraindications
The contraindications for this device include, but may not be
limited to:
• Hypersensitivity to the medication
• Head injuries with impaired consciousness
• Maxillofacial injuries
• Artificial, traumatic or spontaneous pneumothorax
• Air embolism
• Middle ear occlusion, ear infection
• Decompression sickness
• Abdominal distension / intestinal obstruction
1.3. Product Description/Principles of Operation
Two input connectors are provided on the device for the
connection of pressure regulated gas sources of nitrous oxide and
oxygen. The device has only one control for turning ON or OFF.
When it is turned ON, the output of N2O/O2gas mixture will only
be activated by an inspiratory eort by the patient. The output
of gas mixture can be selected among various percentages from
25%/75% (O2/N2O) to 100%/0% (O2/N2O).
The gas specific built-in alarm systems will generate both visual
and audible alarms should either the nitrous oxide or oxygen
input fall below 40 PSI, and the device will be automatically shut
Note: Nitrous Oxide/Oxygen (N2O/O2) mixtures must never
be used in any condition where air is trapped in the body and
expansion (up to 3x original size) would be dangerous. For
example, it will exacerbate pneumothorax and increase pressure
from any intracranial air. Air in any other cavities such as the
sinuses, middle ear and abdomen may also expand.

5
Equinox® Advantage - User manual
1.4. Warranty
Note: The O-Two Equinox® Advantage System is considered a
critical device, and its components considered critical components.
Only those individuals trained in the operation of nitrous oxide/
oxygen analgesic gas delivery systems should use this equipment.
Thoroughly review the instruction manual before use.
o should the oxygen input fall below 35 PSI. Both visual indicator
and audible alarm circuits for both gasses are powered by oxygen
only to prevent dumping nitrous oxide gas into atmosphere during
alarm cycling.
If Oxygen Supply runs out or shuts o, the device will automatically
shut o; however the device will continue to provide atmospheric
room air on demand to the patient.
An Oxygen Enrichment function allows the healthcare professional
to provide a constant flow of 100% oxygen to the patient.
WARRANTY
O-Two Medical Technologies Inc. products are manufactured from
the finest quality materials. Each individual part is subject to strict
quality control tests to ensure exceptionally high standards. The
manufacturer warrants to the purchaser of the O-Two Equinox®
Advantage N2O/O2Analgesic Gas Mixing and Delivery System
that its component parts are free from defects in material and
workmanship for a period of two years from the date of purchase.
The manufacturer will replace and /or repair all parts of the device
at its option for two years from the date of purchase at no cost to
the purchaser, upon the notification of the defects, in writing by
the purchaser. All shipping costs shall be borne by the purchaser.
The manufacturer shall be liable under this warranty only if the
device and its parts have been used and serviced in the normal
manner described in the instruction manual. There are no other
expressed or implied warranties. This warranty gives no specific
legal rights. You may also have other rights which may vary
according to local regulations.

6Equinox® Advantage - User manual
1.5. Safety Precautions
The O-Two Equinox® Advantage is a self-administered device
intended to administer an adjustable mixture of nitrous oxide
analgesic gas and oxygen, self-administered on demand, to a
conscious, spontaneously breathing patient.
The following precautions should always be observed:
WARNING
1. Do not smoke or use near open flame either during operation
or when changing the cylinder.
2. Never allow oil or grease to come into contact with any part
of the cylinder, regulator or Equinox® Advantage System. Gas
mixer has been degreased for oxygen service prior to delivery.
3. Equinox® Advantage System is designed for patient self-
administration.
4. Never attach the facemask to the patient using a head harness.
5. If the alarm sounds continuously, immediately discontinue use
and shut o the gas supply.
6. It is recommended that an oxygen monitor be used with this
device to monitor the gas output. However, if there is a concern
that the device has not undergone regular maintenance, at the
prescribed intervals, in accordance with this manual, then an
oxygen monitor shall be used.
7. It is recommended to use cylinders that are at least 1/4 full.
8. Medical gases must be dry and free from dust and oil.
9. The nitrous oxide cylinder should be operated in an upright
position. If the nitrous oxide cylinder is in a valve-down position
while the post valve is open, liquid may be expelled through
the vent passages. This liquid, nitrous oxide, can cause burns
by freezing on exposed skin.
10. Always turn on cylinder valve slowly and fully.
11. When not in use, always turn o the cylinder.
12. After use, always ensure that a gas cylinder with sucient
volume is attached before returning the unit to its normal
storage position.
13. After use, always ensure that all components are cleaned in
accordance with the instructions provided in this manual.
CAUTION:

7
Equinox® Advantage - User manual
1.6. Performance Specifications
14. Do not disassemble any part of the unit except where
described in this manual as any unauthorized disassembly will
invalidate the warranty.
15. Before use on a patient, the oxygen concentration of the
delivered gas should be checked at the setting intended for use.
16. Us federal law restricts this device to sale by or on the order
of a physician.
Minimum Flow rate 120 L/min
Exhalation Resistance 0 to 6 cmH
2
O @ 60 L/min
Inhalation Resistance 0 to -6 cmH
2
O @ 60 L/min
Oxygen Concentrations
(±5%V/V at Minimum Demand Flow 20 L/min) 25, 40, 50, 60, 70, 75, 90, 100%
Input Pressure 50 to 70 PSI (3.5 - 4.8 Bar)
Low Input Pressure Alarm 40 ± 1 PSI (2.7 Bar)
Device Cut-o Pressure 35 ± 2 PSI (2.4 Bar)
Demand Valve Triggering Pressure -1.5 to -2.5 cmH
2
O
Oxygen Enrichment Flow 30 ± 5 L/min
Operating Temperature 41
0
F to 104
0
F (5
0
C to 40
0
C)
Storage Temperature -40
0
F to 140
0
F (-40
0
C to 60
0
C)
Device Input Connections Nitrous Oxide: CGA1040 DISS Oxygen: CGA1240 DISS
Supply Hose Connections Refer to Section 6
Patient Connector 15/22 mm
Patient Circuit (Single use) Dual limb circuit with one-way valves and 19 mm
Scavenging Port Connection on the exhalation limb
Patient Valve Dead Space 32 ml
Weight 4.4 lb. (2.0 Kg)
Dimensions W x D x H 9.27”x7.6”x4.4” (236x194x112mm)

8Equinox® Advantage - User manual
2. Preparation for Use
2.1. Component List
Ensure that all the following components have been received:
1. Operating Manual
2. O-Two Equinox® Advantage System
3. Single Use Patient Circuit with Mouth Piece
4. Oxygen Supply Hose
5. Nitrous Oxide Supply Hose
If any components are missing from the shipping carton, call the
supplier immediately.
2.2. Pre-Use Functional Checks
Along with the contents of the shipping cartons you will require
the following items to enable you to undertake the pre-use
functional check:
• Nitrous oxide and oxygen pressure sources with 60 PSI output
capable to provide a minimum of 100 L/min at no less than 42
PSI (2.9 Bar).
• Vacuum generator w/30 L/min flowrate
Leak test
Having connected the supply hoses (ISO 5359 compliant) to the
regulators (refer section 3.1 for CONNECTION OF HOSES), ensure
that the O-Two Equinox® Advantage System ON/OFF selector is
in the OFF position and turn on the N2O and O2Gas source. Using
a mild soap solution, spray the input connections to the device to
check for leaks. If any leak is present, tighten the connection and
re-test. Once no leakage is confirmed, turn the ON/OFF control to
the ON position.
Reverse gas flow test
Equinox® Advantage is designed to meet “reverse flow”
requirement of ISO 11195. It is recommended to test the reverse
flow as follows before use:
Connect one gas at a time to the corresponding input connector,
spray the other input connector, no bubbles allowed from this
connector.

9
Equinox® Advantage - User manual
Function test
The following features of Equinox® Advantage System can be
individually tested or measured using calibrated pressure gauge
and flowmeter during the pre-use Functional Check:
1. Demand Valve Function
Apply a vacuum to the patient connector equivalent to a flow
rate of 30 L/min for a minimum of 1 second. The demand valve
will provide a flow rate equivalent to that demanded. Remove
the vacuum from the patient connector; the flow from patient
connector should stop.
Note:
1. Ensure performing this test using the single use patient circuit
for this device otherwise the demand valve will free flow.
2. The vacuum source can be as simple as a 1 Liter gas calibration syringe.
Note: To fully test this function it is necessary to have a supply
regulator with an adjustable output pressure and a release valve
(Not supplied). Checking of the alarm can be undertaken by
simply slowly closing the cylinder valve.
2. Low Input Pressure Alarms
With the adjustable outlet pressure regulator set with an outlet
pressure of 50 PSI, gradually reduce the outlet pressure of the
regulator to around 40 PSI while slowly releasing the gas until
you hear the Low Input Pressure Alarm activate. For the nitrous
oxide alarm the pulsed tone frequency is set at a low frequency
of approximately 60 BPM. For the low oxygen alarm, the pulsed
tone frequency is set at high frequency of approximately 120 BPM.
When low pressure alarm is activated, the Gas Supply Status
Indicator should cycle at the same rate of the alarm.
3. Low Input Pressure Shut O
Continue decrease oxygen regulator outlet pressure to around 35
PSI, the device should be automatically shut o.
4. Oxygen Enrichment Button
When pressed with the ON/OFF switch set to ON, Oxygen should
flow out of the patient circuit.

10 Equinox® Advantage - User manual
5. Oxygen Concentration
The percentage of the oxygen concentration of the delivered gas
can be determined by the following procedure:
A. Connect an oxygen monitor to the output connector of the
Advantage using a T-Connector (as shown in Fig 2).
B. Utilizing a 1 Liter gas calibration syringe, connect the syringe
to the patient connection on the patient circuit connected to T-
connector (as shown in Fig 2). Turn on the Advantage unit, select
the 100% O2setting and activate the demand valve by cycling the
syringe until the oxygen reading on the monitor has stabilized
C. Repeat step “b’ for the remaining settings and confirm that the
oxygen concentration reading falls within the following ranges for
each setting:
Setting Acceptable Range
25% 21 - 35
40% 30 - 50
50% 40 - 60
60% 50 - 70
70% 60 - 80
75% 65 - 85
90% 80 - 100
100% 90 - 100
Note: Factory calibration of this device uses a +/- 5% V/V
tolerance. These Pre-Use tests are designed for the user to confirm
function and accuracy of the device while taking into account
dierences in test equipment and test procedures that may aect
the results obtained. Any devices with results outside of the
tolerance stated in the chart should be returned to an authorized
service center for checking.
3. Operating Instructions
3.1. Connection of hoses
The Equinox® Advantage System is designed to operate on
medical nitrous oxide and oxygen from either pressure regulated
medical gas cylinders or “piped-in” systems. The inlet fittings on
the device are non-interchangeable fittings specifically for nitrous
oxide and oxygen.

11
Equinox® Advantage - User manual
Note: Using a wrench or excessive force when tightening the
supply hose may damage the seal of the thread of the connection.
The device is designed to operate under 50 – 70 PSI (3.5 - 4.8 Bar)
input pressures for both N2O and O2gas supplies.
In case of failure in gas input systems, Equinox® Advantage is
equipped with internal pressure regulators that can handle input
pressure up to 1.5 times the design input pressure without having
damage to internal components.
The nitrous oxide supply hose provided shall be attached to the
N2O input connection on the left side of the device when facing
it. The oxygen supply hose provided shall be attached to the O2
input connection on the right side of the device. Tighten the supply
hoses “Finger tight” only – DO NOT USE A WRENCH (fig 1).
1. Attach the input
hoses to the device.
Fig.1 Connecting the Supply hoses and Patient Circuit
2. Attach a new
patient circuit
to the device.
The patient circuit is attached to the gas outlet on the front panel
of the control module by simply pushing the 22 mm taper over the
outlet.

12 Equinox® Advantage - User manual
3.2. ON/OFF Selector
ON/OFF SELECTOR controls the device in either normal operating
function or shut o.
3.3. Gas Mixture Selection
The gas mixture selection knob allows the user to choose among
8 combinations of Oxygen and Nitrous Oxide mixtures as follows:
Setting 1 2 3 4 5 6 7 8
O2% 25 40 50 60 70 75 90 100
N2O % 75 60 50 40 30 25 10 0
To monitor the output of the N2O/O2mixture, an oxygen monitor
with alarm should be used on the inspiratory line of the patient
circuit. The monitor “Tee” piece is to be placed on the outlet of the
mixer prior to the circuit being attached (fig 2).
Fig. 2 - Connecting the Oxygen Monitor
Note: Placing an oxygen monitor in the above location will remove
the additional monitoring line from becoming an issue for the
patient if the “tee” piece is placed proximal to the facemask.
Additionally, the one-way valve system in the O-Two Equinox®
circuit will prevent expired air from reaching the monitor.
Equinox®
Advantage
Oxygen
Monitor

13
Equinox® Advantage - User manual
3.4. Demand Valve
The device is equipped with a Demand System enabling
spontaneously breathing patients to demand preselected mixture
percentage of nitrous oxide and oxygen.
An inspiratory eort by the patient will open the demand valve
and preselected percentage mixture of nitrous oxide and oxygen
will flow to the patient at a rate in line with their inspiratory eort.
3.5. 100% Oxygen Enrichment Supply
If at any time 100% Oxygen Enrichment is desired, press the
Oxygen Enrichment button to activate “100% Oxygen” supply.
The Oxygen Enrichment function is designed to provide 30 L/min
of 100% oxygen in order to flush any residual gas from the patient
circuit following the completion of the patient treatment.
When the device ON/OFF switch is set to the “OFF” position
or the device not connected to an oxygen supply, the Oxygen
Enrichment function is disabled.
3.6. Low Input Pressure Alarms
Gas Supply Status Indicators
Located on the front panel, the O2visual indicator shows green when
oxygen is supplied to the unit and N2O visual indicator shows green
when nitrous oxide is supplied to the unit. Used in conjunction with
the Low Input Pressure alarms, these indicators provide additional
reference for the operator as to the gas supply status.
Low Input Pressure Alarms
The alarm system will generate a 45 to 75 BPM visual (flashing
Green/Black) and an audible alarm should nitrous oxide input drop
to 40 PSI. Should the oxygen input pressure drop to 40 PSI, a 90
to 150 BPM visual (flashing Green/Black) and audible alarm will be
generated.
WARNING
The Oxygen Enrichment function should never be used to provide
positive pressure ventilation to non-breathing patients.

14 Equinox® Advantage - User manual
3.7. Low Input Pressure Shut O
The device will automatically shut o should oxygen input pressure
drop to 35 PSI. This indicates that the drive gas is now exhausted to
the point where the device will no longer function correctly.
When only oxygen is applied, the device will not shut o, and an
audible alarm will be activated with cycled N2O visual Indicator.
When only nitrous oxide is applied, the device will automatically shut
o with O2gas supply indicator showing black and no audible alarms
activated. However the Equinox® Advantage will continue to allow
the patient to breathe through the device on atmospheric room air.
4. Preventive Maintenance and Servicing
4.1. Routine Maintenance
To ensure proper operation of the O-Two Equinox® Advantage,
regular inspection and checking of the device and accessories for
correct function should be undertaken by a responsible member
of sta. It is recommended that a preventive maintenance record
be maintained for each unit.
It is recommended that the routine preventive maintenance be
carried out and the Equinox® Advantage mixer be returned to
O-Two Medical Technologies or its authorized service center for
maintenance and service every 2 years as follows:
Monthly checking
This check is to ensure that all of the accessories and device
components are present, the nitrous oxide and oxygen cylinders
are full and that the device is in working order.
The device should be checked for proper function and mixing
percentage (oxygen concentration) at least every six months, and
more frequently in high use applications. Units with test pressures
outside of the ranges listed in the product specifications should
not be used.
Any malfunction unit should be returned to the manufacturer or
an authorized service center since this product is not designed for
field disassembly or service. Unauthorized repairs will nullify the
product warranty.

15
Equinox® Advantage - User manual
Level II service
The device shall be returned to the manufacturer or a service
center authorized by the manufacturer for bi-annual Level II
service every 2 years.
Manufacturer full service
The device shall be returned to O-Two Medical Technologies for
Manufacturer Full Service every 6 years.
Description Procedure Criteria Schedule By
PM Visual
inspection
User Manual
Chapter 4.1
Monthly checking
Device in work order,
gas tanks are full,
no missing item Monthly User
PM Leak test User Manual
Chapter 2.2 No leak observed Every 6 months User
PM Function
check
User Manual
Chapter 2.2
[1] - [5] Within specification Every 6
months User
Servicing Level II
service Service manual Meet product specifications Every 2 years Manufacturer/ service center
Servicing Full service Service manual Meet product
specifications Every 6 years Manufacturer

16 Equinox® Advantage - User manual
4.2. Cleaning
Routine cleaning of the device shall be undertaken to maintain the
device in a clean condition.
Patient circuit with mouth piece of the device is intended for single
use and shall be discarded after each patient use in accordance
with local protocols and replaced with a new circuit.
All other components should be wiped clean with a mild soap
solution or hard surface disinfectant suitable for the materials of
manufacture of the device. Under no circumstances should the
complete unit be allowed to be soaked or immersed in cleaning
solutions.
Detailed cleaning procedures are as follows:
1. Ensure that the device is disconnected from the gas supply
source.
2. Remove N2O and O2input hoses and wipe clean with a mild
soap or hard surface disinfectant. Ensure no cleaning solution
enters the hoses.
3. Remove the single patient use circuit from the device and
dispose of safely in accordance with local protocols.
4. The enclosure of the device can be wiped over with a soft
cloth and mild soap solution or hard surface disinfectant.
Ensure no cleaning solution enters the input fittings. If there
is ingrained contamination a soft bristled brush may be used.
5. Dry all components thoroughly.
6. Attach a new patient circuit and connect the unit to gas supply
to check function prior to packaging for emergency use.
WARNING
Do not attempt to clean and sterilize any components that are
designated as disposable.

17
Equinox® Advantage - User manual
5. Schematic Flow Diagram
N2O Low P
Alarm
O2
Regulator
N2O
Regulator
O2Low
P Alarm
Second
Regulator Gas Mixer Demand Valve
Low P Shut
O 
ON/OFF
Control
O2Flush
(If provided)
Patient
N2O
O2

18 Equinox® Advantage - User manual
ORDER N0PART
01CV8028-Cs
O-Two Single-Use Analgesic Gas Patient Circuit with
Scavenger Hose and Adapter with Mouthpiece
(Case/10)
17MP1997 90o(Male to Female) adjustable Oxygen DISS elbow
17MP1998 90o(Male to Female) adjustable Nitrous Oxide DISS elbow
01FM4999 Universal Facemask (Case/12)
6. Replacement Parts & Accessories
ORDER N0PART
01FV4303-AFNR O-Two 6 Foot (1.85 Meter) O2Supply Hose with AFNOR
probe and 9/16” DISS Nut Device Connection
01FV4303-AGA O-Two 6 Foot (1.85 Meter) O2Supply Hose with AGA
probe and 9/16” DISS Nut Device Connection
01FV4303-CZCH O-Two 6 Foot (1.85 Meter) O2Supply Hose with CZECH
probe and 9/16” DISS Nut Device Connection
01FV4303-DIN O-Two 6 Foot (1.85 Meter) O2Supply Hose with DIN
probe and 9/16” DISS Nut Device Connection
01FV4303-DISS O-Two 6 Foot (1.85 Meter) O2Supply Hose with 9/16
DISS Nut and 9/16” DISS Nut Device Connection
01FV4303-UNFR O-Two 6 Foot (1.85 Meter) O2Supply Hose with UNIFOR
probe and 9/16” DISS Nut Device Connection
01FV4303-BM O-Two 6 Foot (1.85 Meter) O2Supply Hose with BRITISH
probe and 9/16” DISS Nut Ventilator Connection
Oxygen Hoses*

19
Equinox® Advantage - User manual
ORDER N0PART
01FV4303-AFN-N2O
O-Two 6 Foot (1.85 Meter) N2O Supply Hose with
AFNOR Gas Supply Fitting and N2O DISS Nut
Device Connection
01FV4303-AGA-N2O
O-Two 6 Foot (1.85 Meter) N2O Supply Hose with
AGA Gas Supply Fitting and DISS Nut Device
Connection
01FV4303-CZCH-N2O
O-Two 6 Foot (1.85 Meter) N2O Supply Hose with
Czech Gas Supply Fitting and DISS Nut Ventilator
Connection
01FV4303-DIN-N2O O-Two 6 Foot (1.85 Meter) N2O Supply Hose with
DIN Nut and DISS Nut Device Connection
01FV4310
O-Two 6 Foot (1.85 Meter) N2O Supply Hose with
DISS Gas Supply Fitting and DISS Nut Device
Connection
01FV4303-UNF-N2O
O-Two 6 Foot (1.85 Meter) N2O Supply Hose with
UNIFOR Gas Supply Fitting and DISS Nut Device
Connection
01FV4303-BM-N2O
O-Two 6 Foot (1.85 Meter) N2O Supply Hose with
BRITISH Gas Supply Fitting and DISS Nut Device
Connection
Nitrous Oxide hoses*
*Select the hose connection type for the country of use.

Your Representative is:
O-TWO MEDICAL TECHNOLOGIES INC.
For your nearest Authorized O-Two Distributor
In North America call Toll Free 1-800-387-3405
MedNet EC-REP GmbH
Borkstrasse, 10
48163 Münster, Germany
EC REP
SERIAL N
0
:
www.otwo.com
45A Armthorpe Road, Brampton, ON, Canada, L6T 5M4
Telephone: [phone]-OTWO (6896) N.A. Toll Free: [phone]
Facsimile: [phone] Email: [e-mail]