Plymouth Nitronox Plus User manual

Nitronox Plus®
Quick Start Guide
Quick Steps to Start the System
1. Using the cylinder wrench attached to your unit’s basket, turn the
nitrous oxide tank yoke valve on first by slowly turning the cylinder
wrench counter-clockwise (left) to fully open the flow of the tank
until you cannot open it further. Next turn the oxygen tank on by
turning the cylinder wrench counter-clockwise (left) to fully open the
flow of the tank.
2. Once both gas tanks are turned on, ensure the O2 supply pressure
and N2O supply pressure are within the green bands on the supply
line pressure gauges (45-60 psi). DO NOT USE DEVICE IF
EITHER OF THE PRESSURE GAUGES ARE NOT WITHIN THE
45-60 PSI GREEN ZONE.
3. Next, ensure that the mixture pressure gauge (center) is within the
green zone (30-40 psi). DO NOT USE DEVICE IF MIXTURE
PRESSURE GAUGE IS NOT WITHIN THE 30-40 PSI GREEN ZONE.
4. Place a patient circuit onto the front inlet and connect mouthpiece
or mask to blue tubing. Ensure the magenta tubing is pointed away
from patient/provider(s).
5. Turn the N2O Key Lock to the ON position to start administering
the gas mixture.
6. Set the desired concentration of nitrous oxide by adjusting the “%
N2O” dial on the front of the device. It is recommended to start with
a low percentage of N2O (30%) and titrate upwards until the desired
effect on the patient is achieved. The 50/50 model is not adjustable
and will deliver a preset 50%N2O/O2 mixture. If, at any time, delivery
of 100% O2 is desired, turn the “%N2O” dial to 0%, then turn the
N2O Key Lock to the OFF position. This will close the internal nitrous
oxide valve and supply the patient with 100% O2.
PLYMOUTH MEDICAL
135 PLYMOUTH ST, SUITE 410
BROOKLYN, NY 11201
TEL – 888.392.5076
FAX – 888.392.1455
WEB – PLYMOUTHMEDICAL.COM
COPYRIGHT © 2020 PLYMOUTH MEDICAL LLC. ALL RIGHTS RESERVED. V3-01-22

Nitronox Plus®
Quick Start Guide
Instructing the Patient
The Nitronox Plus® System provides a 50%:50%, 0-50% or
0-70% ratio of oxygen to nitrous oxide gas; the gas mixture is
used to treat pain and anxiety during medical procedures.
Patient must hold the mouthpiece/mask themselves. If they
are unable, choose alternate method of pain control. Have
patient hold the circuit hose and instruct patient to maintain a
seal with mouthpiece or mask while breathing in and out.
Pain-relief will occur within 30-90 seconds of breathing through the mouthpiece with deep
breaths. The anxiolytic effect of gas mixture will dissipate within 3-5 minutes of the last
inhalation. To ensure safety, watch the patient for 10 minutes post-use.
The following are examples of instructions to give the patient when they are about to use the
Nitrous Oxide Delivery System for the first time.
“Take the hose with the mouthpiece. When you feel pain/anxiety starting, or when instructed, hold
the mouthpiece in your mouth and take slow deep breaths. You will hear the pain-relief gas being
delivered. Keep the mouthpiece in your mouth as you breathe in and out. Within a few breaths you
will start to feel more relaxed, and the pain will be lessened. You may also feel a little bit dizzy and
your voice may sound different.”
“If you feel nauseous, remove the mouthpiece and breathe deeply from the room air. The feeling will
quickly go away.”
“The gas mixture will not completely remove the pain, but should make it less intense and more
tolerable.”
“When the pain lessens, remove the mouthpiece from your mouth and breathe normally. Keep the
mouthpiece ready so you can use it during your next pain/anxiety event during your procedure.”
PLYMOUTH MEDICAL
135 PLYMOUTH ST, SUITE 410
BROOKLYN, NY 11201
TEL – 888.392.5076
FAX – 888.392.1455
WEB – PLYMOUTHMEDICAL.COM
COPYRIGHT © 2020 PLYMOUTH MEDICAL LLC. ALL RIGHTS RESERVED. V3-01-22

Quick Steps to Shut Down the System
1. Turn the N2O knob to 0%.
2. Turn the N2O Key Lock to the OFF position.
3. Turn the oxygen tank off first by slowly turning the cylinder wrench clockwise (right) to
fully open the flow of the tank
4. Next turn the nitrous oxide tank off by by slowly turning the cylinder wrench clockwise
(right) to fully open the flow of the tank
5. Note the visual gas indicators on the front of the mixer will stay green as there is still
gas in the lines - no need to bleed the lines.
6. Take the patient circuit off the mixer front inlet and dispose of the circuit, magenta &
mouthpiece/mask (if used).
7. Wipe the mixer off with disinfectant / sani-cloth (do not spray product directly on device).
8. The system is now shut down which should be done at the end of each day.
9. We recommend removing the keys and storing them in a secure place.
PLYMOUTH MEDICAL
135 PLYMOUTH ST, SUITE 410
BROOKLYN, NY 11201
TEL – 888.392.5076
FAX – 888.392.1455
WEB – PLYMOUTHMEDICAL.COM
COPYRIGHT © 2020 PLYMOUTH MEDICAL LLC. ALL RIGHTS RESERVED. V3-01-22
Nitronox Plus®
Quick Start Guide

Changing Gas Cylinders
When either oxygen or nitrous oxide gas supply pressure drops to approximately 35 psi (2.41
bar), a whistle alarm will sound to alert the user. Check the line pressure gauges to confirm
which gas is low and then replace that cylinder immediately following these steps:
1. Use the cylinder wrench to turn the yoke valve clockwise to firmly close the low cylinder.
(You may want to close the opposite cylinder while performing although it is not necessary.)
2. Turn the regulator T-bar counter-clockwise to loosen the regulator from the cylinder. Lift
the regulator off the yoke and replace the cylinder. Ensure the regulator still has the nylon
washer around the gas inlet. There is no need to undo or loosen any other connections.
3. Remove any protective wrap from around the yoke of the new cylinder. Remove any FULL
tags from new cylinder once you begin using it.
4. Place the regulator over the yoke of the new cylinder, lining up the index pins and gas inlet
so they slide into their receiving holes.
5. Hand-tighten the regulator T-bar (clockwise, to the right) so the regulator is firmly attached
to the cylinder yoke.
PLYMOUTH MEDICAL
135 PLYMOUTH ST, SUITE 410
BROOKLYN, NY 11201
TEL – 888.392.5076
FAX – 888.392.1455
WEB – PLYMOUTHMEDICAL.COM
COPYRIGHT © 2020 PLYMOUTH MEDICAL LLC. ALL RIGHTS RESERVED. V3-01-22
Nitronox Plus®
Quick Start Guide

6. Use the cylinder wrench to slowly open the cylinder yoke valve by turning the valve counter-
clockwise. Keep turning the cylinder wrench until it will not turn any more. Do not force.
7. Listen for leaks at the yoke and at either end of the hose. Tighten connections as required.
8. Check the cylinder pressure on the regulator gauges. A full nitrous oxide tank will read
approximately 750 psi. A full oxygen tank will read approximately 2000 psi.
9. Note the individual N2O and O2 visual gas indicators should be between 45-60 psi. The
mixture pressure gauge (center) should be within 30-40 psi (green zone). DO NOT USE DEVICE
IF NOT MIXTURE PRESSURE GAUGE IS NOT WITHIN THE 30-40 PSI GREEN ZONE.
10. Always ensure you have at least 1 back up tank of nitrous oxide gas and oxygen for
procedures. You will go through 3 oxygen tanks to every 1 nitrous tanks per below.
11. The device is ready for use.
ALWAYS LISTEN FOR LEAKS AT THE CONNECTIONS (HISSING SOUND). IF A LEAK IS
DETECTED, TIGHTEN THE FITTING TO THE REGULATOR (T-BAR) WHERE THE HOSE
SCREWS INTO THE SIDE OF THE TANK/DEVICE.
IF WHISTLE ALARM SOUNDS, DISCONTINUE PATIENT USE IMMEDIATELY AND SHUT OFF
GAS SUPPLY.
DO NOT USE DEVICE (O2 & N2O ON) IF MIXTURE PRESSURE IS OUT OF GREEN BAND, INTO
RED BAND OR IF NEEDLE MOVES SIGNIFICANTLY BELOW GREEN BAND DURING
EACH INSPIRATION (26 PSI OR LOWER) (SEE "MAINTENANCE" IN MANUAL).
For any questions, please contact our Clinical Education Team via phone [phone] Ext 3.
or email [email protected].
PLYMOUTH MEDICAL
135 PLYMOUTH ST, SUITE 410
BROOKLYN, NY 11201
TEL – 888.392.5076
FAX – 888.392.1455
WEB – PLYMOUTHMEDICAL.COM
COPYRIGHT © 2020 PLYMOUTH MEDICAL LLC. ALL RIGHTS RESERVED. V3-01-22
Nitronox Plus®
Quick Start Guide