Ramsey Medical petMAP+ II User manual

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NowyourpetMAP+II
canmeasureETCO2

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ThismanualappliestotheoperationoftheCO2Module(REF#9027),
availableasanoptionwiththepetMAP+II multi‐parametermonitor.The
CO2ModulerequiresapetMAP+IItobeuseful.Readthismanualandthe
petMAP+IImanualcompletelybeforeusingtheequipment.
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petMAP+IIistobeoperatedbyqualifiedpersonnelonly.Beforeuse,
familiarizeyourselfwiththedeviceandreadthemanuals,includingall
warningsandcautions.TheusershouldcheckthatthepetMAP+II,along
withitsaccessories,isfunctioningbothsafelyandeffectivelypriortouse.
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COPYRIGHT©2012‐2018RamseyMedical,Inc.
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Allrightsreserved.Noportionofthismanualmaybereproducedwithout
thewrittenpermissionofRamseyMedical,Inc.

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CO2ModuleOPERATOR’SMANUAL
TABLEOFCONTENTS
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Page
Introduction
DeviceDescription  5
IntendedUses5
Configurations&Accessories 6
Symbols,Warnings&Cautions  7
EMCDeclaration10
DeviceOverviewandOperatingInstructions
Controls&Connections  11
OperatingInstructions/
UserSelections12
Alarms16
Maintenance18
Troubleshooting19
Warranty/Service20
Specifications21
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5
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INTRODUCTION
DeviceDescription
petMAP+IIisasmall,lightweightandportablebatteryoperated
monitoringdevicedesignedforveterinaryuse.Initsvariousbaseunit
configurations,itiscapableofmeasuringbloodpressure(systolic,diastolic
andmeanarterialpressures),heartrate,temperatureandoxygen
saturation(SpO2).Themeasuredvaluesaredisplayedandtrendedonthe
devicecontinuously.DatatrendedonthepetMAP+II canoptionallybe
savedonaSDmemorycardviathepetMAP+II’sintegratedSDmemory
cardslot.
ModulesforECGandCO2canalsobepurchasedandaddedtothebase
unit.
TheCO2ModuleincorporatesamainstreamtypeofCO2sensorforuseon
intubatedpatientsandallowsthepetMAP+IItodisplaythecapnographas
wellastheCO2values:ETCO2(EndTidalCO2),InspCO2(InspiredCO2),
RtCO2(RealtimeCO2)andRRCO2(RespirationRatefromtheCO2
waveform).TheCO2sensorresidesontheairwayandhasanine‐foot
cablethatplugsintotheconnectorlabeled“CO2”onthesideofthe
petMAP+II.TheModuleincludestwoairwayadapters,oneforlarger
endotracheal(ET)tubesandoneforsmallerETtubes.
IntendedUses
petMAP+IIisintendedforuseonveterinarypatientswhenmeasuringor
monitoringofbloodpressure,heartrate,temperatureand/orSpO2is
desired.WhenconfiguredwithamainstreamCO2Module,thepetMAP+II
willalsodisplaytheCO2waveform,CO2valuesandRRCO2.Itcanbeused
onawidevarietyofveterinarypatients,butisprimarilydesignedfor
companionanimals.WhenequippedwiththeCO2module,petMAP+IIcan
beusedonanesthetizedpatientswithETtubes.Applicationsincludeuse
forsurgical,ICUandtraumamonitoringaswellasuseduringprocedures
(imaging,dentals,etc.)inwhichanETtubeisused.

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Configurations&Accessories
Thefollowingtablesummarizesthestandardaccessoriesandoptional
accessoriesavailableforthepetMAP+IICO2Module:
ProductCodeDescription
Standard
Accessories
(included
withthe
Module)
9027
CO2Module
CO2mainstreamsensor with
ConnectorCable(≈9’)
2airwayadapters(large&small)
Operator’sManual
9034 LargeAirwayAdapter
9035 SmallAirwayAdapter
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SYMBOLS
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CautionSymbol ConsultManualSymbol
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WARNINGS&CAUTIONS
(Pleasereadandunderstand) 
ThepetMAP+IIanditsCO2ModuleareintendedforVETERINARY
USEONLY.Donotuseonahumanpatient.
 TheusershouldbeawarethaterroneousmeasurementofETCO2
duetoanycause(eg.,improperlyplacedorsecuredETtube,airway
disconnect,equipmentorsensordamage,excesshumidityinthe
ventilationcircuit,electronicfailure,etc.)couldleadtopotentiallylessthan
effectiveorinappropriateventilatoradjustmentsorotherinappropriate
changesorinterventions.AlwaysconfirmthattheCO2monitoringsystem
issetupandconnectedproperlyandcorrelateunexpectedorunexplained
changesinCO2/capnographreadingswiththeclinicalcircumstancesand
environmentandanarterialbloodgasmeasurementcomparison.
 UseofanElectrosurgicalUnit(ESU)canpotentiallyresultin
interferenceontheCO2traceandtheCO2numericvalues.IfESU
interferenceadverselyimpactstheCO2waveform,donotusetheCO2
datauntiltheCO2waveformhasbeenstablefor10secondsormoreafter
ESUuse.TheBPandSpO2aretypicallynotadverselyaffectedbyESU
usage,butundercertaincircumstancestheESUcouldadverselyaffect
them.AlwaysassurethattheESUgroundplateiswellplacedonthe
patientandplaceddistantfromtheECGelectrodes.
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 ThefollowingfactorscaninfluencetheETCO2measurement:
nitrousoxide,elevatedoxygenlevels,barometricpressure,vaporor
patientsecretions,halogenatedagents,aerosolizedpharmaceuticalsor
nitricoxide.
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Donotusethemoduleifitdoesnotrespondasitisintendedand
expectedtoperform,ifitiswetordamp,orifthemoduleorthecableor
theconnectorappearstohavebeendroppedordamagedinanyway.
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AlossoftheETCO2reading,anacutechangeintheCO2readingor
waveformoradiminishedreadingorwaveformmaybetheresultof
excessivemoistureorsecretionsonthetwoairwayadapter“windows”
thataretheinfraredlightpaththatisusedtomeasuretheCO2level.
Removetheairwayadapterfromthemonitoringcircuitandobserveif
thereismoistureonthe“windows”.Ifso,cleananddryexcessmoisture
andsecretionsfromtheinsideoftheairwayadapter,takingcarenotto
damagetheclear“windows”oftheadapter.Alwayskeeptheinfrared
"windows"inverticalpositionandlevelwithorabovethepatientsothat
secretionsdonotdrainintothesensor.
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 DonotstoretheCO2Moduleattemperatureslessthan14degrees
Forgreaterthan131degreesF.Donotoperatethesensorat
temperatureslessthan50degreesForgreaterthan104degreesF.
 DonotimmersetheCO2sensorinwateroranyliquid.IftheCO2
sensorisaccidentallywetted,itshouldbethoroughlydriedbeforeuse.If
theCO2Modulehasbeendroppedintowaterorotherfluid,itshouldnot
beusedandshouldbereturnedtothemanufacturerforservice.Never
sterilizeorimmersethesensorinliquids.
 IftheCO2Sensorhasbeendroppedordamagedinanyway,it
shouldbecheckedbyqualifiedservicepersonneltoensureproper
operationpriortouse.
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 UseofaccessoriesotherthanthosespecifiedbyRamseyMedical
mayresultindangertothepatient,malfunctionofthemonitoringunit,
andadditionalincreasedelectro‐magnetic(EM)emissionsordecreasedEM
immunityofthedevice.
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 Followlocalgoverningordinancesandrecyclinginstructions
regardingdisposalandrecyclingofdevicecomponentsandpackaging

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ThepetMAP+IIisnotintendedforuseonpatientsbeingimaged
withanMRIdevicesincethepetMAPdevicecontainsmagneticallyactive
materialsandcouldresultininjuryifusedorplacedtooclosetoanMRI
device,eveniftheMRIisnotoperating,sincetheMRImagnetisstillactive
evenifnotinuse.
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Donotgassterilizeorautoclavethedevice.
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EMCDECLARATION
TheCO2Module(REF#9027)hasbeentestedtogetherwiththepetMAP+II
asasystem.PleaserefertothepetMAP+IIManual(R400257)fordetailed
EMCcomplianceinformation.

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DEVICEOVERVIEW&OPERATINGINSTRUCTIONS
Controls&Connections.Notethebelowdiagramforconnectingthe
CO2ModuletothepetMAP+IIandthepatient’srespiratorycircuit.
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2. AttachthecabletothepetMAP+II.
Listenforthesoft“click”thatindicates
fullinsertion.
3. Insertanairwayadapterintothe
breathingcircuit.Examples:
1. Locatetheconnector
labeled“CO2”onthesideof
thepetMAP+II,takingcare
toavoidpluggingtheCO2
connectorintothelarger
ECGconnector.
NOTE:IfaREF#9028petMAP
coverisinuse,lifttheflapto
revealtheconnector.
Y
(optional)

12
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OperatingInstructions/UserSelections.
Note1:TheCO2Moduleisshippedwiththelargeairwayadapterattached
tothesensor.Thesensorhasbeen“zeroed”withthatairwayadapter
attachedpriortoshipmentandshouldnotneedtobezeroedagainbefore
use.However,anytimetheairwayadapterischangedonthesensor,the
sensormustbe“zeroed”withthenewairwayadapterinplace.
Zeroingthesensor:
1. EnsurenoCO2gasisintheairwayadapter.
2. AccesstheCO2sensorzeroscreenonthepetMAP+IIsetupmenu
bypressingandholdingyourfingeronbottomleftquadrantofthe
touchscreenwhilepoweringONthepetMAP+IIwiththepower
button.Releasethetouchscreenatthecountof10toenterthe
CO2sensorzeroingmode.
3. Observetheon‐screenmessagesforwarm‐upandzeroing.Both
warm‐upandzeroingshouldcompletewithin2minuteseach.
4. WaitforthepetMAP+IItoreport“FinishedZeroing”onthe
display—thepetMAP+IIwillautomaticallypowerOFF.Powerthe
petMAP+IIunitONandturnontheCO2function.Verifythe
displayedinstantaneousCO2value(nottheETCO2CO2)is0or1,
andifnot,re‐zerothedevice.

3. Attachthesensortothe
airwayadapter.
****Notethattheairwayand
sensormustbeintheupright
verticalpositionasshown.
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13
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Note2:DuringtheCO2warm‐upperiod,thepetMAP+II’sprogrammed
altitudeisdisplayedandshouldbeconfirmedbytheusertobeacceptably
closetotheiractualaltitude(orelevation).ThepetMAP+IIunitissetby
defaultattimeofmanufacturetoassumeauseraltitudeof1000feet(304
meters)whichwillgiveCO2accuracywithin+/‐3mmHgforuseraltitudes
anywherefromsealeveltoapproximately2000feet(610meters).For
bestaccuracyofCO2measurement,theuser’scurrentaltitudeshouldbe
setusingtheSetAltitude/Time/Dateoption#6onthesetupmenu(seethe
petMAP+IIOperator’sManualforinstructionstogetintotheset‐upmenu
orrefertotheinstructionsabove).This#6setupoptionwillallowtheuser
tosettheelevationtothenearest100feet(30meters)whichwill
eliminatethepotentialsmalloffsetsmentionedaboveiftheuseris
substantiallydifferentfrom1000feet(304meters)altitudeprogrammedin
asthedefaultaltitudeattimeofmanufacture.Afterchangingthealtitude,
theunitwillretainthenewaltitudeuntilitischangedbytheuseragain.


14

1) Followtheearlierinstructionsforinstallinganairwayadapterand
placingtheCO2sensorontheadapter.

2) TurnCO2ONbypressingthe
highlightedCO2ON/OFFbutton
onthepetMAP+II.




3) ThisisthepetMAP+IIscreen
displayastheCO2sensoris
warmingup.Oneshouldallow
5minutesforwarm‐up—note
themessagecountsdownfrom
5minutes.Notealsothat
duringthiswarm‐uptimeno
alertsaredisplayedorsounded.
Thewarm‐upmessagealso
displaysthealtitudesetting.To
changethealtitude,pleaserefer
tothepetMAP+II Operator’s
Manualandinstructions,above.







15

4) Whenthewarm‐upis
complete,thepetMAP+II
displaywilllooklikethisif
Pg_4isselected,displaying
thecapnograph,ETCO2
valueandRRCO2
(RespirationRatefrom
CO2).InspCO2(Inspired
CO2)andRtCO2(Realtime
CO2)arealsodisplayed.



5) Pg_3isanalternate
displayformatshowinga
shorttrendoftheBPand
othervaluesinaddition
totheETCO2,RRanda
shortercapnograph.
NOTE:Alternatedisplays
areachievedbytouching
thescreenareainthe
lowerportionofthe
screenabovethebottom
rowofbuttons
repeatedlyuntilthe
desireddisplayis
reached.



6) Whenmonitoringis
complete,turnCO2OFF
bytouchingtheONCO2
button.


16

AlarmsGeneratedbytheCO2MonitoringSystem
Thefollowingalarms(NoBreath,LowCO2andHighCO2)canbegenerated
bytheCO2ModuleanddisplayedonthepetMAP+II toalerttheuserto
veryabnormalCO2conditions.
NOTE: ThelevelschosenforhighandlowETCO2alarmtriggerpointsare
designedsolelyasabackupforavigilantuser,toalerttheuseriftheyhave
inadvertentlyfailedtopreviouslydetectanadversepatientCO2levelor
trend.Consequently,itisimperativefortheusertounderstandthatthe
absenceofaCO2alarmdoesnotmeanthatthepatient’sCO2is
appropriateoracceptableforthatpatient,andthepresenceofanalarm
shouldnotbeviewedasanythingbutanalertthatCO2levelshavetrended
waybeyondthenormallyexpectedCO2ranges.Asalways,theuseris
expectedtodetectCO2problemsandcorrectthemlongbeforethealarms
havebeentriggered.ForalloftheCO2alarms,thereisastartupdelayof
approximately5minutesduringthewarm‐upperiodwherenoalarmswill
sound.Afterwarm‐up,thereisadelaybeforesoundingtheCO2alarmsof
approximately20secondstoallowtheusertodetectandcorrectCO2
conditionswithoutthedisturbanceofthealarmactuallysoundingandalso
topreventannoyinginappropriatealarmsfortransienteventsoruser
initiatedchangesinCO2monitoringsetup.
CO2isanimportantparametertomonitorforassessingthepatient’s
ventilationandphysiologicstatusduringanesthesia,anditsroutineuseis
highlyrecommendedbymonitoringexperts.However,CO2monitoring
canbesomewhatcomplexduetoitsabilitytoindicatemajorandminor
problemswiththepatient’sbreathing,thepatientscardiovascularstatus,
thepatient’smetabolicstatus,theventilationsetup/equipmentanduser
techniques.Becauseofthiscomplexity,theusershouldeducate
themselvesthoroughlyintheCO2monitoringprocedureandthe
interpretationoftheCO2valuesandCO2waveforms.Therearemany
resourcesinprint,invideoandontheinternetthatteachcapnographyuse
andinterpretation.TheuserofthepetMAP+IICO2Moduleisurgedtoavail
themselvesoftheseeducationalresourcesearlysothattheyareeducated
inCO2monitoringandinterpretationbeforeusingthedeviceonactual
patients.

17

ALARMS
NoBreathingCO2
TheCO2capnographwaveformamplitude
isinsufficientforbreathstobedetected.

Possiblecausesinclude:theventilatoris
notfunctioningproperly,thereisa
ventilationtubingdisconnect,theETtubeis
notinthepatientorthepatientisnot
breathingforwhateverreason,etc,etc.

Identifyandcorrecttheproblem.
HighEndTidalCO2

DisplayedwhenETCO2>60mmHg

Thiscanbecausedbythepatientnotbeing
adequatelyventilatedduetoairway
problems,ventilationtubingproblems,
ventilatorsettings,baggingfrequency
and/orbyaproblem/malfunctionwiththe
ventilationsystemincludingthesetup,the
valves,theCO2absorberorother
components.RefertoCO2monitoring
educationalmaterialforallcausesand
cures.

Identifytheproblem(s)andcorrect.
LowEndTidalCO2
DisplayedwhenETCO2<15mmHg

Thiscanbecausedbythepatientbeing
overventilatedduetoventilatorsettings,
baggingfrequencyand/orbya
problem/malfunctionwiththeventilation
systemincludingthesetup,thevalves,the
CO2absorberorothercomponents.Refer
toCO2monitoringeducationalmaterialfor
allcausesandcures.

Identifytheproblem(s)andcorrect.

Alarmscanbesilencedbytouchingthescreen.
Theabovealarmsareself‐cancelingwhenthecauseofthealarmis
resolved.

18

MAINTENANCE
CO2SensorandConnectionCable:Cleanasneededwithacloth
dampenedwith70%isopropylalcoholorotherdisinfectantsolution.Do
notimmersethesensororcablesinanyfluidanddonotsterilizethe
sensor.
AirwayAdapter:Theairwayadaptercanbecleanedwithwaterandmild
detergentandmustbethoroughlyrinsedandfullydryinsideandout
beforeuse.The“windows”mustbeclearandwithoutmoistureor
contaminationofanykind.Shakingtheairwayadapterwillhelptoremove
waterfromtheinsideoftheadapter.
Note:Forthesensortofunctionproperly,thetwoclearsensor“windows”
ontheinnerportionofthesensoritselfandontheairwayadaptermustbe
cleanandfreeofcontaminantsofanysort,includingdust,dirt,grease,or
moisture.AnythingonthesensororairwaywindowswillrendertheCO2
readingerroneous,uselessandpotentiallydangerouslyinaccurate.



19

TROUBLESHOOTING
Note:Alwayscheckthepatientconditionfirstbeforeworkingtocorrect
anyperceivedmonitoringproblems!TheperceivedproblemwiththeCO2
readingandcapnogrammonitorsmaybeduetoapatientproblem,suchas
notbreathingproperlyornotbeingventilatedproperlywhichneedstobe
detectedandremediedimmediately.Alwayscrosscheckotherpatient
statusinputswhenthereisaperceivedproblemwithanymonitor.
FailuretodisplayausableCO2waveformandclinicallyappropriate
numberscanbecausedbyanumberofproblemsandcanusuallybefixed
bycorrectingoneormoreofthefollowingtechnical/equipmentproblems
afterpatientproblemshavebeendetectedandeliminated:
1) IstheCO2sensorproperlyconnectedtotheCO2connectoron
thepetMAP+II?
Trydisconnectingitandthenreconnectingitmakingsurethatitisinthe
“CO2”connector(notthe“ECG”connector)andthatitissecurelyseated
andisproperlyretainedintheunitifgentlypulled.
2) AretheCO2sensorandairwayadapterproperlyplacedin
theventilationcircuit?
Makesurethesensorisconnectedinthebreathingcircuitclosetothe
patient’sairway(ETtube)andifaventilatorisbeingused,makesurethe
sensorisclosetothepatientandbetweenthepatientandthe“Y”ofthe
ventilator.Confirmthattheventilationcircuitandallofitselementsare
properlyplacedandsecurelyconnected.
3) Istheautomaticventilator(orthe“bagger”)functioning
properly?
Makesurethattherespiratoryrateandvolumearesetcorrectlyandare
functioningproperly.


20

WARRANTY/SERVICE
Warranty
RamseyMedical,Inc.warrantsthattheCO2Module,whennew,iscovered
byaone‐yearwarrantyagainstdefectsinmaterialsandworkmanship.All
warrantiesbeginatthedateoforiginalpurchasefromCardioCommand,
Inc.oritsauthorizeddistributors.
Airwayadaptersarewarrantedtobefreefromdefectsinmaterialsand
workmanshipfor90days.Theseitemswillrequireperiodicreplacement
duetonormalwear.
RamseyMedical’sobligationunderthiswarrantyislimitedtorepairingor,
atitsoption,replacingdefectivepartsorentireunitswithoutcharge,if
suchdefectsoccurasaresultofnormalusewithpromptnotification
withinthewarrantyperiod.
Damageresultingfrominappropriateuseorphysicalabuseisnotcovered
bythewarranty.
THEREARENOWARRANTIESWHICHEXTENDBEYONDTHOSEEXPRESSLY
LISTEDABOVE.INADDITION,THEREARENOWARRANTIESOF
MERCHANTABILITYORFITNESSFORAPARTICULARPURPOSE.
CustomerService&Repairs
Allunitsreturnedforserviceand/orrepairs(warrantyandnon‐warranty)
musthaveaRMAobtainedbycallingCustomerServiceat
CardioCommand,Inc.TheRMAnumberobtainedshouldbewrittenonthe
outsideoftheshippingcontainerandthedeviceshouldbesentto:
CardioCommand,Inc.
4920W.CypressSt.,Ste.110
Tampa,FL33607
Phone:800‐231‐6370
813‐289‐5555
Fax: 813‐289‐5454
Pleaseincludeacompletedescriptionofthedifficultywithallitems
returnedforserviceand/orwarrantyclaims.