Vortran GO2VENT 6123 User manual
05/26/2017
GO2VENT™
VORTRAN®Automatic Resuscitator with Manometer
Unique single patient, multiple-use disposable emergency resuscitator
VORTRAN®GO2VENT™ for patient body weight of 10 kg and above
Model 6123
TABLE OF CONTENTS
Table of Contents .................................................................................1
I. Functional and Operational Characteristics ......................................2
Figure 1 – GO2VENT™ Component Description .................................2
II. Clinical Considerations...................................................................3
Table 1- Estimated Tidal Volume (ML) Delivered................................3
Figure 2 - Airway Pressures - PIP & PEEP .........................................6
III. Protocol: Setup Instructions - GO2VENT™ ........................................7
IV. Cautions and Warnings..................................................................12
V. GO2VENT™ Competency ................................................................13
VI. Frequently Asked Questions ...........................................................14
VII. Clinical Reference .........................................................................20
VIII. Coding Information.......................................................................25
IX. Product Information......................................................................25
X. Troubleshooting............................................................................26
XI. Quick Guide.................................................................................27
USER’S GUIDE
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OPERATIONAL CHARACTERISTICS
I. Functional and Operational Characteristics
The gas-powered GO2VENT™ provides constant flow, pressure cycled automatic
ventilatory support for both breathing and non-breathing patients. The primary
working mechanism of the GO2VENT™ (refer to Figure 1) is the [1] modulator
with [a] peak inspiratory pressure (PIP) and the [b] breathing rate adjustment
dials, which includes an exhalation valve that opens at one pressure (PIP) and
closes at another lower pressure (PEEP). The remaining components of the
GO2VENT™ consist of the [2] pressure manometer, [3] FiO2Control Knob, [4]
patient connection port, [5] redundant pressure pop-off valve, and [6] one-way
valve for entraining additional air.
The pulmonary modulator provides the actual ventilatory support. The primary
working mechanism of the pulmonary modulator is the diaphragm. The
diaphragm is spring loaded, designed like a pressure pop-off valve except the
spring force is adjustable (the [a] PIP Dial).
Figure 1
GO2VENT™ Component Description
Recommended body weight ................................................. 10 Kg and above
Ventilatory frequency...................................... Auto-adjusting to lung capacity
Adjustable PIP range............................................................10 to 45 cm H2O
PEEP.................................................................. 1/5th of PIP (2 to 9 cm H2O)
Inspiratory resistance .................................................. 3 ± 1 cm H2O / L/ sec
Expiratory resistance ................................................... 3 ± 1 cm H2O / L/ sec
Dead space ..................................................................................4 ± 3 mL
Operating environmental limits....................................................-18 to 50 oC
Storage environmental limits ......................................................-40 to 60 oC
Patient connection..........................................Ø15 mm female, Ø22 mm male
Gas inlet ......................................................................DISS gas connection
Oxygen delivery...................................>85% O2when supplied with 100% O2
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II. Clinical Considerations
The GO2VENT™ provides short term, pressure cycled, and constant flow
ventilatory support for either breathing or non-breathing patients. This allows
the patient to receive consistent and reliable ventilatory support. Because the
GO2VENT™ is pressure cycled, changes in the patient’s lung compliance will
cause a change in the patient’s breathing rate. The GO2VENT™ is positional
sensitive. Final adjustments should be made with the GO2VENT™ in its
secured operating position. The GO2VENT™ is pressure cycled on inhalation
and exhalation (PIP and PEEP) which minimizes the possibility of gas trapping.
During inhalation, exhalation will not start until PIP is reached. During
exhalation, inhalation will not begin until pressure drops to PEEP. For the
spontaneously breathing patient, the rate dial of the GO2VENT™ is set so the
baseline pressure is above the intrinsic PEEP allowing the patient to initiate
inhalation by drawing the baseline pressure down to the set PEEP. Because the
GO2VENT™ is a constant flow pressure cycled device, changes in patient
compliance will result in changes in the respiratory rate (stiffer or smaller
compliances produce faster rates). The advantage of this minimizes the danger
of barotrauma. It should be emphasized that the GO2VENT™ is to be used only
by trained personnel who continuously monitor the patient. The GO2VENT™ is
not an ICU stand-alone ventilator with multiple monitoring features.
Setup and use of the GO2VENT™ is simple (refer to Setup Instructions in Section
III on page 7). Set desired flow (Q), adjust PIP pressure dial to obtain desired
inspiratory time (tinsp) to attain tidal volume (TV = Q x tinsp see Tidal Volume
Table 1). The gas flow, patient’s lung compliance, and PIP settings control the
inspiratory time and tidal volume. Then adjust rate dial to obtain desired
breathing rate.
Table 1 – Estimated Tidal Volume (mL) Delivered at
Various Flow (L/min) and Inspiratory Time (Seconds)
Flow
(L/min) Inspiratory Time (Seconds)
0.5 1 1.5 2 2.5 3
15 125 250 375 500 625 750
20 167 333 500 667 833 1000
25 208 417 625 833 1042 1250
30 250 500 750 1000 1250 1500
35 292 583 875 1167 1458 1750
40 333 667 1000 1333 1667 2000
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II. Clinical Considerations (continued)
The GO2VENT™runs on a continuous gas flow (inspiratory flow) of 6 to 40 L/min
depending on patients’ inspiratory flow demand. When connected to a 50 PSIG
gas source, the GO2VENT™will automatically deliver 40 L/min (667 mL/second)
per ASTM Guideline1. Delivered tidal volume may be determined by multiplying
the flow in mL/second and the inspiratory time in second, or by using the
estimated tidal volume table.
The rate dial controls exhalation time (texhl), and when dialed down enough will
cause the GO2VENT™ to stop cycling automatically (infinite exhalation time).
Under these circumstances, the GO2VENT™ is delivering pressure supported
ventilatory support and the patient must trigger the GO2VENT™ to begin
subsequent full inhalations. If the patient is apneic or pressure control
ventilation is desired, restart automatic cycling of the GO2VENT™ by adjusting
the rate dial counterclockwise until cycling begins again. Whenever the
GO2VENT™stops cycling, the first step in the absence of obvious clinical factors,
is to check if it is in pressure support mode by rotating the rate dial counter
clockwise (out). If rotating the rate dial counter clockwise substantially (3 or 4
turns) does not start automatic cycling, the patient’s airway may be occluded or
a very large leak exists.
The PIP may be adjusted from 10 and 50 cm H2O. The PEEP is intrinsic to the
device which ranges from 2 to 9 centimeters and is directly proportional to the
set PIP. Inspiratory time and rate are adjustable over a wide range. Changes in
the PIP setting or flow will also affect the respiratory rate. It is important to
check all settings when making a change to any of these three variables (flow,
PIP and rate). For example: reducing the PIP setting may cause the GO2VENT™
to go into spontaneous breathing mode. Adjust the rate dial out (counter-
clockwise) to restart automatic cycling.
The GO2VENT™ is equipped with an air entrainment valve which allows the
patient to entrain additional air and respond to the demands of the patient.
Patient entrainment of outside air is normally audibly detectable and the percent
oxygen delivered to the patient will be reduced. Specific concentrations of
oxygen may be delivered to the patient with the use of an oxygen blender.
Although the design of the modulator is similar to that of a pop-off valve and is
inherently safe, the GO2VENT™® is also equipped with a redundant pop-off valve
that relieves pressure at 60 cm H2O. When the pop-off valve is activated, the
pop-off valve piston will be seen to open slightly and excess pressure released.
1StandardSpecificationforMinimumPerformanceandSafetyRequirementsforResuscitatorsIntendedforUsewith
Humans,ASTMDesignation:F920–93.
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II. Clinical Considerations (continued)
Although peak pressures are listed on the side of the pressure dial, they are only
approximate. Clinicians using the GO2VENT™ are still required to use good
clinical judgment and monitor the patient appropriately. A manometer may be
connected between the modulator and the patient connector tee.
The GO2VENT™is pressure cycled on PEEP as well as PIP. In the pressure control
mode, there is no prolonged stage where the flow of exhalation gas stops for a
significant duration of time (in the pressure support mode, exhalation time is
determined by the patient). This occurs because the exhalation time is set with
the rate dial by varying the exhalation resistance so the patient just finishes
exhalation with the beginning of the subsequent inhalation. The volume of gas
with which the patient’s lungs are inflated when reaching PEEP is the same as
with any other means of obtaining PEEP. As with all ventilatory support modes,
short exhalation times on patients with high airway resistance may lead to gas
trapping which is not detectable in the patient’s external airways. Upon occlusion
of the patient’s airways, the GO2VENT™will stop cycling or may sometimes cycle
rapidly.
The GO2VENT™ will work with any mask that provides a good seal with the
patient. All clinicians should receive adequate training on the GO2VENT™with a
mask prior to use. In the presence of a small leak, the GO2VENT™will still cycle
between PIP and PEEP. Noticeable changes in the presence of a leak are
increased inspiratory times and decreased expiratory times. The GO2VENT™
works very well with an endotracheal tube.
Inhalation may be initiated by briefly removing the mask from the patient or
briefly disconnecting the modulator from the patient adapter tee. In either
event, inhalation begins because pressure has dropped down to PEEP and the
GO2VENT™is pressure cycled.
Upon contamination of the GO2VENT™ with vomitus, it may be cleared by
disconnecting the modulator from the patient connector tee (see enclosed
instructions) and tapping out vomitus on a hard surface. Additionally, if needed,
the rate dial may also be removed to facilitate removal of vomitus from
modulator. This operation should take less than 20 seconds, and in a lab setting
has consistently been shown to take approximately 11 seconds. Alternatively,
upon contamination with vomitus, the clinician may choose to discard the device
and use a new one.
Inhalation and exhalation are audibly detectable and easily recognizable during
operation of the GO2VENT™.
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2
VENT™ User’s Guide
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II. Clinical Considerations (continued)
The GO
2
VENT™ may be controlled remotely by connecting any length of 22-mm
corrugated tubing between the patient connector tee and the modulator. The
attached tubing will not increase the dead space, the modulator is an exhalation
control valve, and inspiratory gas is delivered through the patient connector tee.
The primary advantage of the GO
2
VENT™, as compared to manual resuscitators,
is the ability to deliver consistent, reliable, and hands free resuscitation. Manual
resuscitators may have adverse effects on patients as a result of inconsistent
ventilation (see Clinical Reference in Section VII).
Figure 2
Airway Pressures - PIP & PEEP
1 PIP – Set by PIP DIAL, controls INSPIRATORY TIME (t
insp
)
2 PEEP – Approximately 1/5th of PIP setting
3 INSPIRATORY FLOW RATE (Q) – Maximum 40 L/min (= 667 mL/sec)
4 INSPIRATORY TIME (t
insp
) – Time required to reach PIP
5 EXHALATION TIME (t
exhl
) – Time required to drop from PIP to PEEP
6 Tidal Volume = Q x t
insp
7 RESPIRATORY RATE (RR) = 60 / (t
insp
+ t
exhl
)
8 RATE DIAL – Set exhalation resistance and change RR
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III. Protocol: Setup Instructions - GO2VENT™
Policy Number:
Institution: Department:
Date Adopted:
Date Received: Date Reviewed:
Approved by:
Name: Title:
1.0 POLICY STATEMENT:
This policy/protocol is intended for use with patients requiring short-term
ventilatory support while being monitored by a clinician trained in the use
of mechanical ventilation.
2.0 PURPOSE:
To provide clinically appropriate recommendations and guidelines for the
use of the GO2VENT™ device, including clinical indications, device set-
up, bedside application, potential hazards, and documentation.
3.0 DESCRIPTION:
The GO2VENT™ provides short term, constant flow, pressure cycled
ventilatory support in either pressure control or pressure support modes
on patients weighing 10kg and above. In the pressure support mode, the
rate dial of the GO2VENT™ is set so that the baseline pressure is above
the set PEEP allowing the patient to initiate inhalation by drawing the
baseline pressure down to the set PEEP. The device includes the
pulmonary modulator (an exhalation valve that opens at PIP and closes
at PEEP) and a patient connector tee to supply gas flow, entrain additional
air, and provides a redundant pop-off valve for patient care. The working
mechanism of the GO2VENT™ consists of a moving diaphragm which adds
or subtracts spring force when it is moved from a horizontal to a vertical
position, the addition or subtraction of spring force will affect the PIP
setting by 1~3 cm-H2O. The GO2VENT™ will function in any position as
long as the final adjustments are made in a secured position (strapped or
taped to the patient).
4.0 PROCEDURE:
4.1 INDICATIONS
4.1.1 Patients in need of emergency, short term, constant flow,
pressure cycled ventilatory support.
4.1.2 Patients unable to maintain an adequate acid-base status
during unassisted ventilation.
4.2 CONTRAINDICATIONS
4.2.1 None.
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III. Protocol: Setup Instructions - GO2VENT™ (continued)
4.3 HAZARDS/PRECAUTIONS
4.3.1 The GO2VENT™ should be used only by individuals who have
adequate training in CPR techniques and the operation of gas-
powered resuscitators.
4.3.2 Do not use grease or oil on the GO2VENT™ for any reason.
4.3.3 Do not use the GO2VENT™™ in oxygen deficient atmospheres
or near open flames.
4.3.4 Do not smoke while using the GO2VENT™ or any other oxygen
equipment.
4.3.5 Do not dismantle or attempt to remove any components other
than those required for routine operations. Any tampering with
the GO2VENT™ may cause the unit to malfunction, and will
automatically void the warranty.
4.4 SET-UP INSTRUCTIONS
4.4.1 The GO2VENT™ is suitable for patients weighing 22 pounds or
10 kilograms.
4.4.2 Select desired FiO2 delivery.
[a] If 100% FiO2is
to be delivered to
the patient, connect
tubing to the white
gas connector with
the DISS thread
connection on the
patient tee. Ensure
that the green knob
is turned clockwise
until it comes to a
stop.
[b] If 50% FiO2 is
to be delivered to
the patient,
connect tubing to
the white gas
connector with the
DISS thread
connection on the
patient tee. Ensure
that the green knob
is turned
counterclockwise
until it comes to a
stop.
ENTRAINED
FLOWCHART
100%
50%
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VENT™ User’s Guide
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III. Protocol: Setup Instructions - GO
2
VENT™ (continued)
4.4.3 STEP [1]: Set flow to 10-25 L/min
Remove the GO
2
VENT™ from package and
connect the supply tubing to either an
appropriate cylinder or wall source. A good
starting point is 10 L/min. Adjust as
needed. See ENTRAINED FLOWCHART
for “Total delivered flow” requirements. The
GO
2
VENT™ is designed to automatically
deliver 40 L/min when connected directly to
a 50 PSIG gas source.
Note: For better flow control, a flowmeter capable of 40 L/min is
preferred. The flow controls the inspiratory time – the higher
the flow, the shorter the i-time; the lower the flow, the longer
the i-time.
Note: If using an orifice-type flow regulator that is common to most
cylinders, you will only be able to provide as much flow as the
regulator indicates. If the regulator being used has a high flow
port connection and you connect the GO
2
VENT™ to this port,
you will automatically get 40 L/min.
Note: The GO
2
VENT™ is completely gas driven, requiring no
electrical power and will deliver 100% oxygen to a patient.
Note: The duration of an “E” cylinder when using the GO
2
VENT™ will
depend on the flow. An “E” cylinder contains 625 L of gas. At
40 L/min, 625 L will last up to 15 minutes; at 20 L/min, 625 L
will last up to 30 minutes. 15 L/min orifice type flowmeters
used on many “E” cylinders will not be able to deliver more
than 15 L/min. When clinicians decide that 15 L/min is not
sufficient flow, the GO
2
VENT™ can be attached to a regulator
that has a high flow port (50PSIG) to deliver 40 L/min. The
length of use for various sizes of compressed oxygen tank (D,
E, M & H) is a function of supplied oxygen flow from 6 to 40
L/min to GO
2
VENT™ (see Table 1 below).
TABLE 1 - LENGTH OF USE FOR COMPRESSED OXYGEN TANKS
Tank D E M H
(Liters) 387 662 3028 6905
Flow (L/Min) Length of use (minutes)
6 65 100 500 1150
8 50 80 380 860
10 40 60 300 690
12 30 50 250 570
15 25 40 200 460
20 20 30 150 340
25 15 25 120 270
30 13 20 100 230
35 11 18 80 190
40 10 16 70 170
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2
VENT™ User’s Guide
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III. Protocol: Setup Instructions - GO
2
VENT™ (continued)
4.4.4 STEP [2]: Verify PIP ~25 cm-H2O
The second step in setting up the
GO
2
VENT™ is to set the patient’s Peak
Inspiratory Pressure, or PIP. Verify PIP
pressure at approximately 25 cm-H2O
(factory pre-set). Adjust pressure dial to achieve desired peak
pressure. Adjust the pressure dial to the desired setting.
Note: Indicated pressures are approximate and may vary depending
on conditions and settings. Verify with a manometer.
Note: Indicated peak pressure is printed on the
pressure dial. PEEP is about 1/5
th
of set PIP.
Indicated pressures are approximate and
depend on conditions and settings. Verify with
a manometer by connecting between
modulator and patient connector. I-time is counted off
manually (1-1000, 2-1000, ...) or with a watch.
Note: Typical required supply pressure is 45 to 55 PSIG. Supply
pressures from 39 to 80 PSIG may be used if the flow is
adjusted to 40 L/min ± 10%. The GO
2
VENT™ will deliver 40
L/min against a patient pressure of 20 to 40 cm-H2O when
connected directly to a 50 PSIG source. Lower flows are
obtainable with flowmeter adjustment. Use minimum flow of
10 L/min for best results.
4.4.5 STEP [3]: FUNCTION CHECK - CONNECT TO PATIENT
Once your flow and pressure have been set,
perform a function check on the unit before
connecting it to the patient. This is accomplished
by occluding the patient connection port and
verifying that the modulator opens and the
pressure does not exceed 60 cm-H
2
O.
Note: It is very important to be trained in the correct
application of the face mask before any attempt
is made to use the GO
2
VENT™.
Note: For use with a mask, clear mouth and airway of visible foreign
bodies and use accepted techniques to ensure correct position
of airway. Hold mask firmly against face ensuring a tight seal
while keeping head in correct position. For use with
endotracheal tube, connect patient adaptor directly to
endotracheal tube.
4.4.6 STEP [4]: ADJUST RATE
Adjust rate dial to achieve desired
respiratory rate. The GO
2
VENT™ may be set
in a spontaneous pressure support mode by
PIP Label
PATIENT
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III. Protocol: Setup Instructions - GO2VENT™ (continued)
adjusting rate dial clockwise until mandatory rate stops. To
return to automatic cycling, rotate rate dial counterclockwise
until desired respiratory rate is achieved.
Note: Observe rise and fall of the chest corresponding to patient’s
inhalation and exhalation. Listen for expiratory flow from
modulator. Listen to chest sounds.
Note: If patient vomits, disconnect patient adaptor from modulator
and remove rate dial if necessary. Tap out vomitus on hard
surface to dislodge and reassemble. Clear patient’s airway and
reconnect. Clearing procedure should take less than 20
seconds. Check that inhalation and exhalation occur without
obstruction.
Note: The GO2VENT™ is pressure limited and is equipped with a
redundant pressure pop-off valve which will activate at a
maximum of 60 cm-H2O.
Note: Changes in patient’s lung compliance will result in respiratory
rate changes. In such an event, make appropriate clinical
changes.
Note: If patient draws air through entrainment port or device is set
to FiO2of 50%, oxygen concentration delivered to patient may
differ from concentration at gas inlet of patient connector.
Note: Perform a FUNCTIONAL CHECK by occluding patient port with
supply gas flowing and verify that pressure DOES NOT
EXCEED 60 cm-H2O.
Note: Gas supply source must be capable of delivering up to 40
L/min. Typical required supply pressure is 50 ± 5 PSIG.
Supply pressures from 12 to 80 PSIG may be used if the flow
is adjusted between 6 to 40 L/min (±10%).
Note: The GO2VENT™ will deliver 40 L/min against a patient
pressure of 20 to 40 cm-H2O when the green knob is turned
all the way clockwise and is connected directly to a 50 PSIG
source. Lower flows are obtainable with flowmeter
adjustment.
Note: The GO2VENT™ will deliver FiO2 of 50% (±10%) when the
green knob is turned all the way counterclockwise and is
supplied with oxygen flow from 6 to 15 L/min with resulting
output flow of 20 to 40 L/min respectively (see “ENTRAINED
FLOWCHART”).
4.4.7 STEP [5]: Adjust Flow, PIP and Rate
Observe the rise and fall of the chest corresponding to
inhalation and exhalation of patient. Listen for expiratory flow
from modulator. Listen to breath sounds of patient. There is
no substitute for a good clinical assessment.
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IV. CAUTIONS AND WARNINGS
CAUTIONS
Federal law restricts the use of this device to sale by or on order of a physician (or
properly licensed practitioner). WARNINGS
1. The GO2VENT™ should be used only by individuals who have adequate training
in CPR techniques and in the operation of gas powered resuscitators.
2. Do not reuse - Risk of cross-contamination.
3. Do not use grease or oil on the GO2VENT™ for any reason.
4. Spontaneously breathing patients may entrain ambient air.
5. Supply pressure of 39 to 80 PSIG must be adjustable to 40 L/min.
6. Redundant pop-off valve is set at 60 cm-H2O.
7. Do not use the GO2VENT™ in oxygen deficient atmospheres or near open
flames.
8. Do not smoke while using the GO2VENT™ or any other oxygen equipment.
9. Do not dismantle or attempt to remove any components other than those
required for routine operations. Any tampering with the GO2VENT™ may cause
the unit to malfunction and will automatically void the warranty.
10. US FDA restricts the use of this device by sale by or on order of a physician (for
properly licensed practitioner).
PRECAUTIONS
1. Patients connected to this device are to be monitored continuously by persons
having adequate training. Do not leave patients unattended.
2. When ventilating an intubated patient, higher pressure release settings may be
required. Select a pressure setting of 35 cm-H2O to start and adjust if necessary.
3. An audible, rapid clicking sound and rapid movement of the diaphragm in the
modulator indicates airway obstruction. Clear the airway and resume the
ventilation procedure.
4. Positive End Expiratory Pressure (PEEP) is intrinsic to this device. PEEP is usually
1/5th PIP and will range from 2 to 9 cm-H2O depending on pressure settings.
Verify actual PEEP with a manometer.
5. For a minute ventilation of 10 L/min and an I:E ratio of 1:1: [a] at 100% FiO2
setting - the GO2VENT™ will operate for 30 minutes (± 10%) with an output
and supply flow rate set at 20 L/min on an “E” cylinder volume of 625 liters, [b]
at 50% FiO2setting - the GO2VENT™ will operate for 100 minutes (± 10%) with
an output flow rate of 20 L/min and supply flow rate set at 6 L/min on an “E”
cylinder volume of 625 liters.
6. Please review and follow the instructions and observe the warnings before using
the GO2VENT™.
7. If the use or operation of the GO2VENT™ is unclear, contact your distributor or
dealer for clarification.
8. GO2VENT™ is a resuscitation management system and should not be used as an
unattended automatic ventilator.
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V. GO2VENT™ COMPETENCY
How to set up your ventilator dependent patient using the GO2VENT™, a fully
automatic disposable ventilator that operates with compressed gas.
Objectives
1. To be able to set up the GO2VENT™.
a. Setting the required flow for FiO2100% or 50%
b. Getting the PIP and PEEP from the manometer
c. Adjusting the respiratory rate
d. For non-breathing and spontaneous breathing patient
2. 2. To be able to troubleshoot and correct any problem that may arise with
the use of the GO2VENT™.
a. Gas consumption during use
b. What is happening if it stops cycling while adjusting the rate dial
Troubleshooting
1. I can set a constant respiratory rate and tidal volume with the GO2VENT™.
[ ] True [ ] False
2. With the GO2VENT™, compliance has a direct effect on the respiratory rate
and volumes being delivered to your patient.
[ ] True [ ] False
After completion of the GO2VENT™competency, the practitioner should be able to set
up the GO2VENT™and troubleshoot problems that may arise with its use.
Name: Institution:
Department: Date Completed:
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VI. FAQ (Frequently Asked Questions)
Question Answer
1. Nomenclatures E-time:
I-Time:
L/min:
Manometer:
PIP:
PEEP:
Exhalation time in seconds
Inspiratory time in seconds
Flow of gas in liters per minutes
Pressure gauge
Peak inspiratory pressure
Positive end-expiratory pressure
2. How does the
GO2VENT™
function during
inhalation and
exhalation?
The GO2VENT™ is a small automatic gas-powered resuscitato
r
intended to provide pressure-limited, flow controlled ventilatory
support for short-term emergency ventilatory support for both
breathing and non-breathing patients while being monitored b
y
a clinician or trained operator. The GO2VENT™ is a single patient,
multiple use device.
• During inhalation, exhalation will not start until the desired
peak inspiratory pressure (PIP) is reached.
• During exhalation, inhalation will not begin until pressure drops
to the controlled positive end-expiratory pressure (PEEP).
3. What is the
definition of
“pressure
control” mode
(mandatory
breathing) and
“pressure
support” mode
(assisted
breathing) when
used with
GO2VENT™?
For non-breathing patients - the mode of ventilation is called
pressure control because no effort is required by the patient to
initiate inhalation (mandatory breathing).
For patients taking spontaneous breaths requiring assisted
breathing - If the rate dial has been adjusted to a position that
the continuous flow of gas creates more pressure than the set
PEEP, then the GO2VENT™ will not go into inhalation until the
patient draws the baseline pressure down to PEEP. Again,
because the GO2VENT™ is cycled on both set PIP and PEEP,
inhalation will not start until pressure reaches the set PEEP
value. This mode of ventilation is called pressure support
because the GO2VENT™ only delivers ventilatory support when
initiated by the patient.
4. How do I set the
GO2VENT™ in
pressure control
or pressure
support mode?
Which mode the GO2VENT™ is in is simply a function of where
the rate dial has been adjusted. Turn the rate dial clockwise until
it is in pressure support (assisted breathing) mode. For pressure
control (mandatory breathing) mode, turn the rate dial counter
clockwise.
5. What does the
rate dial do? The rate dial is a variable resistor which controls the rate at
which gas may escape. When the rate dial has been adjusted to
a position where the continuous flow of gas does not create more
pressure than the set PEEP (set PEEP is approximately 1/5th of
the set PIP), upon completion of exhalation, the GO2VENT™ will
automatically cycle into inhalation because it cycles on both the
set PIP and PEEP.
6. Does the gas
supplied to the
GO2VENT™ flow
continuously
during exhalation
and inhalation?
Yes
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VI. FAQ (Frequently Asked Questions) (continued)
Question Answer
7. Does the
GO2VENT™ work
with a mask or an
endotracheal tube
(Combitube®Dual
Lumen Airway)?
The GO2VENT™ works well with most endotracheal tubes or
masks. When the GO2VENT™ is used with a mask, clinicians
must have proper training to be aware of the increased
mortality associated with aspiration when vomitus occurs. If
there is a small leak around the mask, the GO2VENT™will still
cycle between PIP and PEEP, but inspiratory times will increase
and expiratory times will decrease. In the event of a larger leak,
the GO2VENT™ will stop cycling because it cannot compensate
for the leak.
8. What is the
sensitivity or
pressure drop
required to trigger
the GO2VENT™
into inhalation?
The GO2VENT™ is pressure cycled on PIP and PEEP. Therefore,
as soon as the patient’s pressure drops to PEEP, inhalation will
start whether this occurs because exhalation has been
completed or the patient draws a breath. Compared to time
cycled ventilators, the sensitivity would be zero in the pressure
control mode. In the pressure support mode, the sensitivity
may be set as light as 1 cm H2O or less; therefore, the patient’s
work of breathing will be minimal. If greater effort by the
patient is desired, it may be increased by turning the rate dial
clockwise. Be sure to use a manometer when performing this
procedure.
9. When adjusting
the rate dial on
the GO2VENT™, it
sometimes stops
cycling. What is
happening?
The GO2VENT™ rate dial controls rate by controlling the
exhalation time. Once the PIP and inspiratory flow (L/min) have
been set, inspiratory time is also set. The only way to control
respiratory rate is by controlling the exhalation time. In the
pressure control mode, this is done with the rate dial which is
actually a variable flow resistor. Depending on the patient and
flow conditions used, it is possible to set the rate dial so that
the continuous flow of gas always creates more pressure across
the variable flow resistance than what the modulator is set to
cycle at for PEEP. This means the GO2VENT™ is currently in the
pressure support mode. In this condition, the patient’s airway
pressure will remain slightly above set PEEP just as in a variable
resistance PEEP valve and the GO2VENT™ will not cycle. When
pressure control is the mode of ventilation (which is required),
the situation is easily corrected by dialing out the rate dial
(counterclockwise) until the it starts cycling, thus reducing the
variable resistance so the patient’s pressure is allowed to drop
below PEEP and cycle the modulator automatically. In the
pressure support mode, it is the patient who initiates inhalation
by drawing the baseline pressure down to the set PEEP value.
Therefore, if it is not cycling, chances are the patient is not
spontaneously breathing or the rate dial has been adjusted too
far down, creating a baseline pressure which is too high above
the set PEEP value for the patient to be able to initiate inhalation
(the sensitivity is too high). In either event, turn the rate dial
counterclockwise until the sensitivity is low enough for the
patient to trigger inhalation. Otherwise the GO2VENT™ will go
into the pressure control mode.
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VORTRAN®GO2VENT™ User’s Guide
Page16
VI. FAQ (Frequently Asked Questions) (continued)
Question Answer
10. If I connect to a
15 L/min
flowmeter and
dial it all the
way up, what
flow will I get
through the
GO2VENT™?
Orifice type flowmeters like those which are commonly used on
“E” cylinders will flow a maximum of what is indicated on the
gauge. Timeter and other flowmeters using a floating ball as an
indication of flow are capable of being adjusted to flows above
what is indicated. If connecting to a flowmeter and adjusting
the dial all the way open, the float will be slightly above the 15
L/min flow mark but 40 L/min will actually be flowing through
the GO2VENT™. As long as the hospital gas supply and cylinder
regulators are adjusted to 50 PSIG, which is the standard, the
flow going through the GO2VENT™will never exceed 40 L/min.
11. What kinds of
compressed gas
source can I use
with the
GO2VENT™?
You can use any breathing gas from the hospital wall outlet or
gas cylinder.
12. All I have are 15
L/min orifice
type flowmeters
with my “E”
cylinders. 15
L/min of
inspiratory flow
is not enough
flow for my
patient. What
can I do?
Some cylinder regulators equipped with an orifice type 15 L/min
flowmeter are also equipped with a high flow (power take-off)
port. If you connect the GO2VENT™ to this port, you will
automatically get 40 L/min. If 40 L/min is too much flow or you
don’t have a high flow port, you will need to use a different
flowmeter. If you use the GO2VENT™ at 50% FiO2 setting, you
can operate the GO2VENT™ at 6-8 L/min, which on an H tank
can last up to 14 hours.
13. How long will my
“E” cylinder last
with the
GO2VENT™?
It depends on the flow rate. There are 625 L in an “E” cylinder
so at 40 L/min it will last approximately 15 minutes; at 20 L/min
it will last 30 minutes; at 10 L/min it will last approximately 60
minutes.
14. What is the FiO2
delivered to my
patient?
The GO2VENT™ can be used to deliver an air-O2 mixture of 50%
FiO2 and extend oxygen cylinder functional time.
15. May I connect
any DISS
connector to the
patient tee
connector
threaded gas
inlet fitting?
Yes
16. How can I
measure tidal
volume when
using the
GO2VENT™?
Tidal volume may be estimated by using the tidal volume chart
included with the instructions. The GO2VENT™ runs on a
continuous fixed flow rate of gas (inspiratory flow) of up to 40
L/min (667 mL/second) when connected to a 50 PSIG gas
source with associated flowmeter and control valve. Tidal
volume is the inspiratory time multiplied by the flow rate
(example: 1 second i-time X 667 mL/second = 667 mL tidal
volume).
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Page17
VI. FAQ (Frequently Asked Questions) (continued)
Question Answer
17. PIP ranges are
indicated on the
pressure dial,
but what is the
expected PEEP?
PEEP setting on the GO2VENT™ is automatically set at about
1/5th of the selected PIP. It is good clinical practice to use a
manometer to verify any pressure setting. PIP indications on the
pressure dial are approximate only and ranges between 15 and
50 cm H2O, and PEEP ranges between 2 and 9 cm H2O
respectively.
18. How do I connect
a pressure
manometer to
the GO2VENT™?
A manometer may be connected to the GO2VENT™ by placing a
22 mm fitting between the modulator and patient connector tee
(see enclosed instructions). Although the pressure dial indicates
typical PIP and PEEP is about 1/5th of PIP, a manometer is
recommended because it provides valuable information to the
clinician on what is occurring with the patient.
19. Is it possible to
override the
pop-off valve
(high pressure
relief valve)?
No, the GO2VENT™ is a pressure cycled automatic resuscitator
which has a maximum setting of 45 cm H2O. It includes an
inspiratory pressure relief valve that opens automatically at
approximately 60 cm H2O (preset and non-adjustable) and has
a distinctive and easily recognized warning sound.
20. Can I deliver
aerosol
treatment while
the patient is
connected to the
GO2VENT™?
Yes. NOTE: Deposition of medicine residue may cause the
GO2VENT™ to stick if it dries for an extended period of time.
Always perform a functional check per instructions before
reconnecting the patient.
21. Is the
GO2VENT™
MRI safe?
Yes. The GO2VENT™ has been tested and is MR Conditional and
can be used in the MRI environment according to the following
conditions: 1) Static magnetic field of 3-Tesla or less; and 2)
Spatial gradient magnetic field of 10,000-gauss/cm
(extrapolated) or less.
22. Can I do CPR
(closed- chest
compression)
with
conventional
automatic gas-
powered
resuscitators?
Yes. The cardiopulmonary resuscitation (CPR) guidelines and
American Society for Testing and Materials caution against the
use of automatic gas-powered resuscitators during CPR closed
chest compression because the compression process may
interfere with lung ventilation and airway resistance may
prevent adequate ventilation.
23. Can I use the
GO2VENT™with
CPR?
Yes. The GO2VENT™ is ideal for use in CPR. Studies (by Otto
Raabe, Ph.D. et. al) have shown that the GO2VENT™ is safer
than manual resuscitation using a BVM. The GO2VENT™ should
not cause baro-trauma, as the unit will not exceed the set peak
inspiratory pressure and will automatically cycle at the end of
each compression. In the case of manual bagging, medical
personnel must be careful not to bag and compress the patient
simultaneously in order to avoid high PIP. Manual bagging can
cause pressures that can exceed 60 cm-H2O.
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VORTRAN®GO2VENT™ User’s Guide
Page18
VI. FAQ (Frequently Asked Questions) (continued)
Question Answer
24. Is the
GO2VENT™safe
when used with
CPR?
Because the GO2VENT™responds to thoracic pressure variations,
it appears to provide the maximum ventilation possible during
closed chest compression and responds with a full inhalation at
high flow rate as soon as the compression ends. Because of its
audible and visual indications of inhalation-exhalation cycling,
elevated airway resistance or low tidal volume is readily observed
by the rescuer.
25. How about the
caution
statement?
These results suggest that there is no contraindication associated
with performing CPR closed chest compression while utilizing the
GO2VENT™ as a ventilatory resuscitator. Further, the results
suggest that such use would be beneficial. A revision of CPR
guidelines and ASTM 920-93 should be considered.
26. What are some
of the other
commonly used
devices for
providing patient
ventilatory
support?
The GO2VENT™ is classified as an “automatic pressure-cycled,
gas-powered resuscitator” per ASTM resuscitator guideline
(F920-93). There are “operator-powered resuscitators” such as
Bag-Valve-Mask (BVM); “manually-cycled, gas-powered
resuscitators” such as Demand Valves; “automatic-time cycled,
gas-powered resuscitators” and “volume-cycled, gas-powered
resuscitators” such as the emergency transport ventilators.
27. Why should I
use the
GO2VENT™when
I am use to
BVM?
“Operator-powered resuscitator” – Bag-Valve-Mask (BVMs) are
the most commonly used devices for emergency short term
ventilator support. They are typically disposable and are used
extensively in the pre-hospital and inter-hospital markets.
Manual resuscitators are labor intensive and are unable to deliver
consistent ventilatory support. When used with a mask or
endotracheal tube, they require the clinician to use both hands.
They do not require being connected to a gas supply to provide
ventilatory support but are almost always used in conjunction
with compressed oxygen to increase the patient’s FiO2. Although
they appear easy to use, many studies have shown that they all
deliver insufficient tidal volume and often deliver respiratory rates
which are too high, resulting in significant adverse effects on the
patients (refer to Clinical References in Section VII).
Nevertheless, many clinicians, when questioned about the use of
manual resuscitators, feel certain that they deliver a consistent
tidal volume of 750 mL per breath and that the ventilatory
support they deliver is superior because of the feel they get
through their hands when squeezing the bag.
28. What does
automatic-
cycled
resuscitator do?
There are many automatic resuscitators that are gas or battery
powered and non-disposable. All require some type of regular
cleaning and are sold with some type of associated disposable
products. Most are constant flow, time-cycled devices with no
high-pressure relief valve which puts the patient in danger of a
pneumothorax if there is an unexpected decrease in lung
compliance. These devices have no monitoring or alarm features
and have a minimum list price of $1,000.
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Page19
VI. FAQ (Frequently Asked Questions) (continued)
Question Answer
29. What is the least
expensive
automatic-
cycled
resuscitator
cost?
The Oxylator EM-100 is a gas-powered automatic resuscitator
which provides constant flow, pressure-cycled ventilatory support
just like the GO2VENT™. Unlike the GO2VENT™, the Oxylator EM-
100 is relatively heavy, non-disposable, and is not equipped with
a pop-off valve. The cost is considerably higher than the
GO2VENT™
30. What are the
advantages of
the transport
ventilators?
Transport ventilators are equipped with sophisticated monitoring
and alarm functions. They are usually able to provide several
modes of ventilatory support and provide more versatile
ventilation than the GO2VENT™. Because they are very
complicated, significant training is needed. They are used in
conjunction with disposable products and can cost as much as
$2,000 to $5,000.
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VII. Clinical Reference
A. Berthieaume, Dave Swift RRT, Evaluation of the Vortran Automatic Resuscitator and the Vortran Airway
Pressure Monitor in the MRI Environment. Respiratory Care, Vol. 8. 2 - April-May 2013
INTRODUCTION: The magnetic resonance imaging (MRI, 3 Tesla strength) scanner creates a unique electromagnetic
environment that allows high fidelity images of patients. With critically ill patients requiring mechanical ventilation, this
environment produces some unique challenges in management of ventilation and monitoring of ventilation. Currently, there
are a limited number of ventilatory devices that can provide mechanical ventilation in the MRI environment.
METHODS: To determine if the Vortran Automatic Resuscitator (VAR Plus model) can be safely utilized in the MRI
environment. To evaluate, if the Vortran Airway Pressure Monitor (VAPM) can deliver accurate monitoring capability
within the MRI environment. The VAR-Plus performance was verified in a bench top setting, within the MRI core (with
and without extension lines) and outside of the MRI core (with and without extension lines). The VAPM was used in
parallel to verify the VAR-plus performance.
RESULTS: The VAR-plus consistently delivered the RATE (within one bpm) and pressure set using a static lung
compliance & resistance model. The VAPM unit consistently monitored the set rate. However the unit’s ability to monitor
the inspiratory time was limited by rounding up at the 0.05 mark (ex. Ti of 0.56 displays as 0.6 and 0.45 displays as 0.4). The
VAPM (Vortran Airway Pressure Monitor) is not designed to be used within the immediate magnetic field of the MRI
machine. The magnetic field interferes with its operation and the authors recommend that it not be used within the magnetic
field - it does provide effective remote monitoring capability for the VAR-plus.
CONCLUSION: The VAR-plus can effectively function, according to established performance characteristics, within the
MRI environment. The unit is not impacted by the electromagnetic field of the MRI scanner. The VAPM provides an
effective remote monitor for ventilation within the MRI environment (outside of the magnetic field) for adult and pediatric
populations not requiring very low inspiratory times.
Robert Kohler, EMT-P, The Control of End Tidal CO2. Respiratory Therapy, Vol. 7 No. 2 - April-May 2012
INTRODUCTION: Pre-hospital care can be defined as efforts to achieve or maintain homeostasis. The ability to monitor and
control CO2, a key component of the buffering system, is an essential means to that end. Because of CO2, a key component of
the buffering system, has a direct effect on the pH of the body, the ability to monitor and control End Tidal CO2 (ETCO2), is
essential in order to maintain homeostasis.
Recently the American Heart Association has issued new guidelines defining a narrow range of optimal oxygen saturation for
many situations. Based on these recommendations proper patient care mandates that we have the ability to control both
components of ventilation. This pilot study examines the feasibility of controlling the End Tidal CO2 during 911 ground
ambulance operations.
MATERIAL AND METHODS: There were 2 ventilation adjuncts available, the choice of either was not defined or dictated
by the protocol and was the clinician’s choice.
The control: an adult bag valve mask (BVM) as manufactured by Life Support Products #L770 with a bag volume of 1488 ml,
valve dead space of 7.8 mil (not including mask) and a patient connection of 22 mm outside diameter, 15 mm inside diameter
with no pop off valve.
The study: An oxygen powered disposable PIP cycled automatic resuscitator that regulated: Respiratory Rate, Tidal Volume,
Peek Inspiratory Pressure (PIP). Peak End Expiratory Pressure was variable at 20% of the selected PIP. The VAR-Plus model
PCM (VORTRAN Automatic Resuscitator) was used.
In December of 2009 Stamford EMS Paramedics began a program of training using manufacturer’s competency requirements
and guidelines from FCCS course curriculum. Clinical targets were FiO2 of 100% at a rate of 10-12 bpm and a PIP range
from 20-25cm/H2O. Paramedics were not restricted to these targets and were instructed to vary settings to meet the patient’s
needs. ETCO2 was monitored via Side Stream filter line capnography as manufactured by Microstream and available on the
Lifepak 12s currently in use. January through September of 2010, 152 intubated patients were reviewed. 46 met the criteria of
any patient greater than 10 kg with an intrinsic pulse and in respiratory arrest whether idiopathic or clinician induced as an
example from Rapid Sequence Induction. One patient was excluded due to a metabolic aberration. The remaining cases were
split, with 1,012 specific ETCO2 samplings evenly distributed over 23 cases using a BVM (as the control) and with 1,270
specific ETC) 2 samplings evenly distributed over 22 cases using the VAR. The first 4 minutes of data records from all cases
were excluded to compensate for procedural anomalies experienced while securing the airway. Data for all cases in each
group were combined for the calculation of standard deviation (Sd). The Sd was also calculated for each individual case. The
difference in the quantity of records had no statistical significance on results in a test analysis.
RESULTS: After 9 months, ETCO2 values in the control group reflected a Standard deviation of 16.97 while the test group
ventilated with the VAR reflected as standard deviation of 14.09. In addition the study group trended lower as time progressed
while the control group did not.
CONCLUSION: Although data is still being collected, these initial values show that despite the dynamic environment of the
pre hospital setting, with a minimum of additional training the pre-hospital provider can more accurately control ETCO2 with
a disposable PIP cycled respirator than with a Bag Valve Mask.
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