System 98 Datascope’INTRODUCTION CONTENTS Chapter 1. Operation 2 Theory of Operation 3. Specifications 4. Repair Information 5. Schematics 6. Parts 7. Calibration 8. Preventive Maintenance FOREWORD This Service Manual is intended as a guide for cechnically qualified personne! during repair and calibration procedures. The information has been divided into the eight chapters listed above. A detailed table of contents is provided on che firse page of each chapter. This publication may have been updated to reflect product design changes and/or manual improvements. Any such changes co this manual would be accomplished by supplying replacement pages and instructions for inserting or affixing them into che manual NOTE Unauthorized servicing may void the remainder of the warranty. Check with the faccory of with a local authorized Datascope representative to determine the warranty status of a particular instrument WARNING The System 98 operates on line voltages. Therefore, an electric shock hazard may exist when the instrument covers are removed. Repair and calibration procedures should only be performed by qualified personnel who proceed with care and | follow proper servicing cechniques. Warnings are given in Chapters 4 and 7, as well as in other appropriate locations System 98 Service Manual IntroductionCopyright © Dacascope Corp., 1998. Printed in U.S.A. All rights reserved. Contents of chis publication may nor be reproduced in any form wichout permission of Datascope Corp. System 98 Service Manual IntroductionOPERATION CONTENTS OF THIS CHAPTER 1.1 Introduction 1.2 Conttols and Indicators 1.3 Operation NOTE: Complete Table of Contents for sections 1.2 and |.3 are listed on the first page of each, 1.1 INTRODUCTION This section of the Service Manual provides general information about the instrament. Sections 1.2 and 1.3 are included as review of inscrument functions and operation, although the reader is encouraged to refer to che Operating Instructions, P/N 0070-00-0402, for more complete details. P: 1 age l 2 5 System 98 Service Manual Chapter 1, Operation TI1.2 CONTROLS AND INDICATORS ‘This section of che Operating Instructions identifies and describes each feature and concrol of the System 98. For step-by-step operating inscructions see Section 1.3 "Operation." Refer to the section and page numbers listed below for the location and description of a specific feature, control, or display "Section Number Page Number ‘Description Control/Display | | Number Tigges Sheed | IABP Control Kews 6-11 Aualary Kees [Pasiene Wavetorm Caer Opcion [Rear Panel ‘Trigger Select Keys L BCG 2, Pressure 3. Incernal 4. Pacer WAV 5. Pacer A IABP Control Keys 6. IAB Frequency 7. IAB Augmentation 8. IAB Fill 9. Assise/ Standby 10.TAB Inflation 11. TAB Deflation Auxiliary Keys 12. ECG Gaia 15. Pressure Threshold 14 Internal Rate 15. UP. ¢ DOWN 16. Normal Patient Waveforms Keys 7. ECG LEADIEXT. 18. Pressure Source 19. Inflation fncerval 20, Freeze Display User Options Keys Ref Line Aug. Alarm ‘laren Volume UP & DOWN Change Selec: Done 27, Preferences Mem Princer Menu Help Screen Zero Pressure Peine Strip Alarm Mure Override Keys 33, Slow Gas 34. IAB Fill Mode 35. Timing Display Screen, 36, Alarm Messages Advisories 38. ECG Lead Fron: Pane! 39. BCG Gain 40, Pressure Source and Scale 41 IAB Seatus 42. Trigger 43. Heart Rate 44. Systolic 45, Diastolic 46. Mean 47. Aug Aug. Alarm Battery Indicator Helium Indicator 5, Waveforms “Timang Markers Trigger Indicator ‘Time in Standby BP Waveform Tick Marks Rear Panel 58. IAB Catheter Extender Input 59. Trainer Input DC Output (CRM ECG Inpur Pressure Inpur Mains ON/OFF 67. Phone Line . System Timer 69, 70. Equipotenial Lug Pressure (Monitor Inpuc) ECG (Monitor Inpuc) 2. ECG! Pressure Ouspue 75, Manual Fill Pore Drain Pore IAB Fill Pore Helium Pressure Gauge Front Panel 77 IABP ONIOFF 78. Baccery Charging LED 12 System 98 Service Manual Chapter 1, Operation1.2.1 TRIGGER SELECT KEYS The five individual Trigger Select keys illuminate when activated. They are used co select the one signal by which the balloon pump is triggered and sychronized to the cardiac cycle. Each of the five keys are described below Figure 1-1 Trigger Select Keys ECG The System will trigger on the patienc’s R-wave, The ECG signal source can be from either patient clecceodes or an external ECG signal ‘ PRESSURE The System will crigger on the sytolic upstoke of the paciene’s arterial pressure waveform. The signal source can be either the pressure transducer or an external pressure signal, The pressure transducer must be zeroed to pump in the pressure trigger mode, When in the pressure trigger mode, this key can also be pressed to manually initiate an instantaneous resynchronization. INTERNAL The System will trigger from a built in timer asynchronous with the cardiac eyele. Trigger rate is adjustable from 40 to 120 bpm using the UP and DOWN arrow keys located in the Auxiliary Keys group. In the presence of a valid QRS complex, the System automatically deflates the [AB on each R-wave detected. The "ECG detected" alert message and a tone are generated. System 98 Service Manual 73 Chopter 1, OperationPACER WA-V The System will automatically identify and display which of the two pacer types, Ventricular or Acrio-Vencricular is present. The System eriggers on the vencricular pulse in either case. The patient must be 100% paced and captured (.e., no demand pacing). The ECG signal source can be either patient electrodes ot an external ECG signal. Electro-surgical noise interference automatically suspends pumping and activates "Trigger Interference” alarm message and tone. The IAB remains deflated uncil ESU noise interference stops. PACER A ‘The System will trigger on the patient's R-wave without interference from acrial pacer artifact. The ECG signal source can be either patient electrodes or an external ECG signal. This mode is recommended only if atrial pacer tails interfere with R-wave detection when using the ECG trigger mode. Fixed or demand atrial pacing can be used in this trigger mode. System 98 Service Manual Chapter 1, Operation1.2.2 IABP CONTROL KEYS Figure 1-2 |AB CONTROL KEYS 6. IAB FREQUENCY Press this key to select the ratio of augmented cardiac cycles to actual cardiac cycles. Selections available are every beat assisted (1:1), every other beat assisted (1:2), or every third bear assisted (1:3). The selected LAB frequency is indicaced by illuminated LED indicators. When either 1:2 oF 1:3 is selected, both the assisted and unassisted systolic and diastolic pressures are displayed and may be printed. They are labeled accordingly 7. IAB AUGMENTATION . Pressing the UP and DOWN arrow keys will adjust the time interval, from OFF to MAX, during which drive pressure is epplied to the safety disk. This interval determines che gas volume displaced from che safety disk into the patient balloon, 8. IAB FILL Press and hold for 2 seconds to initiate the IAB gas purge and fill cycle. Also used to perform the Safecy Disk Leak Test by holding ic pressed and turning the power on simultaneously 9. ASSIST/STANDBY tess ¢0 initiate or suspend balloon pumping. The key is continuously illuminated in the Standby Mode and flashes during the inflation period in the Assist Mode. Whenever the ASSIST/STANDBY key is pressed for che first time following system power-up, a rapid start feature will expedite the start of IAB assist (see Section 1.3.2.12 for details). System 98 Service Manual rs Chapter 1, Operation10. IAB INFLATION Slide control which adjusts the time duration between che crigger event and the beginning of the IAB inflation. 11, IAB DEFLATION Slide control which adjusts che time ac which the scart of IAB deflation occurs. Deflation will occur at this time or upon trigger detection, whichever occurs first. rs System 98 Service Manval Chapler 1, Operation1.2.3 AUXILIARY KEYS Figure 1-3 AUXILIARY KEYS, 12. ECG GAIN The ECG GAIN LED is illuminated when ECG, PACER V/A-V or PACER A is selected as the trigger source, When ECG GAIN is illuminated and the NORMAL key is pressed, a fixed gain (x1000) ECG signal is used for criggering che System 98. When either of the ARROW’ keys are pressed, the ECG signal gain can be varied over a range of 0.15 x Normal Gain to 3.0 x Normal Gain. The ECG Gain setting is posted in the "ECG GAIN’ field on the display. 13. PRESSURE THRESHOLD. ‘The PRESSURE THRESHOLD LED is illuminated when PRESSURE is selecced as the trigger source. When PRESSURE THRESHOLD is illuminated and the NORMAL key is pressed, the System will aucomatically select the optimal chreshold value and adapt to changes in systolic pulse height. When either ARROW key is pressed, che blood pressure trigger threshold can be manually adjusted in fixed steps of | mmHg within a 7 co 30 mmMlg range. The current chreshold is posted with the trigger source in the "Trigger" Hield on the display. The arterial waveform is also annotated to indicace when the system triggered and what poinc it «riggered on. NOTE: When manually adjusting Pressure Threshold, reassess the proper timing of balloon inflation and deflation and correct as required. 14, INTERNAL RATE The INTERNAL RATE LED is illuminated when INTERNAL is selected as the trigger source. When INTERNAL RATE is illuminated and the NORMAL key is pressed the internal rigger rate is set co 80 bpm. When either ARROW key is pressed, the internal crigger rate is adjusted by 5 bpm over che range of 40 - 120 bpm. The current internal rate is posted in the “heart race" field of the display. System 98 Service Manual v7 Chopter 1, Operation15. UP & DOWN ARROW KEYS The UP & DOWN ARROW keys allow adjustment of the ECG Gain, Pressure Threshold, o Internal Rate, depending on the selected trigger source 16. NORMAL ‘The NORMAL key selects the normal (default) secting for ECG Gain, Pressure Threshold, of Internal Rate. IFany of these settings have been changed via the arrow keys, the normal secting can be instantly restored by pressing the NORMAL key once. 18 ‘System 98 Service Manual Chapter 1, OperationFigure 1-4 PATIENT. WAVEFORMS, KEYS, 1.2.4 PATIENT WAVEFORMS KEYS 17, ECG LEADIEXT, Press to select the desired ECG signal source. The System 98 accepts a 5-leadwire patient cable and this key sequentially seleccs skin lead configuration I, II, III, aVR, aVL, aVF, and V. A 3-leadwire patient cable ‘can be used, but will provide only leads 1, Il, and ITI. All other lead selections will provide a "Lead Fault" condition with ao ECG waveform. In addition co che skin lead configuration an external monitor can be selected as, an ECG source, When an external ECG signal is selecced, "EXTERNAL! is posted in the "lead" field on the display. This key is disabled when the display is frozen. 18. PRESSURE SOURCE Press to select the desired pressure signal source. When an external pressure signal is selecced, "EXTERNAL" is posted in the "Pressure Source" field on the display. IF a direce transducer source is selected, "XDUCER’ is displayed. This key is disabled when che display is frozen. 19. INFLATION INTERVAL While in the Assist Mode, press and hold co view the period of diastolic augmentation. The marked and highlighted portion identifies the balloon inflation period. When the key is quickly pressed and released, the physiological pressure delay co the pressure monitoring site is recalculated, with respect 0 balloon inflation. The recalculation occurs in synchrony with the pump cycle. 20. FREEZE DISPLAY Press to freeze all traces on the display. Press again to unfreeze the traces. This key is disabled when the recorder is activated. When the races are frozen and the recorder is activated, the freeze is overridden. The ECG gain, pressure source, and lead keys are disabled when in the freeze mode. System 98 Service Manual 19 Chapter 1, Operation1.2.5 USER OPTIONS KEYS Figure 1-5 USER OPTIONS KEYS 21. REF. LINE Press co activate the REF LINE, The LED on the REF LINE key illuminaces when activated. Once activated use the UP & DOWN ARROW keys (24) co adjuse the reference line position. AUG. ALARM The augmentation alarm limit is automatically decermined during the first minute of pumping. This is done by an adaptive learning process whose goal | s to set che alarm to 10 mmHg below the patient’s augmented diastolic pressure. As part of this process, the alarm is armed after the first 15 seconds of pumping and the limic is fixed after one minute This initial alarm seccing can be changed, or set to "OFF", by the use of the UP and DOWN arrow keys. Pressing the arrow keys incrementsidecrements the aug. alarm limic by 2 mmHg. The alarm limir is displayed in the AUG ALARM field (48), The available range of alarm setting is 60 to 200 mmHg. When the alarm is in the off seare, the word "OFF" appears as the alarm limit. ALARM VOLUME 23. Press co activate the volume control for the audible alarm. The LED on the ‘ALARM VOLUME key illuminates when activated. Once activated use the Up & Down Arrow keys (24) co increase or decrease che alarm volume in 8 steps. The audible alarm volume cannot be turned off completely. UP & DOWN ARROWS ‘These keys are used in association with the AUG. ALARM, REF. LINE, HELP SCREEN, PRINTER MENU, PREFERENCE MENU, and ALARM VOLUME keys. The arrow keys are only active when one of the associated keys’ LED is illuminated. ~~ System 98 Service Manual Chopler 1, Operation28. 29. 30. 31. CHANGE / SELECT Press to select or change an item in che PRINTER or PREFERENCES menus. This key is used in these menus to make selections or changes to the user configurable characteristics of the pump and/or printer. DONE Press to exit the current PRINTER, PREFERENCES ot HELP menu. PREFERENCES MENU Press to activate the system preferences menu, The LED adjacent co the PREFERENCES MENU key will illuminate, Display options and audio tone options may be adjusted within these menus. The system time and dare may also be set PRINTER MENU Press to activate the printer configuracion menu. The LED adjacene to the PRINTER MENU key will illuminate. Printer configuration items such as the number and type of waveforms co print, prine duration, ecc. may be set within this menu. HELP SCREEN Press to activate the Help Screen area on the display. The LED adjacent co the HELP SCREEN key will illuminate, Set-up procedures, abbreviated alarm descriptions, and corresponding corrective actions instructions are available in the Help Screens. Once the Help Screen is displayed, use the UP & DOWN ARROW keys (24) to page through the available screens. The UP ARROW displays che previous page and che DOWN ARROW displays the next page. Press the HELP SCREEN key again or the DONE key to return «co the normal display ZERO PRESSURE Press and hold for 2 seconds to zero the pressure transducer. The zeroing function will accommodate pressure transducers with offsets of up to 2120mmHg. The zeroing attempt may not be successful on cransducers with a greater offser chan +120 mmHg and in those cases the message "NO ZERO" will be posted in the "Systolic" field of the display. This key is disabled when the System is in the Assist Mode and pressure crigger is selected, when a transducer is not connected, or when external pressure is selected PRINT STRIP Press this key to initiate a recording. Press it briefly co print a sctip of the duracion specified in the printer menu. Press and hold the key for 2 seconds to print a continuous strip. Pressing che key while the printer is running will stop the current recording. The LED adjacent co the key will be lit continuously during a programmed duration recording and will blink during continuous recordings System 98 Service Manval TT Chopter 1, OperationALARM MUTE Press to temporatily disable an active audible alarm for 30 seconds. This control does nor override the alarm. Ifan alarm condition is not corrected within 30 seconds, the audible alarm is enabled again, Alarm messages will remain displayed while the associated audible tone is temporarily disabled. The LED illuminates when ALARM MUTE is activated, and extinguishes when ALARM MUTE is deactivated. In the event that a new alarm condition ‘occurs when audible alarm’s are muted, the alarm tone will be immediately reactivated. 72 System 98 Service Manval Chapter 1, Operation1.2.6 OVERRIDE KEYS Figure 1-6 OVERRIDE KEYS 33. SLOW GAS Press this key to enable or override che Slow Gas Loss Alarm. When the OVERRIDE LED is illuminated, the advisory message "Slow Gas Loss Override On" is displayed and the SYSTEM 98 continues co operate in the ASSIST mode even when a small gas loss is detected. A starus message is displayed bur no audible alarm is sounded. The gas loss alarm will flash as long as the slow gas loss condition exists NOTE: When in the Manual Fill Mode, the slow gas loss alarm message will be disabled. The OVERRIDE LED is illuminated. , When the ON LED is illuminated, and a slow gas loss is detected, pumping will be suspended, continuous alarm cone will sound, and the message "Leak in [AB Circuit" is displayed WARNING: Continued pumping of an IAB which has a leak may rest in formation of a large blood clot within the balloon casusing an enorapped balloon condition which may require surgical removal of the AB or in a gaseous embolic inpury af organs System 98 Service Manual 13 Chopter 1, Operation34. LAB FILL MODE This key is used co selece between the JAB fill modes, Auto or Manual, The selected mode is identified by LED. The Manual Fill Mode must be se- lected for Pediaccic IAB's, When the AUTO mode is selected, the System 98 will provide Rapid Start of IAB assist (See Section 1.3.2.12"Initiation of Assist") following a powerup. Thereafter, it will automatically purge and refill che IAB's shuttle gas at 2 hour intervals or upon activation of the FILL key When the MANUAL mode is selected, aucomation of che fill process inhibited. The IAB must be purged and filled manually (see Sections 1,3.2.14 "Manual Fill Mode! and 1,3.21.8 " Filling Pediatric Catheters”). Similarly, the aucomated sequence of steps affiliated with the Rapid Stare fearure are not supported. Consequently, this sequence of steps must be performed manually to iniciate pumping 35. TIMING This key is used co change the IAB Inflation/Deflation Timing Mode. When the AUTO LED is illuminated, the Cardio Sync™ sofeware algorichms automatically track changes in patient heart cave or shythm and adjusts the inflation and deflation points accordingly. Minimal timing adjustments are required by the operator in this mode, When che MANUAL LED is illuminated, the IAB inflation/deflation points are fixed, determined by che position of the inflation/deflation controls. (Operator adjustments are required in this mode when patient cates or shychms change significally 14 ‘System 98 Service Manual Chopter 1, Operation1.2.7 DISPLAY SCREEN Figure 1-7 DISPLAY SCREEN 7 7 8 36. ALARM MESSAGES This section of the screen is used co display alarm messages. One alarm message can be posted ata time. If more than one alarm condition occurs, the alarm message is displayed in priority order. | 37. ADVISORIES This section of che screen is used co display alert, status, and prompt messages. There are three available advisory lines in this section. If more than one message is displayed, the advisories are posted in priority order. 38. ECG LEAD ‘This field displays the sclected ECG signal source and ics starus. Selections are skin leads (1, I, II] aVR.aVLaVF,V) or EXTERNAL. When skin leads are selected and a lead faule occurs, chen the selected lead is alcernately displayed with the text "Lead Faule" When an "External" source is selected and a cable is not presence, then the text "No Cable" is displayed 39. ECG GAIN Indicates the gain factor applied to the ECG signal. When normal gain is applied, "Norma!" will be displayed in this field. When using variable ECG gain "N" is displayed with N varying over a range of 0.15 to 3.0. System 98 Service Manual 1s Chapter 1, Operation40, PRESSURE SOURCE Pressure Source displays the source of the blood pressure signal and its scarus. The text, "XDUCER" is displayed when a direct cransducer input is selected. The text, " Excernal" is displayed when an external signal source is selected. In cases wherein the selected source is nor present, the cexr "No Cable" is displayed. + Pressure Scale displays the current state of the Pressure Scale setting either ‘Manual o¢ Auto, Refér to section 1.3.2.1 for more information on this secting, 41. 1AB STATUS INDICATOR A segmented bar graph chat depicts movement of che diaphram within the saftey disk as sensed by the System’s internal pressure transducers. No quantitive measurement is intended. 42. TRIGGER Displays the selected trigger source for both IABP synchronization and Heart Rate decermination. When pressure trigger is selected, the pressure trigger threshold and chreshold adjustment mode (Auto or Manual) will be displayed along with the trigger source. 43. HEART RATE This field is a numeric display of the current average heart rate in Beats Per ‘Minute (BPM). The System 98 displays "0" when the heare rate drops below 15 BPM. 44, SYSTOLIC Indicates peak systolic pressure in mmHg. Displays NO ZERO if transducer requires zeroing. Display is blank if 2 pressure ceansducer is not connected or if external source is selected and the external cable plug is not inserced When 1:2 or 1:3 is selected as the IAB Frequency, both the assisted and 5 unassisted systolic pressures are displayed. They are labeled accordingly. 45. DIASTOLIC Indicates end diastolic pressure in mmHg. Display is blank if the zero [process has not been performed, if a pressure eransducer is nor connected. or if external source is selected and the external cable plug is not inserted. When 1:2 or 1:3 is selected as the IAB Frequency, both the assisted and unassisted diastolic pressures are displayed. They are labeled accordingly 46. MEAN Indicates mean pressure in mmHg. Display is blank if the zero process has not been performed, if a pressure transducer is nor connected, of if external source is selected and external cable plug is not inserted. 47. AUG Diastolic Augmentation) Indicates peak augmented diastolic pressure in mmHg. The display is blank when IABP is in STANDBY, if the zero process for the cransducer has not been performed, if « pressure transducer is not connected, or if external source is selected and external cable plug is not inserted 1-16 ‘System 98 Service Manual Chopter 1, Operation5 5 és ‘9, 0. AUG. ALARM Indicates diastolic augmentation alarm limie in mmHg. Ifthe alarm is not enabled, OFF is displayed. BATTERY INDICATOR Indicates the charge remaining in the internal batteries. This indicator is displayed only when che system is operating off of the internal batteries. Display of the "Lew Bavzery’ advisory message indicates less than 30 minutes of remaining battery life. When this message appears the battery symbol is displayed as empry and starts flashing. Connect the pump to AC power and cura the AC mains swicch on as soon as possible, TOR HELIUM INDI Approximately indicates the amount of helium remaining in the tank. A "Low Helin" advisory message will be displayed when the cank is almost empty ECG Scale The ECG scale is located immediately co the left of the displayed ECG waveform. It is provided co facilitate determination of ECG amplitude. The scale is one centimeter high. The annocation indicates the current scale factor for the displayed ECG waveform, e.g. 1 mvicm, NOTE: The displayed ECG signal is automatically scaled (amplified) for optimal screen presentation. Due co che aucomatic scaling, low ECG amplitudes may appear to be of normal amplitude when displayed. Judgemenes concecning ECG amplitude should be done with reference to the annotated scale or a printed ECG ourpur. Arterial Pressure (AP) Seale The AP scale is locaced immediately co the left of the displayed AP 7 waveform. The scale is a vertical line with annotated "tick" marks. The units of the annocation are mmHg. The scale is provided to facilitate determination of AP amplirude. NOTE: The displayed AP signal can be aucomacically or manually scaled (amplified) and offsec for optimal screen presentation (See section 1.3.22.1 for more information). When using automatic scaling, low AP amplitudes ‘may appear co be of normal amplitude when displayed. Judgements concerning auromatically scaled AP waveforms should be done wich reference to the annozated scale, patient arcerial pressure parameter display, or a printed AP ourput. Waveforms (ECG, AP, shuttle gas ) Depending upon user preferences, che system displays either ewo waveforms (ECG and AP) or three waveforms (ECG,AP, Balloon Pressure). Order of display is fixed, ECG is displayed horizontally across the cop of the screen. Next, Amcerial Pressure is displayed across che middle of the screen and finally, across the boccom, the balloon pressure waveform (if enabled). If the balloon pressure waveform is not enabled, then the additional screen area is used by the arterial pressure waveform display. System 98 Service Manval v7 Chapter 1, OperationWaveforms are plotted from left ro right. The oldest dacs is erased and is, replaced by new daca. To facilitate identification of the newest data, an vertical "erase" bar is drawn, The newest data is to che left of che bur and the oldest is co che right. Visually, the traces appear fixed as a moving vertical bar move thru che traces and updates chetr appearance. Waveforms are assigned a fixed window (invisible) in which they are drawn, For clarity of display, che ECG and AP waveforms have autoscaling algorithms (che AP waveform may be manually scaled in the Preferences Menu, see section 1.3.2.1 for more information). These algorithms continuously adjust the gain and offset of che displayed waveforms so chat their dynamic aspect is fitced co the available display window. These measures simplify adjustment and assessment of LAB timing, since waveform’s morphology is clearly displayed. Inflation Interval Markers While in Assise Mode, the Inflation Interval Markers can be displayed by pressing the INFLATION INTERVAL (19) key. The Inflation Incerval ‘Markers can be set in the Preference Menu (See Section 1.3.22.1) to permanently display on the ECG-waveform. These markers indicace che approximate points at which the pump will initiate the inflation and deflation process. The marked segment is adjusted by moving the INELATION (10) and DEFLATION (11) slide controls. Trigger Indicator A graphic trigger indicator is located at the top right of the screen. It has a diamond shape. Ic blinks on and off each time a trigger event is detected. Time In Standby Time in Standby is numerically displayed on che left side of the screen, This display is active only when the system is in Standby. The timer display starts when che system goes into the standby state for any reason. The timer display is cleared whenever pumping is re-initiated After an elapsed time of 20 minutes, an alert message is continuously displayed in che Advisory field of the screen. An audio cone is affiliated with the initial alerc. Iwill sound a double beep for 30 seconds. Thereafter, it will sound every 5 minutes, The alert is a reminder that a risk is incurred (thrombosis) if the IAB is not pumped for long periods of time Tick Marks on AP waveform Io the arterial pressure trigger mode, "Tick" marks (small horizonal lines) are added co the arverial pressure waveform, The cick marks provide a visual indication of the curtenc arterial pressure trigger threshold. The marks do not indicate the exact moment of che trigger event, they are slightly delayed in cime. 178 System 98 Service Manual Chopter 1, Operation60, Figure 1-8 REAR PANEL | > NOTE: All signal inpuc and signal oucpuc ports are intended only for connection to specified equipment. 58. ). TRAINER INPUT 6. . PRESSURE INPUT 1.2.8 REAR PANEL 1AB CATHETER EXTENDER INPUT Used for connection of the TAB catheter and catheter extender combination, ‘A mini-jack provides the appropriate timing signal required co synchronize the Series 90 Trainer. DC OUTPUT (CONDENSATE REMOVAL MODULE CONNECTION) This is a six pin connector which provides power to the condensate removal module. ECG INPUT A six-pin connector used for attaching patient cable connections. This connection is eleccrically isolaced for patiene safecy. A six-pin male connector used for attaching Datascope specified physiologic pressure transducers (see precautions listed on page xi of Operacor Instructions). This connection is electrically isolaced for patient safery. System 98 Service Manuel Chopter 1, Operction63. 67. 69, 7 MAINS ON/OFF A fuse holder, switch, and line cord receptacle used to apply and remove AC power co the System 98. ies are charging only when the AC Mains switch is sive AC power utility, and she battery PRECAUTION: The bat ON, the AC Mains cord is connected 10 an ac charging status LED is tlaminated. EXTERNAL DC INPUT ‘An input connector for external DC voltage power to the system. . DIAGNOSTIC OUTPUT Reserved for Dacascope use only. RS-232 ‘A 9-pin D-type connector provided for RS-232 serial data communication lines PHONE LINE A standard RJ11 modular telephone jack for connecting the internal modem. to a standaed analog phone line. NOTE: This phone line should be directly connected to an external phone syscem and not a company! hospital switching system. SYSTEM TIMER Displays elapsed system operating time in hours (used ro determine preventive maintenance incervals). The elapsed time cannot be reset. (See Section 8 for Preventive Maintenance Schedule.) EQUIPOTENTIAL LUG A connector used to equalize the voltage potential which may exist becween the System 98 and earth ground or other hospital equipment. PRESSURE (Monitor Input) A 1/4" phone jack which permits the System 98 to display and/or trigger from a 1V/100mmHg Pressure signal acquired from an external monitor. ‘When plugged in and external pressure source is selected, the monitor displays the arterial pressure and can be triggered from the externally supplied signal. See Section 1.3.20, "External Monitor Interfacing" for additional informacion, ECG (Monitor Input) ‘A 1/4" phone jack which permits the System 98 to display and/or trigger from a 1V/mV ECG signal acquired from an external monitor. When plugged in and external ECG source is selected, the monitor displays and can be triggered from the externally supplied signal. See Section 1.3.20, "External Monitor Interfacing” for additional information, 7-20 System 98 Service Menval Chapter 1, Operation74, 76. ECG/PRESSURE OUTPUT This 1/4” phone jack, (with ECG connected on the cip and blood pressure signal connected on the ring) provides patient signal information for external equipment, The ourput sensitiviries are [V/mV and 1V/100mmHz respectively, The phone jack sleeve provides common signal ground for both ECG and Pressure outputs, MANUAL FILL PORT This pnuematic fircing provides a means through which fill gas (helium) may be extracted when a syringe Gp is attached and che helium cylinder is open. This pneumatic port can also be used to fill non-standard balloon volumes such as pediatric IAB sizes. This port is used ONLY for manual filling DRAIN PORT This pneumatic port connects to the Safety Disk/Condensate Removal Module (CRM) assembly. This port is used to automatically drain excess water (condensate) ftom the System. IAB FILL PORT This pneumatic port connects to the Safety Disk/Condensate Removal Module (CRM) assembly. The IAB FILL PORT is normally used for auromatic filling of balloons. This port is located on the safecy disk, and can be used co manually fill or purge the [AB in the MANUAL FILL mode HELIUM PRESSURE GAUGE Indicates the gas pressure in the cylinder, without requiring the System 98, to be "ON". The cylinder valve must be opened to check pressure. System 98 Service Manual Chopter 1, Operation rat1.2. 9 FRONT PANEL IABP ON/OFF This recessed switch controls internal power to the pump console and monitor module Operation of this switch does noc affect che status of the incernal battery charger. BATTERY CHARGING LED Illuminates continuously while the internal bacteries are being charged ar a low rate. The LED indicator flashes when the internal batteries are charging Figure 1.9 FRONT PANEL aca high rate. PRECAUTION: The insernal batteries are charging only when the AC Mains suttch is ON and she AC Mains cord is plugged i TR System 98 Service Manual Chapter 1, Operation| 1.2.10 SPECIAL MODE ACTIVATION During che power-up sequence of the System 98, certain functions or modes can be enabled by pressing assigned keys. The following table describes chese functions and the key required co enable that function. Press and hold the following key(s) while activating the power switch until the function or mode is enabled _Power-up Special Function Keys 'Function Key(s) to press and How to Exit | hold while powering Lo up (call out number) | To Enter che Safety Disk IAB FILL (8) Whentheeses Leak Test | completed the System | | will automatically enter | |che normal operating ‘Safety Disk Leak Test | ASSIST/STANDY (9) _ completed the System } ‘will aucomatically enter | | | mode. ; To Enter the Pediatric IAB FILL (8) and [When the cest is | the normal operating | i i | | mode To Enter the System | PREFERENCES From the Main Menu | | Configuration Mode. (See, MENU (27) [press the DONE key co | section 1.3.23 for decails | exit this mode and enter | jon using this mode.) | the normal operating | \ ! mode | To restore System default (CHANGE / SELECT (25) The System powers up in settings (See section the normal operating | | 1.3.2.12 for derails.) mode with all defaule Lo | settings restored. ‘| To Prine Sofeware ‘PRINT STRIP (31) | The System powers up in | Revisions 'che normal operating mode with the sofeware { irevisions printed from | iL che recorder lo enter Seniee SLOW GASG3)and | Power OFF [Diagnostics (refer co LAB FILL MODE (G4) ‘section 4 for more details) System 98 Service Manual 23 Chopier 1, Operation1.3 OPERATION CONTENTS OHS CHAE 1.3.1 Introduction 1.3.2.1 Establish AC Operacion y Disk Leak Test 3.2.7 Initial Set-Up of Controls for Balloon Pumping 3.2.9 Selection of [AB Frequency 2.13 System Power-Up Defaults 1.3.2.14 Manual Fill Mode 3.6 Use in Electrosurgical Environmene 3.9 Portable Operacion 3.10 Printer Menu (Recording Waveforms and Trends) 3.11 Using Trend 3.12 Installation and Replacement of Helium Cylinder 3.13 Installation/Removal of Safery Disk/Condensate Removal Module 4 Doppler Information 1.3.15 Connecting the Modem 1.3.16 Connecting PC.IABP 1.3.17 Data Communication 1.3.18 Wheels and Casters 1.3.19 Help Screens 1 1 1 1 1 1 1 1 L L L 1 1 1 3.20 External Monitor Interfacing 3.21 Pediacric Balloon Pumping 3.22 Preferences Menu 3.23 System Configuration System 98 Service Manual Chapter 1, Operation 1-251.3.1 INTRODUCTION ‘This section of the manual provides scep-by-step instructions for properly operating the System 98. The Numbers in parentheses identify the controls and indicators described in Chapter 1.2 GENERAL SAFETY PRECAUTION Prior to operating the equipment, the user must be familiar with the controls and functions of the System (refer co Chapter 1.2) and have a thorough knowledge of intra-aortic balloon pumping 1.3.2 Sequence for Establishing IABP NOTE: See Section 1.3.12 for Helium cylinder installation. See Section 1.5.13 for safety disk installation. 1.3.2.1 Establish AC Operation 1. Remove catherer extender cubing or any plug from LAB cathecer extender input connector (58). Visually inspect thae the safety disk is properly seared and char all pneumatic ficcings are sound. 2. Actach the line cord, appropriate for the country of use, securely into the MAINS power receptacle (63) on the pump console. Plug the System line cord into a compatible grounded AC receptacle. In the U.S. use only receptacles marked "Hospital Grade." Do noc use an adapter co eliminace the plug’s connection to ground. If auxiliary equipment is used with the System 98, insure chat the equipment is also properly grounded. 3 ‘Set the MAINS ON/OFF switch (63) co the "ON" position, Confirm AC operation by checking that the BATTERY CHARGING indicator (78) is illuminated or flashing. If a Safety Disk Leak Test is desired continue with Step 1.5.2.2, otherwise proceed to Step 1.3.2.3. 1.3.2.2 Safety Disk Leak Test 1. Press and hold che [AB FILL key (8) while switching IABP ON/OFF (77) co ON, Release the IAB FILL key when the message "LEAK TESTING SAFETY DISK" appears in the ADVISORIES section (37) on the screen. NOTE: If che [AB Catheter Extender Input (51) is not vented co air at the start of the Safety Disk Leak Test, a double beep alarm tone will sound and the message "UNPLUG DISK OUTLET” will be displayed After approximately 10 seconds a tone sounds and the message "PLUG DISK OUTLET’ is displayed in che ADVISORIES section (37) on the Plug the IAB Catheter Extender Input (51 ) on the safety disk with a dead end Luer plug (supplied). 1-26 System 98 Service Menual Chapter 1, Operation3. A double beep will sound at che end of the safery disk eese. If che System passes the cest, the message "SYSTEM TEST OK" is displayed in the ADVISORIES section (37) on the screen, Remove dead end luer plug. SAFETY DISK TEST FAILS," inspect FF co the OFF NOTE: If che message on the display is all pneumatic connections and Luer locks. Switch the IABP O) position and repeat from Step " if in doube about the integrity of the safecy disk, replace i. See Section 1.3.13. “Installation of che Safecy Disk" If the safeey disk has been replaced and no leak is evidene, buc the screen still flashes "SAFETY DISK TEST FAILS," the [AB AUTO FILL System may be malfunctioning and the manual fill procedure should be performed until a Service Representative can be contacted. WARNING: Use only the safety disk/CRM (PIN's 0997-00-0344/0997-00-0380) that is designed +0 be used with the Syster 98. Do not use a System 95 disk WARNING: Do nos performs shis procedure when the System 98 is connected 10 she patient 1.3.2.3 Normal Power Up Procedure (Without Safety Disk Leak Test) L._ IF che System 98 is not already on, press the IABP ON/OFF switch (77) to ON. The System performs an electrical and pneumatic self tes. When the self-check is successful the "SYSTEM TEST 0.K." message appears in che Advisories (37) field of the display. In the event chat any electrical or pneumatic test fails, che message "ELECTRICAL TEST FAILS CODE #___" is displayed on the screen. The code number indicates which test has failed in the System. Power cycle the System (power down for a minimum of LO seconds) and if message repeats, record the code # and call Datascope Service Representative. See Section 4, Troubleshooting Procedure for probable cause and recommended action, 1.3.2.4 Establish Fill Gas Pressure L._ Slowly open the Helium cylinder valve fully counter-clockwise 2. Make sure that the helium indicator (50) on the display indicates that an adequate volume of gas exists in the Helium tank. A mechanical helium pressure gauge (76) directly above the Helium tank provides an alternate check of the helium supply when the pump is off. Ensure the helium supply reading on the gauge is in che operating range (within the white area). NOTE: When the System is not in use, close che cylinder valve fully clock- wise to prevent a potential leak and the deplecion of the helium supply 3. Check char the message "LOW HELIUM" advisory is noe displayed. If the "LOW HELIUM" message is displayed, check helium cylinder icon or gauge for adequate gas capacity and check helium cylinder attachment for leaks. Replace the cylinder if necessary. System 98 Service Manual Chapter 1, Operation aFigure 1-10 lectrode Placement 1.3.2.5 ECG Acquisition An ECG signal can be aquired either [ directly from skin electrodes or | indirectly as a high level ourput from an | ‘external monitor (refer to Section 1.3.20 | "Excemnal Monitor Interfacing" for ' additional information on interfacing requirements when using external monitor sources). an ECG patient cable, lead wires and skin electrodes, Use only the Datascope supplied paciene cable and leads to optimize motion and enviromental noise immunity. Disect ECG signal acquistion requires | The type of skin eleccrode and technique of applying the electrodes are also major factors in determining the quality of the signal obtained. Use high qualicy, silver-silver chloride electrodes. These are designed co acquire an ECG with excellent baseline stability, recovery from defibrillation, and minimum artifact from patient movement. 1, When acquiring an ECG directly from skin electrodes; a. Ensure that the patient lead wires are securely inserted into the yoke of the Dacascope supplied ECG patient cable. Connect each patient lead wire t0 a skin electrode. The following table shows the number of ECG Electrodes vs. Leads available. The recommended minimum number of electrodes is 4 co provide optimal lead selection triggering options. ; bb, Actach electrodes co the patient at the appropriate locations as shown, c. Plug ECG patiene cable into the rear panel ECG INPUT (61) connector, |(#] ELECTRODES AVAILABLE (#) ECG LEADS AVAILABLE | RAIA LL - DLL RATA LL RL [160 H.W aVR, AVL, VF. S)RALALLLRL ¥ TL UII aVR, aVL, aVF_W 1 2. When using a high level ECG ourput from an external monitor, plug the interface cable into the ECG MONITOR INPUT (71) jack. 3. Select desired lead setting for direct skin electrode acquisition, or the external monitor input by pressing the ECG LEAD/EXT key (17) 4. Check that an ECG waveform is now present on the System screen and that the heart rate read-our is now functional. PRECAUTION Conductive parts of electrodes and associated connectors for applied parts including the nextral elecrode, should not contact other conductive parts including earth. 128 System 98 Service Manual Chapter 1, Operation1.3.2.6 Arterial Pressure Acquisition An arterial pressure signal can be acquired either directly from a physiologic pressure transducer or indirectly as a high level ourput from a comparible external monitor (refer to Section 1.3.20 "External Monitor Interfacing’ for additional information on interfacing requirements when using excetnal monitor sources) 1, When acquiring the arterial pressure directly from a transducer, plug the * pressure transducer adaprer cable into the rear panel PRESSURE INPUT connector (62). Verify char XDUCER' is indicaced in the PRESSURE SOURCE display field (40). If necessary, use the PRESSURE SOURCE key (20) co select and then proceed co step 3 When using « high level pressure output from an external monitor, plug the interface cable into the PRESSURE MONITOR INPUT (70) jack and select ‘external pressure inpuc by pressing the PRESSURE SOURCE key (20). Verify pressure waveform display and proceed to step 7 To establish « monitoring site, utilize che cencral lumen of the intra-aortic balloon or introduce an arterial pressure catheter into the patient's radial artery in accordance with standard hospital procedures. Aortic pressure monitoring is recommended for managing patients on LABP therapy 3 4. Connect catheter line with a flushing device to the pressure transducer. Zero pressure transducer as follows: Initially, che message "NO ZERO" is displayed in place of the systolic digital display value (44), indicating the need to 2e¢0 che transducer. a. Open transducer vent to atmosphere. b, Press ZERO PRESSURE key (30) and hold for a minimum of ewo seconds. Two audible clicks will sound and the aucomacic zero process is performed Alll of che numeric pressure values ac che right side of the display will show 0 22mmHg when zeroing is successful. NOTE: If the cransducer offset exceeds +120mmHg, it will not be possible ro aucomatically zero the transducer. A "NO ZERO" message indicates this is a faule condition. If chis occurs, the transducer should be considered incompatible or defective and should not be used. 6. Close pressure transducer vene co atmosphere. Check that che pressure waveform is displayed and SYSTOLIC/DIASTOLIC and MEAN digital displays are functional at this time. 7. To measure any point on che pressure waveform, press REF. LINE (21) to activate the reterence line, Once activated, use the UP & DOWN Arrow keys (24) to move the reference line. ‘The numeric value of the pressure corresponding to the reference line position is shown ac extreme left side of the line (when the monitor is initially cured on the reference Line is aucomarically set co 0 mmHg. If this, ptessure level is below the currenc display window, the reference line will appear at the bottom of the window upon the first press of either arrow key System 98 Service Manual Chapter T, Operation re| 1.3.2.7 Initial Set-Up of Controls for Balloon Pumping 1. Verify che pump controls are set as follows: ‘TRIGGER SELECT @ ECG JAB FREQUENCY ©) la IAB AUGMENTATION (7). OFF IAB INFLATION (10) Midpoint IAB DEFLATION (11) Midpoine SLOW GAS (33) ON JAB FILL MODE (G4) AUTO TIMING (35) AUTO ECG GAIN (12) NORMAL 1.3.2.8 Selection of Trigger Both the patient's ECG and arterial pressure waveform should be visible on the monitor. ECG criggering is always recommended as the primary trigger mode. Triggering is evidenced by a flashing diamond at each trigger event. © ECG Press the ECG TRIGGER SELECT key (1). The Syscem recognizes a 120uV (minimum) QRS as a trigger event, This is indicated by a flashing diamond in che upper right corner of the screen. Pacemaker pulses are rejecced in this mode For the best pacer rejection performance, che use of che auto timing mode is recommended. In this mode the minimum QRS threshold of 120uV will be increased automatically if a pacer spike is present to avoid detection of pacer artifact. If artifact is not problematic but greater sensitivity is needed to detect very small R-waves while pacing, che manual timing mode can be used or the ECG GAIN control can be adjusted to increase ECG signal. ‘When an extremely low or high level ECG signal is encountered, the signal | strengch can be altered by using the ECG GAIN (12) function. The UP & | DOWN ARROW keys (15) will vary the ECG gain from 0.15 to 3.0 times the normal gain of 1,000. The 3.0 setting increases the trigger sensitivity from its normal value of 120V to =-40nV. Make sure QRS detection operates properly by observing the flashing diamond and the HEART RATE display. NOTE: "Normal" gain will handle most cases, gain alteration should be used ONLY if required. 1-30 ‘System 98 Service Manual Chapter 1, Operation© Pressure Trigger Press che PRESSURE TRIGGER SELECT key (2), In the PRESSURE trigger mode che Syscem 98 will use the arterial blood pressure waveform as its trigger source. ‘The pump identifies and triggers on the upstroke of the systolic pressure pulse. This upstroke is identified as a positive upturn in arterial pressure; exceeding the current amplitude threshold level and rising ac a rate consistent with systolic ejection. The trigger level is indlicaced by a horizoncal "tick" mark beside the arterial pressure upstroke. ‘The System 98 continuously optimizes and adapts the chreshold level co changes in the systolic pulse height. Manual threshold mode is provided for greater triggering flexibility. A threshold level from 7 to 30 mmHg can be manually selected in | mmHg steps (see Auxiliary keys, section 1.2.2). The threshold level and mode, manual or automatic, are posted just below the "PRESSURE" trigger mode indication in the "TRIGGER" source display field in che upper right corner of the screen WARNING: Readjust or re-cvaluare inflation and deflation timing after manual pressure trigger threshold change ‘The Systern 98 is designed to trigger on the upstroke of systole and ignore rises in arterial pressure accributed to the augmenting action of the IAB. This protective refractory mechanism is very useful in blocking erroneous diastolic trigger events but consequently can mask very premacure pulses associated with instantaneous rises in heart rate, The System 98 has the means of detecting and adapting to rises in rate, but extreme changes, such as rate doubling, can result in every other systole remaining "invisible" to detection. Alternate beat triggering is apparent when the displayed heart rate is half the patients actual rate. This condition is rare, but if observed can be immediately corrected by pressing or capping the PRESSURE crigger key. This will suspend pumping for a single beat and restore proper crigger detection. If no user action is taken, proper triggering will be restored at the 60 second automatic synchronization check point. See decals in the following paragraph 1 Suspended pumping '8 indicated by the Uuniniensied portion of the displayed wavetorm An important fail-safe feature of che System 98 is the pressure crigger’s 60 second periodic synchronizacion check. Every minure, when in 1:1 assist mode, pumping is suspended for a single beat. (See figure 1-11 above.) This permits the patient's natural systolic pulse and interval parameters, unaltered by the action of the IAB, to be checked. This check periodically ensures that che refractory and IAB timing intervals are being properly determined and if necessary, corrects these intervals, ‘This automatic synchronization check can also be user initiated at any cime by momentarily pressing the PRESSURE «rigger key (LED illuminated). This provides the capability to immediacely resynchronize triggering and timing in i Figure I-11 Suspended Pumping Waveform System 98 Service Manual Chapter 1, Operation 131the rare event that a loss of synchconization is observed. When a synchronization check is initiated by pressing che PRESSURE trigger key, the timer for the next check is automatically reset to 60 seconds ‘The System 98 will automatically adape co sustained random dysthythmias, such as atrial fibrillacion, Such rhychms lack a predictable pattern and will produce early systolic ejections that can unavoidably overlap wich balloon deflation, impairing stable and consistent systolic pulse detection. The System 98 automatically detects such rhythms and minimizes the probability of overlap by utilizing statistical heart rate data in ies deflation timing determinations, Deflation is anticipated based on the fascesc "global" rate recently observed rather than the current "local" instantaneous rate ‘When chis special timing mode is adopced, an "IRREGULAR TRIGGER” message is posted in the Advisory display field (upper left comer of the screen) and an alert cone is briefly activated. This message indicates to users chac the System is compensating for an irregular chychm by deflating somewhat earlier co avoid interfering wich systolic ejection. Consequently, users should NOT attempe co adjust the deflation slider if the patient is dysrhychmic and the “Iegular Trigger’ advisory message is posted. Adjustments to deflation timing could compromise trigger performance when the patient finally resumes a regular rhythm and the System automatically reverts back to standard timing mode. NOTE: When pressure trigger is being used, balloon deflation should always be adjusted co occur and complete prior to the upstroke of systole. Late deflation timing causes a reduction in, and delay in detection of systolic pulse pressure. The System relies on a prominent and timely systolic upstroke for consistent, reliable pressure triggering. Any overlap of balloon deflation and systolic ejection, while in the pressure crigger mode, could cause triggers to be late or missed, potentially resulting in loss of synchronization, PRECAUTION Pressure triggering is NOT recommended for use when sustained irregular cardiac rhythms or tachyarrhythmias are present. Remember t0 adjust deflation ‘early enough s0 that deflation is completed prior to systole and be sure 6 provide | continuous observation while triggering in this mode. Ifa "IRREGULAR TRIGGER" message appears, DO NOT astempt ta adjust the deflation control as the system will automatically compensate by deflating earlier to avoid interfering with the systolic ejection © Vencricular Pacemaker (V/A-V mode) and related triggering (Pacer A) Insure thar the System 98 is reliably recognizing the pacemaker stimulus. Specifically, if a ventricular pacer is used, be sure an enhanced vencricular pacer ppulse is observed on each cardiac cycle. Two enhanced pacer pulses must be observed when using an atrial-ventricular sequential pacer. If this is nor che case, select a different ECG Lead or increase ECG GAIN until reliable detection is achieved. AV Incerval Figure 1-12 Pacer V Figure 1-13 Pacer AV 132 ‘System 98 Service Manual Chapter 1, Operation1, PACER A: Press the "PACER A” crigger select key (5) to trigger on the patient's QRS without interference from atrial pacer artifact. This mode is recommended only if atrial pacer tails interfere with R-wave detection when using the "ECG" crigger mode. Fixed or demand atrial pacing can be used in this trigger mode. NOTE: The name "Pacer A" is 2 misnomer from the perspective that this trigger mode does noc produce trigger's sychronous to the pacing stimulus. The merit ‘thac chis naming convention provides is to associate the use of this trigger mode with the pressure of arterial pacing arcifact. PACER V/A-V: Press the "PACER V/A-V" trigger select key (4) when ECG trigger is unobeainable in che presence of a ventricular of atrial-ventricular sequential pacemaker. In this mode, the System automatically identifies and displays the appropriate pacer type. The System eriggers on the ventricular pulse for eicher type of pacer, provided there is 100% paced rhychm (Le... no demand pacing). If the conditions for either pacer type are hho met, a crigger alarm occurs and the message "CHECK PACER TIMING" is displayed 1, PACER V: The System recognizes the presence ofa venericular pacer provided che ventricular pacing interval is fixed and the rate is less than 185 bpm. 2. PACER A-V: The System recognizes the presence of an atrial-ventricular sequential pacer provided the A-V interval is beeween 80 - 224 msec. and the rate is less than 125 bpm. | NOTE: Pacer V/A-V trigger will noc function in the presence of ESU Incerference. Pumping will be suspended temporarily and will resume automatically when incerference disappears. The "TRIGGER INTERFERENCE" stacus message is displayed when ESU interference is detected in the Pacer V/A-V trigger mode. + Internal Trigger Press the INTERNAL key (3). For asynchronous balloon pumping, che IABP may be triggered from an internal signal generator. The rate can be adjusted from 40 co 120 bpm, in increments of 5 bpm, by pressing NORMAL (16) or UP & DOWN ARROW (15) keys in the Auxiliary Keys Group. The System will display “INTERNAL! in che upper right corner of the screen When Internal Trigger is selected, the System continues to monitor for R-wave activity via the ECG patient cable. If valid R-wave activicy is derecced, then the System sounds a double alarm beep for every R-wave devected and che trigger alarm indicator is illuminated wich a message "ECG DETECTED." The System deflates the IAB immediately after an R-wave detection ro prevent competitively pumping with the pacient. If reliable R-wave activity has resumed then the System should be switched back to che ECG Trigger mode for proper timing. WARNING: Never leave the System set in the Internal Trigger Mode if the patient is generating a cardiac ouput, System 98 Service Manual 1-33 Chapter 1, OperationFigure 1-140 Display Showing Assisted ‘ond Unossisted Pressure Figure 1-14b Detail of Waveform Showing Assisted and Unassisted Pressure 1-34 1.3.2.9 Selection of IAB Frequency he number of heart bea 1:2, one our of ‘The selection of [AB Frequency determin assisted by the IAB. The selections are: 1:1, every beat is assist two beats are assisted; or 1:3, one our of three beats are assisted. Press the IAB FREQUENCY key (6) to make selection. The choice of IAB frequency determines the manner in which the arterial pressure indicies are computed and displayed. In 1:1 mode all beats are assisted and a single “assisted” value is displayed for each pressure index. When either 1:2 or 1:3 is selected, che System 98 will seperately display the essures. These pressure indicies are illuscrated below in figure 3-5b. IF the recorder is activated during 1:2 or 1:3 frequency, the assisted and unassisted systolic and diastolic pressure will also be printed as trailing information on the strip. Figure 1-14a below is a sample of che display illuscracing the assisced and unassisted pressures. See section 1.3.10 for ssisted and unassisted pressures. assisted and unassisced systolic and diascolic samples of the recorder printouts indicating _| “Augmented unassisted Diastolic Pressuee Systolic Pressure Assisted olic Pressure Unaseisted End Diastolic Pressure Assisies End Diastolic Pressure ‘System 98 Service Mar ‘Chapter 1, Operation1.3.2.10 Timing of Intra-Aortic Balloon Automatic Timing Mode Jn this mode the System 98 Cardio Sync™ sofeware algorithms examine cardiac interval parterns, on a beat by beat basis to intelligently ancicipare IAB timing. The System will automatically adjust che inflacion and deflation timing of the JAB co track changes in chychm and heart rate. The user muse establish initial ‘inflation and deflation timing points for each patient, Thereafter, the Syscem will adjust ciming automatically to accommodare changes in the patient's rate and rhythm, To use the Aucomatic Timing Mode: 1. Ensure that the system is in the auto timing mode, as indicated by che "AUTO" LED adjacent to the TIMING key (35). Establish initial timing as described in che "Initial Timing Adjustments" section below In auto timing mode, the System 98's unique ECG deflation timing logic provides consistent tracking under che demands of ectopics (isolated PVCs, couplets, bigeminy. trigeminy) and abrupc changes in heart rates. When either individual or paired ectopic beats are identified, the System 98 invokes pattern specific timing rules to precisely track the compensatory pause to follow. Pactern specific timing rules are also applied when che onsct of a substantial change in rate is detected Sustained random dysthythmias, such as atrial fibrillation, lack a well defined paccern. When managing such cases in the ECG trigger mode, consistency of [AB deflation can be maximized by moving the deflacion slider to its extreme right side stop, labeled "R-Wave Deflare™. The stacus message "R-Wave Deflate" will also be posted in the advisories field of the display. This setting will hold the [AB inflated duting the entire diastolic period. Since the start of [AB deflation is delayed until the next R-wave trigger is detected, this secting may not be appropriate in all patient conditions. Increases in systolic pressure should be monitored and avoided. ‘Manual Timing Mode ‘A manual timing mode is provided co permit an expansion of the timing range available from the pump. In the manual mode, the user sers fixed inflation and deflation delays relacive co the trigger point. Manual timing will NOT. auromatically adapt to changing heart rates or rhythms. To use manual timing mode 1. Press the TIMING (Override) key (35) uncil che MANUAL LED is illuminated. Escablish initial timing as described in the "Initial Timing Adjustments" section below The numbers under the INFLATE and DEFLATE conctols are used as guides when setting che manual timing, On che inflate control, "0" represents inflation at the trigger event with each increment representing approximately a 123 msec delay, On the deflate concrol "0" represents deflacion immediately after inflacion with each increment representing approximately a 125 msec delay NOTE: In manual timing mode, LAB deflation delay begins at the point of [AB inflation. If che inflation point is adjusted, the deflation point will also move by an equal amount, WARNING: If the heart rate varies by more chan 10 bom, readjussment of timing may be required when in the manual timing made System 98 Service Manval Chapter 1, Operation 135Figure 1-15 Intensified Inflation Marker Initial Timing Adjustments - Use of the Inflation Marker While in the Standby mode, an inflation marker is provided to aid in initial timing adjustment 1. Use the INFLATION (10) slide control to move the marked segment of the arterial pressure trace so that it begins at the dicrotic notch, 2. Adjust the DEFLATION (1) slide control so that the marked segment ends slightly before the up slope of the arterial pressure waveform. Dieratie Notch Inflation Marker 1.3.2.11 Arterial Pressure Delay (APD) Arcerial Pressure Delay (APD) is the time delay from when Arterial Pressure changes occur at the heart co when they are observed at che pump. APD will vary with the pressure monitoring site used (typically cencral lumen or radial) and with the physiology of the patient. APD is a value used by the IABP to adjust the time position of the intensified segment of the Arterial Pressure Waveform. APD only effects the position of the intensified segment of the waveform, i does noc effect timing. The initial APD defaule seccing is ser to 40 msec and is automatically computed on the first assisted bear, following power-up. While pumping, press and hold che INFLATION INTERVAL key (19) to confirm that che marked and intensified segment of the arterial presstre ¢race begins approximately at the dicrotic notch If nor, the Arterial Pressure transmission delay (APD) can be aucomatically recalculated by quickly pressing and releasing che INFLATION INTERVAL key (19). Confirm proper intensification position. If still incorrect, APD can be manually adjusted in the Display Preferences section of the Preferences menu. Once APD is selected, the delay may be adjusced from 0 to 180 msec in 4 msec increments using the UP and DOWN ARROW keys (24), The marked and intensified segment of the Arcerial Pressure waveform will consequently move later on che crace. This delay can be adjusted t0 approximate the start of intensification at the dicrotic notch. NOTE: If the pacienc’s pressure monitoring site is changed while pumping, the INFLATION INTERVAL key (19) can be quickly pressed and released co recalculate arterial pressure transmission delay. Reconfirm proper position. This will assure accurate digital pressure displays, 36 System 96 Service Manual Chapter 1, Operation1.3.2.12 Initiation of Assist The System 98 incorporates a single button rapid scart feature when in the Auto Fill Mode, co expedite che scart of IAB assist. The following sequence of operations occur automatically whenever the ASSIST STANDBY key (9) is pressed for the firse cime following System 98 power-up: TAB Autofill - the [AB catheter circuit is double purged and filled with Helium shuttle gas (skipped if previously filled) Start Assisting - inflation/deflation begins immediately following the AutoFill Increase Augmentation - IAB displacement volume is gradually increased co max (skipped if Augmentation Keys (7) are pressed). To Begin Initial Pumping Following a Power-Up: 1. Connect the LAB, with appropriate cathever extender, co the safecy disk pneumatic connection labeled "TAB Catheter Extender Input" (58). NOTE: Incorrect IAB and extender combinations can resule in incorrect filling volumes or AucoFill failures 2. Press the ASSIST/STANDBY key (9) to initiate pumping. Confirm that an IAB AutoFill is in progress, indicated by the "Aucofilling" message posted in the Advisories field of the display. The balloon catheter circuit will be purged and filled wich a calibrated volume of Helium. This fill process will then be repeated, 3. Pumping will begin following the successful completion of AutoFill, indicated by the "Autofilling" message clearing and the ASSIST/STANDBY key indicators flashing with each inflation cycle, To facilitate arterial pressure transmission delay (APD) measurement following a power-up, an abbreviated IAB inflation will occur on the fsse pump cycle The System 98 will then progressively increase augmentation on each, successive pump cycle until the MAX level is reached. This provides an opportunity, prior to full IAB volume displacement, co make the necessary fine adjusements of [AB INFLATION (10) and IAB DEFLATION (11) timing controls. Augmentation should begin at che dicrotic notch. ‘The aucomatic augmentation feature may be disabled at any time by pressing either che UP or DOWN IAB AUGMENTATION key (7). Subsequent presses of the UP or DOWN keys (7) will incremeneally increase or decrease augmentation respectively. 5. Confirm that maximum augmentation was reached, as indicated on the LED bar meter adjacent to the IAB AUGMENTATION keys (7). LAB assise should now be optimized 6. Verify that after one minute of pumping, the Aug. Alarm limit (48) determination on the display panel is approximacely 10mmHeg below che patient's diastolic augmentation pressure. Fifteen seconds after a valid pressure source is derected, the augmentation alarm limit is aucomatically set LOmmHg below augmented diastolic pressure. During this one minute learning interval, che alarm limit can increase co a Sysiem 98 Service Manual Chapter 1, Operation 137maxirnum of 200mmHg. However, the limit will never adapt more than SmmHg below che inicial beat’s augmentation level. Subsequently, manual adjustments can be made at any time to this predetermined limi. 7. [adjustment to che alarm limic is desired, press che AUG. ALARM key (22). Then press the adjacent UP or DOWN ARROW keys (24) to increase or decrease the alarm limit respectively NOTE: The augmentation alarm, when used properly, serves as an important backup to internal monicoring alarms. Due co the dynamic nacure of the shuttle gas system, Gas Loss and IAB Cacheter alarms do not operace under severe patient conditions (see Section 1.3.3 for more details). By setting the augmentation alarm, the system monitors the level of assist and will alert the user in the event ofa decrease in augmentation pressure. Gas Loss and IAB Catheter alarms are inoperative when pumping in the MANUAL IAB FILL mode. Consequently, the use of the augmentation alarm, is essencial when caring for patients while operating in this mode WARNING: Do nos leave the patient unattended dvring [ABP sherapy To Refill IAB and Resume Pumping Subsequent to Rapid-Stare: ‘The single button rapid-stare feature is only available when pumping is initialized following power-up of che System 98. To manage pumping thereafter, the individual IAB Fill and Augmentation Control functions must be accessed directly. (Example: Direce control of these functions is necessary when responding to cerrain classes of pneumatic alarms, like "IAB Disconnect". This class of alarm requires chac che IAB be refilled prior co resuming assist.) If chis or any other event requires balloon eefilling and pump initiation proceed as follows: L._ Verify char che AutoFill mode is selected by checking that the AUTO LED, adjacent co the JAB FILL MODE key (34), is illuminated. 2. Press and Hold the [AB FILL key (8) for 2 seconds and confirm chat an TAB AucoF ill is in progress, as indicated by the "Autofilling" message posted in the Advisories field of the display. The balloon catheter circuit will now be purged and refilled once with a calibrated volume of Helium 3. Assise can be resumed by pressing the ASSIST/STANDBY key (9) when the " Autofilling" message has cleared NOTE: While assisting in che AUTO fill mode the System 98 automatically purges and refills the balloon catheter circuit with Helium every two hours. This Gill cycle will complece in approximately 6 seconds, after which assise will automatically resume. An AutoFill can be initiated, at any time, by pressing the IAB FILL key (8). This resets the 2 hour AutoFill cimer. Should 2 hour AutoFill time-out occur while in the STANDBY mode, an AutoFill will be performed immediately upon recurning co the ASSIST mode. An AutoFill will also occur if local atmospheric pressure decreases or increases by 25 of 50 mmHg respectively, as may occur during air cransport. These pressure changes will initiace AucoFills approximately every 1,000 feet of rise ‘or 2,000 feet of drop in alticude co keep the balloon pressure acclimated to local conditions. 1-38 System 98 Service Manvel Chapier 1, OperationNOTE: If the AucoFill procedure fails to purge and fill the safety disk properly. | the message "AUTOFILL FAILURE" will be displayed and an audible alarm | activated, Corrective action can be obtained by pressing the HELP SCREEN key (29). MANUAL FILL help screens, as well as detailed fll illuseracions (See Section 1,3,2.14) are provided should MANUAL FILL become necessary 1.3.2.13 System Power-Up Defaults ‘The power-up sectings depend upon the amount of time the Syseem has been powered down The System recognizes when ir has been powered down for less than 15 minutes. ‘When the power is restored within che 15 minute period, the System retains the user settings (with exceptions as shaded in the table below) and trend. The shaded items always return to their default seccing, When the System is powered down for longer chan 15 minutes the factory default setting are restored. At chis point when the System is powered on, the user sectings and the trend are cleaced. To adopt the factory defaule seccings prior to a full 15 minutes power down, press the CHANGEISELECT key (25) while powering on the System. The following table lists all of the controls and heir default sectings. Defaule settings are programmed at Dacascope and cannot be changed “CONTROLS, {Tigger Sele ~_[erauts| ECG LL [Sandy oot filed) [Not Filled fa doable amo 6 TAB Augmenticen lor [a8 laltacon Manny Ser = No Baie [HAR Daten ECG Lead z= Presure Somer Tioeernal _ Pressure Zero Nor Zeroed Normal (Fixed 80 BPM) Slow Gut [on _ 1 AUTO. Himing eaeaeestaae IAB Fill Mode z [AUTO System 98 Service Manual Chapter 1, Operation 1-39The followii z table lists all of the default preferences, selected by pressing che PREFERENCES MENU key (27). | PREFERENCES Sep Sceed Brigheness, Ballooe Waveoe ECG lnflaion Mati [Flash Alaron Mesazes Beep Volume ss OFF - As Last Sez (ndally set co OFF 2c Dutascope) | Peessure Scale As Last Sect by Advisory Tone * The Pressure Scale setting will remain as set unless power is shut down for more than 15 minutes. In this case, if the Pressure Scale is set to manual che pump will recurn ro 0-160 scale, If che Pressure Scale is set to Auto, the pump will always return co Auto until the user selects a manual setting The following table lists all che default printer menu sectings, selected by pressing the PRINTER MENU key (28) PRINTER MENU SETTINGS Firs Waveform Second Waveto Scrip Length Timed Prine [Prine on alarm System 98 Service Manual Chapter 1, Operation1.3.2.14 Manual Fill Mode If an Aurofill failure remains unresolved after following the associated HELP SCREEN instructions, the IAB may be manually filled. Step-by-step HELP SCREEN inscructions for manual fill are also provided for display at the bedside. These HELP SCREENS become available following a press and hold of the IAB FILL key (8) in the MANUAL FILL mode. The scep-by-step manual fill instructions with graphical illustrations are included below for Adult [ABs: WARNING: Gas loss and IAB catheter alarms are disabled while in the Manual Fill Mode. (The Slow Gas override LED is illuomina NOTE: When in che Manual Fill Mode, the condensate removal module system will nor operare. 1. Select MANUAL using the IAB FILL MODE key (34) Remove the aucofill cubing, from the [AB Fill Pore (75) on the safecy disk. 3. Accach a three way stopcock to the IAB Fill Port (75) on the saiery disk. 4, Actach a plastic 60cc syringe to the stopcock Figure 1-16 Press Manual Key Figure 1-17 Remove AutofilTbing Figuee 1-18 Aitach 3-way Stpcock Figue 1-19 -Anoth Syringe System 98 Service Manual Chapter 1, Operation Vat+ Figue 1-20 Press IAB il Key Figure 1-21 Open and Close Stopcock Figure 1-22 Pull Back on the Plunges to Evacuate the Syringe Figure 1-23, Attach Syringe to ‘Manual Fill Port 5 10. WL Press the IAB FILL key (8) for 2 seconds to relieve vacuum. Verity "MANUAL FILL" is displayed in the NOTE: All Darascope adult size [AB catheters plus extender have a manual fill volume of 80ce. When using ‘catherets from another manufacturer consult chat manufacturer for guidelines Open the scopcock between the disk and syringe. Evacuate the disk by pulling back on che syringe plunger. Close the stopcock to the disk Evacuate the syringe. Repeat steps 6 and 7 uncil a strong resistance is noted. A strong resistance should be noted within three arcempts. Ifa strong resistance is noted, proceed to step 10. Ifa strong resistance is not noted within three actempts, remove the Drain port tubing and artach che Drain port plug, located in the manual fill accessory ki, to the Drain port. Repeat steps 6 - 8 Arcach the syringe co the Manual Fill Pore (73) located on che rear panel Hold hand over syringe plunger, WARNING: Never use a glass syringe for the Manual Fill Procedure. Posible injury may occur if las breaks Fill che syringe and discard the contents. Re-fill the syringe with 40ce of helium, 1-42, System 98 Service Manual Chopter 1, Operation13. Quickly move and attach the syringe co the stopcock on the safecy disk, and open the stopcock co the disk. ! 14, Press the IAB FILL key (8) for 2 seconds toallow the syringe contents to be drawn into che disk. 15. Close the stopcock co che disk. 16. Refill the syringe wich che remaining 40c¢ fill volume of helium from the Manual Fill Port (73), 17. Quickly move and attach the syringe to the stopcock on the safery disk. 18. Open the scopcock to the safety disk. The remaining 40 ce of gas will be drawn into the disk. 19, Close the stopcock and remove the syringe. PRECAUTION If she conzents of she syringe are not drawn into the safety disk DONOT resume balloon pumping Return to step 5 in the Manual Fill Procedure, paying careful attention to syringe fll volume, If second attempt fails, shere most Hikely is a leak at one of the safety disk ports or stopcock and | shey ‘should be checked. 20. Press the ASSIST/STANDBY key (9) co begin pumping. NOTE: Due to diffusion of gas, the ‘manual fill procedure should be repeated every 2 hours or as needed Figure 1-24 Attach Syringe to Stopcock Figure 1-25 Press the IAB il Key | Figure 1-26 Syringe Contents Drawn into Disk Figure 1-27 Press ASSIST/STANDBY Key System 98 Service Manual Chapter 1, Operation 143| 1.3.3. SYSTEM ALARMS, ALERTS, and STATUS/ PROMPTS || There are various types of condition-specific messages. They ate: ALARMS, ALERTS, STATUS/PROMPTS and AUX (ausiliary). These messages are displayed based on the priority of the condition chat prompted them. When an ALARM message is displayed, IAB pumping is suspended and 2 steady cone is sounded When ALERT messages are displayed, IAB pumping is not suspended, but corrective action is required. ALERT conditions which require immediate action ‘cause a continuous double beep cone to sound, All other ALERT conditions (except for heart rate iw) sound a double beep cone that repeats for 30 seconds. STATUSIPROMPT messages do nor sound any cones (except for "Unplug Outlet and Plug Outler") and are advisory in nature. AUX messages are displayed when Secup or Help screens are available, ALARM messages are displayed in the ALARM MESSAGES (36) section of the display. There is one alarm message line. If more than one alarm condition occurs simultaneously, che highest priority alarm is displayed, When the first alarm condition has been corrected, then the next highest prioricy alarm is displayed. See Message Surnmary Table for priority listing. The table is in priority order ALERT and STATUS/PROMPT messages are displayed in the ADVISORIES (37) section of the display. There are three lines in this display. If more than chree messages need co be displayed simultancously, the three highest priority messages 2re displayed. When one alert or status/prompr condition is corrected or climinated, then the next highest priority message is displayed. See Message Summary Table for priority listing. The table is in priority order. Gas Loss Alarms provide surveillance for leaks which can result in gas leaving or entering the LAB circuit. LAB Catheter Alarms detect an occlusion of the IAB catheter or extender. Gas can be trapped in che IAB andior the safecy disk depending on the timing of the occlusion with respect to the pump cycle. Gas Loss including IAB Disconnect and LAB Catheter alarm operation is maintained at heart rates up to 140 BPM#, However one component of the catheter alarms, detection of gas trapped in che safety disk, is suspended ac 112 BPM* co minimize nuisance alarms. WARNING: The Augmentation Alarm, which is automatically set at power-up. provides back-up to these alarms at bigher rates. Therefore itis important shat once set this alarm NOT be manually disabled WARNING: When the System is operated in the Manual Fill mode, LAB gas loss and catheter alarms are disabled. *Timang sliders at nominal mid-position (Auto Timing). 1-44 ‘System 96 Service Manual Chapter 1, Operation1.3.3.1 Alarm and Advisory Table The following p .ges provide a table of all ALARM, ALERT, STATUS, and PROMPT messages. The table provides detailed information for each message, but does noc concain corrective action, See the Help Screens for correction action Message Message Probable System ‘Audible ‘Alarm “Type Displayed Cause “Response Alarm “Reset ! {Alsem {*Fleereal Failure of one or more [Sytem i held [Steady on, Atternpe co clea by cycling power | | (Fetal, ekctncalabstsem iRVENT mode jimmedately |OFF SON, | Godew + [fee during gen / TAB deflared ipover-up diggnotc i a ysrem [solenoid driver ‘Sysrem disabled |Seeady, on Accempe vo clear by cycling power ifalure’ log deecred_—'detulerive [immediately |OFFRON. Nocusce mabe | Solenond energized for cestred to lpprox. 2 seconde ot |afey disk ___ BBP cceso fauce. IAB doiared "Saky Disk Leak deceeted in Safety SD. Diagnoeric Srady, on Hold FILL kay down fr two seconds TecEals | Drsk/aueo Fill, Mode’ LAB immedicely Aembly duciog SD, NOT connected. prompts not executed rope j Auiofill Buloon could sor be |Venr/ TAB |Sveady, on (Manually, muse bold FILL key for Fuluwe-No AUTOMATICALLY —[delted Immediately ‘two seconde to citer etry autofill or i cum? [filled because of \ a manually 8 sate Ficlium gas | : i ly _ oe a | sient leak in [AB TVent ‘IAB ready, on 'Manually, must hold FILL key for athererfesleng in |eflaed immediately evo eons orcey ani fl \ [ica Sugranon back | eubing een Balloon could no by Vene/ IAB Steady, on”[Mandaily mune bold HL hay fr AUTOMATICALLY def jimmediscely lier eur aol or | ‘filed as defined sn I fll. performance section ‘but, Helium supply 35 { | ___isdssuae i | Rapid Gus [Large ineranancous TTIAB [Seedy on Dosage and cane Le ibeacce-bean losat |deited Imovedisely key i pcsed for wo seconds i appron 23 cof {Standby condiwon cared with | manual depresion FAST) SINDBY be AETER vceessin | 1 ae [fll | TAB iDisconnection TAB [Voor IAB [Seeady, on | Mestage and fone Geared when FILL | Daconnected’ ‘orentenion catheter | deflated immediately | Key pressed for ewa seconds, j Shei che ASSIST Standby condition cleared with | mode fama depeesion of ASSIST) | | ; SEANDAY key APTER successl tn 7 Hf ie i 1-45 System 98 Service Manual Chapter 1, Operation[Message Message Probable system ‘Audible ‘Alarm | Type Displayed Cause [Response Alarm Reset i [Aleem "High Drive Repuacd peat Suny TAB Scot om Manele prune ASST | Presue’ fom somprenordeflned = jemmedisely STANDBY key | | ceceds seep | i eee | ; “auch [Prompts the wer co Seandby IAB (Seely,on (Manually when ae aucoillis | Required’ [aurofilehe LAB. This deflated Nainared | i [prompreniy cccursin | | Thess mode when: | » TAB al i | j seas "Manual and che ' | | user switched co the | | | “Aut mode i j ! 2) The current IAB Fit | is’Auco andthe | i ocomatic il over i | ue because the System | | | feua) wich co the | | ' Sinai IAB Al | | j mode, oc bin the | | SraniSy* made i i "Check TAD Occhision of AB) Seandby TAB Seady, on Manually, by presiog ASIST | | Gerewt"eatensoncatherer or {deflated immediatly STANDBY key. tcowrapped bacon, | | | Thnk in TAB Comutave shutle gas [Sandby TAB |Scady, on | Mesage and rone cleared when fil | Circuit fexsexerds the 3.cobe [aehated immediately |key is pressed for ewo (2) seconds Span lit ox era Scldky condition cleaed wih fenced 135 ce anual depreon of ASSIST “lanve co asset |SEANDBY key APTER succes ‘Solume. active ONLY | ja | een | \ ish IAB inflaton \ ipentod » 150 msec and | iSetiacon period » 200 | "Ro Frssare Displayed when Standby TAB Steady, on [Message and vone cleared when ' [Trigger Zero [internal source BP. ‘deflated immediately transducer is manually zeroed. “Tiiscuces™ | Cameucer ss conneced SGihdby condom seared wich : {ond presurewngger pana depression of ASSIST : { Iseleceed but che | STANDBY key AFTER successful : [amaces bs NOT | serving Z { [ben sree | i "Insuificizr or 0 | Waiting wo [Steady on [Automancaliy, when vacuum is i compresor vacuum, {pump(fieudo |immediaely [restore | Sandby IAB | | [cies el | ' WAV pace coger” Wattins wo OnvenlyAutomancaly. pacer eine Intenalvases 5% or pumpiPieudo ster Tote [conditions are met Manually. be may pacer aceis fandbyy TAB lence 'Seseleceng parce engser nade | sand |Wating © Onvaeady_Automadally, when ger reurn, | | Ser mance eae b do Sei | : | | Ssuon-dop NOTexse [randoy IAB silece | Crisler wile m ECG Geel OTE: The | | Pacer cigyer mos ‘ucible alan | fears i ' lppresed | | Salsa ' | mee RR | i interval was ov anced | Uloce eke [pump was 1 _ [turned on. Ta System 98 Service Manvel ‘Chapter 1, OperationWessage Message Probble System Audible Alerm Type Dipped _—_[Couse Rtigonse Alarm Reset j fm No Prasire Valid eigen a0, Wang co "On ey Taucomnesalp. hen Wager ee jAlarm ‘dcined ipetoemance !pumptiseado ster 13 xe | / Sion doo NOTotce Sundby IAB tissce (Selosebem alge 8? | | ' (Frenne ager mde | lecwosrgel ove | Wang 7 [Sealyjoo [Awami when SU | : Geese-wheinthe pumptGseudo [ater Bcc limestone Sop | i Freetagecr ose’ [fupdoy) tab Seay ene | t deflated cous sfer 15 see : i "Unplog Disk Prompts wer area’ |S.D. Diagnowtic |Steady, on Manual, pees FILL Key fewo Prompt oko fSateyy Disk Leake Mode IAB is limmediaely seconds eo resume esting ae | i leafy eik'scachoree | j | ‘Conuctrs tat | Senesphere presute | ima fog The | i (digoste i ema i paused uneid the I ‘ ce, 4 "Piag Bok Pompe wer at sare SD. Dagaesie “Sead on Aorta se en cond day | SREP Reapers SDD Semin, (dae | Bagnovecstosap he | NOTcomected i sotery disk s catheter i { 1 (Smetbe These | | cri Oucconds | i {Bhar ihe concer i i |befoce the prompt is | i dled and ee | | Segre ame | | “TAB Nor Nowe tbe operator [eye Node [None Nn pos HUD kg Tr wo pale Neer Betas | Monit aera hus been male Bat the | |TAB circuit has NOT | been filled with shuctle | | ‘Mogul Fil Netfes he opancae FllMgie(SB. Naw Mimagl pew FLL Ley ro \ IA into manaily Ri [Brae ened cond Thea coer th shel on Displayed jin MANUAL FILL Uo eben tbe FLL [ring the sie di, TAB deflaced | Sysiom 98 Service Manual Chopier 1, Operation a7‘Message Message Probable System ‘udble Alarm j Type Displayed Cause Response __ Alarm Reset | Ales “ECG TECG actviy Assisting (TAB Continuass [Awomateally when ECG acuity | i |Deteccsd® ececed persistently jsimmediately double beep ceues. Manuals deselecting i ford.Gsecondh whe |defued on each Internal tigget mode | cn eho internal |Rsave ' inonsynh,) mode | i egular While in Pressure System Tafer 60 Automutialy, when wigger ineeval . Teese ciggeemole,eae autoratially ‘Second delay, is eegular. reget tom: 1) fuses deicn double beep ~ linbychmic pactent onshore [eimes ue afer \ yeh Gediae intervals |2"3 seconds i ise detation: | Jacdepeas | j ienibieng prenace | |every bie. | ule detection | |Below Limit has dropped below user \double beep sesabove alarm lie | Ise" selected ae | I | | “Hea tae HR = OBR [iaiael Now Ampawcah who HR nea Low i i jftow Bassey —[Theexteral ounce Unafeced Double bep ~ |Awromatically comoves mesane KEXT)" falls below 50 minuces fumes outset tees of tone anser Coie | Panna SOscconds | barry occur ‘ ! [Repeats every | | i I Ho minnie. i “Low Burery” [Bacery mere ils Umalfeced Double beep - Automatically emoves mesage and. | i Selo 30 minutes of {rime ou after | cens af tone when AC i restored i operuing sme. {Sosecones. | | | i | Repeat every | Tofmnuces | FPMteincenance System maintenance Unalfecced [Double beep - | Attempt co clear by cycling power | Requiced may be eequeed times oueafee (OFF and ON i | Code SO second | "Low Han cium gly wclow Uniesd Double beep Automata wit sew Hecank | i 2 fl reserve a8, mes ave alee | (dceersined By eae SO seconds. | | prsure - | | clone? ump as bem in Unaieced—~ ae abled | Rene papin | | ‘Timein—|Seandby foro lease 20 Disables ~ | | Standby’ minutes Double beep | } ames out ater | j i So second | i | | [Repeasevey | | | [5 minutes | | [No Pusient | nweral clceonics [Amsating IAB Continuous _[Auempr co clear by cycling power | Sas fue. Jinflasing & doublebeep OFFard ON t i Azalable |e | _ 18 System 98 Service Manvel Chopter 1, Operation‘Message Message Probable System ‘Audible “Alorm Type Displayed Cause Response Alara Reset _j [Scarus ‘Leak Tescns Displayed ducing the S.D. Diagnose None Nia Safer Disk safery Disk Leak Mode 'IAB or connected that testing #6 sla peoeress, “Aucfling” Indicate tae che Fill Mode TAB Nowe Na System is ince process sdelaed sfautomaialiy purging and refiling i | l be 1AB wh Helio i | [GasLow and” Allleskand catheter Unaimccd [Nowe ina 1 | Gorheree "ms ace datles : ‘Alarms, when sual il mode H ] Disbled | ; Cachet mancally \ | flea _ Slow Gas Siow guslowsalarm Unaflcad None Na 1 ‘om Override disable selected by { | ‘on (bse (Roce Rapid ose | i Lfmecionvlacive) 4 i *RoWave [Operator enabled Urafeceed Nowe [Move deflation sider away From iDetae”” —'Riwave deflation by | Deflaion ‘xem night poeion j moving dese siec co Regios oh i jesteme right position. |Revave | erccen i "Base in Indias Sytem [Unafiected Nowe |Pover Siem oman AC power | IUseTEXTY ‘apecating fom an ee / } L external DC source. | Bacery im Indicates System is Unalfesed Nowe "Power Spe fom exemal barry | | Use joveting fom en i ounce or AC power source | i steenal buses | "System Test Indicates char all” [Vee TAB [None “Ruvomaci, msrage hs Gplaxed or] | OK subsystem checked delaced ispprox 10 seconde following the | uring power-up completion oft pened dispnees (Sistem [Displaved when the, Unafccied None Na 1 | Trine" Scans 90 Trane i | feing used we ECG and \ i Preuure source i i [Au Fee Displayed ac powerup Unafeced None Na 1 \vsble for jane the fe pump ! | { ‘inital Sug” [ele | [Help [Displayed whca he [Unalcad None Na Available for jise selects MANUAL i |Manual Fill 'Fil, Theee is 20 | I { dviorymesage | \ i | isplayed: Only a racus ! | |metsage on che Socom | H . Sf ehe ster, | re Sysiem 98 Service Manvel Chapter 1, Operation1.3.4 Water Condensation During the balloon pumping procedure, a fine mist or small droplets of wacer may occasionally be observed within the IAB extension catheter andor fill and drain tubing. This mist is condensed water vapor. The System 98 has a condensate removal module which aucomatically collects and removes condensate without operator intervention. Ifdesited, che following procedure may be used to manually check and purge any condensate which may have collected in che IAB extension cacheter. 1. Sec IAB FILL MODE key (34) to "MANUAL! and the ASSIST/STANDBY key (9) 0 "STANDBY." 2. Disconnect patient balloon catheter extender from patient LAB and cip downward 3. Sec pump to "ASSIST." 4, Pump for approximately 20 to 30 seconds, Water will be expelled Sec pump to "STANDBY" and reconnect extender to patient LAB. 6, Return che IAB fill switch co che original fill mode, purge and refill patience balloon/safery disk and resume balloon pumping. NOTE: If large wacer droplets remain in 6 foor extender (P/N 0684-00-0182) ic may be attached to suction to remove them. Be sure extension is disconnected from IAB and safety disk. (See User Maintenance, Chapter 4 of Operating Inscructions). NOTE: When in che Manual Fill Mode or when the battery is low, che condensate removal module will noc operate. NOTE: When cransferring a patient from another IABP System without a condensate removal feature, ensure that all droplets of condensate ate removed from” the extension catherer tubing before connecting to the System 98. To remove condensate the procedures above may be used or follow the [ABP manufacturer's recommendations. condensate removal module requires PRECAUTION Proper operation of the automa sole. Excessive condensate may indicate ‘proper connection of the safety disk assembly 00 the the need to service the condensate removal module. PRECAUTION The Condensate Removal Module (CRM) is designed to function most efficiently chen the anit is in a normal uprighe (vertical) pesition. Transient operation of the CRM in a horizontal position should be limited if condensate removal functionality is regitired. Technical Service rhould be consulted for LABP's which are permanently configured for horizontal use 150 System 98 Service Manvel ‘Chapler 1, Operation1.3.5 CLINICAL CONSIDERATIONS DURING OPERATION 1, ECG: There ate several methods co correct conditions which alter or hamper the sequisition of reliable ECG, Repositioning or replacement of the ECG electrodes. choosing an alternate lead selection or ECG GAIN settings and checking that the patient cable is properly connected are the most common solutions. 2. Pressure: Flush arterial line at regular intervals per scandaed hospital procedure. + Adequate flushing to maintain pressure line patency and alignment of stopcock in the proper position will prevenc the majority of possible pressure crace problems 3. Acrial Fibrillation: Use che AUTO timing mode. With the pump in "STANDBY". adjust the IAB INFLATION (10) and IAB DEFLATION (11) controls to posicion che highlighted inflation interval marker of the arterial waveform to correspond to diastole, In che ECG Trigger mode, the deflare slide control may be moved all the way to the right (to the R-wave deflate label) allowing the R-wave to deflate the IAB. "R-Wate Deflate' will also be posted in the advisories field of the display 4. Triggering on Ectopics: In the Auto mode, the System 98 automatically deflaces on and assists the ectopic beat, if the ectopic R-wave is sensed. If che ectopic is of small amplitude, reliable triggering can be maximized if an ECG Lead is selected which minimizes che amplitude difference between the normal QRS complex and that of the ectopic bear. No special adjustments are necessary Cardiac Arrest-Ventricular Fibrillation: When defibrillating the patient, the System 98 has protection and is completely isolated feom the patient and the unit, However, the operator should stand clear of the System during defibrillation. 6. Ventricular Standstill or Prolonged Cardiac Arrest: If possible, use ECG or arcerial pressure crigger during CPR. The System will synchronize trigger to the rate and rhythm of chest compressions. If ECG or arterial pressute trigger does noc produce adequate trigger to allow for balloon movement, the [AB may be placed in the inceenal trigger mode. The normal internal rate is 80 BPM but can be varied between 40 and 120 BPM using che UP & DOWN ARROW keys (15). Adjust the augmentation key to produce a slight movement of the disk diaphragm by observing the [AB STATUS INDICATOR (41). Observe the IAB STATUS INDICATOR (41) and the patient's arterial pressure to make the proper adjustments, This allows minimal movement of the JAB which will reduce potential chrambus formation, Note that IAB FREQUENCY key (6) does not affece pump race in INTERNAL trigger mode. WARNING: The patient balloon should not remain inactive (i.e, no inflasing and deflating) for more than 30 meinutes: due to the potential for chrombus formation 7. Change in Pressure Monicoring Sice: If patient's pressure monitoring site is changed while pumping, the INFLATION INTERVAL (19) key can be quickly pressed and released to recalculace arcerial pressure transmission delay (APD). This will assure accurate digital pressure display values and arterial pressure trace inflation incerval markers. 8. Simultaneous connection of several medical devices to the patient may cause summation of LEAKAGE CURRENTS which can exceed the values allowed by the Safecy Agency Standards (see section 3 - Agency Compliance). System 98 Service Manvel Chapter 1, Operation TT1.3.6 USE IN ELECTROSURGICAL ENVIRONMENT The System 98 IABP has built in electrosurgical interference suppression which minimizes electrosurgical unit (ESU) noise from disturbing System performance. While the system will suppress ESU noise, ic cannor eliminate it all cogether. Sparking to tissue occurs when an ESU is operated. This generates noise that extends into the ECG frequency range. Since the system must pass ehese frequencies, some ESU noise may interfere with the ECG signal, particularly wich high ESU power settings. Limiting the power of this noise energy is desirable. The magnicude of interference is directly related co the power setting of the ESU, which should be as low as, possible for the intended effect. Successfiul ECG triggering in the presence of ESU noise depends, to a large extent, on proper patient preparation and ESU use. Following the guidelines listed will minimize the amounc of energy coupled from. the ESU to the ECG input of the System 98, generally resulting in stable ECG triggering. However, if noise cannot be reduced to an acceptable level, the arterial pressure trigger mode can be selected. When ECG signal acquisition improves, always recurn to the original trigger mode selection. ‘When the System 98 is to be used in an electrosurgical environment, che following techniques are recommended to minimize interference from electrosurgical devices. «Keep the ECG cables ar right angles to the electrosurgical cables to the greatest extent possible. # Locate the ECG electrodes as far away from the surgical sie as possible. # Locate the ECG electrodes approximately equidistant from the surgical site to minimize any difference in potential between electrodes. # Place all ECG electrodes on the sare plane (either anterior or posterior) to minimize any difference in potential berween electrodes. + Place the electrosurgical return plate directly under che surgical site # Use the minimum required electrosurgical setting WARNING: External bedside monitors used with the System 98 in the operating rooms, must be equipped with electro-surgical interference suppression. 1-52 Sysiem 98 Service Menval ‘Chapter 1, Operation1.3.7 USE DURING CARDIOPULMONARY BYPASS During cardiopulmonary bypass the System 98 can be used co inflate and deflate an IAB already in position by selecting INTERNAL trigger mode. The internal rate can be adjusted by using the UP & DOWN ARROW keys (15) ia the Auxiliary Keys group on the keypad While the patient is on full bypass, auto timing mode can be used and the INFLATION (10) and DEFLATION (11) controls set to mid position. JFECG activity is detected while in the internal trigger mode, the IAB will be immediately deflated co avoid asynchronous pumping and resultant interference with systole. WARNING: Do not remain in the internal trigger made when the patient is generating a cardiac output When weaning 2 patient from cardiopulmonary bypass, the IABP can be used 10 assist cardiac function. [f ECG is established it can be used co trigger the System. Check to see if reliable ECG crigger is present by noting a flashing diamond in the upper right comer of che display. The diamond should flash one time for each R-wave. Ifthe pacient’s ECG amplitude is insufficient to cause triggering, the ECG GAIN may be adjusted to increase amplitude. Ifa pacer is present, the appropriate pacer trigger mode can also be used (sce TRIGGER section 1.3.2.8). Pressure triggering is also available if a7 mmHg minimum pulse pressure is present As bypass flow rate is decreased and the heart begins ro generate a cardiac output, check that timing is correct. Frequent reassessment may be necessary as changes in patient condition may alter the relationship of electromechanical events. System 98 Service Manual Chapter 1, Operation 1531.3.8 WEANING A PATIENT FROM IABP SUPPORT Weaning may be accomplished by a gradual and progressive reduction in IAB frequency, in IAB volume displacement (augmentation) or a combination of both. hen weaning, it is recommended chat frequent assessment of hemodynamic parameters and patient condition be done IRNING: When weaning by reduced IAB augment: 10.4 point at which no movement of the LAB status indicator is observed. do not reduce augmentation 154 System 98 Service Monval Chapter 1, Operation1.3.9 PORTABLE OPERATION certain conditions be met during portable operation. Datascope recommends They are: # Battery fully charged. If power is incerrupted for less chan 15 minutes, the system will restore most user settings upon start-up (refer to Section 1.3.2.1 "System Power-up Defaults" for more information): «Back up battery available # Altitude changes are compensated for automatically in the Auto Fill mode or manually in the Manual Fill mode. The System is secure and stable when used on an ambulance, helicopter or fixed wing aircraft The System 98 is available in two versions. A console version with a hospital cart or the System 98 Universal Transport System (UTS). Both may be used in cransport, however, for mote intensive transport requirements, che UTS version mechanically attaches to a docking station for high losd strength mounting. See section 5.5 in the Operating Instructions for details. PRECAUTION The user should continually rely on visual alarm mesiages during igh noise transport situations. The "Flash Alarms" option in zhe Preferences Mens should be susmned on to inprove she visibility of alarm messages. PRECAUTION Prior to sransport, ensure thas the belinme cylinder yoke handle is tight cand the belizom pressure gauge (76) is a least 25% full. Approximately every 30 minutes daring transport. verify that she yoke handle has remained sight and that a noticeable Pressure drop has not occurred. PRECAUTION Prior to asing the System in any other position except vertical, consuls with Technical Service 1.3.9.1 Battery Operation During porcable operation, the System 98 is powered by a rechargeable battery. Prior co portable operation the batcery should be fully charged. A fully charged battery is indicaced by a continuously illuminated BATTERY CHARGING LED (78), NOTE: Ir is imporcanc co perform preventive maintenance procedures on the battery. Refer to Chapter 4 for guidelines. The "BATTERY IN USE" scacus message and BATTERY INDICATOR (49) display whenever the System 98 is operated from the internal rechargeable bartery. When the bactery has approximately 30 minutes of operating time remaining the following occurs © An audible double beep alarm is activared for 30 seconds. The "LOW BATTERY” ot "LOW BATTERY (EXT)" alert message is displayed on the screen continuously the BATTERY INDICATOR (49) is displayed as empty and ir starts flashing, ‘« The condensate removal module will not operate The "BATTERY IN USE (EXT)" status message is displayed when the spare battery pack or external DC supply is connected and AC power is not present System 98 Service Manual Chapter 1, Operation 551.3.9.2 Battery Charging To charge the internal bactery: 1, Leave the System power cord plugged in and set the MAINS ON/OFF (63) 10 "ON." Check that the BATTERY CHARGING LED (78) is illuminated Allow a minimum of 18 hours ro fully charge a low battery A fally-charged new internal battery will provide at least 120 minuces of portable operation. NOTE: A reduction in run cime will occur over a baccery's life for various reasons such as, age, storage temperature, and discharge depth. Batteries which are continually subjected to complete discharge cycles without the recommended immediace recharging, can incur permanent damage. For furcher information refer to the Preventive ‘Maintenance Schedules A and B, in section 4. 1.3.9.3. Switching from AC to Battery Operation 1. The System automatically switches to battery power if AC power is removed (intentionally or due to power loss) 2. Ifnecessary, charge the baccery as described in accordance with previous inscructions. 3. Verify thar the "BATTERY IN USE” advisory message and BATTERY INDICATOR (49) is displayed NOTE: Battery charging is not active in chis seace 4. When AC power is restored the System automatically reverts from internal battery operation co AC Mains usage. The internal battery pack will resume its charging while the System operates from AC Mains power. Always verify thac the BATTERY CHARGING LED (78) is continuously illuminated or flashing, 1.3.9.4. Operation from Vehicle Inverter , The System 98 can be powered from a portable AC source, such as an emergency vehicle inverter. (An inverter converts the low voltage, DC power from the vehicle's electrical system to AC power compatible with the System 98.) The inverter should be checked for proper operation by qualified maintenance personnel prior to emergency use. The message "Battery in Use” will nor be displayed during proper AC inverter operation. The inverter must meet the following specifications SPECIFICATIONS OF VEHICLE INVERTER FOR USE WITH DATASCOPE SYSTEM 98 Voltage Output 100-120 / 220.240 VAC 410% Frequency: 50 Hz #2 Ha, 60 Hz 22 He Overshsors: Shall not continuously senerate overshoots greater then 575 voles peak with widehs greater than 10 micro seconds ‘vhen powering the Syscem. Waveform Sine wave, modified sine wave or square save NOTE: Square wave level must be 110 VRMS or gteater. Ouepat Capabiliey MBnimum of 1000 wares concinuous power, 10a surge currene Safety Compliance: Muse meet or exceed safeey standards per IEC 601-1 The operating sequence is the same as described in Section 1.3.2.1, except that AC power is obtained from the inverter receptacle, Interruption of the vehicle inverter AC power will result in internal battery operation, as described in Section 1.3.9.1 1-36 System 98 Service Manual Chapter 1, Operation1.3.9.5. Operation From External DC Source In this case, che System is co be powered from an external DC source such as may be available from an ambulance, helicopter, or external battery pack, 1. Connect a voleage-compatible* external source co the External DC Inpuc Connector (64), 2. Internal bacrery will not be charged in this mode. 3. The IABP ON/OFF switch (77) will activate the System 98. 4. Interruption of the external DC source power will result in portable internal battery operation, as described in Section 1.3.9.1 5. The internal BATTERY INDICATOR (49) will not be displayed during excetnal DC operation See Section 3 im che Appendiv for "Power" compatibility issues. 1.3.9.6 Effects of Altitude Changes During Air Transportation NOTE: Before using the System in air transportation, check for sufficient supply of helium since the balloon will be filled several times. For proper operation duting air transport, the System 98 balloon pressure must adapt to local atmospheric pressure. In the Auto Fill Mode the System will auromatically purge and fill the IAB when local atmospheric pressure decreases or increases by 25 or 50 mmHg respectively. These pressure changes occur approximately every 1,000 feet of rise or 2,000 feet of drop in alcicude. NOTE: The Auto Fill Mode should be used during air transport. If che Auto Fill Mode cannot be used and the Manual Fill Mode is required, ensure that a manual fill is performed at che same intervals that an auto fill would occur. NOTE: Por information on outfitting an aircraft for [ABP transport contact your local Datascope sales representative. Also, see Section 5 in the Operating Instructions for instcuctions for use for the Docking Station and Mobilizer. 1.3.9.7 Portable Operation Emergency Battery Back Up Recommendations Darascope recommends that a back-up to the incesnal battery always be available. In the evene that the internal battery pack does not power the System, the ‘operator should firse attempt to restore power via AC Mains sources (including those listed in Section 1.3.9.4). The second attempt is to restore power via ‘external DC sources as listed in Section 1.3.9.5. System 98 Service Manual Chapter 1, Operation 137Figute 1-28 Push Down to Release Handle Figute 1-29 Pull Console Release Handle Figure 1-30 Lift Levers to Unlock Battery { 1.3.9.8. Removing Pump Console from the Cart The console can be removed from the cart with or without the battery pack attached. Removing the console without the battery pack attached reduces the lift weight by approximately 35 Ibs. NOTE: When either removing the pump console from che cart or returning che pump console to the cart, ensure chat the wheels of the cart ate in the locked position. 1. Lock the wheels on the cart. Pivot the care handle out of the way. The care handle swivel release is located on the inside surface of the vertical support column near the cop. To release, push knob down and pivor the handle counter-clockiwise approximately 180° Follow the same procedure when returning the handle to its normal locked” position. To remove console with battery pack attached, continue with step 2. To remove console by detaching battery pack, skip co step 3 ‘To remove wich the battery pack attached: Keep the release levers on the battery pack in the locked position. Pall che console release handle on the cart base by pressing the tab co the right of the handle and pulling straight out. Lift pump console (co life, grab the pump cénsole along the cop edge of the frone and rear panel) straight up, off che care and place down near che cart, Skip co step 5. 3. To remove by detaching battery pack: While the console is attached to the cart, lift both battery release levers up to the unlocked position. Lift the console (co lift, grab the pump console along the top edge of the front and rear panel, as shown in the figure wich step +) straighe up, off the care and place down near che cart, The battery pack remains on the cart. To release the battery pack from the cart, pull the console release handle located just below the bactery pack (as shown figure 1-28). Use both hands to ‘Fomine pump console 1-58 System 98 Service Manual Chapier 1, Operationpick up the battery pack. Place che bactery pack on a dry, flat surface. Life the release levers up to the unlocked position. Lift the pump console (co lift, grab the pump console along the cop edge of the front and rear panels) and carefully lower ic straight down onto the battery pack. When firmly seated, push the release levers into the locked posicion. Test che electrical integrity by turning the [ABP ON/OFF switch ON. If System does not curn on, lift che release levers, lift up pump console and lower again, Repeat until proper connection is made ume Lit from hese Console <4 Connector Block —— From this view. tis inthe back lett corner, Release Aevers Battery Pack 5. Push che button on the rear of che monitor co detach ic from the cart handle. 6. Accach monitor on top of the pump console. Make sure that the monitor is securely attached before transporting the System. Figue 1-31 Plocment of stem Over the Baty | Figure 1-32 7. Pull up che console handle and tilt the Push Buton to * System co pull for cranspore. Detach Monitor PRECAUTION Be sus 10 only pull the System by shis handle, DO NOT PUSH. NOTE: For information on outfitting an aircraft for IABP cranspore contact your local Datascope sales representative, Also, see Section 5 in the Operating Instructions for instructions for use for the Docking Station and Mobilizer. Figure 1-33, Pall Up Handle and Tilt System 159 System 98 Service Manual Chepter 1, Operation1.3.10 PRINTER MENU (RECORDING WAVEFORMS AND TRENDS) The dual crace chart recorder selectively provides a hard copy record of patient ECG, arterial pressure, and optional balloon pressure waveforms, as well as trend dara. Pressing the PRINTER MENU key (28) activates the printer configuration menu. The LED adjacent to the PRINTER MENU key (28) will be illuminated. ‘The following printer configuration items may be set within this menu. PRINTER MENU “Selec che second ps Seip Lengsh Set duration of manually printed sripe 6 seo/75 150 300160 sec | Teed Pent Serintersal for suromacclly primed sips —OfF15 mn!50 min! bel? LECT pr ) inloemanon SELECT eo pr Tread Data Pint alam and eigaer hie NOTE: Items in italiac are default values. If power is turned off for an extended period of time the system returns to these defaults ‘The UP & DOWN ARROW keys (24) are used to highlight the desired item to be reviewed or changed. Pressing the CHANGE/SELECT key (25) displays all the preferences for the selected item, Once inside a desired item's menu the arrow keys are used co select che specific parameter to be changed. As the reverse video field moves through che list of configurable items, che selection field on the right ‘expands co show the current selection in reverse video and other possible options co the right of it. Changes to the preference setting are accomplished by pressing the CHANGEISELECT key (25). Once a change is made either move co another’ item or exit the menu to store this change. Exic by pressing the DONE key (26) to move up one menu or the PREFERENCES MENU key (27) to exic alll menus. Unless prematurely terminated, all buc continuous recordings will last for che duration specified in this menu. Alarm recordings may cherefore terminate prior to termination of the alarm condition. An Alarm recording will terminate any previous recording, except continuous recordings. Also a higher priocity alarm will replace a lower prioricy alarm recording. Prine requests which are either in progress or which are received when the printer ‘runs out of paper are discarded. ‘When the display is in the FREEZE mode, activation of the recorder overrides the FREEZE mode, When the recorder is activated in the FREEZE mode the waveforms thar are frozen on the display are printed followed by a rectangular gap (refer to figure 1-38). ‘Most routine printer operations are performed via the PRINT STRIP key (31). ‘Momentarily pressing this key when che printer is idle will cause daca configured TO Syslem 98 Service Manual Chapter 1, Operationvia the printer configuration menu to be printed. The LED adjacent to the key will blink during printing. Pressing the PRINT STRIP key (31) for 2 scconds causes the printer to print continuously. The LED adjacent to the key will be illuminated continuously during a continuous recording. If the printer is running when the PRINT STRIP key (31) is momentacilly pressed, the current printout will stop immediacely Trailer Anocation # Ac the completion of the recording a starus of patient and System informacion is printed. The IAB Frequency selection determines how the systolic and diastolic pressures are presented. When 1:2 or 1:3 is selected as the IAB Frequency, the recorder will print both assisted and unassisted systolic and diastolic pressure information. Below are samples of the various printouts. The dace and time of the recording is aucomatically princed by the System 98. The Patient ILD. is left blank and can be filled in manually. Peet Pree 1 Pe 1, Dae 200658 Dae: 200698 Dae 200658 Tine 1833 Tine Tine 133 tum and Advice Mesngss | | Aurmand Adee Mees | | Auemand Adie Mesge Abumant ation Megs, | | Atumand Aten Mess | | ALmnand Aine Messe Alumand AdioryNensgn |} Alemand avian ansen | | Alaand Adar Mesa TIMING: Ate TIMING. TIMING: Ato ucoes rc TRIGGER: Eco TRIGGER: ECG MEART RATES EaRT RATE. 40 HEART RATE: ASSIST FREQ. Set ssssT FREQ: C1 ASIST FREQ’ SysrDias. 11752 svsnblas ts Assist#0 Mean 69 avi Sub 100s wean e136 Figure 3-25 Print Out for Figure 3-26 Print Out for AB_ | SH 152 Standby Mode Frequency 1:1 LEAN» Figure 3-27 Print Out for AB Frequency 1:3 (NOTE: 1:2 Sample Waveforms uses the some layout) * ECG: A delayed ECG waveform will be recorded for the length specified in the printer configuration menu. Numeric informacion for Lead selection and Size is printed at the beginning of the race, Ifeither are changed the numeric information is reprinted 1—Trigger Markers Figure 1-37 - ECG Sample System 98 Service Manual Chapter 1, Operation Ver© Heart Pate Trend : * Arrerial Pressure: A delayed invasive arterial pressure waveform will be recorded for the length specified in the printer configuration menu or uncil another recorder function is selected, Scale informacion is annocated a¢ the beginning of the crace. If the pressure scale changes the annotation is aucomatically repeated. Figure 1-38 - Arterial Pressure Sample ‘© Balloon Waveform: A delayed balloon pressure waveform will be recorded for the lengch specified in the printer configuration menu of until another recorder function is selected. NOTE: There is no scale information printed for balloon pressure waveform. Figure 1-39 - Balloon Waveform Sample. Trend: All of the accumulated trend pages are printed. Heart rate trend is printed first followed by che blood pressure trend (includes systolic, diastolic, mean, and augmented pressure). When both assisted and unassisted beats are present, syscolic, diastolic and pressure indices consist of the pressures combined and averaged. NOTE: If no trend daca is available the message "NO TREND DATA AVAILABLE" is printed in i Figure 1-40 -Trend Sample 1-2 System 98 Service Manval Chopter 1, Operation+ Dual Waveforms: Two of the three possible waveforms, ECG, Arterial Pressure and Balloon Waveform may be recorded simuleancously for the lengch specified in the printer configuration menu or until another recorder function is selected. Waveforms will be printed es in the examples below, with the annotation, if any, for the firse waveform printed before the annotation, if any, for the second waveform. Annotations will be as described previously for single waveform recordings. Figure 1-43 - Arterial Pressure and Balloon Waveform Sample System 98 Service Manual Chapter 1, Operation 1631.3.11 USING TREND The IABP trend function and the chare recorder can be used as effective cools for patienc data collection and record keeping. See Section 1.3.10 "Using the Recorder" for information on printing the trend data. Eighc hours of patient parameter data is collected. The plor geephically summarizes the parameter's behavior for the previous § hour interval. For . intervals in excess of 8 hours, the oldest daca is replaced by the newest data Therefore, ic is recommended to print the trend data every eight hours or earlier, and at che end of balloon pumping. Trend is cleared when the IABP ON/OFF switch (77) is placed in the OFF position for more chan 15 minutes or by pressing the CHANGEJSELECT key (25) ‘while powering on the System. For claitiry and detail, the plots are partitioned into ewo subplors. The subplots. have different time scales. The first plot presents the last half hour of daca. This ploc’s time resolution is highest, at 3 minutes per minot division, The second ploc presents the remaining seven and one half hours, at a time resolution of 6 minutes per minor division, Refer co figure 1-40 in Section 1.3.10 for a trend printout sample. Printing is sequential, First, trended heart race is printed. Next, trended blood pressure parameters are printed, In the case of blood pressure, multiple parameters are printed against the same time axis. These parameters are * systolic * diastolic (end) * augmented diastolic * mean When frequency weaning is used, hearcbeats are assisted and unassisted. In this «case, the plorted systolic pressure is the average of assisted and unassisted beats. Similarly, the plotted diastolic pressure is the average of assisted and unassisted beats. Jn che event chat trend data is not available, the phase "no rend daca available" is printed in lieu of the crend dara. This can occur ifa trend printout is requested immediately afcer a syscem power up. Similarly, if a crend plot is initiated prior to zeroing of the blood pressure transducer, then the blood pressure trend printout will report "no pressure available" 64 System 98 Service Manual Chapter 1, Operation1.3.12 INSTALLATION AND REPLACEMENT OF HELIUM CYLINDER. PRECAUTION: Only personnel familiar wich the handling of high pressure gas cylinders should install or replace the helium oy PRECAUTION: Use medical grade helium only The helium cylinder should be replaced whenever pressure drops below a preset devel. This is indicated when che 'LOW HELIUM" message is displayed during operation and/or when the helium pressure gauge (76) shows that the helium supply is in the red zone. There is no need to interrupt IABP. However, the cylinder should be replaced as soon as possible to avoid a pocencial "AUTOFILL FAILURE” which can delay pumping To replace cylinder: 1. Close helium cylinder valve fully clockwise. 2. Slowly loosen che cylinder yoke. Remove the cylinder, 4. Check chat the washer is present and in good condition on the cylinder yoke or the new rank. Install a ftesh helium cylinder. 6. Tighten the cylinder yoke. 7. Slowly open che helium cylinder valve. 8. Verify deflection of the helium gauge needle, (For helium cylinder Specifications see section 3) NOTE: Disposal of used helium cylinders should be in accordance with prevailing local stacues and in conformance wich recycling requirements NOTE: For instructions on installing Figure 1-44 the helium cylinder scrap, see section 5.4 in the Operating Helium Cylinder Inscructions Te System 98 Service Manual Chopter 1, Operation1.3.13 INSTALLATION/ REMOVAL OF SAFETY DISK/CONDENSATE | REMOVAL MODULE PRECAUTION: The installation and removal ofthe safety disk requires a par surning action 40 secure ov remove. When securing, confirm that the rib on the top sur the safety disk assembly is fully rotated to the 12 o'clock position. WARNING: Datascope recammends the ae of surgical gloves while doing these procedures avid contact with residual condensate or other body fluids, Disposal of used sary disk shail be in accordance with prevailing hospital practices for medical refuse. The safety disk and condensate removal module are combined into one assembly ‘The assembly is located on the tear of the System 98. Installation/semoval of the assembly 1. Disconnect assembly's pneumatic connections: a. Luet fitting, labeled TAB FILL PORT (7 b. condensate drain line, located on the rear panel, labeled DRAIN PORT (74). Disconnect assembly's electrical Figure 1-45 connector labeled DC INPUT (60) Turn the Safety Disk | 3. Turn the safecy disk approximately 30° counter-clock-wise. 4, Pull straight ouc - Disassembly of Condensate a Removal Module: | 1. Remove the condensate removal module from che disk by removing i | ae ene Figure 146 label. Assemble the CRM co the new | Lineup the Safety Disk safety disk, replace and tighten | screws and adhere label. Fill in replacement hours and expiration date on label 3. To insrall the assembly, reverse the above procedure aligning the curved narrow slot with the pin Figure 1-47 Softy Disk/CRM Assembly 1-86 System 98 Service Menval Chapter 1, Operation1.3.14 DOPPLER INFORMATION The doppler used wich the System 98 is the Huntleigh Mini Dopplex®, This doppler uses ultrasound techniques to derect vascular blood flow To use che doppler 1. Open the top storage bin. The + doppler is located inside the door panel 2. Remove the doppler from the storage bin, Press the burton on the tether reel co retrace the doppler. If battery replacement is necessary, remove the cover of the battery compartment, and lift our the old bactery. Install a new €LR61, 6LE22, of equivalent 9V alkaline bartery. Replace cover. 4, Place a liberal amount of coupling gel on the transducer or che patiene’s skin. Turn on che unit and position the probe over the artery co be considered 6. Hold the probe ar a 45° angle co che sutface of che skin. Adjust the position and angle of the probe to obtain the optimum audio signal. Refer to the Huntleigh Operators Manual for more detailed inseructions Secker Le0 Display —— Hesdpnone Socket onatt ito | Prove Cabte etter | iL - | socket Ci [Aieshimen Sa! ig volume j oo Battery Camedemen | | “The System 98 transmits bth Assisted and Unasssed Sytlic and Diastolic Pressures Figure 1-48 Doppler, Front View Figure 1-49 Doppler, Rear View System 98 Service Manual Chopter 1, Operation 17Figure 1-50 Connecting the Modem 1.3.15 Connecting the Modem ‘The Syscem 98 has an internal modem. The modem is used for connection to phone lines which can link the System 98 to a remote PC, having PC*eIABP. remote clinical support software. The connection is made through a scandard | analog tclephone line. NOTE: The telephone line should directly connect co che external phone system and nor go through a company/hospical switching system. 1. Connect a standard analog phone line into the PHONE LINE connector (67). 2, Ensure that the telephone line is connected co the telephone jack. 1.3.16 Connecting PC*IABP PCsIABP is a personal computer (PC) software application program that is, designed for clinicians co assist in monitoring an Incra-Aortic Balloon Pump (IABP) supported patient from a remote location. PC*LABP will not affect operator settings on the [ABP, or have the capability of altering patient parameters. PCelABP displays all available information from the System 98 onto a remote PC screen 1. Connece the modem as shown in section 1.3.15. 2, All other work is performed through che PC. See the PCelABP Operating Inseruction, P/N 0070-00-029, for complete details, 1-8 System 98 Service Manual Chapter 1, Operation1.3.17 Data Communication The System 98 can transmit daca chat is requested by a host (i.e., PC*IABP), through the RS-232 port (66) and che Phone Line (67). The following is an overview of the scope of information available via the data communications port in the standard operating mode (for more information, refer to the ‘Communication Protocol Manual P/N’ 0070-00-05 19): Pump Control and Alarm Surveillance Settings *ECG, Arterial Pressure, and Balloon Pressure Waveforms & Markings oP ‘Alarms, Prompts, Alerts, and Starus Messages, ysiologic Indices # Alarm, Faule, Trigger Mode and Trend Histories Sysiem 98 Service Manual Chapter 1, Operation 1-69Figuee 1-51 Dual Function Castors 1.3.18 Wheels and Casters The System 98 features two dual function casters. They are located oni the handle side of the care. Pressing the appropriate pedals on the casters enables the user to have greater control when moving the System and can also lock che wheels and casters in place. Press the caster pedals wich the white arrow on a blue background to prevent the caster ftom swiveling (directional lock). This provides greater control when making cutns and better tracking on long straight-a-ways. Return the pedal to the up position to have greater maneuverability when positioning the System into tight spaces. Press the caster pedals with the white octagon on a red background co apply che wheel brake, which locks the wheel from rotating and the caster from swiveling This should be used once the System has been positioned or when left unattended NOTE: Ic is recommended thar all four caster brakes be applied at this time. WHEEL WHEEL AND. binecTION | CASTER Lock LOCK 170 System 98 Service Manual Chapter 1, Operation1.3.19 HELP SCREENS Help screens are provided to guide the user chrough set-up procedures and for consultation regarding alarm message descriptions and alarm resetting inscructions. Help Screens are context sensitive and chus are only available when the situations arise, For example: The help screens for initial set-up are only available at power-on and a help screen for an alarm message is only available when that alarm occurs, To display the Help Screens: 1. Press the frone panel HELP SCREEN key (29). The key's LED illuminates. A help screen box displays ar the botcom of che screen. NOTE: When a help screen is present on the screen, the ECG and Pressure waveforms are condensed in the upper portion of the screen. If che 3 trace mode is in operation, the third trace is replaced by the help screen. All alarms remain active and no dara is lost when help screens are activated. Use the UP & DOWN ARROW keys (24) ro page through the screens available. Pressing the DOWN arrow displays the next available page of help screen information. Pressing the UP arrow displays the previous page of information. If there are no previous pages of next pages available and the UP or DOWN arrow is pressed, chen che same page is displayed again. Press the HELP SCREEN key (29) again or the DONE key (26) to recurn the screen co the normal waveform or tcend graphics display. 3 TOTAL PAGES INITIAL SETUP 1of7 | 1 Verity MAINS power switch is ON | | 2. Open the Helium Tank | j 5. Establish ECG and Pressure [TeRevious Pace | ynext pace | GELB to end HELP | The following pages show che available alarm and see-up help screens. Figure 1-52 Example of Help Screen System 98 Service Manual CChopter 1, Operation 177iNo Trigger CONDITION * An electrode is detached or malpositioned © An incorrect trigger source has been selected ‘There is inadequate signal acquisition [CORRECTIVE ACTION i 1. Reactach or reposition the electrode. 1 Select a differene trigger source using the TRIGGER SELECT keys. | Resume pumping by pressing che ASSIST/STANDBY ki 1, Try alternare/EXT lead selections. 2. Adjust the ECG gain secting by using the ECG GAIN Auxiliary keys. CONDITION © The patient’s pulse pressure is inadequate for pressure triggering ‘There is no arterial pressure ‘waveform present ee No Pressure Trigger ‘CORRECTIVE ACTION 1. appropriate, select a different | trigger source. Resume pumping by pressing the ASSIST/STANDBY key MANUAL THRESHOLD is | selected, reduce the pressure crigger threshold. Press the down arrow key | lected in che Auxiliary Keypad section until criggering resumes, | 12. If pressure erigger is required and | 1. Verify char desired pressure wavelorm source, Ext/Tnternal, is selected. Press the Pressure Source | key, in the Patient Waveform keypad section, to change the waveform source transducer or monitor cable is |2. Verify char a properly wired "connected | 3. Verify thar cransducer has not | inadvertently been lefe vented «0 atmosphere following zeroing |4. Re-zero transducer, while vented, and reapply arterial pressure to insducer. 72 System 98 Service Manual Chapter 1, OperationNo Pressure Trigger - Zero Transducer [CONDITION _ CORRECTIVE ACTION | © Actempting to use pressure trigger |, Zero the transducer by opening the without having the transducer transducer to air and pressing the | zeroed ZERO key for ewo seconds, 2. Resume pumping by pressing the | ASSIST/STANDBY key. Heart Rate Low | CONDITION CORRECTIVE ACTION | ‘©The patiene heart rate is less chan ‘I. Assess che paciene. 40 bpm. _ 2. Verify proper timing. ‘There is inadequate signal 1. Check electrode contact and acquisition from the patient placement. Verify the integrity of | electrodes. the lead wires and che patient cable. | | 2. Adjuse ECG GAIN by using the | l ECG GAIN Auxiliary keys I ‘Check Pacer Timing ee |CONDITION CORRECTIVE ACTION i © The patient is not 100% Paced. |. Seleer ECG trigger source, using che | TRIGGER SELECT keys, when i | demand pacing a patient | Press the ASSIST/STANDBY key to | es _eestime pumping. © The patient's AV paced rate is 1. Reduce the pacer rate above 125 BPM. The patient's V paced rate is above _185 BPM. |* The system is unable to identify 1. Adjuse the A-V time interval co the A-V interval beeween 80 to 224 msec i System 98 Service Manvel Chapter 1, Operation 173ECG Detected “ONDITION CORRECTIVE ACTION _ # Avalid ECG is now decected with |1. Select ECG as the trigger source the INTERNAL trigger selected as _ using the TRIGGER SELECT keys. j the crigger source / \ | 2. Verify proper timing. Resume pumping by pressing the ejection. Consequently, do NOT ! acternpe t0 adjust che DEFLATION control. t 7 ASSIST/STANDBY key._ lpeculaTacaert(‘=sS*s*stttCtCt Irregular Trigger {CONDITION _ ‘CORRECTIVE ACTION |¢ The patienc’s rhychm is too 1. The System has automatically | variable to accurately predice the | compensated by deflating earlier | next systolic pressure trigger event. | to avoid interfering with systolic | 2, Confirm that che patient's ECG also indicates irregularity. If rhythm disturbance persists, consider using ECG trigger mode for more reliable LS csiggering | * The patient's chythm is regular, 1. Confirm chac the patient's ECG | however IAB deflation ciming is | rhythm is regular. Ifso, then adjust | set too late, interfering with the DEFLATION conctol earlier 0» | systolic detection. improve consistency of pressure | CONDITION | CORRECTIVE ACTION | | © The system is detecting electro- 1, Pumping automatically resumes | surgical interference while ina | when interference cleats. | pacer trigger mode, \ 2. If condition persists however, and | incerferes with patient support, select PRESSURE trigger using the | TRIGGER SELECT keys. | 3. Verify timing and press che ASSIST/STANDBY key to resume pumping, 74 System 98 Service Manual Chapter 1, Operation|Rapid Gas Loss CONDITION CORRECTIVE ACTION a lane lak nee. A large leak has been detected in 1. Check for blood in the cubing. If i the IAB ciscuic. found, stop pumping and notify physician. Refer to [AB ‘manufacturer's instructions for LAB / removal ! 2. If blood is noc found in the eubing, verify che connections are leak free. | | Refill the [AB and closely observe the tubing to verify no blood is | present. Press che 1 ASSIST/STANDBY key to resume pumping. | Leak in IAB Circuit (Loss) | CONDITION ‘CORRECTIVE ACTION © There isa small leak in the IAB I. Check for blood in che cubing. If | citcuie, a loose conneccion, or a found, stop pumping and notify high rate of Helium diffusion, physician. Refer to TAB possibly due co che paciene being manufacturer's inseructions for LAB febrile or cachycardiae removal. j | 2. If blood is not found in the tubing, 1 | verify the connections are leak free. Refill the IAB and closely observe the tubing co verify no blood is | present. Press the ASSISTISTANDBY key to resume pumping |3. If che alarm persists and there is no evidence of a leak in the LAB j | catheter, consider setting the SLOW | | | GAS LOSS ALARM key co the | OVERRIDE position. System 98 Service Manvcl 75 Chapter 1, OperationCONDITION ‘CORRECTIVE ACTION | © A.gas gain has been dececced in the 1. Verify all connections are lea TAB circuit. | 2. Refill the IAB. Press che ASSIST/STANDBY key co resume pumping 3. If alarm persists, contact Datascope | Service | |IAB Disconnected CONDITION, |© The IAB catheter of extension tubing is disconnected. extension tubing. | | |2, Refill che AB catheter. Press the i ASSIST/STANDBY key to resume { L ae ul ‘Gas Loss and Catheter Alarms CONDITION © TABFILLissetto MANUAL, —_ 1. Ifappropriate, see IAB FILL to | AUTO. The system muse now be aurofilled to activate the gas loss and | catheter alarms | NOTE: The surofill system canoe | be used with pediatric size catheters. | 176 System 98 Service Menval Chapter 1, Operation—— ‘Blood Detected _ CONDITION Blood is detected in the IAB jl. Check for craces of blood in the IAB | catheter, catheter and/or Drain Pore cubing. | : 2. If blood is present, notify the Physician. Disconnect the [AB | catheter from che console as soon as_ | | this can be done without : endangering the patient. | 3. Refer co the LAB cachecer | manufacturer’ instructions for [AB | removal | | ls Contact Datascope Service. | 5. Ifrno blood is present, then turn che | | IABP off by setting che SYSTEM. POWER switch, located on the front panel, to the OFF position. | : 6, Waie 10 seconds | j 7. Turn the IABP on by setting the | | SYSTEM POWER switch co the ON position | '8. Depress the IAB FILL key for 2 | seconds 0 iniciae an aurofill. When ' the aucofill completes, depress the | i ASSIST/ STANDBY key to resume | panning’ | 9. If BLOOD DETECTED" message repeats, then the IAB must be manually filled before pumping can | | ; continue: Set [AB FILL MODE to | MANUAL NO. See the Help Screen, "MANUAL FILL IAB" for inseructions on how co perform the manual fill procedure. 11. Contact Datascope Service System 98 Service Manval 7 Chopier 1, Operation“CONDITION _ The IAB remains in the sheath immediately afcer insertion The IAB membrane is not completely unfolded | | There isa kink in the IAB cachecer | or tubing igh Drive Pressure CONDITION: _ 7 ‘There is a component failure in the | pneumatic system. ‘CORRECTIVE ACTION "CORRECTIVE ACTION 1. Check che markings on the IAB catheter to assuse the balloon bas exited the sheath. If not pull sheach back to appropriate position. 2. Press the ASSIST/STANDBY key to | resume pumping. 1. Aspirate co assure blood is not recurned chrough the excracorporeal cubing. 2. If using a 34, 40 or S0ce LAB, manually inflate and deflate the LAB with 60 cc of gas through the male luer of the LAB. (3. fusing a 25cc IAB, manually inflate and deflate the IAB with 30cc of gas through the male luer of the IAB 4, Refill the IAB. Press the | ASSIST/STANDBY key to resume “pumping. 1. Check the catheter tubing and relieve kink if possible. 2. Press the ASSIST'STANDBY key ¢0 resume pumping 1. Attempe co resume pu pressing the ASSIST: STANDBY key 2. If the message persists, contact Datascope Service, System 98 Service Manval Chapter 1, OperationCORRECTIVE ACTION The patienc is cachycardiac. 1, Change the IAB frequency co 1:2 by | using the [AB FREQUENCY key. | ‘© There is insufficient vacuum in che 2. Ifthe message persists, contact daiv . "_Datascope Service ‘Augmentation Below Limit Set ee ‘CONDITION ____ CORRECTIVE ACTION i =e Once AON eee! ‘© There isa change in the patient's 1, Assess che patient. |__ hemodynamic sratus, i | Reset che AUG ALARM limic to 8 - “© The augmentation alarm limi is |L set coo high |" 10 mmHg below the patient's | augmenced diastolic pressure © The IAB AUGMENTATION is 1. If appropriate, inceease | set c00 love augmentation by pressing the [AB | | AUGMENTATION key coward the | maximum setting cone 4 © The Helium conceneration is low. |1, Refill the IAB catheter, Press ASSIST/STANDBY to resume pumping low Helium oo { [CONDON —__ (corrective ACTION _| ¢ The Helium tank is closed 11. Open the Helium tank - |e “There are fewer than 24 Bills of "1. Replace the Helium tank i lecromee a CORRECTIVE ACTION |e There is less chan 30 minuces of 1. The system will switch co internal | battery operating time remaining | batteries when che external batteries | om ehe extemal batcery are depleted System 98 Service Manual Chopter 1, Operation 179© There is less than 30 minutes of 1. Verify MAINS power swicch, j battery operating time remaining. | located above the AC power cord | | connector, is ON. | 2. Connect system co an AC power outlet. Rw 1 “System Failure | CONDITION ‘CORRECTIVE ACTION ]¢ There is a malfunction of che |1. Turn che IABP off by setting the microprocessor | SYSTEM POWER switch, located oon the frone panel co the OFF 2 Wie 10 ends | 3. Turn the IABP on by setting the / SYSTEM POWER switch, located | | con the front panel to the ON | position | 4, If che condition repeats, contact Datascope Service ‘Electrical Test Fails Code # CONDITION, CORRECT = ACTION |e There isa start-up failure ina 1. Turn the IABP off by setting the t major subsystem of the ABP. SYSTEM POWER switch, located fon che front panel to the OFF | pasicion, 2. Wait 10 seconds, (3, Turn the IABP on by seering the | SYSTEM POWER switch, located | | on the front panel to the ON position |4. tf che condition persists, note che code number displayed and contact Datascope Service, | 7-80 ‘System 98 Service Manual CChopter 1, Operation‘Slow Gas Loss Override On CONDITION a |e The SLOW’ GAS LOSS ALARM is 1. Sec the SLOW GAS LOSS ALARM secOOVERRIDE. to the ON position, ifappropriace. | | Maintenance Required Code # j = ss EEE pUE va ‘CORRECTIVE ACTION | The incenal microprocessor has 1. Note the code number displayed and | decermined that system contact Datascope Service. { | maintenance may be required. j | Autofill Failure CONDITION CORRECTIVE ACTION s2e IAB © The IABP cannoc fill the IAB 1. Verify chat che correct si catheter system automatically catheter and excender are atcached 2. Verify thac the aucofill cubing is connected co the IAB Fil! Port and the drain tubing is connected to the Drain Port, on the Safecy Disk |3. Refill che IAB catheter. Press ASSIST/STANDBY co resume pamping. If the aurofill fails again, set IAB FILL MODE to | MANUAL { 4, See the help screen for "Manual Fill | j TAB" for instructions on how to 1 perform the Manual Fill procedure, | 5. Conrace Dacascope Service. | i ‘Autofill Failure - No Helium CONDON | CORRECTIVE ACTION = © = The Helium tank is closed 1. Open the Helium rank. | ©The Helium tank isempey. 1. Replace che Helium nk. System 98 Service Manual Chapter 1, Operation 181— eee ee “Safety Disk Test Fails _ | CONDITION [CORRECTIVE ACTION i |e Thete is a leak in che drive system |. Check chac che fittings are leak cight | or its fictings. | and that the Safety Disk is properly installed. |2. Repeat the leak test. If the test fails | | | again, replace the Safety Dis |, Repeat the leak cese i No Patient Status Available _ ‘CONDITION "CORRECTIVE ACTION [6 Thee wat an inal 1 Mere rm cy | communications failure on the external monitor. 2. Contact Datascope Service. Autofill Required CONDITION CORRECTIVE ACTION © The IAB FILL MODE has been L. If appropriate, recurn the IAB FILL | changed from MANUAL to | key co MANUAL, Press the AUTO without an aurofill | ASSIST/STANDBY key ro resume |. pamping . 12. If the aucofill mode is desired, refill the IAB catheter. Press the ASSIST/STANDBY key to resume pumping. Battery in Use (EXT) _ 4 _CONDITION CORRECTIVE ACTION | |e The [ABP is being powered from | 1. Verify chat it is necessary to operace | anexternal Battery or DC) power | from an external power source. If | source. appropriate, switch to the AC power | source. 2. Verify MAINS power switch, | / located above the AC power cord | connector, is ON. 1-82 System 96 Service Manual Chapter 1, Operation“CORRECTIVE ACTION CONDITION. j® The IABP is being powered from 1. Verify thar it is necessary co operate | | che internal barceries. from the incernal baccery. If ; | appropriate, switch co che AC power | : source. | 2. Verify MAINS power switch, | | located above che AC power cord | \ connector, is ON, Prolonged Time in Standby _ * The IABP has been in STANDBY 1. Verify whether it is appropiate to mode for an extended period of resume ASSIST, time j 2. Press the ASSISTISTANDBY key to | i resume pumping i System 98 Service Manual Chapter 1, Operation 7-83ese steps iF IAB Fill Key has already been pressed) \ Adult Size IAB Catheters 1, Remove the autofill cubing from the IAB Fill Porc on che Safety Disk. | 2. Atcach a three way stopcock to the IAB Fill Port on che Safety Disk. 1.3. Attach a 60 ce syringe to che stopcock. 4. Open the stopcock between the disk and syringe. Evacuate the disk by pulling back on the syringe plunger. 5. Close the stopcock to the disk. Evacuate the syringe, }6. Repeac steps 4 and 5 until strong resistance is noted. A strong resistance should be noted within three attempts, Ifa strong resistance is noted, proceed | | costep 8, 7. If a strong resiscance is not noted within three attempts, remove the Drain port tubing and attach che Drain port plug, located in the manual fill accessory kit, to the Drain port. Repeat steps 4 through 6. | NOTE: All Dasascope adult size IAB Catheters have 2 manual fill pre-load of 80 cc. When using catheters from another manufacturer consult manufacturer for guidelines |S. Attach the syringe to the manual fill port located below the Safery Disk |9. Fill che syringe and discard the contents. | 10. Fill che syringe with 40 cc of Helium, | 11. Holding the syringe tip DOWN, attach the syringe to the stopcock on the Safety Disk, and open the stopcock to the disk. | 12. Press the IAB FILL key far two seconds to allow the syringe contents to be drawn into the disk 11.3. Close che stopcock the disk | 14, Refill che syeinge with che remaining 40 cc pre-load of Helium from the manual fill pore. |15, Holding the syringe tip down, attach the syringe «0 the stopcock on che | Safety Disk. | |16. Open the scopcock co the Safery Disk. The remaining 40 ce of gas is drawn | into the disk. | 17. Close the scopcock and remove the syringe 18. Press the ASSIST/STANDBY key co begin pumping. 184 System 98 Service Manual Chapter 1, Operation|Pediacric IAB Catheters [1. The IABP Override keys, TIMING and IAB FILL, must be set co MANUAL. 2. Refer to the pediatric balloon catheter instructions for the correct Safety Chamber size, pre-load volume and extender, | 1.3. On che Safety Disk, remove the autofill rubing fcom the [AB Fill Port and | the drain tubing from the Drain Pore 4, Remove che Adult Safety Disk from the IABP, Install the pediatric adapcer, drive hose and the appropriate size Safery Chamber as directed in the Operator manual. 5. Attach a three way stopcock to the IAB Fill Port on the Safery Chamber. 6. Attach the patient balloon and extender to che Safety Chamber. 7. Attach 2 20 cc syringe to the stopcock. | 8. Open the stopcock between the chamber and syringe. Evacuate the chamber | by pulling back on the syringe plunger, i 19. Close the stopcock to the chamber. Evacuate the syringe, i | 10. Repeat steps 8 and 9 until scrong resistance is noted. | {11. Actach a 20 ce syringe to the manual fill pore below the Safety Disk {12. Fill the syringe and discard the concencs (11.3, Pill che syringe with the correct pre-load volume of Helium as outlined in the catheter instructions. If the pre-load volume exceeds 20 cc, fill the sytinge with half of the appropriate pre-load volume. |14. Holding che syringe tip DOWN, attach the syringe to the stopcock on the | Safety Chamber, and open the stopcock to the chamber | 15. Press che IAB FILL key for ewo seconds to allow che syringe contents to be drawn into the chamber. Close the stopcock and remove the syringe 16. If the pre-load volume exceeded 20 cc, add che remaining pre-load volume by repeating steps 13 chr 15. | | 17. Close the stopcock and remove the syringe. 18, Press the ASSISTSTANDBY key to be; in pumping. | System 98 Service Manval Chapter 1, Operation| Manvel Fil WB [Follow these steps if LAB Fill Key hos not been pressed) | | Adult Size IAB Catheters 1. Remove the aurofill tubing from the IAB Fill Pore on the Safery Disk |. Atcacha ehree way stopcock co the LAB Fill Porc on che Safery Disk | | 1.3. Attach a 60 ce syringe to the stopcock. Press the IAB FILL key for ewo seconds to relieve vacuum. |5. Open the stopcock between the disk and syringe. Evacuate the disk by | pulling back on che syringe plunger. 16. Close the stopcock to the disk. Evacuate the syringe. | 7. Repear seeps 5 and 6 until scrong resistance is noted. A strong resistance | should be noted within three attempts, Ifa strong resistance is noted, proceed | to step 9. | 8. Ifa strong resistance is not noted within three attempes, remove the Drain port cubing and actach the Drain pore plug, locared in che manual fill | |, accessory kit, to che Drain port. Repeat steps 5 through 7. | | Nore: atl Datascope adult size IAB Catheters have a manual fill pre-load of {| 80ce, When using catheters from another manufacturer consult manufacturer for guidelines. ls Attach che syringe tothe manual il port locaced below che Safety Disk. | | 10. Fill che syringe and discard the contents 11. Fill che syringe with 40 cc of Helium. | |12, Holding the syringe tip DOWN, artach the syringe to che stopcock on the | Safety Disk, and open the stopcock to he disk 11.3. Press the IAB FILL key for two seconds ¢o allow the syringe contents to bé drawn into the disk | 14. Close the stopcock co che disk | 15. Refill the syringe with the remaining 40 cc pre-load of Helium from che | ‘manual fill port | "16, Holding the syringe tip down, attach the syringe to the stopcock on the | safety Disk | | 17. Open the stopcock to the Safety Disk. The remaining 40 cc of gas is drawn | "into the disk. | 18. Close the stopcock and remove the syringe 19. Press the ASSIST/STANDBY key to begin pumping | 1-86 System 98 Service Menval Chopier 1, Operation| Pediateic IAB Catheters |1. The IABP Override keys, TIMING and IAB FILL, must be sec co MANUAL. | 2. Refer co the pediatric balloon cathecer instructions for the correct Safety 4 Chamber size, pre-load volume and extender. 1.3. On che Safecy Disk, remove the autofill tubing from the IAB Fill Pore and | j the drain cubing from the Drain Pore. |4, Remove the Adult Safety Disk from the IABP. Install the pediatric adapter, drive hose and the appropriate size Safecy Chamber as directed in the } | Operator manual | |5. Accach 2 three way stopcock co the LAB Fill Port on che Safécy Chamber. |6. Attach the patient balloon and excender to the Safety Chamber | 4 Attach a 20 cc syringe to the stopcock | 8. Press che IAB FILL key for ewo seconds to relieve vacuum by pulling back on the syringe plunger 9. Open the scopcock between the chamber and syringe. Evacuate the chamber | [ 10. Close the stopcock to the chamber. Evacuate the syringe. 11. Repeat steps 9 and 10 until serong resistance is noted. { 12. Artach a 20 ce syringe to the manual fill pore located below the Safety Disk. J11.3. Fill the syringe and discard the contents Fill the syringe with the correct pre-load volume of Helium as outlined in | the catheter instructions. Ifthe pre-load volume exceeds 20 cc, fill the syringe with half of the appropriate pre-load volume, |15. Holding the syringe ip DOWN, attach the syringe to the scopcack on the Safety Chamber, and open the scopcock to the chamber, |16. Press che LAB FILL key for two seconds to allow the syringe contents to be | drawn into the chamber. Close the stopcock and remove the syringe. 17. If the pre-load volume exceeded 20 cc, add the remaining pre-load volume | by repeating steps 14 thru 16 | 18. Close the stopcock and remove the syringe | [19. Press the A: TANDBY key co begin pumping Sysiem 98 Service Manvel Chapter 1, Operation 1-871, Verify MAINS power switch is ON 2. Open the Helium Tank | 1.3. Establish ECG and Pressure. 4, Zero the transducer: © Open the transducer to air Press the ZERO PRESSURE key for 2 seconds. © Close che cransducer. Confirm the initial pump settings Control Panel: TRIGGER SELECT: ECG IAB FREQUENCY: Ll IAB INFLATION Midpoine | | 1AB DEFLATION: Midpoint 1 Overrides: | TIMING: AUTO | TAB FILL MODE: AUTO | SLOW GAS: ON | ECG GAIN NORMAL | Auxiliary j i 16. Set the Initial Timing # Adjust the IAB INFLATION and DEFLATION controls to position the | inflation incerval of the arterial waveform to begin at the dicrotic notch and end before the systolic upstroke. Attach che IAB catheter and the appropriace extender to the Safety Disk. |s Fill the LAB catheter and iniciace pumping «© Press the ASSIST/STANDBY key and observe "Aucofilling” message | * Once the "Autofilling” message clears, pumping begins. *# Observe optimal augmentation during diastole # Fine cune che timing by adjusting che IAB INFLATION and DEFLATION controls if needed. |9. Verify AUG. ALARM | ¢ Verify thac che AUG. ALARM seccing is approximately 10 mmHg less | than the patient's diastolic augmentation pressure | # Adjust, if needed, by pressing AUG. ALARM and using the arrow keys to. | | change the value displayed on the screen. | 10. Incial set-up is now complete 7-88 System 98 Service Manual Chapter 1, Operation1.3.20 EXTERNAL MONITOR INTERFACING The System 98 can display and be criggered from patient ECG and Arterial Pressure signals provided by external monicors. External Monitor ourpur signals must meee the following minimum requirements to prevent degradation of pump performance * External ECG Monitor Requirements * — Bandwidth* (-3dB 0.5 Hz maximum to 100 Hz minimum referenced to 10 Hz); (Set monicor to Diagnostic Quality bandwidth) NOTE: Direct patient leads are preferred for optimum Ventricular Pacer Triggering due to the system's intergral 100 Fiz low pass filer Propagation Delay* 25 milliseconds maximum (Delay of QRS complex’: Scale Factor* 1 Wimv 410% (referenced to 10 Hz}: Pacer Enhancement Enabled for Vencricular Pacer Triggering if (NOTE: Digital pacer feature is available on the monitor. pulse summed in.) External Arterial Blood Pressure Monitor Requirements Bandwidth* (-3 6B DC co 15 Hz minimum referenced to DC): Propagation Delay*: 25 milliseconds maximum (Delay of AC coupled zero-crossings when a 1 Hz sinc wave is applied to the external monitor inpur) Scale Factor* 1 V/ 100 mmHg 42% * Required for proper IABP triggering and pressure accuracy Datascope supplies as part of the System 98 accessories interface cables which can be custom wired for compacibility with any monitor which meets the minimum requirements above. Wiring inseructions for both ECG and Arterial Pressure interface cables are provided on the next page System 98 Service Menval Chopter 1, Operation 1-89ECG wich Standard Accessory External Signal Cable (0012-00-0325)* L. The cable is supplied with a steteo phone plug to be connected to the ‘System 98 rear panel ECG Monitor Input jack (64). The other end should be terminated with the appropriate connector for the external monitor. Pacer trigger selections can be used with this cable. 2. The following connections should be made to the external monitor connector Brown To 1 Volt /1 mV ECG signel output Ea of externel monitor White To signal ground Black Figure 1-53 - External Signal Coble Pressure with Standard Accessory External Interface Cable (0012-00-0323)* 1. The cable is supplied wich a stereo phone plug to be connected to the System. 98 rear panel Pressure Monitor Input jack (70). The other end should be terminated with the appropriate connector for the excernal monitor. 2. The following connection should be made co the external monitor connector. Brown To! Volt / 100mmHa PRESSURE C gral Suiput oF exert monior White To signel ground Block eee Figure 1-54 External Interface Cable WARNING: Exzernal bedside monitors used with the System 98 in the operating ‘must be equipped with electro-surgical interference suppression. room Daatatcope doesnot recommend the ase of the 0012-00-0467 cable with she Spstem 98. For assistance in interfacing the System 98 with external monicors contac the Darascope Technical Support Department. 1-90 System 98 Service Manual Chapter 1, Operation1.3.21 Pediatric Balloon Pumping The following is an abbreviated version of the normal set up inseructions. Please refer to Sections 1.3.1 through 1.3.16 for derailed procedures The drive system of the System 98 is modified for pediatric use by replacing the safety disk wich the pediacric adapter assembly P/N 0998-00-01 10-01. This adapter extends the drive pressure line allowing remoce placement of the safecy chamber isolator by che patient's side. This is required co keep pediatric IAB catheter length shorr. Note that the 4 and 6 ft. extension catheters are used only with adule balloons. 1.3.21.1 Pediatric Adapter Installation 1. Disconnect all pneumatic and electrical connections [JAB Fill Pore (75), Drain Port (74), IAB Catheter Extender (58), | i and DC Input (60) i | Figure 1-55 | Disconnect Connections 2. Turn the adult safety disk approximately 30° counter-clock-wise and pull steaight out. Figure 1-56 | Remove Safty Disk 3. Inscall pediacric adaprer assembly, Figue 1-57 Install Pediatric Adapter Assembly System 98 Service Manual TT Chapter 1, OperationFigure 1-58 tach Peditric Safety Chamber 4. Hand-tighten the appropriate size pediatric safety chamber onto the other end of che adapter hose. Verify chat the rubber o-ring is in place to ensure a proper seal. (See table below for the correct safety chamber selection.) ib beeen 1,3.21.2 Establish Power (AC Operation) 1. Remove any plug from che patient balloon connector on the safety chamber. 2. Artach the line cord, appropriate for che country of use, securely into the ‘MAINS power receptacle (63) on the pump console. Plug the System line cord into a compatible grounded AC receptacle. In the US. use only receptacles marked "Hospital Grade." Do not use an adapter to eliminate the plug’s connection co ground, If auxiliary equipmenc is used with the System 98, insure that the equipment is also properly grounded. . Ifa Safery Chamber Leaks Test is desired continue with Step 1,3.21.3 otherwise proceed to Step 1.3.21.4 1.3.21.3 Safety Chamber Leak Test (Pediatric) Perform a safety chamber leak test using the following procedure: 1. Unplug the safety chamber fill port and install a plastic 3-way stopcock. 2. Move the safety chamber close co the System 98 and attach the autofill cube co the stopcock. 3. Open stopcock to she safery chamber. 4. Have available a dead end luer plug for later use in capping the patient balloon connector. Press and hold che LAB FILL key (8) and the ASSIST/STANDBY key (9) while pressing the System Power On/Off switch co ON, Release both keys when the 192 Syslem 98 Service Manual Chapier 1, Operationmessage "SAFETY DISK LEAK TEST” appears adjacene to the ADVISORIES (37) on the display. See section 1.3.2.2 for a detailed description of the leak test. ‘Ac che completion of the leak test, remove the autofill cube. The 3-way stopcock can remain in otder to facilitate manual filling of che IAB. Remove any plug from the patient balloon connector on the safety chamber. 1,3.21.4 Normal Power Up Procedure If the System 98 is not already on, press the IABP ON/OFF switch (77) 10 ON. 1.3.21.5 Establish Fill Gas Pressure 1. Slowly open the Helium cylinder valve fully counter-clockwise. 2. Make sure chae the helium pressure gauge (76) shows chat the helium supply is in the operating range (within the white area). NOTE: When the System is not in use, close the cylinder valve fully clock- ‘wise co prevent a potential leak and the depletion of the helium supply 3. Check chat the message "LOW HELIUM" is not displayed. If the "LOW HELIUM" message is displayed, check helium display icon or helium cylinder gauge for adequate gas capacity and check helium cylinder attachment for leaks, Replace the cylinder if necessary, 1.3.21.6 Initial Set-up for Pediatric Balloon Pumping 1. Set the pump concrols as follows: TRIGGER SELECT @ ECG TAB FREQUENCY © ta IAB AUGMENTATION (7) OFF JAB INFLATION (oy Midpoine IAB DEFLATION ap Midpoine IAB FILL MODE 64) MANUAL TIMING G5) MANUAL SLOW Gas 3) OVERRIDE ECG GAIN (2) NORMAL Attach Pediatric IAB catheter to safety chamber now or after acquisition of ECG and pressure signals, See sections 1.3.2.5, 1.3.2.6, and 1.3.2.8 for ECG Acquisition, Arterial Pressure Acquisition, and Selection of Trigger. System 98 Service Manual Chapter 1, Operation 1931.3.21.7 Timing of Pediatric Balloon Pumping MANUAL TIMING ‘Check chat che MANUAL LED adjacent to the TIMING key (35) is illuminated Use the INFLATION (10) slide control to move the higlighted segment of the arterial pressure trace so that it begins at the dicrotic notch. Adjust the DEFLATION (11) slide control so that the higlighted portion ends slighely before syscole On the inflace control scale "0* represents inflacion at che trigger event with each increment representing a 125 msec delay. On the deflate control scale "0" tepresents deflation immediately after inflation with each increment representing 2125 msec delay. Ifinglacion is adjusted, deflation is directly effected and will also require te-adjusting. Ifa rigger event is derected prior to the IAB deflation point, a safeguard will aucomatically deflate the IAB at the crigger event. NOTE: The System 98 is designed to recognize heatt rates up to 200 bpm. Ac races in excess of 200 bpm +4 bpm, the trigger refractory period causes the Syscem 98 to aucomatically assisc every other beat. In manual timing mode, IAB timing will NOT be adversely effected when chis occurs. The System will automatically reresume assisting every beat when the heart rate falls below 200 #4 bpm AUTO TIMING WARNING: Use ONLY MANUAL TIMING when pumping with pediatric catheters, Efficacy of auto timing bas not been clinically verified in she padiatric population and is not recommended. IMPORTANT. Ac races in excess of 200 +4 bpm, it is possible that auco timing logic could cause patient harm, as inflacion could extend into the next cardiac cycle. Under NO circumstances should auto timing be used when the patient's, heart race approaches this range 1.3.21.8 Filling Pediatric Catheters NOTE: Autofill is noc calibrated to fill pediatric catheters. Follow this procedure and use the exact filling volume specified on the balloon package NOTE: The installation of the pediatric adapter assembly must be completed, as detailed in section 1,3.21.1, before proceeding. 1. Verify the LAB FILL MODE (34) is ser co manual. 2. Actach a 3-way stopcock to the side pore luer ficcing on the chamber. 3. Press IAB FILL key (8) for 2 seconds. Screen will display "MANUAL FILL TAB" message 4. Check that the helium gauge indicates sufficient gas pressure, 1-94 System 98 Service Manual Chapter 1, OperationArrach an empty 20 ce syringe co the S-way stopcock. Open the stopcock eeween the syringe and the safety chamber, Use only the plastic syringe EN supplied. Evacuate the safety chamber f by pulling up on che plunger of the sytinge. Close the stopcock to the | « _safecy chamber and press che plunger down co empry the syringe. Repeac f this until a strong resistance is felt = Safety chamber balloon should be | “Bs tightly collapsed after this procedure 6. Close the stopcock ro the safety chamber and remove the syringe. a | sor OPENED cLosED + Atcach a 20ce syringe co the Manual Fill Porc (73). Fill che syringe and discard che concents. Fill che syringe a second time with the amount of fill (preload) volume specified on the balloon package WARNING: Extreme care should be saken during this process. Never use a glass syringe for this procedure. Hold your hand over the syringe plunger 8. Hold the syringe tip down and/or cover | with your finger. Attach che filled syringe co the stopcock on the safery chamber and open the stopcock becween the safety chamber and the as — syringe. Figute 1-59 Atach Syringe to Stopeock Figure 1-60 Open and Close Figue 1-61 Attach Syringe to Manuel fill Port Figure 1-62 Attach filled Syringe to Stopeack System 98 Service Manual Chapter 1, Operation 1-95Figure 1-63 Press IAB Fl Key 9. Press the IAB FILL key (8) fa seconds, Contents of the syringe will be pulled into the safery chamber. PRECAUTION [f she contents o syringe are not drawn into the safety chamber, DO NOT resume balloon ‘pumping, Return to step 3 and repeat the pprocedre paying careful attention 10 the syringe fill volume, If the second atenpt fails, there most likely isa leak at one of the safety chamber ports or stnpeack and they should be checked. 10. Close the stopcock and remove the syringe. Manual fill is complete. NOTE: Due to diffusion of gas, the manual fill procedure should be repeated every 45 minutes or as needed 1,3.21.9 Initiation of Assist (Pediatric) 1. Check that IAB AUGMENTATION (7) is OFF. 2. To initiate assist, press the ASSIST/STANDBY (9) key. The indicator within. the key begins ¢0 flash on each inflation NOTE: A short fall inflacion cycle is initiated to facilitate Arcecial pressure transmission delay (APD) measurements for the first initiation of assist only 3. Use the IAB AUGMENTATION arrow key co slowly increase the level until [AB augmentation is maximum. 4. Inecessaty, adjust che IAB INFLATION (10) and IAB DEFLATION (11) controls to achieve proper timing. Augmentation should begin ac the dicrotic notch. 5. While pumping, press and hold the INFLATION INTERVAL key (19) co confirm that the marked and intensified segment of che arcerial pressure trace begins approximately at the dicrotic notch If not, the Arterial Pressure transmission delay (APD) can be aucomatically recalculated by quickly pressing and releasing the INFLATION INTERVAL key (19). Confirm proper intensification position If still incorrect, APD can be manually adjusted in the Display Preferences section of the Preferences menu. Once APD is selected, the delay may be adjusted from 0 co 180 msec in 4 msec increments using the UP and DOWN ARROW keys (24). The marked and intensified segmenc of the Arterial Pressure waveform will consequently move later on the crace. This delay can be adjusted co approximate the start of intensification at the dicrotic notch. 1-96 ‘System 98 Service Manual Chapter 1, OperationNOTE: If the patient's pressure monicoring site is changed while pumping, the INFLATION INTERVAL key (19) can be quickly pressed and released to recalculate arterial pressure cransmission delay. Recontitm proper position This will assure accurate digital pressure dispiays 6. Confirm that che AUG ALARM is ON and the limit is see approximately LO mmHg below diastolic augmentation. PRECAUTION Wher in the Manual Fill Mode, she IAB Catheter and Gas Lass Alarms are disabled. Therefore, use ofthe Low Axgmentation Alarm is essential in pediatric IAB pasient care By sexting the Low Azgmentation Alarm, the Systere sonitors the level of assist and alerts the user in the exent that readjustment of controls andlor reselaction of modes of operation is required. System 98 Service Manvel Chopter 1, Operation 17Figure I-64 Preferences Menu Figure 1-65 Display Proferences Menu 1.3.22 PREFERENCES MENU. ‘The Preferences menu allows the operator to adjust display options, audio tone options and the system date and time. The Preferences menu can be accessed by pressing che PREFERENCES MENU key (27). While this menu is active the LED adjacent co the key will be illuminated. The initial preference selection menu appears __ PREFERENCE MENU Set Time and Date Adjust APD ‘The UP & DOWN ARROW keys (24) are used to highlight che desired item to be reviewed or changed. Pressing the CHANGE/SELECT key (25) displays all the preferences for the selected item. Once inside 2 desired item's menu the arrow kkeys are used to select the specific parameter to be changed, As the reverse video field moves through che list of configurable icems, the selection field on the right expands to show the current selection in reverse video and other possible options to the tight of it. Changes to che preference seccing are accomplished by pressing the CHANGE/SELECT key (25). Once a change is made either move to another item or exit the menu to store this change. Exic by pressing the DONE key (26) to move up one menu or the PREFERENCES MENU key (27) to exit all menus. 1.3.2.1 Display Preferences Menu Perform the above key strokes co enter the Display Preferences menu: DISPLAY PREFERENCES __ ] (50mm per Sec g Bagniness igh Balloon Wavetorm on ECG Inflation Markers On Flash Alarrns On Pressure Scale Auto EFRrenorowien [WANE sewn [DONE Mammary | 1-98 System 98 Service Menval ‘Chapter 1, Operation‘The following Display Preferences can be set by the user. __DISPLAY PREFERENCES | Function tions Chine Woeelann update se nape 5mm eal ow/ Medium High : —_Tehange Display intensity LOH On feush Alarm ute Sele O]000 NOTE: Items in italiac are default values. Items with an * are retained until the user changes them, All other items (except Pressure Scale, see below) which are changed, will revert to the defaule value when power is curned off for more than 15 minuces. Pressure Scale - When Manual scale is selected and the system is powered off for less ehan L5 minutes, the pump will return to the selected scale. When Manual scale is selected and the system is powered off for more than 15 minutes, che pump will return to the 0-160 scale. If Auco scale is selected, che pump will recurn co Auto scale in all cases until a manual scale is selected. 1.3.22.2 Audio Preferences Menu Enter the menu to Audio Preferences by following procedure outlined in section 1.3.22 "Preferences Menu" AUDIO PREFERENCES Loni Median ‘High [Standby Advisory Tore Ot Bie hohigm vom GRAN) ‘The following Audio Preferences can be set by the user. "9 - AUDIO PREFERENCES lem Fonction Berg Volume Scher volume Standby Advisory Tane® Sound tone on Sandby NOTE: Items in italiac are default values. Items with an * are retained until the user changes them. Alll other items which are changed, will revert to the defaule value when power is curned off for more than 15 minutes. Figure 1-66 Audio Preferences Menu Sysiem 98 Service Manvel Chopter 1, Operation 1-99Figue 1-67 Set Time and Date 1.3.22.3 Set Time and Date Enter the menu to Set Time and Date by following procedure outlined in section "Preferences Menu’ SET TIME AND DATE B37 0s (04/21/98 HH:MM_ MM/DD/YY BGronorionciom | Time is displayed in a 24 hour formar. The date formar is specifed according to che system configuration sercing (MM/DD/YY or DD/MM/YY). Press the CHANGE/SELECT key (25) co move che highlighted field co each of the five adjustable fields. Use the ARROW’ keys (24) to increment or decremenc the highlighted field. Exic by pressing che DONE key (26) co move up one menu or the PREFERENCES MENU key (27) to exit all menus. 1.3.22.4 Adjust APD Enter the menu to Adjust APD (Arterial Pressure Delay) by following procedure ‘outlined in section 1.3.22 "Preferences Menu" ADJUST APD ' "anal Pressure Delay Eins WARNING: Do not attempt to adjust without i first relerring fo the Operating Instructions. Figure 1-68 _ ‘Adjust APD This menu may be used co adjuse a “alculaced" Arterial Pressure Delay. Refer to section 1.3.2.1] for more information on APD. The delay may be adjusted from 0 to 180 msec in 4 msec increments using the UP and DOWN ARROW keys 24, 1100 System 98 Service Manual Chapter 1, Operation1.3.23 SYSTEM CONFIGURATION 1. To enter the System Configuration mode press and hold the PREFERENCE MENU key (27) while turning the IABP ON/OFF switch (77) to ON. NOTE: the key must be pressed uncil che System Configuration screen appears. System Configuration PEI Bate Format Selection i Modem Selection | I Display Software Revision 50/80 Hertz Filter Selection | Figure 1-69 System BS enemies Configuration 1.3.23.1 Language Selection 1. To enter the Language Selection menu item, press the UP & DOWN ARROW keys (24) co highlight Language Selection 2. Press the CHANGE/SELECT key (25) to open the Language Selection menu NOTE: The list of languages will always be shown in the native language while all other cext will be in the selected language. System Configuration ae cen. = | Language Selection | | Current Seecton ~ Frangaie Espana! Japanese i itaiane i Portugues ! i | Figure 1-70, Language Selection 1107 System 98 Service Manual Chopier 1, Operation1.3.23.2 Date Format Selection The System 98 allows che date co be set as DD/MM/YY or MM/DD/YY, 1, To enter the date format menu item, press che UP & DOWN ARROW keys to select Dace Format Selection and press the CHANGEJSELECT key 2. Press the UP & DOWN ARROW keys (24) to select the desired format and press the CHANGE/SELECT key (25) co change it | 3. When the desired format is selected, press che DONE key (26) to move up one menu, The System restarts and returns to the normal monitoring mode. Date Format Selection | ‘opsanivy, CCurtent Selacton -> Figure 1-7 Date Format a Selecion Screen Ee se 1-102 ‘System 98 Service Manual Chapter 1, Operation1.3.23.3 Modem Selection stem 98 is equipped with an internal modem which requires configuration before it can be used. cer the modem selection menu item, press che UP & DOWN ARROW 24) to highlight Modem Selection, key (25) to open the Modem Selection screen. 2. Press che CHANGE! 3. Press the UP & DOWN ARROW keys (24) to highlight the desired modem 4. When che desired modem is highlighted, press the CHANGE/SELECT key 25), System Configuration Modem Selection North America Central/South America, Asia, Far East Japan | France i ! German Curent Selection > Netnerlangs Australia i South-Africa User Define!Country 5. Press the DONE key (26) to move up one menu. The System restarts and retums to the normal monitoring mode. Figue 1-72 Modem Selection Screen System 98 Service Manual Chopter 1, Operation 1-103Figure 1-73 User Define/Country ‘Modem Selection Figure 1-74 User Defne/Country Modem Selection with Key Input *¢ User Define/Country Selection When User Define!Countey is selected, the following screen is displaved. NOTE: Contact Datascope Service Personnel for assistance in secting up a User defined modem. System Configuration User Define/Country Tok-Germany ae, Aarne Reset sirng arse DelautOTe Baud rate ao Override DTE Deaut Of Mosem section itera 1. To set or modify che Modem ID String, Initialization String, or Reset Sering, highlighe one of them and press the CHANGEI/SELECT key (25). A "Key Input" displays at the bottom of the screen along with the string to be modified in square brackets "[ System Configuration CBE User Define/Country i TD-Semmany Ee eens wevet String ase BersunoveSausnare S00 Overnge OTE Deiat oft Novem Location irae! Key input \$-4-ABCDEFGHIJKLMNOPORSTUVWXYZ 3456789 SPACE > SAVE [ TOK- Germany 1 Ss vane W704 System 98 Service Manval Chapter 1, Operation2. A highlighted cursor is placed on the first character within che square brackets To change that character, use the UP & DOWN ARROW keys (24) to highlight the desired character in che "Key Inpu CHANGE SELECT key ( section and press che ». The cursor now moves over to the next character within the square brackers. To skip a character or to go back to a character, highlight either the <- or -> in the "Key Input" and press the CHANGE/SELECT key (25). Each time this is done the cursor will move one space to the lefe or right accordingly 3. The Initialization string must be set properly for the modem co function. The string is "ATSF-1 (country code) Z" where the country code is replaced with the appropriate number from the following table. For example, in the Austria the string will be: AT&F-122Z and in Italy the string will be AT&F-13Z ——— ICou ‘Aust clz7eue Belgium [23. ene Czech Republic__|18 ( Deraarer/e SReete | MERE] [Eovpe 3 | [Finland 9 zal [Ireland 24 I Israel 15. italy 3 Now Zealand [Norway Switzerland 14 Turkey UAE [All Other Councries 4. Press the DONE key (26) when all initialization information has been entered. 5. Verify che Reset String is ser co AT&EF. System 98 Service Manual Chapter 1, Operation 1-105Figure 1-75 User Defne/Country Hodem Selecn, honing the Deful DTE Boud Rate 10. Ww To change the "Default DTE Baud Rare", highlight that line and press che CHANGEISELECT key (25). ‘The available choices display within thar line. Choose 9600 and press the CHANGB'SELECT key (25). System Configuration - enone SESE | User Detine/Country Pode 2 wo) eee ‘To change the "Override DTE Default (Y/N), highlight chac line and press the CHANGE/SELECT key (25). ‘The choices of "Yes" and "No” display on thar line. Choose NO and press the CHANGEISELECT key (25) To change the "Modem Location’, highlight thar line ane press the CHANGE SELECT key (25) A sub-menu displays the choices of "Internal" and "External", Choose “Incernal" and press the CHANGE/SELECT key (25) Press che DONE key (26) to exit. ‘At Modem Selection Screen, press DONE key (26). ‘Ac System Configuration Screen, press the DONE key (26), System should now return fo regular operation, configured and ready for use 7108 System 98 Service Monval Chapter 1, Operation1.3.23.4 Display Software Revision 1. To enter che Display Sofware Revision menu icem, press the UP s: DOWN ARROW keys (24) to highlight Display Sofeware R 2. Press the CHANGE/SELECT key (25) to of Revision information the Display Software System Configuration Display Software Revision FRONT END. 300F comm PROC: 5000 MONITOR KEYPAD: 400K bs 5XXxd [ABE S001 Figure 1-76 leeenes — Software Sa = Revision 1.3.23.5 50/60 Hertz Filter Selection ‘The System 98 allows the selection either a 50 or 60 Hertz Filter. 1, To enter the 50/60 Hertz Filter Selection menu, press che UP & DOWN ARROW keys (24) co selece 50/60 Herts Filter Selection and press the CHANGE/SELECT key (25). 2. Press the UP & DOWN ARROW keys (24) to select the desired format and : press the CHANGEVSELECT key (25) to change ic 3. When che desired formac is selected, press the DONE key (26) to move up one menu. The System restarts and returns ¢o the normal monitoring mode. | System Configuration 50/60 Hert Filter Selection Curren Selector SonensPiter Figure 1-77 50/60 Hertz Filter Selection Syaen 98 Senice Manocd — Tor Chapter 1, Operation2. THEORY OF OPERATION _ CONTENTS OF THIS CHAPTER 2.1 BLOCK DIAGRAMS GENERAL THEORY OF OPERATION 23 DETAILED CIRCUIT DESCRIPTIONS “24 FACTS ABOUT LEAD ACID BATTERIES The Theory of Operation has been divided into two parts. The "General Theory of Operation”, Section 2.2 describes the overall theory of operation of che instrument. This text is included to familiarize service personnel with che internal organization of the instrument. While reading this section refer to the System Block Diagram. The "Detailed Circuic Descriptions’, Section 2.3, provides details regarding circuit operation. This text is included to assist service personnel while repairing the printed circuic boards on a component level. Refer to the individual block diagrams or the schematic drawings, in Chapter 5, when reading the Derailed Circuit Descriptions 2.1 BLOCK DIAGRAMS. The Block Diagrams indicate the internal organization of the instrument. The block diagrams are used to gain both familiarity wich the instrument and locace malfunctioning PC boards as readily as possible. To avoid cluceer, the number of PC board interconnects is minimized. The interconnects shown represent major or essential signal flow and clock connections. Block Diagrams Page System Block Diagram 24 Front End Board (0670-00-0668) 25 ‘Main Board (0670-00-0666) 26 Monitor Module (0997-00-0464) 27 Keypad Controller Board (0670-00-0645) 28 Display Controller Board (0670-00-0640) 29 Solenoid Driver Board (0670-00-0639) 2-10 Video Receiver Board (0670-00-064 1) 211 Pneumatic Block Diagram 213 Power Supply Assembly (0014-00-0033-02) 214 System 98 Service Manvel Chapter 2, Theory of Operation 212.2 GENERAL THEORY OF OPERATION. Power Supplies PIN INPUT 0014-00-0033-02 AC Mains Bactery Motor Controller Board: (067 1-00-0004) = DC motor speed conezol Front End Board: (0670-00-0668) ECG Patient isolation ~ ESU fileers - Lead selection ~ Reference lead drive - External ECG signal selection ~ Pacer detection - ECG trigger signal conditioning - ECG size - ECG ESD protection - ECG defibrillator protection Data Acquisition ~ Pneumatic transducer Amplifiers - AID convercer for display signals ~ 12-Bit A/D convercer - Transducer excitation voltages OUTPUT. 0 - 35 volts (main or bulk supply) 24 V (solenoid supply) +i-12 volts, +5 volts - Batcery charger, charge LED drive Pressure - Patient isolation - Pressure scaling = Auto zero circuit - Pressure gain adjustment - External pressure signal selection - Pressure ESD protection Microcontroller ~ serial interface to Main board = ECG ciecuie contro! latches + Pressure circuit control latches = controls A/D conversion - pacer blanking ~ ESU detect and cimeour ~ Auto 2er0 control ‘System 98 Service Manual Chapter 2, Theory of Operation‘Main Board: (0670-00-0666) 6809 Microprocessor (2MHz) - 50K EPROM (Datasette) - 12K RAM - Solenoid control signals - Watchdog timer ~ Alarm processing - Pneumatic switch status - IABP control status, - Motor speed D/A converter 68HC711 Microprocessor 68020 Microprocessor (24MHz) EPROM (Daaserte) RAM + Real time clock and NVRAM - Display incerface - Recorder concrol ~ Recorder interface + RS-252 interface ~ Modem interface ~ Configuration DIP switch ~ Serial interface to the Eront End, Solenoid Driver and Keypad Controller boards ~ Shared RAM interface Shared RAM = Port 1 interfaces with the 68020 sub-system ~ Pore 2 interfaces wich the 6809 sub-system Pore 3 interfaces with the 6SHC711 (communications Processor) Display Board: (0670-00-0640) - Graphics Processor - Low Voltage Differential Signaling (LVDS) - Frame buffer memory - EL display controller ~ Clock generator Solenoid Driver Board: (0670-00.0639) ~ Solenoid activation circuits - Prolonged inflation watchdog (System failure) - Solenoid LED indicators ~ Blood back sensor - Condensate cooler control Keypad Controller: (0670-00-0645) - Serial interface co Main board (68HC711 microconeroller) - Keypad interface - Keypad LED drivers - Inflare, Deflate por A/D converses Video Receiver Board: (0670-00-0641) + Differencial video buifers - Variable frame rate frame buffer System 98 Service Manval Chapter 2, Theory of Operationeaternal Spute ay fux ve 24 Battery Power Switch Botiery solenoid ver : Board Cherae 4 Connector Front End Board eee | noo ES {0014-00-0055-02 Main Board os70-00-0868 16809 Microprocessor Sub-system ‘Motor Controt ‘Board 0671 -00.0008 OC Brushless Motor DuakHead Compressor 168020 Microprocessor Sub-system ODEN BOARD careons6es Comets (0887 Inara MONITOR Display Board MODULE Video Receiver Board 0670-20-0841 eg] 80| 109] 76| 94] ing Keypad Controtier —_—_—vy= (ce ‘SYSTEM Block Diagram MOTOR COMPARTMENT 24FRONT END BOARD nar i ee 0670-00-0668 ease L| hi eee| ——»— lena eee 2 ER oma | hoc ee f fan 7 fo | vest he omens Test Connector sve (ol | wouareo < | Mh oueaD - ed a: a ruse] [paces [nevaceocresoras DRIVE + “= uf vara. | “se Tea sie a a Faucr cssrene smesveccrnoe re loerecr| se esu_ | meer ce - | | some plot racel Speer GT Tow fcormccen team nas HeLiUw Tank a # Aizorse t >) ass, wo LE TS oo = S\ amosenese | PRESSURE cute s secon fg yy a ; La = , maoowerct < fetal | eeHC7i1 a yi! Saar cee ccoeman =n co i wk a (he i See — sae arrrcims®| I* | sam ae 4| FRONT END BOARD Block Diagram 25DAVENED _cowmmacaD “aeeensty” Soocr ER FRONTEND 8D POWER SUPPLY CONTROLED ASSEMBLY SUPPLY SPEA\ MAIN BOARD an * . * a8 a | — P20; PS; JP 191 1 -00- oavaserte || P17 © JP25C P21 JP23—— SPH i Ps = Ic 0670-00-0666 Saetaaiea seoreoy a670-00-0671 |} so-b0 i ri [oevay] KT. | soos ‘SOLENOID STATE | é 7 FH | 8 509 | rxxe) fotema] | 2a ' stawus | | | tone CONTROL 2 i aurrens | | |oeneraron) | RecisTER zg wROPROCESSOR SAAN aurFeRs | __|CONVERTER| | ng = eaHo11 8 | pos COMMUNICATION PROCESSOR, a Y aoe t 8 HODRESS > RESET WATCHOGG | __rour sop) wana} pecopeRs [> CIRCUIT - TIMER SERVIC |. Jt — - owcnostic — TIMEOUT = y — ‘arcu 2 PORTS rp —_ = FOURPORT i. oT f a 8 sTATICRAM ae Lock res er dl Z wes | CONTROLLER | | 2WXFLASH _ PLD 0670.00-0670 |] CONTROL SUS > [ADDRESS BUS cess a MULTE | INTERRUPT] TIME FUNCTION contrat | 10K PEAPHERAL | PD =) NVRAM (MP) l | DATA BUS MPO" = uP16 ner To DISPLAY ‘BOARD aP3) To re corner TO MODEM y v MAIN BOARD Block DiagramMONITOR MODULE 0670-00-0464 ‘MONITOR KEYPAD ‘CONTROLLER BOARD. ,0670-00-0645 oe ColLED caBLe 70 Lconvititns FROM DISPLAY BOARD eS Sateen wee 2s ed 3 2 a4 & a ea aS ge 36 mie og fi canorss nice. JcontRoLuge co EL Display 640 x 480 na VIDEO RECEIVER BOARD 0870.00-0841 i 1 INFLATION CONTROL, ge AA f owt — i co by Jr cog Ho Leo [—¥ ioRIVER| ) daddd vet 94 » Ar DEFLATION CONTROL - eA AKEYPAD CONTROLLER BOARD 0670-00-0645 ai Safe Crystal From o = | Slide "|.2 . port at Rows. (6)_| 2 33 — = . 4 $3 | Pots. Analog OK Pul-ups] | co BO ‘Inputs Port Cl ra oe os Keypad nae () ESD Protector tonne | Micro- spr, |~crock LED x0 Controller; |-2a#1¢ Driver 22 owe jank #2. CS ce lonviavc Port A J Mb-sc1 ws |. La \—f LED mx Reset’ Driver }®+#°5 Leo FROM Power #2 10 LEDS BAR Proc. Monitor lvoe com) i - oxenvowrsd +8 on Keypad Contellor Board FROM ww a pea Oe ane une nse REET com oun a8 F2 | To Video Receiver Board 1 | | ‘BLVOS LINES ul wes621g yO01g YP7IOULNOD GWdASH BzDISPLAY CONTROLLER BOARD 0670-00-0640 es a oy [om a) tae Na fot | Graphic: mn p Processor | 5 | [ences To | | wl | 2 Gl | LAL Al |] Pehl aces Sontte | Mn-tx a3 0 sav Power Supply wesBeIq x01 YATIONLNOD AVIdSIC ez ap 6 SYNC pRawe IRD YY vvvv v —_¥. SCL Soft Start Cin Con uit (Frame Buffer & EL roller) 2) Mapa Butters rnp. A Ate or Te pH_aDR i | entwne BKN 6X2 us CRT Frame | + Buffer r | | ma ‘« \ 1 | | 2 | YLM Lal 7 2 te p| [-neran | sme | | To Monitor Dist ore j Kom | Board Lep_cr_37ssz, soynte MBOX aA MKERS, |ore SOLENOID DRIVER BOARD 0670-00-0639 . rr) _ _ — AP > cnanoe : WOIGATOR POWER —— spy, Fer cone comae0, + SWITCH enor : a} pence feos - _— - + «PURGE ¢ so.snoos SOLENOIDS, eva | | vk MAINBOARD py | ea — ower Fev conta. | eo = + re eee Fi SOLENOIDS SOLENOIDS wre : Wain BOARD conte + oa er conrroy vn so ane | reverne baive io soLenoins| SOLENOIDS | 204.04 Theta fe a Pausaee vw f]_ SAFETY vent osc. sta a a - > SOLENOID : raw voLuMe SWITCH ; meet yuo STATUS| errr |] Senisons spa veus.owore PELTIER ets comma, orl wel) conoensar Ie Sreneereessd oper Se controt| —reirena |] > PAeoune © oe eet on cr several] F MeDULE sensor — “ 9[ C100 Jory 7 _ [aa BLOCK i - aoe item opAN TusING —[— ies 7 fanorENT 7 = »\ | e0-3evaeay —4—_— | 7w Li 7 | em fue PN vt || -zv [ol eeer LOW 4 | -erer i60w 4 caer 49W | 16VP PFC POST LINcARS 2 van ve J part-va.t —, 2 BATT-cune TEST POINTS i | | || amctave } | swwtaoune | 13) vep-avone 16] uzp-cara DAas00

You might also like

• The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good Life

  

  From Everand

  The Subtle Art of Not Giving a F*ck: A Counterintuitive Approach to Living a Good Life

  Mark Manson

  Rating: 4 out of 5 stars

  4/5 (5819)
• The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are

  

  From Everand

  The Gifts of Imperfection: Let Go of Who You Think You're Supposed to Be and Embrace Who You Are

  Brene Brown

  Rating: 4 out of 5 stars

  4/5 (1093)
• Never Split the Difference: Negotiating As If Your Life Depended On It

  

  From Everand

  Never Split the Difference: Negotiating As If Your Life Depended On It

  Chris Voss

  Rating: 4.5 out of 5 stars

  4.5/5 (845)
• • Magazines
  • Podcasts
  • Sheet music
• Principles: Life and Work

  

  From Everand

  Principles: Life and Work

  Ray Dalio

  Rating: 4 out of 5 stars

  4/5 (609)
• The Glass Castle: A Memoir

  

  From Everand

  The Glass Castle: A Memoir

  Jeannette Walls

  Rating: 4.5 out of 5 stars

  4.5/5 (1717)
• Grit: The Power of Passion and Perseverance

  

  From Everand

  Grit: The Power of Passion and Perseverance

  Angela Duckworth

  Rating: 4 out of 5 stars

  4/5 (590)
• Sing, Unburied, Sing: A Novel

  

  From Everand

  Sing, Unburied, Sing: A Novel

  Jesmyn Ward

  Rating: 4 out of 5 stars

  4/5 (1104)
• Hidden Figures: The American Dream and the Untold Story of the Black Women Mathematicians Who Helped Win the Space Race

  

  From Everand

  Hidden Figures: The American Dream and the Untold Story of the Black Women Mathematicians Who Helped Win the Space Race

  Margot Lee Shetterly

  Rating: 4 out of 5 stars

  4/5 (897)
• Shoe Dog: A Memoir by the Creator of Nike

  

  From Everand

  Shoe Dog: A Memoir by the Creator of Nike

  Phil Knight

  Rating: 4.5 out of 5 stars

  4.5/5 (540)
• The Perks of Being a Wallflower

  

  From Everand

  The Perks of Being a Wallflower

  Stephen Chbosky

  Rating: 4.5 out of 5 stars

  4.5/5 (2104)
• The Hard Thing About Hard Things: Building a Business When There Are No Easy Answers

  

  From Everand

  The Hard Thing About Hard Things: Building a Business When There Are No Easy Answers

  Ben Horowitz

  Rating: 4.5 out of 5 stars

  4.5/5 (348)
• Bad Feminist: Essays

  

  From Everand

  Bad Feminist: Essays

  Roxane Gay

  Rating: 4 out of 5 stars

  4/5 (1018)
• Elon Musk: Tesla, SpaceX, and the Quest for a Fantastic Future

  

  From Everand

  Elon Musk: Tesla, SpaceX, and the Quest for a Fantastic Future

  Ashlee Vance

  Rating: 4.5 out of 5 stars

  4.5/5 (474)
• Her Body and Other Parties: Stories

  

  From Everand

  Her Body and Other Parties: Stories

  Carmen Maria Machado

  Rating: 4 out of 5 stars

  4/5 (822)
• The Outsider: A Novel

  

  From Everand

  The Outsider: A Novel

  Stephen King

  Rating: 4 out of 5 stars

  4/5 (1866)
• The Emperor of All Maladies: A Biography of Cancer

  

  From Everand

  The Emperor of All Maladies: A Biography of Cancer

  Siddhartha Mukherjee

  Rating: 4.5 out of 5 stars

  4.5/5 (271)
• The Sympathizer: A Novel (Pulitzer Prize for Fiction)

  

  From Everand

  The Sympathizer: A Novel (Pulitzer Prize for Fiction)

  Viet Thanh Nguyen

  Rating: 4.5 out of 5 stars

  4.5/5 (122)
• Angela's Ashes: A Memoir

  

  From Everand

  Angela's Ashes: A Memoir

  Frank McCourt

  Rating: 4.5 out of 5 stars

  4.5/5 (441)
• Brooklyn: A Novel

  

  From Everand

  Brooklyn: A Novel

  Colm Tóibín

  Rating: 3.5 out of 5 stars

  3.5/5 (1947)
• The Little Book of Hygge: Danish Secrets to Happy Living

  

  From Everand

  The Little Book of Hygge: Danish Secrets to Happy Living

  Meik Wiking

  Rating: 3.5 out of 5 stars

  3.5/5 (401)
• A Man Called Ove: A Novel

  

  From Everand

  A Man Called Ove: A Novel

  Fredrik Backman

  Rating: 4.5 out of 5 stars

  4.5/5 (4770)
• Steve Jobs

  

  From Everand

  Steve Jobs

  Walter Isaacson

  Rating: 4.5 out of 5 stars

  4.5/5 (808)
• The World Is Flat 3.0: A Brief History of the Twenty-first Century

  

  From Everand

  The World Is Flat 3.0: A Brief History of the Twenty-first Century

  Thomas L. Friedman

  Rating: 3.5 out of 5 stars

  3.5/5 (2259)
• The Yellow House: A Memoir (2019 National Book Award Winner)

  

  From Everand

  The Yellow House: A Memoir (2019 National Book Award Winner)

  Sarah M. Broom

  Rating: 4 out of 5 stars

  4/5 (98)
• Devil in the Grove: Thurgood Marshall, the Groveland Boys, and the Dawn of a New America

  

  From Everand

  Devil in the Grove: Thurgood Marshall, the Groveland Boys, and the Dawn of a New America

  Gilbert King

  Rating: 4.5 out of 5 stars

  4.5/5 (266)
• The Art of Racing in the Rain: A Novel

  

  From Everand

  The Art of Racing in the Rain: A Novel

  Garth Stein

  Rating: 4 out of 5 stars

  4/5 (4208)
• A Tree Grows in Brooklyn

  

  From Everand

  A Tree Grows in Brooklyn

  Betty Smith

  Rating: 4.5 out of 5 stars

  4.5/5 (1929)
• Team of Rivals: The Political Genius of Abraham Lincoln

  

  From Everand

  Team of Rivals: The Political Genius of Abraham Lincoln

  Doris Kearns Goodwin

  Rating: 4.5 out of 5 stars

  4.5/5 (234)
• Yes Please

  

  From Everand

  Yes Please

  Amy Poehler

  Rating: 4 out of 5 stars

  4/5 (1902)
• A Heartbreaking Work Of Staggering Genius: A Memoir Based on a True Story

  

  From Everand

  A Heartbreaking Work Of Staggering Genius: A Memoir Based on a True Story

  Dave Eggers

  Rating: 3.5 out of 5 stars

  3.5/5 (231)
• The Woman in Cabin 10

  

  From Everand

  The Woman in Cabin 10

  Ruth Ware

  Rating: 3.5 out of 5 stars

  3.5/5 (2522)
• Fear: Trump in the White House

  

  From Everand

  Fear: Trump in the White House

  Bob Woodward

  Rating: 3.5 out of 5 stars

  3.5/5 (738)
• Wolf Hall: A Novel

  

  From Everand

  Wolf Hall: A Novel

  Hilary Mantel

  Rating: 4 out of 5 stars

  4/5 (3811)
• John Adams

  

  From Everand

  John Adams

  David McCullough

  Rating: 4.5 out of 5 stars

  4.5/5 (2409)
• On Fire: The (Burning) Case for a Green New Deal

  

  From Everand

  On Fire: The (Burning) Case for a Green New Deal

  Naomi Klein

  Rating: 4 out of 5 stars

  4/5 (74)
• The Light Between Oceans: A Novel

  

  From Everand

  The Light Between Oceans: A Novel

  M.L. Stedman

  Rating: 4.5 out of 5 stars

  4.5/5 (789)
• Manhattan Beach: A Novel

  

  From Everand

  Manhattan Beach: A Novel

  Jennifer Egan

  Rating: 3.5 out of 5 stars

  3.5/5 (792)
• The Constant Gardener: A Novel

  

  From Everand

  The Constant Gardener: A Novel

  John le Carré

  Rating: 3.5 out of 5 stars

  3.5/5 (104)
• The Unwinding: An Inner History of the New America

  

  From Everand

  The Unwinding: An Inner History of the New America

  George Packer

  Rating: 4 out of 5 stars

  4/5 (45)
• Rise of ISIS: A Threat We Can't Ignore

  

  From Everand

  Rise of ISIS: A Threat We Can't Ignore

  Jay Sekulow

  Rating: 3.5 out of 5 stars

  3.5/5 (137)
• Little Women

  

  From Everand

  Little Women

  Louisa May Alcott

  Rating: 4 out of 5 stars

  4/5 (104)
• Abstracts: Kurz Implants, Precision Instruments, Ventilation Tubes

  

  Document32 pages

  Abstracts: Kurz Implants, Precision Instruments, Ventilation Tubes

  Marcos Paulo

  No ratings yet
• Fujifilm SonoSite S-2 Ultrasound - Service Manual

  

  Document86 pages

  Fujifilm SonoSite S-2 Ultrasound - Service Manual

  Marcos Paulo

  No ratings yet
• Agilent Pagewriter 100, 200, 300 ECG - Service Manual

  

  Document162 pages

  Agilent Pagewriter 100, 200, 300 ECG - Service Manual

  Marcos Paulo

  No ratings yet
• Procedure For Repair - Best Practice - Frank Weithoner

  

  Document1 page

  Procedure For Repair - Best Practice - Frank Weithoner

  Marcos Paulo

  No ratings yet