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Graph Ventilator: Technical Manual (Review 04)
Graph Ventilator: Technical Manual (Review 04)
Technical manual
(review 04)
MAY 2006
CHAPTER I
CONTROL PANEL
SAFETY MECHANISMS
CHAPTER II
MAINTENANCE INSTRUCTIONS
CHAPTER III
TROUBLE SHOOTING
CHAPTER IV
SENSOR VERIFICATION
CHAPTER V
CHAPTER VI
DETAIL OF ASSEMBLIES
CHAPTER VII
CHAPTER VIII
CALIBRATION
CHAPTER IX
FINAL CONTROL
Intended use
Purpose and function of the NEUMOVENT Graph Ventilator:
§ Lung ventilator for mechanical ventilation of medical application, electric and
pneumatically driven and microprocessor-controlled.
§ The intended use is to provide continuous ventilation to patients requiring
ventilatory support. This product is intended to be used in a wide range of
patient from infants until adults and to cover a variety of clinical conditions, and
to be used in short or long terms.
§ The device is intended for used in hospitals and hospital-type facilities that
provide respiratory care for patients requiring respiratory support.
Classification
Class: llb (Rule 9). Active therapeutic devices intended to administer or exchange
energy to or from the human body in a potentially hazardous way.
Type: Active medical Device.
Operative Mode: Continuous.
Life Cycle: 5 years if maintenance schedule is followed.
WARNING: Do not use the ventilator in the presence of flammable anesthetics.
An explosion or fire may result.
Description
The NEUMOVENT Graph Ventilator comprises a system of related elements and
designated to alter, transmit and apply energy directly, and in a predetermined mode,
replacing or contributing with the patient's muscular capacity in the execution of the
work of breathing with the intention of achieving an efficient gas exchange.
This function of increase the mechanical support to the patient can be explained for
the following:
1. Control Mechanism. It explains how the machine can work to increase or
supplement the patient's breathing effort.
2. Control Circuit. It defines what types of devices are used to complete this task.
3. Control Variables. It defines which are the dynamic elements that control any
stage in the course of the breathing cycle.
4. Breathing Phases Variables. It explains how the ventilator responds to changes
that produce the beginning, the support and the end of the breathing cycle.
1. Control Mechanism
To understand how the machine can control the substitution or the supplementation
of the natural function of breathing, before, it is required to explain something on the
mechanics of breathing. Specifically on the pressure that is necessary to exercise to
make a flow enters to the airway and increase the volume of the lungs.
Equation of Motion
Muscle Pressure + Ventilator Pressure = Volume + Resistance x Flow
Compliance
Muscle pressure: Forces generated by the breathing muscles during the inspiration.
Ventilator Pressure: Transrespiratory Pressure generated by the ventilator during the
inspiration (e.g.: pressure of the airway less pressure of the surface of the body).
The combined muscle and ventilator pressure cause volume and flow to be delivered to the
patient. Pressure, volume and flow change with time and hence are variables. The
compliance and the resistance are the constants maintained by the respiratory system.
If the patient’s ventilatory muscles are not functioning, the ventilator must generate all the
pressure required to deliver the tidal volume and the inspiratory flow rate. In this case, it will
control the ventilation.
The NEUMOVENT Graph Ventilator is able to control the pressure waveforms like the flow
waveforms. This control also can be doing in a single inspiration.
2. Control Circuit
The NEUMOVENT Graph Ventilator uses an electronic circuit to perform, control and monitor
the ventilation. The critical components of this system include a microprocessor, pressure
sensors and servo proportional valves.
3. Control Variables
As it was mentioned, the control variables of the NEUMOVENT Graph Ventilator are the
Pressure and the Flow.
no
The ventilator is a
Fow
NEUMOVENT Graph Controller
The equation of motion establishes that if the Pressure is selected as the control variable,
then the ventilator is a pressure controller. Therefore, the left side of the equation will be
2
determined by the selections made in the ventilator and they won't be affected by the
changes of the right side (compliance and resistance). As it will be seen, the Pressure
Controlled (PCV) and Pressure Support (PSV) modes use the pressure as the control
variable.
If the change of volume (VT) is maintained stable when the compliance or the resistance
change and simultaneously the flow are measured directly (pneumotachograph), then the
ventilator is classified as a flow controller.
The Volume mode of the NEUMOVENT Graph Ventilator uses the flow as the control
variable. The Pressure Support mode with Volume Assured is able to change, in oneself
inspiratory phase, from pressure controller to flow controller.
4. Breathing phases variables
In each one of the ventilation phases (inspiration and expiration), a particular variable is
measured and used to begin, sustain and conclude the phase. In this context, pressure,
volume, flow and time are referred as the phase variables.
Principles of Operation
Operative definition
The NEUMOVENT Graph Ventilator is a pressure or flow controller. The inspiration is
triggered by pressure, flow, time or manually. It is pressure, volume or flow limited and
pressure, volume, flow or time cycled.
Two proportional valves, one for air and another for oxygen regulate the flow of gas to the
patient. The valves work simultaneously during each respiratory phase mixing the gases to
get the set FIO2.
The microprocessor receives the airway pressure and the inspiratory flow signals, and it
controls the orders for the adjusted variables and the output signals. The airway pressure
sensor is connected at the beginning of the patient's circuit. This sensor also manages the
feedback signals that are used for pressure triggering, alarms levels, and to control the
pressure waves in the pressure controlled, pressure support and mandatory minute
ventilation modes. Two differential pressure transducers related with the internal and external
pneumotachographs obtain the information of the delivered and exhaled flow. The two output
pneumotachographs are screen type; the expiratory is of variable orifice. Also, the signals of
the first are used to control the flow waveform and the tidal volume regulated as reference.
Control valves
The mentioned proportional valves regulate the gas flow to the patient. The flow control is
able to send flows up to 180 L/min when the gases are from a central-supply system, and of
120 L/min when a portable compressor provides the air.
Two solenoids valves govern the expiratory valve, one for the closing and opening
(beginning and end of the inspiratory phase). The other one is a low flow proportional valve
that regulates the partial closing of the expiratory valve to produce positive pressure at the
end of the expiration (PEEP). The activity of these valves is coordinated by the
microprocessor, synchronizing its actions.
The system of valves has, also, four solenoids valves that act synchronously every 15
minutes to make a system zeroing (atmospheric pressure) of all sensors. At the same time,
another solenoid valve allows to pass a calibrated compressed air flow to purge the lines of
the expiratory pneumotachograph to avoid the entrance of water and humidity to the sensors.
Control panel
The control panel comprises the keys to select the different modes and functions. In the
center there is a LCD screen where the results appear, so much in numeric data as graphic
representations and messages.
Some keys have lamps to indicate activation of the required function. The graphics in real
time of pressure, flow, volume, pressure/volume and flow/volume loops appear in successive
form pressing a key. The airway pressure is represented dynamically by an analogical bar
graph.
The numeric values exhibited below and to the right of the screen are those programmed by
the operator. Those of the superior and left part are resulting values.
Some values have small characters, as the indication of high and low alarm limit of VT.
Others are remarkable as the high and low-pressure limit.
The mode in use is shown with highlighted video inverse characters. Above the mode in use
appears, when it is programmed, the sigh and/or pauses indication.
Likewise, the screen shows messages indicating an alarm state or to execute some action.
Respiratory cycle
The process of insulation of gas to the lungs by means of the mechanic ventilation with the
NEUMOVENT Graph Ventilator comprises four steps:
1) Start of inspiratory phase
2) Progression of inspiration
3) End of inspiration
4) Expiratory phase
Pressure breathing curves where is pointed out the beginning and the end of
the inspiratory phase.
For selection of assist/control ventilation the Volume (VCV) or Pressure (PCV) modes are
used. The spontaneous ventilation includes, in this ventilator, the Pressure Support (PSV)
mode and its combinations, where the patient begins and ends the inspiration according to
he/she demand.
The inspiratory effort that triggers the inspiratory phase modifies the pressure of the
breathing circuit or it produces variation of a continuous flow in the same circuit. In both
cases the system is regulated by means of the Inspiratory Sensitivity control.
From the mechanical point of view, the closing of the expiratory valve and the opening of the
flow of gas mixture toward the breathing circuit and the patient characterize this stage.
Progression of inspiration
The duration of this stage depends on the time during which comes out flow of the ventilator
toward the breathing circuit and the patient, while the expiratory valve remains closed.
The form in the flow administration depends on the ventilatory mode and of the selected flow
waveform.
In the VCV mode the flow waveforms, which can be selected, are: descending ramp (decelerating),
rectangular (continuous flow), sinusoidal, ascending ramp (accelerating). In the pressure modes
(PCV and PSV) the flow waveform is decelerating, except in PSV with volume assured where it
could be combined decelerating with continuous flow in the same inspiratory phase.
Layouts of pressure (up) and flow (below) curves. From left to right: Flow in
descending ramp, rectangular, sinusoidal, ascending ramp. Notice the
modifications of the curves of pressure according to the used flow.
End of inspiration
The suspension of the ventilator inspiratory flow depends on the time selected in the VCV
and PCV modes.
In the PSV mode depends on the fall of the inspired flow until a derivative percentage of the
initial flow of that same inspiration is reached. The regulation of this Expiratory Sensitivity can
be made from 5% up to 40% of the initial flow. The default percentage is 25%.
Flow curve during Pressure Support (PSV). In this case the inspiration finishes
when the flow has diminished to 25% of the initial flow (default value).
Expiratory phase
It begins when the expiratory valve opens up allowing escaping the flow exhaled by the
patient. This action is passive and it carries out by the elastic recoil of the lung and the
thoracic cage. Generally, the expiratory flow waveform shows an inverted peak which returns
with variable retard to the zero flow line. The delay in reaching the zero can be due to
expiratory retard of an obstructive lung disease or for breathing circuit defects.
The expiratory phase can be modifying adding Positive Pressure at the End of Expiration
(PEEP). The NEUMOVENT Graph Ventilator produces this positive pressure by means of a
digital regulation of the closing force of the expiratory valve diaphragm.
10
Operative modes
According to the described functional characteristics, as well as the controls and limits
assigned to this device, the following operative modes have been included. These modes
agree with the descriptions of the classic world literature, which is mentioned partly in
"Bibliography."
The division in three parts has for object to separate the groups
according to the predominant variable, volume, pressure, or
combined modes. The combined modes include modes with
participation of the two modalities and other where objectives of
tidal volume or minute volume that should be get.
11
Volume
VCV Assist/Control
Definition and Operative Proceeding: It is a ventilatory mode with specific
regulation of the tidal volume. The inspiratory pressure is variable, and it depends on
the respiratory impedance to regulated volume.
During this mode, the ventilator works as a flow-controller where the selected flow
waveform is sustained during any lung compliance/resistance variation.
In this mode, the ventilator is time cycled, and the inspiratory flow is automatically
calculated and regulated. This means that for a given volume, the variations of the
inspiratory flow are obtained by means of the regulation of the inspiratory time. It also
explains why a rapid pressure drop without an inspiratory plateau marks the end of
inspiration, unless it is specifically regulated.
In the volume mode, the inspiratory flow can be changed by means of the flow
waveform control key.
The different flows are: descending ramp, constant, sine and ascending ramp. Each
of these flow waveforms also produces characteristic pressure and volume
waveforms.
This mode works with the Assist/Control characteristic, changing from a manner to
other according to the patient's demand (inspiratory effort).
If the patient’s inspiratory effort is reduced or an apnea episode is present, then, the
inspiration will be triggered by time (set machine frequency).
On the other hand, the patient's inspiratory effort could be enough to trigger the
ventilator and begin the inspiratory phase with he/she own breathing frequency and
according with the set trigger sensitivity.
Specific Controls for the VCV mode:
VT: Regulation of gas volume propelled by the ventilator in each inspiration.
Flow Waveform: To change the flow waveform.
Sigh: With selection of sigh Vt; number (1,2 or 3 successively); events per hours (5,
10, 15, 20); insp. pressure limit.
Insp. Pause: With time selection from 0.25 to 2.0 seconds.
Pressure
It comprises modes with specific regulation of the inspiratory pressure. It has two sub modes:
1) Pressure Controlled (PCV) Assist/Control
2) Pressure Support (PSV) and/or CPAP.
In both sub modes the ascending slope of the pressure can be varied with the Rise Time
control.
PCV Assisted/controlled
Definition and Operative Proceeding: In the Pressure-Controlled Ventilation mode
(PCV), the ventilator works as a positive pressure controller because the pressure
waveform remains the same when the patient’s compliance or resistance changes.
The switching from inspiration to expiration is normally regulated by time (inspiratory
cycling by time) or by pressure if the maximum safety pressure limit is reached. As in
all pressure-controlled modes, the ventilatory volume is variable and depends on the
12
lung size, the existent pressure gradient at the beginning of inspiration between the
upper airway and the alveoli, the respiratory system compliance and the available
inspiratory time.
The pressure waveform developed during inspiration is rectangular, being the flow of
the descending ramp type (decelerating flow). The typical pressure plotting shows a
rapid lineal increase until the set pressure limit is reached. Pressure is maintained
constant during the set inspiratory time. It cannot be changed.
This mode works with the Assist/Control characteristic, changing from a manner to
other according to the patient's demand (inspiratory effort).
If the patient’s inspiratory effort is reduced or an apnea episode is present, then, the
inspiration will be triggered by time (set machine frequency).
On the other hand, the patient's inspiratory effort could be enough to trigger the
ventilator and begin the inspiratory phase with he/she own breathing frequency and
according with the set trigger sensitivity.
In PCV it is possible to regulate the pressurization, that is to say, the rising speed of
the pressure until reaching the selected pressure limit. The pressurization is regulated
by means of the Rise Time keys, one to increase and another to diminish the speed.
Pressure Support
Definition and Operative Proceeding: Pressure support ventilation is a
spontaneous ventilation mode where the patient begins and ends the inspiratory
phase; this means that he keeps control of the frequency, the duration of the
inspiration and of the tidal volume. As in all modes limited by pressure, the tidal
volume (VT) is variable, depending on the regulated pressure in relation to the
respiratory system impedance, as well as to the patient’s demand.
In this ventilator, the pressure support is programmed directly, alone or in
combination with other modes.
The patient begins the inspiratory phase according to him/her inspiratory effort and set
Inspiratory Sensitivity (pressure or flow). The inspiration end depends on the set Expiratory
Sensitivity (40. 33, 25, 15, 10 or 5% of the initial peak flow). As a safety measure, the end of
inspiration can be for pressure (3 cm H2O above the adjusted one) or time (3 seconds
maximum).
Specific Controls for the PSV mode:
PSV: It regulates the pressure level.
Rise Time: Two keys to increase or to lower the pressurization time.
13
Combined modes
Group of modes in which the patient has spontaneous ventilation with mandatory inspirations
inserted in synchronized form. Also it comprises modes with spontaneous ventilation and
minimum objectives of tidal volume or minute volume.
The combined modes that may be programmed are:
§ SIMV (VCV) + PSV
Synchronized intermittent ventilation with volume-controlled mandatory inspiration
and spontaneous inspirations with pressure support.
§ SIMV (PCV) + PSV
Synchronized intermittent ventilation with pressure-controlled mandatory inspiration
and spontaneous inspirations with pressure support.
§ MMV + PSV
Mandatory minute ventilation with pressure support. The ventilator has an automatic
control of the pressure support level in order to guarantee minimum minute ventilation
during an eventual decrease of the spontaneous breathing.
§ PSV + VT Assured
Pressure support ventilation with assured tidal volume in case of an eventual
reduction of the breathing effort. In this mode the objective is to guarantee a minimum
tidal volume from a pressure regulated inspiration.
§ Airway Pressure Release Ventilation (APRV)
It is a mode which ventilates applying periodic switching between two adjustable
levels (P-high and P-lower) of continuous positive airway pressure (CPAP) during
preset periods of time.
14
VT: Regulation of the propelled volume by the ventilator in the mandatory inspiration.
Flow Waveform: To change the flow waveform.
PSV: Regulates the level of pressure support.
Rise Time: To vary the PSV pressurization.
15
Backup Ventilation
Backup ventilation is a mode intended to guarantee ventilation in patients when there
is a decrease in the breathing effort or episodes of apnea during spontaneous
ventilation modes.
The warning signal, when the apnea alarm is activated, is audible and visual, and
repeats every ten seconds during five seconds. This signal is accompanied with a
message in the screen and activation of the light of apnea alarm.
This mode is of obligatory programming when some spontaneous ventilation form is
selected, as being Pressure Support, SIMV in its two forms, MMV and PSV with VT
Assured. In this way, the backup programming will offer security to the patient in case
the ventilator does not detect signal of pressure or flow to begin an inspiratory phase.
However, in SIMV it is possible to opt for the deactivation of the backup function.
16
As the device does not recognize difference between effort reduction and apnea,
generically this last term is used. For default the apnea time is established in 15
seconds, but it can be modified at 5, 10, 30 or 60 seconds (Menu key). The backup
ventilation for ADULT and PEDIATRIC category is made by volume or pressure
mode. In NEONATOLOGY it is made with pressure (PCV).
17
Alarms
All the alarms have visual and audible signals, and are accompanied by a message on the
screen indicating the name of the alarm activated, and the possible cause and some
suggested solution. The alarms have activation priority and follow an order in accordance
with that priority. This means that if there are two or more events taking place
simultaneously, all the LED’s corresponding to those alarms is lit, but the message on the
screen is that of the alarm with a higher hierarchy. In all cases, the High Inspiratory Pressure
Alarm is considered the one with highest priority.
Some alarms have programmable values (high and/or low limits of pressures, volumes, rate),
other are automatically activated after an elapsed time. While the device remains functioning,
all the alarm events are recorded in memory and they appear in the screen of Activated
Alarms with date and hour in a maximum sequence of 50 lines.
The signals of alarm are grouped in three categories:
1) High Priority
2) Medium Priority
3) Low Priority
18
19
20
Value Change: With the [Alarm Settings] key. The audible signal is suspended
when the pressure recovers accepted limits. The light signal does not disappear
until the [Reset] key is pressed.
Screen message
The audible signal of the alarm is suspended if the pressure returns to an inferior
value to the limit. The light signal of the alarms sector does not disappear until the
[Reset] key is pressed.
22
seconds of persisting the alteration. If, after one minute, no action is taken by the
operator, the alarm status is changed to as a Medium Priority Signal.
Signal type: Audible, and warn in the screen.
Silence: It can be silenced temporarily.
Limits: 2, 4, 6 cm H2O below the PEEP limit. In OFF it is disabled.
Default value: 4 cm H2O.
Value change: With the [Alarm Settings] key or pressing Ctrl + PEEP keys.
Screen message
Automatic reset if the pressure returns above the limit. The light signal does not
disappear until the [Reset] key is pressed.
23
Alarm Complements
Safety Mechanisms
The ventilator’s safety mechanisms comprise the devices that constitute it and the operative
system that governs the microprocessor. Their function is to preserve the integrity of the
procedure, making it safe and reliable.
Ventilator Components
Safety valve: It is located at the beginning of the breathing circuit. It is factory preset.
It is opened when the pressure within the patient’s circuit reaches, for any reason,
120 cm H2O. The gas enters into an internal gas collector and is expelled to the
outside.
Electronic circuit: When the microprocessors detect any failure in the electronic
circuit, not only are the alarm for technical failure activated but also the ventilator
enters into inoperative mode and all solenoid valves are deactivated.
Inspiratory relief valve (antiasphyxia): Located at the beginning of the breathing
circuit. It is opened when there is a power failure or an inoperative state, thus
enabling the aspiration of ambient air.
Operation gases exhaust: The operation gases that normally escape from some of
the internal mechanisms are directed to a common collector from where they are
expelled to the outside.
Low supply pressure of the compressed air: The lack of pressure of the
compressed air (command gas) is compensated by the compressed oxygen through
a connecting valve. The corresponding alarm is triggered, through another device, by
the lack of pressure.
Low supply pressure of the compressed oxygen: The lack of pressure of the
oxygen is compensated by the compressed air. The corresponding alarm is triggered,
through another device, by the lack of pressure.
Monitoring of the airway pressure: There are two pressure transducers located one
at the beginning (proximal pressure) and the other at the end of the patient’s service
circuit (distal pressure).
The proximal transducer commands the pressure in the Pressure-Controlled (PCV)
and Pressure Support (PSV) Modes, the limits of the maximum and minimum airway
pressure, and the positive end expiratory pressure (PEEP). It also originates the
values for the Peak, Plateau, Mean and Baseline Airway Pressure. The distal
transducer is involved in the plotting of the pressure waveforms.
24
Universal Voltage: The power source is self-regulated for alternate current from 100
to 240 volts.
Automatic Zero Reset: The pressure transducers are zeroed every 15 minutes or
when the operator activates this function ([Ctrl] + [Ptr-Vtr]).
Line Purge: In order to avoid any obstruction of and/or humidity in the internal
transducers, air is injected through the tubes connecting the expiratory
pneumotachograph at reset.
Operative System
The operative system, which regulates the functions of the microprocessor, is designed with
algorithms that prevent or avoid the execution of any maneuver that may have unfavorable
effects.
Memory test: Every time the equipment is turned on, a test of the RAM and EPROM
memories is run, thus ensuring the integrity of the operative system.
PEEP and Flow Calibration: Every time the equipment is turned on, the expiratory
valve is electronically calibrated to regulate the positive end expiratory pressure.
There is also a calibration of the flows that go through the expiratory
pneumotachograph.
Parameter limits: Every parameter involved in the ventilation has minimum and
maximum limits that cannot be exceeded.
Values acceptance: All selected or changed values need to be accepted by pressing
[Enter], within a maximum time of 5 seconds.
Alarm limits: Each alarm has preset or programmed limits. When they are exceeded,
in some cases the action is instantaneously suppressed (e.g.: maximum pressure
limit) or in other cases, there is activation delay time (e.g. PEEP loss), depending on
the alarm hierarchy.
Alarm activation indicators: When an alarm is activated, there is not only a light and
auditory signal but also the screen shows a message indicating the name of the
activated alarm, the possible cause and suggestions for the solution of the problem.
Watchdog: The watchdog is an independent system of surveillance of the function of
the electronic circuit.
25
References
26
MAINTENANCE INSTRUCTIONS
2-Functional control.
5-Leds inspections:
b-Press “Silence” key , and check all leds (except :Technical failure,
18-Complete recalibration.
21-Final control.
27
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CHAPTER III
TROUBLE SHOOTING
TROUBLE SHOUTING
PROBLEM POTENTIAL CAUSE CORRECTIVE ACTION
Device does not 1. Leak in the patient’s circuit. 1. Check the patient’s circuit.
pass initial 2. Gas supply closed. 2. Open the gas supply valve.
calibration 3. Occlusion of pneumatic 3. Check inlet filters and supply hoses.
lines. 4. Check the diaphragm of the
4. Expiratory valve control. expiratory valve. Verify if it is
5. Hose of internal circuit is correctly connected.
disconnected or clogged. 5. Check the equipment internal
6. Pressure leak. connections.
7. Internal electrical 6. Check the air-tightness of the
connections. pneumatic set with up to 100 cm of
water. In order to do this, connect
the supply gases to the equipment,
and apply a pressure of 100 cm of
water at the outlet of the internal
pneumotachograph. If pressure
drops sharply, then, there is a leak
inside the pneumatic set. Review
Safety Valve and Antisuffocation
Valve.
7. Check the cable of the proportional
valves, and their connection. Check
voltage in the CPU connectors.
Low flow 1. Defective pressure 1. Check and recalibrate pressure of
regulators. air and oxygen regulators at 2.8
2. Occlusion of pneumatic kg/cm2. Check and recalibrate the
lines or internal pneumatic regulator pressure at 10 PCI.
leaks. 2. Check for loose or kinked filters or
3. Leaks in the patient’s circuit. hoses.
4. Water in the 3. Check the patient’s circuit.
Pneumotachograph system. 4. If there is water in the device,
5. Altered flow sensors. proceed as indicated below.
5. Check the operation of flow sensors,
and then calibrate them.
High flow 1. Defective pressure 1. Check and recalibrate pressure of
regulators. air and oxygen regulators at 2.8
2. Poor flow calibration. kg/cm2.
3. Altered 2. Check to see if there is no water in
pneumotachographs. the device and recalibrate the
4. Altered flow sensors. pneumotachograph and valves.
5. Extremely high 3. Ensure there is no water in the
electromagnetic interference device. Check the operation of flow
(EMI). sensors, and then calibrate
machine.
4. Check the operation of the flow
sensors.
5. Check for the presence of an
electronic equipment nearby that
may be emitting electromagnetic
waves, and altering the normal
operation of the equipment.
29
TROUBLE SHOUTING
PROBLEM POTENTIAL CAUSE CORRECTIVE ACTION
Low Tidal Volume 1. Incorrect initial calibration of 1. Redo initial calibration of the circuit.
the patient’s circuit. 2. Check expiratory valve and
2. Damaged expiratory valve pneumotachograph.
or expiratory 3. Check connections of the expiratory
pneumotachograph. pneumotachograph.
3. Disconnection of the lower 4. Check permeability of P1.
hose of the expiratory 5. Check flow sensors.
pneumotachograph.
4. Obstruction of P1.
5. Damaged flow sensors.
High Tidal Volume 1. Incorrect initial calibration. 1. Redo initial calibration.
2. Damaged expiratory 2. Check pneumotachograph.
pneumotachograph. 3. Check permeability of P2.
3. Obstruction of P2. 4. Check if P1 and P2 are correctly
4. Reversed connection of P1 connected (check they are not
and P2. inverted).
5. Damaged flow sensors. 5. Check the operation of the flow
sensors.
High Inspiratory 1. Occlusion of the patient’s 1. Check the patient’s circuit.
Pressure circuit. 2. Check the volume.
2. High volume. 3. Regulate Rise Time according to the
3. High rise time. patient’s resistance.
4. High inspiratory flow. 4. Complete calibration of the device.
5. Decalibrated flow sensor. 5. Check complete calibration of the
device.
Low Inspiratory 1. Disconnection of the upper 1. Check connections of the expiratory
Pressure hose of the expiratory pneumotachograph.
pneumotachograph. 2. Check connections of the internal
2. Internal disconnection of the pneumatic circuit.
flow sensor. 3. Check the flow sensor.
3. Damaged flow sensor.
High Minute 1. Disconnection of the upper 1. Check connections of the expiratory
Volume hose of the pneumotachograph.
pneumotachograph. 2. Check permeability of P2.
2. Obstruction of P2. 3. Check if P1 and P2 are correctly
3. Reversed connection of P1 connected (check they are not
and P2. inverted).
4. Damaged flow sensors. 4. Check flow sensors.
Low Minute Volume 1. Obstruction of P1 or P2. 1. Check permeability of P1 and P2.
2. Damaged flow sensors. 2. Check flow sensors.
3. Altered 3. Ensure there is no water in the
pneumotachographs. device, and recalibrate the device
completely.
There is no PEEP 1. Damaged expiratory valve. 1. Check expiratory valve.
2. Leaks in the patient’s circuit. 2. Check the patient’s circuit.
3. Defective PEEP 3. Check operation of the PEEP
electrovalve. electrovalves in the sensors board.
4. Water in the PEEP 4. Check if water has entered into the
electrovalve. pneumatic box. If water has entered
into the valves, replace the PEEP
electrovalve.
30
TROUBLE SHOUTING
PROBLEM POTENTIAL CAUSE CORRECTIVE ACTION
High PEEP 1. Diaphragm of the expiratory 1. Replace the diaphragm of the
valve stuck. expiratory valve.
2. Obstruction of the patient’s 2. Check the patient’s circuit.
circuit. 3. Check the operation of the
3. Defective PEEP electrovalve.
electrovalve.
Low PEEP 1. Leaks in the patient’s circuit. 1. Check the patient’s circuit.
2. Damaged expiratory valve. 2. Check expiratory valve.
3. Leaks in the internal 3. Check the internal pneumatic circuit.
pneumatic circuit. 4. Check the operation of the
4. Defective PEEP electrovalve.
electrovalve.
Nebulizer without 1. Inspiratory flow lower than 7 1. Increase the inspiratory flow.
flow L/min. 2. Check the internal pneumatic circuit.
2. Disconnection in the internal 3. Check permeability of the nebulizer
pneumatic circuit. capillary.
3. Obstruction in nebulizer. 4. Check operation of the solenoid
4. Damaged solenoid valve. valve.
FiO2 different from 1. Decalibrated air or oxygen 1. Recalibrate proportional valves, and
% FIO2 proportional valves. then recalibrate the measurement
measurement 2. Decalibrated pressure parameters of the device.
regulators. 2. Check the calibration of the
3. Decalibrated oxygen pressure regulators. Then,
analyzer. recalibrate the device completely.
3. Calibrate oxygen analyzer.
Blower failure 1. Back fan disconnected or 1. Check fan and check connections.
blocked. 2. Replace fan by one with the same
2. Damaged back fan. features.
Low battery charge 1. Low battery charge. 1. Charge the battery for 12 hours, and
2. Damaged battery. if it does not become charged,
3. Battery disconnected. replace with new one.
4. Electrical failure. 2. Replace the battery with a new one.
3. Check the battery connections.
4. Check charge voltage (13 0.5 V).
Screen does not 1. Burnt screen. 1. Replace the display with a new one.
work 2. Bad contact in display 2. Check and clean the contacts of the
connections. different jacks of the display.
Emergency 1. Failure of an electrical 1. Check the condition of the electronic
ventilation component. components of the sensors board,
or technical failure 2. Bad contact of an electronic ancillary board and CPU board.
component or cable. 2. Check soldering of wires and
3. Too much dirt inside the electronic components.
device. 3. Clean all the inside of the device,
4. Extremely high and clean the jacks.
electromagnetic interference 4. Check for the presence of electrical
(EMI). devices nearby.
31
TROUBLE SHOUTING
PROBLEM POTENTIAL CAUSE CORRECTIVE ACTION
Water in the device 1. Water has entered 1. Open the device and
through the air or clean all pneumatic
oxygen supply. components (2.8kg/cm2
2. pressure regulators,
proportional valves,
nonreturn valves, 10 PSI
regulator,
pneumotachograph,
meshes of
pneumotachograph)
Then, recalibrate the
device completely.
Not all LED’s of the keyboard 1. Burnt LED’s. 1. Disassemble the device
are lit. 2. Disconnected key board and check and replace all
jack. burnt LED’s.
3. 2. Check the connection of
the key board to the
CPU, and clean contacts.
3.
Autocycling of device 1. Incorrect initial 1. Redo initial calibration.
calibration. 2. Check the patient circuit.
2. Leak in the patient 3. Check if there is a high
circuit emission electromagnetic
3. Extremely high equipment nearby that
electromagnetic may be interfering with
interference (EMI). the device.
4. Inadequate sensitivity. 4. Set an adequate
5. sensitivity.
32
SENSOR VERIFICATION
Sensor Inspection
When the device is off, press the “Reset” key, and turn it on while keeping the key pressed.
The message “Enter Code” will be displayed on the screen. At that moment, press any key four times.
A message will then be displayed warning that the code entered is incorrect.
Press any key to continue.
At that moment, the calibration menu is displayed on the screen.
Choose the option “Analog Inputs” with the “selection” keys
The readings of the sensors are displayed in this window, and it is also possible to manually open and
close the air and oxygen proportional valves.
Select the window “Analog inputs” in the Calibration menu, and then enter into the menu by pressing
the “Enter” key.
Analog Inputs Screen:
In the lower left corner of the “Analog Inputs” window, there is an4-line column. Each line is identified.
The numbers shown correspond to the opening value of the respective valve. When it is zero, the
valve is closed.
- With the “selection” keys a valve may be chosen. A red bar will appear over the chosen
valve on the screen, then press “Enter” key.
33
Sensor Inspection
- The value for the opening of the chosen valve may be increased or decreased with selection keys
This opening value may range between 0 (Closed Valve) and a maximum of 4095 (Valve completely
opened). If press “ctrl” +“selection” the values go up or dawn in tens.
- All valves (Opening value = 0) may be closed with the “Reset” key.
Sensors Check
In the upper left corner of the window, there is an 8-line column.
Each lines shows the digitalized readings of the flow and pressure. These readings will vary depending
on the flows or pressures being applied on the sensors.
When there are no supply gases connected to the device, the readings given by these sensors are
the ones shown in the following table:
34
Sensor Inspection
35
Sensor Inspection
2) - Cover with a finger exerting pressure in port “P2”of the device and check if the expiratory flow
reading decreases to zero.
3) - Cover with a finger exerting pressure in port “P1”of the device and check if the reading
increases. With a pressure of 6 cmH2O in this port, the expiratory flow reading will be of 900
units approximately.
4) - Close valves with "Reset" Key.
Power Source:
3) - Check if the reading off the “Power Source” is not under 750.
4)- Close valves with "Reset" key.
Nebulizer:
Purging:
1)-Press “I:E” key.
2)-Check if there is flow in P1 and P2 outlet.
3)-Close valves with "Reset" key.
36
Sensor Inspection
Pneumotacograph:
Fig.:1
Ventilator
Fl
Flow
Analyzer
Patient outlet
Fig.:2 Ventilator
Pressure analyzer
Fl
Inspiratory outlet
3)-Check the maximum value of the pressure must be between 40 and 70 cmH2O.
4)- Close valves with "Reset" key.
Inspiratory valve:
1)-Connect the pressure analyzer in the inspiratory outlet (Fig.:2).
2)-Open it with “fiO2” key.
3)-Check the maximum value of the pressure must be between 70 and 130 cmH2O.
4)- Close valves with "Reset" key.
37
Sensor Inspection
Proportional valves:
AirVal:
5)-Press the “Reset” key to finish and press one more time to go back to the calibration menu.
OxyVal:
Idem AirVal
38
- Lay the device down with the face downwards, and place it on foam rubber.
- Lay the back cover down as indicated in the figure, and disconnect the cables.
Device
Back Cover
Foam Rubber
39
Battery Cables
Speaker Cables
Fan
1 Battery
Fan Cable
Speaker
RS-232 Cable
40
Fig.:2-A Fig.:2-B
Fig.:2-C
41
Back
Gabinet To Con14 of CPU Board
Proportional Valves
Fig.:3-A Cables
ON-OFF Cables
AC Cable
To power source
PNEUMATIC BOX
AC Cable
POWER
SOUCE
CPU
ANCIL
BOARD
Con.14
BOARD
Front Proportional Valves
Gabinet Cables
Con.3
ON-OFF Cables
42
o2 aire
salida
Nebulizer P1 P2 Espiratory V.
10PSI
O2 AIR
O2 AIR Antisofocation
Back Gabinet Val.
Gas
Inlet
43
Fig.:4-B
Cabinet sealing joint
Front Cabinet Rear Cabinet
44
Nebulizer P1 P2 Expiratory V-
Outlet Manifold
45
Fig.: 5-B
Front Gabinet
Pneumatic Box
46
Front Cabinet
Pneumatic Box
salida
1 2 3 4
1 2 3
4
Outlet Manifold
47
Fig. 6-A
Front
Gabinet
CON 10
CON 4
CPUBoard
CON 1
Ancil Board
CON 4
J1
S/N
J2
CON 2
CoaxialCables
Pneumatic Box
Power source
48
Con3
In this direction
CON 1
J1
CON 4
S/N
J2
CON 2
From Con 3 cable
CON 3 CON 5 of
Ancil board
Positiion 1
(Box Ground cable)
Ffront 1
Gabinet Position 2
To
J2 in power source (Side shield)
2
49
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TECHNICAL AND MAINTENANCE MANUAL
Graph VENTILATOR Date: 09/05/06
Shield
Fig.:8-B
50
Inverter Board–DisplayCables
Fig. 9-B :
Nut
Keyboard board
Filler
Screw
Nut, do not remove
Panel
51
Fig.:10-A
Flange
Flange
- The panel can be now removed. Proceed with extreme care since it is attached to the cabinet
with silicone sealer.
52
Conector
1 2
A B Gas
Control set
Screws
Pneumotacograf
o
Security Valve
Proportional Valves
screws
O2 AIR
53
DETAIL OF ASSEMBLIES
ASSEMBLY DETAILS
Code:1782 A1V Name: Oxygen inlet
1 5 4 5 2
54
ASSEMBLY DETAILS
Code:1781 A1V Name: Air inlet
1 5 4 2 3
55
ASSEMBLY DETAILS
Code: 2200-A1V Name: Expiratory valve
2
4
56
ASSEMBLY DETAILS
2 2
Code: 0554-A1V Name: 2.8Kg/cm and 0.7 Kg/cm Regulator’s
13
12
11
9
10
8
14
7
5
4
57
ASSEMBLY DETAILS
2 2
Code: 0554-A1V Name: 2.8Kg/cm and 0.7 Kg/cm Regulator’s
58
ASSEMBLY DETAILS
Code: 2460-A1V Name: Line nonreturn valve
1 2 3 4 5
59
ASSEMBLY DETAILS
Code: 2294-A1V Name: Pneumotacograph
1
3 4
2
N° CÓDIGO DESIGNACIÓN
1 2781-M1V Left cover
2 2453-A1V Mesh holder
3 2772-M1V Pneumotacograph body
4 2773-A1V Right cover
5 2493-A1V Safety valve
60
ASSEMBLY DETAILS
Code:2545-A1V Name: Complete NV-Graph proportional valve
61
ASSEMBLY DETAILS
Code: 2493-A1V Name: Safety valve
2
1 3 4
62
ELECTRONICS DETAILS
Code: 2410-A1V Designation: CPU-Board
63
ELECTRONICS DETAILS
Code: 2410-A1V Designation: CPU-Board
Qty Code Obs. Placed
1 3V 35mAh LITIO Batery BT1
1 TCSD-10-D-09.00-01-F-N CABLE
2 Jack:413990-2 J1;J2
Plug:413985-1
1 103309-1 M: CONECTOR 10 P/C CON1
64
ELECTRONICS DETAILS
Code: 2410-A1V Designation: CPU-Board
65
ELECTRONICS DETAILS
Code: 2410-A1V Designation: CPU-Board
66
ELECTRONICS DETAILS
Code : 2109-A1 V Designation: Ancillary Board
67
ELECTRONICS DETAILS
Code:2109-A1V Designation:Ancillary Board
68
ELECTRONICS DETAILS
Code:1799-E2V rev7 Designation: Sensor Board, electric part.
Differentials sensors
pressure
TECME S.A.
P/N 1799E2V
Rev 6
69
CALIBRATION
Remarks:
- The EMI must be periodically calibrated by an official organization and the calibration
must be recorded and filed.
-The air used must be free of oil, humidity, and particles larger than 0.3 m
When the device is off, press the “Reset” key, and turn it on while keeping the key pressed.
The next message will be displayed on the screen:
Pasword:
1- If the changes to be made are to be saved in the memory, press the following sequence
of keys:
Correct Pasword
70
Incorrect Pasword
20
Calibration and Setup Menu:
The calibration and setup menu displays a list in the following order:
b-Press “enter” to enter into the selected calibration screen. Then, press “Reset”to return
to initial menu.
71
b- Press “enter” to enter and modify the values with “Selection” key
Press “Menú” and the next message will be displayed on the screen:
SAVE
EXIT
Select the desired option with the “Selection” key and press “Enter”.
-If you select EXIT and the values was modified; the next message will be displayed on
the screen:
[ Enter ] Accept
[ Reset ] Cancel
72
Press “Menú” and the next message will be displayed on the screen:
SAVE
EXIT
Select the desired option with the “Selection” key and press “Enter”.
-If you select EXIT and the values was modified; the next message will be displayed on
the screen:
[ Enter ] Accept
[ Reset ] Cancel
73
Air Flow
Target
0
Lectura
0
Flow
0
Memory
0
Apertura
c-Select the target value with “Selection” key and press “Enter”
Low
Fast
SAVE
EXIT
Select the desired option with the “Selection” key and press “Enter”.
-If you select EXIT and the values was modified; the next message will be displayed on
the screen:
[ Enter ] Accept
[ Reset ] Cancel
74
Air valve
Target
0.1
Flujo
0.0
Apertura
0
Memoria
0
a-If the valve don’t have previous calibration the next message will be displayed
on the screen:
START
SAVE
EXIT
b-If the valve have previous calibration then press “Menú”.
d-Press “Menú” and the next message will be displayed on the screen:
SAVE
EXIT
Select the desired option with the “Selection” key and press “Enter”.
-If you select EXIT and the values was modified; the next message will be displayed on
the screen:
[ Enter ] Accept
[ Reset ] Cancel
75
Oxigen Valve
80
Pressure Sensors
Presssure Sensors
Derecho 0 0 0 Cm H2O
Izquierdo 0 0 0 Cm H2O
Aire 0 0 0 Kg./cm2
Oxigeno 0 0 0 Kg./cm2
The screen will display a list of the calibration values saved in the memory which
correspond to the pressures indicated in the following table:
Select the desired option with the “Selection” key and press “Enter” to save the zero
value of the four sensors
76
2- Connect a 100 cmH2O pressure at the at the P1 and P2 inlets. simultaneously with
a Y piece connection
3- Save the value with “Enter”.
2- Connect an oxygen tube with a manometer at the gas inlet. Regulate a 5 kg/cm2
(or 71 PSI) pressure.
3- Save the value with “Enter”.
d-Press “Menú” and the next message will be displayed on the screen:
SAVE
EXIT
Select the desired option with the “Selection” key and press “Enter”.
-If you select EXIT and the values was modified; the next message will be displayed on
the screen:
[ Enter ] Accept
[ Reset ] Cancel
77
Press “Menú” and the next message will be displayed on the screen:
START
SAVE
EXIT
Select SAVE option with the “Selection” key and press “Enter”.
START
SAVE
EXIT
Select INICIAR option with the “Selection” key and press “Enter”.
Press “Menú” and the next message will be displayed on the screen:
START
SAVE
EXIT
Select SAVE option with the “Selection” key and press “Enter”.
78
Press “Menú” and the next message will be displayed on the screen:
SAVE
EXIT
Select the desired option with the “Selection” key and press “Enter”.
-If you select EXIT and the values was modified; the next message will be displayed on
the screen:
[ Enter ] Accept
[ Reset ] Cancel
79
Ventilator
Fl
Standard
flowmeter
Patient outlet
Ventilator
Patient´s Circuit
Cap
80
FINAL CONTROL
The purpose of this document is to provide the necessary information for the final control
of the operation of the NEUMOVENT Graph ventilators.
Elements
§ Ventilator.
§ Adult or Pediatric Patient’s Circuit
§ Test Lung with a compliance of 50 and a resistance of 5.
Steps
Operation Description
10 Turn on the device.
81
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TECHNICAL AND MAINTENANCE MANUAL
Graph VENTILATOR Date: 09/05/06
Minimum Pressure
Rise the minimum pressure alarm limit to the peak pressure level read.
High Vt
With the initial parameters, lower the High Vt limit to 500 ml.
Check alarm activation. Reset.
Return the limit to 750 ml.
Low Vt
Gas supply
Air
Close the main supply valve.
Check alarm activation.
Open the supply valve again. Reset.
Oxygen
Follow the procedure indicated for air supply.
82
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TECHNICAL AND MAINTENANCE MANUAL
Graph VENTILATOR Date: 09/05/06
Select PCV
Programming: PCV = 10 ± 2 cm H2O
Ti= 1.5 sec.
Peep = 0
The rest is programmed with <CTRL> + <ENTER>
b) Program PSV.
Pressure = 15 cm. H2O
Peep = 0
ENTER
Trigger the test lung.
Check the mode operation (with the graph generated on the screen).
Check Peak Pressure = 15 cm +/- 2 cm H2O
Apnea Alarm
83
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TECHNICAL AND MAINTENANCE MANUAL
Graph VENTILATOR Date: 09/05/06
Programming: VE = 7 L / min.
Min. VE Alarm = minimum value
PSV = 10 cm H2O
<ENTER>.
Trigger the test lung at a low frequency to obtain a VE lower than that programmed.
Ensure:
a) Peak pressure should increase breath by breath.
b) VT should increase breath by breath.
180 Control the operation of the device installed with a circuit and test lung for 48 hrs.
84
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