Operation guide for Mindray thermal-chip neonatal flow sensor (V1.

0)

Operation guide
Mindray thermal-chip neonatal flow sensor

1 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

Contents
Contents ........................................................................................................................................................... 2

1. The types of neonatal flow sensors.......................................................................................................... 3

2. Operation guide of Mindray neonatal flow sensor .................................................................................. 3

2.1 Installation of thermal type neonatal flow sensor ........................................................................ 3

2.2 Replacing the neonatal flow sensor ............................................................................................. 4

2.3 Routine maintenance of neonatal flow sensor ............................................................................. 6

2.3.1 Common alarms of neonatal flow sensor ........................................................................ 6

2.3.2 Neonatal airway secretions management[1]...................................................................... 7

2.4 Cleaning and disinfection of neonatal flow sensor ...................................................................... 7

2.4.1 When to clean? ................................................................................................................ 7

2.4.2 When to disinfect? ........................................................................................................... 8

2.4.3 The method of cleaning and disinfection......................................................................... 8

2.5 The switch of neonatal flow sensor ............................................................................................. 8

3. Ventilation without a neonatal flow sensor.............................................................................................. 9

4. Additional precautions of neonatal ventilation ...................................................................................... 10

4.1 The connection of flow sensor and Endotracheal Tube ............................................................. 10

4.2 Common setting parameters for neonates[2] .............................................................................. 11

5. References: ............................................................................................................................................ 11

2 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

1. The types of neonatal flow sensors

The proximal neonatal flow sensor is important for neonatal ventilation, and is necessary in the volume
ventilation of neonatal. The proximal neonatal flow sensor can be classified into three types according to its
working principles.
First one is the most traditional one, differential pressure flow sensor. It is easily affected by moisture
and secretion, and the measurement is of low precision. Due to its principle, it needs frequent calibration
during the routine use.
Second one is the hot-wire flow sensor. It is more precise and needs no calibration during daily use.
However, the hot-wire is so fragile that the hot-wire flow sensor is easily broken during the cleaning and
disinfection procedure.
Third one is the thermal-chip flow sensor, and Mindray SV300 uses this one. It is as precise as the hot-
wire one and also needs no calibration during daily use. What’ s more, due to it uses a micro thermal chip,
which is more durable than the hot-wire, so the reusable thermal-chip flow sensor can stand up to 30 times
cleaning and disinfection operation. In order to satisfy different needs, Mindray SV300 offers reusable and
disposable thermal-chip proximal neonatal flow sensor.

Figure 1. Types of neonatal flow sensors

Specifications of Mindray thermal-chip neonatal flow sensor:

Flow range: ± (0.05 to 33) L/min; Dead space: < 1ml; Resistance: 0.9 cmH2O@10L/min; Accuracy:
±3% of reading, or ± 0.02 LPM; Update time: 0.5ms.

2. Operation guide of Mindray neonatal flow sensor

Since proper installation and routine maintenance play an important role in the precise flow
measurement of the neonatal ventilation, so it’s recommended to install and maintain the neonatal flow sensor
according to the following instructions.

2.1 Installation of thermal type neonatal flow sensor

Steps of install the thermal type neonatal flow sensor:
1 Insert the neonatal flow sensor (A) into the patient connector of the Y-piece (B).
2 Connect plug (C) of the flow sensor cable to the flow sensor, most importantly the plug (C) should be
placed upward so as to keep the thermal-chip in the top to avoid the secretion contamination.

3 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

3 Position patient connectors of the Y-piece to point approx. 30~60° downwards to prevent condensation
from forming on the neonatal flow sensor.
4 Run the cables along the breathing hoses to the device.
5 Insert the connector (F) of the flow sensor cable into the socket (G) at the rear of SV300.

Figure 2. The connection of neonatal flow sensor

Figure 3. The connection of flow sensor cable

If a neonatal flow sensor and HME are used in the neonatal patient, the HME must be installed between
the neonatal flow sensor and the patient connector.

Note:
 The flow sensor cable DO NOT support hot-plugin use to ensure the safety. Ensure the flow sensor
cable (F) has been connected to the socket(G) of SV300 before turn on the ventilator.
 In non-invasive ventilation and non-neonate patient, neonatal flow sensor is disabled.
 Remove the neonatal flow sensors from ventilator tubing before initiating nebulization.

2.2 Replacing the neonatal flow sensor

When the neonatal flow sensor needs to be replaced, there is no need to stop ventilation or shut down
the ventilator, you can remove the neonatal flow sensor from the cable plug (C) directly.
Here are the instructions for the connection and separation of flow sensor and cable plug. Both reusable
and disposable neonatal flow sensor is applicable.

4 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

Connect the sensor to the cable plug (C):

Step1: Find the connection Step2: Align the indicator Step3: Put them together until
indicator of sensor and cable between sensor and cable you hear a snapping sound

Buckle

Step4: Confirm the connection

between sensor and cable

Figure 4. The connection step of sensor and cable

Remove the sensor from the cable plug (C):

Step1: Remove the sensor from Step2: Separate two parts after Step3: Done
the buckle of the cable plug the buckle is opened

Figure 5. The separation step of sensor and cable

5 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

Note:
Please follow the instructions when connect or remove the sensor, or the sensor or the cable plug may be
broken.

2.3 Routine maintenance of neonatal flow sensor

2.3.1 Common alarms of neonatal flow sensor

When the use of neonatal flow sensor is improper, or the working status of neonatal flow sensor is
abnormal, corresponding alarms may be triggered to inform clinicians to pay attention to these events and
deal with them. The most frequent alarms during ventilation are Clean Neo. Flow Sensor, No Neo. Flow
Sensor, Neo. Flow Sensor Monitoring Off.
2.3.1.1 Clean Neo. Flow Sensor
Cause:
 The thermal-chip in the neonatal flow sensor is contaminated by secretions or condensate from the
neonatal airway.
Ventilator protect mechanism:
 The flow measurement after flow sensor is contaminated is severely deviated, in order to avoid the
incorrect guide of flow and tidal volume, the flow and waveform are disabled, and flow related
monitoring parameters display ‘— ‘.
 And in volume ventilation mode, the ventilator will switch to backup pressure ventilation automatically.
Handling advice:
 Replace the contaminated flow sensor with a clean one.
 If no backup flow sensor is available, consider temporarily turning OFF the neonatal flow sensor and
using pressure ventilation mode, the detailed operation can be seen in Part 2.5 and 3.
2.3.1.2 No Neo. Flow Sensor
Cause:
 The neonatal flow sensor cable is not connected properly.
 Connection of neonatal flow sensor cable is after ventilation startup, causing the ventilator cannot detect
the flow sensor in system check period.
 The neonatal flow sensor is not connected to the cable plug.
 The neonatal flow sensor is not connected to the breathing circuit, or the breathing tube is occluded,
causing flow sensor detects there is little flow passing through.
 The thermal-chip in the neonatal flow sensor is contaminated by secretions.
Ventilator protect mechanism:
 The flow measurement is near 0 during this alarm, in order to avoid the incorrect guide of flow and tidal
volume, the flow and waveform are disabled, and flow related monitoring parameters display ‘-- ‘.
 And in volume ventilation mode, the ventilator will switch to backup pressure ventilation automatically.
Handling advice:
 Check the cable and sensor connection.
 Confirm whether the connection of neonatal flow sensor cable is after ventilation startup.
 Check whether the Endotracheal Tube is occluded by the secretions.
 Check the sensor for contamination. Refer to the alarm handling of Clean Neo. Flow Sensor.

6 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

2.3.1.3 Neo. Flow Sensor Monitoring Off

Cause:
 The switch of neonatal flow sensor is turned OFF in volume ventilation mode.
Ventilator protect mechanism:
 The flow and waveform are disabled, and flow related monitoring parameters display ‘— ‘. The
ventilator switches to backup pressure ventilation automatically.
Handling advice:
 Turn ON the switch of neonatal flow sensor, the detailed operation can be seen in Part 2.5.

2.3.2 Neonatal airway secretions management[1]

Secretions are the main reason of contamination of flow sensor, and secretion management is also vital
to effective gas exchange, especially in the neonates with an artificial airway. Suctioning of the artificial
airway is a common procedure performed worldwide on a daily basis to remove the airway secretions.
What are the clinical indications of the need for suctioning in infants and neonates?
All studies recommended that the decision to suction should be based on individual patient assessment
and identified the following clinical signs that may indicate the need for suctioning: visible secretions in the
ETT, audible secretions, coarse and/or decreased breath sounds, oxygen desaturations, decreased chest
excursion, changes in blood gas values, changes in respiratory rate and pattern, bradycardia, patient agitation,
and increased proximal airway pressure on the ventilator. For example, oxygen desaturations may indicate
the tube obstruction caused by secretions.
Should suctioning be performed on a schedule or only on an as-needed basis?
Based on the evidence presented in published studies, as-needed suctioning is just as effective as routine
suctioning and does not increase morbidity or mortality in neonatal and pediatric populations. The current
evidence supports the previous recommendation advanced in the 2010 AARC CPG to perform airway
suctioning of the artificial airway only as needed.
Should patients be preoxygenated and/or hyperoxygenated before suctioning?
Artificial airway suctioning may cause a clinically decrease in oxygenation in infants or neonates.
However, no evidence was available with regard to preoxygenation in the neonatal population.
What limit should be imposed on the duration of the suctioning event?
Limiting the duration of each session is an intuitive strategy to mitigate the potential complications
and/or hazards of artificial airway suctioning. And studies recommend keeping each suctioning event as brief
as possible and no longer than 15s.

2.4 Cleaning and disinfection of neonatal flow sensor

2.4.1 When to clean?

When the following situations happen, it’s recommended to clean the neonatal flow sensor.
 When the alarm Clean Neo. Flow Sensor is triggered.
 When the alarm No Neo. Flow Sensor is triggered and the cause of this alarm is contamination.
 When the neonatal flow sensor is used on another neonate.
 Other necessary situations.

7 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

2.4.2 When to disinfect?

When the following situations happen, it’s recommended to disinfect the neonatal flow sensor.
 When the neonatal flow sensor is used on another neonate.
 Other necessary situations.

2.4.3 The method of cleaning and disinfection

The cable of the neonatal flow sensor and reusable neonatal flow sensor can be cleaned and disinfected
as necessary. This table is our recommended cleaning and disinfection methods for Mindray SV300 neonatal
flow sensor, including use for the first time and use after many times.

Cleaning methods (Wipe and Bath Immersion):

① Wipe: wipe with a damp cloth immersed in alkalescent detergent (soap water, etc.) or alcohol solution
and then wipe off the remaining detergent with a dry lint free cloth.
② Immersion: flush with water first (About 3 minutes recommended) and then immerse it in
alkalescent detergent (soap water, etc.) (water temperature 40ºC recommended) or ethanol (75%) for
approximately three minutes. Finally, clean with water and dry completely.
Disinfection methods:
A: Wipe: wipe with a damp cloth immersed in medium- or high-efficiency detergent and then wipe off the
remaining detergent with a dry lint free cloth.
B: Immersion: immerse it in medium- or high-efficiency detergent for more than 30 minutes (recommended
time). Then clean with water and dry completely.
C: Steam autoclave at 134ºC for 10 to 20 minutes (recommended time).
D: Ultraviolet radiation for 30 to 60 minutes (recommended time).
The table below lists the cleaning and disinfecting agents and autoclaving process that may be used
on the ventilator.

2.5 The switch of neonatal flow sensor

When you want to use the ventilator without a neonatal flow sensor, for example, when the neonatal flow
8 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

sensor is contaminated and cannot work normally, you can turn OFF the neonatal flow sensor.
 Step1: Select [Setup] → [Sensor] → [Neo. Module].
 Step2: Set the [Monitoring] to OFF.
Once the neonatal flow sensor is turned OFF, the following features will not be available.
 Volume control mode: V-A/C, PRVC, PRVC-SIMV, V-SIMV or VS
 Flow related monitoring parameters: Tve, Tvi, Mve, alarms of Tv and Mv
 Waveforms: Flow, Volume

Figure 6. The monitoring switch of neonatal flow sensor

3. Ventilation without a neonatal flow sensor

If the neonatal flow sensor is misbehaving then it may be safer to use a standard pressure mode (e.g. P-
A/C). Especially when the neonatal flow sensor is contaminated or broken, the ventilator cannot work
properly while the neonatal flow sensor cannot be replaced immediately, which is frequent scenarios in
clinical operation. In this situation, you can turn OFF the neonatal flow sensor and use the standard pressure
mode before you replace the neonatal flow sensor.
Without a neonatal flow sensor, only pressure ventilation mode is available. The standard pressure
ventilation modes of SV300 neonatal function are:
 Invasive ventilation mode: P-A/C, CPAP/PSV, DuoLevel, APRV
 Non-Invasive ventilation mode: P-A/C, nCPAP, PSV-S/T, DuoLevel, APRV
Note: All non-invasive modes are used normally without a neonatal flow sensor.
However, during the ventilation without a neonatal flow sensor, the monitoring information that is
related to flow is unavailable, which is detailly described in 2.5. So, in order to evaluate the efficacy of the
ventilation, especially whether the airway is obstructed by the secretions, it’s suggested to pay attention to
oxygen saturations, decreased chest excursion, changes in blood gas values, changes in respiratory rate and
pattern, bradycardia, patient agitation of the neonates.

9 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

Figure 7. Ventilation without a neonatal flow sensor

4. Additional precautions of neonatal ventilation

4.1 The connection of flow sensor and Endotracheal Tube

The connection of flow sensor and Endotracheal Tube should reduce the dead space of ventilation, hence
the flow sensor had better be close to the Endotracheal Tube. For example, the flow sensor connects to the
Endotracheal Tube directly, shown in Figure 8.

Figure 8. Flow sensor connects to the Endotracheal Tube directly

If an extension tube is needed to better place the circuit, then a neonatal expandable catheter mount
should be used, reducing the dead space and improve the flow measurement precision.

Wrong application

a) A neonatal expandable catheter mount b) Wrong, adult one

Figure 9. The right and wrong example of expandable catheter mount

10 / 11
 Operation guide for Mindray thermal-chip neonatal flow sensor (V1.0)

4.2 Common setting parameters for neonates[2]

A proper ventilation setting parameters are important for an effective ventilation of neonates. Generally
speaking, ventilation settings should be individualized to the needs of the baby, and the initial ventilation
settings can refer to the following procedure.
Table 1. Suggested Initial Respirator Settings

Condition Rate (Breaths/Min) PIP (cmH2O) PEEP (cmH2O) FiO2

RDS 30-40 16-24 4-6 *

Primary Apnea 15-25 14-20 3-4 *

Congestive Heart Failure 15-25 18-22 4-6 *

(Pulmonary Edema)

Meconium Aspiration 30-60 24-30 4-6 **

Syndrome

Pneumonia 30-40 24-30 6-8 **

 Inspiratory Time: All neonates should have an inspiratory time of 0.3 to 0.5 seconds and an expiratory
time not less than 0.5 seconds unless the rate exceeds 60/minute. At rates above 60, use equal inspiratory
and expiratory times (I: E=1:1).
 Confirmation of correct PIP should always be determined by appropriate chest wall excursion.
 Adjust FiO2 as indicated to maintain oxygen saturation 85%-95% (PaO2 50-70mm Hg).
 Because of the risk of right to left shunting (PFC), the FiO2 in this condition is adjusted to maintain the
oxygen saturation greater than 95% (PaO2 > 80mm Hg) in term infants.

5. References
[1] Blakeman, Thomas C et al. “AARC Clinical Practice Guidelines: Artificial Airway Suctioning.”
Respiratory care vol. 67,2 (2022): 258-271. doi:10.4187/respcare.09548
[2] Jonathan M. Klein, MD. Use of mechanical ventilation in the neonate. University of Iowa Stead Family
Children’s Hospital.

11 / 11