Perseus A500

Instructions for use Perseus A500

WARNING Anesthesia workstation To properly use this medical device, Software 1.1n read and comply with these instructions for use. Typographical conventions

1 Consecutive numbers indicate steps of action, Use of terms with the numbering restarting with "1" for each new sequence of actions. Dräger uses the term "Accessory" not only for accessories in the sense of IEC 60601-1, but also  Bullet points indicate individual actions or dif- for consumable parts, removable parts, and ferent options for action. attached parts. – Dashes indicate the listing of data, options, or The product "Perseus A500" is also referred to as objects. "Perseus". (A) Letters in parentheses refer to elements in the related illustration. A Letters in illustrations denote elements Screen layouts and illustrations of the referred to in the text. device

Any text shown on the screen and any labeling on The actual screen layout or the device may differ in the device are printed in bold and italics, for appearance or in configuration from the example, PEEP, etCO2, or Screen layout. illustrations. The "greater than" symbol > indicates the navigation path in a dialog window, for example, System setup > Alarms > Alarm limits. In this example, System setup represents the dialog window title, Alarms represents a horizontally aligned tab, and Alarm limits a vertically aligned tab.

Trademarks

Trademark Trademark owner Trademark Trademark owner Perseus® Dismozon® Infinity® Mikrobac® BODE Chemie DrägerService® Korsolex® Dräger-Vapor® Neodisher Medi- Dräger ® Dr. Weigert D-Vapor® clean ® Drägersorb® Buraton Schülke & Mayr MEDIBUS.X® Trademark WaterLock® BIPAP1) Selectatec® Datex-Ohmeda 1) Trademark used under license

2 Instructions for use Perseus A500 SW 1.1n Safety information definitions

WARNING CAUTION A WARNING statement provides important A CAUTION statement provides important information about a potentially hazardous information about a potentially hazardous situation which, if not avoided, could result in situation which, if not avoided, may result in death or serious injury. minor or moderate injury to the user or patient or in damage to the medical device or other property.

NOTE A NOTE provides additional information intended to avoid inconvenience during operation.

Definition of target groups

For this product, users, service personnel, and Service personnel experts are defined as target groups. These target groups must have received Service personnel are persons who are instruction in the use of the product and must have responsible for the maintenance of the product. the necessary training and knowledge to use, Service personnel must be trained in the install, reprocess, maintain, or repair the product. maintenance of medical devices and install, The target groups must understand the language reprocess, and maintain the product. of the present document. The product must be used, installed, reprocessed, maintained, or repaired exclusively by defined Experts target groups. Experts are persons who perform repair or complex maintenance work on the product. Users Experts must have the necessary knowledge and experience with complex maintenance work on the Users are persons who use the product in product. accordance with its intended use.

Instructions for use Perseus A500 SW 1.1n 3 Abbreviations, symbols, and product labels

Explanations are listed in Chapter ''Annex'' in sections ''Abbreviations'', ''Symbols'', and ''Product labels''.

4 Instructions for use Perseus A500 SW 1.1n Contents

Contents

For your safety and that of your patients.... 7 Adjusting the alarms...... 93 General safety information ...... 8 Changing the patient data ...... 96 Product-specific safety information...... 10 Exporting data ...... 96 Other settings ...... 97 Application...... 12 Ending the therapy ...... 99 Intended use...... 13 Patient change ...... 100 Indications/Contraindications...... 13 Further information on application...... 14 System test ...... 102 Information on the availability of individual Overview...... 15 device functions...... 103 Hardware...... 16 Testing the system ...... 103 Functional scope ...... 29 Performing the tests ...... 105 Gas flow plan...... 32 Processing the checklist...... 106 Operating concept...... 35 Ending operation...... 111 Screen ...... 36 Switching off the device...... 112 Color concept ...... 38 Selecting and setting ...... 39 Alarms ...... 114 Display of alarms...... 115 Assembly and preparation ...... 41 Response to alarms ...... 116 Mounting of accessories...... 42 Adopting alarm settings when changing the Before first operation ...... 43 ventilation mode ...... 120 Transport within the hospital...... 47 Alarm delay and alarm escalation ...... 121 Connecting the gas supply ...... 48 Activation of alarms after breath detection ...... 124 Ensuring the gas supply ...... 53 Intelligent alarm behavior ...... 124 Preparation for an operation day / after cleaning and sterilization ...... 54 Configuration...... 125 Selecting and connecting patient-specific Device settings ...... 126 accessories...... 58 Defining start settings...... 126 Connecting or exchanging consumables...... 65 Transferring device configurations ...... 144 Activating applications...... 145 Getting started...... 68 Overview of the configurable screen contents 146 Switching on Perseus...... 69 Checking for the readiness of operation...... 70 Troubleshooting ...... 153 Operation in case of emergency...... 71 Leakages...... 154 Power supply failure ...... 155 Operation...... 72 Failure of the gas supply ...... 157 Safety information...... 73 Failure of fresh-gas delivery (electronically Starting the therapy ...... 74 controlled gas mixture) ...... 158 Adjusting the therapy...... 77 Ventilator failure ...... 159 Special forms of therapy...... 80 Failure of the gas measurement...... 159 Using fields with special functions...... 82 Failure of flow measurement ...... 159 Organizing the screen display ...... 87 Screen fault/user interface failure...... 160 Displaying additional data...... 90 Complete failure ...... 160 Setting the sound volume...... 92

Instructions for use Perseus A500 SW 1.1n 5 Contents

Problems with the anesthetic gas receiving Influence of patient category, weight, and age system (AGS) ...... 161 on device behavior ...... 248 Problems with the pressure reducers...... 162 Infinity ID accessory support ...... 248 Problems with the Vapor View option...... 162 Schematic diagram of alarm tones...... 250 Alarm – Cause – Remedy ...... 162 Combination lock on the drawer (optional)...... 251

Cleaning, disinfection and sterilization...... 184 Annex ...... 253 Disassembly ...... 185 Abbreviations...... 254 Reprocessing procedures ...... 187 Symbols...... 256 Reprocessing list ...... 191 Product labels...... 259 Assembling the parts...... 194 Overview of the menu structure ...... 261 Before using on patients again...... 194 Password ...... 265 Maintenance...... 195 Configuration password for Perseus Overview ...... 196 A500 Software 1.1n...... 265 Inspection ...... 196 Preventive maintenance...... 198 Repairs ...... 199 Disposal ...... 200 Disposing of the medical device...... 201 Disposing of accessories...... 201 Technical data ...... 202 General information...... 203 Ambient conditions ...... 203 Fresh-gas delivery...... 204 Fresh-gas delivery (electronically controlled gas mixer)...... 204 Fresh-gas delivery (mechanically controlled gas mixer)...... 205 Ventilator ...... 205 Breathing system...... 207 External fresh-gas outlet ...... 209 Anesthetic gas receiving system ...... 209 Measurement systems and displays ...... 210 Display of calculated values ...... 215 Operation characteristic values ...... 217 Device outlets...... 221 Relevant standards ...... 223 Diagrams ...... 226 EMC declaration...... 229 Device combinations ...... 233 Connections to IT networks...... 234 Software license compliance (optional)...... 236 Principles of operation ...... 237 Description of the ventilation modes ...... 238 Minimum O2 delivery ...... 247

6 Instructions for use Perseus A500 SW 1.1n For your safety and that of your patients

For your safety and that of your patients

General safety information...... 8 Strictly follow these instructions for use...... 8 Maintenance...... 8 Safety checks ...... 8 Accessories ...... 8 Patient safety...... 9 Patient monitoring...... 9 Information on electromagnetic compatibility .. 9 Training...... 10 Keeping the instructions for use ...... 10 Product-specific safety information ...... 10 Functional safety ...... 11 Handling Infinity ID components...... 11

Instructions for use Perseus A500 SW 1.1n 7 For your safety and that of your patients

General safety information

The following WARNING and CAUTION Maintenance statements apply to general operation of the medical device. WARNING and CAUTION statements specific to WARNING its subsystems or particular features appear in the Risk of medical device failure and of patient respective sections of these instructions for use or injury in the instructions for use of any other product being used with this device. The medical device must be inspected and serviced regularly by service personnel. Repair and complex maintenance carried out Strictly follow these instructions for use on the medical device must be performed by experts. Dräger recommends DrägerService for a service contract and for repairs. Dräger WARNING also recommends using original Dräger parts for maintenance. Risk of incorrect operation and incorrect use If the above is not complied with, medical Any use of the medical device requires full device failure and patient injury may occur. understanding and strict observation of all Observe chapter ''Maintenance''. sections of these instructions for use. The medical device must only be used for the purpose specified under ''Intended use'' (see page 13) and in conjunction with appropriate Safety checks patient monitoring (see page 9). Strictly observe all WARNING and CAUTION The medical device must be subject to regular statements throughout these instructions for safety checks. See chapter ''Maintenance''. use and all statements on medical device labels. Accessories Failure to observe these safety information statements constitutes a use of the medical device that is inconsistent with its intended WARNING use. Risk due to incompatible accessories Dräger has only tested the compatibility of accessories that appear in the current list of accessories or in separate declarations by Dräger. If other, incompatible accessories are used, there is a risk of patient injury due to medical device failure. Dräger recommends using the medical device only with accessories from the current list of accessories.

8 Instructions for use Perseus A500 SW 1.1n For your safety and that of your patients

Patient monitoring WARNING Risk of operating errors and incorrect use The user of the medical device is responsible for choosing suitable monitoring that provides Strictly observe the instructions for use of all appropriate information about medical device accessory parts, e.g.: performance and the patient's condition. – Water traps – Flow sensors Patient safety may be achieved by a wide variety –CLIC adapter of means ranging from electronic surveillance of – CLIC absorber medical device performance and patient condition – Soda lime to simple, direct observation of clinical signs. – Breathing hoses The responsibility for selecting the best level of – Masks patient monitoring lies solely with the user of the –Filter medical device. – Endotracheal suction –Vaporizer – Manual resuscitator – AGSS terminal unit Information on electromagnetic compatibility

Patient safety General information on electromagnetic compatibility (EMC) according to the international The design of the medical device, the EMC standard IEC 60601-1-2: accompanying documentation, and the labeling on Medical electrical equipment is subject to special the medical device are based on the assumption precautionary measures concerning that the purchase and the use of the medical electromagnetic compatibility (EMC) and must be device are restricted to persons familiar with the installed and put into operation in accordance with inherent characteristics of the medical device. the EMC information provided (see page 229). Instructions and WARNING and CAUTION Portable and mobile RF communications statements are therefore largely limited to the equipment can affect medical electrical equipment. specifics of the Dräger medical device. WARNING These instructions for use do not provide any information on the following: Risk of electric shock – Dangers that are obvious to the user Do not connect connectors with an – Consequences of intentional misuse of the ESD warning symbol and do not medical device touch the pins of such connectors without implementing ESD protective – Possible negative impacts on patients with measures. Such protective measures may various underlying diseases include antistatic clothing and shoes, Medical device modification or misuse can be touching a potential equalization pin before dangerous. and during connection of the pins, or using electrically insulating and antistatic gloves. All relevant users must be instructed in these ESD protective measures.

Instructions for use Perseus A500 SW 1.1n 9 For your safety and that of your patients

Training WARNING Risk of device failure User training is offered by the responsible Dräger organization, see www.draeger.com. Electromagnetic fields, e.g., those generated by radio frequency communication equipment such as mobile phones, high- frequency electrical surgery equipment, Keeping the instructions for use defibrillators or shortwave therapy devices can disrupt the function of the medical CAUTION device. Risk of incorrect use Only operate radio frequency devices at a sufficient safety clearance of at least 20 The instructions for use must be kept in an cm (7.9 in). accessible location for users.

Product-specific safety information

WARNING WARNING Risk due to device failure Risk of fire Device failure can compromise the correct To avoid a fire hazard, do not introduce drugs therapy functionality of the device. or other substances based on flammable solvents, such as alcohol, into the breathing To ensure immediate remedial action in case system and do not use explosive anesthetic of device failure, the device may only be agents such as ether or cyclopropane or operated under permanent supervision of spray them into the device. users. Always have a manual resuscitator ready. If highly flammable substances are used for disinfection, adequate ventilation is required. WARNING CAUTION Dräger recommends that the user remains in the vicinity of the anesthesia machine, i.e. Risk of crushing within a distance of up to 4 meters (12 feet). Movable device parts or attached components This facilitates fast recognition and response may cause crushing due to clamping. Pay special in the event of an alarm. attention to edges, movable parts, and corners when working with the following components: WARNING – Column cover Risk of malfunction – Breathing system cover –Drawers Unallowed modifications to the medical – Extensible writing tray device can lead to malfunctions. – Swivel arms for mounted devices This medical device must not be modified – Accessories such as gas cylinders, without permission from Dräger. vaporizers, CLIC absorber, and CLIC adapter

10 Instructions for use Perseus A500 SW 1.1n For your safety and that of your patients

WARNING Risk due to electromagnetic fields Although the medical device does not exceed the applicable limiting values for electromagnetic fields, such radiation can interfere with the functioning of pacemakers. All wearers of pacemakers should maintain a distance of at least 25 cm (10 in) between pacemaker and medical device.

Functional safety

The essential performance features comprise: – Supplying the anesthesia workstation with O2 If the O2 supply (central gas supply or gas cylinder) fails, an alarm is issued. – Supply of the patient with adequately oxygenated breathing gas If the breathing gas contains insufficient levels of O2, an alarm is issued. – Patients are not supplied with excessively high anesthetic gas concentrations If excessively high anesthetic gas concentrations are delivered, an alarm is issued. – Monitoring of the airway pressure and the expiratory minute volume Alarms are issued depending on the set alarm limits.

Handling Infinity ID components

Ownership or purchase of this medical device with RFID technology only includes the right to use the medical device and RFID technology in conjunction with products approved by Dräger and in strict compliance with these instructions for use. No intellectual property rights or any rights to the use of the medical device or RFID technology are hereby granted, either explicitly or implicitly, which are contrary to the above-mentioned conditions.

Instructions for use Perseus A500 SW 1.1n 11 Application

Application

Intended use ...... 13

Indications/Contraindications...... 13 Indications ...... 13 Contraindications...... 13 Further information on application...... 14 Environment of use ...... 14

12 Instructions for use Perseus A500 SW 1.1n Application

Intended use

The Perseus anesthesia workstation is intended Ventilation is accomplished on the patient through for use in anesthetizing adults, children, and a laryngeal mask airway, a full-face mask, or an neonates and can be used for automatic and endotracheal tube. manual ventilation, pressure-supported The integrated breathing system can be used with spontaneous breathing, and spontaneous partial rebreathing (low-flow or minimum-flow). breathing. A non-rebreathing system such as the Kuhn or Perseus is equipped with airway monitoring, gas Medec Water System may be used at the external measurement and device monitoring, O2 fresh-gas outlet (optional). insufflation, and an anesthetic gas receiving system. Anesthesia is achieved through a mixture of pure oxygen and Air (medical compressed air) or pure oxygen and nitrous oxide, with the addition of volatile anesthetic agents.

Indications/Contraindications

Indications – For patients with suspected malignant hyperthermia: Do not use any volatile Perseus is specified for inhalational anesthesia anesthetic agents or Perseus with residual and/or patient ventilation in accordance with the concentrations of these gases above 5 ppm. intended use during surgical or diagnostic – Do not perform low-flow anesthesia on patients interventions. with ketoacidosis or patients under the influence of alcohol. This will raise the risk of acetone accumulation in the patient. Contraindications The user is responsible for setting the gas delivery – Perseus applies medications such as oxygen, and ventilation according to the individual patient status. Patient status must be continually nitrous oxide, or volatile anesthetic agents, among others. For contraindications to the monitored for any potential changes. applied medications, strictly follow the instructions for use of the medication. – Do not use soda lime based on potassium hydroxide. Otherwise, there is a risk of CO formation. – Only use pelletized soda lime. Otherwise, there is a risk of faulty measurement or faulty delivery as well as progressive damage to the breathing system due to dust.

Instructions for use Perseus A500 SW 1.1n 13 Application

Further information on application

Environment of use

Perseus is designed for use in rooms in which therapeutic or diagnostic interventions can be performed.

WARNING Risk of explosion and fire This medical device is neither approved nor certified for use in areas where oxygen concentrations greater than 25 Vol%, combustible or explosive gas mixtures are likely to occur.

WARNING Risk of device malfunctions and/or patient injury and user injury Magnetic fields can negatively influence the correct functioning of the medical device and therefore endanger the patient or user. Do not use the medical device in rooms where devices for magnetic field applications are used (e.g., magnetic resonance imaging).

In addition, do not use Perseus in the following environments: – Outside buildings – On intensive care units – During patient transport – In vehicles, airplanes, or helicopters

14 Instructions for use Perseus A500 SW 1.1n Overview

Overview

Hardware ...... 16 Front ...... 16 Screen ...... 17 Plug-in connection with Vapor View option for up to 3 vaporizers...... 17 Breathing system...... 18 Side view from left ...... 19 Device column...... 20 Rear...... 21 Interfaces...... 23 Gas inlets...... 24 Hanger yokes (optional) for gas cylinders with pin-index connections...... 25 Auxiliary power sockets...... 26 Gas mixing unit (electronically controlled)...... 27 Gas mixing unit (mechanically controlled)...... 28 Functional scope...... 29 Device versions, options, and accessories...... 29 Gas delivery...... 29 Ventilation modes...... 29 Additional operation modes...... 29 Monitoring...... 29 Display on the screen...... 30 Protocoling...... 30 Gas supply...... 30 Gas scavenging...... 30 Data exchange, interfaces...... 30 Gas flow plan ...... 32 Breathing system...... 32 Gas supply (electronically controlled gas mixer)...... 33 Gas supply (mechanically controlled gas mixer)...... 34

Instructions for use Perseus A500 SW 1.1n 15 Overview

Hardware

Front

M B L C K D J

I E H F G 10335 A Screen with integrated workplace illumination L External fresh-gas outlet (optional) B Gas mixing unit (electronically controlled gas M Plug-in connection with Vapor View option for mixer shown here) up to 3 vaporizers C Work surface D Extensible writing tray with compartment for instructions for use (optional) E Central brake F Castors with central brake G Footrest H Trolley I Anesthetic gas receiving system with flow indicator J CO2 absorber K APL valve

16 Instructions for use Perseus A500 SW 1.1n Overview

Screen

DE C B 10340 A Touch screen to call up functions or dialog windows B Audio paused key to suppress the alarm tones of all active alarms for 2 minutes C Rotary knob with background illumination to select and confirm settings D key for switching the workplace illumination on and off and dimming the illumination intesity in 3 steps (dark, medium, and bright) E key for switching the device on or off

Plug-in connection with Vapor View option for up to 3 vaporizers

B 10397 A Sensor unit B Illumination unit

Instructions for use Perseus A500 SW 1.1n 17 Overview

Breathing system

ACDEB F

I H 10370 A Water trap with connection for sample line F Expiratory port G Holder, e.g., for breathing bag hose CAUTION H CO2 absorber Pressure gauge indication possibly inaccurate I Anesthetic gas receiving system Always compare the pressures indicated on the pressure gauge with those on the status display. Only use the pressure gauge as the primary source of information if the pressure indicator on the status display has failed.

B Pressure gauge (optional) for indicating the pressure in the internal breathing system, see also (G) on page 27 and (H) on page 28 C Inspiratory port D Bag elbow with circuit plug, e.g., to occlude the Y-piece during an automatic test E APL valve

18 Instructions for use Perseus A500 SW 1.1n Overview

Side view from left

C A

B 10337 A GCX rail for mounting additional workstation components B Strain relief for AGS hose, adjustable height C External fresh-gas outlet (optional)

Instructions for use Perseus A500 SW 1.1n 19 Overview

Device column

The following illustration shows the left side of the device:

F B

E D

C 10369 A Column cover B GCX rail C Recesses for cables which lead e.g., into the device arms D Screw for closing the cable conduit lid E Tabs to hold the cable F Cable conduit

20 Instructions for use Perseus A500 SW 1.1n Overview

Rear

Version with screw connections for gas cylinders

A H

A A

G C F

D D E E 10336 A Mounting rail B Gas inlets C Strain relief for compressed gas hose D Connection for optional pole (38 mm) E Castor with castor brake F Gas cylinder holders (optional) with hook-and- loop strap G Interfaces H Rating plate

Instructions for use Perseus A500 SW 1.1n 21 Overview

Version with hanger yokes for gas cylinders with pin-index connections (optional)

A H B

A A C G

D D

E E 20406 A Mounting rail B Gas inlets C Strain relief for compressed gas hose D Connection for optional pole (38 mm) E Castor with castor brake F Gas cylinder holders (optional) with hook-and- loop strap 2 mounting positions are possible. G Interfaces H Rating plate

22 Instructions for use Perseus A500 SW 1.1n Overview

Interfaces

ABCDE

GF 10367 A Device switch B Serial interfaces (COM 1 and COM 2) C USB interface D Network interface E Interface for work light (optional) F IEC connector (socket for power cable) G Potential equalization pin

Instructions for use Perseus A500 SW 1.1n 23 Overview

Gas inlets

C B 10338 A Connections for gas pressure measurement for gas cylinders (optional) B Connections for central gas supply (N2O optional) C Connections for external gas cylinders (optional) D Label Advanced Cylinder Support (optional)

24 Instructions for use Perseus A500 SW 1.1n Overview

Hanger yokes (optional) for gas cylinders with pin-index connections

A 20405 A Hanger yokes (optional) for gas cylinders with pin-index connections B Wrench for opening and closing the gas cylinder valves C Label Advanced Cylinder Support (optional)

Instructions for use Perseus A500 SW 1.1n 25 Overview

Auxiliary power sockets

View with column cover removed:

A B

C 10368 A Auxiliary power sockets, depending on equipment variant B Isolation transformer switch (optional) C Circuit breakers or fuses, depending on equipment variant

26 Instructions for use Perseus A500 SW 1.1n Overview

Gas mixing unit (electronically controlled)

A H

G B F

E CD 10339 A Status display WARNING B O2 flowmeter (for O2 insufflation Aux. O2 and emergency O2 delivery Add. O2) Risk of mix-up due to deviating arrangement C Current time or time for Auto On In certain countries, the arrangement of the gases on the status display may differ from D O2 switch (for switching between O2 the arrangement of the flow tubes depicted insufflation Aux. O2 and emergency O2 on the screen. delivery Add. O2) Always pay attention to the respective E Outlet for O2 insufflation, e.g., for nasal cannula labeling. F Symbol for programmed Auto On Explanation of the symbols which may be G Display of pressure in the internal breathing displayed, see page 256. system, see page 18 H O2+ button (O2 flush) I Symbols for mains power supply and power supply from internal battery J Symbols for gas supply (O2, Air, N2O) through central supply and gas cylinders

Instructions for use Perseus A500 SW 1.1n 27 Overview

Gas mixing unit (mechanically controlled)

J KL

A I

H B

L L L G min min min

E D C 20305 A Status display Explanation of the symbols which may be displayed, see page 256. B O2 flowmeter (for O2 insufflation Aux. O2) C Outlet for O2 insufflation, e.g., for nasal cannula D Flow control valves for fresh gas (O2, Air, N2O) E Total flow tube for fresh gas F Display of the set fresh-gas flows G Symbols for gas supply (O2, Air, N2O) from central supply and gas cylinders H Display of pressure in the internal breathing system, see page 18 I O2+ button (O2 flush) J Symbols for mains power supply and power supply from internal battery K Symbol for programmed Auto On L Current time or time for Auto On

28 Instructions for use Perseus A500 SW 1.1n Overview

Functional scope

Device versions, options, and Ventilation modes accessories – Manual / Spontaneous Some functions are optional and differ from the On selection: CPAP (optional) individual device configuration. Not all device – CPAP / Pressure Support (optional) versions or options are available worldwide. – Pressure Control - CMV Perseus is intended for use with the options and – Pressure Control - BIPAP accessories listed in the list of accessories 9052630. – Pressure Control - BIPAP / PS (optional) – Pressure Control - APRV (optional) – Volume Control - CMV Gas delivery – Volume Control - CMV / AF Perseus can deliver mixtures of medical gases to – Volume Control - SIMV / AF which an anesthetic agent is added by means of a – Volume Control - SIMV / AF / PS (optional) vaporizer: For a detailed description of the ventilation modes and the additional settings, see page 238. Usable gas mixtures (electronically controlled gas mixer)

–O2/Air Additional operation modes –O2/N2O (optional) – External fresh-gas outlet (optional)

Usable gas mixtures (mechanically controlled – Pause gas mixer) –O2/Air/N2O (N2O optional) Monitoring

Usable anesthetic agents Perseus can monitor the following: – Halothane – Airway pressure – Enflurane – Minute volume – Isoflurane – Inspiratory tidal volume – Sevoflurane – Inspiratory anesthetic gas concentration – Desflurane – Inspiratory O2 concentration – Inspiratory and expiratory CO2 concentrations – Apnea (pressure, flow, and CO2) – Occurrence of anesthetic gas mixtures – Degree of filling of the breathing bag

Instructions for use Perseus A500 SW 1.1n 29 Overview

Display on the screen Gas supply

Perseus can display the following: Gas supply variants – Waveforms Central gas Gas cylinder connec- Gas – Graphical trends supply tion with – Numeric trends fixed-mounted Dräger –Loops pressure reducer (optional) – Alarm history or – Logbook O2 Yes – Numeric parameters third-party pressure reducer (via country- – Prediction of the FiO2 concentration (optional) specific NIST or DISS – Prediction of the anesthetic gas concentration connection) (optional) Air fixed-mounted Dräger – Pre-configured lists for measured values and pressure reducer N2O Yes (optional) set values (optional)

Protocoling Gas scavenging

Perseus can save the following data in a logbook Gas scavenging is conducted through the (among others): integrated anesthetic gas receiving system (AGS). – Measured values The particle filter it contains filters the ambient air. This ensures the display accuracy of the flow – Set values and their changes indicator. – Patient data – Ventilation modes Data exchange, interfaces – Events (e.g., alarms, confirmed alarms) – Test results Serial ports – Gas consumption and anesthetic agent Two serial ports, COM 1 and COM 2, are provided consumption for data communication using the Dräger MEDIBUS data protocol.

USB interface After connecting a Dräger USB storage medium, a USB interface allows, e.g., the following actions: – Saving screen content as screenshot – Saving and loading device configurations – Saving system test results or protocols as text file

30 Instructions for use Perseus A500 SW 1.1n Overview

Network interface If a corresponding service contract has been obtained, the function Remote Service can be executed via a network connection and the hospital network. Perseus can be connected to the Dräger ISG (Infinity Services Gateway) or a DrägerService computer. The following are used: – SNMP: Device monitoring, device status queries, support of software installations and software downloads, configuration support – FTP (as client): Device status queries, support of software installations and software downloads, configuration support For more information, see ''Connections to IT networks'' on page 234.

Support of Infinity ID accessories – Exchange interval monitoring – Anti-interchange security for breathing hoses For more information, see page 248.

Instructions for use Perseus A500 SW 1.1n 31 Overview

Gas flow plan

Breathing system

K H L

J M G N E I F O

C B P

A 20412 A Gas supply from gas mixer M Changeover between automatic ventilation and B Inspiratory pressure measurement Manual / Spontaneous C Inspiratory valve N Breathing bag D Inspiratory flow sensor O CO2 absorber E Expiratory flow sensor P Blower module TurboVent 2 F Patient G Expiratory pressure measurement H Patient gas measurement module I Expiratory valve J PEEP/Pmax valve K APL valve L Anesthetic gas receiving system

32 Instructions for use Perseus A500 SW 1.1n Overview

Gas supply (electronically controlled gas mixer)

H I G

F Add. O2 A D

C E Aux. O2 B 20413 A Gas supply (central supply or gas cylinders) B Gas mixer C Vaporizer D O2 flowmeter E O2 switch F O2 flush G Switch-over valve H Breathing system I External fresh-gas outlet (optional)

Instructions for use Perseus A500 SW 1.1n 33 Overview

Gas supply (mechanically controlled gas mixer)

Aux. O2 H

F A

E D C

B 20414 A Gas supply (central supply or gas cylinders) B Flow control valves C Minimum O2 delivery D Total flow tube E Vaporizer F O2 flush G O2 flowmeter H Breathing system

34 Instructions for use Perseus A500 SW 1.1n Operating concept

Operating concept

Screen...... 36 Main screen...... 36 Therapy bar ...... 36 Dialog windows...... 37 Quick setup window...... 37 Color concept ...... 38 Colors of the control elements...... 38 Waveforms and parameters ...... 38 Color coding for anesthetic agents and medical gases...... 39 Day and night colors...... 39 Selecting and setting ...... 39 Setting of parameters ...... 39 Canceling the setting procedure or the change procedure ...... 39 Activation of buttons ...... 39 Operating the flow control valves ...... 40

Instructions for use Perseus A500 SW 1.1n 35 Operating concept

Screen

Main screen C Main menu bar The main menu bar contains permanently The main screen displays the most important assigned buttons to open dialog windows and information regarding anesthesia and ventilation. activate functions. These buttons are assigned to various groups. A 1:35 Touching a button opens the corresponding dialog window with the same name or activates the corresponding function. B For more information, see page 261. C D Therapy bar The ventilation settings can be adjusted in the therapy bar. D Electronically controlled gas mixer:

10398 – Tabs for selecting ventilation mode AHeader bar – Therapy controls for ventilation parameters – Therapy controls for fresh-gas delivery The header bar contains the following fields: – Patient category Mechanically controlled gas mixer: – Patient data – Tabs for selecting ventilation mode – System information (date, time, device – Therapy controls for ventilation parameters name) – Alarms, messages, and instructions for the Therapy bar user, see page 162 – Information regarding temporarily The illustration shows the expanded therapy bar deactivated alarms for the electronically controlled gas mixer: B Monitoring area The following information is displayed in the A DE monitoring area: B – Gas measurement C – Waveforms F E

– Parameter fields 10404 –Loops A Name of active ventilation mode – Mini-trends B Tab – Virtual flow tubes C Therapy controls – Prediction for anesthetic agents or FiO2 (optional) D Message field for information Information regarding configurable fields, E Buttons to expand and shrink the therapy bar. see page 146.

36 Instructions for use Perseus A500 SW 1.1n Operating concept

F Field with additional information: Dialog windows – Additional and calculated setting values – spontaneous breathing activity of the Dialog windows consist of one or several pages patient which are displayed by touching the corresponding horizontal or vertical tab.

Start values A D Arrows on the scales of the therapy controls B mark the values resulting from the patient data and C start settings. The start values can be configured, see page 126.

Linked therapy controls 10401 Certain parameters can be linked to other A Dialog window title parameters. If one parameter is changed, the linked parameter is also selected and changed. B Horizontal tab to open a page Among other things, this applies to the adjustment C Vertical tab to open subordinate structures of ventilation pressures, ventilation times or during D Button for closing the dialog window electronically controlled fresh-gas delivery. Example: The device can be configured so that a change to the PEEP setting automatically causes Quick setup window a change to Pinsp; as a result, the difference between PEEP and Pinsp and therefore the tidal The Quick setup window is a context-sensitive volume remain constant. dialog window. Depending on the selected Linking therapy controls, see page 138. parameter field or waveform, it contains various setting possibilities, e.g., for limits, scale, or content. Additional information Some setting values can be limited or be mutually Quick setup restricted so that certain combinations of therapy settings are not possible, e.g. Ti 6.9 s with RR 100 /min. If a condition is reached in which a parameter cannot be changed any more, Perseus displays a corresponding message in the message field (D). 10402 This window can be opened by touching the corresponding parameter field in the monitoring area. In the event of an alarm, the window can be opened automatically, see page 132.

Instructions for use Perseus A500 SW 1.1n 37 Operating concept

Color concept

Colors of the control elements Rotary knob

The availability of functions and settings is indicated by certain colors of the therapy controls, of the therapy bar, and in dialog windows.

Therapy controls and buttons

Color Example Meaning

Dark green Available ele- 10342 ment: The rotary knob lights with different colors. function activated Color Meaning Blue Therapy in progress Yellow Selected ele- Yellow A selected function or setting ment: must be confirmed. not yet con- Blinking yellow Functions or settings, which are firmed with still not confirmed, will be reset rotary knob within the next 5 seconds. Light green Available element: function not Waveforms and parameters activated Waveforms for mechanical breaths are displayed in the colors specified in the start settings, see Dark gray Operating ele- page 128. ment: In the flow waveform, spontaneous breathing and currently not pressure support are displayed in a light brown available, func- color. tion activated Measured values whose specified accuracy Gray Unavailable cannot be maintained are displayed in dark gray. element

38 Instructions for use Perseus A500 SW 1.1n Operating concept

Color coding for anesthetic agents and Day and night colors medical gases Three color modes are available: Standardized color coding complying with – Day light ISO 5359 / ISO 32 / ISO 5360 is used to identify anesthetic agents and medical gases. – Day dark – Night The colors for O2, Air, and N2O are adapted to locally applicable standards. Setting the color modes, see page 90.

Selecting and setting

Setting of parameters Canceling the setting procedure or the change procedure Each of these settings requires confirmation by pressing the rotary knob. If a change to a parameter should be canceled 1 Select (color is still yellow), the following options exist to Touch the operation element (A). The color retain the previous setting: turns yellow. For therapy controls, the unit of  Touch the changed parameter again. This the parameter to be set is displayed. resets the selection of and the change to the parameter.  Select another parameter. This selection resets the change to the other parameter. A  Do not press the rotary knob. After 15 seconds,

10434 the change is reset and signal tones sound 2Set during the last 5 seconds (timeout). Turn the rotary knob to set the value. For some therapy controls, faster turning raises the increment width. Activation of buttons 3Confirm Some buttons are immediately active without Press the rotary knob to confirm the value. The additional confirmation. The color immediately color of the operating element changes to turns to dark green. green. Examples: In the following chapters of this document, this sequence of action is represented by simplified – Selecting a view explanations: – Deactivating the CO2 alarms. – "Set the value." Or – "Touch the button."

Instructions for use Perseus A500 SW 1.1n 39 Operating concept

Operating the flow control valves

The flow control valves of the mechanically controlled gas mixer and the O2 flowmeter are operated as follows:

Opening the flow control valve  Turn the flow control valve counterclockwise.

Closing the flow control valve  Turn the flow control valve clockwise to the end stop. In the subsequent chapters of this document, the following is represented by simplified explanations: – "Open the flow control valve." – "Close the flow control valve."

40 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Assembly and preparation

Mounting of accessories ...... 42 Mounting on the sides of the device column ... 42 Mounting on the mounting rails ...... 43 Before first operation...... 43 Connecting the mains power supply...... 43 Charging the battery...... 44 Connecting additional devices...... 45 Establishing potential equalization ...... 46 Using the MEDIBUS protocol ...... 46 Transport within the hospital ...... 47 Increasing the tipping stability during transport 47 Parking the medical device...... 47 Visual inspection after transport ...... 47 Connecting the gas supply...... 48 Central gas supply...... 48 Connecting the gas cylinders ...... 48 Mounting the vaporizers ...... 51 Ensuring the gas supply...... 53

Preparation for an operation day / after cleaning and sterilization...... 54 Assembling the breathing system...... 54 Inserting the breathing system ...... 56 Mounting the flexible arm (optional) or the bag elbow ...... 57 Selecting and connecting patient-specific accessories...... 58 Safety information...... 58 Connecting the breathing circuit and the filters 58 Breathing bag ...... 62 Observing resistance and compliance...... 62 Connecting a non-rebreathing system (optional)...... 63 Connecting or exchanging consumables ... 65 Single-use CO2 absorber ...... 65 Reusable CO2 absorber ...... 65 Water trap...... 66 Connecting the sample line ...... 67

Instructions for use Perseus A500 SW 1.1n 41 Assembly and preparation

Mounting of accessories

Mounting on the sides of the device The maximum tilting moment is calculated based column on the following equation: Variants with plug-in connections for 2 vaporizers: Depending on the arm length, the following maximum weights are permissible: One attached P= (A * B) <8500 mm*kg component: (<738 in*lbs) Maximum weight Multiple attached P1 + P2 + P... <8500 mm*kg Arm Version with Version with components: (<738 in*lbs) length plug-in connec- plug-in connections for 2 tions for 3 Variants with plug-in connections for 3 vaporizers: vaporizers vaporizers One attached P= (A * B) <5000 mm*kg 215 mm 20 kg 13.5 kg component: (<434 in*lbs) (8.5 in) (44 lbs) (29.8 lbs) Multiple attached P1 + P2 + P... <5000 mm*kg 300 mm 15 kg 8.5 kg components: (<434 in*lbs) (11.8 in) (33 lbs) (18.7 lbs) 400 mm 15 kg 8.5 kg Explanation: (15.7 in) (33 lbs) (18.7 lbs) A: Distance (including arm length) to outer 570 mm 15 kg 8.5 kg edge of the attached component (22.4 in) (33 lbs) (18.7 lbs) B: Arm weight (B1) + weight of attached component (B2) Note the following information in addition: P: Product of distance and weight – If more than one arm is installed on a device side, the weights or arm lengths must be reduced. Do not exceed the maximum tilting moment. – Maximum weight on the right side of the device: 35 kg (77 lbs) B2 – Maximum weight on the left side of the device: – Variants with plug-in connections for 2 vaporizers: 25 kg (55 lbs) – Variants with plug-in connections for 3 vaporizers: 15 kg (33 lbs) B1 – Maximum installation height: 1400 mm (55.1 in) A 23537

42 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Example of a permissible configuration: Mounting on the mounting rails

Maximum Arm weight Weight of the Depending on the position of the mounting rail, the length attached com- following weights are permissible: ponent 400 mm 4 kg 5 kg Position Maximum weight (15.7 in) (8.8 lbs) (11 lbs) On the side of the work- 10 kg 300 mm 3 kg 12 kg ing surface (22 lbs) (11.8 in) (6.6 lbs) (26.5 lbs) At the top on the rear of 2.5 kg the device (5.5 lbs) P1= 400 mm * (4 kg + 5 kg) = 3600 mm*kg (P1=15.7 in * (8.8 lbs + 11 lbs) = 310.9 in*lbs) WARNING P2= 300 mm * (3 kg + 12 kg) = 4500 mm*kg Risk of tipping over (P2= 11.8 in * (6.6 lbs + 26.5 lbs) = 390.6 in*lbs) If the weight of the mounted accessories 3600 mm*kg + 4500 mm*kg = 8100 mm*kg exceeds the permissible maximum weight, (310.9 in*lbs + 390.6 in*lbs = 701.5 in*lbs) the medical device may tip over. 8100 mm*kg < 8500 mm*kg Observe the maximum weight per arm. (701.5 in*lbs < 738 in*lbs)

If a combination of arms on one device side WARNING exceeds the value of 8500 mm*kg (738 in*lbs), tipping stability as per IEC 60601-1 is no longer Risk of tipping over given. Check the tilting stability. If the weight of the accessories is unevenly distributed about the device, the medical device may tip over. Distribute the weight evenly.

Before first operation

Connecting the mains power supply WARNING The mains voltage must correspond to the voltage Risk of electric shock and device malfunction range indicated by the rating plate on the rear of If the device is connected to a power socket the device. with incorrect mains voltage or without a protective ground, the user can be injured and the device damaged. Only connect the power cable to power sockets with a protective ground, see ''Technical data''.

Instructions for use Perseus A500 SW 1.1n 43 Assembly and preparation

4 Plug the power cable into the mains power NOTE socket on the wall. The mains plug must be readily accessible so 5 Check the displays for mains voltage and that the power supply to Perseus can be battery on the status display. interrupted quickly in the event of a device failure. 6 Set the device switch to position I, see page 23. 1 Connect the power cable to the device and secure it. Charging the battery 2 Lay the power cable in the cable conduit on the right side of the device. The internal batteries are automatically charged by the mains power supply.

WARNING Risk of device malfunction If the batteries are not sufficiently charged, it may not be possible to maintain operation for long enough if the mains power supply fails. Before first operation or after storage, charge A the batteries for at least 8 hours.

WARNING Risk due to reduced power supply from the 20095 internal battery 3 Pass the power cable around the lower lug (A) Batteries are wear parts. The capacity of the for strain relief. battery diminishes with the period of use. WARNING Check the functional capability of the battery by performing regular inspections. Risk of electric shock If the device is connected to additional power WARNING socket strips, this may lead to increased leakage current. The leakage current may Risk of patient injury exceed the permissible values. If Perseus is operated or connected to the – Do not connect the device to additional mains power supply at ambient temperatures power socket strips. above 35 °C (95 °F), the battery cannot be – Do not connect additional power socket charged properly. The power supply out of strips to the auxiliary power sockets under the battery may be limited. the column covering. Do not expose the device to temperatures above 35 °C (95 °F) on a permanent basis.

44 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Connecting additional devices WARNING Perseus is equipped with auxiliary power sockets Risk of electric shock and of device (with automatic circuit breakers or fuses) under the malfunction column covering, see page 26. Any connected devices or device 1 Connect the power cable of the additional combinations not complying with the device to an auxiliary power socket. requirements in these instructions for use 2 For Perseus with isolation transformer: may compromise correct functioning of the Switch on the power for the isolation medical device. transformer and the auxiliary power sockets – Do not connect high-frequency surgery using the isolation transformer switch. equipment to the auxiliary power sockets of the anesthesia machine. Make sure that the maximum power consumption – Before using the medical device, refer to of additional devices does not exceed permissible and strictly comply with the instructions values. for use of all connected devices and device combinations. WARNING Risk of fire WARNING In combination with oxygen or nitrous oxide, Risk of electrical shock due to penetration of ignition sources such as electrosurgery and fluids laser surgery can cause fires. Only use the medical device with the column – Maintain a distance of at least 200 mm cover closed. (7.9 in) between electrical connections and components which conduct oxygen and nitrous oxide. Other interfaces – Cables and connections must be Only connect devices to COM 1 or COM 2 that sufficiently insulated and must not be comply with the limiting values for safety extra low damaged. Check cables for damage daily. voltage (SELV) at the interface, even in case of malfunction. WARNING Risk of electric shock WARNING The connection of devices to auxiliary power Risk of electric shock sockets can lead to an increased leakage If a USB storage medium with its own power current. If the protective ground of one of supply is used, failure of its protective these devices fails, the leakage current may ground may raise the patient leakage current. rise above the permissible values. Only connect with the approval of the respective Only use USB storage media without their device manufacturer. Have the leakage own power supply as authorized by the list of current checked by service personnel. accessories. If the permissible value is exceeded, use a mains power socket on a wall instead of the auxiliary power socket of the device.

Instructions for use Perseus A500 SW 1.1n 45 Assembly and preparation

Using the MEDIBUS protocol CAUTION To ensure electrical safety, only connect devices MEDIBUS is a software protocol for data transfer to the serial interfaces (COM 1 and COM 2), or between Perseus and an external medical or non- devices and networks to the network interface medical device (e.g., hemodynamic monitors, data (Ethernet connection), with a maximum rated management systems, or computers) via an voltage of 24 Vdc that meet one of the following RS 232 interface. standards: Before transferring data, strictly observe the – IEC 60950-1: Ungrounded SELV circuits following: – IEC 60601-1 (as of 2nd edition): Touchable secondary circuits – MEDIBUS.X, Rules and Standards for Implementation (9052607) – MEDIBUS.X, Profile Definition for Data Establishing potential equalization Communication V1.n (9052608)

Differences in electrical potential between devices WARNING can be reduced by potential equalization. Risk of patient injury Potential equalization does not replace the All data transferred over the MEDIBUS protective ground connection. interface are for information only and must During operation, the potential equalization not be used as the sole basis for diagnostic connectors must be readily accessible and the or therapeutic decisions. Data accessible connection must be able to be disconnected through this interface are not suitable for a without the use of tools. decentralized alarm system in accordance with IEC 60601-1-8:2012 (in the sense of Connecting the potential equalization cable remote monitoring). 1 Connect the potential equalization cable to the 1 Connect the external device to the COM 1 or potential equalization pin on the device. COM 2 port, see page 23. Use MEDIBUS 2 Connect the potential equalization cable to a cables as stipulated in the list of accessories. potential equalization connector of the hospital 2 Configure the corresponding COM interface, (e.g., wall, ceiling supply unit, operating table). see page 142.

WARNING Risk of electric shock Connecting devices to the MEDIBUS interfaces can lead to an increased leakage current. If the protective ground of one of these devices fails, the leakage current may rise above the permissible values. Only connect with the approval of the respective device manufacturer. Have the leakage current checked by service personnel. If the permissible value is exceeded, disconnect the devices from the MEDIBUS interface.

46 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Transport within the hospital

Transport comprises any movement of a medical Increasing the tipping stability during device that does not serve solely for positioning. transport

WARNING 1 Carefully fold the holding arm with any Risk of tipping over during transport mounted equipment against the device, e.g., patient monitoring, data management systems, The medical device may tip over if handled and syringe pumps. When folded in, these incorrectly. components should not project beyond the – The medical device may only be moved by mounting rails if possible. people who have the physical ability to do so. 2 Remove loose objects from the attached arms – Dräger recommends that the medical and the shelves. device always be transported by two 3 Remove the heavy objects of more than 8 kg people. This improves maneuverability. from the mounting rails, e.g., the vaporizers. When transporting over inclines, around 4 Clear the writing tray and slide it completely corners, or over thresholds (e.g., through into the device. doors or in elevators), make sure that the medical device does not bump against 5 Position the optional flexible arm for the anything. Do not pull the medical device breathing bag close to the device. over hoses, cables, or other obstacles 6 Push the optional drawers in. lying on the floor. 7 Lock the lockable optional drawers. – Do not activate the central brake while the medical device is being moved. – To push the medical device, hold on to the Parking the medical device mounting rails on the work surface. – Do not lean against the medical device. When parking, always engage the brakes (central brake for front castors, individual wheel brakes at WARNING rear), especially on inclined surfaces. Risk of injury

The device may tip over when it is Visual inspection after transport transported over inclines. Always move the device using two people. 1 Visually check the medical device for damage, particularly the hoses and cables. 2 Any damage must be repaired by service personnel before using the device.

Instructions for use Perseus A500 SW 1.1n 47 Assembly and preparation

Connecting the gas supply

Central gas supply WARNING Risk due to gas supply failure 1 Screw the compressed gas hoses for the central gas supply to the gas inlets on the rear All gas supplies (central gas supply, gas of the device by hand, see page 24. cylinders) must be correctly connected since otherwise the backup system (gas cylinders) 2 Insert the compressed gas hoses into the strain will not be available if gas supply fails. relief and screw the strain relief tightly into – Make sure that all compressed gas hoses place, see page 21. are correctly connected to the rear side of 3 Connect the compressed gas hoses to the the device. terminal units. – After connecting the gas supply, check for correct function. 4 Check if all gas supplies are correctly – Even when the anesthesia machine is connected. Check if the gases to be supplied connected to the central gas supply, the are available by observing the status display gas cylinders should remain at the device (see page 27). with valves closed as backup. Connecting the gas cylinders CAUTION Risk of device malfunction Only use gas cylinders and pressure reducers whose connectors are free from dust, particles, Gas supply (central gas supply or gas cylinders): and grease. Otherwise, there is risk of fire. To avoid damage to devices connected to the gas supply, only use medical gases. In particular, When handling pressure reducers, strictly observe observe the national and international standards the relevant national laws and regulations. regarding the use of medical gases.

WARNING Danger to the patient and user The device may be damaged if the strain relief of the compressed gas hoses is not used correctly. Use the strain relief of the compressed gas hoses correctly.

48 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Connecting the gas cylinders on variants with 4 Tightly screw the pressure reducer (D) to the screw connections gas cylinder valves. The connections must fit each other directly; do not use transition pieces.

B D

C C 10343 1 Insert the compressed gas hoses into the strain relief (A) and screw the strain relief tightly into place. 2 Connect the compressed gas measurement lines to the connections (B) through the gas inlets. 3 Set the full gas cylinders (C) into the gas cylinder holders and secure them with the hook-and-loop straps.

CAUTION Risk of damage to the device When connecting the pressure reducers, ensure that they do not protrude beyond the device.

Instructions for use Perseus A500 SW 1.1n 49 Assembly and preparation

Connecting the gas cylinders on variants with Before first use: pin-index connections 1 Insert the compressed gas hoses into the strain Gas cylinder with pin-index connection: relief (L) and screw the strain relief tightly into place. 2 Connect the pressure measurement lines to H I A the connections (M). B 3 If the gas cylinders are large, have the cylinder holders (K) relocated to the lower position by C service personnel. D 4 Remove the protection cap from the head of the cylinder. When changing gas cylinders: E G 5 Remove the old sealing washer (D). F 6 Insert a new sealing washer (D) at the cylinder

20421 holder (I). Rear of device: 7 Make sure that both pin-index pins (A) are present below the gas inlet (B). M 8 Align the gas cylinder (F) so that the pin-index holes on the head of the cylinder (E) are pointing towards the pin-index pins (A) on the cylinder holder (I). 9 Insert the cylinder head (E) of the gas cylinder H J (F) from below into the cylinder holder (I) of the hanger yoke (J). 10 Allow the pin-index pins (A) to engage in the pin-index holes. F F F 11 Turn the handle (H) on the cylinder holder (I) clockwise. The tip of the threaded retaining pin will then be turned into the visible recess on the cylinder head. L Make sure that the gas cylinder (F) is suspended vertically. 12 Tighten the handle (H) on the cylinder holder (I). 13 Secure the gas cylinders (F) with hook-and- loop straps (K). K If required, the gas cylinder valve (C) can be opened with the supplied wrench (G). 20415

50 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Handling O2 gas cylinders Mounting the vaporizers

WARNING Depending on the configuration, Perseus can be operated with vaporizers which have a Dräger Risk of explosion Auto Exclusion plug-in adapter or a Selectatec When pressurized, O2 is self-igniting in plug-in adapter. Dräger recommends using only combination with oil or grease. vaporizers that have been tested and are listed in the list of accessories. Do not oil or grease the gas cylinder valve or the pressure reducer of the O2 cylinder. Do WARNING not touch with oily or greasy fingers. Risk due to incorrect anesthetic agent Gas cylinder valves must only be opened and delivery closed slowly. Do not use any tools with the screw connection variants. If the vaporizer is filled with the wrong anesthetic agent or if it is not filled Have service personnel repair any leaky or stiff sufficiently, incorrect anesthetic gas gas cylinder valves. concentrations or concentrations that are too low can occur as a result. WARNING Strictly observe the instructions for use of the Risk due to failure of the O2 gas supply vaporizer. Compare the color coding on the Using a pressure reducer without the vaporizer with the anesthetic agent bottle. required pressure sensor in place of a Dräger The vaporizers used must conform to the pressure reducer or connecting a central ISO 8835-4 or ISO 80601-2-13 standard. If the supply hose to the connection for the internal patient gas measurement module fails, an external gas cylinders will prevent the independent gas measurement system complying availability of the auxiliary supply from being with ISO/IEC 80601-2-55 must be used. monitored during the system test and while the system is in use. The back-up WARNING functionality may be compromised. Risk due to improperly mounted vaporizers If the O2 gas cylinder monitoring function is not available, the user must take measures to Incorrectly mounted vaporizers can cause ensure that the pressure indicator can be leakage. This can cause the fresh-gas flow to read from the user's operating location. Do be too low or contaminate the ambient air. not connect central supply hoses to the Patient and user can be endangered. external gas cylinder connection. – Make sure that the connected vaporizers are hanging vertically. – When using D-Vapor vaporizers, make sure that the power cable is not pinched. – After mounting the vaporizers, perform a leakage test.

Instructions for use Perseus A500 SW 1.1n 51 Assembly and preparation

The following illustration shows the Dräger- Vapor View option Vapor 3000. When combined with Dräger-Vapor 3000 or D-Vapor 3000, the Vapor View option provides the A A following functions: – Illumination of control dial and sight glass on C C vaporizer – Reading the anesthetic agent type – Reading the control dial position – Monitoring the filling level – Prediction of the anesthetic gas concentration BB 10386 1 Set the vaporizer on the plug-in adapter evenly and tightly. 2 Turn the locking lever (A) clockwise. The lever is in the locked position when it is pointing left. 3 Check the vaporizer filling level through the sight glass (B). If necessary, fill the vaporizer. 4 Turn the control dial to position 0; the button (C) latches into place. 5 Check the locking: Set the control dial on the vaporizer into another position than 0 and make sure the other vaporizer remains locked in its 0 position. Repeat the test with the other vaporizer. 6 Set both control dials to position 0.

When connecting D-Vapor 3000 vaporizers 1 Connect the power cable to an auxiliary power socket under the Perseus column covering. 2 If needed, establish potential equalization. 3 If needed, stow the cable in the cable conduit.

52 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Ensuring the gas supply

Perseus is equipped with an integrated anesthetic As an option, the integrated anesthetic gas gas receiving system (AGS). receiving system can be operated in combination with a control valve. Observe the assembly instructions for the control valve.

CAUTION Danger of ambient air contamination A If the anesthetic gas receiving system (AGS) is not connected to the disposal system, contamination of the ambient air with anesthetic gas may result. B Make sure that the anesthetic gas receiving system (AGS) and the disposal system are correctly connected. The anesthetic gas scavenging system must be functioning properly. 10354 1 Connect the suction hose to the nozzle (A) of the receiving system. 2 Secure the suction hose (B) with strain relievers. 10353 3 Connect the probe of the suction hose to the terminal unit of the scavenging system.

Instructions for use Perseus A500 SW 1.1n 53 Assembly and preparation

Preparation for an operation day / after cleaning and sterilization

Assembling the breathing system Installing the TurboVent 2 blower module

WARNING Risk of insufficient anesthetic gas concentrations A If the component connections of the breathing system are not leak-tight enough, ambient air may be added to the anesthetic gas mixture. Make sure that all components of the breathing system are connected tightly. 10540 1 Check all components for damage or wear: 1 Insert the TurboVent 2 blower module (A) into – Blower module TurboVent 2 the breathing system mount. – APL valve – Upper housing of the breathing system – Lower housing of the breathing system – Valve cages and valve plates B – Flow sensors –Ports – Incident flow grills in the inspiratory limb of the lower part of the breathing system and in the expiratory port B – Seals and sealing rings 10394 2 Screw in the quick release screws (B) tightly with a clockwise rotation of 90°, e.g., with a coin.

54 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Inserting the non-return valves WARNING There are recesses in the valve cages of the non- return valves. These recesses are arranged Risk of an incorrectly set pressure limitation differently on the red valve cage (inspiratory valve) If the points marked on the APL valve are not than on the blue valve cage (expiratory valve). aligned toward the user, it may not be When inserting the valve cages, these recesses possible to make or read out the setting align with the corresponding lugs on the bottom correctly. housing of the breathing system. When mounting, always align the APL valve so that the marking faces the user.

C Mounting the upper part of the breathing system housing

I D 10395 1 Align the red valve cage (C) so that the G recesses are above the lugs in the bottom I housing of the breathing system. I 2 Insert the red valve cage. 3 Repeat steps 1 and 2 for the blue valve cage (D). H

Mounting the APL valve 10357 1 Set the upper part of the breathing system (G) F on the lower part of the breathing system (H). E 2 Pay attention to the correct alignment of the three levers (I), see illustration above. 3 Turn the levers (I) about 120° clockwise. 10391 1 Set the valve vertically on the upper housing of the breathing system. 2 Tightly screw the knurled nut (E) clockwise until it engages. Points (F) face the user when the breathing system is installed.

Instructions for use Perseus A500 SW 1.1n 55 Assembly and preparation

Installing the flow sensors and ports N L

K J 10392  Attach the CLIC adapter. Pay attention to the correct orientation of the M adapter: The two bypass symbols (N) must align in a vertical line. 10358 1 Insert the inspiratory flow sensor (J) and turn the knurled nut clockwise to tighten the port Inserting the breathing system (K). 2 Insert the expiratory flow sensor (L), insert the port (M) and turn the knurled nut clockwise to tighten the port. A

Attaching the CLIC adapter (optional)

CLIC adapter allows the following single-use CO2 absorbers to be used: – Infinity ID CLIC Absorber 800+ – CLIC Absorber 800+ – Infinity ID CLIC Absorber Free 10363 – CLIC Absorber Free 1 Insert the assembled breathing system (A) vertically into the breathing system mount.

56 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Mounting the flexible arm

B A B

D 10366

2 Lock the inserted breathing system: Turn the 10347 middle lever (B) clockwise about 120°. 1 Attach the attachment piece of the arm (B) to the connection piece (A) on the breathing system and screw down tightly with the two knurled screws. Check that the arm is fixed securely! C 2 Attach the elbow (C) to the end of the flexible arm. 3 Align the flexible arm so that collisions with other mounted assemblies are prevented.

Mounting the bag elbow 10364 3 Set the breathing system cover into place (C)  Attach the bag elbow (D) directly to the and click it into position. connection piece on the breathing system.

Mounting the flexible arm (optional) or the bag elbow

The breathing bag can be mounted either on the flexible arm or, using the bag elbow and a breathing hose, mounted directly on the breathing system.

Instructions for use Perseus A500 SW 1.1n 57 Assembly and preparation

Selecting and connecting patient-specific accessories

Safety information

WARNING NOTE Risk of increased rebreathing Perseus is not made with natural rubber latex. Leakage between the inner and outer hose To minimize the risk of exposure to latex, use cannot be detected when coaxial breathing latex-free breathing bags and breathing hoses. hoses are used.

To prevent insufficient gas exchange or CO2 rebreathing, pay strict attention to the measured gas concentration.

Connecting the breathing circuit and the filters

WARNING Risk due to particles and dust In order to protect the patient from particles and dust, a filter must be used between the inspiratory limb of the breathing system and the patient. Use a patient-side filter or a filter at the inspiratory port.

WARNING Risk of infection If no microbial filter is used, the breathing system may become contaminated with disease-causing germs. In this case, hygienically reprocess the breathing system after each patient.

58 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Perseus can be used with Infinity ID breathing hoses or conventional breathing hoses. If no leakage test has yet been carried out after switching on the system, hose compliance and hose resistance will automatically be adopted when Infinity ID breathing hoses are connected.

WARNING Risk of underpressure in the lungs If filters are blocked, the sample gas flow can immediately cause underpressure in the lungs. When ventilating pediatric patients and neonates, do not use HMEF or other filters at the Y-piece in connection with a hose adapter that have a patient-side connection for a sample line.

NOTE When applying tidal volumes in the range of the maximum or minimum values indicated for each patient category, use the smaller breathing bag and the smaller breathing circuit.

NOTE In order to make use of the functionality of the Infinity ID breathing circuit, dispense with the inspiratory and expiratory microbial filters and fit the Y-piece with a filter instead. In cases which preclude use of a microbial filter at the Y-piece, the ID functionality of the Infinity ID breathing hoses cannot be used.

Instructions for use Perseus A500 SW 1.1n 59 Assembly and preparation

1 Select suitable accessories for the respective patient category.

Adults Pediatric patients Neonates Tidal volume >700 mL 201 to 700 mL 50 to 200 mL <50 mL Breathing bag 3L 2L 1L 0.5L Breathing circuit Adults Pediatric Neonates (or pediatric) Filter Filter or HMEF Use filters with low resistance and compliance.

2 Assemble the breathing circuit and connect it with the Y-piece and the inspiratory and expiratory ports on the breathing system, see ''Table with recommended hose configurations'' on page 61. 10393 When attaching or removing the breathing hoses, always hold them at the connection sleeve and not at the spiral ribbing.

60 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Table with recommended hose configurations

Adults Pediatric patients Neonates Filter or HMEF with connection for sample line between Y-piece and Filter at inspiratory port and expi- patient: ratory port, connection for sample line as close to patient as possible: LQVS

LQVS

H[S

Or H[S

Filter at inspiratory port and expiratory port, connection for sample Lateral connections for the sam- line at Y-piece: ple line support CO2 measurement and help to flush the dead- space between Y-piece and hose LQVS adapter. If it is not possible to use an expiratory filter (e.g., due to an intrin- sic PEEP due to air trapping), hygienically reprocess the device after use with this patient, see H[S page 184.

Instructions for use Perseus A500 SW 1.1n 61 Assembly and preparation

Breathing bag Attaching the breathing bag to the flexible arm (optional) Attaching the breathing bag

A 10345 1 Attach the breathing bag (A) to the elbow.

10346 Observing resistance and compliance 1 Connect the breathing bag to the breathing bag hose using the connection nozzle. Attach the breathing bag hose to the bag elbow. CAUTION Risk due to accessory components in breathing WARNING circuit Risk of high airway pressure or lack of fresh When using additional components or hose gas configurations which deviate from the standard If the breathing bag is pinched, excessive breathing circuit, the inspiratory and expiratory airway pressures or a lack of fresh gas may resistance values may be increased beyond occur. standard requirements. Attach and align the breathing bag so that it When such configurations are used, the user is not pinched and may inflate freely. must pay special attention to the measured values. 2 Hang the breathing bag over the hose holder so that it hangs vertically downwards. CAUTION To allow the bag to unfold freely, place it to the Risk due to misleading data right over the hose holder so that it is not obstructed by cables or breathing hoses. Exchanging breathing hoses, filters, vaporizers, or soda lime can change the determined leakage values or compliance values of the anesthesia machine and thus affect therapy. – Perform a leakage test after replacing breathing hoses, particularly flex hoses, vaporizers or soda lime. – Perform a leakage test after changing the length of flex hoses.

62 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Connecting a non-rebreathing system CAUTION (optional) Risk due to changed hose lengths Changed hose lengths can change resistance This connection is only possible with the option and compliance. Especially for neonates, this External fresh-gas outlet. may cause increased or decreased ventilation volumes. WARNING For neonates in particular, do not use flex hoses. Insufficient gas supply to the patient Non-rebreathing systems are only suitable Accessories or accessory components such as and intended for manual ventilation or filters may change dead-space, compliance, or spontaneous breathing and may only be resistance. connected to the external fresh-gas outlet. When using a non-rebreathing system, Calculating the resistance of the breathing ensure an adequate gas monitoring. system and connected accessories To keep the patients' work of breathing as low as WARNING possible, according to ISO 8835-2 a total Risk of excessively high airway pressure inspiratory and expiratory resistance of 6.0 hPa (cmH2O) at 60 L/min may not be exceeded. Without a pressure-relief valve or breathing bag, airway pressure may become too high. The following formula is used to calculate the resistance (R): Only connect breathing systems with breathing bags or pressure-relief valves RInspiration = which comply with ISO 8835-2. RBreathing system_insp + RInsp hose + RBreathing bag hose + RInsp filter (port) + RInsp filter (Y-piece) Strictly observe instructions for use of the non- RExpiration = rebreathing system and transfer hose. RBreathing system_exp + RExp hose + RExp filter (port) + To prevent contaminating the ambient air, connect RExp (Y-piece) the gas outlet of the breathing system with the inlet Only include resistance data in calculations that on the AGS. Use transfer hose with overpressure was taken under the same flow conditions (for valve complying with ISO 8835-3. adults 60 L/min, for pediatric patients 30 L/min, and for neonates 5 L/min). WARNING If necessary, take into consideration additional Risk of faulty gas delivery parts such as water traps or additional hoses. O2 and CO2 and any anesthetic gases must Resistance of the breathing system, see page 226. also be monitored for non-rebreathing systems. The sample line must be connected to the elbow and the water trap on Perseus.

Instructions for use Perseus A500 SW 1.1n 63 Assembly and preparation

B C

A 10389 10388 3 Remove the sealing plugs from the inlet nozzle 1 Tightly screw the sample line to the elbow of (C) of the AGS. the non-rebreathing system and water trap (A). For elbows without port for sample line: 4 Use the transfer hose to connect the non- rebreathing system with the inlet nozzle at the  Place the T-piece with T-piece filter directly AGS (C). at the elbow and tightly screw the sample line to the T-piece filter. The part numbers CAUTION for the T-piece and the T-piece filter are listed in the list of accessories. Risk due to open AGS inlet nozzle Or After using a non-rebreathing system, reinsert  If necessary, use the gas sampling port of the sealing plug into the inlet nozzle to prevent the filter on the Y-piece. contamination of the ambient air with anesthetic Ensure the correct course of the sample gases. line. Do not use adapters. 2 Connect the fresh-gas hose of the non- rebreathing system to the external fresh-gas outlet (B).

64 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

Connecting or exchanging consumables

Dismounting and emptying WARNING

Risk of high inspiratory CO2 values Use of soda lime over prolonged periods can B increase the inspiratory CO2 values. Check the color of the soda lime regularly and exchange as needed, especially if the A inspiratory CO2 value increases unexpectedly.

Single-use CO2 absorber 10348 1 Turn the CO2 absorber (A) clockwise and  Connect or replace the CLIC absorber or the remove it from below. Infinity ID CLIC absorber. 2 Remove and dispose of the soda lime dust Strictly observe the instructions for use of the filter (B). single-use CO2 absorber. 3 Empty used soda lime and dispose of according to the instructions for use. WARNING Risk of insufficient ventilation

If the CO2 absorber is not correctly locked into place, system leakage may occur. C After mounting and replacing, make sure the CO2 absorber is firmly locked into place.

Reusable CO2 absorber

As an alternative to single-use CO2 absorbers, the 10349 reusable CO2 absorber may also be used. 4 If it is necessary to clean the absorber insert (C), remove the absorber insert from the CAUTION absorber container. Leave the inner and outer Risk of chemical burns sealing rings on the absorber insert. Soda lime is caustic and is a strong irritant for eyes, skin, and airway. Handle this absorption material carefully and do not spill it.

Instructions for use Perseus A500 SW 1.1n 65 Assembly and preparation

Filling and mounting 3 Insert a new soda lime dust filter (E). Only use soda lime dust filters indicated in the list of accessories. Only use undamaged filters, as exterior damage to the filter decreases protection! 4 Insert CO2 absorber (F) on the breathing system from below and then rotate it counter- D clockwise as far as it will go. Strictly observe the instructions for use for Drägersorb 800 Plus or Drägersorb Free soda lime. 10350 1 After any cleaning, push the absorber insert Water trap back into the absorber container (D) completely.  Empty or replace the water trap according to its instructions for use. 2 Fill CO2 absorber with fresh soda lime to the upper mark. WARNING Recommendation: Only use Drägersorb 800 Plus or Drägersorb Free. Risk due to full water trap When the water trap is full, the gas WARNING measurement can fail and insufficient Risk of hypoventilation ventilation may occur. Reuse of the soda lime dust filter can Check the water level in the water trap increase filter resistance and impair the regularly and empty it as necessary. ventilation function of Perseus. CAUTION Replace the soda lime dust filter each time the soda lime is replaced. Risk due to gas measurement failure Contaminants, damage, or overfilling of the water trap can influence gas measurement. E Observe the instructions for use of the water trap.

CAUTION F Risk of misleading data Silicon can get into the measuring cuvette and disrupt measurement. Do not spray the O-rings of the water trap holder 10351 with silicon spray.

66 Instructions for use Perseus A500 SW 1.1n Assembly and preparation

WARNING Risk of fire Silicon or aerosol residues in the water trap can cause fires. Do not spray the O-rings of the water trap holder with silicon spray.

Connecting the sample line

WARNING Risk due to leakage from improperly connected or damaged sample line Connect the sample line correctly, otherwise faulty gas measurements may result. 10344  Screw on the sample line at the Y-piece, HME filter, or hose adapter and at the water trap. Ensure the correct course of the sample line. Do not use adapters.

NOTE Only use an original sample line, as other lines can change the technical data of the device.

Instructions for use Perseus A500 SW 1.1n 67 Getting started

Getting started

Switching on Perseus ...... 69

Checking for the readiness of operation .... 70

Operation in case of emergency...... 71 Electronically controlled gas mixer ...... 71 Mechanically controlled gas mixer ...... 71

68 Instructions for use Perseus A500 SW 1.1n Getting started

Switching on Perseus

Prerequisite: The device has been reprocessed (see page 184) and is assembled and ready for operation (see page 41). To prevent condensation and resulting failures of electrical components, do not switch on the device after abrupt temperature changes for 1 to 2 hours (e.g., after storage in unheated rooms).

WARNING Risk of explosion and fire A Do not set the device into operation if oxygen leakage is suspected in the medical device or 10340 its vicinity. 1 Connect the mains plug if necessary and set Stop all oxygen supplies and contact service the device switch to position I. personnel. 2 Switch Perseus on: Press the button (A).

WARNING If the battery charge is sufficient, Perseus will also start without the mains plug being connected as Risk due to unbraked device long as the device switch is not set to position 0. An unbraked device may accidentally move When the starting procedure is completed, the during operation. Standby page is displayed. Prevent this by actuating the central brake or After the device was stored or when it is switched the castor brakes and check their function. on for the first time, set the time if necessary, see page 139. WARNING Risk of device malfunction Some safety systems are only checked during start-up. Restart Perseus at least once per month to maintain proper functionality.

Instructions for use Perseus A500 SW 1.1n 69 Getting started

Checking for the readiness of operation

On the Standby page, the readiness for operation resulting from the system test is indicated by color (A).

A B C D

Standby E 10410

Color Meaning Green System is fully operational. Yellow System is operational with limitations. There are functional restrictions. Take further measures to ensure patient safety (e.g., external monitoring). Red System is not operational. Call service personnel.

If the system is not fully operational, the most important irregularities (C) are displayed and a specific test (D) is recommended as a remedy. To view details regarding the status of the system, touch the Details... button (B) or the Test... button (E), see page 103. Dräger recommends performing the system test every 24 hours.

70 Instructions for use Perseus A500 SW 1.1n Getting started

Operation in case of emergency

Electronically controlled gas mixer Mechanically controlled gas mixer

1 Adjust the APL valve. 1 Adjust the APL valve.

D C A B C B A 10376 20341

2 Set O2 switch (C) to Add. O2 position. 2 Open the flow control valve (A) and set the 3 Open the flow control valve (B) and set the desired O2 flow. If required, press the O2+ key desired O2 flow. If required, press the O2+ key (C) to fill the breathing bag quickly. (D) to fill the breathing bag quickly. 3 Monitor the set flow on the total flow tube (B). 4 Monitor the set flow on the O2 flowmeter (A). 4 Set the anesthetic gas concentration at the 5 Set the anesthetic gas concentration at the vaporizer. vaporizer. 5 Manually ventilate the patient. 6 Manually ventilate the patient. 6 Switch on the device. 7 Switch on the device. 7 As soon as the Standby page is displayed, 8 As soon as the Standby page is displayed, start the therapy, see page 74. start the therapy, see page 74. 9 Set O2 switch (A) to Aux. O2 to stop the increased fresh-gas flow. 10 Close the flow control valve (B).

Instructions for use Perseus A500 SW 1.1n 71 Operation

Operation

Safety information...... 73 Displaying additional data...... 90 Viewing current measured values ...... 90 Starting the therapy ...... 74 Logbook...... 91 Loading the patient data...... 74 Trends ...... 91 Checking the patient data...... 75 Displaying installed options...... 92 Setting and starting the therapy ...... 75 Displaying an overview of the accessories and Useful tips...... 76 consumptions ...... 92 Adjusting the therapy ...... 77 Setting the sound volume ...... 92 Adjusting the APL valve ...... 77 Setting alarm tone volume and breathing Using the O2 flush ...... 78 sound volume...... 92 Using the vaporizer ...... 78 Changing the ventilation mode...... 79 Adjusting the alarms...... 93 Synchronizing the breaths...... 79 Setting the alarm limits...... 93 Ventilating children and neonates ...... 79 Activating or deactivating CO2 alarms...... 94 Automatic xMAC monitoring...... 94 Special forms of therapy ...... 80 Deactivation of automatic xMAC monitoring ... 95 Using non-rebreathing systems...... 80 Activating or deactivating the CBM mode ...... 80 Changing the patient data ...... 96 Pausing the therapy / using Pause...... 81 Exporting data ...... 96 Using fields with special functions ...... 82 General information...... 96 xMAC display (MAC multiples)...... 82 Exporting screen contents...... 96 Prediction of anesthetic gas concentration Exporting trends and data ...... 96 (optional) ...... 83 Other settings...... 97 Prediction of the inspiratory O2 concentration (optional) ...... 84 Switching the breathing system heating on or Econometer (optional) ...... 85 off ...... 97 Stopwatch...... 85 Creating additional logbook entries...... 98 Countdown ...... 85 Resetting user-specific settings...... 98 Volumeter ...... 86 Ending the therapy...... 99 Low-flow wizard (optional)...... 86 Switching to the Standby mode...... 99 Organizing the screen display ...... 87 Using the O2 insufflation...... 99 Available views...... 87 Patient change...... 100 Changing the current view...... 87 Using loops...... 88 Cleaning and disinfecting the workstation ...... 100 Displaying mini-trends ...... 88 Checking or replacing consumables ...... 100 Displaying alarm limits and units of Checking the system...... 101 measurement ...... 88 Flushing the breathing system ...... 101 Adjusting the current view ...... 89 Adjusting the sweep speed and the scales ..... 89 Changing the color mode and the screen brightness...... 90

72 Instructions for use Perseus A500 SW 1.1n Operation

Safety information

WARNING WARNING Risk of strangulation Risk of injury Negligent placement of hoses, cables, and Looking directly into the LEDs of the similar device components can endanger the workplace illumination and of the illumination patient. unit on the vaporizer plug-in connection can cause damage to the retina. Use particular caution when establishing connections to the patient. Do not look directly into the LEDs. Make sure that the patient is not dazzled by the LEDs. CAUTION WARNING Risk due to falsified gas measurement values and failure of the gas measurement Danger due to inaccurate gas measurement values Aerosols can damage the patient gas measurement module and the membrane of the Due to the technical characteristics of gas water trap. Propellants can falsify the gas measurement, the gas measurement values measurement values. might be inaccurate at high respiratory rates. Do not use medication nebulizers. Observe the technical data.

WARNING WARNING Risk of faulty gas delivery Risk of infection

O2 and CO2 and anesthetic gases must be Disease-causing germs can be transmitted monitored every time breathing systems are between patients via the circuit plug. If the used. circuit plug is fitted to a used Y-piece or filter, and then later to a reprocessed component Ensure adequate gas monitoring. (e.g., during a leakage test), the new component can become contaminated. WARNING Only fit reprocessed components to the Risk of misinterpretation circuit plug. Misdiagnosis or misinterpretation of the measured values or other parameters can endanger the patient. Do not make therapeutic decisions based solely on individual measured values and monitoring parameters. Therapeutic decisions must be made solely by the user.

Instructions for use Perseus A500 SW 1.1n 73 Operation

Starting the therapy

Prerequisite: The device is in Standby mode. Loading the patient data

Start Load a preset A B Check patient data C A B Select mode Standby C 20411 10461 There are 2 possibilities for starting the therapy: There are two possibilities for loading patient data: Quick start with Manual / Spontaneous mode A Defining a new case B Continuing a case  To perform a quick start with the displayed fresh-gas settings (A), touch the Quick start In the area Check patient data (C), patient data MAN/SPON button (B). (e.g., age, weight) are filled in depending on the selection. Or Normal start with customized settings Defining a new case 1 Touch the Start... button (C). Select to start the therapy for a new patient: 2 Adjust the patient data and ventilation settings.  Depending on patient category, touch New adult, New ped, or New neo (A). The ventilation parameters and alarm limits are set to the configured start settings, see page 126. The set value for Ti is automatically set based on RR in such a way that the resulting I:E ratio is 1:1 for neonates and 1:2 for all other patient categories.

Continuing a case Select to start the therapy with the settings of the last case:  Touch the Continue case button (B).

74 Instructions for use Perseus A500 SW 1.1n Operation

The ventilation parameters and alarm limits are Setting and starting the therapy adopted from the preceding case.

After switching on the device, no previous case is Select mode available. Perseus then starts with the configured A start settings. D C B E 10463 Checking the patient data 1 Select a ventilation mode (A) as needed. The following ventilation modes are available: WARNING – MAN / SPON Risk due to incorrect settings – Pressure Support (optional) – Pressure Control Different standard alarm limits or therapy settings might be configured for medical – Press. Ctrl. APRV (optional) devices within the same area. The user must – Vol. Ctrl. AutoFlow observe the following: – Volume Control – Make sure that the values set for new patients are appropriate. The following operation modes are also available: – Make sure that the alarm system is neither – Ext. FG outlet (optional) rendered useless by setting extreme – Pause values for the alarm limits nor deactivated Additional information about the ventilation modes, by switching off the alarms. see page 238. – Check the start settings for alarms and alarm settings each time the ventilation 2 Set the fresh-gas delivery. mode is changed. Electronically controlled gas mixer:  Select the carrier gas (B). CAUTION Set the O2 concentration (D) and fresh-gas Risk due to incorrect setting for patient age flow (C). Incorrectly setting the patient age can lead to inappropriate xMAC values and therefore to an inappropriate anesthetic gas delivery. Always set patient age correctly.

Check patient data A 10462  Adjust patient data (A) if necessary. When these data are adjusted, appropriate therapy settings are suggested e.g., for tidal volume, respiratory rate, alarm limits. For more information, see page 248.

Instructions for use Perseus A500 SW 1.1n 75 Operation

Mechanically controlled gas mixer: 3 Set the ventilation settings (C). 4 To start therapy, press the rotary knob. A signal WARNING tone is emitted when therapy starts. Risk of incorrect gas delivery

Use the flow values on the status display as Useful tips the primary source of information. Always compare these values against the values on the total flow tube. Quick start with MAN / SPON mode Only use the total flow tube as the primary source of information in the following Electronically con- Mechanically con- circumstances: trolled gas mixer trolled gas mixer – The status display has failed.  In Standby mode,  Open the flow con- – The values on the status display do not touch Quick start trol valves for fresh match the values on the total flow tube. MAN/SPON. gas.

 Use the flow control valves to adjust the fresh-gas flows. Opening the start dialog in Standby mode Use the total flow tube to check the total  Touch the screen in the monitoring area. flow set, see page 28. Or Perseus is equipped with a minimum O2 delivery, which ensures that a minimum quantity of oxygen  Squeeze the breathing bag. is delivered when N2O is used as the carrier gas, see page 247. To prevent the soda lime from Starting when time is limited drying out at an increased rate, the electronically controlled gas mixer reduces the fresh-gas flow When time is limited it is possible to bypass the FG flow automatically. This reduction takes place adjustment of the patient data and the ventilation depending on the set tidal volume VT and the set settings. Start the therapy as follows: respiratory rate RR. 1 Touch the screen. 2 Check the displayed start values. CAUTION 3 To start therapy, press the rotary knob. Risk of patient injury 4 Adjust the patient data and ventilation settings Unsuitable soda lime can result in disintegration as soon as possible. products from the anesthesia gases. Use suitable soda lime such as Drägersorb Free.

CAUTION Risk of patient injury The use of minimum-flow or low-flow settings can lead to accumulation of metabolic by-products in the breathing system. If minimum-flow or low-flow settings are used, flush the breathing system regularly.

76 Instructions for use Perseus A500 SW 1.1n Operation

Adjusting the therapy

Adjusting the APL valve The patient can be manually ventilated with the breathing bag. The pressure is limited by the set The pressure limitation set with the APL valve only value. takes effect during manual ventilation or spontaneous breathing.

WARNING Risk of excessively high airway pressures If the ventilator fails, the device switches into the MAN / SPON ventilation mode. The APL valve should also be set to a pressure limitation value suitable for the

patient when using automatic ventilation 10380 modes. If the ventilator fails, ventilate the In the Manual / Spontaneous mode, lifting the patient manually. valve head relieves pressure from the breathing system.  The selection between manual ventilation (Man) and spontaneous breathing (Spont) is made at the APL pressure limitation valve, see Spontaneous breathing page 16.

Manual ventilation

10 20 30 10379  Turn the APL valve counterclockwise as far as it will go. 10378 The points are vertically aligned and the valve  Set the APL valve to the desired maximum head is raised. airway pressure. The pressure limitation is canceled and the valve is open for free spontaneous breathing.

Instructions for use Perseus A500 SW 1.1n 77 Operation

Using the O2 flush When the Vapor View option is installed, the control dial and sight glass on the The O2 flush is used for flushing and quickly filling Dräger-Vapor 3000 and D-Vapor 3000 are the breathing system and breathing bag with O2 illuminated: while bypassing the vaporizer. Control dial position Illumination  Press the O2+ button. O2 flows for as long as the button is held down. T to <0 Off Use of the O2 flush can increase airway pressure 0 Medium very quickly and abruptly change the gas >0 Bright concentration. WARNING Using the vaporizer Risk due to faulty Vapor View option If the Vapor View option is faulty, the following information could be displayed WARNING incorrectly on the screen: Anesthetic gas Risk due to incorrect anesthetic agent type, filling level, control dial position, delivery prediction of anesthetic gas concentration – Do not rely solely on the display on the Filling the vaporizer with an incorrect screen, but always pay attention to the anesthetic agent results in an incorrect settings and values at the vaporizer as anesthetic gas concentration. well. Compare the color coding on the vaporizer – Do not make therapy decisions based used to that of the anesthetic agent indicated solely on a displayed prediction. on the screen. WARNING  Operate the vaporizer according to its instructions for use. Risk of increased anesthetic agent delivery Using the emergency O2 delivery (Add. O2) may cause an increased anesthetic gas concentration. Carefully monitor the gas mixture.

78 Instructions for use Perseus A500 SW 1.1n Operation

Changing the ventilation mode WARNING Risk of insufficient ventilation A In ventilation modes in which breaths are to be triggered only by the patient (e.g., B C Pressure Support), adverse settings or

10403 sensor failure can lead to insufficient 1 In the therapy bar, touch the tab (A) of the new ventilation. ventilation mode. Set the respiratory rate to a suitable value so When the ventilation mode is changed, the start that a minimum ventilation of the patient is settings are adopted from the parameters of the maintained. previous ventilation mode and the patient data, or they are sensibly derived. WARNING In addition, the alarm settings are adjusted to Risk of insufficient ventilation reasonable values, see page 120. The display of the spontaneous minute 2 Adjust the therapy as needed with the therapy volume MVspon shows the volume that controls (B) or buttons (C). results from the patient's own breathing and 3 Activate the ventilation mode by pressing the machine support. If machine support is rotary knob. A signal tone is emitted when the triggered by small tidal volumes of the mode is changed. patient, a large part of MVspon is achieved by machine support and not by the patient's own breathing. In this case, MVspon shows a high Synchronizing the breaths value although the actual spontaneous minute volume is very low. Switching on the synchronization activates the set Do not base therapy decisions solely on the pressure support, for example, see page 238. value displayed for MVspon.

D Ventilating children and neonates

A For tidal volumes below 200 mL:  Use suitable ventilation accessories, see B C chapter ''Selecting and connecting patient- specific accessories'' starting on page 58. 10464 1 Switch the synchronization on or off with the For tidal volumes below 20 mL or when using buttons Sync. on (A) or Sync. off (B). unblocked tubes: 2 As needed, the expanded therapy bar can be  Use pressure-controlled ventilation, see table displayed using the buttons More (C) or (D); ''Ventilation modes and effective parameters'' here, additional parameters (Trigger sens., starting on page 239. ∆Psupp, etc.) can be adapted to the patient.

Instructions for use Perseus A500 SW 1.1n 79 Operation

Special forms of therapy

Using non-rebreathing systems The CBM mode can be used in all active ventilation modes. Only available with the option External fresh-gas When ventilation modes are changed, the CBM outlet. mode remains active. Changing to the Standby Prerequisite: The non-rebreathing system is mode deactivates the CBM mode. connected, see page 63. Deactivating the CBM mode activates the apnea alarms. CAUTION

Risk of gas contamination Activating The extracted sample gas is also returned to the 1 Open the Alarms dialog window. internal breathing system during operation with an external fresh-gas outlet if the Perseus 2 Touch the Settings tab (A). sample gas measurement is used. Alarms Use breathing circuit to close the breathing A system or set the APL valve to spontaneous breathing. Flush the breathing system each time patients or anesthetic gas are changed!

Conducting the fresh gas to the external outlet B C 1 Start Ext. FG outlet operating mode. 2 Adjust the fresh-gas delivery. Adjust the vaporizer if necessary.

Strictly observe the instructions for use of the non- 10465 rebreathing system. 3 For Cardiac bypass mode (CBM), touch the On button (B). Activating or deactivating the CBM mode Deactivating  For Cardiac bypass mode (CBM), touch the The CBM mode allows patient monitoring without Off button (C). unnecessary alarms during extracorporeal Or oxygenation of the patient by a heart-lung  In the main menu bar, touch the Exit CBM machine. button. Properties of CBM mode: – All gas concentrations are measured independent of the respiratory phase. –The CO2 apnea and pressure apnea alarms are inactive.

80 Instructions for use Perseus A500 SW 1.1n Operation

Pausing the therapy / using Pause

In Pause mode, ventilation is stopped. Gas delivery is also stopped with electronically controlled gas mixers. The gas concentration measurement remains active and waiting for respiratory phases. This mode is equipped with an adjustable therapy control (Timer) dependent on the patient category. When the set time has elapsed, this emits an alarm as reminder that ventilation should be resumed. Setting the therapy control Timer to 0:00 deactivates the alarm. The total elapsed time is also displayed. Use this operating mode to reduce contamination of the ambient air with anesthetic gases due to an open Y-piece, e.g., for short pauses in therapy such as disconnection or intubation.

Activating 1 Start Pause operating mode. 2 Adjust the therapy control Timer if necessary.

Returning to the previous mode 1 Touch the Resume ventilation button. 2 Confirm the ventilation mode. For more information, see page 132.

Instructions for use Perseus A500 SW 1.1n 81 Operation

Using fields with special functions

xMAC display (MAC multiples)

1 MAC corresponds to: in et (in 100 % O2) O2 Isoflurane 1.15 Vol% Desflurane 6.0 Vol% N2O Sevoflurane 2.1 Vol% Iso N2O 105 Vol% The age-corrected MAC values are calculated using an equation developed by W.W. Mapleson (British Journal of Anaesthesia 1996, pp. 179- 185). The equation applies to patients older than 1 year. xMAC Age years 12203 MACage corrected = MAC* x 10(–0.00269 x (age –40)) The MAC value is a simple navigation aid for anesthetic agent delivery. Perseus displays the inspiratory and expiratory measured values for O2, N2O, and anesthetic gases and the xMAC in the monitoring area. The xMAC is the MAC multiple calculated from the current expiratory measured values and the age- dependent MAC values. If no respiratory phase is detected, expiratory values and xMAC cannot be displayed. The integrated MAC algorithm is based on the MAC values shown in the following table. These values are guiding values only. The binding values are specified on the package information leaflet of the anesthetic agent. The MAC values depend on the age of the patient. The values specified in the table apply to a patient age of 40 years.

1 MAC corresponds to: (in 100 % O2) Halothane 0.77 Vol% Enflurane 1.7 Vol% * 40 years

82 Instructions for use Perseus A500 SW 1.1n Operation

For gas mixtures, the respective multiples for N2O and anesthetic agents are added according to the following equation. exp. Conc. Anesth.1 exp. Conc. Anesth.2 exp. conc. N2O xMAC = + + MACage corrected Anesth1 MACage corrected Anesth2 MACage corrected N2O

Example exp. Iso. = 0.65 Vol%; exp. N2O = 69 %; age = 32 years

MACage corrected from Iso.: MAC* = 1.21 Vol% MACage corrected from N2O: MAC* = 110 Vol% xMAC = 0.54 + 0.63 = 1.2 The influence of other drugs (opiates or intravenous hypnotics) is not considered in the xMAC calculation.

* 32 years

Prediction of anesthetic gas concentration (optional)

Perseus offers the possibility to display predictive These restrictions in the patient data result from concentrations of anesthetic agent in the breathing the scientific models all calculations are based on. gas. This requires the Vapor View option and a Dräger-Vapor 3000 or D-Vapor 3000. WARNING The anesthetic gas prediction is appropriate for Risk of incorrect therapy settings patients with the following data only: The anesthetic gas prediction is based on Height: 150 to 200 cm mathematical models and does not provide (59.1 to 78.7 in) individual patient values. Weight: 40 to 140 kg Do not make therapy decisions based solely (88 to 308 lbs) on the displayed anesthetic gas prediction. Age: 18 to 90 years

The anesthetic gas prediction is not suitable for the following patients: – Alcohol dependents – Greatly overweight patients (BMI >35) – Patients with ASA ≥IV – Patients with severe circulatory disorders or a cardiopulmonary bypass

Instructions for use Perseus A500 SW 1.1n 83 Operation

Using the anesthetic gas prediction Prediction of the inspiratory O2 Prerequisite: The Agent prediction parameter concentration (optional) field must be configured in the monitoring area and respiratory phases must be detected. Perseus offers the possibility to display the predicted inspiratory O2 concentration in the breathing gas. This requires the O2 prediction Iso prediction option. The FiO2 prediction parameter field must be configured in the monitoring area.

C D FiO2 prediction D

A B C

A B 10452 The following is displayed: A Section for the trend 10453 The following is displayed: B Section for the prediction A Section for the trend of inspiratory and C Current O2 fresh-gas concentration expiratory anesthetic gas concentration D Prediction curve ("what if..." function)

B Section for the prediction The inspiratory O2 concentration is displayed as a C Current vaporizer setting line. D Prediction curve ("what if..." function) The previously measured concentration is displayed in the left-hand section (A) and the The anesthetic gas concentration of the currently predicted concentration in the right-hand section delivered anesthetic agent (or of the measured (B). The predicted concentration is dependent on primary anesthetic agent if delivery is switched off) the set O2 flow and the measured patient values. is displayed as a color diagram. The corresponding expiratory concentration is shown Electronically controlled gas mixer only: by the color coding for the anesthetic agent. A dotted line (D) is displayed during the setting procedure for the O2 flow (the so-called "what if..." The previously measured concentrations are function). When the value is altered with the displayed in the left-hand section (A) and the therapy control, the line moves and shows a predicted concentrations in the right-hand section preview of the predicted concentration. (B). The predicted concentrations are dependent on the vaporizer setting, the set fresh-gas flow, WARNING and on various measurements. Risk due to incorrect O2 prediction Electronically controlled gas mixer only: 2 dotted lines (D) are displayed during the setting Therapy decisions should not be made solely procedure for the fresh-gas flow (the so-called on the basis of a displayed O2 prediction. "what if..." function). When the value is altered with the therapy control, the lines move and show a preview of the predicted concentration.

84 Instructions for use Perseus A500 SW 1.1n Operation

Econometer (optional) Stopwatch

During operation, Perseus monitors the breathing bag for sufficient filling. Stopwatch A

Surplus 10451

Using the stopwatch Efficient 1 Touch the Start button (A) to start. 2 Touch the Stop button (A). 3 To reset the stopwatch to zero, touch the Reset button (A). Deficit Countdown

Econometer Countdown 10512 The bar graph indicates the qualitative fresh-gas supply.

Range Color Meaning AB Surplus Yellow Indication of a possibility to save fresh gas and, 20070 therefore, volatile anes- thetics Setting the countdown Efficient Green – No action necessary 1 Touch the Set key (B) or the parameter field. – Breathing bag suffi- 2 Set the countdown time. ciently filled – Sufficient reserve Using the countdown capacity available The countdown always starts with the last time set. Deficit Red – Insufficient fresh-gas 1 Touch the Start button (A) to start. supply 2 Touch the Stop button (A). – Fill the breathing bag immediately 3 To reset the countdown to zero, touch the Reset button (A). An inadequately filled breathing bag can trigger the Fresh gas low or leakage or Emergency air inlet activated alarms, for example.

Instructions for use Perseus A500 SW 1.1n 85 Operation

Volumeter Low-flow wizard (optional)

The volumeter can be used to observe and assess The Low-flow wizard displays bar graphs for the the ventilation during spontaneous breathing, required fresh-gas flow and the total flow. Both bar manual ventilation, or mechanical ventilation. graphs are to the same scale. The required fresh- gas flow is calculated on the basis of balancing the gas volumes. Volumeter B Required FG flow F VT A C

Volume

Total flow E D Efficient 20152 10450 An evaluation of the total flow is displayed below The bar graph tracks the inspiratory and expiratory the bar graph: tidal volume. At the end of the inspiration, the delivered tidal Evaluation Color Meaning volume is displayed as a bar (A). Too high Yellow The fresh-gas flow is At the end of expiration, the difference between possibly too high. If the inspiratory and expiratory tidal volume (F) is fresh-gas flow can be displayed. reduced, both fresh gas and anesthetic agent will The expiratory tidal volume is displayed next to the be saved. bar graph (C). Efficient Green No action is necessary. Too low Red The fresh-gas flow is too Using the volumeter (minute volume low. measurement)  Check the fresh-gas 1 Touch the Start button (B) to start. flow. The bar graph displays the individual measured breaths in segments (E). The  Check the position of summed volumes (D) are displayed next to the the breathing bag. bar graph. Refill bag Red The fresh-gas flow is too 2 Touch the Stop button (B) to stop. low. 3 To reset the volumeter and time display to zero,  Refill the breathing touch the Reset button (B). bag immediately, e.g., with O2 flush. The volumeter stops automatically after 60 seconds. The measured values are displayed An insufficient fresh-gas flow can trigger the Fresh for 4 minutes and then deleted. gas low or leakage or Emergency air inlet activated alarms, for example.

86 Instructions for use Perseus A500 SW 1.1n Operation

Organizing the screen display

Available views Changing the current view

Perseus offers two view settings for the monitoring Two buttons are available for changing the current area: view: – Standard view – Views... button

123 – View button

A Changing with the Views... button

Views B A

C B

10474 B The three waveforms (A), (B), and (C) are displayed along with their associated parameter fields. – Expert view 10475 D E F G 1 Touch the Views... button. The Views dialog

10473 window will be opened. In addition to the standard view, the four additional 2 Touch the button for the desired view: parameter fields (D), (E), (F), and (G) are A Opens the standard view displayed. B Opens the expert view The views can be renamed, see page 127.

Instructions for use Perseus A500 SW 1.1n 87 Operation

Changing with the View button Displaying or deleting reference loops

123  Touch the View button.  To save a reference loop, touch the Save ref.

123 The screen displays the second view . button (C).

123  Touch the View button. Or

123 The screen displays the third view .  To delete the reference loop, touch the Delete 123 ref. button (D).  Touch the View button.

123 The screen displays the first view . Displaying mini-trends

Using loops In an expert view, the appropriate mini-trend (B) for the displayed waveforms (A) can be displayed. The following loops can be displayed in the expert view: – Volume / airway pressure – Flow / volume B A

A 10477 1 Open the Views dialog window. C 2 Touch the Mini-trends button. B D Larger and more detailed graphic and numeric 10476 trend displays, see page 91. 1 Open the Views dialog window. 2 Touch the Loops button. Displaying alarm limits and units of The following is displayed: measurement A Current loop and the last 5 loops B Parameters: The alarm limits and the units can also be displayed in the waveform and parameter fields. – Cdyn – R – TC The value displayed here for Cdyn is updated more frequently and thus may differ from the value 10478 displayed in the Trends/Data dialog window. 1 Open the Views dialog window. 2 Touch the Limits & units button.

88 Instructions for use Perseus A500 SW 1.1n Operation

Adjusting the current view Adjusting the sweep speed and the scales The monitoring area can be changed during operation: 1 Open the System setup dialog window. 1 Touch a waveform or parameter field. The 2 Touch the Screen layout > Waveforms tab Quick setup window opens. (A).

Quick setup System setup A B C A C C B C C A 10402

2 For Content (A), select the desired content 10485 from the list. For a list of the possible screen content, see Setting the sweep speed page 146.  Touch the button (B). Set the sweep speed. 3 For Scale (B), select the desired scale. Adjusting the waveform scale CAUTION  To change the waveform scale, touch one of Risk of insufficient monitoring the buttons (C) and select the value. National and medical regulations require certain parameters to be displayed. Always consider the relevant regulations when configuring the screen layout.

Restoring the current view The changes in the current view can be reset to the saved standard. 1 Open the Views dialog window. 2 Touch the Restore current view button.

Instructions for use Perseus A500 SW 1.1n 89 Operation

Changing the color mode and the 2 Touch the Screen layout > General settings screen brightness tab (A).

1 Open the System setup dialog window. System setup A B A

C 10479 3 To change the color mode, touch one of the buttons for Display mode (B). 4 Set the screen brightness for Display mode, screen brightness (C).

Displaying additional data

Viewing current measured values 2 Touch the Values tab (A). The vertical tabs (B) display different combinations During operation, measured values for ventilation, of parameters. gases, and the device are available in tabular overviews. Trends/Data 1 Open the Trends/Data dialog window. A

B 10497

90 Instructions for use Perseus A500 SW 1.1n Operation

Logbook The following illustration shows the graphical trend: The logbook can save up to a maximum of 20000 entries. Logbook data are displayed in table form. Trends/Data 1 Open the Trends/Data dialog window. AB 2 Touch the Logbook tab (A). C G F Trends/Data A B C D E 10481 E The vertical tabs (C) display different combinations of parameters. D

10480 Zooming Use the rotary knob or the arrow buttons to scroll In both trend displays, the displayed time period the cursor (B) up (C) or down (D) in the logbook. can be enlarged or diminished. To scroll quickly, touch the gray area (E). Changing the time period: The entries in the logbook cannot be deleted and  Touch one of the following buttons (D) are retained even after the device has been according to choice: switched off and on again or following a power supply failure. When the storage limit is reached, – Zoom + the oldest entries are overwritten. – Zoom - Creating entries and associated settings, see Displaying the standard time period and the page 98. current point in time:  Touch the Reset zoom button (E).

Trends Moving the cursor Trends are displayed in the form of a graphic or a The exact measured values for a specific point in table. time can be displayed numerically in area (F). To do so, move the cursor. 1 Open the Trends/Data dialog window.  Use the rotary knob to move the cursor (G). 2 Touch the Graphical trends (A) or Tabular trends tab (B). Or  Touch the corresponding area on the screen.

Instructions for use Perseus A500 SW 1.1n 91 Operation

Displaying installed options Vertical tab Overview

Listing of the additionally installed software Supply Status display of the con- options. nected gas and power supplies. 1 Open the System setup dialog window. Consumption Gas consumption 2 Touch the Applications tab. During operation: – for the current case Displaying an overview of the In Standby: accessories and consumptions – for the last case 1 Open the System setup dialog window. – since the last reset 2 Touch the System status tab. In Standby > System setup > System status > Vertical tab Overview Consumption, the gas consumption levels can be reset to zero, see page 144. Accessories Accessories (when Dräger Infinity ID accessories are used) and information as to when the accessory must be replaced.

Setting the sound volume

Setting alarm tone volume and 1 Open the System setup dialog window. breathing sound volume 2 Touch the System > Sound volume tab (A).

WARNING Risk of operation error The acoustic alarm signals might not be heard if functions such as "Breathing sound" are used or when operating in a noisy environment. Always set the alarm tone to be sufficiently loud.

92 Instructions for use Perseus A500 SW 1.1n Operation

Alarm tone volume System setup A  Set the desired value for Alarm tone volume (B). B C A Breathing sound volume (optional)  Set the desired value for Breathing sound volume (C). 10482

Adjusting the alarms

Setting the alarm limits Setting via the Alarms dialog window In the Alarms dialog window, the alarm limits can For a current case, the alarm limits can be set in be set either manually or automatically. two ways: 1 Open the Alarms dialog window. – Setting via the Quick setup window 2 Touch the Limits tab (C). – Setting via the Alarms dialog window

Alarms Setting via the Quick setup window C 1 Touch the respective waveform or parameter field. The Quick setup window opens.

Quick setup D A E B F FFF G 10483

Manual setting 1 Set the upper alarm limits (D). 10402 2 Set the lower alarm limits (E). 2 Set the upper alarm limit (A). 3 Set the lower alarm limit (B).

Instructions for use Perseus A500 SW 1.1n 93 Operation

Automatic setting 2 Touch the Settings tab (A).

Alarm limits can be adapted to current measured Alarms or setting values. A 1 Touch the Autoset limits button in the main menu bar. The Autoset all button (G) is selected. 2 Confirm to adapt the alarm limits for all B parameters. Or To adjust the alarm limits for an individual parameter, touch one of the buttons Autoset (F) and confirm.

As an alternative, open the dialog window via 10465 Alarms > Limits (B). 3 For CO2 alarms, touch the button (B): Only use the automatic setting when measured or On: Alarms are activated. setting values are stable to prevent artifacts of the Off: Alarms are deactivated adjustment algorithm. Or The lower alarm limit for the xMAC level is also  Use the CO2 alarms off button in the main adjusted during automatic setting, see page 94. menu bar to activate or deactivate the alarms. Configuration and algorithm, see page 131. This button is only visible in the following ventilation modes: – Manual / Spontaneous Activating or deactivating CO2 alarms – External fresh-gas outlet – Pause The CO2 monitoring (affects the alarms for inCO2, etCO2, and CO2 apnea) can be activated or The alarm system is immediately activated when deactivated. the CO2 monitoring is activated. Deactivation is indicated in the header bar and in the parameter field by the symbol. Automatic xMAC monitoring 1 Open the Alarms dialog window. Perseus provides monitoring of the xMAC level. The monitoring is automatically activated as soon as the following conditions are met: – Anesthetic gas is administered. – The inspiratory xMAC value is greater than the expiratory xMAC value. – The expiratory xMAC value reaches approximately 0.3.

94 Instructions for use Perseus A500 SW 1.1n Operation

[0$& LQVS[0$& H[S[0$&

ORZHUDODUPOLPLW

ABCDEF GH 13941 If the xMAC value rises, the lower alarm limit for the xMAC level will be automatically adjusted to the anesthetic gas concentration after activation (A). The lower alarm limit (B) can thus reach a maximum value of 1.0. The lower alarm limit can be recalculated by touching the Autoset button (C). In special anesthesia situations, the xMAC low alarm can be adjusted in this way and consequently also exceed the value of 1.0 if necessary. If the expiratory xMAC value falls below the alarm limit (D or G), Perseus generates the xMAC low alarm with low priority. If the alarm is not acknowledged with the ALARM RESET button, the priority is raised to medium priority after 60 seconds.

Deactivation of automatic xMAC monitoring

If the xMAC low alarm (D or G) is acknowledged with the ALARM RESET button (E or H), the monitoring is deactivated. This prevents renewed alarms as a result of the anesthetic gas concentration continuing to fall at the end of anesthesia (H). If the anesthesia is continued (E), the monitoring will be automatically reactivated as soon as the inspiratory xMAC value rises above the expiratory xMAC value (F). In CBM mode the lower alarm limit is adjusted both upwards and downwards so that no alarm is issued during this time. Similarly, the value is not limited to 1.0 during this time.

Instructions for use Perseus A500 SW 1.1n 95 Operation

Changing the patient data

Patient data can be changed during operation. Changes influence, e.g., therapy suggestions, as 1 Open the Patient dialog window. is recognizable by the position of the arrow at the therapy controls. Patient The current therapy settings remain unaffected. When patient category is changed, age, weight, and height are adapted as needed so they remain within the described limits, see page 135. 10484 2 Make the desired changes.

Exporting data

General information Exporting trends and data

Prerequisite: The USB flash drive is connected to In Standby mode, the following data can be saved the USB interface. to a USB flash drive: During a saving process, the button is displayed as – System test result activated (dark green). – Alarm history The data are stored in the "Draeger\ExportData" – Trends directory. 1 Open the Trends/Data dialog window.

Exporting screen contents

The screen contents can be exported to a USB flash drive as a screenshot.  Touch the Export screenshot button in the main menu bar. The screen contents are saved to the storage medium as a ".bmp" file.

96 Instructions for use Perseus A500 SW 1.1n Operation

2 Touch the Export tab (A). The data will be saved as a ".txt" file.

Trends/Data A

B B B 10496 3 Touch the desired button (B).

Other settings

Switching the breathing system heating 2 Touch the Therapy tab (A). on or off System setup The breathing system heating should only be A switched off in special situations (e.g., for intentional reduction of the body temperature of B the patient). 1 Open the System setup dialog window. 10513 3 To switch the heating on or off, touch the corresponding button (B).

Instructions for use Perseus A500 SW 1.1n 97 Operation

When switching to Standby mode, the heating is 2 Touch the System > Logbook tab (A). reset to the value configured in System setup. System setup CAUTION A Risk due to defective or switched-off breathing A system heating Increased condensation or accumulation of water in the breathing system and the hoses may B occur. Increase fresh-gas flow as required. Remove condensation from hoses, water traps, and breathing system regularly. Have service

personnel repair the defective breathing system 10486 heating. 3 Touch the corresponding button (B).

CAUTION Risk of inaccurate measured values Resetting user-specific settings

The accuracy of the flow measurement may be Changes made in the System setup dialog compromised if the breathing system heating is window during operation can be reset to the start switched off. settings. When the breathing system heating is switched 1 Open the System setup dialog window. off, do not make therapy decisions solely on the 2 Open the corresponding dialog window basis of the displayed values for flow and volume. 3 Touch the System defaults button and confirm.

Creating additional logbook entries

The following events can create logbook entries with measured values for the parameters etCO2, MV, Pmean, PIP, Pplat, PEEP, FiO2, exp. concentration of the primary anesthetic gases, and etN2O: – Adjustable time intervals – Alarms with high or medium priorities 1 Open the System setup dialog window.

98 Instructions for use Perseus A500 SW 1.1n Operation

Ending the therapy

Switching to the Standby mode WARNING 1 In the main menu bar, touch the Standby... Risk of a device fire button. If there is a fire on the patient side, the device Or may ignite. Press the key below the screen. If there is a fire, disconnect the device from 2 In the Standby dialog window, confirm the all oxygen-carrying supplies. automatically selected Standby button.

With mechanically controlled gas mixer: WARNING 3 Close the flow control valves. Risk due to overpressure When the patient is connected to the outlet Using the O2 insufflation for O2 insufflation without a relief valve, increased pressure may be applied to the patient. WARNING Only connect the patient in a way that allows Risk of fire excess gas to escape (e.g., through a relief In combination with oxygen or nitrous oxide, valve). ignition sources such as electrosurgery and laser surgery can cause fires. – Prevent leakages, e.g., at endotracheal tubes, laryngeal mask airways, face masks, Y-piece, breathing system including hoses, filters, and breathing bag, at the external fresh-gas outlet, and at the O2 outlet for insufflation. – Use only intact and leak-free hoses at the outlet for O2 insufflation. – Before beginning laser surgery or electrosurgery, flush with sufficient air (<25 % O2), and flush beneath the surgical drapes as well. – Close the flow control valve of the O2 flowmeter.

Instructions for use Perseus A500 SW 1.1n 99 Operation

Electronically controlled gas mixer: – With electronically controlled gas mixer: The O2 switch is horizontal in the Aux. O2 position (C).

Beginning O2 insufflation

 Open the flow control valve (B) of the O2 C B flowmeter. A Ending O2 insufflation 10359  Close the flow control valve (B) of the O2 Mechanically controlled gas mixer: flowmeter.

B A 20364 Prerequisite: – The appropriate accessory is connected to the outlet for O2 insufflation (A).

Patient change

Cleaning and disinfecting the Sample gas measurement workstation 1 Check the water trap of the sample gas measurement; empty or replace as needed.  Clean and disinfect the workstation according 2 When no filter is used, replace the sample line to hospital hygiene regulations, see and dispose of used sample lines. ''Reprocessing list'' on page 191.

Vaporizer filling level Checking or replacing consumables  Check the vaporizer filling level at the sight glass. If necessary, fill the vaporizer. Prerequisite: The device is in Standby mode

100 Instructions for use Perseus A500 SW 1.1n Operation

CO2 absorber WARNING  Check the coloration of the soda lime and replace if necessary, see page 65. Risk due to residual concentrations of anesthetic agent

Breathing hoses and filters Even after flushing the breathing system and breathing circuit, residual concentrations of 1 Replace the hoses and filters according to anesthetic agent might not be sufficiently hospital hygiene regulations. reduced. 2 Select and connect a suitable breathing circuit For patients suspected of having malignant and filters, see page 58. hyperthermia, do not rely solely on the flushing function.

Checking the system CAUTION

1 Perform the leakage test or the breathing Risk of impaired ventilation due to faulty drying system test, see page 104. function 2 Flush the breathing system if necessary. The breathing system and breathing hoses may still retain traces of moisture even after the flushing and drying functions are performed. Flushing the breathing system Check the breathing system and breathing hoses for condensate. With the Flush function, excess moisture and any residual anesthetic agent present in the breathing system and breathing circuit can be reduced by flushing with ambient air. 1 In the main menu bar, touch the Test... button. 2 Touch the Flush button. 3 Prepare the device according to the displayed checklist. 4 Touch the Start button. 5 After flushing is complete, touch the OK button to change to the Standby mode, or end the flushing prematurely with Cancel.

Instructions for use Perseus A500 SW 1.1n 101 System test

System test

Information on the availability of individual device functions ...... 103

Testing the system...... 103 Available test types ...... 104 Performing the tests ...... 105 Fully automatic tests...... 105 Leakage assistant ...... 106 Processing the checklist ...... 106 Checking the gas supply ...... 106 Checking the vaporizers...... 108 Checking the breathing system ...... 108 Miscellaneous...... 110

102 Instructions for use Perseus A500 SW 1.1n System test

Information on the availability of individual device functions

 In Standby mode, touch the Details... button Color Meaning or the Test... button. Green Successfully tested, fully available Yellow A non-critical fault has been detected. Results The device can be operated with restricted function. A Red A serious fault has been detected. Operation is not possible or is forbid- den.

WARNING System test - do not connect patient. Risk due to faulty sensors

10411 If the sensors for flow, O2, N2O, CO2, or In the Results list (A), the following information is anesthetic agent are not operational, the displayed in color: patient will not be adequately monitored. – Influence of the individual device functions on Before using the medical device, ensure a the availability of the entire device suitable substitute monitoring. – Latest detected leakage values

Testing the system

CAUTION Risk due to device malfunction and/or patient injury If the system test is canceled, it is possible that some malfunctions might not be detected. Thus, more attention is required during operation. Perform the system test every day. If the system test is canceled during execution, perform it again as soon as possible.

Instructions for use Perseus A500 SW 1.1n 103 System test

Available test types

Test Type and Perform the test Description duration System test Fully auto- – Daily Preparation: matic, – Check of components which about 8 min frequently cause operational restrictions: e.g., major system leakage, incorrectly set APL valves. Test: – Calibration of all valves and sensors – Test of all device functions – Includes the breathing system test – The test can be programmed, see page 112. Breathing syst. test Fully auto- – After exchange of – Calibration of flow sensors matic, breathing system – Includes the leakage test about 5 min – After exchange of flow sensors Leakage test Fully auto- – After filling the CO2 – Detection of leakage, system matic, absorber compliance, and system resis- about 2 min – After changing the hose tance configuration (e.g., changed hoses, changed lengths of flex hoses etc.) Leakage assistant Manual, as – If leakage suspected in – Continuous display of the test required breathing system and pressure and the leakage to (after occurrence of breathing circuit support the manual check. problems with leakage Changes are immediately visi- during automatic tests) – On suspicion of leakage at vaporizer ble. – Leakage test of a connected vaporizer

104 Instructions for use Perseus A500 SW 1.1n System test

Performing the tests

5 After the system test, wait for 2 acoustic WARNING signals. Risk of patient injury NOTE During the system test, the system is pressurized. If the acoustic signals are not emitted, contact service personnel. To prevent patient injury, do not perform the system test on the medical device if a patient is connected. Test interruption due to irregularities If an irregularity is determined during a fully automatic test, the test is stopped and information Fully automatic tests regarding cause and remedy is displayed.

Prerequisites: Test details – Flex hoses are extended to their maximum intended use length. –O2 supply is available. 1 Touch the button for the test. C

Checklist System test A B A 10510 B Remedying the cause: 1 Remedy the cause of the interruption. If there is a leak, the leakage assistant (C) can C be used to support troubleshooting. System test - do not connect patient. 2 Touch the Repeat button (A) and repeat the test of the component. 10414 Accepting the irregularity: 2 Prepare the device according to the screen display (A) and checklist (B), see page 106.  Touch the Accept button (B) and continue the test. 3 Start the test with the Start button (C). Accepted irregularities prevent the total result of Test progress and test results are indicated by the the system test from indicating "fully operational" progress display. and are protocoled in the logbook. 4 End the test with the OK button.

Instructions for use Perseus A500 SW 1.1n 105 System test

Leakage assistant 2 Follow the instructions on the screen display. After touching the Start or Leakage assistant Prerequisite when vaporizers are connected: button, a continuous test pressure is generated. – Vaporizer is vertically level and securely The resulting leakage values are continuously mounted on the plug-in adapter. displayed. – The filling device is closed. Manually changing the system (e.g., loosening or readjusting hose connections) may change the 1 Touch the button for the test (Leakage leakage value so the cause of the leak is easier to assistant). locate. The displayed leakage value may differ from the leakage value that was determined in the automatic leakage test or the breathing system test. The reasons for this are the different measuring methods and different pneumatic ranges. 3 Touch the Cancel button to end generation of test pressure. 4 End the test with OK. 10514

Processing the checklist

Checking the gas supply WARNING

Danger when using O2 concentrators WARNING The following effects may occur: Risk due to impermissible gas supply – Differences between the set values and the pressure actual values of fresh-gas flow and O2 Impermissible gas supply pressures may concentration in the fresh gas cause incorrect gas composition. – Inaccurate measured values for volume, anesthetic agent consumption, econometer Check the supply pressures of the central gas (optional), and low-flow wizard supply and of the gas cylinders before – Inaccuracy of the FiO2 prediction operation. – Inaccurate volume delivery in volume- controlled ventilation modes WARNING – Accumulation of argon in low-flow Risk due to impermissible gas supply operation and minimal-flow operation Using oxygen supplies with less than 100 % Do not use any O2 concentrators. O2 may cause incorrect gas composition.

When using O2, only use 100 % O2.

106 Instructions for use Perseus A500 SW 1.1n System test

Central gas supply Checking the O2 flush  Check that the displayed pressures are within 1 Occlude the Y-piece. To occlude the Y-piece, fit the permissible range, see ''Technical data''. it firmly to the circuit plug, see page 18.

Gas cylinders B 10374

A 2 On the gas mixer unit, press the O2+ key (B). The breathing bag fills and the inflow of gas is audible.

Checking the emergency O2 delivery (with electronically controlled gas mixer) Prerequisite: The Y-piece is occluded, see ''Checking the O2 flush''.

C D 10381

1 Slowly open the gas cylinder valves (A). 10375 Check that the displayed pressures are within 1 Set O2 switch (C) to Add. O2 position. the permissible range. 2 Open the flow control valve (D) of the O2 If there is an optional external O2 gas cylinder, flowmeter and set the desired O2 flow. read the pressure from its pressure gauge. The breathing bag fills and the inflow of gas is 2 Close the gas cylinder valves (A) again. audible. On devices that are equipped with Advanced 3 Close the flow control valve (D). Cylinder Support, the gas cylinder valves can remain open during operation. These devices are 4 Reset O2 switch (C) to Aux. O2 position. identified by an appropriate label near the gas inlets, see page 24.

Instructions for use Perseus A500 SW 1.1n 107 System test

Checking the flow control valves of the fresh- 2 Check the filling level at the sight glass (B), add gas delivery (with mechanically controlled gas anesthetic agent as needed. mixer) When using a Dräger Vapor 3000 or D-Vapor 3000 with the Vapor View option, a Prerequisite: The Y-piece is occluded, see yellow triangle on the screen indicates that the ''Checking the O2 flush''. filling level has fallen below the refill mark. Perform the following steps for each gas: 3 The control dial is set to position 0 and the button (C) is locked in. 4 The filling device is closed (D).

Checking the breathing system

E B 20369 1 Open the flow control valve (E) and set a C desired gas flow. The breathing bag fills and the inflow of gas is audible. 2 Close the flow control valve (E).

Checking the vaporizers

AA A CC

DD 10385 Checking the breathing system and the accessory BB components: 1 Breathing system is complete and locked. 2 Breathing system cover is in place. 10386 3 Hoses (A) and filters, e.g., at the Y-piece (B), For each vaporizer, check: are connected properly. 1 The locking lever (A) points left, indicating the vaporizer is locked.

108 Instructions for use Perseus A500 SW 1.1n System test

4 Flex hoses are extended to the foreseen use 7 Soda lime (G) has not changed color. Change length. the soda lime if it is discolored or when its maximum period of use has been reached, see NOTE page 65. Do not change the length of flex hoses after the When Infinity ID functionality is configured: test is done. – Absorbers of the type Infinity ID CLIC 5 Sample line (C) is connected. Absorber will automatically be detected, and the exchange date will automatically be set.

When Infinity ID functionality is not configured: – Absorbers will not be detected, e.g., G reusable CO2 absorbers  Update the exchange date manually: In the line Last soda lime change:, touch the Reset button when the soda lime is changed.

D WARNING Risk due to soda lime drying out The soda lime loses moisture. If the moisture E falls below the minimum moisture, the following adverse reactions occur independent of the type of soda lime and the F inhalational anesthetic used: Decreased CO2

10377 absorption, increased generation of heat in the CO2 absorber resulting in increased 6 Flow on the anesthetic gas receiving system is breathing gas temperature, formation of CO, set. absorption and/or degradation of the The red flow indicator (D) hovers in the "normal inhalational anesthetic. range" (E). – Do not use unnecessarily high fresh-gas To avoid contaminating the environment, flows. certain minute volumes should not be – With electronically controlled gas mixer: exceeded when the flow indicator is in the Only use the emergency O2 delivery if "restricted range" (F), see "Anesthetic gas necessary. receiving system", chapter ''Technical data''. – With mechanically controlled gas mixer: Do not leave the flow control valves open for an unnecessarily long period of time.

NOTE Only perform leakage tests with CLIC absorber locked into place because this affects the system compliance values.

Instructions for use Perseus A500 SW 1.1n 109 System test

Miscellaneous

1 Check the functioning of the endotracheal suction. 2 Check to ensure there is a manual resuscitator at the device. Check the correct functioning of the manual resuscitator. 3 Check the water level in the water trap. 4 Pay attention to the period of use of the water trap, replace if necessary.

When Infinity ID functionality is configured: – Water traps of type Infinity ID WaterLock 2 will automatically be detected and the exchange date will automatically be set.

When Infinity ID functionality is not configured: – Water trap will not be detected.  Update the exchange date manually: In the line Last water trap change:, touch the Reset button when a new water trap is installed.

110 Instructions for use Perseus A500 SW 1.1n Ending operation

Ending operation

Switching off the device ...... 112 End of operation ...... 112 Preparing the device for automatic switch-on, including system test (Auto On option)...... 112 Flushing and drying the breathing system (Flush & Dry function)...... 113 Storing the device...... 113 Disconnecting the mains power supply ...... 113

Instructions for use Perseus A500 SW 1.1n 111 Ending operation

Switching off the device

Dräger recommends shutting down Perseus End of operation during longer periods of non-use, such as overnight or on weekends. This can lower power 1 Make sure that all flow control valves are consumption and prolong the life span of the closed. medical device without negatively influencing 2 Press the button. device availability. 3 Observe the instructions on the screen. When shutting down the device, several functions are available to the user.

Function Preparing the device for automatic switch-on, including system test (Auto Auto On Prepares the device for auto- On option) (optional) matic start-up, including system test. Using the Auto On function, the device can be Flush & Dry Flushes and dries the breathing programmed so that it switches on on the next system. operation day, performs a system test, and is ready for use at a specific time. To do this, set the day and time when the device (QGRIRSHUDWLRQ should next be ready for use. Before shutting down, Auto On runs a preparatory test to check the components that frequently cause Prepare Auto On irregularities: e.g., large system leakages, incorrect setting of the APL valve. Shut down Auto On 1 Touch the Prepare Auto On button. Start 2 Prepare the device in accordance with the instructions on the screen. For details on the 3UHSDUDWRU\WHVW test steps, see page 106. 3 Set the desired day and time when the device should next be ready for operation.

Start Flush & Dry 4 Touch the Start button. 5 Take note of any messages that appear. Flush & Dry 6 Shut down the device when the preparatory test is complete. When the automatic start-up is activated, the 2II corresponding symbol appears in the status display, see page 27. 10676 For more information, see page 140.

112 Instructions for use Perseus A500 SW 1.1n Ending operation

Flushing and drying the breathing system (Flush & Dry function)

Dräger recommends always flushing the breathing system before switching off to prevent damage or failure due to residual anesthetic agent and residual humidity. During this process, first ambient air is used for flushing because this does not dry out the soda lime. Then a small amount of Air or O2 from the central gas supply or the gas cylinders is used to dissipate residual moisture. 1 Prepare the device in accordance with the instructions on the screen. 2 Touch the Start Flush & Dry button. 3 If necessary, cancel the flushing with Cancel to return to standby mode. After the flushing processes ends, Perseus switches off automatically.

Storing the device

To store Perseus 1 Set device switch to position 0. 2 Disconnect from mains power supply if necessary.

Disconnecting the mains power supply

 Pull out the mains plug.

Instructions for use Perseus A500 SW 1.1n 113 Alarms

Alarms

Display of alarms...... 115 Optical alarm signals ...... 115 Acoustic alarm signals...... 115 Alarm priorities ...... 116 Response to alarms ...... 116 Displaying information on alarms ...... 116 Suppressing the alarm tone ...... 117 Downgrading and acknowledging alarm messages ...... 118 Opening the alarm history ...... 118 Adjusting the alarm limits ...... 119 Adopting alarm settings when changing the ventilation mode...... 120 Activating the alarms related to volume ...... 121 Resetting the Apnea (no CO2) alarm ...... 121 Alarm delay and alarm escalation ...... 121

Activation of alarms after breath detection 124

Intelligent alarm behavior...... 124 Combined alarms ...... 124 Suppressed alarms ...... 124

114 Instructions for use Perseus A500 SW 1.1n Alarms

Display of alarms

Alarms are signaled optically and acoustically. Acoustic alarm signals

It always is the alarm with the highest priority that Optical alarm signals is acoustically signaled. The signal is emitted until either the cause of the alarm is remedied or the Audio paused key is pressed. On the screen Depending on the overall alarm situation, it is In the event of an alarm, the system displays the possible that the 10-tone sequence for the alarm relevant alarm message in the alarm message priority "Warning" is only emitted as a 5-tone field (A). The parameter field (B) for the alarm- sequence due to the coinciding occurrence of generating parameter flashes. alarms. A Regardless of the set alarm volume, the No O2 C delivery alarm is issued at maximum volume. B B B B B B 10490 Up to 8 alarms can be displayed simultaneously in the alarm message field in the header bar (A). If more alarms occur, the All alarms button (C) is displayed in the header bar. Touching this button opens the dialog window Alarms > Current alarms with information about all active alarms, see page 116.

On the Dräger Vapor 3000 When the Vapor View option is installed, alarms concerning the vaporizer are signaled by blinking illumination on the Dräger Vapor 3000 if their cause can be remedied by adjusting or refilling the vaporizer, e.g.: – Inspiratory xMAC high – Filling level of vaporizer low – Vaporizer open

Instructions for use Perseus A500 SW 1.1n 115 Alarms

Alarm priorities

Perseus assigns the appropriate priority to each alarm message. The background color of the alarm message field indicates the alarm priority of the active alarms. The parameter field of the parameter triggering the alarm flashes in the color matching the alarm priority.

Warning Red High-priority alarm Immediate action is necessary in order to avert message imminent danger. Caution Yellow Medium-priority Prompt action is necessary in order to avert a dan- alarm message ger. Note Cyan Low-priority alarm Attention is necessary, but a delayed response is message sufficient.

Response to alarms

Displaying information on alarms 3 Refer to the information text below Cause (C) and Remedy (D) to remedy the error. 1 Touch the alarm in the header bar. A list of all possible alarms can be found in chapter Or ''Troubleshooting'', see page 162. Open the Alarms dialog window and touch the Current alarms tab (A).

Alarms A B

C D 10488 2 In the list (B), touch the corresponding alarm or select it with the rotary knob.

116 Instructions for use Perseus A500 SW 1.1n Alarms

Suppressing the alarm tone

The alarm tone can be suppressed for a maximum of 2 minutes.

A 10362  Press the Audio paused key (A) below the screen, see page 17. In the header bar, the symbol and the remaining time for the suppressed alarm tone are displayed. After the alarm suppression has expired, the alarm tone immediately resumes if the cause of the alarm still exists. While the alarm tone is suppressed, only new alarms with a higher alarm priority or a higher internal priority rating are acoustically signaled, see page 162.

Switching on the suppressed alarm tone prematurely  Press the Audio paused key again.

Instructions for use Perseus A500 SW 1.1n 117 Alarms

Downgrading and acknowledging alarm Option 1 Option 2 messages Touch the ALARM In the Alarms > Cur- RESET button (A) in the rent alarms dialog win- Some alarms can be downgraded to low priority header bar and confirm. dow (B), touch the (note) or they can be cleared completely. The Reset all button (C) and relevant alarms can be recognized in the table confirm. ''Alarm – Cause – Remedy'' on page 162 by the following remedial messages: All the alarms displayed All alarms will be down- in the alarm message graded or reset. Remedial message Effect field will be downgraded Use "ALARM RESET" Alarm priority is or reset. to downgrade alarm changed to low (note). After an alarm is downgraded, the respective priority. priority rating is maintained, see table ''Alarm – Use "ALARM RESET" Alarm is reset. Cause – Remedy'' on page 162. to acknowledge alarm.

There are 2 options for downgrading or resetting Opening the alarm history the alarms: Option 1: The alarm history records all alarm messages for the current case in chronological sequence. A 1 Open the Alarms dialog window. 2 Touch the Alarm history tab (A).

Alarms 10495 A Or Option 2: B

Alarms B

C 10489 Use the rotary knob or the arrow buttons to scroll the cursor up (B) or down (C). The alarm history is deleted when Perseus is shut C down or a new case is started. 10488

118 Instructions for use Perseus A500 SW 1.1n Alarms

Adjusting the alarm limits

If an alarm is triggered because a lower limit or an upper limit is transgressed, it might be necessary to adjust the alarm limits. To do this, either adjust the alarm limits, see page 93, or change the alarm limit in the Quick setup window.

A 10491 1 Touch the parameter field (A). The Quick setup window opens and the alarm limit that was violated (B) or the xMAC OK button is already selected.

Quick setup

B 10492 2 Adjust the value (B) and confirm. Perseus can be configured so that the Quick setup window opens automatically in the event of an alarm, see page 132.

Instructions for use Perseus A500 SW 1.1n 119 Alarms

Adopting alarm settings when changing the ventilation mode

When the ventilation mode is changed, the alarm Some modes can be configured whether or not the settings are adjusted as well. settings are adopted. Depending on the mode, alarm settings can either However, the settings can be adjusted at any time be adopted or set to Off. during operation.

Alarm or alarm Mode limit Volume Control, Pause, MAN / SPON, Ext. FG out- CBM mode Vol. Ctrl. AutoFlow, Pressure Support let (optional) Pressure Control, (optional) with Pressure Control - ∆Psupp <5 hPa APRV (optional) Pressure Support (optional) with ∆Psupp≥5hPa FiO2 low Alarm settings are adopted inAgent high Apnea (no CO2) Alarm settings are adopted etCO2 high Off etCO2 low inCO2 high configurable, see page 133 FiO2 high Is restored or remains configurable, see inAgent low active page 133 xMAC low Not activated Paw high Alarm settings are Alarm settings are Paw low adopted adopted Not mea- MV high configurable, see sured configurable, see MV low page 133 page 133 Apnea (no flow)1) Apnea (no pres- On Off sure)

1) This alarm is only activated when the MV low alarm limit is also activated.

120 Instructions for use Perseus A500 SW 1.1n Alarms

Activating the alarms related to volume In volume-controlled ventilation modes, the alarm limit for the inspiratory tidal volume is automatically The upper alarm limits for MV and VTi are disabled set to 130 % of the set tidal volume. by default and can only be set during operation. The set alarm limits remain active until the next patient. Resetting the Apnea (no CO2) alarm The MV low alarm is delayed in certain cases and When changing to a ventilation mode with higher is indicated as follows: respiratory support, the Apnea (no CO2) alarm is – No sooner than 90 seconds after a case starts, reset. If the apnea situation persists, an alarm – No sooner than 60 seconds after changing to a appears after the time specified in the table ''Alarm mode with greater respiratory support, see delay and alarm escalation''. page 239. – No sooner than 60 seconds after an Apnea (no flow) or Apnea (no pressure) alarm.

Alarm delay and alarm escalation

To prevent unnecessary alarms, some alarms are not displayed immediately after a limit violation, but after a delay. In addition, certain circumstances can cause the alarm priority to change.

Priority Alarm Note Caution Warning (Low) (Medium) (High) inCO2 high etCO2 high After two successive etCO2 low --- respiratory phases --- FiO2 high and 15 seconds Inspiratory N2O high inAgent low After two successive respiratory phases and 15 seconds

FiO2 low ------or after 30 seconds if no respiratory phases are detected

Instructions for use Perseus A500 SW 1.1n 121 Alarms

Priority Alarm Note Caution Warning (Low) (Medium) (High) 30 s before the After two successive medium-priority alarm respiratory phases (This technical alarm is for and 45 seconds inAgent high information purposes only or >150 seconds later and reduces unnecessary alarms. It can be caused by after 60 seconds if no inhomogeneous gas mix- respiratory phases are tures, for example.) detected longer than 30 seconds: insp. MAC ≥3 insp. MAC ≥3 and Inspiratory xMAC high --- for more than exp. MAC ≥2.5 180 seconds or insp. MAC ≥5 xMAC low 0 to 60 seconds >60 s --- at the latest after 20 seconds (for RR ≥6) or 15 seconds later at the latest after Apnea (no CO2) (for RR ≥6) 35 seconds Apnea (no flow) --- (for RR <6) or Apnea (no pressure) Apnea or 30 seconds later (for RR <6) at the latest after 65 seconds for the Pause, Manual / Spontaneous and Ext. FG outlet modes At the latest after 20 seconds Apnea Ventilation (15 seconds for RRapn ≥4) --- (configurable, see page 132) No CO2 detected >60 s ------Inspiratory tidal volume high After 3 successive ------Tidal volume not achieved breaths > 15 seconds above Airway press. continuously high ------the manually or automatically set limit

122 Instructions for use Perseus A500 SW 1.1n Alarms

Priority Alarm Note Caution Warning (Low) (Medium) (High) Pmean < –2 Airway pressure negative ------or Paw < –10 Airway pressure >(PEEP +5 hPa) PEEP/CPAP high ------during more than 10 successive breaths >15 seconds (for RR ≥6) or Airway pressure not achieved ------>30 s (for RR <6 or Pres- sure Support) If a minute volume of >50 % of the sug- Cardiac bypass mode still gested value is mea------active? sured after CBM mode has been activated for >60 seconds after 30 s or in case of the additional alarm "Apnea (no flow)" or "Apnea Breathing bag almost Fresh gas low or leakage Breathing bag empty (no pressure)" empty or in case of the additional alarm "Emer- gency air inlet activated"

Instructions for use Perseus A500 SW 1.1n 123 Alarms

Activation of alarms after breath detection

All O2 alarms, CO2 alarms, N2O alarms, and Once 2 breaths have been detected, the message anesthetic gas alarms are only active once 2 disappears and only then the O2 alarms, CO2 breaths have already been detected. alarms, N2O alarms, and the anesthetic gas alarms are active. If no breaths have yet been detected when leaving the modes Standby or Pause, the message Waiting for respiratory phases is displayed in the CO2 waveform.

Intelligent alarm behavior

Combined alarms

If multiple alarms occurring at the same time are caused by the same problem, they are combined into one alarm.

Problem Alarms occurring at the same Combined alarm time Apnea (no flow) Several causes of apnea are Apnea (no pressure) Apnea present. Apnea (no CO2) Faults in multiple components. Example: This causes failure of a system Insp. press. sensor failure Ventilator failure function. Exp. press. sensor failure

Suppressed alarms

Some low-priority alarms indicate a fault in a measurement function. If this measurement function monitors physiological parameters, alarms based on these parameters will not be generated. Example:

Fault Displayed alarm Non-generated alarm CO2 measurement is faulty Sample line occluded Apnea (no CO2)

124 Instructions for use Perseus A500 SW 1.1n Configuration

Configuration

Device settings ...... 126 Factory settings ...... 126 Start settings...... 126 User-specific settings ...... 126 Defining start settings...... 126 Adjusting the settings ...... 126 System setup > Screen layout...... 126 System setup > Alarms ...... 128 System setup > Therapy ...... 135 System setup > System...... 139 Resetting the start settings...... 144 Resetting the consumption...... 144 Transferring device configurations ...... 144 Importing the configuration...... 145 Exporting the configuration...... 145 Activating applications ...... 145 Loading the license key from a USB flash drive ...... 145 Manual entry of the license key...... 146 Activating the licensed application...... 146 Overview of the configurable screen contents...... 146 Waveforms and associated parameter fields .. 146 Miscellaneous parameter fields...... 147

Instructions for use Perseus A500 SW 1.1n 125 Configuration

Device settings

Factory settings User-specific settings

Dräger delivers Perseus with factory settings that User-specific settings can be adjusted by the user are used when starting the device for the first time. without a configuration password. The settings Service personnel can reset the device to the take effect immediately but are discarded at the factory settings. latest after a device restart.

Start settings

Start settings take effect after every restart of the device or when starting a new case (touching the button New adult, New ped, or New neo). The start settings can be adjusted and saved by service personnel after the configuration password is entered. If required, Perseus can be delivered with start settings that may differ from the factory settings.

Defining start settings

Entry of the configuration password is required to Adjusting the settings access the settings in the System setup dialog window as soon as a vertical tab is selected. The following tables show all the setting Information on the configuration password, see possibilities in the System setup dialog window. page 265. The respective factory settings are entered or marked in bold format.

System setup > Screen layout

Vertical tab "General settings"

Headline/ Setting range Description Parameter Display mode Day light; Day dark; Night Setting the color mode, see page 39

126 Instructions for use Perseus A500 SW 1.1n Configuration

Headline/ Setting range Description Parameter Screen brightness 10 to 100 Set screen brightness. 80

Vertical tab "Views"

Headline/ Setting range Description Parameter Rename views 1 Standard; 2 Expert; 3 Expert Specify names for screen layouts. Touch the button with the respective screen layout, enter the new name on the screen keyboard and confirm with the button or with the rotary knob. Default view 1Standard; 2 Expert; 3 Expert Specify the standard view. Save as system Current view Save current screen layout. defaults (only available during operation) All views Save all screen layouts.

Vertical tab"Waveforms"

Headline/ Setting range Description Parameter Sweep speed 6.25; 12.5; 25 6.25; 12.5; 25 6.25; 12.5; 25 Specify sweep speed. [mm/s] VT scale Auto; Auto; Auto; Specify volumeter scale. 0 to 50; 0 to 50; 0 to 50; [mL] 0 to 150; 0 to 150; 0 to 150; 0 to 500; 0 to 500; 0 to 500; 0 to 1000; 0 to 1000; 0 to 1000; 0 to 2000 0 to 2000 0 to 2000 Flow scale Auto Auto Auto Specify flow waveform scale. -10 to 10; -10 to 10; -10 to 10; [L/min] -30 to 30; -30 to 30; -30 to 30; -60 to 60; -60 to 60; -60 to 60; -120 to 120 -120 to 120 -120 to 120 O2 scale Auto; Specify O2 waveform scale. 0 to 100; 15 to 35; 25 to 45; 35 to 55; [%] 45 to 65; 55 to 75; 65 to 85; 75 to 95; 85 to 105

Instructions for use Perseus A500 SW 1.1n 127 Configuration

Headline/ Setting range Description Parameter

CO2 scale [%]; [kPa]: Auto; 0 to 6; 0 to 12 Specify CO2 waveform scale. [mmHg]: Auto; 0 to 50; 0 to 100 Paw scale Auto; -5 to 20; -7.5 to 30; -10 to 40; -20 to 80 Specify Paw waveform scale. [mbar]; [hPa]; [cmH2O] Agent prediction Full range; 0 to 2 xMAC; 0 to 1 xMAC Specify scale for anesthetic gas scale prediction. Flow-volume loop ISO standard; Dräger Specify coordinate axes for flow/volume loop display.

Vertical tab "Colors"

Headline/ Setting range Description Parameter

CO2; Standard color; color palette with 7 additional Specify parameter colors. Paw; colors Flow, volume O2; Standard color; ISO color Agent

System setup > Alarms

Vertical tab "Alarm limits"

Headline/ Setting range Description Parameter Alarm limits for ventilation and gases for each patient category FiO2 [%] 19 to 100; 19 to 100; 19 to 100; Inspiratory oxygen fraction Off Off Off 90 FiO2 [%] 18 to 99 18 to 99 18 to 99 20 20 20

128 Instructions for use Perseus A500 SW 1.1n Configuration

Headline/ Setting range Description Parameter Alarm limits for ventilation and gases for each patient category etCO2 Expiratory CO2 concentration [%]; [kPa] 0.1 to 9.8; 0.1 to 9.8; 0.1 to 9.8; Off Off Off 7.0 7.0 7.0 [mmHg] 1 to 75; 1 to 75; 1 to 75; Off Off Off 53 53 53 etCO2 [%]; [kPa] Off; Off; Off; 0.0 to 9.7; 0.0 to 9.7; 0.0 to 9.7; [mmHg] Off; Off; Off; 0 to 74 0 to 74 0 to 74 inCO2 Inspiratory CO2 concentration [%]; [kPa] 0.1 to 1.4; 0.1 to 1.4; 0.1 to 1.4; Off Off Off 1.0 1.0 1.0 [mmHg] 1 to 10; 1 to 10; 1 to 10; Off Off Off 8 8 8 Paw high 5 to 110 5 to 110 5 to 110 Airway pressure [mbar]; [hPa]; 40 25 20 [cmH2O] Paw low Auto; Auto; Auto; 3 to 108 3 to 108 3 to 108 [mbar]; [hPa]; [cmH2O] inSev 0.10 to 9.95 0.10 to 9.95 0.10 to 9.95 Sevoflurane [%]; [kPa] 4.00 5.00 6.20 inSev Off; Off; Off; 0.00 to 9.85 0.00 to 9.85 0.00 to 9.85 [%]; [kPa] inDes 0.1 to 20.0 0.1 to 20.0 0.1 to 20.0 Desflurane [%]; [kPa] 12.0 17.2 18.8 inDes Off; Off; Off; 0.0 to 19.9 0.0 to 19.9 0.0 to 19.9 [%]; [kPa]

Instructions for use Perseus A500 SW 1.1n 129 Configuration

Headline/ Setting range Description Parameter Alarm limits for ventilation and gases for each patient category inEnf 0.10 to 8.50 0.10 to 8.50 0.10 to 8.50 Enflurane [%]; [kPa] 3.20 3.40 3.40 inEnf Off; Off; Off; 0.00 to 8.40 0.00 to 8.40 0.00 to 8.40 [%]; [kPa] inIso 0.10 to 9.95 0.10 to 9.95 0.10 to 9.95 Isoflurane [%]; [kPa] 2.3 3.20 3.70 inIso Off; Off; Off; 0.00 to 9.85 0.00 to 9.85 0.00 to 9.85 [%]; [kPa] inHal 0.10 to 8.50 0.10 to 8.50 0.10 to 8.50 Halothane [%]; [kPa] 1.50 1.80 2.40 inHal Off; Off; Off; 0.00 to 8.40 0.00 to 8.40 0.00 to 8.40 [%]; [kPa]

Vertical tab "Alarm tone volume"

Headline/ Setting range Description Parameter Alarm tone volume 10 to 100 Set the alarm tone volume. 40

130 Instructions for use Perseus A500 SW 1.1n Configuration

Vertical tab "Autoset limits"

Headline/ Setting range Description Parameter Offset for "Autoset limits" function Automatic adjustment of the parameters to current measured values, see page 94. By touching the Autoset button, the alarm limits are adjusted so that the upper alarm limit is above the current measured value by at least the percentage or value set here and the lower alarm value is correspondingly below it. Example: In the mode Pressure Control - CMV: measured MV: 5 L/min set offset: ±40 % new alarm limits: 7 and 3 L/min etCO2 ± [%] Off; 20 to 80 In modes with low or no respiratory support (MAN / SPON, Ext. 20 FG outlet (optional), CPAP / Pres- sure Support (optional) and Pause), 20 percentage points are added to the configured value. Paw Off; 5 to 20 The following parameters are taken into account when determin- +[mbar]; [hPa]; 5 ing the Paw value: PIP, Pplat, [cmH2O] Pinsp, PEEP, ∆Psupp, and Phigh. In the MAN / SPON and Pause modes, the new alarm limit is at least 25 hPa. MV ± [%] Off; 20 to 80 In modes with low or no respiratory support (MAN / SPON, CPAP 40 / Pressure Support (optional) and Pause), a further 20 percentage points are added to the configured value. VTi +[%] Off; 20 to 80 The setting for this parameter has no effect in volume-controlled ven- 40 tilation modes.

Instructions for use Perseus A500 SW 1.1n 131 Configuration

Vertical tab "Alarm config. 1"

Headline/ Setting range Description Parameter General alarm behavior Open "Quick setup" On; Off Automatically open Quick setup if alarm occurs window in the event of an alarm. "Second agent On; Off Alarm when an anesthetic gas detected" alarm mixture is detected. "xMAC low" alarm On; Off Activate the xMAC low alarm. "FiO2 too high for Off; 0:10 to 9:50 Set the time until FiO2 too high for neonates" alarm neonates alarm is sounded. 0:15 after [h:mm] Priority of "Apnea Medium; Low Specify the alarm priority when the ventilation" alarm set minimum respiratory rate is not reached in Pressure Support ventilation mode. Alarm behavior in "Pause" mode Only available for electronically controlled gas mixer. Priority of "Pause Medium; Low Specify the alarm priority when the time expired" alarm set duration in the Pause mode has expired. Default value for 0:00 to 60:00 0:00 to 60:00 0:00 to 60:00 Specify standard duration for "Timer" [mm:ss] Pause. 2:00 1:00 0:30

132 Instructions for use Perseus A500 SW 1.1n Configuration

Vertical tab "Alarm config. 2"

Headline/ Setting range Description Parameter Deactivate the alarm limit when activating MAN/SPON, CPAP, or The CPAP and CPAP / Pressure CPAP/PS with ∆Psupp < 5? Support modes are optional. FiO2 high Yes; No Yes; No Yes; No Specifies the alarm behavior when changing to a different ventilation etCO2 low Yes; No mode. etCO2 high Yes; No These settings apply only to a inCO2 high Yes; No change to a ventilation mode with MV low Yes; No lower or no respiratory support MV high Yes; No (see page 239). inAgent low Yes; No The alarm behavior at the start of the therapy is defined by the con- xMAC low Yes; No figuration in the vertical tab Alarm limits. Deactivate the alarm limit in cardiac bypass mode (CBM)? FiO2 high Yes; No Specify alarm behavior in CBM MV low Yes; No mode. MV high Yes; No inAgent low Yes; No

Instructions for use Perseus A500 SW 1.1n 133 Configuration

Vertical tab "Alarm config. 3"

Headline/ Setting range Description Parameter Alarm limits for "Cylinder almost empty" O2 [bar]; [kPax100]: Off; 15 to 31 Specify alarm limits for supply pressure of connected gas cylin- 20 ders. [psi]: Off; 218 to 450 290 Air [bar]; [kPax100]: Off; 15 to 31 20 [psi]: Off; 218 to 450 290 N2O [bar]; [kPax100]: Off; 15 to 31 20 [psi]: Off; 218 to 450 290

134 Instructions for use Perseus A500 SW 1.1n Configuration

System setup > Therapy

Vertical tab "Start sett. vent. 1"

Headline/ Setting range Description Parameter Default ventilation Buttons with available ventilation modes Specify the standard ventilation mode mode at start of therapy. MAN/ SPON VT and RR start settings Specify the tidal volume and respi- Based on Patient category; Ideal body weight ratory rate. Selected: Specify tidal volume and respira- [Patient category] tory rate based on patient cate- VT 20 to 2000 20 to 2000 20 to 2000 gory. [mL] 500 150 50 RR 3 to 100 3 to 100 3 to 100 [1/min] 12 20 30 Selected: [Ideal body weight] VT 20 to 2000 Specify the tidal volume and respi- [mL] ratory rate based on ideal body 100 kg (220 lbs): 700 weight. 75 kg (165 lbs): 520 Set the tidal volume and the respi- 15 kg (33 lbs): 110 ratory rate for the supporting points 5; 15; 75; 100 kg (11; 33; 5 kg (11 lbs): 35 165; 220 lbs). RR 3 to 100 [1/min] For calculated values for ideal 100 kg (220 lbs): 10 body weight values that lie 75 kg (165 lbs): 12 between these four supporting points, the start settings for tidal 15 kg (33 lbs): 26 volume and respiratory rate are 5 kg (11 lbs): 32 interpolated linearly. For ideal weight values lying outside these supporting points, calculation pro- ceeds with the values of the highest or lowest supporting point.

The start settings for VT and RR influence the MV low = VT x RR x (1 – offset); start values of the alarm limits for MV high, MV minimal: 0.3 L/min low, and VTi high: VTi high = VT x (1 + offset) MV high = VT x RR x (1 + offset); minimal: 2.0 L/min

Instructions for use Perseus A500 SW 1.1n 135 Configuration

The "Offset" value corresponds to the respective offset setting for automatic alarm adjustment. The "Offset" value can be set in System setup > Alarms > vertical tab Autoset limits. The following applies in volume-controlled modes:

VTi high = 130 % x VT

Vertical tab "Start sett. vent. 2"

Headline/ Setting range Description Parameter Start settings for ventilation Specify start settings for the venti- Pmax 7 to 80 7 to 80 7 to 80 lation. [mbar]; [hPa]; 40 30 25 [cmH2O] Pinsp 3 to 80 3 to 80 3 to 80 [mbar]; [hPa]; 15 15 15 [cmH2O] ∆Psupp Off; Off; Off; 1 to 80 1 to 80 1 to 80 [mbar]; [hPa]; [cmH2O] 10 10 10 Insp. term. 5 to 80 5 to 80 5 to 80 [%PIF] 25 25 25 PEEP Off; Off; Off; 2 to 35 2 to 35 2 to 35 [mbar]; [hPa]; [cmH2O] 3 3 3 Slope 0 to 2 0 to 2 0 to 2 [s] 0.2 0.2 0.2 RRapn Off; Off; Off; 3 to 25 3 to 25 3 to 25 [1/min] 6 10 15 %Tplat 20 to 60 20 to 60 20 to 60 [%] 20 20 20 Trigger sens. 0.3 to 15 0.3 to 15 0.3 to 15 [L/min] 4.0 2.0 1.0 Sync. On; Off On; Off On; Off

136 Instructions for use Perseus A500 SW 1.1n Configuration

Headline/ Setting range Description Parameter Start settings for APRV (optional) Phigh 3 to 80 3 to 80 3 to 80 [mbar]; [hPa]; 15 15 15 [cmH2O] Plow Off; Off; Off; 2 to 35 2 to 35 2 to 35 [mbar]; [hPa]; [cmH2O] 3 3 3 Tlow 0.2 to 10 0.2 to 10 0.2 to 10 [s] 4.0 2.0 1.0 Thigh 0.2 to 10 0.2 to 10 0.2 to 10 [s] 2.0 1.0 1.0 Slope 0 to 2 0 to 2 0 to 2 [s] 0.0 0.0 0.0

Vertical tab "Start sett. fresh gas" (only with electronically controlled gas mixer)

Headline/ Setting range Description Parameter Start settings for fresh gas Select start settings for the fresh- gas delivery. FG O2 21 to 100 21 to 100 21 to 100 Set the O2. [%] 100 100 100 FG flow 0.2 to 15 0.2 to 15 0.2 to 15 Set flow. [L/min] 2.0 2.0 2.0 Minimal O2 flow 50 to 300 50 to 300 50 to 300 Set the minimal O2 flow that is (carrier gas N2O) delivered when N2O is used as 200 200 200 carrier gas. [mL/min] Do not set this value too small; recommended is, e.g., 200 for adults, 100 for pediatric patients, and 50 for neonates. Carrier gas Air; N2O Air; N2O Air; N2O Set the carrier gas.

Instructions for use Perseus A500 SW 1.1n 137 Configuration

Vertical tab "Start sett. patient"

Headline/ Setting range Description Parameter Default selection for Continue case; Load patient data: The button that "Start" dialog New adult; New ped; New neo is set is preselected the first time the Start dialog window is opened or after changes to the system configuration. Weight Specify start settings for: [kg] 30 to 300 5 to 50 0.4 to 10 – Patient weight 80 25.0 5.0 – Patient height [lbs] 66 to 661 11 to 110 0.9 to 22 – Patient age 176 55 11 Height [cm] 120 to 300 50 to 300 20 to 80 185 100 55 [in] 48 to 118 20 to 118 8 to 31 73 39 22 Age [years, Neo: 12 to 130 0 to 16 0 to 24 months] 32 8 6

Vertical tab "General settings"

Headline/ Setting range Description Parameter Pinsp changes with On; Off Changing the PEEP automatically PEEP changes Pinsp, so the difference between PEEP and Pinsp always remains constant. Ti changes with RR On; Off Changing the respiratory rate (I:E ratio is locked) automatically changes Ti, so the ratio I:E remains constant. Breathing system On; Off Switch breathing system heating heating on or off. Auto wake-up On; Off The Start dialog window opens automatically when ventilation activity is detected (e.g., by squeezing the breathing bag several times).

138 Instructions for use Perseus A500 SW 1.1n Configuration

System setup > System

Vertical tab "Country"

Headline/ Setting range Description Parameter Language List of available languages Select language. English (United States) A flag symbol identifies the tabs that lead to the page with the language settings. Date and time day; month; year Set the date and time. The change is assigned on leaving the "Coun- hour; minute try" tab. Time source MEDIBUS 1; MEDIBUS 2; None Select source for time synchronization. Prerequisite: Connected device supports this function. Automatic switch to On; Off Activate or deactivate automatic daylight savings switching to daylight saving time. time OR operating time hour : minute to hour : minute Set the operating time of the operating room. 6:30 to 18:30 During operating time, the gas measurement is kept in a pre- heated and calibrated state so measured values are available after only a short waiting period. However, this decreases the life span of the patient gas measurement module. System name Rename Change system name to, e.g., enter the installation site. Device name (up to 16 alphanumeric charac- ters) Perseus

Instructions for use Perseus A500 SW 1.1n 139 Configuration

Vertical tab "Units"

Headline/ Setting range Description Parameter Weight kg; lbs Set units. Height cm; in Airway pressure mbar; hPa; cmH2O Supply pressure bar; kPa×100; psi CO2 %; kPa; mmHg Volatile agents %; kPa

Vertical tab "Auto On/ Flush & Dry"

Headline/ Setting range Description Parameter Auto On Set Auto On option. Perseus offers Day and time Monday to Sunday; hour : minute a calendar function which, when the device is shut down, suggests Monday to Friday: 6:30 the next time the system should be Saturday & Sunday: Off automatically ready for use in dependence on the weekday. To activate the automatic ready-for- use time for a desired day, select the corresponding day and set the time, see page 112. Pay attention to the correct setting of the gas supplies to be tested, see page 141. Flush & Dry Flush duration Off; 1 to 5 Set the flush cycle duration, e.g., between cases at patient change. 1 [min] Off: Flush function is deactivated. Flush & Dry dura- Off; 5 to 30 Set the duration of flushing and tion before shut- drying when the device is shut 10 down [min] down. Off: Drying function is deactivated.

140 Instructions for use Perseus A500 SW 1.1n Configuration

Vertical tab "Gas supply"

Headline/ Setting range Description Parameter Check during system test Central O2 supply On; Off Select which gas supplies are tested during the automatic sys- Central Air supply tem test. Central N2O supply If Auto On is configured, only O2 cylinder On; Off select the gas supplies whose Air cylinder actual availability is guaranteed after the automatic start-up. Set- N2O cylinder ting both O2 sources to Off - in order to make the system test suc- ceed - is not possible. N2O free system On; Off A device equipped with connections for nitrous oxide can also be configured for operation without nitrous oxide. Prerequisite: – Current carrier gas is Air – Nitrous oxide is not connected or available To apply the settings, restart Perseus if necessary. On: – Nitrous oxide cannot be delivered. – Measured nitrous oxide concentration is only displayed when not equal to zero. Off: – Nitrous oxide can be delivered. – Measured nitrous oxide concentration is continuously displayed.

Instructions for use Perseus A500 SW 1.1n 141 Configuration

Vertical tab "Logbook"

Headline/ Setting range Description Parameter A logbook entry with measured values is created Create additional logbook entries with measured values. Every 1 min; 2 min; 5 min; 10 min; 15 min Create entries regularly. For all high-priority On; Off Create entries for alarms. alarms For all medium-pri- On; Off ority alarms

Vertical tab "Sound volume"

Headline/ Setting range Description Parameter Alarm tone volume 10 to 100 Set the alarm tone volume. 40 Minimum alarm tone 10 to 100 Set the minimum volume with volume which an alarm tone will be sig- 10 naled. Breathing sound Off; 10 to 100 Set the breathing sound volume. volume (optional) 50

Vertical tab "Interfaces"

Headline/ Setting range Description Parameter LAN Configure the network. DHCP On; Off Make network settings. IP address XXX . XXX . XXX . XXX When using DHCP, consult with IT Subnet mask XXX . XXX . XXX . XXX personnel to make sure that Perseus is always assigned the Default gateway XXX . XXX . XXX . XXX same IP address from the DHCP server. Restart the device after each change to the network settings. The network settings are not affected by a reset to factory settings.

142 Instructions for use Perseus A500 SW 1.1n Configuration

Headline/ Setting range Description Parameter COM 1 Configure the COM interfaces. Protocol MEDIBUS.X; None A baud rate of 19200 or 38400 is Baud rate 1200; 2400; 4800; 9600; 19200; 38400 required for transmission of high- speed data, e.g., for real-time COM 2 waveforms. Protocol MEDIBUS.X; None Baud rate 1200; 2400; 4800; 9600; 19200; 38400 USB Activate or deactivate the USB USB interface On; Off interface.

Vertical tab "Infinity ID"

Headline/ Setting range Description Parameter Monitoring of Infinity ID accessories Breathing circuit; On; Off Activate or deactivate the Infinity ID functionality. Water trap; On: Flow sensors; – Generates a message when CO2 absorber the maximum period of use is exceeded – Generates a message when Infinity ID breathing hoses are incorrectly connected Off: – Messages are suppressed. Exchange interval [days] Breathing circuit Off; 1 to 9 Set the exchange intervals for Infinity ID accessories. 2 Water trap Off; 28 Flow sensors Off; 1 to 180 90 CO2 absorber Off; 1 to 28 7

Instructions for use Perseus A500 SW 1.1n 143 Configuration

Vertical tab "Service"

Headline/ Setting range Description Parameter A service password is required for the following functions: – To access the service menu – To change the configuration password – To reset all settings for the System setup dialog window to the factory settings

Resetting the start settings Resetting the consumption

Certain tabs in the System setup dialog window The gas consumption can be reset in Standby > have a button for resetting the respective start System setup > System status > Consumption. settings to the factory settings.  Touch the Reset data button and confirm.

Resetting the changes in a dialog window 1 Open the corresponding tab. 2 Touch the Factory defaults button and confirm.

Transferring device configurations

Configurations can be exported and imported with the aid of a USB flash drive. Configurations from one device version (electronically or mechanically controlled gas mixer) can be transferred to other Perseus devices of the same version in this way. Prerequisite: The USB flash drive is connected to the USB interface.  Open System setup > Im/Export config. > Im/Export config. (A).

144 Instructions for use Perseus A500 SW 1.1n Configuration

The following settings are neither imported nor System setup A exported: A – System name C – Date and time D B – IP address

Importing the configuration

1 Touch one of the configurations in the list (B).

10500 2 Touch the Import button (C) and confirm. The configurations saved on the USB flash drive 3 Restart Perseus. are displayed in a list (B). If not all of the configurations can be seen, delete all configurations from the USB flash drive that are Exporting the configuration not needed or move them to a subdirectory on the flash drive.  To export configurations, touch the Export button (D) and confirm.

Activating applications

The following applications are optional and System setup therefore require entry of a corresponding license A key and subsequent activation: – Auto On E A – Pressure Support C – APRV – FiO2 prediction – Econometer trend DB – Low-flow wizard 10501 A license key is linked with the serial number of the respective device and cannot be transferred. The license key can either be loaded from a USB flash Loading the license key from a USB drive or entered manually. flash drive  Open System setup > Applications > Applications (A). Prerequisite: A USB flash drive with valid licenses for this Perseus anesthesia machine is connected to the USB interface.  Touch the Load from USB button (B).

Instructions for use Perseus A500 SW 1.1n 145 Configuration

The license keys found on the storage medium are Activating the licensed application uploaded and displayed in the list (C). The licensed applications must be activated before they become available. Manual entry of the license key 1 Select the corresponding license from the list (C). 1 Touch the Enter code button (D). 2 Touch the Activate button (E) and confirm. 2 Use the screen keyboard to enter the license key and confirm with OK. 3 After activating all desired licenses, restart Perseus. The license is unlocked and displayed in the list (C).

Overview of the configurable screen contents

During operation, waveforms and parameter fields Paw are selected in the Quick setup window, see page 89. Paw 10455 Waveforms and associated parameter fields Paw (3) Volume-controlled modes: etCO2 Parameters PIP, Pplat, PEEP All other modes: CO2 Parameters PIP, Pmean, PEEP

10454 Paw

CO2 in/et 10504

CO2 Paw (4)

10502 Parameters PIP, Pplat, Pmean, PEEP:

Paw CO2 in/et, RR

CO2 10505

10503 Volume MV, VT, RR

Volume 10456

146 Instructions for use Perseus A500 SW 1.1n Configuration

Volume VT, MV, RR etCO2

Volume CO2

10506 et

O2 10420 10457 CO2 in/et O2, ∆

O2 CO2 et in 10507

Primary agent

Iso 10421

10458 CO2 in/et, RR

"Empty" CO2 et in

10508 RR

Miscellaneous parameter fields 10416

Compliance trend Paw

Cdyn PEEP Paw PIP 10419 20035 The value displayed here for Cdyn is updated more frequently and thus may differ from the value displayed in the Trends/Data dialog field.

Instructions for use Perseus A500 SW 1.1n 147 Configuration

Paw (3) MV, VT, RR Volume-controlled modes: Parameters PIP, Pplat, PEEP Volume All other modes: MV VT Parameters PIP, Pmean, PEEP

RR Paw

PIP Pmean 10418

MV×CO2 trend PEEP WARNING 10417 Risk of incorrect therapy settings Paw (4) The numerical value displayed for the Parameters PIP, Pplat, Pmean, PEEP: MV×CO2 parameter is not sufficiently accurate to enable therapy decisions to be made. Paw Do not make therapy decisions based solely PIP Pplat on the displayed numerical value. Only the trend curve can be used for therapeutic decisions. Pmean PEEP

10459 MV×CO2

MVmand, spon

MV Mand Spon 20033

∆VT

10499 ∆VT VTi

Paw 20036

148 Instructions for use Perseus A500 SW 1.1n Configuration

Volume MV, VT, RR O2 uptake Volume VT MV

RR 20034 10498 Primary agent O2 Iso O2 in et 10423 10460 RR O2, ∆ RR O2 in ∆ 10449 10422 Econometer (optional) O2 uptake trend

WARNING Econometer Risk of incorrect therapy settings Deficit Efficient Surplus The numerical value displayed for the O2 uptake parameter is not sufficiently accurate to enable therapy decisions to be made. 10427 Do not make therapy decisions based solely on the displayed numerical value. Only the trend curve can be used for therapeutic decisions.

Instructions for use Perseus A500 SW 1.1n 149 Configuration

Low-flow wizard (optional) Stopwatch

Required FG flow Stopwatch Start

Total flow Efficient 10451 20152

Gases in/et Countdown timer

Countdown Gases in/et in et O2

N2O

Iso AB 20070 10424

Gas supply Econometer trend (optional)

Gas supply Econometer trend

O2 Air N2O 10428 10426

Volumeter FiO2 prediction (optional)

FiO2 prediction Volumeter Start VT

Volume 13718 10452

150 Instructions for use Perseus A500 SW 1.1n Configuration

Vaporizer setting (optional) Flow tubes (electronically controlled gas mixer)

Vaporizer sett. WARNING Iso Sev Des Risk of mix-up In some countries, the representation and order of the virtual flow tubes on the screen Refill may differ from that illustrated here. 10425 Pay attention to the labeling of the virtual flow tubes. Empty

WARNING Insufficient fresh-gas supply The indication on the virtual flow tubes is intended only as additional information. Do not use the virtual flow tubes alone when making therapeutic decisions. 10509

Agent prediction (optional) Surplus

Iso prediction

Efficient

Deficit

O2 N2O Econometer 10511

Flow tubes (mechanically controlled gas mixer) 10453

WARNING Risk of mix-up In some countries, the representation and order of the virtual flow tubes on the screen may differ from that illustrated here. Pay attention to the labeling of the virtual flow tubes.

Instructions for use Perseus A500 SW 1.1n 151 Configuration

O2 Air N2O 20367 When the Agent prediction parameter field is displayed, the flow tubes will be displayed at reduced size:

O2 Air N2O 20788

152 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Troubleshooting

Leakages ...... 154 Possible leakage causes...... 154 Systematic localization of leakages...... 155 Power supply failure ...... 155 Mains power supply failure...... 155 Mains power supply failure and empty batteries ...... 156 After power supply is restored...... 156 When fuses of auxiliary power sockets are blown ...... 156 Failure of the gas supply ...... 157 Failure of one gas supply ...... 157 Changing an empty gas cylinder ...... 157 Complete failure of the gas supply ...... 157 After the central gas supply is restored ...... 158 Failure of fresh-gas delivery (electronically controlled gas mixture)...... 158

Ventilator failure ...... 159

Failure of the gas measurement ...... 159

Failure of flow measurement...... 159

Screen fault/user interface failure...... 160

Complete failure ...... 160

Problems with the anesthetic gas receiving system (AGS)...... 161 Replacing the anesthetic gas receiving system (AGS)...... 161 Problems with the pressure reducers ...... 162

Problems with the Vapor View option ...... 162

Alarm – Cause – Remedy...... 162

Instructions for use Perseus A500 SW 1.1n 153 Troubleshooting

Leakages

Leakages may result in the system not being Possible leakage causes operational or being operational with limitations only. – The CO2 absorber or the CLIC adapter is not securely screwed to the breathing system. CAUTION – The APL valve is not correctly fitted to the Risk due to contamination breathing system or is not set to 30 hPa (cmH2O). Anesthetic gas can get into the ambient air as a result of leakages. – The breathing bag, the breathing hoses, the Y- piece, or the microbial filter is incorrectly fitted Perform the leakage test before using the device. or damaged. Remedy all leakages. – The flexible arm for the breathing bag (optional) is incorrectly fitted to the breathing CAUTION system. The sealing ring is soiled or damaged. Risk due to leakage at the valves – The water trap is not connected. Leakages at valves can allow ambient air to enter – The sample line is not connected, is kinked, or the breathing system and alter the composition of is leaking. the breathing gas. – The connections for the sample line are Before using the device, perform the leakage test damaged. to check the leak-tightness of all the valves. – The O-rings on the inspiratory port or expiratory port are damaged, soiled, or WARNING missing. Risk of insufficient ventilation – The flow sensors are incorrectly installed or damaged. The rear O-ring is missing. Breathing gas may escape because of leakages, with the result that the applied – The upper part of the breathing system housing volume is less than the set volume. is incorrectly fitted or damaged. Perform the leakage test before using the – The valves or seals of the breathing system are device. Remedy all leakages. damaged. – The circuit plug is scratched or damaged. – The filling or emptying connections on the vaporizer are leaking or are open. The vaporizer is incorrectly fitted. The O-ring is missing or damaged. The control dial is not at the 0 position.

154 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Systematic localization of leakages

To find causes of leakages, isolate individual components from the leakage test.

Component Measure Sample line Remove the sample line and occlude the Luer-Lock connection on the Y-piece. Breathing Disconnect the breathing hoses. hoses Connect the inspiratory port and expiratory port with a hose that is known to be without leakages. Connect the breathing bag directly to the breathing system. Vaporizers Remove the vaporizers.

1 Perform a leakage test, see page 105, and use the leakage assistant if necessary. 2 Contact service personnel if the leakages cannot be localized.

Power supply failure

Mains power supply failure CAUTION If the mains power supply fails, Perseus Risk of device malfunction automatically switches to the internal battery. A If mains power fails, devices connected to the fully charged battery will maintain operation for at auxiliary power sockets are not supplied from the least 30 minutes. internal battery. Remaining battery charge is displayed on the Ensure an alternative power supply for status display. connected devices. The breathing system heating is deactivated during battery operation. The peak inspiratory pressure PIP may be limited, but it will equal at least 55 hPa (cmH2O).

Instructions for use Perseus A500 SW 1.1n 155 Troubleshooting

Mains power supply failure and empty Using the emergency O2 delivery batteries (electronically controlled gas mixer)

If mains power fails and the batteries are empty, a signal tone is emitted. Manual ventilation and spontaneous breathing remain available. O2 and anesthetic agent can still be delivered using the emergency O2 delivery (with electronically controlled gas mixer) or the flow control valves A B (with mechanically controlled gas mixer) and connected vaporizers.

The following are not available: 10375 – Ventilator 1 Check vaporizer setting. – Electronically controlled gas mixer 2 Set the O2 switch (A) upwards to position Add. O2. – Device monitoring and patient monitoring 3 Open the flow control valve (B) on the O2 WARNING flowmeter and set the desired flow. This O2 flow flows through the vaporizer. Risk of patient injury If all power sources fail, the screen goes dark and automatic ventilation ends. After power supply is restored

Manually ventilate the patient. 1 Restart the device, see page 69. Further procedures: 2 Charge empty batteries for at least 8 hours. 1 Check vaporizer setting. 3 Check the displays for mains voltage and battery on the status display. 2 Electronically controlled gas mixer: Use emergency O2 delivery. Mechanically controlled gas mixer: When fuses of auxiliary power sockets Close the Air flow control valve and the N2O flow control valve and use only O2 as fresh are blown gas. 1 Disconnect mains power supply. 3 Monitor the O2 flow on the O2 flowmeter (electronically controlled gas mixer) or on the 2 Remedy the malfunction. total flow tube (mechanically controlled gas 3 For devices without isolation transformer: mixer). Replace the fuses. 4 Manually ventilate the patient. For devices with isolation transformer: – If necessary, wait at most 2 minutes for the 5 Ensure corresponding substitute monitoring. circuit breaker to cool. – Press the key on the circuit breaker back in or operate the switch on the isolation transformer. 4 Restore mains power supply.

156 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Failure of the gas supply

A failure of the central gas supply can result in Changing an empty gas cylinder simultaneous device malfunctions on all systems connected to it. 1 Close the valve of the empty gas cylinder. Perseus signals an alarm if the gas supply for the 2 Completely use up or completely vent any gas gases O2, Air, or N2O (optional) fails. remaining in the pressure reducer and in the hose between Perseus and the gas cylinder. WARNING If there is no patient connected, venting can be performed as follows: Risk of contaminating the gas supply – Disconnect the central O2 supply. When the central gas supply is connected, – Open the flow control valve of the O2 the smallest internal leakage can cause flowmeter. Wait until gas is no longer contamination of the supply gases. flowing. If the central gas supply fails during – Close the flow control valve of the O2 operation, disconnect the hoses for the failed flowmeter again. gas from the central supply. 3 Unscrew the pressure reducer from the gas  Open the corresponding gas cylinder. cylinder valve.  Restore central gas supply. 4 Replace the gas cylinder with a full gas cylinder. Electronically controlled gas mixer only: If the 5 Connect the pressure reducer to the new filled central gas supply for a gas fails and there is no gas cylinder, see page 48. sufficiently filled gas cylinder connected (see page 27 "Status display"), a substitute gas is used: 6 Open the valve of the filled gas cylinder.

Failed gas Substitute gas O2 100 % Air Complete failure of the gas supply N2O100% O2 If the central gas supply for O2 and Air fails at the Air 100 % O2 same time and there are no sufficiently filled gas cylinders connected, operation can be continued in The level of the fresh-gas flow remains constant. automatic ventilation modes. This is possible because the ventilator does not require a drive gas. Failure of one gas supply 1 Remove the breathing bag. Operation of fresh-gas delivery is still possible 2 Continue automatic ventilation. when supply of one gas fails. If, e.g., N2O fails, with the electronically controlled gas mixer, Air or 100 % O2 can be set as carrier gas. With the mechanically controlled gas mixer, open the corresponding flow control valve of the substitute gas.

Instructions for use Perseus A500 SW 1.1n 157 Troubleshooting

When the breathing bag is removed, the missing CAUTION fresh-gas volume will automatically be filled by ambient air. This is likely to cause the alarm Fresh Risk of increased anesthetic gas concentration in gas low or leakage to be triggered. the ambient air

WARNING If the breathing bag is not connected, expiratory anesthetic gases may escape from the breathing Risk of patient recovering consciousness system. If the gas supply fails completely, further Ensure adequate circulation of the ambient air. operation takes place through gas supply of the anesthesia machine with ambient air. Anesthetic agents are no longer delivered After the central gas supply is restored and the inspiratory anesthetic gas concentration in the breathing gas decreases. 1 Connect the compressed gas hoses to the Monitor the gas mixture carefully and use terminal units. intravenous anesthetic agents if need be. 2 Close the gas cylinder valve on the corresponding gas cylinder again. On devices that are equipped with Advanced Cylinder Support, the gas cylinder valves can remain open.

Failure of fresh-gas delivery (electronically controlled gas mixture)

The current ventilation mode remains active in the  If necessary, ventilate the patient with the event that the fresh-gas delivery fails. manual resuscitator.

WARNING Risk of patient injury If the gas mixer fails, no fresh gas is delivered. Check vaporizer setting. Supply the patient with O2. Use emergency O2 delivery.

 Use emergency O2 delivery, see page 156.  To prevent permanent acoustic alarm signals, downgrade the priority of the Fresh-gas delivery failure alarm, if necessary.  If necessary, perform ventilation with ambient air, see ''Complete failure of the gas supply'' on page 157.

158 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Ventilator failure

If the ventilator fails, only manual ventilation or spontaneous breathing remain possible. No other ventilation modes can be selected. The fresh-gas delivery remains ready for operation. 1 Switch to the MAN / SPON ventilation mode. 2 Manually ventilate the patient.

Failure of the gas measurement

CAUTION Risk due to gas measurement failure If the gas measurement fails, the patient can no longer be adequately monitored. – Ensure corresponding substitute monitoring. – Check sample line and water trap for damage or blockage and resolve these as needed. Observe the exchange intervals.

 Ensure corresponding substitute monitoring.

Failure of flow measurement

If the flow measurement fails, normally the therapy WARNING can be continued. Thus, the flow sensors can be replaced during the next Standby. There may be Risk due to malfunction of the inspiratory limitations in measured parameters or selection of flow measurement therapy. If the inspiratory flow sensor malfunctions, the device automatically switches to pressure-controlled ventilation. If there is an additional malfunction of the inspiratory pressure sensor, the system automatically switches to the non-synchronized Pressure Control - CMV mode. In either case, check the ventilation settings and adjust as needed.

Instructions for use Perseus A500 SW 1.1n 159 Troubleshooting

1 Replace the flow sensor: To remove the flow sensors, follow the steps described in chapter ''Installing the flow sensors and ports'' in reverse order, see page 56. Then install the new flow sensors. 2 Perform the breathing system test, see page 105.

Screen fault/user interface failure

The screen does not respond to operation. It has failed or the screen display is faulty. 1 Switch Perseus to Standby mode: Press the button and confirm with the rotary knob. 2 Use emergency O2 delivery, see page 156. 3 Check vaporizer setting. 4 Manually ventilate the patient. 5 Ensure corresponding substitute monitoring.

Complete failure

The device no longer responds to operation. WARNING 1 Switch off the device using the device switch, see page 23. Risk of device malfunction 2 Manually ventilate the patient. If the breathing bag does not fill with fresh gas, the patient cannot be sufficiently 3 Perform a start-up for operation in case of ventilated. emergency, see page 71. – Check the oxygen supply and, if necessary, open the gas cylinder valves. – If fresh gas still is not delivered or manual ventilation is not possible, close the flow control valve of the O2 flowmeter. – Disconnect the patient from the device and use a replacement device!

160 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Problems with the anesthetic gas receiving system (AGS)

Fault Cause Remedy Flow indicator beneath the The suction power of the ejector Have the function of the AGSS "restricted range" in the terminal unit of anesthetic terminal unit checked. Observe gas scavenging system (AGSS) related instructions for use. is insufficient. Particle filter contaminated or Replace the anesthetic gas blocked. receiving system (AGS) or have service personnel replace the particle filter. Flow indicator above "normal The suction power of the ejector Have the suction power of the range" in the AGSS terminal unit is too ejector in the AGSS terminal unit high. adjusted to the working range of the AGS. Particle filter missing. Replace the anesthetic gas receiving system (AGS) or have service personnel install the particle filter.

Replacing the anesthetic gas receiving Disassembling the anesthetic gas receiving system (AGS) system (AGS) 1 Remove the suction hose. View from below: 2 If necessary, remove the transfer hose for the non-rebreathing system. 3 Remove the three screws (A). 4 Dispose of the AGS. A Assembling the anesthetic gas receiving system (AGS) A A  Follow the above steps in reverse order to assemble the new AGS. 10396

Instructions for use Perseus A500 SW 1.1n 161 Troubleshooting

Problems with the pressure reducers

Fault Cause Remedy The connection between gas cyl- Sealing ring damaged Replace the sealing ring. inder and pressure reducer leaks. Output pressure rises, relief valve Valve seat contaminated or dam- Close gas cylinder valve. Repair relieves the outlet of the pressure aged by service personnel. reducer. Leakage in the housing area. Membrane faulty Repair by service personnel.

Problems with the Vapor View option

Fault Cause Remedy Dräger Vapor 3000/ Vaporizer is not correctly Correctly mount and lock vapor- D-Vapor 3000 is not detected. mounted and locked. izer. Sensor unit is faulty. Repair by service personnel. Control dial setting position or fill- Sensor unit or vaporizer is soiled. Clean sensor unit and remove ing level of Dräger Vapor 3000/ foreign particles. D-Vapor 3000 is not detected. Sensor unit or vaporizer is dam- Repair by service personnel. aged. Dräger Vapor 3000/ Control dial is in position T. Turn control dial to position 0. D-Vapor 3000 is not illuminated. Illumination unit is soiled. Clean illumination unit and remove foreign particles. Illumination unit is faulty. Repair by service personnel. Illumination is switched on, even Vapor View option is faulty. Repair by service personnel. though no Dräger Vapor 3000/ D-Vapor 3000 is fitted.

Alarm – Cause – Remedy

Alarm messages are displayed in hierarchal form indicated by exclamation marks. in the alarm message field of the header bar, see page 116. Warning !!! Red The priority of the alarm messages is indicated by Caution !! Yellow different background colors. Note ! Cyan In the Current alarms table and Alarm history table, the priority of the alarm messages is also

162 Instructions for use Perseus A500 SW 1.1n Troubleshooting

In order to classify the alarms within an alarm The following table lists the alarm messages in priority, internal priority numbers are given in the alphabetical order. If an alarm occurs, the table table below. The most critical alarm is given the helps to quickly identify causes and remedies. The number 255. Lower numbers indicate a lower possible causes and remedial measures should be alarm priority. looked through in the order they are listed until the alarm is resolved. Some alarms appear in this table several times with different priorities because their priority may change under certain conditions, see page 121.

Alarm Alarm Cause Remedy priority !! 100 "Add. O2" activated O2 switch is set to "Add. O2". Close the flow control valve of the O2 flowmeter. Set the O2 switch to "Aux. O2". Use "ALARM RESET" to downgrade alarm priority. ! 100 "Audio paused" key stuck Key is stuck or was pressed Ventilation performance is not for more than 10 seconds. affected. If the problem persists, call DrägerService. ! 100 Absorber disconnected? Infinity ID CLIC absorber is Check absorber. not correctly connected. Use "ALARM RESET" to acknowledge alarm. ! 220 Air cylinder almost empty The cylinder is almost empty. Replace the cylinder. Use the central supply. ! 255 Air cylinder empty The cylinder is empty or Replace the cylinder. Use the closed. central supply. ! 190 Air cylinder sensor? Cylinder pressure sensor is Check if cylinder pressure not connected. sensor is connected. Use "ALARM RESET" to acknowledge alarm. !! 150 Air FG flow measurement The measurement system for Only use O2 as fresh gas. failed the Air fresh-gas flow has Use the total flow tube to failed. check the fresh-gas flow. Adjust the fresh-gas flow so that it equals or exceeds the minute volume. !!! 110 Air supply low Central supply pressure and Check central Air supply or cylinder pressure are low. use cylinder. Use "ALARM RESET" to downgrade alarm priority.

Instructions for use Perseus A500 SW 1.1n 163 Troubleshooting

Alarm Alarm Cause Remedy priority !!! 255 Airway press. continuously Airway pressure has been Check spontaneous breathing high continuously high. ability of the patient. Check ventilation settings. Check breathing hoses, breathing system, and anesthetic gas scavenging system. In MAN/SPON mode, check the APL valve setting. Check lower alarm limit for airway pressure. !!! 255 Airway pressure high The upper alarm limit for the Check ventilation settings. airway pressure has been Check alarm limit. exceeded. The applied inspiratory pressure is higher than the set value. Breathing hoses are blocked Check breathing circuit and or the tube is kinked. tube. !!! 255 Airway pressure negative Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. Suction maneuver during Check endotracheal suction ventilation. system. Failure of the anesthetic gas Check anesthetic gas scav- scavenging system. enging system. !! 10 Airway pressure not Fresh-gas flow is insufficient, Check fresh-gas settings and achieved breathing bag is blocked or position of breathing bag. positioned incorrectly. Leakage or disconnection. Check the breathing circuit for tight connections and leakages. !!! 220 Apnea No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check spontaneous breathing ability of the patient. !! 255 Apnea No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check spontaneous breathing ability of the patient.

164 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !!! 220 Apnea (no CO2) No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check spontaneous breathing ability of the patient. Sample line is not connected. Connect sample line to breathing circuit. !! 255 Apnea (no CO2) No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check spontaneous breathing ability of the patient. Sample line is not connected. Connect sample line to breathing circuit. !!! 220 Apnea (no flow) No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check spontaneous breathing ability of the patient. Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. The breathing hoses are Check breathing circuit and blocked or leaking. tube. !! 255 Apnea (no flow) No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check spontaneous breathing ability of the patient. Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. The breathing hoses are Check breathing circuit and blocked or leaking. tube. !!! 220 Apnea (no pressure) No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check alarm limit. Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. The breathing hoses are Check breathing circuit and blocked or leaking. tube.

Instructions for use Perseus A500 SW 1.1n 165 Troubleshooting

Alarm Alarm Cause Remedy priority !! 255 Apnea (no pressure) No breathing or ventilation. Start manual ventilation! Check ventilation settings. Check alarm limit. Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. The breathing hoses are Check breathing circuit and blocked or leaking. tube. !! 0 Apnea Ventilation No inspiratory effort of the Check spontaneous breathing patient detected. ability of the patient. Adjust the setting for "Trigger sens.". Change to pressure-controlled or volume-controlled ventilation mode. Use "ALARM RESET" to downgrade alarm priority. ! 0 Apnea Ventilation No inspiratory effort of the Check spontaneous breathing patient detected. ability of the patient. Adjust the setting for "Trigger sens.". Change to pressure-controlled or volume-controlled ventilation mode. !! 100 Backup speaker failure The backup speaker for alarm Call DrägerService. tones is faulty. Use "ALARM RESET" to acknowledge alarm. ! 170 Bag pressure sensor failure Sensor calibration failed. Manually check the filling level of the breathing bag. Perform the system test. ! 170 Battery low Battery charge is less than Restore mains power supply. 20 % and mains power sup- Breathing system heating is ply is not available. switched off. Check breathing circuit for condensation. Increase fresh-gas flow if necessary. ! 100 Battery temperature high The battery temperature is Ensure that the system is high. Charging of the battery connected to the mains power has been suspended to pro- supply. tect it from damage.

166 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !! 30 Battery very low Battery charge is less than Make sure that the mains 10 %. power supply is correctly connected. Breathing system heating switches off in the event of mains power failure. Check breathing circuit for condensation. Increase fresh-gas flow if necessary. Prepare manual ventilation with 100 % O2. The battery is not connected Call DrägerService. or the battery fuse is blown. Use "ALARM RESET" to downgrade alarm priority. !! 135 Breathing bag too small The breathing bag is too Use correct breathing bag. small. The tidal volume cannot be delivered. Breathing bag hose is too Use correct hose. long/thin. Use "ALARM RESET" to acknowledge alarm. ! 100 Breathing circuit expired Accessory has been used too Replace the accessory if nec- long. essary. Use "ALARM RESET" to acknowledge alarm. ! 100 Breathing system heating The breathing system heating Check breathing circuit for failure has failed. condensation. Increase fresh- gas flow if necessary. Call DrägerService. An internal temperature sen- Call DrägerService. sor is faulty.

Instructions for use Perseus A500 SW 1.1n 167 Troubleshooting

Alarm Alarm Cause Remedy priority !!! 255 Breathing system temp. Failure of the breathing sys- Check inspiratory breathing- high? tem heating. gas temperature as close to the Y-piece as possible. Use longer inspiratory hose. Remove breathing system cover. Switch off breathing system heating. Switch off the device with the device switch. Start manual ventilation using "Add. O2". Disconnect the patient and ventilate with a manual resuscitator. ! 100 Cardiac bypass mode still A significant minute volume Use "Exit CBM" to deactivate active? was measured during car- the cardiac bypass mode. diac bypass mode. Use "ALARM RESET" to acknowledge alarm. ! 100 Central Air supply high The central supply pressure Check central supply. is high. The gas delivery might fail. ! 255 Central Air supply low Central supply pressure is Check central supply. low. !100 Central N2O supply high The central supply pressure Check central supply. is high. The gas delivery might fail. !255 Central N2O supply low Central supply pressure is Check central supply. low. !100 Central O2 supply high The central supply pressure Check central supply. is high. The gas delivery might fail. !!! 210 Central O2 supply low Central supply pressure is Check central O2 supply or low. use cylinder. Use "ALARM RESET" to downgrade alarm priority. !255 Central O2 supply low Central supply pressure is Check central supply. low. !100 CO2 absorber expired Accessory has been used too Replace the accessory if nec- long. essary. Use "ALARM RESET" to acknowledge alarm.

168 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority ! 100 CO2 sensor accuracy low Accuracy of the CO2 sensor If the problem persists for cannot currently be guaran- more than 10 minutes, call teed. DrägerService. !! 135 Cooling fan failure An internal fan for evacuating To prevent potential damage, gases is faulty. switch off system at your ear- liest convenience. Increased risk of fire. Call DrägerService. !! 140 CPAP changed to "Off" The set CPAP pressure could Check the breathing circuit for not be achieved due to leak- tight connections and leakage. The system has ages. changed the CPAP setting to Increase fresh-gas flow. "Off". Reapply the CPAP setting. Use "ALARM RESET" to acknowledge alarm. !! 150 Emergency air inlet acti- Negative pressure in the Refill breathing bag (e.g., with vated breathing system due to "O2+" or "Add. O2"). insufficient fresh gas in the Increase fresh-gas flow. breathing bag. The system Check the breathing circuit for utilizes ambient air to ensure tight connections and leak- ventilation. ages. !! 135 etCO2 high etCO2 has exceeded the Check ventilation. upper alarm limit. !! 135 etCO2 low etCO2 is below the lower Check ventilation. alarm limit. !! 100 Exp. press. sensor failure Sensor calibration failed. Ensure that a suitable substitute monitoring is available. Perform the system test. ! 100 Expiratory flow sensor Accessory has been used too Replace the accessory if nec- expired long. essary. Use "ALARM RESET" to acknowledge alarm. ! 190 Expiratory flow sensor not The sensor is not calibrated. Perform the breathing sys- calibrated The breathing system has tem test. been replaced or disconnected since last calibration. Failure of the flow sensor. Replace the flow sensor and perform the breathing system test.

Instructions for use Perseus A500 SW 1.1n 169 Troubleshooting

Alarm Alarm Cause Remedy priority !!! 200 External fresh-gas outlet Failure when switching to Use "O2+" button to deter- failure? external fresh-gas outlet. Fail- mine flow direction of fresh ure when switching from gas: external fresh-gas outlet to -If internal breathing system another ventilation mode. or breathing bag fill, external fresh-gas outlet is not available. -If gas flows out of the external fresh-gas outlet, external fresh-gas outlet can be used. Internal breathing system can only be used when the breathing bag is not connected (ventilation with ambient air only). Check fresh-gas settings. Call DrägerService. ! 100 Filling level of vaporizer low The filling level of an inactive Check filling level. Refill if vaporizer is low. necessary. !! 50 Filling level of vaporizer low The filling level of the active Check filling level of vapor- vaporizer is low. izer. Use "ALARM RESET" to downgrade alarm priority. !! 10 FiO2 high FiO2 has exceeded the upper Check FG O2. alarm limit. !!! 255 FiO2 low FiO2 has fallen below the Check O2 concentration and lower alarm limit for: -at least fresh-gas settings. 15 seconds (with respiratory Check the breathing system phases) -at least 30 seconds for high leakages. (without respiratory phases) Check O2 supply. !! 135 FiO2 too high for neonates FiO2 has exceeded 50 % for Check O2 concentration and more than the configured fresh-gas settings. time. Use "ALARM RESET" to acknowledge alarm. !! 30 Flow control valve still open At least one flow control valve Close all flow control valves. is still open. ! 80 Flow sensor calibration The flow sensors have not Perform the breathing sys- required been calibrated since the tem test. device was powered on. The last calibration of the flow sensors was performed more than 24 hours ago.

170 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !!! 150 Fresh-gas delivery failure The fresh-gas delivery sys- Administer O2: 1. Set the O2 tem is not operational until switch to "Add. O2". 2. Set the the system test is success- O2 flowmeter to the desired fully performed. flow and check the vaporizer setting. Use "ALARM RESET" to downgrade alarm priority. Perform the system test after finishing the case. If the problem persists, call DrägerService. !! 100 Fresh-gas flow high The total fresh-gas flow is Reduce fresh-gas flow. greater than 12 L/min. !! 50 Fresh-gas flow inaccurate The accuracy of the fresh-gas Set all fresh-gas flows below flow measurement of the 12 L/min. mechanically controlled gas Check the total flow tube. mixer is reduced. Use "ALARM RESET" to downgrade alarm priority. !! 60 Fresh-gas flow inaccurate The fresh-gas flow delivered Make sure that sufficient by the electronically con- fresh-gas and anesthetic trolled gas mixer differs from agent are delivered. the set fresh-gas flow. Use "ALARM RESET" to downgrade alarm priority. !!! 100 Fresh gas low or leakage Fresh-gas flow is insufficient, Refill breathing system breathing bag is blocked or immediately (e.g., with positioned incorrectly. "O2+"). Check fresh-gas settings and position of breathing bag. Leakage or disconnection. Check the breathing circuit for tight connections and leakages. Check tube or mask. !! 150 Fresh gas low or leakage Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. Leakage or disconnection. Check the breathing circuit for tight connections and leakages. Check tube or mask. Use "ALARM RESET" to downgrade alarm priority.

Instructions for use Perseus A500 SW 1.1n 171 Troubleshooting

Alarm Alarm Cause Remedy priority ! 170 Fresh gas low or leakage Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. Leakage or disconnection. Check the breathing circuit for tight connections and leakages. Check tube or mask. !! 100 Gas sensor failure The patient-gas measure- Ventilation performance might ment module has failed. be reduced (e.g., inaccurate volume measurement and volume delivery). Use alternative gas measurement system. Call DrägerService. Use "ALARM RESET" to downgrade alarm priority. !! 255 Hose connected to wrong A breathing hose is not cor- Connect breathing hoses cor- port rectly connected. rectly. ! 100 Hose does not fit to pat. The detected breathing hose Use compatible accessory. category is not suitable for the selected Use "ALARM RESET" to patient category. acknowledge alarm. !! 100 Hose does not fit to pat. The detected breathing hose Use compatible accessory. category is not suitable for the selected Use "ALARM RESET" to patient category. acknowledge alarm. !! 150 inCO2 high Soda lime is depleted. Check soda lime. Increase fresh-gas flow. Check fresh-gas settings. Leakage in breathing system. Replace the breathing system. Gas measurement is inaccu- Adjust alarm limits if neces- rate due to high respiratory sary. rate. Large dead space. Check ventilation settings. ! 100 Infinity ID breathing circuit An incompatible accessory is Check accessory. not compatible connected. Use "ALARM RESET" to acknowledge alarm. ! 100 Infinity ID CO2 absorber not An incompatible accessory is Check accessory. compatible connected. Use "ALARM RESET" to acknowledge alarm. ! 100 Infinity ID water trap not An incompatible accessory is Check accessory. compatible connected. Use "ALARM RESET" to acknowledge alarm.

172 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !! 100 Insp. press. sensor failure Sensor calibration failed. Change to MAN/SPON mode and ventilate manually. Perform the system test. ! 255 Inspiratory desflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 255 Inspiratory desflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !!! 255 Inspiratory desflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 75 Inspiratory desflurane low The inspiratory anesthetic Check vaporizer and fresh- gas concentration is below gas settings. the lower alarm limit. Check the breathing system for high leakages. The soda lime has dried out. Replace the soda lime. ! 255 Inspiratory enflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 255 Inspiratory enflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !!! 255 Inspiratory enflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 75 Inspiratory enflurane low The inspiratory anesthetic Check vaporizer and fresh- gas concentration is below gas settings. the lower alarm limit. Check the breathing system for high leakages. The soda lime has dried out. Replace the soda lime. ! 100 Inspiratory flow sensor Accessory has been used too Replace the accessory if nec- expired long. essary. Use "ALARM RESET" to acknowledge alarm. ! 190 Inspiratory flow sensor not The sensor is not calibrated. Perform the breathing sys- calibrated The breathing system has tem test. been replaced or disconnected since last calibration. Failure of the flow sensor. Replace the flow sensor and perform the breathing system test.

Instructions for use Perseus A500 SW 1.1n 173 Troubleshooting

Alarm Alarm Cause Remedy priority ! 255 Inspiratory halothane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 255 Inspiratory halothane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !!! 255 Inspiratory halothane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 75 Inspiratory halothane low The inspiratory anesthetic Check vaporizer and fresh- gas concentration is below gas settings. the lower alarm limit. Check the breathing system for high leakages. The soda lime has dried out. Replace the soda lime. ! 255 Inspiratory isoflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 255 Inspiratory isoflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !!! 255 Inspiratory isoflurane high Inspiratory anesthetic gas Check vaporizer and fresh- concentration has exceeded gas settings. the upper alarm limit. !! 75 Inspiratory isoflurane low The inspiratory anesthetic Check vaporizer and fresh- gas concentration is below gas settings. the lower alarm limit. Check the breathing system for high leakages. The soda lime has dried out. Replace the soda lime. !! 10 Inspiratory N2O high Inspiratory N2O exceeds Check fresh-gas composition. 82 %. Press "O2+" button. ! 255 Inspiratory sevoflurane Inspiratory anesthetic gas Check vaporizer and fresh- high concentration has exceeded gas settings. the upper alarm limit. !! 255 Inspiratory sevoflurane Inspiratory anesthetic gas Check vaporizer and fresh- high concentration has exceeded gas settings. the upper alarm limit. !!! 255 Inspiratory sevoflurane Inspiratory anesthetic gas Check vaporizer and fresh- high concentration has exceeded gas settings. the upper alarm limit.

174 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !! 75 Inspiratory sevoflurane low The inspiratory anesthetic Check vaporizer and fresh- gas concentration is below gas settings. the lower alarm limit. Check the breathing system for high leakages. The soda lime has dried out. Replace the soda lime. !! 255 Inspiratory tidal volume The delivered inspiratory tidal Check ventilation settings. high volume is higher than the set Check patient compliance. value. Check if the patient is breathing spontaneously. !! 255 Inspiratory tidal volume The delivered inspiratory tidal Check ventilation settings. high volume exceeds the upper Check patient compliance. alarm limit. Check if the patient is breathing spontaneously. Check alarm limit. !! 50 Inspiratory tidal volume The ventilation settings are Change ventilation mode or high not adequate for AutoFlow. adjust tidal volume. !! 255 Inspiratory xMAC high The inspiratory anesthetic Check vaporizer and fresh- gas concentration has gas settings. exceeded 3 xMAC for more than 180 seconds. !!! 255 Inspiratory xMAC high The inspiratory anesthetic Check vaporizer and fresh- gas concentration has gas settings. exceeded 3 xMAC for more than 30 seconds. The expiratory anesthetic gas concentration has exceeded 2.5 xMAC for more than 30 seconds. The inspiratory anesthetic Check vaporizer and fresh- gas concentration has gas settings. exceeded 5 xMAC. !! 100 Internal device temperature A ventilation slot at the rear of Check the ventilation slots. high the device is blocked. Ensure air flow at the rear of the device. Ambient temperature is too Check ambient conditions. high. A fan is faulty. Call DrägerService. Excessive ventilation set- Check ventilation settings. tings are applied (e.g., high respiratory rate, high inspiratory pressure, short slopes).

Instructions for use Perseus A500 SW 1.1n 175 Troubleshooting

Alarm Alarm Cause Remedy priority ! 255 Internal device temperature A ventilation slot at the rear of Check the ventilation slots. high the device is blocked. Ensure air flow at the rear of the device. Ambient temperature is too Check ambient conditions. high. A fan is faulty. Call DrägerService. Excessive ventilation set- Check ventilation settings. tings are applied (e.g., high respiratory rate, high inspiratory pressure, short slopes). !!! 0 Loss of data An internal memory failure Check current settings and has occurred. System data default settings. and system settings are lost. Call DrägerService. ! 0 MEDIBUS COM 1 failure Communication via the corre- Check the cable and the con- sponding COM port is inter- nection. rupted. Use "ALARM RESET" to acknowledge alarm. The configured baud rate is Increase the baud rate. not sufficient for the amount Check the configuration of the of data to be transferred. external device. ! 0 MEDIBUS COM 2 failure Communication via the corre- Check the cable and the con- sponding COM port is inter- nection. rupted. Use "ALARM RESET" to acknowledge alarm. The configured baud rate is Increase the baud rate. not sufficient for the amount Check the configuration of the of data to be transferred. external device. !! 30 Minute volume high Upper alarm limit for the min- Check spontaneous breath- ute volume has been ing. exceeded. Check ventilation settings (e.g., VT, Pinsp, RR). In Pressure Support, correct the trigger threshold if necessary. Check alarm limit. Flow measurement is inaccu- Replace the expiratory flow rate. sensor if necessary and perform the breathing system test.

176 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !! 10 Minute volume low The minute volume is below Check ventilation settings. the lower alarm limit. Check alarm limit. Check tube or mask. Flow measurement is inaccu- Replace the expiratory flow rate. sensor if necessary and perform the breathing system test. Leakage or disconnection. Check the breathing circuit for tight connections and leakages. ! 220 N2O cylinder almost empty The cylinder is almost empty. Replace the cylinder. Use the central supply. ! 255 N2O cylinder empty The cylinder is empty or Replace the cylinder. Use the closed. central supply. ! 190 N2O cylinder sensor? Cylinder pressure sensor is Check if cylinder pressure not connected. sensor is connected. Use "ALARM RESET" to acknowledge alarm. !! 150 N2O FG flow measurem. The measurement system for Only use O2 as fresh gas. failed the N2O fresh-gas flow has Use the total flow tube to failed. check the fresh-gas flow. Adjust the fresh-gas flow so that it equals or exceeds the minute volume. !!! 110 N2O supply low Central supply pressure and Check central N2O supply or cylinder pressure are low. use cylinder. Use "ALARM RESET" to downgrade alarm priority. !!! 110 No Air delivery Air is not available. Gas mixer Check central Air supply or is using 100 % O2 instead. use cylinder. Use "ALARM RESET" to downgrade alarm priority. ! 100 No CO2 detected Ventilation was started, but Check sample line, water no exhaled CO2 was detected trap, and patient-side filter. for more than 60 seconds. Use "ALARM RESET" to acknowledge alarm. !!! 200 No fresh-gas flow No fresh-gas flow is set. Open the flow control valves. Use "ALARM RESET" to downgrade alarm priority.

Instructions for use Perseus A500 SW 1.1n 177 Troubleshooting

Alarm Alarm Cause Remedy priority !!! 110 No N2O delivery N2O is not available. Gas Check central N2O supply or mixer is using O2 instead. use cylinder. Use "ALARM RESET" to downgrade alarm priority. !!! 210 No O2 delivery O2 is not available. Gas mixer Check central O2 supply or is using Air instead. use cylinder. Use "ALARM RESET" to downgrade alarm priority. !220 O2 cylinder almost empty The cylinder is almost empty. Replace the cylinder. Use the central supply. !!! 210 O2 cylinder empty The cylinder is empty or Replace the cylinder. Use the closed. central supply. Use "ALARM RESET" to downgrade alarm priority. !255 O2 cylinder empty The cylinder is empty or Replace the cylinder. Use the closed. central supply. !190 O2 cylinder sensor? Cylinder pressure sensor is Check if cylinder pressure not connected. sensor is connected. Use "ALARM RESET" to acknowledge alarm. !! 150 O2 FG flow measurement The measurement system for Only use O2 as fresh gas. failed the O2 fresh-gas flow has Use the total flow tube to failed. check the fresh-gas flow. Adjust the fresh-gas flow so that it equals or exceeds the minute volume. !! 255 O2 sensor failure The O2 sensor in the patient- Use alternative O2 measur- gas measurement module is ing system. faulty. Call DrägerService. Use "ALARM RESET" to downgrade alarm priority. !!! 210 O2 supply low Central supply pressure and Check central O2 supply or cylinder pressure are low. use cylinder. Use "ALARM RESET" to downgrade alarm priority. ! 100 On/Standby key stuck Key is stuck or was pressed Ventilation performance is not for more than 10 seconds. affected. If the problem persists, call DrägerService.

178 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !! 100 Pause time expired Ventilation and gas delivery Resume ventilation or adjust have been paused longer timer. than the set pause time. Use "ALARM RESET" to acknowledge alarm. ! 100 Pause time expired Ventilation and gas delivery Resume ventilation or adjust have been paused longer timer. than the set pause time. Use "ALARM RESET" to acknowledge alarm. !! 50 PEEP/CPAP high The expiratory limb is Check expiratory breathing blocked. hose and breathing system. Perform the breathing system test. Failure of the anesthetic gas Check anesthetic gas scav- scavenging system. enging system. !! 100 PEEP/CPAP low Fresh-gas flow is insufficient, Check fresh-gas settings and breathing bag is blocked or position of breathing bag. positioned incorrectly. Leakage or disconnection. Check the breathing circuit for tight connections and leakages. Failure of the anesthetic gas Check anesthetic gas scav- scavenging system. enging system. !! 60 PEEP not applied Failure of the PEEP valve. Check the breathing circuit for tight connections and leakages. Perform the breathing system test. ! 170 Power failure Device is not connected to Restore mains power supply. mains power supply. !!! 100 Power supply failure Internal fault in the power Operation of the device can supply. be continued. Call DrägerService. ! 255 Pressure-relief valve Pressure in the breathing sys- Check APL valve and fresh- opened tem is too high. gas settings. !! 100 Pressure sensor failure There is condensate in the Check the breathing hoses. breathing hoses. Sensor calibration failed. Perform the system test. If the problem persists, call DrägerService.

Instructions for use Perseus A500 SW 1.1n 179 Troubleshooting

Alarm Alarm Cause Remedy priority !!! 200 Rotary knob stuck Key is stuck or was pressed Ventilation performance is not for more than 10 seconds. affected. Press and turn rotary knob repeatedly. If alarm condition persists, settings cannot be adjusted anymore. Disconnect the patient and ventilate with a manual resuscitator. Switch off the device with the device switch. Start manual ventilation using "Add. O2". ! 170 Sample line disconnected? Ventilation was started, but Check sample line, water no exhaled CO2 was trap, and patient-side filter. detected. ! 170 Sample line occluded Sample line is occluded. Check sample line, water trap, and patient-side filter. !! 75 Second agent detected A second anesthetic agent Flush the system if necessary. has been detected. Check fresh-gas settings. Wait for transition phase to end. ! 100 Service date reached Maintenance is due. Call DrägerService. Use "ALARM RESET" to acknowledge alarm. !! 0 Speaker failure The loudspeaker is faulty. Call DrägerService. Use "ALARM RESET" to downgrade alarm priority. !! 100 Synchronized ventilation Inspiratory efforts of the Check ventilation settings. failure patient cannot be detected Change to a non-synchro- due to faulty sensors. nized ventilation mode. Change to MAN/SPON mode and ventilate manually.

180 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority !!! 100 System failure Failure of internal compo- Start manual ventilation! nents. System is no longer 1. To avoid excessive agent operational. concentrations, make sure that the vaporizer setting is in accordance with the O2 flow to be set at the O2 flowmeter. 2. Set the O2 switch from "Aux. O2" to "Add. O2". 3. Set the desired O2 flow using the O2 flowmeter. When in doubt, switch off the device with the device switch. Call DrägerService. ! 255 Temperature of Temperature of TurboVent 2 Reduce airway pressure or TurboVent 2 blower module blower module is too high. respiratory rate. high !!! 0 Therapy settings not The last changes to the ther- Change to MAN/SPON and applied apy settings were not applied. restart the ventilation mode. If the problem persists, call DrägerService. !! 100 Third agent detected A mixture of more than Flush the system if necessary. 2 anesthetic agents has been Check fresh-gas settings. detected. Wait for transition phase to end. There is electromagnetic Check for electromagnetic interference. radiation in the vicinity. !! 30 Tidal volume not achieved The delivered inspiratory tidal Check ventilation settings. volume is lower than the set Check Pmax setting. value. Check patient compliance. Check if the patient is breathing spontaneously. !!! 100 TurboVent 2 failure The TurboVent 2 blower mod- Start manual ventilation! ule is not operational or over- Replace TurboVent 2 blower heated. module. !!! 100 TurboVent 2 not connected The TurboVent 2 blower mod- Insert the TurboVent 2 blower ule is not connected. module. Use "ALARM RESET" to downgrade alarm priority. !!! 100 Unknown alarm Error in the internal alarm Check patient condition. system. Call DrägerService.

Instructions for use Perseus A500 SW 1.1n 181 Troubleshooting

Alarm Alarm Cause Remedy priority ! 0 USB write error The USB flash drive is full, Check the USB flash drive. faulty, write-protected, or not Use "ALARM RESET" to compatible. The USB flash acknowledge alarm. drive is not correctly connected. The USB flash drive is not correctly formatted. !! 100 Vaporizer open Control dial is not in position Close vaporizer to prevent "0". accumulation of anesthetic agent in the breathing system. ! 100 Vapor View failure (left slot) Failure of Vapor View hard- If the problem persists, call ware. DrägerService. Use "ALARM RESET" to acknowledge alarm. ! 100 Vapor View failure (middle Failure of Vapor View hard- If the problem persists, call slot) ware. DrägerService. Use "ALARM RESET" to acknowledge alarm. ! 100 Vapor View failure (right Failure of Vapor View hard- If the problem persists, call slot) ware. DrägerService. Use "ALARM RESET" to acknowledge alarm. ! 100 Vapor View not operational Failure of Vapor View hard- Call DrägerService. ware. Use "ALARM RESET" to acknowledge alarm. !!! 120 Ventilator failure Failure of the pressure sen- Start manual ventilation! sors. Perform the system test. If the problem persists, call DrägerService. !! 100 Vol. Ctrl. ventilation failure The inspiratory flow sensor is Change to a pressure-con- faulty. trolled ventilation mode. Replace the flow sensor and perform the breathing system test. ! 100 Water trap disconnected? Infinity ID water trap is not Check water trap. correctly connected. ! 100 Water trap expired Accessory has been used too Replace the accessory if nec- long. essary. Use "ALARM RESET" to acknowledge alarm.

182 Instructions for use Perseus A500 SW 1.1n Troubleshooting

Alarm Alarm Cause Remedy priority ! 100 Water trap full Water trap is full. Check water trap. Sample line is occluded. Check sample line, water trap, and patient-side filter. ! 170 xMAC low Inspiratory and expiratory gas Check patient condition. concentrations are lower than Check filling level of vapor- the automatically calculated izer. limit. Check vaporizer setting. Check the breathing system and the breathing bag for leakages. Check the current xMAC. If the current xMAC is accept- able, use "ALARM RESET" to acknowledge the alarm and to recalculate the lower alarm limit. !! 80 xMAC low Inspiratory and expiratory gas Check patient condition. concentrations are lower than Check filling level of vapor- the automatically calculated izer. limit. Check vaporizer setting. Check the breathing system and the breathing bag for leakages. Check the current xMAC. If the current xMAC is accept- able, use "ALARM RESET" to acknowledge the alarm and to recalculate the lower alarm limit. !! 100 Y-piece is open or not con- The Y-piece is open or not Make sure that the Y-piece is nected connected during flush or occluded. Flush & Dry procedure.

Instructions for use Perseus A500 SW 1.1n 183 Cleaning, disinfection and sterilization

Cleaning, disinfection and sterilization

Disassembly ...... 185 Observe before disassembling...... 185 Instructions for disassembly ...... 185 Sequence of disassembly ...... 185 Note on removable accessories, consumable parts, and attached parts...... 186 Reprocessing procedures ...... 187 Classification of medical devices...... 187 Tested procedures and agents...... 187 Non-critical medical devices...... 187 Semi-critical medical devices ...... 188 Visual check ...... 190 Sterilization...... 190 Reprocessing list ...... 191 Non-critical medical devices...... 191 Semi-critical medical devices ...... 193 Assembling the parts...... 194

Before using on patients again...... 194

184 Instructions for use Perseus A500 SW 1.1n Cleaning, disinfection and sterilization

Disassembly

Observe before disassembling CAUTION  Switch off the device and accessory devices Risk of injury due to breathing system heating and remove their mains plugs. When the breathing system heating is switched on, the bottom side of the breathing system and the heating plate beneath it can become very hot. Instructions for disassembly Allow the breathing system to cool off before To disassemble, follow the steps listed in removing. ''Preparation for an operation day / after cleaning and sterilization'' in reverse order, see page 54. 7 Remove the breathing system. – Remove the breathing system cover. – Turn the middle lever counterclockwise Sequence of disassembly about 120°. – Remove the assembled breathing system 1 Unscrew and dispose of sample line. vertically upwards from the breathing 2 Remove water trap. system mount. 3 Disassemble CO2 absorber: 8 Unscrew the CLIC adapter (optional).  CLIC absorber (single-use) 9 Remove the flow sensors. or – Loosen and pull out the expiratory port.  Reusable CO2 absorber: – Loosen and pull out the inspiratory port. – Remove the CO2 absorber from the – Remove the flow sensors. breathing system. – Remove and dispose of the soda lime dust filter. – Empty the CO2 absorber. – Remove the absorber insert from the absorber container. Leave the inner and outer sealing rings on the absorber insert. 4 Remove the breathing bag. 5 Remove the breathing circuit and the filter. 6 Unscrew the flexible arm for the breathing bag (optional).

Instructions for use Perseus A500 SW 1.1n 185 Cleaning, disinfection and sterilization

10 Remove the upper housing of the breathing Consult the appropriate instructions for use: system. – Turn the three levers counterclockwise Accessories and consumable parts about 120°. – Flow sensors – Lift off the upper housing of the breathing system. – CLIC adapter – CLIC absorber, Infinity ID CLIC absorber WARNING – Breathing hoses Risk of damage to breathing system – Filter If the APL valve is not removed before the – Breathing bag breathing system is reprocessed, this can lead to leakages in the breathing system. – Masks – Water trap Always remove the APL valve prior to reprocessing. – Vaporizer

11 Screw off the APL valve. Attached parts 12 Remove the non-return valves (red and blue). – Endotracheal suction 13 Remove the TurboVent 2 blower module. – Hinged arms NOTE – Monitors To prevent accidental penetration of soda lime – Sensors and cables into the breathing system, do not transport the – IT systems breathing system with a filled reusable CO2 – Vacuum connection adapter absorber. – Workstation light

Note on removable accessories, Single-use articles without instructions for use consumable parts, and attached parts – Soda lime dust filter – Sample line CAUTION Risk of injury to patients due to failure of WARNING accessories Risk of infection Disposable items have been designed, tested, Used sample lines may be infectious due to and manufactured exclusively for single use. the breathing gases that passed through Reuse, reprocessing or sterilization can result in them. failure of the accessory and injury to the patient. Replace the sample lines regularly, see Do not reuse, reprocess or sterilize disposable page 193, table ''Semi-critical medical items. devices''.

186 Instructions for use Perseus A500 SW 1.1n Cleaning, disinfection and sterilization

Reprocessing procedures

Manual disinfection: WARNING – Korsolex extra (3 %, 15 minutes) from Bode Risk of infection Chemie Use validated reprocessing procedures when Machine cleaning: reprocessing the device and accessories. – Neodisher MediClean from Dr. Weigert – Neodisher FA from Dr. Weigert Classification of medical devices Machine disinfection:

For reprocessing, the medical devices and their – Thermal, 93 °C (199.4 °F) for 10 minutes components are classified according to their type Sterilization: of application and the resulting risks: – Hot steam, 134 °C (273.2 °F) for 5 minutes – Non-critical medical devices: Surfaces accessible to the user and patient, e.g., device surfaces, cables Non-critical medical devices – Semi-critical medical devices: Parts carrying breathing gas, e.g., breathing hoses, masks Manual disinfection with simultaneous cleaning Tested procedures and agents When selecting a suitable disinfectant, adhere to the country-specific lists of disinfectants. The list of Cleaning, disinfection and sterilization have been the German Association for Applied Hygiene tested using the following procedures and agents. (Verbund für Angewandte Hygiene VAH) applies in The following agents showed good material German-speaking countries. compatibility and effectiveness at the time of the Strictly observe the manufacturer's information on test: the disinfectants. Manufacturers may change the composition of disinfectants over time.

Non-critical medical devices Manual disinfection with simultaneous cleaning: – Buraton 10 F from Schülke & Mayr – Dismozon pur from Bode Chemie – Mikrobac from Bode Chemie (for temperature measurement nozzles and pneumatic connections in the breathing system mount)

Semi-critical medical devices Manual cleaning: – Neodisher LM2 (2 %, 20 minutes) from Dr. Weigert

Instructions for use Perseus A500 SW 1.1n 187 Cleaning, disinfection and sterilization

Procedure: Procedure: 1 Remove soiling immediately with a cloth 1 Wash off soiling on surface under running soaked in disinfectant. water. 2 Use cleaning agents in accordance with WARNING manufacturer’s specifications. Risk of electric shock or device malfunction 3 Thoroughly swish the components back and Liquid that enters into the device can cause forth in the solution several times. Make sure the device to malfunction or may damage the that all surfaces and interior spaces to be device and endanger the patient. cleaned can be reached effectively. Use suitable brushes if necessary. Only scrub-and-wipe-disinfect device 4 Rinse components under running water until surfaces and cables and make sure no liquids cleaning agent residues are no longer penetrate into the device. discernible. 2 Perform surface disinfection by scrubbing and 5 Inspect components for visible soiling and wiping. damage. Repeat manual cleaning if necessary. 3 Remove disinfectant residues after the contact time has elapsed.

Special procedures for inspiratory/expiratory ports, the bag elbow, and housing openings in the lower Special procedures for the breathing system part of the breathing system: mount: 1 Brush the components for 1 minute and wait 1 Soak a disposable cloth in disinfectant or use a briefly. ready-to-use disposable cloth. 2 Repeat step 1 at least 1 time. 2 Wipe back and forth 3 times around the temperature measurement nozzles and WARNING pneumatic connections. Risk of faulty components 3 Repeat steps 1 and 2 4 times each. Manual cleaning and disinfection by brushing can wear out or destroy the components. Semi-critical medical devices After manual cleaning and disinfection of the lower part of the breathing system, check the silicone parts and incident flow grills (in the Manual cleaning insp. limb of the lower part of the breathing Running water and typical cleaning agents based system and in the expiratory port) for on mildly alkaline compounds are recommended intactness. for manual cleaning. Position of the incident flow grills, see chapter ''Manual disinfection''.

188 Instructions for use Perseus A500 SW 1.1n Cleaning, disinfection and sterilization

Manual disinfection 2 Repeat step 1 at least 1 time. Observe the applicable country-specific listings for the disinfectants. The list of the German A Association for Applied Hygiene (Verbund für Angewandte Hygiene VAH) applies in German- speaking countries. The composition of the disinfectant is the responsibility of the manufacturer and can change over time. Strictly observe the manufacturer's information on the disinfectants. Procedure: B 1 Disinfect components by immersing. Thoroughly swish the components back and

forth in the solution several times. Make sure 16356 that all surfaces and interior spaces to be 3 Flush the incident flow grills in the inspiratory disinfected can be disinfected effectively. Use limb of the lower part of the breathing system suitable brushes if necessary. (A) and in the expiratory port (B) 3 times with a 2 After the contact time has elapsed, rinse the disposable syringe. components under running water until disinfectant residue is no longer discernible. WARNING 3 Inspect components for visible soiling and Risk of faulty components damage. Repeat manual disinfection if Manual cleaning and disinfection by brushing necessary. can wear out or destroy the components. 4 Shake off all excess water. Allow components to dry thoroughly. After manual cleaning and disinfection of the lower part of the breathing system, check the silicone parts and incident flow grills (in the insp. limb of the lower part of the breathing Special procedures for inspiratory/expiratory ports, system and in the expiratory port) for the bag elbow, and housing openings in the lower intactness. part of the breathing system: 1 Brush the components for 1 minute and wait Machine cleaning and disinfection briefly. For machine cleaning and disinfection of components that conduct breathing-gas, use a washer-disinfector in accordance with ISO 15883, preferably with a cart for anesthesia and ventilation accessories.

Instructions for use Perseus A500 SW 1.1n 189 Cleaning, disinfection and sterilization

Procedure: WARNING 1 Strictly observe the instructions for use of the washer-disinfector. Risk due to flow measurement failure 2 Position components so that all interior spaces Deposits which are not removed during and surfaces are completely flushed and water reprocessing can damage the measuring can drain off freely. wires in the flow sensor or cause fire. – Perform regular visual inspections for 3 Use a suitable cleaning agent. dried mucus residues, drug aerosols and 4 Select a suitable program (preferably lint. anesthesia program). – Prevent contamination of the flow sensor – Cleaning is carried out at 40 °C to 60 °C due to particles in the disinfectant. (104 °F to 140 °F) for at least 5 minutes. – If deposits remain after reprocessing, or if – Thermal disinfection is carried out at 80 °C the flow sensor is damaged, replace the to 95 °C (176 °F to 203 °F) with flow sensor. corresponding contact time. 5 Carry out final rinsing with deionized water. Sterilization 6 Immediately remove the components from washer-disinfector. Sterilization eliminates living microorganisms from 7 Inspect components for visible soiling and semicritical medical devices and dries residual damage. If necessary, repeat the program or water in the interior of components. perform manual cleaning and disinfection.  Sterilize only components that have been 8 Allow components to dry thoroughly. cleaned or disinfected. For sterilization, use a vacuum steam sterilizer (in accordance with EN 285), preferably with Visual check fractional vacuum.

Check all parts for damage and external wear such as cracking, brittleness or severe hardening, and remnants of contamination.

WARNING Risk of faulty components Reusable accessory parts (e.g., when reprocessed) and removable device components also have a limited life span. Due to a number of factors associated with handling and reprocessing, (e.g., corrosive effects of disinfectant residues are greatly increased by autoclaving), wear can increase to distinctly reduce life span. Exchange any components exhibiting signs of external wear (e.g., cracks, deformation, discoloration, delamination).

190 Instructions for use Perseus A500 SW 1.1n Cleaning, disinfection and sterilization

Reprocessing list

Follow the guidelines of the healthcare facility concerning special procedures and agents for reprocessing, subject to the following criteria. The healthcare facility is responsible for specifying which individual components need reprocessing and how often. The following list is only for guidance.

Non-critical medical devices

Recommended repro- Manual Items which can be reprocessed cessing intervals Cleaning Disinfection Screen and device surfaces includ- After each patient Outside Outside ing: – Touch screen – Rotary knob – O2+ key –O2 switch on gas mixing unit (electronically controlled gas mixer) – Flow control valves – Table surface – APL valve – Grip bar under table – Drawer handles – Writing tray – Mounting rails on both sides – CLIC adapter – CLIC absorber, Infinity ID CLIC absorber

Instructions for use Perseus A500 SW 1.1n 191 Cleaning, disinfection and sterilization

Recommended repro- Manual Items which can be reprocessed cessing intervals Cleaning Disinfection Other surfaces which are frequently Daily Outside Outside touched: – Front side of device column – Side parts of the housings of the screen and of other patient monitors – Pressure gauge (optional) for the internal breathing system – Accessory parts: – Storage trays – Hinged arms – Probes of compressed gas hoses – Mains plug – Gas cylinder valves – Probe of AGS hose – Cables and hoses that lie on floor – Brake switch Breathing system mount Weekly Yes Yes (caution, do not (caution, do not allow fluid to pene- allow fluid to penetrate.) trate.) Surfaces which are touched less fre- Weekly Outside Outside quently: – Top side of trolley – Network cables and data cables – Compressed gas hoses – Pressure reducers – Gas cylinders – Outer and inner surfaces of drawers –AGS – Sensor unit and illumination when Vapor View option is installed

192 Instructions for use Perseus A500 SW 1.1n Cleaning, disinfection and sterilization

Semi-critical medical devices

Items which can be Recommended Prelimi- Machine Manual Steriliza- reprocessed reprocessing inter- nary cleaning Cleaning Disinfec- tion vals cleaning and disin- tion fection Breathing system: Weekly Yes Yes Possible Possible Possible – Housing (upper Minimum and lower housing) of 250 – Inspiratory/expira- steriliza- tory ports, APL tion valve cycles – Non-return valves (red and blue) – Bag elbow Circuit plug (on bag After each patient No No Yes Yes No elbow) Absorber container Weekly Yes Yes Possible Possible Possible and absorber insert Soda lime dust filter Replace after each No No No No No refilling of soda lime. Blower module As needed No No Only out- Only out- Yes TurboVent 2 side side Minimum of 60 sterilization cycles Sample line Replacement only – When the sample Daily line is fitted to the filter on the Y- piece. – When the sample After each patient No No No No No line is fitted directly to the Y-piece and the filters are fitted to the breathing system. Breathing system Weekly Yes No Only out- Only out- No mount side side Flexible arm for breath- Weekly Yes Yes Only out- No Yes ing bag (optional) side

Instructions for use Perseus A500 SW 1.1n 193 Cleaning, disinfection and sterilization

CAUTION Material damage due to disinfectants Disinfectants can damage the sample line, the water trap membranes and thus the patient gas measurement module. This may result in faulty measurements. Sample lines are single-use items and may not be disinfected.

Assembling the parts

Information on assembly, see ''Preparation for an operation day / after cleaning and sterilization'' on page 54.

Before using on patients again

1 Assemble the device components, see ''Preparation for an operation day / after cleaning and sterilization'' on page 54. 2 Check operational readiness, see ''Testing the system'' on page 103.

194 Instructions for use Perseus A500 SW 1.1n Maintenance

Maintenance

Overview...... 196

Inspection...... 196 Remote Service...... 197 Safety checks ...... 197 Preventive maintenance ...... 198 Table of maintenance intervals...... 198 Repairs ...... 199

Instructions for use Perseus A500 SW 1.1n 195 Maintenance

Overview

This chapter describes the maintenance measures WARNING required to maintain the proper functioning of the medical device. Maintenance measures must be Risk of electric shock performed by the personnel responsible. There are conducting components under the housing cover. WARNING – Do not remove the housing cover. Risk of infection – Maintenance measures must be performed by the personnel responsible. The responsible personnel may be infected Dräger recommends DrägerService for by pathogenic germs. repairs and complex maintenance tasks. Disinfect and clean device or device parts before any maintenance measures and also before returning the medical device for repair.

Definitions of maintenance terms

Term Definition Maintenance All measures (inspection, preventive maintenance, repair) intended to maintain and restore the functional condition of a medical device Inspection Measures intended to determine and assess the actual state of a medical device Service Recurrent specified measures intended to maintain the functional condition of a medical device Repair Measures intended to restore the functional condition of a medical device after a device malfunction

Inspection

Inspections must be carried out regularly according to the following guidelines and within the specified intervals. Technical documentation is available on request.

Checks Interval Responsible personnel Inspection and safety checks1) Every 12 months Service personnel

1) Designation applies to the Federal Republic of Germany; corresponds to the “Recurring safety inspection” in the Federal Republic of Austria

196 Instructions for use Perseus A500 SW 1.1n Maintenance

Remote Service – No visible damage on: – Trolley and housing parts Perseus supports the following Remote Service – Brakes functions: – Auxiliary power sockets – Help Ticket – Vaporizer mount – Remote Device Check – O-rings of the water trap mount – Proactive call – Screen Contact the responsible DrägerService –Gas inlets organization for further information on the Remote – Status display Service function. – Breathing system –AGS Safety checks – Holding arms – Hoses and cables The safety checks are no substitute for service – Strain reliefs for AGS, compressed gas measures indicated by the manufacturer, including hoses, cables the preventive replacement of wearing parts. – Pressure reducers and their sensor lines WARNING – Fuses which are accessible from the Perform safety checks at the indicated outside are in compliance with the specified intervals. Otherwise, operation of the medical values device may be compromised. – Country-specific labeling of gas types – Check the end stop of the holding arms for 1 Check the accompanying documents: patient monitors. – Latest instructions for use are available 4 Check for electrical safety in compliance with 2 Check the following functions according to the IEC 62353. instructions for use: 5 Check safety features: – Emergency O2 delivery – function of optical and acoustic alarm 3 Verify that the device combination is in good generators condition: –O2 switch on gas mixing unit (electronically – Labels are complete and legible controlled gas mixer) – Internal battery 6 Check the accuracy of the gas measurement based on a certified test gas concentration: – Anesthetic gas measurement: Isoflurane, 1 Vol% Sevoflurane, 1 Vol% Accuracy ±0.35 Vol% –N2O measurement, 70 Vol% Accuracy ±7.6 Vol% –CO2 measurement, 5 Vol% Accuracy ±0.83 Vol%

Instructions for use Perseus A500 SW 1.1n 197 Maintenance

7 Check the accuracy of the O2 measurement: 10 Check the non-return valve of the central gas – Ambient air 21 Vol% supply for leakage: Accuracy ±3 Vol% – Leakage ≤20 mL/min –100 Vol% 11 Check the accuracy of the pressure gauge Accuracy –5 Vol% (optional) for the internal breathing system: 8 Check the sampling rate of the patient gas – Accuracy 30 hPa (cmH2O) ±10 hPa measurement module: (cmH2O) – Accuracy 200 ±20 mL/min 12 Check the function of the minimum O2 delivery 9 Check the patient gas measurement module (mechanically controlled gas mixer). for leakage: 13 Check the external cylinder pressure reducers – Leakage at –200 hPa (cmH2O) (optional): – <20 hPa/min (cmH2O/min) – Annually: Relief valve 7.5 to 8 kPa x 100 – Every 6 years: output pressure 5 to 6 kPa x 100

Preventive maintenance

WARNING WARNING Risk of faulty components Risk of electric shock Device failure is possible due to wear or Before performing any service work, material fatigue of the components. disconnect all electrical connections and gas connections from power and gas supplies. To maintain the function of all components, this device must be inspected and serviced at the intervals specified by the manufacturer.

Table of maintenance intervals

Component Interval Task Responsible personnel CO2 absorber / soda If colored violet or Replace, see page 65 Users lime with soda lime dust according to the config- filter ured Infinity ID exchange interval Water trap If required, if soiled, or Replace, see page 66 Users according to the configured Infinity ID exchange interval

198 Instructions for use Perseus A500 SW 1.1n Maintenance

Component Interval Task Responsible personnel Flow sensors If required, if calibration Replace, see page 159 Users is no longer possible, or according to the configured Infinity ID exchange interval AGS If required, if filter is Replace, see page 161 Users soiled, or flow is no longer achieved AGS filter If required, if filter is Replace Service personnel soiled, or flow is no longer achieved Sample gas return filter Every 2 years Replace Service personnel O-rings on the water trap Every 2 years Replace Service personnel mount Sealing, sieve insert, Every 3 years Replace Experts and sintered filter on the cylinder connection of the external cylinder pressure reducer (optional) Air filter mat Every 3 years Replace Service personnel – Patient gas measurement module – Power supply unit CLIC adapter (optional) Every 4 years Replace Users Diaphragm unit, valve Every 6 years Replace Experts cone, discharge valve, and safety valve spring of the external cylinder pressure reducer (optional) Lead-gel battery Every 2 years Replace Service personnel (2 pieces) Or after determination of Replace Experts remaining capacity

Repairs

Dräger recommends that all repairs are carried out by DrägerService and that only authentic Dräger repair parts are used.

Instructions for use Perseus A500 SW 1.1n 199 Disposal

Disposal

Disposing of the medical device...... 201 For countries subject to the EU Directive 2002/96/EC ...... 201 Disposing of accessories ...... 201

200 Instructions for use Perseus A500 SW 1.1n Disposal

Disposing of the medical device

For countries subject to the EU WARNING Directive 2002/96/EC Risk of infection The device and its components must be This device is subject to EU Directive 2002/96/EC disinfected and cleaned before disposal! (WEEE). In order to comply with its registration according to this directive, this device may not be At the end of its service life: disposed of at municipal collection points for waste electrical and electronic equipment. Dräger has  Have the medical device appropriately authorized a company to collect and dispose of disposed of in accordance with applicable laws this device. To initiate collection or for further and regulations. information, visit Dräger on the Internet at www.draeger.com. Use the search function with the keyword "WEEE" to find the relevant information. If access to the Dräger website is not possible, contact the local Dräger organization.

Disposing of accessories

When disposing of the following accessory parts, observe the hospital hygiene regulations and the respective instructions for use: – Flow sensors – Breathing hoses – Filter, HME, HMEF – Breathing bag – Masks – Water trap – CLIC absorber, Infinity ID CLIC absorber – Soda lime Dispose on the following articles according to hospital hygiene regulations: – Sample line – Soda lime dust filter –AGS

Instructions for use Perseus A500 SW 1.1n 201 Technical data

Technical data

General information ...... 203 Reduced safety clearance for portable and mobile high-frequency communication Ambient conditions...... 203 equipment...... 232 Emission of high-frequency energy...... 233 Fresh-gas delivery...... 204 Device combinations ...... 233 Fresh-gas delivery (electronically controlled gas mixer) ...... 204 Connections to IT networks ...... 234 Fresh-gas delivery (mechanically Information on connecting to the network ...... 234 controlled gas mixer) ...... 205 Software license compliance (optional)...... 236 Ventilator...... 205

Breathing system ...... 207

External fresh-gas outlet ...... 209

Anesthetic gas receiving system...... 209

Measurement systems and displays ...... 210

Display of calculated values ...... 215

Operation characteristic values...... 217

Device outlets ...... 221

Relevant standards ...... 223

Diagrams ...... 226 Pressure characteristics and flow characteristics of a breathing system without breathing hoses and filters (conforming to ISO 8835-2 and ISO 80601-2-13) ...... 226 Response times in event of concentration changes...... 227 Flow characteristic curves for pressure reducers ...... 228 EMC declaration ...... 229 General information...... 229 Electromagnetic transmission ...... 230 Electromagnetic immunity ...... 230 Recommended safety clearance for portable and mobile high-frequency communication equipment...... 232

202 Instructions for use Perseus A500 SW 1.1n Technical data

General information

Units of measurement for pressure 1 hPa = 1 mbar = 1 cmH2O 100kPa = 0.1MPa = 1bar = 1kPa x 100 User's operating location At the front at a distance of 1 m (39 in) and a height of 1.5 m (59 in) All specified tolerances apply for 20 °C (68 °F), 60 % relative humidity, and 1013 hPa (760 mmHg). The accuracies indicated below change according to ambient pressure, temperature, and relative humidity. If one of the ambient conditions is changed up to the permissible limit, the accuracy of the corresponding value can change by up to 50 %. If more than one of the ambient conditions are changed, the accuracy may change by up to 100 %. Example: Accuracy of a measured pressure value: ±4 % under standard conditions. At 10 °C, the accuracy changes to ±6 %; at 10 °C and 20 % relative humidity, to ±8 %. All patient-related volumes and flow values are standardized to the conditions in the lung. (BTPS)

Ambient conditions

During operation Temperature 10 to 40 °C (50 to 104 °F) Ambient pressure 620 to 1060 hPa (9.0 to 15.3 psi) Relative humidity 20 to 95 %, without condensation CO2 concentration 300 to 1000 ppm Altitude Up to 4000 m (13123 ft) During storage and transport Temperature Device without battery -20 °C to 60 °C (-4 °F to 140 °F)

Instructions for use Perseus A500 SW 1.1n 203 Technical data

Ambient conditions (continued)

Battery –15 °C to 40 °C (5 °F to 104 °F) For storage longer than 12 months –15 °C to 25 °C (5 °F to 77 °F) Maximum storage duration without 180 days recharging Ambient pressure 500 to 1060 hPa (7.3 to 15.3 psi) Relative humidity 10 to 95 %, without condensation CO2 concentration Not relevant The permissible ambient conditions depend on the accessories used. Observe related instructions for use.

Fresh-gas delivery

All data are standardized to STPD conditions. O2 flush 25 to 75 L/min at 2.7 to 6.9 kPa x 100 (39 to 100 psi) supply pressure O2 flow for Aux. O2 and Add. O2 Range Off; 2 to at least 10 L/min at 2.7 kPa x 100 (39 psi) supply pressure Accuracy ±10 % of the set value for flows >2.0 L/min Resolution of displayed value 1.0 L/min (up to 10 L/min) 5.0 L/min (above 10 L/min)

Fresh-gas delivery (electronically controlled gas mixer)

All data are standardized to STAPD conditions. O2 concentration FG O2 21 to 100 Vol% (carrier gas Air); 25 to 100 Vol% (carrier gas N2O) ±5 % or ±2 Vol% (the larger value applies) Fresh-gas flow FG flow Off; 0.2 to 15 L/min; ±10 % or ±50 mL/min (the larger value applies)

204 Instructions for use Perseus A500 SW 1.1n Technical data

Fresh-gas delivery (mechanically controlled gas mixer)

All data are standardized to STAPD conditions. O2 concentration FG O2 21 to 100 Vol% Setting range for fresh-gas flow (FG flow) 0 to at least 12 L/min volumetric per gas (O2, Air and N2O) Electronic measurement of fresh-gas flow (FG flow) Range 0 to 15 L/min (O2, Air and N2O) Accuracy ±10 % or ±0.12 L/min (the larger value applies) Resolution of the value displayed on the 0.01 L/min (from 0 to 0.2 L/min) screen 0.02 L/min (from 0.2 to 0.5 L/min) 0.05 L/min (from 0.5 to 1 L/min) 0.1 L/min (from 1 to 15 L/min) Resolution of the value displayed in the sta- 0.1 L/min (from 0 to 15 L/min) tus display Total flow tube All data are standardized to STPD conditions. Range 0 to 10 L/min Accuracy ±10 % of the set value at 100 % O2 and for flows >1 L/min Resolution of displayed value 0.5 L/min

Ventilator

Time-based settings Respiratory rate RR 3 to 100 /min ±10 % of the set value or ±1 /min (the larger value applies) Respiratory rate during apnea ventilation Off, 3 to 25 /min RRapn ±10 % of the set value or ±1 /min (the larger value applies) Inspiratory time Ti 0.2 to 10 s ±10 % of the set value or ±100 ms (the larger value applies) Maximum inspiratory time for supported breaths (fixed setting) Patient category "adult" 4 s or 1 / (2 x RRapn) (the smaller value applies)

Instructions for use Perseus A500 SW 1.1n 205 Technical data

Ventilator (continued)

Patient categories "pediatric patient" and 1.5 s or 1 / (2 x RRapn) (the smaller value "neonate" applies) Pressure rise time (Slope) 0 to 2 s; ±20 % of the set value or ±200 ms (the larger value applies) Ratio of inspiratory time to expiratory time 1:50 to 50:1 Time at upper pressure level (Thigh) in 0.2 to 10 s Pressure Control - APRV mode ±10 % of the set value or ±100 ms (the larger value applies) Time at lower pressure level (Tlow) in Pres- 0.2 to 10 s sure Control - APRV mode ±10 % of the set value or ±100 ms (the larger value applies) Inspiration termination criterion (Insp. term.) 5 to 80 %PIF ±20 % of the set value or ±2.5 L/min (the larger value applies) Percentage ratio of plateau time to the inspi- 20 to 60 % ratory time in Volume Control - CMV ±20 % of the set value or ±200 ms (the larger mode (%Tplat) value applies) Volume-based and flow-based settings Tidal volume VT 20 to 2000 mL standardized to BTPS conditions ±10 % of set value or ±15 mL (the larger value applies) The applied VT is corrected by the determined breathing hose compliance. The applied VT is also corrected by the sampling flow of the built- in patient-gas measurement module as soon as CO2 respiratory phases are detected. Trigger sensitivity Trigger sens. 0.3 to 15 L/min ±20 % of the set value or ±1 L/min (the larger value applies) Inspiratory flow Flow for adults Minimum 1 L/min, maximum >180 L/min Results from the VT / Pinsp and Ti settings Inspiratory flow Flow for children and neo- Minimum 1 L/min, maximum 60 L/min nates Results from the VT / Pinsp and Ti settings Pressure-related settings Inspiratory pressure Pinsp PEEP +1 to 80 hPa (cmH2O); ±10 % of the set value or ±2 hPa (cmH2O) (the larger value applies)

206 Instructions for use Perseus A500 SW 1.1n Technical data

Ventilator (continued)

Pressure limitation Pmax PEEP +5 to 80 hPa (cmH2O); ±10 % of the set value or ±3 hPa (cmH2O) (the larger value applies) Lower pressure level Plow in APRV mode Off, 2 to 35 hPa (cmH2O); ±10 % of the set value or ±2 hPa (cmH2O) (the larger value applies) Upper pressure level Phigh in APRV mode Plow +1 to 80 hPa (cmH2O); ±10 % of the set value or ±2 hPa (cmH2O) (the larger value applies) Pressure amplitude above PEEP: ∆Psupp In CPAP/Pressure Support and Pres- Off, 1 to (80 - PEEP) hPa (cmH2O), sure Control - BIPAP / PS mode ±10 % of the set value or ±2 hPa (cmH2O) (the larger value applies) In Volume Control - SIMV / AF / PS Off, 1 to (Pmax - PEEP) hPa (cmH2O); mode ±10 % of the set value or ±2 hPa (cmH2O) (the larger value applies) Positive end-expiratory pressure PEEP Off, 2 to 35 hPa (cmH2O); ±10 % of the set value or ±2 hPa (cmH2O) (the larger value applies) Continuous positive pressure CPAP Off, 2 to 35 hPa (cmH2O); ±10 % of the set value or ±2 hPa (cmH2O) (the larger value applies) Minimum pressure limit as per ISO 8835-5 0 hPa (cmH2O); and ISO 80601-2-13

Breathing system

Total volume including the disposable CO2 absorber CLIC Absorber Free In MAN / SPON mode Typically 2.18 L In automatic ventilation modes Typically 2.18 L Compliance (without breathing circuit) In MAN / SPON mode Typically 2.18 mL/hPa (mL/cmH2O) In automatic ventilation modes Typically 0.28 mL/hPa (mL/cmH2O) Volume of absorber container Reusable CO2 absorber, filled 1.5 L

Instructions for use Perseus A500 SW 1.1n 207 Technical data

Breathing system (continued)

Disposable CO2 absorber CLIC absorber 1.3 L 800+ Disposable CO2 absorber CLIC absorber 1.2 L Free Flexible arm for breathing bag Volume 0.13 L Compliance 0.13 mL/hPa (mL/cmH2O) Total system leakage <150 mL/min at 30 hPa (cmH2O) standardized to BTPS conditions APL valve Setting range Open, 5 to 70 hPa (cmH2O) Accuracy (in range from 15 to 30 L/min): ±20 % of the set value or ±3 hPa (the larger value applies), but not more than +10 hPa (cmH2O) Breathing system resistance at 60 L/min (reusable CO2 absorber or disposable CO2 absorber, with or without flexible arm for breathing bag, normal operation, filled with Drägersorb 800 Plus) According to ISO 8835-2, dry, with adult Inspiratory: –3.5 hPa (cmH2O) breathing hose set M30146 Expiratory: 4.1 hPa (cmH2O) According to ISO 8835-2, dry, without hoses Inspiratory: –1.1 hPa (cmH2O) Expiratory: 3.4 hPa (cmH2O) Recommendation for breathing hoses All compliances, resistances, and volumes indicated include inspiratory and expiratory filters VT= 20 to 100 mL Maximum compliance: 2.0 mL/hPa (mL/cmH2O) Maximum resistance: 6 hPa (cmH2O) at 15 L/min VT= 50 to 300 mL Maximum compliance: 4.0 mL/hPa (mL/cmH2O) Maximum resistance: 6 hPa (cmH2O) at 30 L/min VT= 200 to 2000 mL Maximum compliance: 6.0 mL/hPa (mL/cmH2O) Maximum resistance: 6 hPa at 60 L/min Maximum length 200 cm (78.7 in) 350 cm (137.8 in) (with restrictions for compliance correction and pressure metering accuracy)

208 Instructions for use Perseus A500 SW 1.1n Technical data

Breathing system (continued)

Maximum hose volume 1.6 L 2.7 L (with restrictions for compliance correction and pressure metering accuracy) Recommendation for a breathing bag hose if no flexible arm is in use. Maximum resistance 1.5 hPa (cmH2O) at 60 L/min 3 hPa (cmH2O) at 60 L/min with increased fresh-gas consumption Maximum length 180 cm (70.9 in) 350 cm (137.8 in) with increased fresh-gas consumption Maximum hose volume 0.7 L 0.9 L with increased fresh-gas consumption Recommendation for the bag size Volume 0.5 L to 5 L (should have at least double the applied tidal volume)

External fresh-gas outlet

Connection 22 mm outer taper / 15 mm inner taper (ISO) Delivery See "Fresh-gas delivery" Pressure limitation Not pressure-limited

Anesthetic gas receiving system

Suction flow Normal range 32 to 50 L/min At lower end of restricted range 14 L/min Maximum fresh-gas flow to prevent contaminating ambient air For external breathing systems (normal 16 L/min range) For external breathing systems (restricted 5L/min range)

Instructions for use Perseus A500 SW 1.1n 209 Technical data

Anesthetic gas receiving system (continued)

For internal breathing systems (restricted 7L/min range)

Measurement systems and displays

As Perseus uses more accurate values for alarming and internal calculation, small devia- tions due to rounding may occur. Airway pressure Airway pressure Paw Plateau pressure Pplat Positive end-expiratory pressure PEEP Peak inspiratory pressure PIP Mean airway pressure Pmean Range –20 to +120 hPa (cmH2O) Accuracy ±4 % of the measured value or ±2 hPa (cmH2O) (the larger value applies) Resolution of displayed value 1 hPa (cmH2O) Pressure gauge for indicating the pressure in the internal breathing system Range –20 to +80 hPa (cmH2O) Accuracy ±5 % of the measured value or ±2 hPa (cmH2O) (the larger value applies) Resolution of displayed value 5 hPa (cmH2O) Volume Measured volumes are corrected by the determined breathing hose compliance. The measured volumes are also corrected by the sampling flow of the built-in patient-gas measurement module as soon as CO2 respiratory phases are detected. Tidal volume Inspiratory VTi Expiratory VT

210 Instructions for use Perseus A500 SW 1.1n Technical data

Measurement systems and displays (continued)

Range 0 to 2500 mL Accuracy ±8 % of measured value or ±15 mL (the larger value applies) Resolution of displayed value 1 mL ∆VT Range 0 to 2500 mL Accuracy ±16 % of measured value or ±30 mL (the larger value applies) Resolution of displayed value 1 mL Minute volume Total MV Mandatory MVmand Spontaneous MVspon Range 0 to 40 L/min Accuracy ±8 % of measured value or ±0.2 L (the larger value applies) Resolution of displayed value 0.1 L T0...90 <45 s (RR ≥6/min) <105 s (RR <6/min) Low-flow wizard Range 0 to 8 L/min Accuracy ±25 % of measured value or ±100 mL/min (the larger value applies) Respiratory rate Total RR Spontaneous RRspon Mandatory RRmand Range 0 to 150/min Accuracy ±1 /min or 10 % (the larger value applies) Resolution of displayed value 1/min T0...90 <45 s (RR ≥6/min) <105 s (RR <6/min) Compliance Cdyn Range 0 to 200 mL/hPa (mL/cmH2O)

Instructions for use Perseus A500 SW 1.1n 211 Technical data

Measurement systems and displays (continued)

Accuracy ±30 % or ±3 mL/hPa (mL/cmH2O) (the larger value applies) Resolution of displayed value 0.1 mL/hPa (mL/cmH2O) Resistance R Range 0 to 100 hPa / (L/s) (cmH2O / (L/s)) Accuracy ±3 hPa / (L/s) ( cmH2O / (L/s)) or ±30 % of measured value (the larger value applies) (With increasing spontaneous breathing activity, the R values may be greatly distorted. Hence maintaining measurement accuracy cannot be guaranteed with spontaneous breathing). Resolution of displayed value 1 hPa / (L/s) (cmH2O / (L/s)) Elastance E Range 0.005 to 10 hPa/mL (cmH2O/mL) Resolution of displayed value 0.001 hPa/mL (cmH2O/mL) Gas measurement Sidestream gas measurement (The sample gas is fed back into the breathing system and included in calculations for measurements and delivery); All values are measured under ATPS conditions; Sample flow standardized to STPD conditions. The measurement is corrected for ambient pressure. Due to the T10...90 time and the sampling rate, the accuracies of the measured values for O2, N2O, and anesthetic agent may deviate at respiratory rates of 75 /min or higher and an I:E ratio of 1:2. The influence of respiratory rate and the I:E ratio on the accuracy has been verified in a simulated breathing system using a rectangular waveform for the gas concentration. Endtidal measured values are calculated for each breath from the local maxima and minima of the real-time measurements during expiration. Sample flow 200 mL/min ±10 % Maximum time until emptying of the water 41 h (sample gas under BTPS conditions at trap is necessary 23 °C ambient temperature)

212 Instructions for use Perseus A500 SW 1.1n Technical data

Measurement systems and displays (continued)

System response time The system response time results from the typical delay and the gas type specific T10...90 time. Sensor sampling rate <50 ms Time after switch-on until the specified accu- <500 s racy is attained Time until CO2 measured values are dis- 95 s played with reduced accuracy Typical delays <5 s Cross sensitivity None concerning alcohol (<3000 ppm in blood), acetone (<1000 ppm), methane, water vapor, NO, and CO Drift Compensated by automated cyclic zeroing Ambient air is fed into the breathing system during automatic zeroing O2 Range 0 to 100 Vol% Accuracy ±(2.5 Vol% + 2.5 % relative) Resolution of displayed value 1 Vol% T10...90 <500 ms CO2 Range 0 to 13.6 Vol% 0 to 13.6 kPa 0 to 102.0 mmHg Accuracy ±(0.43 Vol% + 8 % relative) ±(3.3 mmHg + 8 % relative) Resolution of displayed value 0.1 Vol% 0.1 kPa 1 mmHg T10...90 <350 ms N2O Range 0 to 100 Vol% Accuracy ±(2 Vol% + 8 % relative) Resolution of displayed value 1 Vol% T10...90 <500 ms Anesthetic gases Range

Instructions for use Perseus A500 SW 1.1n 213 Technical data

Measurement systems and displays (continued)

Halothane 0 to 8.5 Vol% Isoflurane 0 to 8.5 Vol% Enflurane 0 to 10 Vol% Sevoflurane 0 to 10 Vol% Desflurane 0 to 20 Vol% Accuracy ±(0.2 Vol% +15 % relative) Resolution of displayed value 0.1 Vol% for desflurane 0.01 Vol% for all other anesthetic gases T10...90 <500 ms Detection Automatic Primary gas At the latest at 0.3 Vol% Secondary gas At the latest at 0.4 Vol% or 0.1 xMAC (the larger value applies) With a desflurane concentration greater than 4 Vol%, mixture detection occurs at the latest when the concentration of the second anesthetic gas rises above 10 % of the desflurane concentration. The secondary gas becomes the primary gas when the expiratory xMAC value is more than 0.2 xMAC above the primary gas. Minimum displayed concentration The specified detection thresholds refer to rising anesthetic gas concentrations (e.g., at the start of an operation). If the anesthetic gas concentration falls, a concentration of down to 0.05 Vol% will be measured, based on the last anesthetic agent detected. Below this concentration, a value of 0 Vol% will be displayed. xMAC Based on patient age, anesthetic agent, and nitrous oxide concentration Range 0 to 9.9 Accuracy Corresponds to accuracy of the gas measurement Resolution of displayed value 0.1 Measurement of gas supply pressures Central supply Range 0 to 9.8 kPa x 100 (0 to 140 psi)

214 Instructions for use Perseus A500 SW 1.1n Technical data

Measurement systems and displays (continued)

Accuracy ±4 % or ±0.2 kPa x 100 (the larger value applies) ±4 % or ±3 psi (the larger value applies) Resolution of displayed value 0.1 kPa x 100 1psi Gas cylinders Range 0 to 250 kPa x 100 (0 to 3600 psi) Accuracy ±4 % or ±6 kPa x 100 (the larger value applies) or ±4 % or ±87 psi (the larger value applies) Resolution of displayed value 1 kPa x 100 1psi Test results Total leakage Range 10 to 5000 mL/min Resolution of displayed value 1 mL/min Leakage in automatic ventilation

Range 10 to 5000 mL/min Resolution of displayed value 1 mL/min Hose compliance Compliance

Range 0 to 9.9 mL/hPa (mL/cmH2O)

Resolution of displayed value 0.1 mL/hPa (mL/cmH2O)

Display of calculated values

Measurement of consumption and production CO2 production of the patient Range 0 to 9999 mL/min Accuracy ±25 % or 100 mL/min (the larger value applies) Resolution of displayed value 1 mL/min O2 uptake of the patient Range 0 to 9999 mL/min

Instructions for use Perseus A500 SW 1.1n 215 Technical data

Display of calculated values (continued)

Accuracy ±25 % or 100 mL/min (the larger value applies) Resolution of displayed value 1 mL/min Fresh-gas consumption Range 0 to 99999 L, only gas delivered by the gas mixer is measured Accuracy ±15 % Resolution of displayed value 1 L Anesthetic agent Range 0 to 3000 mL liquid Accuracy ±25 % Resolution of displayed value 0.1 mL Real-time waveforms O2 concentration Primary anesthetic gas concentration CO2 concentration Airway pressure Volume Flow Sweep speed 6.25; 12.5; 25 mm/s Scale Airway pressure Paw (t) –20 to 80 hPa (cmH2O) Flow (t) –120 to 120 L/min Volume (t) 0 to 2000 mL O2 (t) 0 to 100 Vol% CO2 (t) 0 to 100 mmHg (0 to 12 Vol%, 0 to 12 kPa) Anesthetic agent (t) Halothane 0 to 5 Vol% (kPa) Enflurane 0 to 6 Vol% (kPa) Isoflurane 0 to 5 Vol% (kPa) Sevoflurane 0 to 10 Vol% (kPa) Desflurane 0 to 20 Vol% (kPa) Loops Volume/pressure Flow/volume

216 Instructions for use Perseus A500 SW 1.1n Technical data

Operation characteristic values

Mains power supply Electrical mains connection Without isolation transformer 100 to 240 V~ 50/60 Hz With isolation transformer 100 to 127 V~ 50/60 Hz or 220 to 240 V~ 50/60 Hz Maximum power consumption 12 A Power cable Maximum length 5 m (16.4 ft) Protective ground resistance Maximum 0.1 ohm Operating voltage ≥250 V Operating current ≥16 A Power consumption At 230 V~ Standby 0.30 A Typical (without charging the internal 0.35 A battery) Maximum (with auxiliary power sock- 12 A ets) At 110 V~ Standby 0.55 A Typical (without charging the internal 0.65 A battery) Maximum (with auxiliary power sock- 12 A ets) Power consumption Standby 55 W Typical 70 W Maximum 2.2 kW Inrush current With isolation transformer Approximately 26 to 48 A peak Approximately 18 to 34 A quasi-RMS Without isolation transformer Approximately 8 to 14 A peak Approximately 6 to 10 A quasi-RMS

Instructions for use Perseus A500 SW 1.1n 217 Technical data

Operation characteristic values (continued)

Internal battery Type Lead-gel battery Sealed, maintenance-free Capacity 7.2 Ah Voltage 24 V Fuse F15A 80V UL248 Current Maximum 15 A Backup time with new and fully charged battery Minimum 30 minutes Typical 150 minutes Charging time (to reach full power) At least 8 hours Charging power Maximum 50 W Gas supply Gas quality Oil content <0.1 mg/m3 Dew point 5 °C (41 °F) at ambient temperature Particle size Dust-free air (filtered with pore size <1 μm) Supply pressure for O2, Air, N2O 2.7 to 6.9 kPa x 100 (or 39 to 100 psi) Maximum short term peak inlet flows at 6.9 kPa x 100 (or 100 psi) supply pressure O2 135 L/min Air Without suction unit 50 L/min Including a directly connected Dräger 130 L/min ejector suction unit N2O40L/min Drive gas Not needed Gas supply connection Depending on configuration: DIN, NIST, DISS, Air Liquide, SIS Gas cylinders (dimensions) Diameter 100 to 140 mm (3.94 to 5.51 in)

218 Instructions for use Perseus A500 SW 1.1n Technical data

Operation characteristic values (continued)

Maximum height 830 mm (32.68 in) 750 mm (29.52 in) for versions with hanger yokes for gas cylinders with pin-index connection Pressure reducers Version Single-stage pressure reducers Permissible inlet pressure range (PV) Air, O2 11 to 200 kPa x 100 N2O 11 to 60 kPa x 100 Nominal outlet pressure (PA) Fixed setting See "Flow characteristics" Due to design, outlet pressure rises as cylinder pressure falls. Air, O2 With pre-pressure PV = 11 kPa x 100 4.75 kPa x 100 ±50 kPa and nominal flow QN = 80 L/min With pre-pressure PV = 200 kPa x 4.55 kPa x 100 ±50 kPa 100 and nominal flow QN = 80 L/min N2O With pre-pressure PV = 11 kPa x 100 5.2 kPa x 100 ±50 kPa and nominal flow QN = 65 L/min With pre-pressure PV = 60 kPa x 100 4.95 kPa x 100 ±50 kPa and nominal flow QN = 65 L/min Nominal flow Air, O2 QN = 80 L/min N2OQN = 65 L/min Performance data See "Flow characteristics" Relief valve Opening pressure (7.5+0.5) kPa x 100 Minimum flow 220 L/min Air Input connections Complying with either EN 850, ISO 407 DIN 477 T1 NF E 29-650 BS 341; Part 1 NBN 226

Instructions for use Perseus A500 SW 1.1n 219 Technical data

Operation characteristic values (continued)

Noise emissions from device Free field measurements complying with ISO 3744 Average sound pressure level Leq(A) during ≤42 dB(A) ventilation with typical settings Sound pressure level L(A) of the alarm tones at the workstation, measured according to IEC 60601-1-8 Edition 2.1: Alarm tone sequence IEC Alarm tone volume (high priority) Settable from approximately 52 dB(A) to 70 dB(A) Alarm tone volume (medium priority) Settable from approximately 51 dB(A) to 69 dB(A) Alarm tone volume (low priority) Settable from approximately 50 dB(A) to 68 dB(A) Auxiliary alarm ≥55 dB(A) and ≤75 dB(A) Mains supply failure alarm ≥55 dB(A) and ≤75 dB(A) Dimensions (can deviate with accessory equipment) Width 1150 mm (45.23 in) Altitude 1480 mm (58.27 in) Depth 790 mm (31.1 in) Weight Nominal configuration consisting of trolley approx. 160 kg (353 lbs) version with isolation transformer, electronic 3-gas gas mixer, screen mounted centrally on the column, plug-in connections for 2 vaporizers, Vapor View option, breathing system, CLIC adapter and CLIC absorber, breathing hoses, central supply hoses (5 m (16.4 ft)), suction hose (5 m (16.4 ft)) Various attached parts (e.g., baskets, flexi- approx. 10 kg (22 lbs) ble breathing bag holder, handles, vaporizer parking holders, cylinder pressure reducers, cylinder holders) Hanger yokes with pin-index connection + approximately 3 kg (7 lbs) Plug-in connection for 3 vaporizers with + approximately 3 kg (7 lbs) Vapor View option Mechanically controlled gas mixer + approximately 3 kg (7 lbs)

220 Instructions for use Perseus A500 SW 1.1n Technical data

Operation characteristic values (continued)

Drawer module (standard) + approximately 12 kg (26 lbs) Drawer module (large) + approximately 16 kg (35 lbs) Endotracheal suction with swivel arm and + approximately 6 kg (13 lbs) accessories Permissible total weight approx. 330 kg (728 lbs) Electromagnetic compatibility in compliance Tested in compliance with IEC 60601-1-2 with Directive 89/336/EEC Protection classes Device I, in compliance with IEC 60601-1 Applied parts (connections for breathing TYPE BF hoses) Penetration of liquids IP20 in compliance with IEC 60529, fulfills IEC 60601-2-13 Classification in compliance with Directive II b 93/42/EEC, Annex IX UMDNS Code Universal Medical Device 10-134 Nomenclature System - nomenclature system for medical devices GMDN Code Global Medical Device Nomencla- 37710 ture - worldwide nomenclature for medical devices Use of latex Perseus is not made with natural rubber latex.

Device outlets

Serial ports COM 1 and COM 2; Only connect devices that meet the requirements of IEC 60950-1 for ungrounded SELV circuits and the requirements of IEC 60601-1 (as of the 2nd edition) for touchable secondary circuits with a maximum nominal voltage of 24 VDC. Protocol MEDIBUS.X Alarm delay time Typically <2 s Connector 9-way Sub-D Baud rate 1200, 2400, 4800, 9600, 19200, 38400 baud

Instructions for use Perseus A500 SW 1.1n 221 Technical data

Device outlets (continued)

Data bits 8 Parity Even Stop bits 1 Pin assignment Pin 1 n/c Pin 2 RXD Pin 3 TXD Pin 4, 6 Pins 4 and 6 are connected internally Pin 5 SHLD-GND Pin 7, 8 Pins 7 and 8 are connected internally Pin 9 n/c Housing SHLD-GND USB interface Only connect passive storage media, i.e. devices that do not have a separate power supply. Type USB type A plug; USB 1.1 Supported devices USB flash drive from list of accessories formatted with FAT16 and FAT32 LAN interface Only for Dräger Remote Service Only connect devices and/or networks that meet the requirements of IEC 60950-1 for ungrounded SELV circuits and the requirements of IEC 60601-1 (as of the 2nd edition) for touchable secondary circuits with a maximum nominal voltage of 24 VDC. Type RJ45 plug Transfer speed 10BASE-T, IEEE 802.3 Clause 14. Requires at least a CAT3 cable. Connection for external workstation light Only for workstation lights approved by Dräger, (optional) see "List of accessories". Mains power sockets Observe maximum current per power socket, total current for all power sockets, and permissible total leakage current. Mains power sockets have no battery back-up and are independent from the device switching status. Power sockets (version without isolation transformer)

222 Instructions for use Perseus A500 SW 1.1n Technical data

Device outlets (continued)

Power socket type IEC Power sockets with protective ground 2 (maximum 3.15 A per power socket) Power sockets without protective ground 2 (maximum 1 A per power socket) Fuse type Fuses, T3,15AH250V IEC 60127-2/V and T1AH250V IEC 60127-2/V, size 5 mm * 20 mm Power sockets (version with isolation transformer) Power socket type Country-specific Fuse type Electronic automatic circuit breakers: 4 x 3 A, slow-blow fuse, for voltages up to 250 V and breaking capacity 2000 A. And 1 x 8 A, slow-blow fuse, for voltages up to 250 V and breaking capacity 2000 A, in each case conforming to IEC 60934 Power sockets with protective ground 4 (maximum 3 A per power socket) Total current Maximum 8 A Main switch for isolation transformer and all power sockets

Relevant standards

In addition to the standards listed here, this medical device meets various other standards, e.g., standards concerning special national requirements.

IEC 60601-1 2nd ed. Part 1: Medical electrical equipment General requirements for safety

IEC 60601-1-2 Part 1-2: Medical electrical equipment General requirements for safety, Collateral standard: Electromagnetic compatibility; Require- ments and tests

Instructions for use Perseus A500 SW 1.1n 223 Technical data

Relevant standards (continued)

IEC 60601-1-8 Part 1-8: Medical electrical equipment General requirements for safety, Collateral standard: General requirements, tests and guidance for alarm systems in medical electrical systems

IEC 60601-2-13 Part 2-13: Medical electrical equipment Particular requirements for the safety of anaesthetic systems

ISO 8835-2 Part 2: Systems for inhalational anaesthesia Anaesthetic breathing systems

ISO 8835-3 Part 3: Systems for inhalational anaesthesia Transfer and receiving systems of active anaesthetic gas scavenging systems

ISO 8835-4 Part 4: Anaesthetic vapour delivery devices

ISO 8835-5 Part 5: Systems for inhalational anaesthesia Anaesthetic ventilators

ISO 21647 Particular requirements for the basic safety and Medical electrical equipment essential performance of respiratory gas monitors

For devices manufactured since July 2014, the following also apply: IEC 60601-1 3rd ed. Part 1: Medical electrical equipment General requirements for basic safety and essential performance

IEC 80601-2-13 Part 2-13: Medical electrical equipment Particular requirements for basic safety and essential performance of an anaesthetic workstation

224 Instructions for use Perseus A500 SW 1.1n Technical data

Relevant standards (continued)

ISO 80601-2-55 Part 2-55: Particular requirements for basic safety and essential performance of respiratory gas monitors IEC 60601-1-2 Part 1-2: Medical electrical equipment General requirements for safety - Collateral standard: Electromagnetic compatibility - Requirements and tests

IEC 60601-1-8 Part 1-8: General requirements for basic safety and essential performance - Collateral standard: Alarm systems - General requirements, tests and guidance for alarm systems in medical electrical equipment and medical electrical systems

Instructions for use Perseus A500 SW 1.1n 225 Technical data

Diagrams

Pressure characteristics and flow characteristics of a breathing system without breathing hoses and filters (conforming to ISO 8835-2 and ISO 80601-2-13)

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Pexsp [hPa (cmH2O)], ventilation drive inactive Pexsp [hPa (cmH2O)] MAN / SPON Pinsp [hPa (cmH2O)], ventilation drive inactive

Pinsp [hPa (cmH2O)] MAN / SPON

Resistance [hPa (cmH2O)] Peak flow in MAN / SPON use [L/min] Inspiratory Expiratory Conforming to ISO 8835-2, dry, (at 60 L/min max- 60 –3.5 4.1 imum ±6.0 hPa (cmH2O)), including M30146 breathing circuit for adults, filled MX50115 reusable CO2 absorber and filter and MP01730 inspi- 30 –1.1 2.9 ratory filter

226 Instructions for use Perseus A500 SW 1.1n Technical data

Resistance [hPa (cmH2O)] Peak flow in MAN / SPON use [L/min] Inspiratory Expiratory Conforming to ISO 8835-2, dry, including M27542 breathing circuit for pediatric patients, 15 –0.7 3.0 filled MX50115 reusable CO2 absorber and filter and MP01735 inspiratory filter Conforming to ISO 8835-2, dry, including MP00333 breathing circuit for neonates, filled 2.5 1.1 1.7 MX50115 reusable CO2 absorber and filter and MP01735 inspiratory filter 60 –1.1 3.4 Conforming to ISO 8835-2, dry, with filled 30 –0.4 2.6 MX50115 reusable CO2 absorber and filter but without breathing circuit and inspiratory filter 15 0.6 2.0 2.5 1.0 1.7

Response times in event of concentration changes

Typical response times (T0...90) for an oxygen concentration change from 21 Vol% to 100 Vol% at the following fresh-gas flows:

2 L/min 4 L/min 8 L/min O2 flush Test lung for adults (MP02400), breathing circuit (MP00300), breathing bag 2 L (MP00222) 712s 174s 32s 9s VT=500 mL, RR=10 /min, I:E=1:2 Test lung for neonates (8410079), breathing circuit (MP00333), breathing bag 1 L (MP00383) 91 s 64 s 46 s 7 s VT=30 mL, RR=30 /min, I:E=1:1

Instructions for use Perseus A500 SW 1.1n 227 Technical data

Flow characteristic curves for pressure reducers

Pressure reducers for O2 and Air

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PA Pressure [kPa x 100] Q Flow [L/min] P2 Outlet pressure with pre-pressure PV = 200 kPa x 100 (2901 psi) P3 Outlet pressure with pre-pressure PV = 11 kPa x 100 (160 psi)

228 Instructions for use Perseus A500 SW 1.1n Technical data

Pressure reducer for N2O

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PA Pressure [kPa x 100] Q Flow [L/min] P2 Outlet pressure with pre-pressure PV = 60 kPa x 100 (870 psi) P3 Outlet pressure with pre-pressure PV = 11 kPa x 100 (160 psi)

EMC declaration

General information The medical device must only be used adjacent to or stacked with other devices when the The EMC conformity of the device has been configuration is approved by Dräger. When use evaluated in conjunction with the external cables, adjacent to or stacked with other devices is transducers, and accessories specified in the list of absolutely necessary without the configuration accessories. Other accessories which do not affect being approved by Dräger, the correct operation of EMC conformity may be used if no other reasons the device in this configuration must be tested forbid their use (see other sections of these before the product is used. In any case, strictly instructions for use). The use of non-compliant observe the instructions for use of the other accessories may result in increased emissions or devices. decreased immunity of the medical device.

Instructions for use Perseus A500 SW 1.1n 229 Technical data

Electromagnetic transmission

Electromagnetic environment The medical device is intended for use in an electromagnetic environment as specified in the following. The user must ensure that the medical device is used in such an environment.

Transmissions Complies with Electromagnetic environment High frequency transmission Group 1 The medical device only uses high fre- (CISPR 11) quency energy for its internal functions. Therefore its high frequency transmission is very low and it is unlikely that adjacent electronic devices are impaired. Class A The medical device is not specified for Harmonic emissions Not applicable operation in residential buildings and (IEC 61000-3-2) such equipment as is directly (without transformer) connected to the same Emissions of voltage fluctuations Not applicable low voltage network as the residential and flicker (IEC 61000-3-3) building.

Electromagnetic immunity

The medical device is intended for use in an electromagnetic environment as specified below. The user must ensure that the medical device is used in such an environment.

Immunity against IEC 60601-1-2 test Compliance level Electromagnetic environ- level (medical device) ment Electrostatic discharge Contact discharge: ±6 kV Floors should be wood, con- (ESD) ±6 kV crete, or ceramic tiles. If (IEC 61000-4-2) Air discharge: ±8 kV ±8 kV floors are covered with syn- thetic material, the relative humidity should be at least 30 %. Electrical fast tran- Power supply lines: ±2 kV Mains voltage quality should sients/bursts ±2 kV be that of a typical commer- (IEC 61000-4-4) Longer input lines/out- ±1 kV cial or hospital environment. put lines: ±1 kV Surges Common mode: ±2 kV ±2 kV Mains voltage quality should (IEC 61000-4-5) Differential mode: ±1 kV ±1 kV be that of a typical commercial or hospital environment.

230 Instructions for use Perseus A500 SW 1.1n Technical data

Immunity against IEC 60601-1-2 test Compliance level Electromagnetic environ- level (medical device) ment Magnetic field with sup- 3 A/m 3 A/m Power frequency magnetic ply frequency fields should be at levels (50/60 Hz) characteristic of a typical (IEC 61000-4-8) commercial or hospital environment. Voltage dips and short Voltage dip >95 %, >95 %, Mains voltage quality should interruptions of supply 0.5 periods 0.5 periods be that of a typical commer- voltage Voltage dip 60 %, 60 %, cial or hospital environment. (IEC 61000-4-11) 5 periods 5 periods If the user of the medical device requires continued Voltage dip 30 %, 30 %, operation during mains 25 periods 25 periods power supply interruptions, Voltage dip >95 %, >95 %, it is recommended that the 5 seconds 5 seconds medical device is powered from an uninterruptible power supply or a battery. Radiated radio fre- 80 MHz to 2.5 GHz: 10 V/m Recommended minimum quency disturbance 10 V/m distance to portable and (IEC 61000-4-3) mobile radio frequency transmitters with transmission power PEIRP to the medical device including its lines:1)

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IWၮ3(,53>ZDWWV@ Conducted radio fre- 150 kHz to 80 MHz: 10 V Recommended minimum quency disturbance 10 V inside ISM distance from portable and (IEC 61000-4-6) bands2) mobile radio frequency 150 kHz to 80 MHz: 3V transmitters with transmis- 3 V outside ISM sion power PEIRP to the bands2) medical device including its lines: 1)

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1) For PEIRP, insert the highest possible "equivalent isotropic radiated power" of the adjacent radio frequency transmitter. In the vicinity of equipment marked with the symbol , interference can occur. Field strengths from fixed, portable, or mobile radio frequency transmitters at the location of the medical device should be less than 3 V/m in the frequency range from 150 kHz to 2.5 GHz and less than 1 V/m above 2.5 GHz. 2) ISM bands in this frequency range are: 6.765 MHz to 6.795 MHz; 13.553 MHz to 13.567 MHz; 26.957 MHz to 27.283 MHz; 40.66 MHz to 40.70 MHz.

Instructions for use Perseus A500 SW 1.1n 231 Technical data

Recommended safety clearance for portable and mobile high-frequency communication equipment

The safety clearances listed in the following comply with IEC 60601-1-2.

Max. PEIRP 150 kHz to 2.5 GHz All other frequen- Examples (watts) cies 0.03 0.32 m (1.1 ft) 0.96 m (3.2 ft) WLAN 5250 / 5775 (Europe) 0.10 0.58 m (1.9 ft) 1.8 m (5.9 ft) WLAN 2440 (Europe) 0.17 0.76 m (2.5 ft) 2.3 m (7.6 ft) Bluetooth, RFID 2.5 GHz 0.20 0.82 m (2.7 ft) 2.5 m (8.2 ft) WLAN 5250 (not in Europe) 0.25 0.92 m (3.0 ft) 2.8 m (9.2 ft) UMTS mobiles 0.41 1.2 m (3.9 ft) 3.5 m (12 ft) Cordless DECT devices 0.82 1.7 m (5.6 ft) 5.0 m (16 ft) RFID 13.56 MHz 1.00 1.8 m (5.9 ft) 5.5 m (18 ft) WLAN 5600 (not in Europe) 1.64 2.4 m (7.9 ft) 7.1 m (23 ft) GSM 1800 / GSM 1900 3.3 3.3 m (11 ft) 10 m (33 ft) GSM 900 mobile phones, RFID 868 MHz

Reduced safety clearance for portable and mobile high-frequency communication equipment

The safety clearances listed below are the result of tests that Dräger has performed to determine the minimum necessary safety clearances. These reduced safety clearances apply only to mobile high-frequency communication equipment that uses the standards specified.

Mobile high-frequency communication equipment with ... Safety clearance GSM 850, GSM 900, RFID 868 (limited to 2 W ERP) 0.30 m (12 in) GSM 1800, GSM 1900 (limited to 1 W ERP) 0.30 m (12 in) UMTS, DECT (limited to 0.25 W ERP) 0.15 m (6 in) Bluetooth, WLAN 2450, RFID 2450 (limited to 0.1 W ERP) 0.30 m (12 in)

232 Instructions for use Perseus A500 SW 1.1n Technical data

Emission of high-frequency energy Dräger hereby declares that the RFID components comply with the basic requirements and the other This medical device is equipped with an RFID pertinent regulations of Directive 1999/5/EC. system for wireless communication with Infinity ID A copy of the declaration of compliance can be accessories. obtained through the local distribution company. This medical device has been designed and manufactured so that emission limit values for high-frequency energy are not exceeded. These limit values are incorporated in international safety standards like IEC 60601-1-2 which have been defined by regulation authorities, such as the Federal Communications Commission (FCC Rules), Industry Canada (Radio Standards Specifications), and the European Telecommunications Standards Institute (ETSI standards). The RFID system of this medical device complies with Part 15 of the FCC regulations and its operation is subject to the following conditions: 1 This medical device does not cause any harmful interference. 2 The medical device will not suffer damage when receiving interference, including interference causing undesired operating conditions.

Device combinations

This device can be operated in combination with controlled functions) other Dräger devices or with devices from other – IEC 60601-1-2 (electromagnetic manufacturers. Observe the accompanying compatibility) documents of the individual devices. – IEC 60601-1-8 (alarm systems) If a device combination is not approved by Dräger, Or: the safety and the functional state of the individual devices can be compromised. The operating – IEC 60601-1, 2nd edition (general organization must ensure that the device requirements for safety) combination complies with the applicable editions – IEC 60601-1-1 (device combinations) of the relevant standards for medical devices. – IEC 60601-1-2 (electromagnetic Device combinations approved by Dräger meet the compatibility) requirements of the following standards: – IEC 60601-1-4 (software-controlled – IEC 60601-1, 3rd edition (general requirements functions) for safety, device combinations, software- – IEC 60601-1-8 (alarm systems)

Instructions for use Perseus A500 SW 1.1n 233 Technical data

Connections to IT networks

Data can be exchanged across an IT network by Information on connecting to the using hard-wired and wireless technologies. An IT network network can be any data interface (e.g., RS232, LAN, USB, printer interface) that is described in standards and conventions. Prerequisites During operation, this device can exchange This device must only be connected to the network information with other devices and support the by service personnel. The IT representative of the following functions by means of IT networks: hospital must be consulted in advance. – Display of waveforms and parameter data The following documents must be followed: – Signaling of alarms – Accompanying documents of this device – Recording, storing – Description of the network – Transfer of device settings and patient data – Description of the network-based alarm systems – Service mode, access to logbooks Dräger recommends observing IEC 80001-1 (risk Connecting this device to a network that management for IT networks with medical incorporates other devices or making subsequent devices). changes to that network can lead to new risks for patients, users, and third parties. Before the device is connected to the network or the network is LAN networks changed, these risks must be identified, analyzed, – LAN networks are usually configured in a star and evaluated, and appropriate measures taken. topology. Individual devices can be combined Examples of subsequent changes to the network: into groups by means of layer-n switches. – Changing the network configuration Other data traffic is decoupled by means of separate VLAN networks. Configure the – Removing devices from the network network settings of the device in accordance – Adding new devices to the network with these instructions for use and the network specifications. – Performing upgrades or updates on devices that are connected to the network – Specifications for LAN connections are described in the following standards: – Hard-wired networks: IEEE 802.3 – Wireless networks: IEEE 802.11 (b, g, n) – If the device is used with a layer-2 switch or a layer-3 switch, the port settings on the network switch must be configured. Before the device is shipped, Dräger can configure the network settings of the device so that they correspond with the specifications of the operating organization. – The network must support the following – Unicast (static or dynamic addressing with transmissions and protocols: the ARP or RARP network protocols) –TCP/IP

234 Instructions for use Perseus A500 SW 1.1n Technical data

VLAN networks – Without firewall and antivirus software: If data is exchanged within a single physical – Data are not protected. network and a clinical information system is being – Device settings are changed. used, an independent VLAN network must be set – Data are sent incomplete, sent to the wrong up for the information system. Furthermore, at device, or not sent at all. least one of the following independent VLAN networks must be set up: – Patient data are intercepted, falsified, or damaged. – Network for medical devices for intrahospital use – Data have incorrect time stamps. – Network for portable patient monitors – An overload of the device due to very high network loading (e.g., caused by denial-of- service attacks) can lead to deactivation of the Serial ports interface. The interface will only be available The following interfaces are supported: again after the device has been restarted. In rare cases, a warm boot may take place and – RS232 interfaces conforming to EIA RS-232 may occur repeatedly. (CCITT V.24/V.28) for the following applications –MEDIBUS.X Requirements for the electrical characteristics – Interfaces based on USB 1.1 (e.g., USB flash The LAN interfaces and the serial interfaces are drive) only suitable for connection of devices or networks that have a nominal voltage of at most 24 V DC on the network side and that meet the requirements of Consequences of using an unsuitable network one of the following standards: If the network does not meet the requirements, – IEC 60950-1: Ungrounded SELV circuits hazardous situations can result. The following – IEC 60601-1 (as of 2nd edition): Touchable situations can occur with this device: secondary circuits – Due to an insecure decentralized alarm system: – Alarms are not transmitted. – Alarms or data are transmitted with a delay. – False alarms are triggered. – During an interruption of the network connection: – Alarms are not transmitted. – Suppressed alarms or alarm tones are not reactivated, but remain suppressed.

Instructions for use Perseus A500 SW 1.1n 235 Technical data

Software license compliance (optional)

If the medical device was purchased with the Vapor View option, portions of the device software use open-source software which is published under GPL, LGPL, or a proprietary license. This particularly concerns the operating system "Linux", the software tool "BusyBox", the libraries "GNU C Library" and "The Independent JPEG Group's JPEG software". The source text of the software used can be obtained on CD/DVD from Dräger Sales by stating the keyword "Open Source Software Perseus". If the Vapor View option was purchased, the license regulations for this software are enclosed with the medical device in the original text on a separate sheet.

236 Instructions for use Perseus A500 SW 1.1n Principles of operation

Principles of operation

Description of the ventilation modes ...... 238 Meaning and function of the therapy controls.. 238 Degree of respiratory support...... 239 Ventilation modes and effective parameters ... 239 Pressure-supported ventilation...... 242 Pressure-controlled ventilation ...... 243 Press. Ctrl. APRV (optional)...... 244 Volume-controlled ventilation ...... 245

Minimum O2 delivery...... 247

Influence of patient category, weight, and age on device behavior...... 248 Influence of patient category ...... 248 Influence of the ideal patient weight and patient height...... 248 Influence of the patient age ...... 248 Infinity ID accessory support ...... 248 Infinity ID functionality...... 248 Schematic diagram of alarm tones...... 250 Tone sequence for various alarm priorities ..... 250 Tone signals during operation ...... 250 Combination lock on the drawer (optional) 251 Opening the combination lock ...... 251 Changing the combination...... 251 Loss of the combination...... 252

Instructions for use Perseus A500 SW 1.1n 237 Principles of operation

Description of the ventilation modes

Meaning and function of the therapy controls

Therapy controls Meaning / Function %Tplat Plateau time as a percentage of the inspiratory time Ti in Volume Control - CMV mode Insp. term. When the flow falls below this flow value (in % of the measured peak flow), a supported breath is interrupted. PEEP/CPAP Positive end-expiratory pressure / Continuous Positive Airway Pressure Pressure that is always maintained. ∆Psupp Pressure difference of a pressure-supported breath between PEEP level and inspiratory pressure. This pressure support is only available if spontaneous-breathing support (Sync. on) is switched on. Switching on the pressure support in the Pressure Control - BIPAP and Volume Control - SIMV / AF controlled ventilation modes adds the "/ PS" extension to the ventilation mode. Phigh Upper pressure level in APRV Pinsp Inspiratory pressure Plow Lower pressure level in APRV Pmax Upper pressure level at which a breath is interrupted. RR Respiratory rate RRapn Minimum respiratory rate of supported breaths that is applied in Pressure Sup- port mode. Sync. on/Sync. off Switching spontaneous respiratory support on / off Switching on the synchronization changes the ventilation mode from CMV to BIPAP (in pressure-controlled ventilation) or SIMV (in the Vol. Ctrl. AutoFlow mode). When synchronization is switched on, mandatory breaths are synchronized with the patient's breathing effort. The respiratory rate RR is held constant by adapt- ing the mandatory breaths and the expiratory time. At the end of the expiratory phase, an inspiratory trigger window is activated so that the mandatory breath can be initiated prematurely by up to 5 seconds (patient category Adult) or 1.5 seconds (patient categories Ped and Neo). If the spontaneous inspiratory flow reaches the set value of the flow trigger Trigger sens. during this trigger window, a premature mandatory breath is triggered. If no spontaneous breathing is detected within the inspiratory trigger window, a mandatory breath will be triggered immediately afterwards.

238 Instructions for use Perseus A500 SW 1.1n Principles of operation

Therapy controls Meaning / Function Trigger sens. Flow that, when exceeded, triggers a supported breath Thigh Period of time in APRV during which the upper pressure level is maintained. Ti Inspiratory time Tlow Period of time in APRV during which the lower pressure level is maintained. Slope Period of time during which the PEEP or CPAP pressure increase to the inspiratory pressure or Pressure Support pressure. This time determines the steepness of the rise in pressure from the lower to the upper level. VT Tidal volume

Degree of respiratory support

Respiratory support Ventilation mode None Standby, Pause, Ext. FG outlet Low MAN / SPON , CPAP , CPAP / Pressure Support with ∆Psupp <5 hPa (cmH2O) Medium CPAP / Pressure Support with ∆Psupp ≥5 hPa (cmH2O) High Volume-controlled modes Pressure-controlled modes

Ventilation modes and effective parameters

Additional parame- Base parameters ters Group Tab Ventilation mode (normal therapy bar) (expanded therapy bar) Manual ventila- MAN / SPON Manual / Spontaneous CPAP1) tion / Sponta- neous breathing Pressure-sup- Pressure CPAP / Pressure Sup- Trigger sens. Insp. term. ported ventila- Support1) port ∆Psupp tion RRapn PEEP Slope

Instructions for use Perseus A500 SW 1.1n 239 Principles of operation

Additional parame- Base parameters ters Group Tab Ventilation mode (normal therapy bar) (expanded therapy bar) Pressure-con- Pressure Pressure Control - CMV Pinsp Slope trolled ventila- Control RR tion PEEP Ti Sync. off Pressure Control - Pinsp Trigger sens. BIPAP ∆Psupp1) = Off Slope RR PEEP Ti Sync. on Pressure Control - Pinsp Trigger sens. BIPAP / PS1) ∆Psupp1) >0 Insp. term.1) RR Slope PEEP Ti Sync. on Press. Ctrl. Pressure Control - Phigh APRV2) APRV Thigh Slope Plow Tlow

240 Instructions for use Perseus A500 SW 1.1n Principles of operation

Additional parame- Base parameters ters Group Tab Ventilation mode (normal therapy bar) (expanded therapy bar) Volume-con- Vol. Ctrl. Aut- Volume Control - CMV / Pmax Slope trolled ventila- oFlow AF VT tion RR PEEP Ti Sync. off Volume Control - SIMV / Pmax Trigger sens. AF VT ∆Psupp1) = Off RR Slope PEEP Ti Sync. on Volume Control - SIMV / Pmax Trigger sens. AF / PS1) VT ∆Psupp1) >0 RR Insp. term.1) PEEP Slope Ti Sync. on Volume Con- Volume Control - CMV Pmax %Tplat trol VT RR PEEP Ti

1) Required software option Pressure Support 2) Required software option APRV

Instructions for use Perseus A500 SW 1.1n 241 Principles of operation

Pressure-supported ventilation

Pressure Support (optional)

Paw ∆Psupp

PEEP

Slope 7LPH 1/RRapn Flow

Trigger sens. Insp. term.

7LPH

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CPAP / Pressure Support (optional) Patient-triggered breaths are ended as soon as the inspiratory flow falls below the flow defined by the – Spontaneous breathing Insp. term. setting. The duration of a machine- – Spontaneous breathing with continuous triggered breath is additionally determined by the positive pressure level with or without pressure patient category and the set minimum respiratory support rate RRapn. Each detected inspiratory effort at CPAP level Purely spontaneous breathing at CPAP level is induces a patient-triggered, flow-controlled, and achieved by setting ∆Psupp=Off. In this case the pressure-supported breath. Point in time, number, patient does not receive any more machine- and duration of pressure-supported breaths are triggered breaths. determined by the patient. When no inspiratory effort is detected, mechanical breaths are delivered at the set minimum respiratory rate RRapn and pressure support ∆Psupp.

242 Instructions for use Perseus A500 SW 1.1n Principles of operation

Pressure-controlled ventilation

Pressure Control

Paw Pinsp 7ULJJHUZLQGRZ LQVS PEEP ∆Psupp

Slope Slope 7LPH Ti 1/RR

Flow Trigger sens. Trigger sens.

Insp. term.

7LPH

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Pressure Control - CMV Pressure Control - BIPAP – Pressure-controlled – Pressure-controlled – Time-controlled – Time-controlled – Machine-triggered – Machine-triggered The mandatory breaths are machine-triggered and – Synchronized to inspiration are not triggered by the patient. In Pressure Control - BIPAP, the patient can breathe spontaneously at any time, while the number of mandatory breaths is predefined. When synchronization is switched on, the breaths are adapted to the spontaneous breathing efforts of the patient. If spontaneous breathing effort by the patient is detected during the inspiratory trigger window, a patient-triggered breath will be initiated.

Instructions for use Perseus A500 SW 1.1n 243 Principles of operation

Pressure Control - BIPAP / PS (optional) This mode is similar to Pressure Control - BIPAP, except that the patient's spontaneous breathing at the PEEP level during the expiratory phase is pressure-supported with ∆Psupp when outside the trigger window.

Press. Ctrl. APRV (optional)

Paw Phigh

Plow

Slope 7LPH Thigh Tlow

Flow

7LPH 10561

Pressure Control - APRV In Pressure Control - APRV, the patient's spontaneous breathing occurs at the upper – Pressure-controlled pressure level Phigh. This pressure level is – Time-controlled maintained for the duration Thigh. – Machine-triggered The number of pressure releases is determined by – Spontaneous breathing at continuous positive the Thigh and Tlow settings. The releases are airway pressure with short pressure releases time-controlled and are not triggered by the patient. The duration is determined by Tlow.

244 Instructions for use Perseus A500 SW 1.1n Principles of operation

Volume-controlled ventilation

Compliance correction The applied VT is corrected by the determined breathing hose compliance, i.e., an additional volume is delivered in order to ensure the application of the volume to the patient. The applied VT is also corrected by the sampling flow of the built-in patient-gas measurement module as soon as CO2 respiratory phases are detected.

Volume Control

Paw Pmax

PEEP

%Tplat 7LPH

Ti 1/RR

Flow

7LPH 10558

Volume Control - CMV – Constant inspiratory flow – Volume-controlled In this volume-controlled ventilation mode, the – Pressure-limited patient receives the set tidal volume VT with each mandatory breath. – Time-controlled – Machine-triggered

Instructions for use Perseus A500 SW 1.1n 245 Principles of operation

Vol. Ctrl. AutoFlow

Paw 7ULJJHUZLQGRZ LQVS PEEP Pmax ∆Psupp

Slope Slope 7LPH Ti 1/RR

Flow

Trigger sens. Trigger sens.

Insp. term.

7LPH

PDFKLQHWULJJHUHGEUHDWK SDWLHQWWULJJHUHGEUHDWK 10560 With AutoFlow, the set tidal volume VT is applied starting a ventilation mode with AutoFlow in order for all mandatory volume-controlled breaths with to estimate the lung parameters. The inspiratory the lowest required pressure. The patient can pressure required at the start is determined from breathe spontaneously throughout the entire this test breath. Each additional breath-related respiratory cycle, during both inspiration and readjustment of the inspiratory pressure is limited expiration. The pressure patterns and flow patterns to ±3 hPa (cmH2O). The pressure difference of the mechanical inspiratory breaths correspond (inspiratory pressure - PEEP) is at least 5 hPa to those of pressure-controlled ventilation. (cmH2O) and the upper inspiratory pressure limit is set by Pmax. If the setting for VT is reduced, the Due to the patient's spontaneous breathing efforts inspiratory pressure will be reduced by a greater or compliance changes in the lungs, the tidal amount if necessary. volume in an individual breath may deviate from the set tidal volume VT. However, on a time average a tidal volume corresponding to the set volume VT is applied. If no automatic ventilation has previously taken place, a volume-controlled test breath with constant inspiratory flow is performed when

246 Instructions for use Perseus A500 SW 1.1n Principles of operation

Volume Control - CMV / AF In Volume Control - SIMV / AF, the patient can breathe spontaneously at any time, while the – Volume-controlled number of mandatory breaths is predefined. When – Pressure-limited synchronization is switched on, the breaths are – Time-controlled adapted to the spontaneous breathing efforts of the patient. If spontaneous breathing effort by the – Machine-triggered patient is detected during the inspiratory trigger – Decelerating inspiratory flow window, a patient-triggered breath will be initiated. The mandatory breaths are machine-triggered and are not triggered by the patient. Volume Control - SIMV / AF / PS This mode is similar to Volume Control - SIMV / Volume Control - SIMV / AF AF, except that the patient's spontaneous breathing at the PEEP level during the expiratory – Volume-controlled phase is pressure-supported with ∆Psupp when – Pressure-limited outside the trigger window. – Time-controlled – Machine- or patient-triggered – Synchronized to inspiration

Minimum O2 delivery

Electronically controlled gas Mechanically controlled gas Carrier gas O2 mixer mixer Minimum FG-O2 25 % 21 % concentration Configurable for each patient cat- Continuously adjustable with flow egory, see page 137. control valves. If the N2O flow control valve is N2O When the minimum O2 delivery open and the O2 flow control Minimum O2 flow switches on, the FG O2 therapy valve is closed or the O2 flow is control turns yellow as does the less than 200 mL/min, the mini- active set value. If there is further mum O2 delivery inhibits the N2O change to the active set value, flow. O2 will continue to be deliv- the FG O2 therapy control will ered in the event of an N2O fail- then be automatically adjusted. ure. Minimum FG O2 Air 21 % 21 % concentration

Instructions for use Perseus A500 SW 1.1n 247 Principles of operation

Influence of patient category, weight, and age on device behavior

Influence of patient category The calculated ideal patient weight affects: – Start settings for tidal volume VT – Alarm limits and start settings for therapy – Start settings for respiratory rate RR – Volumeter scale – Start settings for VT and MV alarm limits – Flow measurement and software algorithms to suppress artifacts – Flow trigger – Maximum duration of a pressure-supported VT and RR are only dependent on the ideal patient breath weight when the Ideal body weight function is selected in System setup > Therapy, see page 135. Influence of the ideal patient weight and Changing the patient weight during an automatic patient height ventilation has no effect on the current ventilation settings. Ideal patient weight describes the portion of the body that is relevant to setting the ventilation parameters (patient body weight minus assumed Influence of the patient age excess fat). In the Adult and Ped patient categories, the ideal During operation, the set age influences: patient weight is calculated from the entered – Calculation of MAC value patient height. In the Neo patient category, the ideal patient weight is equal to the entered patient weight.

Infinity ID accessory support

Perseus can be operated with accessories with Infinity ID functionality Infinity ID functionality.

– Infinity ID breathing circuit WARNING – Infinity ID WaterLock 2 water trap If no Infinity ID accessories are used, the – Infinity ID flow sensors additional functions such as exchange – Infinity ID CLIC absorber interval monitoring and anti-interchange security are not available. The Infinity ID functionality can be configured, see page 143.

248 Instructions for use Perseus A500 SW 1.1n Principles of operation

This interval must be specified in accordance with WARNING the applicable hygiene regulations or the Risk of incorrect values for resistance and requirements stated in the instructions for use of compliance the corresponding accessory.

If an unused RFID accessory is in the WARNING immediate vicinity of the device, values may be transferred from this accessory. Risk of inappropriate operating life Do not keep unused RFID accessories in the Exchange monitoring only considers the vicinity of the device. absolute period of use and not the current condition of the Infinity ID accessory and CAUTION therefore does not excuse the user from periodic checks of the accessory. Risk of inappropriate compliance values The exchange interval which can be set for When accessories are added to an Infinity ID the exchange monitoring does not represent breathing circuit, the values for compliance and a guarantee for the maximum period of use of leakage may deviate from those saved on the the accessory. breathing circuit.

Always perform the leakage and compliance Anti-interchange security tests before starting therapy in order to determine the actual values for compliance and resistance. WARNING If the test cannot be performed because the patient is already connected, particular attention Risk of interchanged or incorrect breathing is required during ventilation. hoses The Infinity ID function to prevent CAUTION interchanging the breathing hoses does not Malfunctions of the Infinity ID functionality excuse the user from checking the accessories. Particular EMC situations or defects in Infinity ID components can cause permanent alarms. The Infinity ID function to prevent interchanging does not represent a guarantee To prevent distracting the user under these that the hoses are correctly connected. circumstances, contact service personnel to deactivate the Infinity ID alarms. When Infinity ID breathing hoses and Infinity ID breathing bags are used, the incorrect connection of breathing hoses and the breathing bag is Exchange monitoring detected and reported. Hoses that are incorrectly An automatic monitoring of the period of life is connected with the breathing system trigger an available for Infinity ID WaterLock 2 water traps, automatic alarm. Infinity ID CLIC absorbers, Infinity ID breathing circuits, and Infinity ID flow sensors. An exceeded period of use is signaled during the system test. The exchange interval for the connected Infinity ID accessories can be adjusted.

Instructions for use Perseus A500 SW 1.1n 249 Principles of operation

Schematic diagram of alarm tones

Tone sequence for various alarm priorities

Alarm priority Standard (according to IEC 60601-1-8) Repetitive

Warning Depending on the overall alarm situation, this tone sequence Yes may be played as a 5-tone sequence due to the timing of the individual alarms.

Caution Yes

Note No

The described acoustic alarm signals are handled by a backup loudspeaker if the primary loudspeaker fails. It plays the tone sequence of the alarm priorities "Warning" and "Caution" at a constant tone frequency and unchanged volume.

Tone signals during operation

When Signal Therapy start or change of ventilation mode

Timeout

250 Instructions for use Perseus A500 SW 1.1n Principles of operation

Combination lock on the drawer (optional)

The lower drawer on the large drawer module is 2 To open the combination lock, turn the knob to provided with a combination lock. When delivered, OPEN. the combination on the lock is set to 3333.

Opening the combination lock 20427 The combination lock is opened. The digit wheels return automatically to 0000. Alternatively, the combination lock can be opened

20425 with the supplied key. For information on the 1 Set the combination with the digit wheels. procedure, see ''Loss of the combination'' on page 252.

Changing the combination 20426 20428 1 While the combination lock is open, set the current combination.

Instructions for use Perseus A500 SW 1.1n 251 Principles of operation 20432 20429 2 Turn the knob to position C. 2 Turn the key counterclockwise to the final position stop. 3 Set the new combination. 20433 20430 4 Turn the knob to CLOSE. 3 Turn the knob to OPEN. The digit wheels show the current combination. The new combination is stored.

Loss of the combination 20431 1 Insert the key.

252 Instructions for use Perseus A500 SW 1.1n Annex

Annex

Abbreviations...... 254

Symbols...... 256

Product labels...... 259

Overview of the menu structure...... 261

Instructions for use Perseus A500 SW 1.1n 253 Annex

Abbreviations

Abbreviation Explanation Abbreviation Explanation %, Vol % Percentage gas ratio, related to CISPR Comité International Spécial des total volume Perturbations Radioélectriques, A Ampere International Special Committee on Radio Interference Add. O2 Emergency O2 delivery cmH2O Centimeters of water AGS Anesthetic gas receiving system CMV Continuous Mandatory Ventila- AGSS Anesthetic gas scavenging sys- tion, continuous mandatory ven- tem tilation Air Medical compressed air CO Carbon monoxide APL Adjustable Pressure Limitation, CO2 Carbon dioxide adjustable pressure limitation COM Serial interface APRV Airway Pressure Release Venti- lation CPAP Continuous Positive Airway Pressure, continuous positive ASA American Society of Anesthesi- airway pressure ologists, american society of anesthesiologists CSA Canadian Standards Agency ATPS Ambient Temperature and Pres- dB(A) Decibel, rated sound level unit sure, Saturated Des Desflurane Ambient temperature and pres- EMC Electromagnetic compatibility sure, 100 % relative humidity Enf Enflurane Aux. O2 O2 insufflation ERR Display when a measured value BIPAP Biphasic Positive Airway Pres- cannot be determined. sure, spontaneous breathing under continuous positive airway ESD Electrostatic Discharge, electro- pressure with 2 different pres- static discharge sure levels FG Fresh gas BMI Body Mass Index FiO2 Inspiratory oxygen fraction BTPS Body Temperature and Pres- FTP File Transfer Protocol sure, Saturated GPL General Public Licence 37 °C (98.6 °F), ambient pressure, 100 % relative humidity Hal Halothane CAL Display when a measurement HF High-frequency value is calibrated. HME Heat and moisture exchanger CBM mode Cardiac bypass mode HMEF HME filter Cdyn Dynamic compliance (patient) hPa Hectopascal Hz Hertz

254 Instructions for use Perseus A500 SW 1.1n Annex

Abbreviation Explanation Abbreviation Explanation I:E Ratio of inspiratory time to expi- Pmax Maximum pressure ratory time Pmean Mean pressure ID Identification Pplat Plateau pressure Insp. term. Inspiration termination criterion ppm Parts per million in % based on peak inspiratory flow R Resistance Iso Isoflurane RFID Radio Frequency Identification, radio frequency identification JPEG Image format RR Respiratory rate kg Kilogram RRapn Minimum respiratory rate LLiter Sev Sevoflurane LAN Local network Slope Pressure rise time lbs Pound; unit of mass SNMP Simple Network Management LED Light emitting diode Protocol LGPL Lesser General Public Licence STAPD Standard Temperature, Ambient MAC Minimum Alveolar Concentration Pressure, Dry MAN/ SPON 20 °C (68 °F), ambient pres- Manual ventilation / Sponta- Manual / Spon- sure, dry gas neous breathing taneous STPD Standard Temperature and Pres- mbar Millibar sure, Dry 20 °C (68 °F), 1013 hPa, dry gas MEDIBUS.X Dräger communications protocol for medical devices with uni- TC Time constant form data definition for all Ti Inspiratory time devices UMDNS Universal Medical Device min Minute Nomenclature System, nomen- mL Milliliter clature for medical devices mmHg Millimeter of mercury USB Universal Serial Bus, computer interface MV Minute volume V Volt N2O Nitrous oxide, dinitrogen monoxide VT Tidal volume xMAC Accumulated multiple of the O2 Oxygen MAC values of anesthetic agents O2+O2 flush and N2O Pa Pascal; unit of pressure ∆O2 Difference between inspiratory Paw Airway pressure and expiratory O2 concentration PEEP Positive end-expiratory pressure ∆Psupp Pressure support above PEEP Pinsp Inspiratory pressure PIP Peak inspiratory pressure

Instructions for use Perseus A500 SW 1.1n 255 Annex

Symbols

Symbol Explanation Symbol Explanation

Manufacturer Patient categoryAdult

XXXX Date of manufacture Temporarily suppress acoustic alarm signal Information on disposal Audio paused WEEE label, Directive Acoustic alarm signal is tempo- 2002/96/EC rarily suppressed.

Consult instructions for use Alarm inactive Warning! Strictly follow these instructions for use Alarm temporarily inactive Caution! Observe the accompanying documentation! (symbol) Mains power

Attention! (safety sign) Mains power unavailable

Group Views... Battery completely charged

Group Trends/Data... Battery empty Central gas supply connected Group Alarms... and pressure within specified range Group System setup... Central gas supply not connected or pressure not within Group Start.../Standby... specified range Device on/Standby Gas cylinder full

Device switch On Gas cylinder empty or gas cylinder valve turned off

Gas cylinder pressure sensor Device switch Off not connected

Symbol for programmed Patient categoryNeo Auto On Key for switching on and off and Patient categoryPed dimming the workplace illumination

256 Instructions for use Perseus A500 SW 1.1n Annex

Symbol Explanation Symbol Explanation

Emergency O2 delivery Breathing bag (Add. O2) Applied part, protection class BF Vaporizer plug-in system, "fixed" (Body Floating) position Connection for potential equal- Auto Exclusion Plug-in connec- ization tion Closes the dialog window REF Order number

Upper alarm limit Serial number

Lower alarm limit LOT Batch designation

No alarm limit Use by Spontaneous breathing activity by the patient Keep away from sunlight In lists: One line up Temperature limitation In lists: One line down Relative humidity In lists: One page up

Atmospheric pressure In lists: One page down Do not use if package damaged Risk of crushing Do not reuse ESD warning label, observe the warning statement, see ''Infor- Spare part mation on electromagnetic compatibility'' on page 9 LAN connection Locked USB connection Unlocked Identifies the interface for the Inspiration workstation light Identification on the breathing system and the breathing sys- External fresh-gas outlet tem cover CO2 absorber bypass Expiration Identification on the breathing Enter key system and the breathing system cover

Instructions for use Perseus A500 SW 1.1n 257 Annex

Symbol Explanation Connection for Embedded Con- trol Display Indicates a changed view which has not yet been saved Identifies the tabs that lead to the page with the language settings. Read the flow at the center of the float.

Advanced Cylinder Support

Identifies N2O gas cylinders. The color coding conforms to the locally applicable standard. Identifies O2 gas cylinders. The color coding conforms to the locally applicable standard. Identifies Air gas cylinders. The color coding conforms to the locally applicable standard. Gas outlet

Gas inlet

Display on the total flow tube indicating the cumulative value of the individual flows MR unsafe Do not use this device in the vicinity of magnetic resonance imagers.

258 Instructions for use Perseus A500 SW 1.1n Annex

Product labels

Product label Explanation When connecting auxiliary devices, be aware of the leakage current. Observe chapters ''Connecting additional devices'' and ''Technical data''.

Transport instructions, ''Transport within the hospital'' on page 47

Ensure that the control dial of the vaporizer is correctly positioned. Do not leave the control dial in the "T" position while the vaporizer is connected to the medical device.

Maintain the correct minimum distance of 200 mm (8 in) between the electrical connections and the gas cylinder.

Observe the weight of the nominal configuration and the permissible total weight, see ''Technical data''.

Instructions for use Perseus A500 SW 1.1n 259 Annex

Product label Explanation Observe the correct flow of the anesthetic gas receiving system, see 108.

260 Instructions for use Perseus A500 SW 1.1n Annex

Overview of the menu structure

The following tables list the grouped buttons of the main menu bar with the resulting dialog windows of the same name and the tabs. Information on operating see ''Operating concept'' on page 35.

Group

Button in main menu Horizontal tab Vertical tab Description bar Alarms... Limits Displaying or changing alarm limits Current alarms Displaying information on active alarms Alarm history Viewing alarm history Settings Setting the alarm tone volume

Activating or deactivating CO2 alarms1) Switching CBM mode on or off1) CO2 alarms off1),2) Deactivating CO2 alarms Autoset limits1),3) Automatically adapts alarm limits to current measured or set values Exit CBM1),4) Exit CBM mode

1) Only during operation, not in Standby mode 2) Only in the following modes: Manual / Spontaneous, Ext. FG outlet, Pause 3) Only in the following modes: Pressure Support, Pressure Control, Pressure Control - APRV (optional), Volume Control - CMV / AF, Volume Control - CMV 4) Only in CBM mode

Group

Button in main menu Horizontal tab Vertical tab Description bar Views...1) Switching to other configured views Resetting current view to start settings Displaying alarm limits, units, mini- trends, and loops

123 View 1) Switching between the 3 configured 123 View 1) views. 123 View 1) Export screenshot Exporting screenshots to USB flash drive

1) Only during operation, not in Standby mode

Instructions for use Perseus A500 SW 1.1n 261 Annex

Group

Button in main menu Horizontal tab Vertical tab Description bar Trends/Data... Graphical trends Overview Displaying trends of measured values Vent. 1 in graphic form Vent. 2 Anesthesia Tabular trends Overview Displaying trends of measured values Vent. 1 in table form Vent. 2 Anesthesia Values Ventilation1) Displaying overview of current mea- Gases1) sured values System Logbook Displaying the logbook Export2) Exporting data to USB flash drive

1) Only during operation, not in Standby mode 2) Only in Standby mode

Group

Button in main menu Horizontal tab Vertical tab Description bar System setup... Configuring device functions and start settings, see page 126 Patient...1) Setting patient data Test...2) Displaying test results Testing the system Flushing the breathing system

1) Only during operation, not in Standby mode 2) Only in Standby mode

262 Instructions for use Perseus A500 SW 1.1n Annex

Group

Button in main menu Horizontal tab Vertical tab Description bar Start...1) Beginning or continuing a case Standby...2) Ending the case

1) Only in Standby mode 2) Only during operation, not in Standby mode

Instructions for use Perseus A500 SW 1.1n 263 This page intentionally left blank.

264 Instructions for use Perseus A500 SW 1.1n Password

Password

Configuration password for Perseus A500 Software 1.1n

Cut out from the instructions for use Perseus A500 Software 1.1n To prevent unauthorized alteration, the start settings for Perseus A500 are protected by the following configuration password:

0000

Information for the configuration password

To prevent unauthorized alteration, the start settings for Perseus A500 are protected by a password with 0 to 8 digits. Information on the start settings, see page 126. The configuration password appears on this page of the instructions for use. Cut out the area with the password and keep in a place which is safe from access by unauthorized persons. If it is necessary to reset the configuration password, contact service personnel.

Instructions for use Perseus A500 SW 1.1n 265 This page intentionally left blank.

266 Instructions for use Perseus A500 SW 1.1n Index

Index

A Anti-interchange security...... 249 APL valve ...... 16, 18 Abbreviations ...... 254 Adjusting ...... 77 Accessories Mounting ...... 55 Connecting ...... 8, 58 Applications Accessories and consumptions ...... 92 Activating ...... 145 Additional devices APRV...... 244 Connecting ...... 45 Audio paused ...... 17 Advanced Cylinder Support ...... 107 Auto On ...... 112, 140 Alarm tone volume AutoFlow ...... 246 Setting...... 92, 130, 142 Auxiliary power sockets...... 26, 156 Alarms Acknowledging alarm messages ...... 118 Adjusting the alarm behavior ...... 133 B Adjusting the alarm limits ...... 119 Battery Alarm settings when ventilation mode is Charging ...... 44 changed...... 120 Blower module Apnea alarms ...... 122 Installing...... 54 Breath detection ...... 124 Breathing bag Causes ...... 163 Connecting...... 62 CBM mode ...... 133 Breathing hoses Colors ...... 116, 162 Connecting...... 58 Defining alarm limits ...... 128 Breathing sound Details...... 116, 163 Setting volume...... 142 Displaying ...... 115 Breathing system...... 18 Displaying alarm limits ...... 88 Assembling ...... 54 Downgrading alarm messages ...... 118 Breathing system test ...... 104 Dräger Vapor 3000 ...... 115 Checking ...... 108 Gas cylinders ...... 134 Flushing ...... 101 MV alarms...... 121 Heating ...... 97 Priorities ...... 116, 162 Inserting...... 56 Quick setup...... 119, 132 Pressure/Flow characteristics ...... 226 Remedy ...... 163 Removing...... 185 Setting alarm limits automatically . . . . .94, 131 Breaths Setting alarm tone volume ...... 92 Synchronizing ...... 79 Setting limits ...... 93 Setting volume ...... 130, 142 C Suppressing alarm tone ...... 117 Viewing the alarm history ...... 118 Cable conduit ...... 20 Anesthetic gas concentration Cardiac bypass mode ...... 80 Prediction ...... 83 CBM mode ...... 80 Anesthetic gas receiving system (AGS) . . . .16, 18 Central brake...... 16 Checking...... 109 Central gas supply Connecting ...... 53 Checking ...... 107 Replacing ...... 161 Connecting...... 48

Instructions for use Perseus A500 SW 1.1n 267 Index

Checklist...... 106 Disinfection ...... 187 Circuit plug ...... 18 Display for time and Auto On ...... 27, 28 Cleaning ...... 187 Disposal...... 201 CLIC adapter Drying function ...... 140 Attaching...... 56 CO2 absorber...... 16, 18, 65 E Filling and mounting ...... 66 CO2 alarms Econometer (optional)...... 85 Adjusting...... 94 Electromagnetic compatibility ...... 9 Color mode...... 126 Electromagnetic transmission ...... 230 Setting...... 90 EMC declaration ...... 229 Colors for parameters Emergency O2 delivery...... 27 Specifying ...... 128 Checking ...... 107 Colors of the control elements ...... 38 Using ...... 156 COM 1, COM 2...... 23, 142 Emergency operation ...... 71 Combination lock ...... 251 Environment of use ...... 14 Changing the combination ...... 251 Expiratory port...... 18 Loss of the combination ...... 252 Exporting configurations ...... 145 Opening ...... 251 External fresh-gas outlet ...... 80 Complete failure ...... 160 Compliance correction ...... 245 F Configurable screen contents...... 146 Confirm...... 39 Factory settings...... 126, 144 Consumables Resetting to factory settings ...... 144 Connecting ...... 65 Failure Consumption Flow measurement ...... 159 Resetting...... 144 Fresh-gas delivery ...... 158 Consumptions Gas measurement ...... 159 Displaying ...... 92 Gas supply...... 157 Contraindications ...... 13 Failure of the gas supply ...... 157 Filters Connecting ...... 58 D FiO2 concentration Data Prediction...... 84 Exporting...... 96, 96 Flexible arm Date Mounting ...... 57 Setting...... 139 Flow measurement faulty ...... 159 Daylight savings time ...... 139 Flow sensors Default ventilation mode Installing...... 56 Defining...... 135 Flow waveform scale Device combinations ...... 233 Specifying ...... 127 Device configurations Flush & Dry ...... 113, 140 Transferring ...... 144 Flush function ...... 140 Device name Functional scope ...... 29 Changing ...... 139 Fuses...... 26, 156 Device switch ...... 23 Diagrams ...... 226 Disassembly ...... 185

268 Instructions for use Perseus A500 SW 1.1n Index

G Leakage Causes...... 154 Gas cylinders Current values ...... 103 Advanced Cylinder Support ...... 107 Locating ...... 154 Changing ...... 157 Leakage assistant ...... 104 Checking...... 107 Leakage test ...... 104 Connecting ...... 48 License key ...... 145 Connections ...... 24, 24 Linked therapy controls ...... 37 Gas flow plan ...... 32 Logbook Gas inlets ...... 24 Creating entries ...... 98, 142 Gas measurement faulty ...... 159 Viewing ...... 91 Gas mixer (electronically controlled) ...... 27 Loops Gas mixer (mechanically controlled) ...... 28 Configuring ...... 127 Total flow tube...... 28, 34, 71, 76 Using ...... 88 Gas mixtures for the carrier gas ...... 29 Gas supply Checking...... 106 M Connecting ...... 48 MAC ...... 82 Ensuring ...... 53 Main screen...... 36 Monitoring ...... 141 Mains power supply Connecting...... 43 H Mains power supply failure ...... 155 Maintenance ...... 8 Hardware ...... 16 Maintenance intervals ...... 198 High-frequency energy ...... 233 Manual ventilation ...... 77, 239 Hose configurations ...... 61 Measured values Hose set and filters Viewing ...... 90 Connecting ...... 58 MEDIBUS ...... 31 Menu structure ...... 261 I Minimal O2 flow...... 137 Minimum O2 delivery...... 247 Illumination ...... 17 Mini-trends...... 88 Importing configurations ...... 145 Minute volume measurement ...... 86 Indications ...... 13 Infinity ID...... 31, 143, 233, 248 Accessories exchange monitoring ...... 249 N Accessory support ...... 31 N2O-free ...... 141 Activating the functionality ...... 143 Name Exchange intervals for accessories ...... 143 Changing ...... 139 Inspection ...... 196 Name for the screen layout ...... 127 Inspiratory port ...... 18 Network Interfaces ...... 23 Configuring ...... 142 IT networks...... 234 Network interface ...... 23 New case L Defining ...... 74 Language Selecting ...... 139 Latex...... 58

Instructions for use Perseus A500 SW 1.1n 269 Index

Non-critical medical devices...... 187, 191 Pressure-supported ventilation ...... 239, 242 Non-rebreathing system Preventive maintenance ...... 198 Connecting ...... 63 Using...... 80 Q O Quick setup ...... 37 O2 flowmeter ...... 27, 28 R O2 insufflation Using...... 99 Rating plate ...... 21, 22 O2 switch ...... 27, 33 Rear...... 21 O2 waveform scale Remote Service...... 197 Specifying ...... 127 Repairs ...... 199 O2+...... 27, 28, 33, 34 Reprocessing list...... 191 Checking the function ...... 107 Reprocessing procedures ...... 187 Using...... 78 Resistance...... 63 Operating time Respiratory support...... 239 Setting...... 139 Rotary knob ...... 38 Operation Safety information...... 73 S Safety checks ...... 8, 197 P Sample line Parameter fields ...... 146 Connecting ...... 67 Parameters Scale Setting...... 39 Adjusting ...... 89 Password ...... 265 Screen...... 17 Patient category ...... 248 Adjusting the brightness ...... 126 Patient change ...... 100 Contents ...... 146 Patient data Failure ...... 160 Changing ...... 96 Saving the layout ...... 127 Checking...... 75 Setting brightness ...... 90 Influence on device behavior ...... 248 Screen brightness Loading...... 74 Setting ...... 90 Pause ...... 81 Screenshot Potential equalization Exporting ...... 96 Establishing ...... 46 Semi-critical medical devices ...... 188, 193 Potential equalization pin ...... 23 Service ...... 144 Power supply failure ...... 155 Setting procedure Prediction Canceling...... 39 Anesthetic gas concentration ...... 83 Settings FiO2 concentration ...... 84 Resetting to start settings ...... 98 Pressure reducer Sockets ...... 26 Problems...... 162 Soda lime Pressure reducers Checking ...... 109 Flow characteristic curves ...... 228 Software license compliance...... 236 Pressure-controlled ventilation ...... 239, 243 Software options Displaying ...... 92

270 Instructions for use Perseus A500 SW 1.1n Index

Sound volume USB interface ...... 23, 142 Setting alarm tones...... 92 User-specific settings ...... 126 Setting breathing sound ...... 92 Spontaneous breathing...... 77, 239 V Start dialog ...... 74 Opening ...... 76 Valves Start settings...... 126 Inserting...... 55 Gas delivery ...... 137 Vapor View ...... 52 Patient category ...... 138 Vaporizer Resetting...... 144 Checking ...... 108 Ventilation ...... 135 Illumination...... 78 Start values...... 37 Mounting ...... 51 Sterilization ...... 190 Using ...... 78 Stopwatch Ventilation mode Using...... 85 Changing ...... 79 Storage ...... 113 Ventilation modes ...... 29, 238 Switching off ...... 17, 112 Ventilation parameters Switching on ...... 17, 69 Linked setting...... 37, 138 Automatic ...... 140 Ventilator failure...... 159 Symbols ...... 256 View Synchronized ventilation...... 79 Adjusting ...... 89 System test...... 104 Available views ...... 87 System testing ...... 103 Changing ...... 87 Volume T Setting breathing sound...... 130, 142 Volumeter Technical data...... 202 Specifying the scale...... 127 Test results ...... 70 Using ...... 86 Therapy Volume-controlled ventilation ...... 239, 245 Ending...... 99 Setting and starting...... 75 W Therapy controls...... 36, 38 Time Water trap ...... 18 Setting...... 139 Checking ...... 110 Tipping stability Emptying or exchanging ...... 66 Increasing ...... 47 Waveforms Transport ...... 47 Configuring ...... 127 Trends Overview ...... 146 Displaying ...... 91 Saving the view ...... 127 Exporting...... 96 Specifying the scale...... 127 MVxCO2 ...... 148 O2 uptake ...... 149 X xMAC...... 82, 94 U Units Displaying ...... 88 Setting...... 140

Instructions for use Perseus A500 SW 1.1n 271 A +49 451 882-2080 FAX request. customer upon or exchanged updated be only will and only information customer These instructions for use are provided for device. medical specific any with use for intended not are and only information general for provided are use for instructions these Dräger, by in filled been has number serial no If with the Serial No.: 1.1n SW Perseus A500 to apply only use for instructions These to the device without prior notice. Dräger reserves the right tomake modifications –2013-04) 1 (Edition: 3–2015-01 Edition: GmbH Medical © Dräger en GA6500.510 – 9054101 devices medical concerning 93/42/EEC Directive Drägerwerk AG&Co.KGaA Drägerwerk to changes GmbH Medical Dräger As of2015-08: http://www.draeger.com +49 451 882-0 Germany Lübeck D-23542 Moislinger Allee53 –55 Dräger Medical GmbH Manufacturer telecommunication equipment telecommunication and onradio 1999/5/EC Directive Á9054101yÈ

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