INDUSTRIAL TRAINING PROJECT

MAQUET: VENTILATOR SYSYEM SERVO I V3.1

INSTITUION NAME

: UNIVERSITY OF MALAYA : ROSHIELD RANDASAN

TEAM LEADER : MR JASNI HJ SAPAR SUPERVISOR SITE : MR MARTIN LEE SZE EN : BEMS, HOSPITAL DUCHESS OF KENT, SANDAKAN

DATE OF SUBMISSION: 22 JULY 2011

TMD REF NO:

REGION REF NO:

Table of ontents
ontents Abstract.. Acknowledgement. Objectives.. Introduction i. ii. iii. iv. v. Human respiratory system.. Ventilator history. Modes of mechanical ventilation 4-5 6-7 8-9 age o 1 2 3

Waveform in mechanical ventilation..10-11 Important parameters in ventilation.12-14

Ventilator System Servo I V3.1 i. ii. iii. iv. v. vi. vii. viii. ix. x. xi. Description.15-18 Modes.19-20 Set ups and preparations. 21 Pre use check...22-25 User Interface and Keys.26-27 Starting Ventilation.... 28-29 Alarm Types and Alarm Handling.30-31 Cleaning and Maintenance.. 32-34 Troubleshooting and Servicing 35-37 Planned Preventive Maintenance 38-40 Asset management.. 41

Conclusions..42 References....43 Appendices...44-51

Prepared by:

Signature

Name: RoshieldRandasan

Date: 22July 2011 Institution: University of Checked by: alaya Kuala Lumpur Signature

Name:

r Martin Lee Sze En

Position: Technician HDOK Date: 22 July 2011 Acknowledged by:

Signature

Name: Mr JasniHj Sapa Position: Team Leader Sandakan Date: 22 July 2011 Approved

Rejected

Signature

Name: Mr Herman AbuSaini Position: Regional Head Sabah

Abstract
Human respiratory system is consist of two lungs and trachea that function as a tube that will be the path of air or gaseous when it is inhale or exhale from the lung. In lung, there is site called gas exchange site that consist of bronchioles, alveolar ducts and alveoli. However, the primary site for gaseous exchange is the alveoli where exchange of oxygen and carbon dioxide from and into the blood will occur. Since human body cells need oxygen to live and run their function, respiratory system is considered one of the vital human systems in the body aside from the heart. However, respiratory system can also infected by several diseases that may interrupt its function. Diseases such as bronchitis may cause the exchange of gas to failure. Patient with polio will also have problem with their respiratory system as they may not be able to breathe thus failed to exchange gaseous in their blood. To overcome this problem, ventilator machine was introduced. Firstly, this report will focus on the Maquet Ventilator System Servo I V3.1. So, in this report, details on the history of the ventilator machine will be explained. The modes of ventilator that used for treatment such as pressure or volume control will also be explained in detailed. Besides that, procedure of Planned Preventive Maintenance, User Training and Testing and Commissioning will also be explained later. Documentation for ventilator management as one of the assets in hospital will also be included and explained in this report especially on Maquet Ventilator System Servo I V3.1.

Acknowledgement
After several weeks of research and training, the report on Maquet Ventilator System Servo I V3.1 can finally be done. Firstly I want to thanks University of Malaya especially Department of Biomedical Engineering and also CITRA for giving me the chance to undergo industrial training which is an essential opportunity for me and other students to exactly see the situation in the job world and also gained experience from people who is actually working. Also big thanks to all my lecturers for the knowledge that they have given as it help me the most during my training and in doing this report. Lots of thank and gratitude also to Healthronics (M) SdnBhd for giving me the chance to undergo training in their company. Also to Mr Herman Abu Saini, the Regional Head of Sabah region Healthronics for giving advice in my project proposal form, to Mr JasniHj Sapar whom is the Team Leader of Healthronics Sandakan for giving lots of knowledge and advice along my journey in doing this report and also in my industrial training. Big thanks also for the Healthronics Sandakan staff for their support and knowledge that they have shared me during the making of this report. To Mr Martin Lee Tze En, my supervisor in doing my report, for his knowledge and guidance thatextremely helping me. Once again big thank and gratitude from my heart to all of you for helping me in making this report and while I undergo my industrial training. Last but not least, to my family that always got my back and supported me while I am making this report and undergo training, thank you very much. Also to other people that contribute directly or indirectly in making in this report, a big thanks to all of you. May this report will be beneficial to people who read it and most likely give if not much, a bitinformation on ventilator machine on how important it is in treating patient with respiratory failure.

Objectives
There are several objectives that need to be achieved through this report. Those objectives are: i. To know and understand the history of ventilator machine and how it has developed throughout the years before. ii. iii. To learn and understand the function of ventilator machine. To learn and understand the mode of treatment used in ventilator for respiratory failure treatment. iv. To learn and understand on how to do Planned Preventive Maintenance for ventilator machine. v. To learn and understand how to use equipment needed for doing Planned Preventive Maintenance such as safety test analyser. vi. To learn and understand about the documentation needed for registering and managing ventilator machine as one of the assets in the hospital.

Introduction
I. Human respiratory system Human body consists of several system that run their own function such as skeletal system, digestive system, muscular system and also circulatory system. Each system run their own function in order so that human do their daily activity. Every day in human life, there is one most crucial and certain thing that must they done which is breathing. Breathing is important as it enable human body to receive oxygen and remove carbon dioxide that not used by the cells. In order for human to breath and exchange gaseous, respiratory system is needed. This system consists of several organs such as nose, lung, trachea and bronchi. These organs take part in the process of gaseous exchanging as some of them function as passage for the airway such as nose and trachea while some function as gas exchanger such as lung and bronchi.

Figure 1. Human Respiratory System Taken from: http://bcscience8.wikispaces.com/The+Respiratory+System

When i i inhaled, it

ill i t enter the nose assage. o, nose is i

ortant in here

as it ecome the medi m of air to go into the l ngs.

owever, air ca also enter from the n fter the air have

mouth as nose and mouth are connected in the assage called the trachea. gone through the assage, it will then arrive at the lungs. human ody, which is the right and left lung.

here are actuall two lungs in

ach of them is actually covered y thin

membrane called lural membrane. nside the lung there is bronchi where there i bronchioles s and alveoli akab, . ll these are like tree branches that spread out in the lungs. he his is the main site for the

most important site or part in the lungs is actually the alveoli. exchanges of oxygen and also carbon dioxide.

lveoli as mentioned before is the exchange

site of gaseous, but how does it happen will be explained here. lveoli is a sac like shape and have an elastic characteristic. t is able to expand and deflatedue to its elasticity. t is also surrounded by many blood vessels around its wall. t is very tiny and given lots of empty space in the lungs due to its si e. t walls is very thin and about the same thickness as one cell. ue to its thin wall, oxygen that goes in from the nose he same process happen to carbon dioxide

can diffused into it and goes into the blood.

where it also diffuse into alveoli and into the air and follow the air out from the lungs.

igure . xchange of gas in alveoli aken from: http://peer.tamu.edu/curriculum_modules/organsystems/module_4/whatweknow_lungs2.htm

II.

Ventilator history Ventilator machine is a machine used mechanically move air or gaseous mixture into

and out of the lung. It is also delivers either controlled or supported breaths with either constant volume or pressure with a set of oxygen concentration (Maquet, 2004). Ventilator was first introduced during the 20th century when polio diseases spread during that time. However, the first form of ventilator introduced was using negative pressure and non invasive (Geddes, 2007). The improvement was then made by the person named John Haven in 1931. There are also other forms of non invasive ventilators such as rocking bed, biphasic cuirass ventilation and iron lung and these types of ventilators were used widely for polio patient (Geddes, 2007). Later in 1950, ventilator machine began to be used in anaesthesia and intensive care due to the development of mechanical assister by John Haven with the cooperation of Harvard University in 1949. The first positive pressure ventilator was introduced back in year 1952 by Roger Manley and the ventilator was named Mark I. It then developed become Manley Mark II after a collaboration of Roger Manley with Blease company was made. The ventilator then widely used around Europe and was the starting point of the used of positive pressure ventilation around the continent. In 1955, the Americans introduced a ventilator that widely known as Bird or Bird Mark 7. This ventilator was a pneumatic device thus not required any electrical power source to operate. By the time of 1971, the intensive care environments revolutionized due to the introduction of the SERVO 900 ventilator machine. This ventilator is small, silent and effective in operating. It also has SERVO feedback system that enable user to regulate and set the delivery of gaseous to patient. Later in 1991, SERVO 300 ventilator series was introduced. This version enable the used of ventilator for all range or categories of patient,

form neonate to adult in one single unit of ventilator. It also has rapid flow triggering response. The latest model, which used mostly nowadays, the SERVO i was introduced in 2001. This model used modular concept, a concept that enable user to choose different mode of mechanical ventilation from single ventilator. This type of ventilator is extremely easy and saved more space in certain ward.

III.

Modes of Ventilation As mentioned earlier, ventilator is used as a machine that will help carried air and

oxygen into and out of the lung so that gas exchange in the alveoli can occur. So basically, patient that need ventilator for in their treatment is usually patient that have respiratory diseases or patient that not able to breath themselves such as patient that is on comma or having stroke and paralyzed on the upper body parts. Respiratory problem mentioned here is including acute respiratory distress syndrome, pneumonia, heart failure and complications from surgery and trauma. COPD or chronic obstructive pulmonary disease and neuromuscular disorder are also the factor that will lead to respiratory failure (Carbery, 2008). To determine the right treatment for certain treatment, clinician or doctor must considered several factors such as patients history and appropriate lungs compliance. But the most important assessment can be obtained from the ABG test. ABG test or arterial blood gas test is important because it can give information such as blood pH, partial pressure of CO2, and also partial pressure of O2. From this test, an acute respiratory can be determined if the partial pressure of oxygen is less than 60 mmHg, partial pressure of carbon dioxide is greater than 50 mmHg, and the blood pH is lower than 7.25 and falling (Carbery, 2008). Respiratory failure if not treated can lead to more chronic diseases such as CNS (Central Nervous System) disorder. In mechanical ventilation, there are several modes that used in delivering breath or air into patient. Those modes are volume control, volume support, pressure control, pressure support, SIMV (Synchronized Intermittent Mandatory Ventilation), and CPAP (Continuous Positive Airway Pressure). Basically, there are three basic of breath delivering system which is controlled, support and continuous. In control mode such as volume or pressure control, the
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whole patient breath is supported by the ventilator machine. The first mode in controlled breath delivering system is the volume control. In volume control, the volume or Tidal Volume is set by the user and the pressure will be dependent on patients Tidal Volume, inspiration time and the resistance and compliance of the patients respiratory system (Maquet, 2002). The other mode is the pressure control mode.In pressure controlled, the parameter that set as constant is the pressure meanwhile the volume (Tidal volume) will be independent on pressure above PEEP, lung compliance and also the resistance in the patients circuit. Volume and pressure control mode can also be called as the control assist mode. Usually in many books or reference, the word control assist mode is used instead of control mode, but these two carried the same meaning. Besides control mode, there is also support mode in mechanical ventilation. Support mode happen whenever a patient triggered the ventilator. After being triggered, ventilator will give positive pressure ventilation to the patient. This mode is also divided into two which is pressure and volume support. Support mode that need to be used is determined by the doctor or clinician. The next mode is the spontaneous mode orcontinuous positive airway pressure. In this mode, patient is breathing on their own, but trigger function will also be provided in this mode if patient effort is not sufficient to be said as spontaneous breathing. Another mode is the Synchronize Intermittent Ventilation mode. In this mode, patient breathing is synchronized with the ventilation given by ventilator itself. SIMV in Maquet Servo I is used with other mode which is the control mode and also support mode. Triggered also available in this mode too. Triggered function will be explained more in the Servo I V3.1 section, on how to use the ventilator.

IV.

Waveform i Mechanical Ventilation There are several waveforms that need to be observed during different mechanical

ventilation. These waveforms will indicate several parameters that will be important in assessments of lung condition or the flow of air th travel through the lungs. Three main at important waveforms that usually observed in mechanical ventilation are the pressure, flow and volume waveform. n a mode where pressure is the variable that being set as a constant, the waveform will be looked like in the igure 2a below.

igure 2a. ressure controlled waveform Taken from:http://www.frca.co.uk/article.aspx?articleid=100421 olume also will be constant in a mode where volume is delivered constantly in a same value throughout the ventilation. The waveform when volume is being fixed is pictured as in the igure 2b.

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nspiration phase

igure 2b. olume controlled waveform Taken from: http://fn.bmj.com/content/ / / 202.abstract

s can be seen from these two types of waveform, it can be said that pressure and volume waveform changed it shapes as the mode changes. The flow waveform also change shape but still same process happen in both waveform which is inspiration and expiration.There is also one similarity between the flow waveform in pressure and volume control modes, which both of the flow waveform have negative value. The negative phase in the flow volume is actually referring to the expiration phase of a breathing Chatburn, 2003). Meanwhile the positive value is indicating the inspiration phase of certain breathing.

olume

ressure

xpiration phase
Flow

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V.

Important Parameters in Ventilation There are many parameters in mechanical ventilation that need to be focus on while

on treatment. It is also called as breathing parameters since it is all important to maintain sufficient or efficient breath that delivered to the patient. This report will mentioned some of the important parameters such as tidal volum, peak expiratory end pressure (PEEP) and breath rate. First parameter would be the oxygen concentration (O2 concentration). This parameter is important and need to be observed during ventilation so that patient will receive enough oxygen to their lungs and blood. The range of oxygen given to patient is usually 20 100% of concentration. The second one is the respiratory rate or also called as breath rate or frequency. Normally, a person should breath total of 12 cycles of breath in one minute (Rakhimov, 2011). But this value can be higher in person that is sick or in an infant. By determining respiratory rate, the total of tidal volume per minute can also be calculated. Next is the tidal volume which is volume that delivered in one breath. Some also called tidal volume as the target volume that need to be achieved during ventilation. Then there is PEEP or peak expiratory end pressure. PEEP is actually the pressure that left behind in the lungs after the expiration is done. The need of PEEP in mechanical ventilation is to ensure that human lungs do not flattened completely. This is important as lungs that contained PEEP will be accepting more oxygen during the next breath due to increase in mean airway pressure. Usually PEEP is set to be 5cmH2 O. The next parameters would be inspiratory rise time which is the time for a person to inhaled air into their lung. Longer inspiratory rise time will increase the oxygen absorption and also make the patient more comfortable. Other parameter that also important is shown in the Table 1.

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Parameters

Definition and Range Fraction ofmaximum flow at which inspiration shouldswitch to expiration.

Inspiratory cycle-off (%)

Minute volume (Vmin)

Volume per minuteor target Minute volume (ml/min or l/min). Note Presentation can be configured toeither tidal or minute volume.

Determines the level ofpatient effort required to triggerinspiration. The sensitivity is set as high aspossible without self-triggering. This ensuresthat triggering is patient initiated and avoidsautocycling by the ventilator. There are two types of triggering: 1) Pressure triggeringThis is the pressure below PEEP which the patient must create to initiate an inspiration. The allowed range is: -20 to 0 cmH2 O. 2) Flow triggeringAs the dial is advanced tothe right (step wise from the green into the red area) the trigger sensitivity increases so that the inhaled fraction of the bias flowleading to triggering is reduced. The allowed range is: 100% to 0% of the bias flow. Note You cant set trigger sensitivity in NIV mode.

Trigger sensitivity

PC above PEEP

Inspiratory pressure levelfor each breath (cmH2 O) in Pressure Control. Important In all pressure controlled modes, it is important to set alarm limits to adequate levels.

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Pause time (Tpause) I:E ratio (I:E)

Time for no flow orpressure delivery (% or s). Ratio of Inspiration time +Pause time to Expiration time. Usually set as 1:2.

Table 1. Other parameters in mechanical ventilation

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Maquet Servo I V3.0 Ventiilator

I. Description Maquet ervo from 3.0 is a ventilator from Maquet etinge roup which is a company

weden. This machine is a Class 1 and Type B machine which means that it has

protected ground and it also have long conductivity contact to the person, but not directly to the patient s heart. This product wa launched in the year 2001, which is 10 years ago. erv o as mentioned earlier is a ventilator which comprises of many different mode within a ventilator. This is a major advantage of this type of ventilator as it is made easy for user plus save cost or space in getting many ventilator with different functi n each. Based on Figure 3 o below, it can be seen that ervo 3.0 has three main sections which is the user interface,

patient unit and also the ari compressor below the patient unit. There are also other accessories that comes with this ventilator which will be explainedin detail later. ser nterface

ir Compressor

atient nit Figure 3: Maquet ervo 3.0 entilator

atient Breathing ystem

15

As seen from Figure 3, there is one section called the User Interface, which is the place for user such as doctor or nurse to operate the system of the machine or setting any values that correlated to any mechanical ventilation. This User Interface is also the place for data to be displayed so that clinician will be able to monitor patients condition. All the alarms related to patient or even the ventilator itself will also indicated in the User Interface. There are also several keys and buttons that important in managing the settings for mechanical ventilation. All these keys will be displayed and explained further in the User Interface section in this chapter. Next part is the patient unit where all the gas from the module will flow in together before flowing into the inspiratory circuit. Servo I V3.0 can support different modules such as air module, oxygen module and carbon dioxide module. But in this report, only two module will be included which is the air and the O 2 module. After gaseous flow from this two modules, it will then enter patient unit where the gas can be said to be mixed before it is proceed into the inspiratory circuit. The next section is the patient breathing system which comprises of patient circuits. There are actually two patient circuit which is the inspiratory and the expiratory circuit. The inspiratory circuit or tubing carry the breath that goes into a patients lung while the expiratory circuit carry the air that exhaled by the patient. These two patient circuit is important and any leakage in any of these two circuit will bring complication to the patient. To find out whether there is any leakage in the tubing system, a Pre Use check must be done on the machine. Tubing compensation must also be done to make sure that the breath that delivered to the patient is same as the one that is being set in the system. Compensation is done also during the Pre Use check. Pre Use check procedure will be explained later in detailed.

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Other than these three main components, there are also others accessories that used together with Servo I ventilator such as humidifier and nebulizer. Humidifier in mechanical ventilation is very important as it helps prevent patient from inhaling dry air. Without the usage of humidifier, the epithelium cell of a patient will undergo destruction. Patient can also suffered hypothermia which is a condition of low in body temperature. When using humidifier, the temperature is set to be maximum of 37C, and using sterile water to be vapored (AARC, 1992). The humidifier used in this Servo I V3.1 ventilator is the Fisher &Paykel humidifier with model MR340E.

Figure 4. Fisher &Paykel Heated Humidifier MR340E Other than humidifier, heat and moist exchanger can also be used to provide humidity to patients breath. Heat and moist exchanger is also called as HME. The other accessory is the nebulizer or Servo Ultra Nebulizer. Same as basic nebulizer, Servo Ultra Nebulizer also deliver medication through mist that produced by vibration. When using Servo UltraNebulizer, the HME or humidifier cannot be used to prevent any blockage to any of these two.

17

II.

Modes There are several modes that can be run on Servo I V3.1. Modes that provided in

this ventilator is almost same as the basic mechanical ventilation that already explained in the
18

previous chapter. But there is an addition of mode which is the ressure Regulated

olume

Control or R C. R C mode means that pressure is also one of the key factor in giving controlled volume breath to patient. For example, if a tidal volume is set to be sent at certain level, the pressure that comes along must suitable with lung compliance as high pressure that may come with high volume may burst the lung. f this case happen, R C mode will cut off the tidal volume value that need to delivered if the pressure that comes with it exceeded the limit set in the system or not compatible with lung compliance. n ervo 3.1, there is actually many modes which is the pressure and volume M mode, R C mode, spontaneous mode and also

control, pressure and volume support, the automode.

utomode in this machine provides unique mechanisms that enable the

controlled and supported mode to exchange whenever patient initiated breath or not. There is also backup ventilation is support mode except in controlled and utomode. Backup

ventilation is important because if patient suddenly having apnea, this backup ventilation can replaced the patient initiated breath.

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Figure 5. Ventilation Modes in Servo I V3.1

III.

Sets up and Preparation Before starting using Servo I Ventilator, several set ups and preparation need to be

done to make sure that the ventilator is safe to use. The most important thing would the Pre Use check that must be done each time a new patient circuit or expiratory cassette are changed. The detail procedure of Pre Use check will be explained later in the next section of this chapter. Battery module must also be inserted at least two to support the machine if any blackout happen during ventilation. There are actually six slots for battery module, and if all of it are inserted, these batteries can support the machine for at least 3 hours of operation time. Figure 6 below shows the battery module location on Servo I V3.1.
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Figure . Battery module

IV. Pre ervo .

Pre Use Check se Check is actually the most important process before starting of using the ther than making sure that all pressure transducer is working fine, it also able to

compensate the volume in the patient circuit that will be useful in delivering breath later. Pre se check also test the ability of the machine to transform into battery support if the mains is not connected to the machine. ny leakage will also be tested and detected if any) in this
2

procedure. Calibration process for new

cell and expiratory cassette membrane will also be

done in this process even though the process is not actually appear on the screen during the
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test. ervo

that installed with new patient circuit must also undergo this test to make sure se check,

that the volume compensation for patient circuit can be done. To run Pre

equipment that will be needed is the blue test tube that provided by the manufacturer that will be used later to connect the inspiratory and the expiratory outlet.

Figure . Pre While doing the Pre

se check flow

se check, some instructions will appear on the screen of the ervo

i. First will be the Connect the inspiratory and the expiratory outlet, which means the blue test tube should be used to connect inspirator and expiratory outlet. y ther type of tube

cannot be used in this process as it will failed the test. The next instruction will be to unplug and plugged the power source to test the battery operation. Then the patient circuit is connected and Y piece is blocked. Compensation will be done in this section. f there is Y sensor module on the machine, Y sensor test will also be done.

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Figure . Y fter all test is done and pass, the Pre

ensor module

se checked can be completed. f any error message

appear, action needed for be taken will be explained in the Table 2 and Table 3.

Message Cancelled

Description Test cancelled by user

Remedy if test fails sers are recommended to se Check perform Pre before connecting ventilator to patient Check all connections and expiratory cassette. Test pass with some limitation. i. Battery capacity less than

Failed ot Completed

Test did not pass Test was not completed

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Passed Running

Test has passed Test in progress

10 minutes ii. Gas missing while Pre Use check. -

Table 2. Pre Use check status Display message Alarm state test Description Checks that no Technical error alarms are active during Pre-Use check. Check the barometric pressure measured by the internal barometer Check whether gas supply measured by transducer are within the specified range. Check patient circuit or any other tube connected to machine. Remedy if test fails Refer to Service Manual

Barometer test

Check barometer pressure in Status in touch panel. Check whether gas connected is within the range for air and oxygen. Make sure blue test tube is connected properly and patient circuit connection is clean and connected properly. Check/replace transducer for inspiratory/expiratory section or make sure expiratory cassette is cleaned and dried thoroughly. Check whether safety valve membrane is placed and closed properly during Pre Use check. Also check if the inspiratory pipe is mounted properly. Check/replace O2 sensor or gas modules.

Gas supply test

Internal leakage test

Pressure transducer test

Calibrates and check inspiratory and expiratory transducer.

Safety valve test

Check or adjust safety valve opening pressure to 117 3 cmH2 O.

O2 cell/sensor test

Flow transducer test

Check O2 lifespan and calibrates it at 21% and 100% of oxygen. Check/calibrate inspiratory Check whether gas supplied and expiratory flow is within range or expiratory transducers. cassette is properly mounted
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Battery switch test

Patient circuit test Y sensor test

in its place. Checks if the power supply Check battery status. Battery change to battery if mains is status must be more than 10 disconnected and vice versa. minutes. Check patient circuit leakage Check/replace patient circuit Check the pressure and flow Check Y module and Y measurement of Y sensor sensor and replaced if

necessary. Alarm state test Checks that no Technical error alarms are active during Pre-Use check. -

Table 3. Pre Use check error

V.

User Interface and Keys The User Interface of Servo I is a touchscreen interface. Thus it made easier for the

user as all can be seen and access directly on the screen. Figure below shows how the screen appear on the Standby mode after the Pre Use check. All the entry such as ventilation mode, patient data, and status of battery or oxygen cell can be observed from the User Interface.

25

Figure . creen

ser interface) of ervo

3.1

n the top left corner, there is mode appear and user can just press it to e nter the ventilation mode, beside it is the patient category and now it shows infant category for this ventilator. There is also dmit Patient column specially for entering patient data and the tatus column

for the general status of machine such as battery, oxygen cell and expiratory membrane life span. There is also than dditional etting column for dditional alue parameter setting. ther

ser nterface in the touchscreen panel, there are also few keys or button that also

function as parameter setter for the ventilator. There are also some rotary dial that will be used to set the values of any parameter on the ventilator. shown in the figures below. ll of these keys and rotary dial are

26

Figure . Fixed keys, Quick ccess eys and Main Rotary ial

Figure 10. irect ccess nob and pecial Function eys ll these knob and keys have their own function. t will be explained in detail in the ppendices section. VI. Starting Ventilation To start a ventilation, first a mode need to be selected. The mode should be selected from the modes provided on the Touchscreen panel.
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elect mode from here

Figure 11. electing ventilation mode fter mode is being selected such as Pressure Control like in the figure above, parameters such as PEEP, respiratory rate, and oxygen concentration can be set using the nob. s a reminder, the changes made using irect irect ccess

ccess mode will be auomatically t

applied to the next cycle of breath without any confirmation. fter all setting is done the tandby key beside the irect ccess nob is pressed to start the ventilation.

28

Press to start ventilation

Figure 12. tandby button for start ventilation

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VII.

Alarm Types and Alarm Handling

In Servo I V3.1, there are actually three types of alarm. These alarm are high priority alarm, medium priority alarm and low priority alarm. High priority alarm is indicated by red colour while medium and low priority alarms are indicated by yellow colour. The high priority alarm will turn into yellow colour after it is fixed or reduced. Details of several important high, medium and low alarms and action needed to be taken to fixed the alarm will be explained in the table below. Alarm messages Apnea Possible Cause Remedy

Preset or default alarm Check ventilator setting, exceeded. Time between two patient and breathing system. consecutive inspiratory exceeded the limit. Gas supply pressures: Low Air and O2 is below 2.0kPa Check gas connection for any leakage Expiratory Minute Volume: Preset or default alarm Check breathing system and Low exceeded. patient. Change alarm limit settings No battery capacity Less than 3 minutes of Change power supply to battery capacity mains and recharge battery. Paw high Airway pressure exceed Check patient and also Upper pressure limit breathing system. Check also ventilator and alarm settings. Restart ventilator! Software related error Restart ventilator and perform Pre-Use check. Table 4. High priority alarms

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Alarm messages Air supply pressure: Low Battery operation Check Y sensor

Possible Cause Air supply below 2kPa

Remedy

Inspiratory flow over range

Nebulizer disconnected

Respiratory rate: High

Check gas supply lines and perform Pre-Use check Mains voltage disappears Check mains connection Y sensor in not working Check sensor connection or properly or not connected to replace Y sensor module patient breathing system. Combination of settings Check ventilator settings or exceed allowable inspiration increase the gas inlet flow range pressure. Cable connection problem or Connect nebulizer or change nebulizer disconnected cable connection. during nebulization. Respiratory frequency too Attend patient and check high. Auto triggering. trigger settings. Table 5. Medium priority alarms Possible Cause Remedy

Alarm messages

Touch screen or knob press Screen or knob has been Check screen and knobs. time exceeded. pressed for more than 1 min. Contact technician if problem Screen or knob hardware persist. time out.

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VIII. Cleaning and maintenance Servo ventilator must be clean and maintain regularly to make sure that it perform

to the fullest and to make sure that any bacteria or harmful virus did not spread into patient s body through the patient circuit. For cleanliness of the machine, any blood or other form of liquid should not left dry on the machine. This is to prevent any bacteria to build up at the machine. To clean the body of the machine, soap or bacteria disinfector should be used. T he patient unit must also be cleaned especially in the ventilation area such as the fan to prevent any dirt from built up in the patient unit. This is to make sure that in the future, the dirt does not interrupt the function and ventilation of the Servo itself.

Figure 13. Fan of the patient unit that need cleaning for clear ventilation of the Servo itself ext feature of cleaning would be the cleaning of the expiratory cassette. t is recommended that the expiratory cassette is cleaned with soap or medical dish disinfector. But the use of alcohol is also can and isopropyl is used. The use of glutaraldeyhde however is not recommended. fter cleaning and rinsing the expiratory cassette, it should be dried in the
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dryer and not by using any pressure or force as it may damage the expiratory membrane. However, the expiratory cassette can be shake a little bit to let out all the liquid from the disinfectant earlier. The best is to hang the expiratory cassette vertically in the dryer. The expiratory cassette should be dry or it will fail the Pre Use check. Sterilization can also be done on the expiratory cassette but it is not recommended as autoclaving can reduce the lifetime of the expiratory cassette itself. To make sure that any bacteria from patient is not exposed to the surrounding environment, Servo Guard bacteria filter is mounted in the expiratory outlet. The inspiratory inlet is also mounted with filter to prevent any bacteria from outside environment to enter the patient circuit and patients lungs. Maintenance of Servo I is including the maintenance kit of the Servo I itself and the replacement of other parts such as battery and expiratory membrane. Maintenance kit mentioned earlier is including filter of the gas module, nozzle unit for gas module, bacteria filter for inspiratory circuit and bacteria filter for oxygen cell. This kit actually need to be changed every 5000 hours. The oxygen cell must also be replaced if its status shown in the Status menu in the User Interface is less than 10%. After replacement, a Pre Use check must be performed. The membrane of the expiratory cassette is also recommended for exchanged if its status is shown as 0% in the Status menu. Even though the status shows that the status is already 0%, the membrane still can actually be used, but the manufacturer suggest that it should be replaced. The handling of expiratory should be done as in the Figure 15.

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Figure 15. andling of expiratory membrane

Figure 16. Parts of the expiratory membrane fter replacing the expiratory cassette, it lifespan value should be reset back to 100% in Biomed menu right after Pre se check is done.

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IX.

Troubleshooting In troubleshooting, there is actually two parts which is action needed for Pre se

check error and also the Technical errors. This report will explained some of them and the full troubleshooting procedure can be refer from the Service Manual of the Servo I 3.1. Pre use Check

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Technical Error Codes

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X.

Planned Preventive Maintenance This section will explained about the procedure and tools used in doing Planned

Preventive Maintenance by Biomedical Engineer Maintenance and Service staff. In the planned preventive maintenance, the most important will be the safety test and also the test that included in the checklist provide by Ministry of ealth. Basically there are two

equipment needed which is the ventilator analyser and also the safety test analyser. The model used for ventilator analyser in this PPM is Certifier FA Plus which is manufactured by TSI company. Some of the parts of the ventilator analyser is shown in the figures below.

Figure 17. Certifier FA Plus kit

Figure 18. igh Flow Module

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Figure 19. xygen sensor tester To perform PPM, the ventilator should be connected to the analyser as shown in Figure 20.

After connection is done, parameters such as Tidal

olume, Breath Rate, Fi

and Peak

Inspiratory Pressure are set in a certain value according to the checklist. The value set should be display in the Certifier FA Plus and must be within the range given.

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For safety test, safety test analyser is used. The voltage, current and the resistance are measured in this test. Earth leakage current and leakage current is also included in the procedure. Details about the value will be shown in the Appendix section.

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XI.

Asset Management Asset management is severely important in every BEMS department and also

hospitals. Document such as KEW PA is important as it is considered as a birth certificate for a machine. It will later useful for variation order or beyond economic procedure which is very important for a machine. Testing and commissioning form is also important as it will be the from that needed for a machine to be registered to the Central Management System. Other than that, there is also Condition Appraisal form that needed for beyond economic repair procedure. This form is actually not available for Servo I since there is no Servo - I ventilator that need to undergo BER. Other form such as Material Request form is also important as it is the form used for ordering any parts that need to be replaced. All these forms will be shown in the Appendix section.

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Conclusions
From this report it can be conclude that Servo I is actually important in treating patient with respiratory problem. Other than easy to use, it also gi e much user friendly v function such as touchscreen interface. The asset management form such as Training and Commissioning and KEW-PA is also important for any asset especially Servo I so that proper disposal of the machine when it undergo Beyond Economic Repair can be done.

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References
1. American Association of Respiratory Care. (1992). Humidification during Mechanical Ventilation. Journal of Respiration Care. 37. pp 887 890. 2. ArtourRakhimov. (2011). Normal Respiratory Rate and Ideal Breathing. Retrieved July 20, 2011 from Normal Breathing website: http://www.normalbreathing.com/index-rate.php 3. Catherine Carbery. (2008). Basic Concept in Mechanical Ventilation. Retrieved June 29, 2011 from Bnet website: findarticles.com/p/articles/mi_m074B/is_3_18/ai_n31345616 4. Cheryl Jakab. (2006). Respiratory System. Smart Apple Media. Minnesota. 5. Geddes LA. (2007). The History of Artificial Repiration. IEEE Engineering in Medicine and Biology Magazine. 26(6). pp38 41 6. Maquet. (2004). Servo I V3.1 Service Manual. MaquetGetinge Group. Sweden. 7. Robert Chartburn. (2003). Fundamentals of Mechanical Ventilation: A Short Course in The Theory and Application of Mechanical Ventilators. Mandu Press Ltd. Cleveland.

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Appendices

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