Puritan Bennett 840
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electric (120 AC battery) and pneumatic (compressed air and oxygen)
Back Up Battery
- provides backup power to BDU and screen
- does not power compressor or humidifier
- to charge keep ventilator plugged in between patients
- Includes main inspiratory line, patient connector, main expiratory line connected to an internally mounted exhalation valve
- inspiratory and expiratory (heated collector vial for liquid condensate from exhaled gas) filters
- Power On Self Test-runs automatically to check the microprocessor when the ventilator is powered on
- Exteded Self Test-more extensive test, generally run by a qualified service technician
- Short Self Test-takes three minutes and verifies proper ventilator operation, checks the patient circuit for leaks, measures circuit complience and resistance, and checks the exhalation filter. Should be preformed when a new circuit or humidifier is added, between patient uses, and at least every 15 days during use. Can only be run immediately after the ventilator is turned on.
For any self test ventilator must be disconnected from the patient and Y connector uncapped
- Graphic User Interface
- 3 basic sections: touch sensitive screen, status indicator section, control function screen/control funtion knob
Dual View (touch sensitive) Screen
- visually divided into two sections
- upper screen displays patient data in both digital and waveform
- lower screen shows actual settings, information and instruction area, Sandbox
- Sandbox allows therapist to select several changes at one time and view them before they are activated.
- patient data
- alarms and ventilator status
- miscellaneous data
- NO VENT SETTINGS CAN BE CHANGED IN THIS AREA
- Data Areas expressed in abbreviations which can be defined by touching and holding said abbreviation
- The pt data area gives information about monitored parameters-i.e. PEEP, mand RR, I:E ratio, TV, Peak Flow
- Below the monitored patient data on the top of the upper screen are the alarm messages.
- Alarms are grouped together by conditions that cause them
- accompanied by help messages with suggestions to remedy problem
- digital timer to indicate length of any nonventilated period
- can list the two highest priority alarms at any time
- Others are displayed in more alarms section in the miscellaneous window
Graphics Display Area (upper screen)
typically monitors waveforms, additional graphs, and loops.
control that allows access to other scalers and loops
more information clipboard
has data not commoly displayed at the top of teh screen such as spontaneous minute volume and measured oxygen percentage.
alarm log icon
- displays the last 80 alarm events
- is deleted when a new patient is set up for ventilation
More Alarms Icon
displays active alarms not included in the upper alarm message section ner the top of the screen that displays the top two alarms
Other Screens for Upper Data Window
- Ventilator configuration
- Operational time log
- Test Summary
- SST Results
5 areas: primary settings, Sandbox, setup keys, symbol definition area, prompt area
- Current set parameters
- may include trigger senstitivity, mode, mandatory rate, ad volume, depending on the mode being used.
- accessed when the operator wants to chage the mode or several settings all at one time.
- Allows changes to be made without the changes becoming active until the ACCEPT key is pressed.
used to display information to guide use of the ventilator functions.
Status Indicator Panel
- Located in the right upper touch screen
- provides information about the status of alarm indicators, ventilator inoperative conditions, saftey vlave open, and compressor status.
show level of alarm priority
High level alarms
- indicated by "!!!"
- displayed in red
- blink rapidly
- emit tone
- indicated by "!!"
- displayed in yellow
- beeps three times
- blinks slowly if active
Low Priority Alarm
- indicated by "!"
- steady yellow light
- alert gives two tone alert
"Vent Inop" Indicator
- means the unit cannot ventilate the patient and must be taken out of service.
- must use alternative means to ventilate patient until unit can be replaced
- located on left of BDU
- illuminates red for serious conditions
- cannot be reset when active
Safety Valve Open (SVO)
- only a spontaneously breathing patient can breathe room air through this valve
- occurs when ventilator is inoperative (valve opens automatically)
- middle alert on BDU
Screen Lock Keys
- appears yellos when the screen is in the locked position
- when locked touching the screen has no effect on the ventilators function
- prevents accidental chages in settings and displays and allows for cleanig the screen
- can be unlocked by touching control again
- automatically unlocks during alarm conditions
Display Contrast Key/Display Brightness Key
alter contrast and brightness in the original black and which screen but have no function with the color GUI and are non-functional in newer versions of the GUI displays
Alarm Volume Key
to change hold down while turning control knob
Alarm Silence Key
- 2 minutes in duration
- turns green
- reactivated when: when 2 min passes, alarm reset key is pressed, new high-urgency alarm codition occurs
Reset alarm key
- clears active alarms
- clears autoreset high urgency alars so they are no loner illuminated
- cancels an active alarm silence
- records any active alarms into memory
- *a device alert alarm cannot be reset due to danger to patient
Question Mark Key
provides a display of basic operating information about the ventilator in the upper display window
"100% O2/Cal 2 min"
- delivers 100% oxygen for 2 minutes when the ventilator is connected to an oxygen source
- lights up green when in use
- pressing again restarts 2 minute interval
Manual Inspiration Key
- delivers a manually triggered breath based on the current mandatory settings.
- can only be activated during the latter part of a mandtory exhalation to avoid breath stacking
Expiratory Pause Key
used to estimate end expiratory pressure and auto-PEEP
Inspiratory Pause Key
- used to estimate end inspriatory pressure
- pause inspriation as long as held (up to 8 seconds)
- freezes pressure-time waveform and shows the value for plateau pressure and, compliance, and resistance
loss of Graphic User Interface
- right indicator on BDU
- illuminates red when a malfuntion is present in the GUI so that information displayed is unreliable
- ventilator must be taken out of service
- triggers ventilator to go into apnea ventilation and AV screen to be displayed
- can push reset button to reinitiate normal ventilation
- Normal Ventilation will resume when the pt takes two sponanteous breaths
- indicates that a background check detects a serious problem
- ventilator will only reset when an EST test is run and passed
- initiated at detection of "procedure error" (i.e. if pt is connected to ventilator before setup is completed, if power is disconnected for 5 minutes or more)
- Consists of pressure control madatory breaths with a set pressure of 10cmH2O, a rate of 16 bpm, an inspiratory time of 1.0 seconds, an FiO2 of 1.0, PEEP of +3 cm H2O.
Ideal Body Weight
for kilograms divide by 2.2
Breath Timing Bar
- shows results of parameter setting changes on the I:E ratio.
- visual representation of the effect of the changes made
- actual value in seconds appears inside bar for both TE and TI
- Total cycle time is shown at the right end of the bar
- The minute ventilation based on set rate and tidal volume and appears above the bar.
i time shortens for the same volume and rate in volume ventilation
Lock on Breath Timing Bar
- During pressure ventilation
- appears above breath timing bar
- if left lock activated TI becomes constant but any changes in rate affect the I:E ratio and TE
- if the second lock is activated the I:E ratio becomes constant and TI and TE can change
- if the right lock is activated TE is constant and TI and I:E ratio can be affected by changes in rate (this could be good for a pt who is airtrapping to make sure exhalation is long enough for complete exhalation)
- available as volume or pressure targeted
- all breaths delivered have the preset volume or preset pressure delivered for every breath
- in VoluME AC breaths can be either time or patient triggered (pressure or flow), volume limited, and volume cycled
- In Pressure AC Ventilation (PC), the breath is time or patient triggered (pressure or flow), pressure limited or time cycled
- can have mand breaths at either volume or pressure targeted
- have the same parameters set as in A/C
- Spont breaths can be at baseline or with PEEP/CPAP added
- can be aided with PSV
- Additional parameters set with PS is pressure support, rise time percent (RT%), expiratory sensitivity (ESENS)
- If no PS applied each spontaneous breath recieves pressure support of 1.3 cmH2O above PEEP to reduce work of breathing. For apnea ventilation, VC or PC with associated parameters must be chosen.
- Time for application of both PEEP levels and breath rate are also set.
- allows for urestricted spontaneous ventilation and synchronization of breathing with the patients inspiratory and expiratory pattern.
- it provides two levels of PEEP or CPAP designated PEEPH (5 to 90cmH2O) PEEPL (0 to 45 cmH2O). PEEPL should be at least 5cmH2O lower than PEEPH
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