alia vietnamese language

My th

Alia

Alia

EXPIRATIONS-DRUCK PEEP 10 0 mbar

INSPIRATIONS-DRUCK 60 PLATEAU 15 20 50

5

30 1 40

O212 V ext.

AIR30 25 20 15 10 5 2

30 25 20 15

Steriles aqua dest. max.

10 5 2

Med. AIR

Ti liu hng dn s dng

F. STEPHAN GmbH Medizintechnik D-56412 Gackenbach Kirchstr. 19 Tel. (06439) 9125-0 Fax (06439) 9125-111 [email protected] www.stephan-gmbh.com

Li gii thiu Ti liu hng dn s dng ny nhm mc ch tr li mt cch ngn gn v sng sa bt c cu hi no m bn c th c lin quan n vic vn hnh v bo dng my th Alia. Ti liu ny khng bao gm cc hng dn sa cha v tho lp my. Khi c s c xy ra trong khi vn hnh my, xin hy lin h vi i H tr k thut c cng ty F. Stephan GmbH y quyn hoc vi i l c y quyn m bn mua my nhn c hng dn v h tr. Nh sn xut ch m bo s an ton v n nh ca my th Alia, khi n c vn hnh theo ng nhng hng dn trong ti liu ny.

Nh sn xut: F. Stephan GmbH - Medizintechnik Kirchstrae 19 56412 Gackenbach CHLB c Dch t phin bn ting Anh: Alia Operator Manual Version: V 1.2 (date: January, 2005) Phin bn ting Vit: V1.0 /01-20052 Hng dn s dng my th Alia, 01/2005

Mc lc

Mc lcMc lc ..................................................................................................................................................... 3 1. Cc thng tin chung ....................................................................................................................... 5 1.1. 1.2. 1.3. 1.4. 1.5. 1.6. 1.7. 2. 2.1. 2.2. 3. 3.1. 3.2. 3.3. 3.4. 3.5. Kt hp thit b ................................................................................................................... 5 Nhn hiu v nh sn xut ................................................................................................. 5 Cc ng dng c thit k............................................................................................... 5 ng gi.............................................................................................................................. 5 Gii thiu ............................................................................................................................ 5 Cc ch vit tt................................................................................................................... 6 Thng s k thut ............................................................................................................... 8 Cc cnh bo nguy him .................................................................................................. 10 Cc cnh bo Cn trng................................................................................................... 11 Mt trc .......................................................................................................................... 13 Cnh tri ........................................................................................................................... 14 Cnh phi.......................................................................................................................... 14 Mt sau ............................................................................................................................. 14 Mn hnh theo di ............................................................................................................. 15 3.5.1. Cc vng mn hnh .............................................................................................. 16 3.5.1.1. 3.5.1.2. 3.5.1.3. 3.5.1.4. 3.5.2. 3.6. 3.7. 3.8. Cc thng s ci t................................................................................ 17 Hin th trng thi .................................................................................... 18 Hin th th v cc gi tr o c ...................................................... 19 Hin th bo ng v thng bo .............................................................. 19

Hng dn an ton ...................................................................................................................... 10

M t cu to v chc nng......................................................................................................... 13

Menu chnh ........................................................................................................... 21

Ct o lu lng kp........................................................................................................ 25 Khi bnh nhn................................................................................................................. 26 H thng ng th.............................................................................................................. 27 3.8.1. 3.8.2. ng th cho tr em .............................................................................................. 28 ng th ngi ln................................................................................................ 28

4.

Chun b cho my hot ng ....................................................................................................... 29 4.1. 4.2. Lp t my ...................................................................................................................... 29 Kt ni ti h thng kh v ngun in............................................................................. 29 4.2.1. 4.2.2. 4.3. 4.3.1. 4.3.2. 4.3.3. 4.3.4. H thng cung cp kh.......................................................................................... 29 Ngun cp in .................................................................................................... 29 Lp rp b lm m................................................................................................ 30 G cht khi bnh nhn ....................................................................................... 31 nc cho b lm m....................................................................................... 31 H thng ng th.................................................................................................. 31 3

Chun b cho khi bnh nhn ........................................................................................... 30

Hng dn s dng my th Alia, 01/2005

Mc lc 5. 6. Danh sch cc mc kim tra........................................................................................................ 32 Hot ng..................................................................................................................................... 34 6.1. 6.2. 6.3. 6.4. Bt cng tc my .............................................................................................................. 34 Chn la cc phng thc thng kh (ch th).......................................................... 35 Lng khng kh tri ........................................................................................................ 35 Ci t cc thng s ......................................................................................................... 37 6.4.1. Ch thng kh .................................................................................................. 37 6.4.1.1. 6.4.1.2. 6.4.1.3. 6.4.1.4. 6.4.1.5. 6.4.1.6. 6.4.1.7. 6.4.2. 6.4.3. 6.4.4. 6.4.5. 6.5. 6.6. 7. 8. STNDBY (Ch ch)............................................................................ 37 CMV......................................................................................................... 37 A/CV ........................................................................................................ 38 SIMV........................................................................................................ 38 C/BKUP ................................................................................................... 39 ASB ......................................................................................................... 39 N/CPAP ................................................................................................... 40

Thi gian ht vo................................................................................................... 41 Thi gian th ra .................................................................................................... 41 Trigger ( nhy) ................................................................................................. 41 Ci t nhit kh h hp................................................................................... 42

Ci t cc gii hn cnh bo .......................................................................................... 42 Tt my ............................................................................................................................. 42

Cnh bo, nguyn nhn v bin php khc phc........................................................................ 43 Bo dng, bo tr. ...................................................................................................................... 47 8.1. 8.2. V sinh v tit trng. ......................................................................................................... 47 Chun b c bn ............................................................................................................... 47 8.2.1. 8.2.2. 8.2.3. 8.2.4. 8.2.5. 8.3. 8.4. 8.5. Bo qun khoang my.......................................................................................... 48 Dy dn kh v dy cp ngun ............................................................................. 48 H thng ng ca bnh nhn ............................................................................... 48 u d dng chy PNT ........................................................................................ 49 B phn bnh nhn .............................................................................................. 51

Tng quan St trng v tit trng ..................................................................................... 53 Kim tra an ton k thut.................................................................................................. 54 Kim tra v bo dng..................................................................................................... 54 Cc ph kin chnh ........................................................................................................... 54 Danh sch cc b phn thay th ...................................................................................... 54

9.

Danh sch ph kin/b phn thay th ......................................................................................... 54 9.1. 9.2.

10. 11.

Bo hnh ...................................................................................................................................... 56 Ghi ch ......................................................................................................................................... 57

4


Cc thng tin chung

1. 1.1.

Cc thng tin chung Kt hp thit b

F. Stephan GmbH lun m bo tun th theo lut bo v mi trng.

1.5.

Gii thiu

F. Stephan GmbH khng chu trch nhim bo hnh cho cc hng hc khi my c kt hp s dng vi nhng thit b m khng c php ca nh sn xut hay khng c chng nhn l tng thch. Ch s dng cc ph kin v vt t thay th trong danh sch nm phn 9 trang 57.

Theo cc quy nh v thit b y t ca c (German Medical Equipment Regulations MPG), Theo cc o lut v s dng thit b y t ca c (MPBetreibV) v Lut p dng cho cc vt liu k thut, quy nh rng ngi s dng cn ch tun th theo ng cc im sau: Ch nhng ngi kh nng v c o to mi c th vn hnh my. Cc kin thc hon thin v hng dn vn hnh l iu kin bt buc phi c. Ngi s dng phi c k v hiu cc hng dn vn hnh v hon ton tun theo cc thng tin c cung cp trong v ch nhng thao tc vn hnh khng c li mi c th m bo an ton cho bnh nhn v thit b. Ch s dng my th Alia cho cc mc ch c thit k cho my v lit k trong hng dn s dng. Cc chm sc v vn hnh cu th c th dn n hng hc v tai nn. Ti liu hng dn s dng phi lun trong tm tay khi vn hnh my.

1.2.

Nhn hiu v nh sn xutAlia

Nhn hiu: Nh sn xut:

F. Stephan GmbH - Medizintechnik Kirchstrae 19 D 56412 Gackenbach, Germany Fax +49 (0) 6439 / 9125 0 +49 (0) 6439 / 9125 111 [email protected] www.stephan-gmbh.com

1.3.

Cc ng dng c thit k

My th Alia c thit k s dng thng kh di ngy cho cc i tng: tr non, tr s sinh, tr nh cng nh ngi ln.

Cc yu cu bo hnh pht sinh do cc thao tc vn hnh sai, chm sc khng ng cch hay sa cha s khng c chp nhn bi nh sn xut. Nh sn xut ch m bo c s an ton v tin cy ca my Alia khi n c vn hnh ng vi Ti liu hng dn s dng.

1.4.

ng gi

Cc vt liu s dng ng gi thit b u c th ti s dng hoc ti ch. Thng ba cng c th ti s dng hoc a vo loi giy thi. Cc vt liu bao ngoi l cc m khng cha CFC, chng c th c phn loi vo rc ti ch.


5

Cc ch vit tt

1.6.

Cc ch vit tt

Vit tt A/CV AIR Battery Apnea aqua dest. ASB bar BTPS

Tn y Assisted Controlled Ventilation Chargeable battery Apnea Aqua destilata (lat.) Assisted Spontaneous Breathing

Gii ngha Thng kh h tr/iu khin Kh nn tiu chun y t c quy Ngng th Nc ct Thng kh t nhin c h tr ca my n v o p lc

Body Temperature and Ambient iu kin o vi nhit c th, p lc Pressure Saturated kh quyn thc t v kh bo ha hi nc. Thi gian ngng th ca bnh nhn th t nhin (apnea) v ch th d phng c kch hot vi cc thng s c ci t trc Continuous Positive Airway Pressure / Backup Ventilation Continuous Mandatory Ventilation Thng kh p lc dng lin tc c ch d phng. n v o p lc Thng kh kim sot. My th kim sot hon ton qu trnh thng kh ca phi, bnh nhn khng c bt c mt hot ng tham gia no. Thng kh p lc dng lin tc S sai khc nhit gia ng th v bung lm m Vin tiu chun c. Tiu chun chu u Thi gian th ra K hiu: V Dng chy Nng oxy ca kh th vo Tn s th Nu cn t nng Hgh Priority Tn hiu cnh bo nguy him mc cao, yu cu bo s phi c hnh ng x l ngay lp tc (DIN EN 475). Phm quay v bm Thi gian th vo Trong tim Trong no Hng dn s dng my th Alia, 01/2005

Backup time

C/BKUP cmH2O CMV

CPAP Diff TankTube DIN EN EXSP Flow FiO2 Freq ggf. Heat HP

Continuous Positive Airway Pressure

IGR INSP intracardial intracranial 6

Incremental transmitter

Cc ch vit tt

Vit tt calibration LED MAP mbar min Mode MP Minute

Tn y Light Emitting Diode Mean Airway Pressure

Gii ngha Hiu chun thit b it pht quang p lc trung bnh ng kh n v o p lc n v o thi gian Mode th Tn hiu cnh bo nguy him mc trung bnh, yu cu bc s phi ch ngay n ngi bnh (DIN EN 475). Multiple resistant Staphylococcus aureus

Medium Priority

MRSA MV N/CPAP O2 UL Open Minute volumen Nasal / Continuous Positive Airway Pressure

Thng kh pht MV = VT Frq [L] Thng kh t nhin bng mt n vi p lc dng lin tc Oxy Gii hn trn Ch hot ng M: H thng c m vi mt dng kh n nh chy lin tc

PEEP Pmax PNT Pressure CDD s Semi open

Positive End Expiratory Pressure Pneumotachograph Symbol: P second

p lc dng cui k th ra p lc nh u d dng chy p lc Thit b lm sch v tit khun n v o thi gian Ch hot ng Bn m: H thng bn m vi dng kh n nh chy lin tc

SIMV Stenosis Stndby Tbc Temp Trg LL VT CGS

Synchronized Intermittend Mandatory Ventilation Standby

Thng kh bt buc ngt qung ng th Tc ng Ch ch Bnh lao Nhit Trigger Gii hn di

Tidal volume

Th tch kh lu thng. Kh nn trung tm


7

Thng s k thut

1.7.

Thng s k thut

iu kin mi trng Hot ng: Nhit 10 40 C m: 10 95 % p sut: 500 1060 hPa Cn thit b tr v nhit phng trc khi a vo hot ng Nhit 5 45 C m: 10 95 % p sut: 500 1060 hPa Bo v khi cc cht lng Trnh bi Trnh ng bng

Lu tr:

Tng qut MPG Rating: Chu k kim tra/bo dng: Kch thc (H x W x D) My chnh: C xe y: Cn nng: V tr hot ng: Thng s hot ng Ngun in Ngun cp: Ngun chnh: Cng sut tiu th: Dng tiu th: Cu ch: c quy trong t np Loi: Trng lng: in p: Dung lng: Cu ch: Thi gian np: Thi gian hot ng: Ngun in trn t in p: Dng tiu th: Kch thc mn hnh: 12 V= 10 A LCD 128 x 240 Pixels c quy kh 6.2 kg 12 V 17 Ah 10 A 18 h khong 1 gi c b lm m Khong 3.5 gi khng c b lm m cm chng sc in 90 240 V~ / 50 60 Hz 180 VA 3A 2 x 3.15 A, slow-blow My chnh: II B

1 nm/ln 2363 x 305 x 358 560 x 1165 x 660 23.5 kg

Nm ngang

8


Thng s k thut Ngun kh O2: p lc hot ng: Loi u ni: B ni gc cho kh: 1.5 6 bar 0.5 bar M 12 x 1 inner / NIST DIN 13260

Cc mode th Standby CMV SIMV A/CV C / BKUP ASB N / CPAP Ch ch, my ang sn sng hot ng Thng kh bt buc kim sot Thng kh bt buc ngt qung ng th Thng kh h tr/kim sot Thng kh t nhin vi p lc dng lin tc Thng kh t nhin c h tr Thng kh t nhin vi p lc dng lin tc qua mt n

Unit settings Cc ci t Ch hot ng: u d dng chy: H thng m H thng bn m D, C Thng kh dng chy hng nh Thng kh dng chy hng nh

Thi gian d phng ngng th: 2, 4, 8, 16, 60 s Cc thng s ci t (Vi cc iu kin tiu chun 23C v 1.013 bar) O2 AIR Phm vi: n v: 0 30 l/pht

Phm vi: 0 30 n v: l/pht n v s s L/min C Phm vi 0.35 2 0.5 2 2 60 0.8 8.0 30 40 Bc iu chnh 0.05 0.05 0.5 0.1 0.2

Thng s Thi gian th vo Thi gian th ra Trigger Nhit Khi bnh nhn PEEP: PLATEAU: Van x khn cp: Dung tch bnh lm m: B lm m: ng lm m:

0 10 mbar 15 60 mbar m ti 2 ti 4 mbar 850 ml 12 V / 35 W 12 V / 20 W


9

Thng s k thut Cc thng s o c v hin th Thng s MV VT MAP PEEP Frq Dng sng hin th: Kiu: chia: n v L Ml cmH2O cmH2O /min Bc iu chnh 0.01 1 1 1 1 p lc Thi gian (P t) Dng chy Thi gian (V t) Trc Y :12, 30, 60, 90 Trc X: 4, 8, 16 s

Gii hn bo ng Thng s Pmax MV FiO2 Temp VT n v cmH2O L % C ml Gii hn thp (LL) 1 UL / 60 0 0.5 0.5 UL 18 OG 29 OG 1 10 10 100 LL 29,8 21 / LL 100 36 / LL 41 Gii hn cao (UL) LL 70 Bc tng 1 0.05 0.1 1 0.2 1 10

2.

Hng dn an ton

Cc hng dn an ton sau c lp li ti mi im lin quan trong ti liu hng dn s dng ny. V chng phi c tun theo trong mi hon cnh. Nu b qua cc cnh bo nguy him, s c th e da ti tnh mng ca bnh nhn cng nh bn thn ngi s dng thit b. Nu b qua cc cnh bo cn trng, s c th gy ra hng hc ca thit b, do cng c th gy ra nguy him cho bnh nhn trong hon cnh no .

My th phi c vn hnh theo ng nhng hng dn trong ti liu ny. Khng c vn hnh my Alia ti nhng vng c nguy c chy n Lun phi c d phng bng bp tay! m bo cc dy dn v ng h p lc phi c lp t ng! m bo khng c nc ng u ng th vo gn vi ch Y m c th chy vo u d dng chy. m bo khng c nc ngng t cc ng ni ng h p lc.

2.1.

Cc cnh bo nguy himMy th Alia phi c vn hnh bi nhng ngi c chng nhn v o to nghim chnh.

10


Hng dn an ton Trc mi ln s dng my th, cc bc kim tra cn phi c tin hnh y . Trc mi bnh nhn, cn kim tra m bo l u d dng chy c chn ng v cc ng h p lc c lp t thch hp. Kim tra m bo l ng ni ti u d dng chy phi nm nga mt ln trn nhm mc ch ngng khng cho nc ngng t chy vo ng.

2.2.

Cc cnh bo Cn trngCh s dng cc vt t c chun b tt vn hnh my! Khng s dng ng th bng cc vt liu dn in hoc tch in. Ch s dng xy kh v c chng nhn t tiu chun y t! Hi m trong ng ng dn kh c th s gy cc hng hc k thut cho my. Thao tc cn thn cc b phn ri trnh cc hng hc v c kh. Trong trng hp mt in, c quy 24V np y c th gip my hot ng c t 2 n 4 gi. m bo s d phng ny cn lm theo th tc sau: - My th phi c ni vi ngun in li, - Cng tc ngun chnh ca my phi v tr Bt (ON), - Phm bm ON/OFF phi v tr Tt (OFF). Nu khng th duy tr c iu ny, c quy s phi c np trong 24 gi sau mi 14 ngy. lm vic ny hy tin hnh th tc ni trn. Mch np s t ng bo v c quy khng b np qu mc.


11

Hng dn an ton Nu my th khng th lin tc ni vi ngun in li, cn tun th - Cng tc ngun chnh nm v tr Tt (OFF) - Phm bm ON/OFF nm v tr OFF. Nu b qua iu ny s dn n tnh hung c quy b x ht in v khng th np li c na. Khi s phi thay th mi c quy v vic ny ch c th c tin hnh bi k s ca nh sn xut hoc i h tr k thut c F. Stephan GmbHf y quyn. Vic b qua cc hng dn an ton ny s b coi nh l vic vn hnh my sai ca ngi s dng. Ch s dng ng th chnh hng c cung cp bi F. Stephan GmbH. Khi lp t my, cn m bo l my nm ng gia ca xe y. Khi di chuyn xe y, cn nh kha cc bnh xe v nh kha chng li trc khi bt u vn hnh my. My th c trng lng khong 20 kg. Nu my th c gn vo tng th cn phi gia c gi treo cho lc. Cc thit b iu tr bng in cao tn (High-frequency therapy equipment) nu s dng gn my th s c th nh hng n s vn hnh an ton ca my. Trng hp ny bnh nhn v my phi c theo di lin tc v st sao. Vi cc thit b y t c u cm tng thch vi chun DIN EN 60601-1 v VDE 0751-1. Theo cc tiu chun ny, chng ch c th c a vo s dng mi nh sn xut hoc ngi c y quyn ca nh sn xut. Khi kt ni cc thit b in bn ngoi, tiu chun DIN EN 60601-1 phi c tun theo v tn trng trit . Cc thit b ngoi vi phi c ni ti bin p cch ly ( c kim tra in p 4kV) ging nh cc thit b c cung cp bi F. Stephan GmbH). Cc thay i, sa i, sa cha hay thay th c-quy ch c th c thc hin bi nhng ngi c y quyn ca F. Stephan GmbH. iu ny khng bao gm vic tho lp khi bnh nhn nh c m t trong Ti liu hng dn s dng. Ch s dng vt t v ph kin cung cp bi F. Stephan GmbH. u d dng chy phi c lm sch mt cch cn thn bng nc. Khng c s dng cc my lm sch y t!

12


Cu to v chc nng

3. 3.1.

M t cu to v chc nng Mt trc

1

1. My chnh 4EXPIRATIONS-DRUCK PEEP 10 0 mbar 50 5 30 1 40 INSPIRATIONS-DRUCK 60 PLATEAU 15 20

Alia

2. Xe y 3. H thng ng th 4. u d dng chy 5. Mn hnh theo di 6. Cng tc tt bt 7. Ct o dng chy kp 8. Khi bnh nhn 2

O2

AIR30 25 20 15 10 5 2

3

12 V ext.

30 25 20 15


10 5 2

Med. AIR

5Alia



5

30 1 40

O212 V ext.

AIR30 25 20 15 10 5 2

30 25 20 15


10 5 2

Med. AIR

8

7

6


13

Cu to v chc nng

1

2

3

3.2.

Cnh tri

1. cm dy lm nng 2. Dy cm bin nhit v cm b lm mHeater T-Sensor V-Sensor

3. cm u d dng chy 4. Khi bnh nhn 4 5. Ngun O2 (CGS) 6. Ngun kh nn (CGS)


6

5

3.3.

Cnh phi

1. ng h m thi gian hot ng 1 2 3 2. u ni 12 V 3. u cm dy t 4. cm in 5. Cng tc ngun chnh 6. Cu ch12 V EXTh 00000000

7. Cng RS 232 8. Qut

2 x 3,15 AT

8

7

6 5 1

o

I

4

3.4.

Mt sau

1. Van an ton 2. B lc khun vo 3. Cm bin xy 4. B lc

4

3

2

14


Cu to v chc nng

3.5.

Mn hnh theo di

Alia2 1 3

4

512 V ext.

1. Mn hnh 2. Phm tt ting bo ng m thanh bo ng s b tt trong vng 2 pht. m thanh bo ng s ku tr li nu c mt bo ng khc xy ra. C th bm tip mt ln na nn phm ny tt ting ng thm 2 pht. Trng thi bo ng c th c c qua cc n LED nhp nhy: Xanh Vng Khng c bo ng Bo ng mc nguy him trung bnh Bo ng mc nguy him cao

3. Phm Menu S dng gi menu chnh ca my gm c cc menu ph sau:-

Alarm Settings (Ci t bo ng) Valve.Settings (Ci t cho van) Monitor Settings (Ci t b theo di) Options (Ty chn) Curve Display (Hin th dng sng)

Nu bm phm ny trong khi ang menu chnh hoc menu ph, my s thot tr v mn hnh bnh thng v tt c cc thay i s c ghi nh v lu li. Trong qu trnh thay i gi tr ca cc ci t, phm ny s b kha.

Nu bm phm ny khi ang c mt bo ng xy ra, n LED s vn sng vi mu tng ng vi trng thi ca bo ng . Nh c 8 bo ng. C th bm lin tc phm ny xem hoc xa ln lt cc bo ng c nh li. Tuy nhin chc nng ny ch c tc dng nu lc ang khng c bo ng no xy ra.


15

Cu to v chc nng 4. Phm quay v bm IGR Vi phm IGR tt c cc tnh nng ca my Alia u c th c chn kch hot hay b kch hot. Phm IGR c cc chc nng sau:-

Thay i cc ty chn trong menu Chn v thc hin mt chc nng no trong menu.

Bng cch quay phm theo chiu kim ng h hoc ngc chiu kim ng h c th gi ln tt c cc menu c trong my. Mi khi cun qua cc mc menu, chng s c lm sng ln vi trn mu ti. Bng cch bm nn mt mc menu s c th thc hin c mt chc nng hoc gi ln mt menu con khc. 5. Ch th hot ng Dng ngun in li 90 240 V AC Ch th trng thi np ca c quy Xanh: 90 100 % Vng: 40 90 % : 10 40 %12 V ext.

S dng ngun in ca t 12 14 V DC

3.5.1.

Cc vng mn hnh

1. Cc thng s ci t2 4

2. Hin th trng thi 3. Hin th th v cc gi tr o c 4. Cc thng bo v cnh bo

3

1

16


Cu to v chc nng

3.5.1.1. Cc thng s ci tMode th Cc ci t : STNDBY CMV SIMV A/CV C/BKUP ASB N/CPAP

Thi gian th vo n v: Phm vi: Bc tng: giy (s) 0.35 2.00 0.05

Thi gian th ra n v: Phm vi: Bc tng: Phm vi: Bc tng: Trigger n v: Phm vi: Bc tng: L/min 0.8 8.0 0.1 giy (s) 0.5 2.00 0.05 2.00 60.0 0.5

Nhit ca kh th n v: Phm vi: Bc tng: C 30 40 0.2 C


17

Cu to v chc nng

3.5.1.2. Hin th trng thiVng mn hnh ny hin th thng tin qua trong v ci t van ca my (Valve Settings). 3 thng bo sau c th c hin th ti y:-

Operation mode Backup time Pneumotachograph

Operation mode Hin th: OPEN Thng kh bng dng chy hng nh, h thng ang m Thng kh vi Th tch hng nh, h thng ang bn m (semi-open)

Hin th: SEMI

Backup time Hin th: 2, 4, 8, 16, 60 Thi gian d phng ci t, nu bnh nhn ngng th sau khong thi gian ny, ch th d phng s c kch hot vi cc thng s c t t trc. Pneumotachograph Hin th: PNT D Hin th: PNT C Hin th: NO cn nng > 10 kg cn nng < 10 kg Khng s dng u d dng chy

Ch khng s dng u d dng chy ch c th thc hin c trong cc mode sau:-

STNDBY CMV N/CPAP

Cc mode khc khng th chn c qua ci t thng s. Nu my ang hot ng mode th khc m ngi s dng t ty chn Pneumotach trong menu Valve Settings v NO th my s lp tc chuyn v mode STANDBY.

18


Cu to v chc nng

3.5.1.3. Hin th th v cc gi tr o cHin th cc gi tr o c Tt c cc gi tr o c u c hin th vi iu kin BTPS (Body Temperature and Ambient Pressure Saturated). Cc gi tr sau c hin th di dng s: Pmax FiO2 Temp MV VT MAP PEEP Freq p lc cc i Nng Oxy ca kh th vo Nhit ca kh th vo Thng kh pht Th tch kh lu thng p lc trung bnh ng kh Tn s th cmH20 % C L ml cmH2O

p lc dng cui k th ra cmH20 /pht

Hin th th Cc dng sng sau c th c hin th:-

P t [cmH2O]: V t [L/min]:

p lc Thi gian Dng chy Thi gian

Bng cch truy cp vo menu Monitor Settings, ngi s dng c th t cc thng s cho th cng nh iu chnh chia.

3.5.1.4. Hin th bo ng v thng bo1. Bo ng My Alia cung cp nhiu bo ng nhm bo v bnh nhn, lu bc s v thng bo cho bc s tnh trng thay i ca bnh nhn hay nhng trc trc ca my. Cc bo ng bng m thanh hay nh sng u ph hp vi quy nh DIN EN 475 (04/ 95).


19

Cu to v chc nng Mc nguy him ca bo ng c phn bit bng cc m thanh khc nhau: Bo ng nguy him mc cao L bo ng m yu cu bc s phi lp tc phn ng. Chui m: 2 beep, theo sau bi mt khong ngng ngn. 4. Cm ting Biu tng ny hin th nu phm cm ting b bm khi my ang pht sinh bo ng. 3. o dng chy Biu tng ny hin th khi gii hn di ca Thng kh pht b t v 0. Trong trng hp ny cc bo ng bng c m thanh v nh sng cho MV u b tt.

Bo ng nguy him mc trung bnh L bo ng m yu cu bc s phi c mt hnh ng sm. Chui m: 2 beeps, theo sau bi mt khong ngng di.

m bo ng s ngng ngay sau khi iu kin gy ra bo ng khng cn na trong trng hp cc bo ng l mc cao hay mc trung bnh, tuy nhin thng bo bo ng vn hin th cho n khi bc s xem v n ln phm cm ting. Xem chi tit v nguyn nhn, ngha v cch x l cc bo ng phn 7 trang 47. 2. Lm nng B t ngng hot ng, khi thng s v nhit cng khng c hin th trn mn hnh. B t c bt, khi trng thi ca chc nng t c hin th nh sau; 0 = OFF 1 = ON C 2 u cm bin nhit c hin th-

H1 = Bung cha nc H2 = ng th

20


Cu to v chc nng

3.5.2. Main Menu Alarm Settings... Ventil.Settings... Monitor Settings... Options... Curve Display

Menu chnhMenu chnh khng th b kch hot trong khi ang tin hnh ci t thng s.

Menu chnh bao gm cc menu ph sau:-

Alarm Settings... Ventilation Settings... Monitor Settings... Options... Curve Display

Alarm Settings

Alarm Settings Pmax MV FiO2 Temp VT 1 0.00 18 29.0 1 70 19.9 100 41.0 back

S dng ci t cc gii hn trn v gii hn di cho cc thng s sau:-

Pmax MV FiO2 Temp. VT

p lc nh Thng kh pht Nng oxy Nhit kh th Th tch kh lu thng th ra. n v Gii hn di LL 1 UP / 60 0 0,5 0,5 UL UG 29,8 21 / LL 100 36 / LL 41 Gii hn trn UL LL 70 Bc tng

Thng s

Pmax MV

cmH2O L

1 0.05 0.1 1 0.2 1 10

FiO2 Temp VT

% C ml

18 UL 29 UL 1 10 10 100

Ventil.Settings Semi open Heating Diff TankTube Pneumotach Backup time Main Menu NO ON 6 Typ A 4s back


21

Cu to v chc nng

Ci t cho van Menu ny c dng ci t cho ch hot ng ca my th. Ventilation Semi open NO: YES: Thng kh dng chy hng nh, h thng m Thng kh th tch hng nh, h thng bn-m

22


Cu to v chc nng Heating ON Bt b t nng B t nng c th khng th kch hot nu khng nc vo bnh cha. OFF Tt b t nng

chnh nhit Diff TankTube n v: Vng ci t: Bc tng: C -2 +6 1

Ty chn ny s t chnh nhit gia gi tr ci t ca Nhit kh th (c o ti u ch Y ca ng th) v gi tr nhit ca bung lm m/m. chnh dng c ngha l nc trong bnh m hn kh th ti u ch Y s gip tng m tng i ca kh. Nu b lm nng b tt, ci t ny s khng th thc hin c. u d dng chy Pneumotach Kiu D Kiu C NO cn nng bnh nhn > 10 kg cn nng bnh nhn < 10 kg khng s dng u d dng chy Ch khng s dng u d dng chy ch c th thc hin c trong cc mode sau:-

STNDBY CMV N/CPAP

Cc mode khc khng th chn c qua ci t thng s. Nu my ang hot ng mode th khc m ngi s dng t ty chn Pneumotach trong menu Valve Settings v NO th my s lp tc chuyn v mode STANDBY. Backup time n v: Phm vi: Giy (s) 2, 4, 8, 16, 60

Nhng ci t ny ch c tc dng vi cc mode th C/BKUP v ASB. Thi gian d phng ci t, nu bnh nhn ngng th sau khong thi gian ny, ch th d phng s c kch hot vi cc thng s c t t trc.


23

Cu to v chc nng Ci t cho mn hnh

Monitor Settings Curve Y-Scale X-Scale Main Menu V-t 30 8s back

Menu ny cho php ci t thng s cho cc th hin th trn mn hnh. Cc th sau c th c hin th: Pt V t p lc thi gian Dng chy thi gian

chia ca cc trc th c th c thit lp trong menu ny Trc Y 12, 30, 60, 90 Trc X 4, 8, 16 s

Ty chn Calibr.O2

Options Calibr.O2 Save Set.s Main Menu NO NO back

YES

Tin hnh hiu chun u cm bin oxy. Vic hiu chun s c t ng tin hnh mi khi khi ng my Alia v sau mi 4 gi.

NO

Hiu chun c thc hin

Save Set.s YES NO Lu tt c cc thay i va tin hnh. Khng lu cc thay i

24


Cu to v chc nng

3.6.

Ct o lu lng kp

1. Ct o Oxy

O230 25 20 15 10 5 2

AIR30 25 20 15 10 5 2

2. Ct o kh nn Vi h thng ct o lu lng kp, ngi s dng c th d dng thit lp c dng kh th cng nh nng xy cn thit. Khi c gi tr trn ct cn s dng mp trn ca bi. Van iu chnh dng chy O2 Van iu chnh lng oxy cho php iu chnh v thit lp nng xy ca kh th. Nng xy s tng nn khi tng dng chy ca xy, iu ny cng c ngha l khi s dng ch dng chy hng nh ngi s dng cn gim dng chy ca kh nn mt lng ng bng lng tng ca dng oxy. Van iu chnh dng chy kh nn (AIR) Van iu chnh dng chy kh nn gip iu chnh v thit lp dng kh.

Med. AIR

Nng xy s gim i khi ngi s dng tng gi tr ca dng chy kh nn. t c s trn kh ti u cho mt gi tr ca dng kh, cn iu chnh lun phin c 2 van sao cho t c gi tr mong mun.

1

2

Nng ca xy c th kim sot d dng bng mn hnh hin th (xem Phn 3.5.1.3 trang 19).


25

Cu to v chc nng

3.7.2 5 1

Khi bnh nhn

1. Van p lc th vo (PLATEAU) 2. Van PEEP 3. Khay lm nng v ng Teflon 4. Bnh lm m 5. Vt g Van p lc th vo (PLATEAU) Van p lc th vo c s dng thit lp v iu chnh p lc th vo cho bnh nhn. Van cng thc hin cc chc nng ca van an ton v gii hn cnh bo p lc. Ty theo gi tr ca t l thi gian th vo/thi gian th ra (I:E) v dng chy c t trc m kiu (hnh dng) p lc cao nguyn c t ln van. Gi tr ci t phi c kim tra v kim sot s dng gi tr thng s p lc nh Pmax c c trn mn hnh. Van PEEP Van ng trong sut k th vo v m trong k th ra bng cch s dng h thng in t, p lc dng cui k th ra (PEEP) c th c ci t v iu chnh qua van ny. Gi tr ci t cn phi c kim tra v kim sot qua gi tr thng s PEEP o c trn mn hnh. Hp lm nng vi ng Teflon Kh th c y qua ng teflon c cc b lm nng bn trong s c lm m ln trc khi i vo bnh lm m. Nhit ti b mt ca b lm nng rt cao c th gy bng nu chm tay vo. Bnh lm m Kh th c lm bo ha hi nc ti bnh lm m, m tng i ca kh ti u ra ca bnh s nm trong khong 95% - 98%. Khng c vn vt tho bnh lm m trong khi my th ang hot ng v p lc trong bnh trong khi hot ng s vo khong 60cmH2O. Vt g C nhim v g ton b khi bnh nhn vo thn my chnh.



5

30 1 40

3Steriles aqua dest. max.

4

26


Cu to v chc nng

1 2

3

4 1. Cm bin nhit ca bnh nc 2. u ni tiu chun y t (Luer Lock) S dng np nc vo trong bnh 3. u ni ng th vo 4. u ni ng th ra Ch s dng nc ct cho b lm m. Khng nc y qu vch Max.


Khng c vo bnh cc cht gy m d chy. Kim tra r r ca bnh lm m sau mi ln tit trng.

3.8.

H thng ng thS dng ng th bng vt liu dn in hoc tnh in c th gy bng nu c mt thit b phu thut in cao tn hot ng gn. Do khng c s dng ng th lm bng cc vt liu dn in hoc dn tnh. Lun nm cht ng th khi cm vo hoc tho ra khi my, nu khng c th lm hng ng th H thng ng th c lm nng c ng th vo v ng th ra gip gn nh trit tiu hin tng ng nc trn ng th ra do khng cn s dng cc h thng by nc.


27

Cu to v chc nng

3 1 2

3.8.1.

ng th cho tr em

1. Cc u ni ca cm bin nhit cho bnh nc nm trn khi bnh nhn 4 5 2. Cc u ni ca cm bin nhit cho ng th v b t nng nm pha my th Alia 3. u ni ca cc b dy lm nng ng th vo v ng th ra. u ni nm cnh tri ca my th. 4. ng th ra c lm nng 5. ng th vo c lm nng 6. u ni cho cm bin nhit 6 7. u ch Y ni gia ng th vo v ng th ra vi bnh nhn

3.8.2.7 3 1 2

ng th ngi ln

1. u ni ca cm bin nhit bnh nc nm pha khi bnh nhn. 2. u ni ca cm bin nhit ng th v b lm nng nm pha tri ca my th Alia. 3. u ni ca cc b dy lm nng ng th vo v ng th ra. u ni nm cnh tri ca my th. 4. ng th ra c lm nng 5. ng th vo c lm nng 6. u ni cho cm bin nhit 7. u ch Y ni gia ng th vo v ng th ra vi bnh nhn

4 5

6 7

28


Chun b

4. 4.1.

Chun b cho my hot ng Lp t my

Bnh kh nn Van gim p cho xy khng c dnh du, m v c th gy chy n. Khng c s dng cc van b h hay b kt. Cn gi ngay ti cc c s chuyn mn sa cha. Ch c m ng van bng tay, khng s dng bt c dng c no lm vic ny. 1. t bnh xy vo gi v g cht. 2. Vn u ni van gim p vo bnh. 3. Ni dy xy vi van gim p v vi u ni trn cnh tri ca my. 4. M van bnh.

t my th vo gia ca xe y. Cc bnh trc ca xe c h thng kha gip my khng b di chuyn ngoi mun. p xung kha bnh xe v dng u bn chn gy ln m kha. Khi di chuyn xe y, cn ch m kha ca cc bnh xe v kha li khi t xong v tri mi.

4.2. Kt ni ti h thng kh v ngun in 4.2.1. H thng cung cp khKh nn theo tiu chun y t cn phi sch khng c bi, du m v phi kh. H thng cp kh trung tm (CGS) 1. Ni ng dn xy vi u ni xy nm trn cnh tri ca my v vi cp xy ca h thng cp kh trung tm. 2. Ni ng dn kh nn vi u ni kh nn(AIR) nm trn cnh tri ca my v vi cp kh nn ca h thng cp kh trung tm. Nu my Alia c cp kh t h thng trung tm n s t ng tt my nn kh bn trong ca n.

4.2.2.

Ngun cp in

Ngun cp in li My Alia c th hot ng vi ngun in li t 90 V ti 240 V AC. Kim tra dng in cho php ca ngun cp c ph hp vi yu cu ca my hay khng. 1. Cm dy dn in vo cm nm cnh phi ca my. 2. Cm u phch cm vo cm in ca ngun in li. 3. Bt cng tc Tt/Bt cnh phi ca my v v tr (I).


29

Chun b Ngun in -t My Alia c th s dng ngun in cp t b cp in 12 14 VDC ca -t. Khi ngun in 12V ca -t cn phi c bo v t nht l 16A. 1. Cm dy dn dnh ring vo cm 12V nm cnh phi ca my. 2. Cm u cn li vo cp 12V ca -t. c-quy Trong trng hp ngun in li hoc ngun in -t b mt, my s s dng n b cquy 12V gn sn bn trong. Thi gian hot ng bng c-quy khong 1 gi. c-quy phi c np li sau mi 12 ngy trong 24gi. Mch np in s bo v c quy khi b np qu mc. 1. Cm dy dn in vo cm nm cnh phi ca my. 2. Cm u phch vo cp in. 3. Bt cng tc Tt/Bt nm cnh phi v v tr I Nu lm sai quy tc ny, c quy s ht in v gy hng hc cho my. Vic khng tun theo cc quy nh ny s b coi l vic s dng khng ng cch thit b. Trong trng hp c quy ht in, th c th nguyn nhn l n khng c np in trong mt thi gian di. Khi cn phi thay th c quy mi. Vic thay th ny cn phi c tin hnh bi cc k s ca hng F. Stephan GmbH hoc bi cc i h tr k thut c y quyn. Mi khi bt my, c quy s c t ng kim tra (xem phn 6.1 trang 34). Ni t cho thit b Trong trng hp s dng trong phng phu thut no hoc tim, my Alia cn c ni t bng cch cm mt u dy t vo cm dnh ring nm cnh phi ca my v u kia cm vo im ni t ca phng bnh.

4.3.

Chun b cho khi bnh nhn Lp rp b lm m

4.3.1.

1. y ng ngoi vo ng trong v xoy cht chng vo nhau theo chiu ngc kim ng h.

Innenrohr

Auenrohr

2. n ng lm m vo ng gi nm trn khi bnh nhn.

30


Chun b

4.3.2.

G cht khi bnh nhnNhm trnh vic b nhm vi cc khi bnh nhn khc ca hng F. Stephan GmbH cung cp, khi bnh nhn 12V ca my Alia c cung cp vi h thng m ha Vic khng tun th cc quy nh an ton ny s b coi l vic khng s dng thit b ng cch ca ngi dng.

Thng xuyn kim tra mc nc trong bnh cha!

4.3.4.

H thng ng thLun kim tra chc chn l ng th khng b hng. Lun nm cht ng th khi lp vo hoc tho ra khi my nu khng c th gy hng ng.

1. Ci rnh g ca khi bnh nhn vo cc thanh ray nm mt tri ca my. 2. y ht c khi bnh nhn v pha sau my cho n khi n nm ngang bng vi v my. 3. Vn cht vt g nm mt trc ca khi bnh nhn.

1. Khi s dng cc b ng th tr em, trc tin cn lp ng ni 15mm vo ng u cm tng ng trn khi bnh nhn. 2. Ni ng th vo ti u ni tng ng nm trn khi bnh nhn. 3. Ni ng th ra ti u ni tng ng nm trn khi bnh nhn. 4. Ni cm bin nhit ca bnh cha nc vo ng cm nm trn khi bnh nhn. 5. Ni cm bin nhit ca ng th v b lm nng vo ng cm nm trn khi bnh nhn. 6. Cm u ni ca dy lm nng ng th vo v ng th ra vo ng cc cm trn my. 7. Ni ng th vo v ng th ra vo u ni ch Y. 8. y u ch Y bng np bo v. 9. Ni u d dng chy vo u ni ch Y.

4.3.3.

nc cho b lm mCh s dng cc b phn c tit trng/tit khun.

1. Ni bm tim vi bnh cha ht nc ct. 2. Ni bm tim vo u ni Luer Lock nm trn mt ca khi bnh nhn v bm nc vo cho n khi t n vch max. Nhit b mt ca b lm nng c th gy bng nu chm thay vo. Khng c tho bnh cha nc trong khi my ang vn hnh v p lc trong bnh khi c th t ti 60 cmH2O! Phi chc chn l piston ca bm tim khng b y ra khi xi-lanh do p lc. Trong khi my ang hot ng, ch c thm nc vo qua ng u ni Luer Lock.


31

Chun b

5.

Danh sch cc mc kim tra

Tt c cc bc kim tra cn phi c tin hnh trc khi a my vo hot ng. Ngi thc hin cc kim tra ny phi c kin thc v s dng my Alia. iu kin trc khi kim tra My phi c kim tra k thut ng nh k. Kim tra tem hoc s nht k ca my m bo vic ny. My c lp t v kt ni hon chnh. c quy phi c np y. Nu mt trong cc kim tra khng c thc hin hoc khng hon thnh tt, my c th s khng th hot ng c!

32


Bo dng

Kiu my: MC KIM TRABnh Oxy d tr

S hiu: CCH THCM van ca bnh

Ngy thng: MC TIU

K tn: KQ

p lc O2 O2 > 70 bar p lc hot ng ca Alia 3 6 bar ng van v thay bnh mi nu cn. O2 AIR (kh nn) xanh/trng en/trng

Cc u ni kh trung tm

Kim tra mu dy c ng vi mu cm

Hnh dng cm Ct o lu lng Kim tra r r ng tt c cc van O2 M van AIR M van Kim tra bng mt cc u ni

O2

AIR

Bi ch th trn mi ct phi chy v 30 l/min 30 l/min Khng c hng hc n bo ngun mu xanh sng n bo c quy sng xanh hoc cam My phi tip tc hot ng, bo ng Powersupply Fail System test, qua Theo di Pmax trn 40 cmH2O

Ngun in li v c quy

Rt dy ngun T ng kim tra Kim tra h h thng Bt my Semi open = No AIR-Flow = 4 l/min Bo ng Pmax 10 u. 60 cmH2O p lc. Plateau = 50 mbar PEEP = 3 mbar Mode th CMV Insp = 1 s Exp = 4 s Semi open Yes

Trong vng 10 giy cho n khi bnh cha kh c in y sau p lc Pmax phi cao hn 40 cmH2O Pmax o c phi bng p lc th vo t PEEP o c phi bng gi tr t Bo ng sau 30 s Apnea Bo ng Low Min. Volume Bo ng Peak Press, ngng li. Bo ng Low Press/Discon Cm thy dng kh u mt n Kh t in y Bng ch c th b bp vo mt t

p lc th vo v PEEP

Bt u ch Y

Theo di ngng th Theo di thng kh pht Theo di p lc ng th

Chuyn v mode C/BKUP Mode th CMV Bo ng thp ca MV = 1L Chuyn v Mode th CMV t gii hn trn Pmax = 40 cmH2O t Plateau = 50 mbar Tho u ch Y Bp vo bng tay Nh ra Bt cht u mt n

AMBU - Bng

Cc kim tra khc


33

Bo dng

6. 6.1.

Hot ng Bt cng tc my

S cn chnh hin th nhp nhy trn mn hnh hin th FiO2 o cc gi tr hin th. Nu cn chnh sensorO2 khng thnh cng, mt tnh hiu bo ng bng m thanh s kch hat (O2 SENSOR FAILand CALIBRATION O2). Cn chnh flow sensor Sensor dng chy (flow sensor) c cn chnh trong sut qui trnh chy kim tra (xp x 1pht sau khi bt ngun my Alia) v t ng cn chnh sau . Nu cn chnh Flow Sensor khng thnh cng, mt tnh hiu bo ng bng m thanh s kch hat (FLOW SENSOR FAIL). Kim tra ngun p lc O2 ca CGS v/hoc bnh kh Nu trong sut qui trnh kim tra ny, p lc ca ngun cung cp O2 qu thp hoc O2 khng kt ni, my s hin thi mt dng thng bo sau:

Cng tc ngun in chnh phi t t v tr ON/OFF n v tr ON. Cng tc sng mu xanh. Hai van trn 2 flow meter phi ng knh trong sut qu trnh khi ng cng tc ca my. Khi cng tc c m, my Alia s kim tra h thng. H thng kim tra s kim tra theo qui trnh sau:-

Kim tra LEDs v cc tnh hiu trigger bo ng Kim tra s np in ca cqui Cn chnh sensor O2 Cn chnh flow sensor Kim tra p lc ca ngun oxy ca ngun CGS v/hoc bnh kh nn

Kim tra LEDs v cc tnh hiu trigger bo ng Trong qu trnh kim tra ny, cc b phn iu khin s c kim tra nh sau:-

Low Oxygen Pres. Is O2 available? YES NOYES NO Mn hnh xut hin thng bo cnh bo O2 Pressure low. Theo di O2 p lc ngun cung cp khng kch hat (khng hin th thng bo cnh bo O2 Pressure low). Tuy nhin, nu trong qu trnh my hat ng c kt ni vi h thng cung cp O2 , vic theo di p lc ngun cung cp O2 s hin th thng bo cnh bo.

LED ca ngun in chnh sng ln LED ca ngun in ti sng ln LED ca cqui sng ln mu xanh v Cc tnh hiu bo ng pht ra m thanh

Bt k b phn no ca qu trnh test ny khng qua th my s bo ng. Lp tc thng bo cho k s ca hng F. Stephan GmbH hoc nh cung cp Kim tra s np in ca cqui Kim tra cqui s hin th trn LED ch th cqui, sng ln mu v mu xanh. Nu kim tra cqui khng qua, my s pht ra m thanh cnh bo (n LED cqui nhp nhy mu ). Trong trng hp hng cu ch, cqui li hoc cqui khng np in, my th s khng hat ng. My s t ng tt my. Cn chnh u d O2 Mt h thng kim tra t ng cn chnh sensor v sau mi 4 gi s t ng cn chnh. Bn c th cn chnh bng tay, ti bt k thi im no, bng cch vo menu Options (xem phn 3.5.2 trang 21).

34


Bo dng

6.2.

Chn la cc phng thc thng kh (ch th)

YES:

Constant volume ventilation

Main Menu Alarm Settings... Ventil.Settings... Monitor Settings... Options... Curve Display1. Nhn phm Menu bt menu chnh. 2. Dng nt xoay IGR chn menu ty chn Valve.Settings v xc nhn la chn bng cch nhn phm IGR. Menu ty chn Valve.Settings s c kch hat.

Nhu cu ln v dng chy th vo ban u ca cc bnh nhn ngi ln s c gii quyt qua ti cha kh (H thng bn m). N gip m bo vic a kh vo phi bnh nhn mt cch hi ha hp sinh l nht trong khi vn m bo c cc iu kin yu cu ca kh th. Liu lng ca kh th c th c ci t v iu chnh bng h thng ct lu lng kp.

6.3.

Lng khng kh tri

S iu chnh ca lng khng kh tri c th a vo bng van liu lng O2 v AIR. Xoay van theo hng ngc chiu kim ng h s tng lu lng dng kh; v xoay ngc chiu kim ng h s lm gim lu lng dng kh. t c s trn kh ti u cho mt gi tr ca dng kh, cn iu chnh lun phin c 2 van sao cho t c gi tr mong mun. Nng ca xy c th kim sot d dng bng mn hnh hin th (xem Phn 3.5.1.3 trang 19).

Ventil.Settings Semi open Heating Diff TankTube Pneumotach Backup time Main Menu NO ON 6 Typ A 4s back

3. Xoay nt IGR bn c th chn chc nng Semi open v sau xc nhn chn bng cch nhn nt xoay IGR. 4. Ci t ca ch thng hat ng c kch hat bng cch xoay nt IGR. V nhn nt IGR xc nhn v ch th mi c ci t. Semi-open NO: Thng kh dng chy hng nh

Dng chy hng nh trong sut chu k th v chu k th ra c th c iu chnh v ci t trn 2 flow meter. Van th ra ng li trong sut chu k th vo v phi bnh nhn c y kh. Kh CO2 (ti u ch Y) s c y ra ngoi trong sut chu k th ra bi mt dng kh lin tc. Lng kh c th ty thuc vo vic chn ch th ti 2 flow meter.


35

36 Flow [L/min] 6 O2 0 0,75 1,5 2,25 3 3,75 4,5 5,25 6 0 8 0 10 0,75 7 1 8,75 1,25 0 1,5 6 2 7,5 2,5 2,25 5 3 6,25 3,75 7,5 9 10,5 12 3 4 4 5 5 6 6 4,5 3 1,5 0 3,75 3 5 3,75 6,25 4,5 7,5 4,5 2 6 2,5 7,5 3 9 5,25 1 7 1,25 8,75 1,5 10,5 1,8 3,75 5,6 7,5 9,4 11,25 13,1 15 6 0 8 0 10 0 12 0 15 13,2 11,25 9,4 7,5 5,6 3,75 1,9 0 AIR O2 AIR O2 AIR O2 AIR O2 AIR 8 10 12 15 O2 0 2,5 5 7,5 10 12,5 15 17,5 20 20 AIR 20 17,5 15 12,5 10 7,5 5 2,5 0 O2 0 3,75 7,5 11,25 15 18,75 22,5 26,25 30 30 AIR 30 26,25 22,5 18,75 15 11,25 7,5 3,75 0 Bo dng

O2 [%]

2

4

O2

AIR

O2

AIR

21

0

2

0

4

30

0,25

1,75

0,5

3,5

40

0,5

1,5

1

3

50

0,75

1,25

1,5

2,5

60

1

1

2

2

70

1,25

0,75

2,5

1,5

80

1,5

0,5

3

1

90

1,75

0,25

3,5

0,5


100

2

0

4

0

Bo dng

6.4. 6.4.1.

Ci t cc thng s Ch thng khCh thng kh khng th iu chnh v ci t trong khi menu ang c kch hat.

6.4.1.2. CMVThng kh bt buc iu khinP [mbar]

PEEP

Insp

Exsp

Insp

T [sec]

Flow [l/min]

1. Nhn phm Mode. Thng s ci t sng nhp nhy 2. Xoay nt IGR, ch thng kh c th c thay i. 3. Xc nhn v chp nhn ch thng kh mi bng cch nhn nt xoay IGR. 4. Nhn bt k phm thng s no s lm ngng kch hot vi thng s mi. 5. Nu ci t mi khng c xc lp trong vng 15giy sau khi nhp vo, cc ci t mi s khng c hiu lc.

T [sec]

Insp

Exsp

Insp

Trong trng hp thng kh iu khin bt buc, tt c thng s my th c ci t mc nh. S nh hng ca dng sng thng kh th vo l do bnh nhn. Hin th cc gi tr o

6.4.1.1. STNDBY (Ch ch)My th ch sn sng hot ng (Standby operation). Hin th cc gi tr o


37

Bo dng

6.4.1.3. A/CVThng kh iu khin/h trP [mbar]Trigger

6.4.1.4. SIMVThng kh bt buc ngt qung ng b SIMV c m t l mt ch thng kh cho tr em vi dng chy hng s (m). Ch thng kh ny l s kt hp gia ch CPAP v A/CV.T [sec] P [mbar]Insp

PEEP

Triggersperre 200 ms

Erwartungsfenster Insp Exsp

Flow [l/min]PEEP

Trigger

Triggersperre

Exsp/2

Exsp/2Erwartungsfenster

T [sec]Insp

Trigger

Insp

Exsp

T [sec]Triggersperre 200 ms Erwartungsfenster

Flow [l/min]

Insp

Exsp

Insp

Trong ch thng kh ny, cc c gng ht vo ca bnh nhn s c p tr bng mt nhp th bt buc, ngc li vi thng kh iu khin. Ngha l bnh nhn c gng ht vo, my cm nhn c nhp c gng ny v to ra mt lng kh th vo, nu ci t trc thi gian trigger 200ms b vt qu. Ca s c s ca mt trigger nhp th bt buc, s c to ra trong thi gian th ra nh hn 200 ms. Nu c mt c gng ht vo ti ca s ny, v trigger ca bnh nhn vt mc ngng vi chu k gim xung. Nu trigger khng vt ngng vo cui ca s c s, mt nhp th iu khin bt buc s c kch hat. Hin th cc gi tr o

Trigger

T [sec]

Triggersperre

Exsp/2

Erwartungsfenster

Exsp/2

Insp

Exsp

Insp

Thi gian th ra s kha trigger v ca s c s b chia nh ra. i vi ch SIMV ca s c s b chia nh theo cch . Ngha l kha trigger v ca s c s bao gm thi gian th ra. Kha trigger trong ch CPAP chu k, lm tng cng c gng nhp t th ca bnh nhn. Sau ca s c s trigger, nhp c gng t th ca bnh nhn c h tr bng nhp th h tr bt buc nu thi gian trigger vt qu ngng ci t. Nu trigger khng vt ngng vo cui ca s c s, mt nhp th iu khin bt buc s c kch hat.

38


Bo dng Hin th cc gi tr o vy, cc nhp t th s kt thc thng kh d phng. Hin th cc gi tr o

6.4.1.5. C/BKUPThng kh p lc dng lin tc/d phng Dng thng kh CPAP/Backup l mt c tnh ca h tr th ng hon ton ca cc nhp th t nhin ca bnh nhn bng cch tng p lc ng th dng lin tc.P [mbar]

Trong sut thng kh d phng, cc gi tr Pmax v PEEP vn c o v m bo.

6.4.1.6. ASBH tr nhp t th ASB c gii thiu nh l mt dng thng kh cho ngi ln vi ch th tch hng nh (bn m). S dng ti cha kh khi ng dng chy ln hn khi bt u th vo vi dng chy hng nh. Trong ch thng kh ny, cc c gng ht vo ca bnh nhn chng li cc nhp thng kh iu khin bt buc. Ngha l bnh nhn ht vo, my th cm nhn cc c gng ny v to ra mt nhp th h tr nu kch hat trigger ci t trc sau khi ng trigger 200 ms.Flow [l/min]Abbruch der Inspiration nach Erreichen der 25 % Flow max.

PEEP T [sec]Backup-Zeit Insp

Flow [l/min]

Trigger

T [sec]Backup - Zeit Insp

Flow max.

My th khng can thip nh trong trng hp thng kh h tr bt buc. Tuy nhin, dng thng kh ny cn c mt kim tra nhp t th bng cch dng mt ngng trigger pht hin.. Nu trigger khng t ti mc ngng, v d ngng nhp t th nm trong thi gian ci t d phng, my th s h tr bnh nhn bng cch thng kh d phng vi cc thng s ci t trc. Nu my khng cm nhn cc c gng t th trong vng 30 giy, mt bo ng APNEA c kch hat. Bo ng ny s tt bng cch kt thc thi gian thng kh d phng v my pht hin nhp c gng th ca bnh nhn v tr v ch thng kh trc . Nh Hng dn s dng my th Alia, 01/2005

25 % Flow max. Trigger Triggersperre 200 ms

T [sec]

Insp

Backup - Zeit

Insp

Fig. 1

39

Bo dng

P [mbar]

6.4.1.7. N/CPAPEinsetzen der Backup-Beatmung nach Ablauf der Backup-Zeit ohne Triggerung.

Th mi /p lc ng th dng lin tcT [sec]

PEEP

Insp

Backup-Zeit

Insp

Ch thng kh N/CPAP c m t nh l h tr th ng cc nhp t th, ngha l tng p lc ng th dng lin tc.P [mbar]

Flow [l/min]Abbruch der Inspiration nach Erreichen der Inspirationszeit, obwohl 25 % des max. Flowsnoch nicht erreicht wurde.

Trigger Flow max.

25 % Flow max. Trigger

T [sec]

PEEP

T [sec]Insp Exsp

Insp

Backup - Zeit

Insp

Flow [l/min]

Fig. 2 S ht vo s kt thc nu lng dng chy gim xung bng 25% dng nh(Fig. 1), hoc thi gian th vo vt qu 2 giy (Fig. 2), trc khi dng chy gim xung 25% dng inh. Trng hp khng c cc nhp t th trong thi ci t pht hin ngng th, my th s h tr thng kh cho bnh nhn vi tng ng cc thng s ngng th c ci t trc. Thi gian th ra khng phi l thng s quyt nh k th ra trong ch thng kh ny. M l thi gian ngng th xc nh khang thi gian th ra. Nu my khng pht hin c nhp t th trong thi gian ny, th bo ng APNEA c kch hot. Bo ng ny s mt khi kt thc thi gian d phng v c nhp th h tr, my s tr lai h tr cc nhp t th ca bnh nhn. Hin th cc gi tr o

T [sec]

H tr bt buc l khng phi cung cp t my. Bt k s r r ca ng th phi c lai tr v phi thc hin vic kim tra cc c gng t th. iu ny ngha l my khng h tr thng kh v cng khng kim tra c ngng th. Ch c p lc nh c kim tra, nu c kch hat bo ng vt PEAK PRESS. Hin th cc gi tr o

40


Bo dng

6.4.2.

Thi gian ht vo

Tnh ton tn s h hp

(Insp + Exsp) Frq = 60 sFrq = 60 s Insp + Exsp Insp = 1,5 s Exsp = 4,5 s Frq = 60 s 1,5 s + 4,5 s Frq = 10 / min

z.B.

1. Nhn phm Insp. Thng s c chn bt u nhp nhy. 2. Xoay nt IGR, gi tr thng s ci t c th c chnh v ci t. 3. Xc nhn v ci t gi tr mi bng cch nhn li phm Insp hoc n phm xoay IGR . 4. Nhn bt k 1 phm khc b ci t mi. 5. Nu 1 ci t mi khng xc nhn trong vng 15 giy, s khng tc dng na.

6.4.4.

Trigger ( nhy)

Trong tt c cc ch thng kh (ngoi tr STNDBY, N/CPAP) bo ng Apnea ch kch hot khi c s dng ca cc nhp t th Nu trong ca s c s, nu c c gng ht vo ca nhp t th vt qu dng chy ci t trc, my s thm mt nhp h tr bt buc. Ch xy trong trong cc ch thng kh SIMV, A/CV, C/BKUP v ASB. Nu t c ngng nhy (trigger), vng hin th gi tr trigger s nhp nhy.

6.4.3.

Thi gian th ra

1. Nhn phm Exsp. Thng s c chn bt u nhp nhy. 2. Xoay nt IGR, gi tr thng s ci t c th c chnh v ci t. 3. Xc nhn v ci t gi tr mi bng cch nhn li phm Exsp hoc n phm xoay IGR. 4. Nhn bt k 1 phm khc b ci t mi. 5. Nu 1 ci t mi khng xc nhn trong vng 15 giy, s khng tc dng na. 1. Nhn phm Trig. Thng s c chn bt u nhp nhy. 2. Xoay nt IGR, gi tr thng s ci t c th c chnh v ci t. 3. Xc nhn v ci t gi tr mi bng cch nhn li phm Exsp hoc n phm xoay IGR. 4. Nhn bt k 1 phm khc b ci t mi. 5. Nu 1 ci t mi khng xc nhn trong vng 15 giy, s khng tc dng na.


41

Bo dng

6.4.5.

Ci t nhit kh h hp

4. Cc gi tr ci t c tc dng bng cch xoay nt IGR. Nhn nt IGR xc nhn mt ci t mi c lu vo b nh. S hin th cc gii hn cnh bo cao/thp v di iu chnh, tng gim c th xem (mc 3.5.2 trn trang 21).

6.6.1. Nhn phm Temp. Thng s c chn bt u nhp nhy. 2. Xoay nt IGR, gi tr thng s ci t c th c chnh v ci t. 3. Xc nhn v ci t gi tr mi bng cch nhn li phm Temp hoc n phm xoay IGR. 4. Nhn bt k 1 phm khc b ci t mi. 5. Nu 1 ci t mi khng xc nhn trong vng 15 giy, s khng tc dng na.

Tt my

1. Ci t phm Mode v ch thng kh STNDBY. 2. Chuyn cng tc ngun chnh v v tr ON/OFF. 3. u tin, xc nhn yu cu ca my. Mn hnh s hin th cu hi:

Exit Ventilation? YES NOTrong qu trnh hin th dng cu hi, s thng kh vn tip tc. Dng hin th xut hin cng vi m thanh cnh bo. 4. Tr li cu hi vi YES. My Alia kt thc thng kh v t tt my. Nhn cng tc ngun ON/OFF khi khng cn hin th nh sng mu xanh. 5. ng van liu lng O2 v AIR, bng cch xoay chng theo chiu kim ng h. 6. Sau khi s dng my Alia vi ngun kh trung tm (CGS), ngt ngun kh trung tm trnh dng kh i ngc tr li v lm bn h thng ngun kh. 7. Chuyn cng tc ngun ON/OFF n v tr (0). in chnh

6.5.

Ci t cc gii hn cnh bo

Main Menu Alarm Settings... Ventil.Settings... Monitor Settings... Options... Curve Display1. Nhn phm Menu. Menu chnh s hin th. 2. Xoay nt IGR, menu ty chn Alarm Settings v xc nhn bng cch nhn nt IGR, menu ty chnAlarm Settings hin th.

8. Tho dy ngun in t u cm tng. Nu c th, cng tc ngun in chnh v u cm phi c cm vo np cqui.

Alarm Settings Pmax MV FiO2 Temp VT 1 0.00 18 29.0 1 70 19.9 100 41.0 back

3. Xoay nt IGR, cc gii hn cnh bo tng ng s c chn v xc nhn bng nt IGR.

42


Bo dng

7.

Cnh bo, nguyn nhn v bin php khc phcPhn lp MP MP Nguyn nhn Li dy cp u d Li u d Gi tr nng O2 th vo thp hn mc ngng c t p lc O2 cung cp thp hn 400 mbar Gi tr nng O2 th vo cao hn mc ngng c t Nng FiO2 thp hn 18 % Li cn chun Nhit o c nm ngoi di c th o (-1 +48 C), Lng dy cp u d, Hng dy cp u d Hng u d Nhit o c nm ngoi di c th o (-1 +48 C), lch di ca u d qu ln Nhit o c gn bnh nhn thp hn mc gii hn-

Bo li O2 SENSOR FAIL LOW FiO2

Bin php khc phc Kim tra dy cp Thay th u d Kim tra mc ngng FiO2 v chnh li mc ci t nu cn thit Kim tra p lc O2 u vo Kim tra mc ngng FiO2 v chnh li mc ci t nu cn thit Cn chun u d O2 Kim tra ng cp kh Cn chun u d Thay th u d Kim tra dy cp Thay th u d Gi nhn vin k thut ca hng ti Vit Nam.

O2 Pressure low HIGH FiO2

HP MP

-

-

FIO2 41C

Phn lp HP

Nguyn nhn Nhit gn bnh nhn vt qu 41C Cc cng tc h thng b nng B un nng kh th ca bnh nhn khng hot ng. My th v b un nng kh th khng c kt ni vi nhau. u ni dy lm nng b lng hoc tip xc km. H thng ng lm nng kh th khng hot ng. Trong qu trnh th ra p lc th ra khng t ti mc gii hn thp nht t-

Bin php khc phc Kim tra b nhit . Kim tra b u d nhit .

HEATING H1 FAIL

MP

-

Thay th b un nng kh th. Lin lc vi nhn vin h tr k thut ca hng ti Vit Nam.

HEATING H2 FAIL

MP

-

Kim tra li u ni ca ng lm nng kh th. Thay th ng lm nng kh th ca bnh nhn. Kim tra li mc gii hn thp nht ca p lc nh( Pmax), nu cn c th iu chnh li cho ph hp Kim tra li h thng ng dn. Kim tra li thng s th Kim tra mc gii hn cao ca p lc nh(Pmax), nu cn c th iu chnh li cho ph hp. Kim tra li cc thng s ca my th. Kim tra li cc ph kin dnh cho bnh nhn. Kim tra li gi tr ca p lc nh(Pmax) t mc thp, nu cn c th t li gi tr mi cho ph hp. Kim tra van PEEP Kim tra h thng dy b tc Lin h vi nhn vin k thut ca hng ti Vit Nam. Chn PNT NO (ch c th thc hin vi kiu th CMV v thng kh t nhin bng dng chy vi p lc dng lin tc(N/CPAP). Kim tra u d dng chy(PNT) v ng dn. Lin h vi nhn vin k thut ca hng ti Vit Nam. Kim tra gi tr t ngng thp nht ca thng kh(MV), nu cn th c th t li gi tr ny.

LOW PRESS/DISCON

HP

-

-

PEAK PRESS

HP

Mc gii hn cao ca p lc nh(Pmax) b vt qua B qua qu trnh th vo v bt u qu trnh th ra.

-

-

STENOSIS

HP

Trong qu trnh th ra, p sut th ra khng xung ti mc gii hn thp p lc nh(Pmax) (PEEP ln hn mc gii hn thp ca p lc nh Pmax). lch chun ca cm bin ln. Dng kh o c vt ra ngoi ngng quy nh. u d dng chy(PNT) b tc. PNT sp t khng ng. Nc b ngng t trong PNT ng dn.

-

-

P SENSOR FAILURE FLOW SENSOR FAIL

HP MP

-

-

LOW MIN. VOLUME

HP

Mc thng kh thp hn ngng t mc thp nht. u d dng chy(PNT) b

-

44


Bo dng

Bo li

Phn lp

Nguyn nhn tc PNT ng t sai v tr ng hi nc trong ng PNT-

Bin php khc phc Kim tra thng s th. Kim tra u d dng chy v ng Kim tra gi tr t ngng cao nht ca thng kh(MV), nu cn c th t li gi tr ny. Kim tra thng s th Kim tra u d dng chy v ng dn. Kim tra ngng t th tch lu thng thp nht, nu cn c th t li gi tr mi cho ph hp. Kim tra thng s th. Kim tra u d dng chy vh thng ng dn. Ngng c t qu cao vi bnh nhn

HIGH MIN. VOLUME

MP

Mc thng kh cao hn ngng t mc cao nht. u d dng chy(PNT) b tc PNT ng t sai v tr. Hi nc ng trong PNT v ng dn. Mc th tch kh lu thng thp hn ngng t thp nht. u d dng chy(PNT) b tc, PNT ng t sai v tr. Hi nc ngng t trong ng u d dng chy (PNT) Khng th t nhin trong khong thi gian 30 s. CMV, SIMV, A/CV: Khng c bo ng apnea khi ht hn thi gian th ra ASB, C/BKUP: Ch c kiu th t nhin spontaneous nh hng ti apnea N/CPAP: Khng c bn tin cnh bo apnea Van th vo khng hot ng.Defective inspiration valve Ngun cp khng hot ng (sau mt pht khng c ngun, ch c c quy hot ng)

-

-

VT (EXP) LOW

HP

-

-

APNEA

HP

-

INSPIRAT. VALVE

HP

-

Lin h vi nhn vin k thut ca hng ti Vit Nam. Kim tra ngun cp (100 240 V AC) Kim tra dy cp ngun t cng tc ngun chnh v v tr m. Kim tra cu ch. Lin h vi nhn vin k thut ca hng ti Vit Nam. Lin h vi nhn vin ca hng ti Vit Nam. Thay th ph kin dnh cho bnh nhn. Lin h vi nhn vin ca hng

POWERSUPPLY FAIL

MP

-

TEMP. TANK>46C EXP/O2Cal VALVE

HP HP

u d nhit khng hot ng. Van th ra khng hot ng Van nh chun O2 khng hot ng

-

-


45

Ph kin

Bo li

Phn lp

Nguyn nhn Mt kt ni gia my th Aila v ph kin dnh cho bnh nhn.

Bin php khc phc ti Vit Nam.

46


Bo dng

8. 8.1.

Bo dng, bo tr. V sinh v tit trng.Thit b phi c v sinh sch s, bi nhn vin c o to v vn hnh v s dng my. Nhn vin vn hnh my phi nhn thc r s nguy him v phng nhim trng khi v sinh lm sch my.

Ch lm theo cc yu cu ca dung dch lm sch trnh nh hng ti my khi tin hnh st trng my. Nu s dng cc loi ha cht ty ra mi, cn lin h vi nh sn xut xem chng c tng thch ty ra cho my hay khng. Lin h vi nh sn xut nhn mt bn danh sch cc ha cht c th s dng tit trng v ty ra cho my. Khi lm vic vi cc phn t nh th cn t chng ring r khng lm hng cc thnh phn cht v gen vn ca n.. Cc phng php tit trng-

V sinh my c tin hnh nh k trong nhng khong thi gian xc nh. Khong thi gian nh k tin hnh v sinh my c th c ko di nu my c s dng b lc vi khun, ty theo quy nh ca tng bnh vin. Tt c nhng vt t, thit b tiu hao cn thay th v c an ton vi mi trng hay khng ty theo quy nh ca tng bnh vin. Cch kh c, chng nhim trng.-

Tit trng bng hi nc

8.2.

Chun b c bn

Ra sch bng nc. Lau bng khn c tm thuc st trng

Trc khi tit trng, tt my v rt in ra khi cm, tho b cc h thng nn kh. (xem phn 6.6 trang 42).

Cch thc v sinh.-

Ngm vo trong dung dch lm sch. Ra bng RDG .

Tt c cht ty ra c sn xut da trn alcohol v aldehyd u c th s dng c. Nhng cht ty ra c cha oxigen, chlorate phenole v cc dn xut ca chng khng ph hp vi vic lm sch cc thit b ny. Cc dn xut Amine c th lm hng cc chi tit nha mm(VD: cc ng nha mm). m bo cc cht ty ra s dng phi l cc ha cht c cho php lu hnh.


47

Ph kin

8.2.1.

Bo qun khoang my

8.2.3.

H thng ng ca bnh nhn

K hoch v sinh (khuyn co) Loi: nh k: Lau st trng Hng ngy

K hoch v sinh (khuyn co) Loi: - Ngm trong dung dch st trng - Ra trong RDG - Tit trng bng hi Sau khi s dng trn bnh

Thao tc tin hnh Lau khoang my bng dung dch ra pha sn (dung dch ty ra b mt). Lm m nh lp gi lau. Khng hi m vo trong khoang my. Lm g khi my b li Chun b Khi pht hin my hoc ph kin b hng, cn lin h vi b phn k thut ca bnh vin hoc lin h vi hng STEPHAN GmbH hoc nh phn phi. Frequency: nhn

Nn s dng thit b gia nhit c kh. C th dng dung dch trung ha pH. Ch s dng a xt citric trung ha dung dch ra c kim.

Lun lun gi cc ng bnh nhn trn b gi khi tho hoc di chuyn h thng ng. 1. Tho ng h o ra khi ch Y.

8.2.2.

Dy dn kh v dy cp ngun

2. Tho ch Y ra khi ng th ra v th vo 3. Tho th ra v th vo khi khi cc mt tng ng ca b phn bnh nhn. 4. Ko u d nhit khi h thng ng bnh nhn. Thao tc tin hnh-

K hoch v sinh (Khuyn co) Sau khi ni vi bnh nhn v khng c ly nhim bnh: Loi: nh k: Lau st trng Hng thng

Ngm trong dung dch tit trng t h thng ng bnh nhn vo dung dch tit trng pha sn (dung dch st trung thit b). Ch ngm ton b ng trong dung dch v khng cc ti kh c trong ng.

Sau khi ni vi bnh nhn v c ly nhim bnh (Tbc, MRSA): Loi: nh k: Lau st trng Hng ngy

Thao tc tin hnh Lau dy dn kh v dy cp ngun bng dung dch ra pha sn (dung dch ty ra b mt). Lm m nh lp gi lau. Lm g khi my b li Khi pht hin my hoc ph kin b hng, cn lin h vi b phn k thut ca bnh vin hoc lin h vi hng STEPHAN GmbH hoc nh phn phi.-

Ra trong RDG Khi ng my tit trng theo hng dn ca nh sn xut v np chng trnh hot ng ph hp. Hp tit trng bng hi nc Tit trng ton b cc b phn bng hi nc 140 C. Np thit b vo ni hp theo hng dn ca nh sn xut v khi ng chng trnh tng ng.

Cc chng trnh tip theo-

Ngm trong dung dch tit trng Hng dn s dng my th Alia, 01/2005

48

Bo dng Chun b PNT C Sau khi tit trng, ra tht k cc b phn bng nc lnh vi cht lng nc c nc ung tr ln. Lm kh cc b phn (Tt nht l dng t m lm kh) v ct chng trong cc t sch khng c bi cho ln s dng tip theo.-

1. Tho ng o p lc khi u kt ni PNT. 2. Cn thn tho b thit b xoy hai bn PNT. t u hc ca dng c i km vo hai u i din ca thit b xoy thit b xoy c th c ko d dng ra khi u ng m khng b hng.

Ra bng RDG Lm kh cc b phn (Tt nht l dng t m lm kh) nu my ra khng t lm kh v ct chng trong cc t sch khng c bi cho ln s dng tip theo.

-

Hp tit trng bng hi nc Ct chng trong cc t sch khng c bi cho ln s dng tip theo.

7 5 6 3

Cc thao tc chun b vn hnh xem phn 4.3.4 trang 31. Lm g khi my b li Khi pht hin my hoc ph kin b hng, cn lin h vi b phn k thut ca bnh vin hoc lin h vi hng STEPHAN GmbH hoc nh phn phi.

1

2

4

1. Cc ng o p lc 2. u ni ng o 1 3. u ni ng o 2 4. u d dng chy 5. Thit b xoy 6. u Hook 7. Dng c t hp i vi PNT D ch cc ng o p lc c tho ra. m bo trong qu trnh v sinh v tit trng bn trong ng, cc cht liu bn trong PNT khng b lm hng. Khng c tit trng PNT trong RDG.

8.2.4.

u d dng chy PNT

Cleaning plan (recommendation) Loi: - Ngm trong dung dch st trng - Tit trng bng hi Sau khi s dng trn bnh nhn

Frequency:


49

Ph kin Ngm trong dung dch tit trng t h thng ng bnh nhn vo dung dch tit trng pha sn (dung dch st trung thit b). Ch ngm ton b ng trong dung dch v khng cc ti kh c trong ng.-

-

4 8 5 a b 4

Hp tit trng bng hi nc Tit trng ton b cc b phn bng hi nc 140 C. Np thit b vo ni hp theo hng dn ca nh sn xut v khi ng chng trnh tng ng.

7

Cc thao tc vi PNT C 1. Kim tra cc thnh phn xem c b h hng c kh hay khng.-

4. Khoang PNT 5. Thit v xoy a. Vng m O-ring ca thit b xoy 7. Dng c tng hp b. u phng ca dng c tng hp 8. H thng ng ng tm i vi PNT D, Ch c cc ng o p lc cc u ng phi tho ra ( thay th xem PNT C). Sau khi lp t li, bo qun PNT ni kh ro v khng c bi chun b cho ln s dng tip theo Chun b vn hnh xem phn 4.3.4 trang 31. Lm g khi my b li Khi pht hin my hoc ph kin b hng, cn lin h vi b phn k thut ca bnh vin hoc lin h vi hng STEPHAN GmbH hoc nh phn phi.

2 thit b xoay v cc vng hm O-ring Lp v PNT sleeve v h thng ng ng tm c gi mi bn vi 3 vng m cho mi ci. Kim tra cht ca cc h thng ng trong bung.

-

2 u ni ng

2. Thi sch cc b phn bng khng kh nn, m bo khng c nc ng cc u ni. 3. Tho thit b xoy bng cch s dng mt phng ca dng c tho v n n vo trong khoang PNT. 4. t thit b xoay nh nhng vo cho n khi tht cht v kim tra xem chng kht v cht cha. 5. t ng o p lc vo ng o tng ng. t u o p lc c m ha (ng o p lc pha gn) vo u ni 1gn u ni (ang m rng) ca PNT (m ha bng cc chm en trn u cm ca khoang PNT). n u th hai ca dy o p lc vo u ni th hai.

50


Bo dng

8.2.5.

B phn bnh nhn

Thao tc tin hnh-

K hoch v sinh (khuyn co) Loi: - Ngm trong dung dch st trng - Ra trong RDG - Tit trng bng hi Sau khi s dng trn bnh nhn

Ngm trong dung dch tit trng t h thng ng bnh nhn vo dung dch tit trng pha sn (dung dch st trung thit b). Ch ngm ton b ng trong dung dch v khng cc ti kh c trong ng.

Frequency:

-

Ra trong RDG Khi ng my tit trng theo hng dn ca nh sn xut v np chng trnh hot ng ph hp.

Nn s dng thit b gia nhit c kh. C th dng dung dch trung ha pH. Ch s dng a xt citric trung ha dung dch ra c kim. Chun b 3. Vn lng cc c gn v tho b phn bnh nhn ra khi my chnh. 4. Tho b lm m v sch nc trong . 5. Tho ng lm m khi v bo v bn di b phn bnh nhn. 6. Xoy ng bn ngoi theo chiu kim ng h v ko n xung.-

Hp tit trng bng hi nc Tit trng ton b cc b phn bng hi nc 140 C. Np thit b vo ni hp theo hng dn ca nh sn xut v khi ng chng trnh tng ng.

Cc chng trnh tip theo-

Ngm trong dung dch tit trng Sau khi tit trng, ra tht k cc b phn bng nc lnh vi cht lng nc c nc ung tr ln. Lm kh cc b phn (Tt nht l dng t m lm kh) v ct chng trong cc t sch khng c bi cho ln s dng tip theo.

Innenrohr

-

Ra bng RDG Lm kh cc b phn (Tt nht l dng t m lm kh) nu my ra khng t lm kh v ct chng trong cc t sch khng c bi cho ln s dng tip theo.

Auenrohr

-

Hp tit trng bng hi nc Ct chng trong cc t sch khng c bi cho ln s dng tip theo.

Nhit bn ngoi ng rt nng v c th gy bng nu chm tay vo..

Cc thao tc chun b vn hnh xem phn 4.3 trang 32.


51

Ph kin

Lm g khi my b li Khi pht hin my hoc ph kin b hng, cn lin h vi b phn k thut ca bnh vin hoc lin h vi hng STEPHAN GmbH hoc nh phn phi. a ch h tr k thut ti Vit nam:

52


8.3.

Tit trng

St trng

Bo dng

Hp hi ncAxits Citric Axt Phosphor Aldehyde Cn 70 % Biguanid QAV H phn tch O2/Cl Gc Amin Phenole v gc ca n

Tit trng

Nhit Macjamocal

Bng tay

Ti 140 C

H2O2 STERAD

Cc b phn bnh nhn ? ?

?


Chai lm m

Tng quan St trng v tit trng

u d dng chy !!!

ng u d dng chy ?

?

u d v dy cp ca n

?

?

?

?

H thng ng dy bnh nhn v u ni Khoang chnh ca my

?

!!! Xem hng dn s dng. Cn m bo cc b phn c t trong khoang cha v trong thit b st trng thit b xoy khng bi hng.

Ph hp

Ph hp trong cc iu kin nht nh

Khng ph hp

?

Khng c thng tin

53

Ph kin

8.4.

Kim tra an ton k thut

Kim tra an ton k thut c thc hin mi su thng mt ln bi nh sn xut hoc y quyn ca F. Stephan GmbH.

8.5.

Kim tra v bo dng

V cc l do an ton v n nh, nh sn xut khuyn co bo dng my th Alia mi su thng mt ln. Bo dng c thc hin bi i ng k thut hoc c y quyn ca F. Stephan GmbH. Trong qu trnh bo dng, ch s dng ph kin thay th ca F. Stephan GmbH.

9. 9.1.

Danh sch ph kin/b phn thay th Cc ph kin chnh1 112 61 400 1 001 61 030 1 802 60 399 1 605 61 029 My th Alia Ph kin bnh nhn Dy ngun c phch cm cch ly di 3 mt Dy ngun c quy 12

Ph kin ty chn 1 102 61 104 1 102 61 102 ng dn kh di 3 mt c hai u cm v ngng DIN ng dn kh O2 di 3 mt c hai u cm v ngng DIN

Ph kin thay th cho ngi ln 1 112 61 600 1 003 61 510 H thng ng bnh nhn, ngi ln u d nhit P3

1 112 61 300 u d dng chy PNT D, Dng mt ln Ph kin thay th cho tr em 1 001 61 500 1 003 61 510 1 112 61 301 H thng ng bnh nhn, tr em u d nhit P3 u d dng chy PNT C, Dng mt ln

9.2.Mc 1 2 3 4

Danh sch cc b phn thay thM t Ph kin bnh nhn, ton b Lc vi khun u vo T bo xy B lc M 1 001 61 030 1 701 60 250 1 300 60 001 1 112 60 002 Trang 26 14 14 14

54


Bo dng

Mc 5 6 7 8 9 10 11 12 13 14 15 16 14 15 16 Dy ngun chnh Dy ngun 12 vn B lm m - ng ngoi B lm m - ng trong Chai b lm m

M t

M 1 802 60 339 1 605 61 029 1 007 53 136 1 112 53 075 1 651 60 010 1 953 42 001 1 953 42 014 1 112 61 500 1 701 60 416 1 112 61 600 1 701 60 403 1 701 60 021 1 112 61 301 1 112 61 300 1 003 61 510

Trang 30 30 26 28 28 28 28 28

Du ni dy 15 mm vi u qun c bng, dnh cho tr em, t nhin Du ni dy 15 mm vi u qun c bng, dnh cho tr em, H thng ng bnh nhn c t nng vi ch Y Ch Y cho tr em vi np y gn hai u H thng ng bnh nhn ngi ln vi ch Y c t nng Ch Y ngi ln vi u ni xoy 22 mm B thch hp ng lm gim khong khng cht trong h thng ng bnh nhn u d dng chy PNT C u d dng chy PNT D u d nhit


55

Ph kin Bo hnh Thit b c nh sn xut bo hnh 24 thng k t ngy mua hng. Tt c cc thay i hoc sa cha phi c thc hin bi F. Stephan GmbH, hoc c y quyn bi nh sn xut nu khng s khng c bo hnh. Thit b s khng c bo hnh nu b s dng khng ng theo hng dn. a ch h tr k thut ti Vit nam:

56


Bo dng

10.

Ghi ch


57

Nh sn xut: F. Stephan GmbH - Medizintechnik Kirchstrae 19 D 56412 Gackenbach Germany Fax +49 (0) 6439 / 9125 0 +49 (0) 6439 / 9125 111 [email protected] www.stephan-gmbh.com

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