Avance CS2
Quick Reference Guide
Software Revision 10.X
User responsibility
Refer to the User’s Reference manual for step-by-step instructions. Read
each component’s User’s Reference manual before using this system. All
Warnings and Cautions are in the User’s Reference manual.
WARNING
Before using the system:
• Complete all of the preoperative tests.
• Test all other system components.
System controls and menus
System overview
$&
1. Light knob 8. Lower dovetail
2. Vaporizer 9. Brake
3. Upper Dovetail 10. O2 flush button
4. Alternate O2 control 11. Advanced breathing system
5. System switch 12. Auxiliary O2 flow control
6. Mains indicator 13. Anesthesia display
7. Integrated suction (optional)
Figure 1 • Front view
M1241484 1
$&
1. Outlet circuit breaker 6. AGSS
2. Isolated electrical outlet 7. Equipotential stud
3. Vacuum connection 8. Mains inlet
4. Collection bottle connection 9. System circuit breaker
5. Cylinder yoke 10. Pipeline connections
Figure 2 • Rear view
2 M1241484
Advanced breathing system components
$&
1. Expiratory check valve 9. Breathing system release
2. Inspiratory check valve 10. Adjustable pressure-limiting (APL) valve
3. Inspiratory flow sensor 11. Bag/Vent switch
4. Expiratory flow sensor 12. Bellows assembly
5. Absorber canister 13. AGSS indicator (only on some versions)
6. Absorber canister release 14. Sample gas return port
7. Leak test plug 15. Airway module (optional)
8. Manual bag port
Figure 3 • Advanced breathing system
M1241484 3
$&
1. Bag support arm 5. EZchange canister release
2. ACGO switch 6. Condenser
3. ACGO port 7. Condenser drain button
4. EZchange canister module (CO2 bypass)
Figure 4 • Breathing system options
Vaporizer controls
Refer to the vaporizer User’s Reference manual for more detailed
information on the vaporizer.
$%
1. Lock lever
2. Concentration control and release
3. Silence alarm touch key
Figure 5 • Vaporizer controls
4 M1241484
Display controls
The system uses touchscreen technology, hard keys, and a ComWheel to
access system functions, menus, and settings.
Touch only one touch point at a time to ensure the correct selection is
made.
CAUTION
Do not apply excessive force to the touchscreen as damage may occur.
$&
1. ComWheel Selects a menu item or confirms a setting. Turn clockwise
or counterclockwise to scroll through menu items or
change settings.
2. Home key Removes all menus from the screen.
3. Screen Lock/ Locks the touchscreen. Toggles between lock and unlock
Unlock key functions.
4. Start/End Initiates Start or End Case function.
Case key
5. Touchscreen Activates functions when touch areas on the screen are
selected.
6. Audio Pause Stops audio for 120 seconds for any active, eligible high
key and medium priority alarms. Prevents audio (audio off) for
90 seconds when no medium or high priority alarms are
active. Allows the operator to acknowledge any non-active
medium or high priority latched alarms. Hold the key for 2
seconds to cancel the audio pause function.
Figure 6 • Display controls
M1241484 5
Touch points
$&
1. Wave fields 5. Ventilator quick keys
2. Measured values 6. Gas quick keys
3. Function keys 7. Split screen values
4. Digit fields
Figure 7 • Normal/Full screen view with shaded touch point areas
Using menus
Use the function keys to access the corresponding menus. When a menu
is selected, the menu field overlays the normal view and the waveform
fields start at the right edge of the menu.
1. Select the menu key to access the corresponding menu.
2. Select a menu item to choose the item, or turn the ComWheel left or
right to highlight a menu item and then push to confirm.
3. If the menu item selected is an adjustment, turn the ComWheel left or
6 M1241484
right to make the setting and then push to confirm.
If the menu item has a drop-down list, select the desired value from the
list by touching the item.
4. Select Close, touch the waveform area, or push the Home key to exit
the menu.
M1241484 7
Operation
Turning on the system
1. Plug the power cord into an electrical outlet. Make sure the system
circuit breaker is on.
• The mains indicator is lit when AC power is connected.
• Battery is charging if it is not already fully charged.
2. Check that the breathing system is properly connected.
CAUTION
Do not turn on the system with the right-hand (inspiratory) port plugged.
3. Turn the System switch to On.
The display shows the power-up screen.
The system does a series of automated self tests.
4. Perform a Full Test before the first case of the day.
5. Perform a preoperative checkout before each case. See the
“Preoperative checkout” section.
Note
The system must perform a power-up self test after 12 hours of remaining
on. If the system has been on longer than 12 hours without a power-up self
test, the ‘Turn power Off and On for self tests’ alarm occurs. Turn the
power off and then back on between cases to resolve the alarm.
Starting a case using custom settings
1. Set the Bag/Vent switch to Bag.
2. Select Start Case.
The Case Defaults selection shows the first preset case type.
Ideal Weight, Age, CO2 Alarms, and Volume Apnea Alarm show
the default settings that correspond to the case type shown.
3. Change Ideal Weight, Age, or Volume Apnea Alarm settings on the
menu.
The Case Defaults changes from the case name to Preset.
If the CO2 Alarms setting on the menu is changed, the Case Defaults
remains as previously selected.
4. To change ventilation mode, select Mode. Make the change.To
change the ventilation settings, select a ventilator quick key or More
Settings. Make the change.
5. To change alarm settings, select Alarm Setup. Make the change.
6. To change the gas settings or the circuit type, select Gas Setup.
Make the change.
7. From the Start Case menu, select Start Case Now. Gas flow starts.
8 M1241484
End a case
1. Set the Bag/Vent switch to Bag.
2. Select End Case.
3. Select End Case Now on the menu to put the system in standby
(stops the gas flow and patient alarms). The End Case menu shows
the gas and agent usage for the case.
Changing ventilator mode
1. Select the Mode quick key. The Vent Mode menu shows.
2. Select the desired ventilation mode.
3. Set and confirm the primary ventilation setting to activate the
ventilation mode.
Controls that are frequently used in the ventilation mode can be
adjusted with the ventilator quick keys and the More Settings quick
key.
Changing ventilator settings
1. Select the ventilation setting to be adjusted. Set the desired value.
2. Push the ComWheel to activate the change.
Gas setup
Use the Gas Setup menu to adjust the O2% and total flow, to change the
balance gas, and to change the circuit type.
Changing gas settings
1. Select the Gas Setup quick key.
2. Select the setting to change from the Gas Setup menu.
3. Change the setting.
4. For Circuit, select the menu item and change using the drop-down
menu. Select Confirm.
5. For Other Gas, select the menu item and change using the drop-
down menu.
6. For O2% and Total Flow, select the setting and make the change
using the ComWheel and push to confirm the setting.
Changing balance gas
1. Select the Gas Setup quick key.
2. Select the Other Gas menu item.
3. Select the balance gas to use with O2.
Changing circuit type
1. Select the Gas Setup quick key.
M1241484 9
2. Select Circle or Non-Circle.
3. Select Confirm.
Using the circle circuit
1. Select the Gas Setup quick key.
2. Select Circle.
Fresh gas oxygen concentration is displayed on the screen.
Fresh gas flow combines with the exhaled gas and exits out through
the inspiratory port.
3. Set the alarm limits to clinically appropriate settings.
Using the non-circle circuit
1. Select the Gas Setup quick key.
2. Select Non-Circle.
Fresh gas oxygen concentration is displayed on the screen.
Fresh gas flow is diverted around the inspiratory check valve and out
through the inspiratory port.
3. Set the alarm limits to clinically appropriate settings.
Setting waveform fields
1. Select System Setup - Screen Setup.
2. Select the Layout tab.
3. Select the desired waveform button and select the value from the
drop-down menu.
4. Select Close.
Setting digit fields
1. Select System Setup - Screen Setup.
2. Select the Layout tab.
3. Select the desired digit field button and select the value from the
drop-down menu.
4. Select Close.
Setting the split screen
1. Select System Setup - Screen Setup.
2. Select the Layout tab.
3. Select Split Screen and select the desired view from the drop-down
menu.
4. Select Close.
10 M1241484
Setting the data source
1. Select System Setup - Screen Setup - More Settings or
Spirometry - Setup Loops.
2. Select Data Source.
3. Select Patient to have spirometry data sourced from the airway
module or Vent to have spirometry data sourced from the ventilator.
4. Select Back to view changes made and access other functions of the
Spirometry menu.
Setting display brightness
1. Select System Setup - Screen Setup.
2. Select More Settings.
3. Select Display Brightness.
4. Select the desired brightness level with 1 being the dimmest and 5
being the brightest.
5. Select Close.
Setting keypad brightness
1. Select System Setup - Screen Setup.
2. Select More Settings.
3. Select Keypad Brightness.
4. Select the desired brightness level with 1 being the dimmest and 5
being the brightest.
5. Select Close.
Setting CO2 alarms
1. Select Alarm Setup.
2. To turn off the CO2 alarms, set CO2 Alarms to Off.
The ‘CO2 Alarms Off’ message shows in the general message field.
The CO2 alarm limit waveform numerics shows dashes during a case.
The alarms remain disabled until the Bag/Vent switch is set to Vent,
the case is ended, or the CO2 Alarms is set to On.
3. To turn on the CO2 alarms, set CO2 Alarms to On.
4. Select Close.
Setting volume apnea alarm
1. Select Alarm Setup.
2. To turn the volume apnea alarms off, select Vol Apnea Alarm to Off.
‘Volume Apnea Off’ shows in the general message field.
• If mechanical ventilation is started, the volume apnea alarms are
active.
M1241484 11
• If manual ventilation is restarted, a pop-up confirmation window
appears to resume the Off setting.
3. To turn the volume apnea alarms on, set Vol Apnea Alarm to On.
4. Select Close.
Setting MV/TV alarms
1. Select Alarm Setup.
2. To turn the volume alarms off, set MV/TV Alarms to Off.
‘MV/TV Alarms Off’ appears in the general message field.
The volume alarm limits waveform numerics shows dashes during a
case.
3. To turn the volume alarms on, set MV/TV Alarms to On.
4. Select Close.
Setting alarm limits
WARNING
Do not set alarm limits to extreme values. Setting limits to extreme values
can render the alarm useless.
1. Select Alarm Setup.
2. From the Primary Limits and More Limits tabs, select the alarm limit
and make the change.
3. Push the Home key, touch the waveform area of the display, or select
Close to close the menu.
Viewing alarm history
1. Select Alarm Setup.
2. Select the Alarm History tab.
The list of alarms shows in the window.
3. Select Close.
Setting alarm volume
1. Select Alarm Setup.
2. Select the Configure tab.
3. Set Alarm Volume to the desired value.
The alarm volume range is 1 to 5.
4. Select Close.
Silencing leak audio alarms
1. Select Alarm Setup.
2. Select the Configure tab.
3. Set Leak Audio to Off.
The audio alarms for small leaks are silenced.
12 M1241484
4. To turn audio alarms back on, set Leak Audio to On.
5. Select Close.
Setting auto MV limits
1. Select Alarm Setup.
2. Select the Configure tab.
3. Set Auto MV Limits to On.
The MV alarm limits are automatically calculated until Auto MV Limits
is set to Off or until an MV limit is manually adjusted during mechanical
ventilation. The MV alarm limits are automatically calculated based on
TV and RR settings.
4. Select Close.
Setting to default limits
1. Select Alarm Setup.
2. Select the Configure tab.
3. Select Change to Default Limits.
4. Select Close.
Trends
Use the Trends menu to view patient trends and set the time scale. There
are three views for patient trends: measured (numerical), settings, and
graphical. Trend information is saved every 15 seconds for the most
recent 24 hours.
Setting trends
1. Select Trends.
2. Select the desired view.
3. Select Scroll to move through the current trend view.
4. Select Time Scale to select the desired scale from the drop-down
menu.
5. Select Next Page to view additional parameters.
6. Select Close.
Setting loop type
1. Select Spirometry.
2. Select Loop Type and select the loop from the drop-down list.
3. Select Close.
Setting loop graph scaling
1. Select Spirometry - Setup Loops.
M1241484 13
2. Select Spirometry Scaling and set the scale type from the drop-
down list.
3. Select Back to view changes made and access other functions of the
Spirometry menu.
Setting patient and sensor type
1. Select Spirometry - Setup Loops.
2. Select Patient and Sensor and then select Adult or Pedi depending
on the sensor used.
3. Select Back to view changes made and access other functions of the
Spirometry menu.
Setting spirometry volume type
1. Select Spirometry - Setup Loops.
2. Select Show MV or TV and select MV or TV from the drop-down list.
Set to TV to show TVinsp and TVexp on the spirometry split screen.
Set to MV to show MVexp and TVexp on the spirometry split screen.
3. Select Back to view changes made and access other functions of the
Spirometry menu.
Saving, viewing, and deleting spirometry loops
1. Select Spirometry.
2. To store a loop to memory, select Save Loop. Up to six loops can be
saved.
3. To view a saved loop, set Show Ref. Loop to the time at which it was
saved.
4. To delete a saved loop, set Delete Ref. Loop to the time at which it
was saved.
5. Select Close.
Using the timer
1. Select Start to start the clock.
2. Select Stop to pause or stop the clock.
If Start is selected, the clock will resume operation.
If Start is selected and held for longer than 1 second, the clock will
reset to zero.
14 M1241484
Preoperative tests
Circuit compliance compensation
The ventilator adjusts gas delivery and monitoring to compensate for the
compliance of the patient circuit if:
• The system has a airway module installed.
• The Circuit Compliance is set to On from Super User - System
Config. - Ventilator Settings.
• The Checkout is completed after the system is turned on.
Circuit compliance is determined during the Checkout - Full Test or
when the Vent and Gas check is done as an individual test. Circuit
compliance must be set by the Super User for the Circuit Compliance
compensation function to be active. See the “Super user mode” section
for information on the circuit compliance setting.
In volume modes, circuit compliance compensation increases the volume
delivered at the inspiratory port by taking into consideration the circuit
compliance value. In all modes, circuit compliance compensation adjusts
the volume measurements. Circuit compliance compensation provides
consistent ventilator accuracy at the patient circuit.
WARNING
Perform a Vent and Gas test after changing the patient tube type.
Changing the patient breathing circuit after completing a Vent and Gas
test affects the volume measurements in all modes.
Breathing circuits and breathing circuit components are available in
many different configurations from multiple suppliers. Attributes of
the breathing circuits such as materials, tube length, tube diameter,
and configuration of components within the breathing circuit, may
result in hazards to the patient from increased leakage, added
resistance, or changed circuit compliance.
Checkout menu
The Checkout menu shows on the display after turning on the system. To
access the Checkout menu between cases, select Checkout. Step-by-
step instructions show in the Checkout menu during the tests. Use the
Checkout menu to:
• Perform a Full Test.
• Perform any of the individual tests.
• View the Test Log.
• Start a case.
M1241484 15
Full test
The Full Test or the individual tests must be performed at least once
within every 24-hour period.
Perform the Full Test at the start of each day. The full test runs
automatically and beeps to indicate when it is finished or if interaction is
required.
The Full Test does the following tests: Vent and Gas, Circuit Leak, and
Circuit O2 Cell (if circuit O2 cell is present). When one of the tests is
completed, the next test begins.
1. From the Checkout menu, select Full Test and follow the
instructions.
2. If a test fails, follow the instructions to perform a retest or accept the
results.
3. When the Full Test is completed, start a case.
Note
In case of a patient emergency, the Full Test may be bypassed by
selecting Start Case. The general message ‘Please Do Checkout’ is
displayed if a Full Test or all of the individual tests are not completed with
passing results within 24 hours.
Full test - vent and gas
The Vent and Gas test checks the Bag/Vent switch, proper gas supply
pressures, ventilator operation and leak, battery and electrical power,
circuit compliance, and flow control operation. This is a two-step test.
To run this test, follow the on-screen instructions. When the test passes,
the next test starts.
Full test - circuit leak
The Circuit Leak test checks the Bag/Vent switch, proper gas supply
pressures, airway pressure measurement transducer, APL valve, and
manual circuit leak.
To run this test, follow the on-screen instructions. When the test passes,
the next test starts.
Full test - circuit O2 cell
The Circuit O2 Cell test measures the O2 percent.
To run this test, follow the on-screen instructions. Do not select Done
when 21 is first displayed. Allow the reading to stabilize, then select
Done. Calibrate the O2 cell if necessary.
16 M1241484
Alarms and troubleshooting
Alarms
WARNING
Do not use malfunctioning equipment. Contact an authorized service
representative for service. Refer to the User’s Reference manual for a
complete list of alarms and troubleshooting information.
Message Cause Action
Apnea Apnea time delay 10-30 Check for leaks in the patient
seconds) has passed without a circuit. Check for patient
measured breath. Apnea time disconnection.
delay (20-30 seconds) has
passed without a change in
measured CO2 by at least 1%.
Apnea > 120 s Apnea time exceeds 120 Check for leaks or blockages
seconds. in the breathing circuit.
Ensure the Bag/Vent switch
is in the Vent position. Check
the patient.
Increase low Low MV limit is off in SIMV VCV, Increase low MV alarm limit
MV limit SIMV PCV, SIMV PCV-VG, to improve patient
CPAP + PSV, or PSVPro disconnection detection.
modes.
MVexp high MVexp is greater than MVexp Set alarm limits
high alarm limit (for nine breaths appropriately. Check the
or one minute). ventilation settings.
MVexp low MVexp is less than MVexp low Set alarm limits
alarm limit (for nine breaths or appropriately. Check the
less than one minute). ventilation settings.
Ppeak high Paw is greater than Pmax alarm Check for blockages in the
limit. patient circuit.
Reverse exp Flow toward the patient seen in Calibrate the flow sensors.
flow. Check the expiratory flow sensor
valves ok? during inspiration for six breaths
in a row.
Set Alt O2 Software or hardware failure Contact an authorized
flow! Check prevents mixed gas delivery. service representative.
agent setting!
Unable to Bellows is collapsed. Check the drive gas.
drive bellows Increase fresh gas flow (or
push the O2 flush button) to
fill the bellows.
M1241484 17
Message Cause Action
Ventilate Software or hardware failure Use a manual bag to
manually! prevent mechanical ventilation. ventilate the patient or use
No pressure, no flow, and no an alternate machine. Shut
volume monitoring from down the system as soon as
ventilator. possible and contact an
authorized service
representative.
18 M1241484
Avance CS2
Quick Reference Manual
English
M1241484
03 12 A 01 04 23
Printed in USA
