Intermittent Therapy Chapter 7: Advanced Therapies • BSA OR press Calculate to manually calculate BSA (if available) Figure 92: Intermittent Programming Screen 10. Press Enter to accept the dose. The rate is automatically calculated and appears in the rate field. Figure 93: Intermittent Dose Calculation Screen 11. Press VTBI field (Volume to be infused) and enter the amount of fluid to be delivered. Time is automatically calculated.
Chapter 7: Advanced Therapies Intermittent Therapy Note: Entering two of the three programming parameters (Rate, VTBI, or Time) automatically calculates the third. 11 13 Figure 94: Intermittent Programming Screen 12. Press Enter to accept VTBI. 13. To enter Time—if required—press time field. Select hours (hh) or minutes (mm). Enter time period using numeric keypad. Press Enter. Figure 95: Time Numeric Keypad 14.
Intermittent Therapy - Chapter 7: Advanced Therapies Clear restores default field values for current screen Setup displays the Intermittent Setup screen Clear All deletes entire program Back displays the Intermittent Setup screen Press Setup to advance screen to access Clear All. Clear All deletes entire Intermittent program. Note: User may enter KVO rate for continuous delivery between Intermittent cycles. See “Chapter 8: Program Options” for more detail. 15.
Chapter 7: Advanced Therapies Intermittent Therapy 16. The therapy begins and the Delivering screen displays with DELIVERING INTERMITTENT Delivery X of Y (where Y is the total number of programmed intervals) on the status line. To stop the therapy, press Stop Program. ICU A 0.6 mL / hr 0.1 mL Ceftriaxone Bolus Program Advanced Piggyback DELIVERING INTERMITTENT 1 of 2 Ceftriaxone [ 1 grams / 250 mL] Dose: Rate: Time Remaining: 2.5 mcg/kg/min 0.
Intermittent Therapy Chapter 7: Advanced Therapies 17. When the Intermittent program completes and the VTBI is delivered, COMPLETED INTERMITTENT displays on the status line of the Delivering screen. ICU A 1 mL / hr 0 mL Ceftriaxone Bolus Program Advanced Piggyback COMPLETED INTERMITTENT Ceftriaxone [ 1 grams / 50 mL] KVO: Time Remaining VTBI: Volume Infused Stop Intermittent 1 mL / hr 00:00 hh:mm 0 mL 0.5 mL A Press Stop to end infusion. Advanced button to view current program.
Chapter 7: Advanced Therapies Intermittent Therapy NOTES: 104 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 8: Program Options Options allows the selection of additional functions and alarms while infuser is stopped. Options button is available from any therapy programming screen. Press Options to access Options selection menu. Press up or down arrows on scroll bar to view available options. Press selectable fields to change an option. The following options may be changed by the user: Deliver at End of Infusion Press Deliver at End of Infusion and select None, KVO, or Continue Rate.
Chapter 8: Program Options Power Priming a Set Power priming may be used to prime or remove air from an administration set. In general, the time required to power prime an administration set is: • 60 seconds for a 72" microbore set Note: Refer to the SYMBIQ™ administration sets labels for information regarding use with different flow rates.
Chapter 8: Program Options 2. On the Options screen, press Select Amount under the Power Prime label. ICU A 0 mL / hr 0 mL Program Bolus Power Prime Deliver at End of Infusion Advanced Piggyback Select Amount KVO mL/hr 1 KVO Rate Delayed Start --:-- hh:mm Yes Standby Alarm Options Done Options Press button or field to select option to change. Done to return to previous screen when finished. Mode Settings Lock Logs Alarm 04:34 PM Figure 102: Options Screen 3.
Chapter 8: Program Options Note: The power prime rate is 250 mL/hour. ICU A Program Bolus Piggyback Advanced Power Prime Ensure tubing is not connected to the patient. Prime 3 mL Prime 1 mL Cancel Prime 5 mL Options Press button to select amount to prime. Cancel to return to Options screen. Mode Settings Logs Lock Alarm 10:28 AM Figure 104: Power Prime Screen 5. The Power Prime Progress screen displays showing the cumulative amount of fluid primed measured in mL.
Chapter 8: Program Options administration set. Repeat Power Prime as often as necessary to obtain steady drip at end of tubing. 6. On the Options screen, press Done to return to the Programming screen. The power priming process is complete; continue entering program parameters as desired. Note: If an occlusion occurs during power priming, priming stops and the infuser reverts to the Power Prime screen. Clear the occlusion and select one of the three power prime options to restart priming.
Chapter 8: Program Options 4. The infuser starts therapy when the delayed start countdown reaches zero. 5. Press Delayed Start to start the therapy before the delayed start time elapses. ICU A 0 mL/hr 0 mL Bolus Program Piggyback Advanced CONFIRM DELAYED START DOPamine [400 mg/ 250 mL] 5 mcg / kg / min 13.1 mL/ hr 103 mL 08:00 hh:mm Dose: Rate: VTBI: Time: Delayed Start A Press Program to edit program. Delayed Start button to begin countdown.
Chapter 8: Program Options To place an infuser in Standby mode: 1. Press the Standby field to display the Standby drop-down list. ICU A 0 mL / hr 0 mL Program Bolus Power Prime Piggyback Advanced Select Amount Deliver at End of Infusion KVO 1 KVO Rate Delayed Start --:-- mL/hr hh:mm Yes Standby Alarm Options Done Options Press button or field to select option to change. Done to return to previous screen when finished.
Chapter 8: Program Options 3. Press Done to accept changes and return to the Programming screen. ICU A 0 mL / hr 0 mL Program Bolus Power Prime Deliver at End of Infusion Advanced Piggyback Select Amount KVO 1 KVO Rate Delayed Start --:-- mL/hr hh:mm Yes Standby Alarm Options Done Options Press button or field to select option to change. Done to return to previous screen when finished. Mode Settings Logs Lock Alarm 04:34 PM Figure 110: Options Screen 4.
Chapter 8: Program Options Note: The unit of measure is either psi or mmHg as configured in the Drug Library from the facility’s respective CCA. Figure 111: Options Screen 2. Select the desired distal occlusion setting. ICU A 0mL/hr 0mL Program Bolus Advanced Piggyback of Infusion 6 psi KVO Rate Delayed Start 6.5 psi Options Standby 7 psi Options Alarm Options Options 7.5 psi Distal Occlusion Options Cancel Options 8 psi 8.
Chapter 8: Program Options 3. Press Yes to change the distal occlusion setting. Press No to return to the psi settings list without saving changes. Figure 113: Change Distal Occlusion Setting Message Box 4. Press Done to return to the Programming screen. Figure 114: Options Screen Proximal Occlusion To select the Proximal Occlusion alarm: 1. 114 From any programming screen, press Options to display the Options screen.
Chapter 8: Program Options 1. Use the vertical scroll bar to scroll down to the Alarm Options section, and then press the Proximal Occlusion field. Figure 115: Options Screen 2. Select Solution Container or Syringe.
Chapter 8: Program Options 3. Press Yes to change the proximal occlusion setting. Press No to return to the proximal occlusion settings list without saving changes. Figure 117: Change Proximal Occlusion Setting Message Box 4. 116 Press Done to return to the Programming screen.
Chapter 8: Program Options Infusion Complete Callback To select the Infusion Complete Callback alarm: 1. Use the vertical scroll bar to scroll down to the Alarm Options section, and press the Infusion Complete Callback field. Figure 118: Options Screen 2. Select Yes or No.
Chapter 8: Program Options 3. Press Yes to change the Infusion Complete Callback setting. Press No to return to the Infusion Complete Callback settings list without saving changes. Figure 120: Change Infusion Complete Callback Message Box 4. Press Done to return to the Programming screen. Note: If selecting the Infusion Complete Callback alarm for a Multistep therapy, the alarm activates at the end of each step in the therapy. Air-In-Line To select the Air-In-Line alarm setting: 1.
Chapter 8: Program Options 2. Select the desired air-in-line setting. Figure 122: Air-In-Line Sensitivity Drop-Down List 3. Press Yes to accept the air-in-line setting. Press No to return to the mcL settings list without saving changes. Figure 123: Change Air Sensitivity Setting Message Box 4. Press Done to return to the Programming screen.
Chapter 8: Program Options Nearing End Of Infusion To select the Nearing End Of Infusion alarm: 1. Use the vertical scroll bar to scroll down to the Alarm Options section. Press the Nearing End Of Infusion field to display the selection list. Note: A medium urgency alarm sounds until silenced. Figure 124: Options Screen 2. Select the desired setting.
Chapter 8: Program Options 3. Press Yes to change the Nearing End of Infusion setting. Press No to return to the settings list without saving changes. Figure 126: Change Nearing End of Infusion Setting Message Box 4. Press Done to return to the Programming screen.
Chapter 8: Program Options NOTES: 122 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 9: Bolus Overview This chapter describes how to program bolus deliveries and select program options for a therapy. Bolus Use Bolus to program a delivery from a primary or secondary container. Only medications designated by facility may be delivered by bolus. Bolus is only available with Basic and Multistep therapies. Note: In Bolus from a primary container is confirmed without an underlying primary therapy confirmed, a primary therapy cannot be entered until the Bolus delivery is complete.
Chapter 9: Bolus Overview 4. Press When Bolus Completes and select either Resume Primary Infusion or Stop Infusion press Next to display the Bolus Programming screen. Note: Press Bolus Calculation and enter Bolus medication amount using numeric keypad (enter patient weight, height, and BSA, if required). VTBI will be calculated. Press Enter to accept Bolus amount.Press Time and enter time period using numeric keypad. Rate will be calculated. (Entering rate will calculate time period.
Overview 7. Chapter 9: Bolus The Delivering Bolus screen displays; to stop the therapy, press Stop Bolus. ICU A 100 mL / hr 49.9 mL Heparin Program Bolus Advanced Piggyback DELIVERING BOLUS Heparin [ 25,000 units / 250 mL] Dose: 5000 units 100 mL / hr Rate: Time Remaining 24.6 mL VTBI: Volume Infused: 49.9 mL 0.1 mL Stop Program A Press Stop to end infusion. Bolus button to view program. Program parameters may be changed after stopping.
Chapter 9: Bolus Overview NOTES: 126 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 10: Alarm and System Messages Alarm There are three types of alarms: invalid keypress, operational and malfunction. • Invalid Keypress—an alert tone that sounds when an invalid entry is touched; for example, a double keypress. • Operational alarms—active based on program options selection or when other delivery issues occur. • Malfunction alarms—activate when mechanical or software issues occur that require the infuser be removed from service and examined by authorized service personnel (Biomed).
Chapter 10: Alarm and System Messages Alarm Table 10: Alarm Conditions and Criteria (Continued) Alarm Urgency Alarm Sound Medium High Alarm Tab Color Channel LED Color Criteria for Alarm Repeating two- Flashing note melody yellow Flashing yellow if alarm is deliveryrelated Condition which, if not resolved promptly, could result in an escalation to a Warning alarm.
Alarm Chapter 10: Alarm and System Messages A device-level alarm is not associated with a channel, e.g., a Low Battery alarm, displays with a center tab as shown in Figure 132. An alarm associated with the infuser displays with a center tab, because it is not associated with a channel. ICU A ICU A 13.1 mL / hr 24.6 mL 13.1 mL / hr 96.1 mL DOPamine DOPamine Bolus Program Piggyback Advanced DOPamine DELIVERING PROGRAM [400 mg / 250 mL] DOPamine Rate [ 400mg / 250 mL] Dose: 13.1 mL / hr 24.
Chapter 10: Alarm and System Messages Alarm If a new alarm occurs during an alarm silence period, an audible alarm sounds and a message displays on the touchscreen for the highest priority active alarm. To silence an audible alarm: 1. Press and release the SILENCE button on the top of the infuser. Figure 134: Infuser SILENCE Button Multiple Alarms Should multiple alarms occur, the highest priority alarm features both audible and visual priority.
System Messages Chapter 10: Alarm and System Messages If more than one alarm occurs, resolving or minimizing the highest-priority alarm overlay displays the next highest alarm overlay. ICU A 0 mL/hr 0 mL Program Bolus Advanced Piggyback Infusion DOPamine [400 mg / 250 mL] Dose 5 mcg / kg / min Rate 13.1 mL / hr (Calculated) VTBI 103 Time (Calculated) 07:51 Clear A Options mL hh:mm Cancel Titration Next A CHECK CASSETTE Cassette Improperly installed or missing. Reinstall cassette.
Chapter 10: Alarm and System Messages System Messages Exceeded Soft Limits The Outside of Soft Limits system message activates when selected medication values exceed Drug Library-defined soft limits but do not exceed hard limits. ICU A B Program Bolus Advanced Piggyback Infusion DOPamine [ 400 mg / 250 mL] OUTSIDE LIMITS (Programmed Value) 5 mg/kg/hr 10 30 50 Override 70 Edit Press Override to bypass Limit. Press Edit to re-enter value.
System Messages Chapter 10: Alarm and System Messages Note: When a program is delivering Outside of Soft Limits, an Exceeded Soft Limit icon appears. ICU A Bolus Program Advanced Piggyback DELIVERING PROGRAM Ampicillin ( 2 grams/ 100 mL) Dose Rate VTBI: Time: Volume Infused: Stop Program 100 mL / hr 100 mL/hr 99:9 mL 01.00 hh:mm 0.1 mL A Press Stop to end infusion. Program button to edit program.
Chapter 10: Alarm and System Messages System Messages When entering a program value that exceeds the hard limit, the event is recorded to both the Event Log and the Rule Set Override Log. To override a hard limit: A hard limit may be overridden with proper authorization if enabled by hospital policy. A passcode is then required. The user may enter a passcode to override a Hard Limit. Press the Override button to display the passcode system message.
System Messages Chapter 10: Alarm and System Messages If no valid override passcode is defined for the current CCA, the Invalid Passcode system message activates. ICU Figure 140: Delivery Screen with Exceeded Upper Hard Limit Icon Invalid Entry Entering a value that exceeds infuser system limits, e.g., 1100 mL/hr, activates the Invalid Entry system message (Figure 141).
Chapter 10: Alarm and System Messages System Messages Invalid Entry system message closes the numeric keypad without saving changes. Invalid Entry are recorded to the Event Log.
Chapter 11: Stored Data The SYMBIQ™ Infusion System collects and stores data which is available for on-screen viewing.
Chapter 11: Stored Data Patient Information Patient Information Use the Patient Information screen shown in Figure 142 to enter patient name and ID (if required by your facility), Weight, Height, BSA, and Caregiver ID. ICU A 0 mL/hr 0 mL CCA ICU Caregiver ID GREEN PATIENT INFO Last Name SMITH First Name PAT ID 976543 Weight Height 80 BSA 2 (Calculated) 180 cm Calculate Clear Patient Information Height and Data Done Refer to Manual during use.
Patient Information Chapter 11: Stored Data activates when you change a previously selected CCA; it does not activate when you initially select a CCA. After confirming the CCA change, press Done on the Patient Information screen to return to the prior screen and update Patient Information button display, if necessary. While a primary infusion is delivering under the old CCA rule sets, any secondary infusions (bolus or piggyback) programmed on the same line also deliver under the old CCA rule sets.
Chapter 11: Stored Data Patient Information Note: Entering an invalid passcode three consecutive times activates the Invalid Passcode system message for each attempt. Entering an invalid passcode a fourth time closes the Enter Code dialog box and displays the Patient Information screen without changing the CCA. 3. Press the BSA field to enter the patient’s BSA (Body Surface Area) after entering patient weight and height. Note: To calculate the BSA, enter patient’s weight and height. Press Calculate.
To display Program Totals Chapter 11: Stored Data To display Program Totals The Program Totals screen shown in Figure 146 contains program totals for these items: • Medication name/medication concentration • Number of boluses infused • Bolus volume infused • Bolus medication amount infused (if applicable) • Primary volume infused • Primary medication amount infused (if applicable) • Total volume infused • Total medication amount infused All volume infused totals and medication amount infused totals includ
Chapter 11: Stored Data Shift Totals Data WARNING: Accuracy of medication amounts recorded in the logs are dependent on the fill accuracy of IV container and amount discarded during priming. To view the Program Totals Log: 1. Press Logs at the bottom of the touchscreen to display the Logs menu screen. Figure 147: Logs Menu Screen 2. From the Logs menu screen, press Program Totals. See Figure 146. 3.
Shift Totals Data Chapter 11: Stored Data ICU A B ! Logs: Shift Totals Shift Cleared Date & Time Mar 17, 2006 10:33 AM Infuser Shift Totals (All Programs) Volume Infused 1.1 mL Exit Clear Press arrows to scroll to other entries. Press Exit to return to prior screen. Press Clear Shift Totals button to delete all shift information. Exit to return to previous screen.
Chapter 11: Stored Data Event Log Event Log The Event Log records infuser events including infusion programs, limit overrides, out-of-limit alerts, changes to settings, power events, and operational alarms, and malfunctions. Figure 149 illustrates the Event Log screen. The infuser stores up to 8,000 entries in the Event Log. Figure 149: Event Log Screen Entering new patient information on the Patient Information screen clears the Event Log viewable in Clinical mode. To view the Event Log: 1.
Alarm Log Chapter 11: Stored Data Alarm Log The Alarm Log (Figure 150) is a filtered view of the Event Log. Every operational alarm, and malfunction is recorded in the Alarm Log. Each entry includes the associated time, date, and description of the alarm event. Figure 150: Alarm Log Screen Entering new patient information on the Patient Information screen clears the Alarm Log viewable in Clinical mode. To view the Alarm Log: 1.
Chapter 11: Stored Data Rule Set Alert Override Log Rule Set Alert Override Log Attempts to override CCA Rule Sets are recorded to the Rule Set Alert Override Log. Out-of-limit alerts, and rule set overrides are recorded and stored as illustrated in Figure 151. The infuser stores up to 1,000 entries in the Rule Set Alert Override Log. ICU A Rule Set Alert/Overide Log: 1 of 40 Drug Library: 1234567891234567889 Patient: ID: 1234567890 Height: 100 cm Weight: 40 kg BSA: 6.
Current Program Chapter 11: Stored Data Current Program Select Current Program to view information about the current program including dose, rate, volume, time, VTBI, volume infused, and program options. To view the Current Program Log: 1. Press Logs at the bottom of the touchscreen to display the Logs menu screen. 2. From the Logs menu screen, press Current Program to display the Logs Current Program screen. 3.
Chapter 11: Stored Data Default Drug Library High-Risk Medications Your hospital or institution can designate certain medications as high-risk medications. High-risk medications display on the infuser touchscreen highlighted in yellow as shown in Figure 153. ICU Figure 153: Far Viewing Delivery Screen with High-Risk Medication Infusing Table 11 describes other touchscreen elements that display high-risk medications highlighted in yellow.
Using the Hospira MedNet® Service Suite (MMS) Chapter 11: Stored Data Table 11: Touchscreen Elements with High-Risk Medications Highlighted Element Highlighted Touchscreen Location High-risk medication in Infusion Selection dropdown list Confirmation screen ICU A 0 mL/hr 0 mL DOPamine Bolus Program Advanced Piggyback CONFIRM PROGRAM DOPamine [400 mg/ 250 mL] 5 mcg / kg / min 13.1 mL/ hr 103 mL 08:00 hh:mm Dose: Rate: VTBI: Time: Start Titration A Press Start to begin infusion.
Chapter 11: Stored Data Using the Hospira MedNet® Service Suite (MMS) Programming a Soft Outside limits Message If the values enter result in either a higher or lower than the pre-defined limits, an alarm tone will sound and a pop-up OUTSIDE LIMITS is displayed. (figure 71 using dopamine as drug) Press Edit to return to programming screen and re-enter programmed value and proceed with programming If the clinical decision is to bypass the limit message, press Override and proceed with programming.
Chapter 12: Cleaning, Maintenance, and Storage This chapter describes how to clean, store, and service the SYMBIQ™ Infusion System. This chapter also describes battery maintenance and battery disposal. Cleaning the Infuser To ensure the SYMBIQ™ Infusion System functions properly, practice the cleaning guidelines in this chapter. Establish a routine weekly schedule for cleaning the infuser.
Chapter 12: Cleaning, Maintenance, and Storage Battery Maintenance Cleaning Cautions Avoid damaging the SYMBIQ™ Infusion System by following these cleaning cautions: CAUTION: To avoid mechanical or electronic damage, DO NOT immerse the SYMBIQ™ Infusion System in fluids or cleaning solutions. DO NOT spray cleaning solutions in or near infuser openings. DO NOT allow cleaning solutions to saturate the air-in-line detectors or enter the infuser when cleaning the air-in-line detectors.
Storage Chapter 12: Cleaning, Maintenance, and Storage company for information on environmentally sound ways of collecting, disposing, and recycling used batteries.
Chapter 12: Cleaning, Maintenance, and Storage Product Handling and Disposal NOTES: 154 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Chapter 13: Product Specifications Physical Specifications One-channel infuser dimensions: Width: 9.9 inches Height: 10.2 inches Depth: 8.6 inches Depth with Pole Clamp: 13.0 inches Weight: 10.7 pounds Casing: High-impact plastic Electrical Specifications Power frequency: Between 47 Hz and 63 Hz Fuses: T1.
Chapter 13: Product Specifications Wireless Connectivity Transceiver band: 2.4GHz ISM band Wireless certification: FCC Part 15 Class B compliant Communications standard: IEEE 802.11b Input Device/Keypad Off-screen: Off-screen buttons including LOAD/EJECT, On/Off, SILENCE, Emergency Stop Touchscreen keypad: Thin film transistor (TFT) touchscreen keys LCD Display Display size: 8.
Chapter 13: Product Specifications Date and Time Settings Time of day clock: Displays time of day in either 12-hour or 24hour formats Temperature Parameters Ambient Operating temperature range: 5°C to 40°C Storage temperature range: 20°C to 60°C Relative humidity: Operational range of 10% to 90% noncondensing Barometric pressure range: Operational range from 0 to 10,000 feet Surface temperature: Maximum of 50° C Occlusion Settings Distal occlusion: User specified range in either psi (from 1 to
Chapter 13: Product Specifications Flow Rate Accuracy Flow Rate Accuracy Flow rate accuracy represents the infuser’s fluid delivery performance under these conditions: Table 13: Standard Environmental Conditions and Specifications Condition Specification Ambient and fluid temperature: 22° C + 5° C Back pressure: + or -1 psig Filling head height: 18 inches of water (+ 4 inches) IV fluid: Sterile water or D25W. Delivery rate range: 0.
Trumpet Curves Chapter 13: Product Specifications Sample Trumpet Curve On the trumpet curve graph sample shown in Figure 155, find the 5 minute interval (A) at the horizontal axis and read the corresponding points (B) and (C) on the vertical axis. The values are approximately +2.8% and -0.5%. This means at the rate of 25 mL/hr, the average maximum flow rate fluctuation for any 5 minute time interval during the 2nd hour of operation was within the limits of +2.8% and -0.5% from the nominal rate.
Chapter 13: Product Specifications Trumpet Curves NOTES: 160 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Appendix A: System Messages and Troubleshooting Appendix A outlines system messages generated by the SYMBIQ™ Infusion System, the cause of the message, how the message text displays, steps to remedy the condition, and message logging. On-Screen Text System Message Message Cause Steps to Remedy Battery Depleted Battery Depleted Powering on an Infuser with a battery not having sufficient charge to power the device if AC power is disconnected. Press OK to acknowledge.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Calculated VTBI Out of Range Calculated VTBI Out of Range The user enters a parameter on the Dose Calc Complex Pop-up that results in a calculated VTBI outside of the acceptable range. Press OK to acknowledge. Standby when Delayed Start is Selected Selecting Standby when Delayed Start is already programmed. Press Continue to cancel the Delayed Start and program Standby.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Change CCA? Change CCA Changing the current CCA by selecting a CCA from the CCA Selection drop-down list. Press Yes to change CCA. Change CCA from to ? Changing the CCA will clear any partially programmed channels.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Delete Information? Delete Information Pressing Clear Shift Totals on the Shift Totals Screen in Clinical Mode Press Yes to delete information.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Malfunction Malfunction Occurred The Infuser is powered on after a malfunction occurred during the last power up which may not display. Press OK to acknowledge. Multiple CCAs Programming one or more channels under the current CCA and pressing Yes on the Change CCA system message when no CCA passcode is required Therapies in progress will continue operating under the prior CCA rule sets.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Operation Test Due Operation Test Due The infuser is powered down, “Operation Test Notify When Test is Due” device setting is set to Yes and the “Reminder Test is Due” setting is reached. Press OK to acknowledge. Return Infuser to Biomed for Operation Test as soon as possible. Note: Activation of the Operation Test Due System Message will be based on the current Date of the Infuser.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Outside Limits Outside of Soft Limits Informational Pressing a 3-D touchscreen tab when an Outside of Soft Limits condition exists. Press OK to acknowledge. Hard Limit Override Pressing Override on the Outside of Hard Limits system message. Enter override code by pressing number buttons and then press Enter. (Information will vary.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Program Data Will Be Deleted Program Data Will Be Deleted Reducing the number of steps in a Multistep program, and the deleted steps contain programmed data. Press Continue to proceed with change and clear associated program data.
Appendix A: System Messages and Troubleshooting On-Screen Text System Message Message Cause Steps to Remedy Values out of Range Height/ Weight/BSA Out of Range Invoking a CCA that results in the current Master patient Weight, Height and/or BSA being out of range. Press OK to acknowledge.
Appendix A: System Messages and Troubleshooting NOTES: 170 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Appendix B: Alarm Messages and Troubleshooting Appendix B outlines alarm messages generated by the SYMBIQ™ Infusion System, the cause of the alarm, how the alarm text displays, steps to remedy the alarm, the alarm urgency, and alarm logging. On-Screen Text Alarm Alarm Cause Message Steps to Remedy Alarm Urgency ACCUMULATED AIR-INLINE Air-in-Line Restart the infusion to clear the alarm. High ANALYSIS: Infusion stopped. REMEDY: Remove air from line. Restart infusion.
Appendix B: Alarm Messages and Troubleshooting On-Screen Text Alarm Alarm Cause Message Steps to Remedy Alarm Urgency BOLUS COMPLETE (Bolus) Infusion Complete Press alarm window to clear the alarm. Medium PIGGYBACK COMPLETE (Piggyback) STEP COMPLETE (Multistep) ANALYSIS: Stop Infusion or Callback requested by caregiver. OR Callback Option is set to Yes because Stop Infusion during Bolus programming was selected. REMEDY: None ACTION: Press here to clear alarm.
Appendix B: Alarm Messages and Troubleshooting On-Screen Text Alarm Alarm Cause Message Steps to Remedy Alarm Urgency CHECK FLOWSTOP Check Flowstop Cassette problem bit is set (door is closed with high pressure indicating possible debris present) Open the door to clear the alarm. High The distal pressure is greater than the selected pressure level and the channel is in Delivery mode.
Appendix B: Alarm Messages and Troubleshooting On-Screen Text Alarm Alarm Cause Message Steps to Remedy Alarm Urgency END OF INFUSION (KVO) (KVO is delivering) END OF INFUSION (KVO is not delivering) End of Infusion Press alarm window to clear alarm. Medium Press the alarm window to clear the alarm for that channel. Medium Infuser detects AC power to clear the alarm. 30 minutes: Low Onset of a higher-priority Low Battery alarm clears a lower-priority Low Battery alarm.
Appendix B: Alarm Messages and Troubleshooting On-Screen Text Alarm Alarm Cause Message NEARING END OF INFUSION Nearing End of Infusion ANALYSIS: Infusion almost complete. REMEDY: None. ACTION: Press here to clear alarm. The total time remaining on a primary infusion transitions from being greater than the user-defined Nearing End of Infusion alarm setting to being less than or equal to that setting.
Appendix B: Alarm Messages and Troubleshooting On-Screen Text Alarm Alarm Cause Message Steps to Remedy Alarm Urgency PROXIMAL OCCLUSION Proximal Occlusion If proximal pressure becomes greater than 50% of the selected pressure level within 60 seconds of detection, alarm auto-clears and becomes latched, Proximal Alarm Auto-Clear counter increments by 1, and delivery resumes—if the channel has not exceeded the allowed number of auto clears. High ANALYSIS: Delivery stopped.
Appendix B: Alarm Messages and Troubleshooting On-Screen Text Alarm Alarm Cause Message Steps to Remedy Alarm Urgency RESTART REQUIRED Restart Required The flash memory has completed formatting. Touch alarm overlay body to minimize the alarm. High Service Battery Battery shorted Low OR Replace Battery to clear alarm. SMBus error/Battery Communication error Press alarm window to minimize the alarm. ANALYSIS: The infuser needs to be restarted. REMEDY: Please restart the infuser.
Appendix B: Alarm Messages and Troubleshooting NOTES: 178 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Appendix C: Accessories, Administration Sets, and Components Appendix C outlines the list number and description of accessories, administration sets, and components available for use with the SYMBIQ™ Infusion System. List Number Item Description 2006-04-01 Standard I.V. Pole 11249-04-01 Heavy Duty I.V. Pole 11868-04-01 PlumXL3M I.V.
Appendix C: Accessories, Administration Sets, and 180 List Number Item Description 16012-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 106 Inch, Piggyback with Backcheck Valve, 2 CLAVE Ports, Distal microbore segment and OPTION-LOK 16013-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 104.5 Inch, Piggyback with Polyethylene-Lined Tubing, Backcheck Valve, 2 CLAVE Ports, 0.
Appendix D: Glossary Term Definition AC Alternating Current. active screen A selected programming screen or a programming screen in use. administration set The sterile, disposable assembly with flexible tubing that connects to a source fluid container for input to the cassette carriage and to some output device for administration to the patient. air sensitivity The amount of air detected in which the Air-In-Line alarm activates. air-eliminating filter Used to reduce the risk of infusing air.
Appendix D: Glossary Term Definition callback alarm An alarm indicating additional action is required before an infuser can continue its program. cancel To stop or nullify a previously intended action. cassette A Hospira cassette that contains the actual pumping chamber with inlet and outlet valves and a flow stop. It also contains access ports to diaphragms for proximal and distal line pressure sensing. cassette carriage The cassette is loaded in the infuser via an automatic door.
Appendix D: Glossary Term Definition distal In relation to the casette, this refers to the tubing leaving the cassette going to the patient. distal end End closest to patient. distal occlusion Blockage between the infuser and the patient. dose frequency The rate or interval in which medication is given. dose limit An optional restriction of fluid deliveries. dose rate Delivery rate times medication concentration. dose/dose amount A specified volume or amount of medication.
Appendix D: Glossary Term Definition infuser settings Adjustable settings, e.g., distal occlusion pressure limits, air sensor sensitivity, real-time clock, and audible alarm volume. intermittent To give a specified dose amount of medication at regular intervals, e.g., every 4 hours. isopropyl alcohol A disinfectant not to be used to clean the SYMBIQ™ Infusion System. I.V. pole A pole that an infusion bag and an infuser are attached to.
Appendix D: Glossary Term Definition power sources Energy source an infuser draws power from like rechargeable batteries or AC mains. power off (verb) Turning off infuser allow the internal processors to shut off. pressure The measured fluid pressure for the proximal line or the distal line when a fully primed administration set is loaded into an infuser with the cassette carriage closed.
Appendix D: Glossary Term Definition standard conditions Conditions the defined infuser accuracy. standby A delivery program state that resembles a delayed start of 24 hours for a channel in all respects except a status display of Standby instead of Delayed. stop mode Operating mode an infuser enters when the programmed therapy is complete, and during certain alarm conditions. Stop Program button Stops an infusion. stop time A specific time to stop a program.
Appendix E: Default Drug Library (DDL) Medication Name Medication Name Medication Name Fluid Only DOXOrubicin Morphine Other Drug Epinephrine Nafcillin Abciximab Epoprostenol Naloxone Acyclovir Eptifibatide NitroGLYCERIN Albumin Erythromycin NitroPRUSSIDE Aldesleukin Esmolol Norepinephrine Alfentanil Etomidate Ofloxacin Alteplase (rt-PA) Etoposide Ondansetron Amikacin Famotidine Other Drug Aminocaproic acid Fentanyl Oxacillin Aminophylline Fluconazole Oxytocin Amiodarone
Appendix E: Default Drug Library (DDL) NOTES: 188 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Index A AC power 33 Active button 16 administration sets general information 54 loading 62 non-blood sets 57 preparing 55 with syringe holder 60 advanced therapies overview 87 Air-In-Line 118 alarm 118 alarm Air-In-Line 118 conditions and criteria (table) 127 Distal Occlusion 112 Infusion Complete Callback 117 log 145 messages 127 minimized tabs 129 multiple 130 Nearing End of Infusion 120 Proximal Occlusion 114 silence audible 130 silencing 129 touchscreen appearance 128 urgency 127 alarm messages 127 alar
Index D Default Drug Library (DDL) delayed start programming 109 Depressed button 16 disposal product 153 Distal Occlusion 112 alarm 112 document conventions 7 137, 147, 187 E electrical artifacts 12 Emergency Stop button 42 end-of-list indicator 17 F features channel level 23, 24 device level 23, 26 infuser 23 program level 23, 25 flow continuity 158 flow rate accuracy 158 standard specifications (table) 158 fluid container compatibility 56 G glossary 181 grasping infuser (figure) 51 H hard limit ov
Index system message (figure) 136 invalid value handling 45 hard limit 134 P K keypad Intermittent Time Numeric 100 L label Sterile Parts and Pathways 54 list numbers accessories 179 administration sets 179 loading administration sets 62 logs Alarm Log 137, 145 Event Log 137, 144 Rule Set Alert Override Log 137, 146 M maintenance battery 152 battery disposal 152 cleaning solutions 151 cleaning the infuser 151 medication concentration, specifying messages alarm 127 system 127 minimized alarm tabs 129
Index channel LED location 35 channel level feature 24 Completed Intermittent 103 Completed Multistep 94 Concentration drop-down list 76 Confirm Bolus 124 Confirm Program 78 Delivering Bolus 125 Delivering Intermittent X of Y 102 Delivering Multistep 94 Delivering Program 85 device level features 26 Disconnect Tubing system message 107 Dose Calculation 77 End of Infusion, alarm tab 80 Enter Code dialog box activating 31 unlocking 32 Event Log 144 Exceeded Upper Hard Limit icon 135 Exceeded Upper Soft Limit
Index Invalid Entry (figure) 136 Outside of Hard Limits 133 Soft Limit Outside of Limits 132 Soft Limit Outside of Limits (figure) system messages 127 T tab minimized alarm 129 multiple alarm 131 Time touchscreen 77 titrate infusion 81 titration 105 touchscreen button 16 front view 15 icons 17 symbols 17 troubleshooting alarm messages 171 system messages 161 132 U Unavailable button 16 V value rounding 46 VTBI piggyback VTBI 84 W wireless communication workflow Basic program 71 SYMBIQ™ Infusion Syst
Index 194 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
SYMBIQ™ Infusion System License & Warranty Subject to the terms and conditions herein, Hospira, herein referred to as Hospira, warrants that (a) the product shall conform to Hospira's standard specifications and be free from defects in material and workmanship under normal use and service for a period of one year after purchase, and (b) the replaceable battery shall be free from defects in material and workmanship under normal use and service for a period of 90 days after purchase.
SYMBIQ™ Infusion System License & Warranty NOTES: 196 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
Hospira, SYMBIQ™ and Hospira MedNet® MedNet Service Suite are registered trademarks of Hospira. The process of downloading a customized drug library to an infuser is covered by U. S. Patent Numbers 5681285. Other patents pending. The SYMBIQ™ Infusion System uses components and technologies protected by U. S. Patent Numbers 6,497,680, 5,989,222, 5,186,779, 5,745,378, 5,586,868, 5,462,256, and 5,191,795. WARNING: Possible explosion hazard exists if used in the presence of flammable anesthetics.
198 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
