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NO Setup
Newborn Intensive Care Unit

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1. Initial Connections & Leak Test
2. System Purge & Pre Test

3. Manual NO Delivery System Purge & Performance Test

4. Changing NO Cylinders & Purging Regulator Assembly
5. Circuit Assembly for Bird, Drager & Sensormedics
6. System Calibration

 



  • 1. Initial Connections & Leak Test
  • 1.1 Connect the INOvent delivery system as described in the Operations and Maintenance Manual
  • 1.2 Check the cables and hoses for signs of wear or damage and replace as needed.
  • 1.3  Turn the INOvent delivery system ON and confirm that the buzzer and the speaker sound.
  • 1.4 Confirm for your records that a Monthly System Checkout has been donein the last month.  If it hasn't, do a Monthly  System Checkout. (see manual section 4.2)
    1.5 Do a system high pressure leak test
  • a. With the INO vent delivery system ON, turn each cylinder valve ON thenOFF.  Check for adequate cylinder pressures (minimum 200 psig -red zone on gauge). Wait for 30 seconds & check for pressure decrease.


  • tank knob turner too
  • NO tank gauge on front of INOvent
  • 2. System Purge and Performance Test-
  • WARNING: Make sure a purge has been completed within five minutes before the start of NO therepy.  If not,repeat the perfomance test as described here, making sure the NO2 is less than the value listed for the cylinder concentration being used.
  • 2.1  Connect the Injector Module to an O2 auxillary flowmeter usingO2 tubing, a 4.5 mm to 15 mm adapter and a breathing circuit adapter tocondition the flow before the Injector Module.  (See Figure 1)
  • 2.2 Connect a sample tee to the outlet of the Injector Module with 300mm of 22mm hose to ensure gas mixing prior to gas sampling. (See Figure 1) Attach a sampling line from the sample tee to the sample connector onthe front panel.
  • Figure1
  • 2.3   Do a low range calibration ofthe NO, NO2 and O2 monitors (See Section 4/Calibration of the Operation and Maintenance Manual)
  • 2.4   Make sure both NO cylinders are turned off after beingturned on.
  • 2.5   Set the oxygen flow to 15 L/min and the Set NO concentration to it's maximum setting.
  • 2.6   Make sure both cylinder high pressure gauges go to zero to purge both high pressure circuits.
  • 2.7   Check that the NO2 value is higher than 0.2 ppm toverify that the NO2 monitor is functional.
  • 2.8   Make sure that these two alarms occur:  LowNO/N2 Pressure  Delivery Failure (This may take a few minutes depending on the cylinder pressures at the startof the test.)
  • 2.9   When the alarms have occured,turn on the NO cylinder with which you intend to start therapy. Leave the other cylinder turned off.
  • 2.10 Set the O2 flow on the auxillary flowmeter to 15 L/min and the Set NO to 40 ppm.
  • a. Wait for 3 minutes or until the monitor readings are stable.
  • b. Make sure that the O2, NO2 and NO readings are withing the acceptable ranges given below. Note:These acceptable readings include the errors of the NO delivery system & the NOtherapy gas.
  • At NO 40ppm O2 %v/v (+/-3%v/v) = 95
  • NO2v ppm max.+ 1.5 NO ppm (min/max)+  32 / 48
  • 2.11 Perform the monitor high range calibrations if required.
  • 3. Manual NO Delivery System Purge andPerformance Test
  • Place the Injector Modulein line with the manual resuscitator to maintainNO delivery during manual ventilation.
  • 4. Changing NO Cylinders & Purging the Regulator Assembly
  • WARNING: You must purge the regulator ssembly immediately before using a new NO cylinder tomake sure the patient continues to receive the correct NO concentration and does not receivegreater than 3.0 ppm of NO2.
  • IMPORTANT: Replace an NO therapy gas cylinder when its pressure is less than 200 psig. Theregulator assembly must be purged before using a new NO therapy gas cylinder. A small purge manifold allows you topurge the regulator assembly.  The manifold is located either betweenthe regulators on the transport cartor attached to the wall mount regulator inlet fitting.
  • 4.1  To purge the regulator assembly before using a new NO therapy gas cylinder:
  • a. Determine which regulator assembly is not being used and requires purging.  the cylinder valve should be closed on the regulator assembly  that is not being used.
  • b. On the regulator assembly that requires purging, disconnect the lowpressure hose quick connect fitting from the NO.N2 input on the rear of the INOvent delivery system (shown in Figure 2-2 of theOperation and Maintenance Manual.)
  • c. Open the cylinder valve on the new NO therapy gas cylinder.
  • d. Close the cylinder valve on the old NO therapy gas cylinder.
  • e. Check for leaks at the cylinder valve outlet connection of the newtherapy cylinder using soapy water. See section 13/Appendic B of the Operationa and Maintenance Manual.
  • f. Insert the low pressure hose quick-connect fitting into the purge manifold (See Figure 3)
  • . g. Firmly push and hold the quick-connect fitting in place while the  pressure drops to zero on the regulator gauge.
    .h. After the pressure drops to zero (approx. 215 serconds) reconnectthe low pressure hose quick connect fitting to the NO/N2 input on the rear of the INOvent delivery system

  • quikpurge


  • 4.2 Open the cylinder valve on the new cylinder
  • 4.3 Close the cylinder valve on the empty cylinder and label appropriately
  • 4.4 Replace the empty NO therpy gas cylindr See Section 13/Appendix B of the Operation and Manintenance Manual.  Leave the cylinder valve on the replacement cylinder turned off until needed.  The purge procedure will be performed on this cylinder immediately beforeits use.
  • 5. Injector Module Circuit Assembly -SIMV & HFO
  • The diagram below shows placement of the sample tee (6-12" before pt.)for conventional (Bird & Drager) ventilation.
  • Assure that the sensor line is up.
  • Sampleport-conventional insp.  line
  • Sampleport-HFO insp. line
  • For Sensormedics, cut the insp limb tygon tubing 6-12 " before the patientand insert the tee using the provided adaptor and a 15/15 mm adaptor
  •   injector pre- humidifierIMV injectorpre-humidifier HFO
  • 6. Calibration of the System while on NO Tx.
  • Calibrate low daily -make no changes during calibration
  • calibrate -power flush 2 minutes set display to Cal NO and set same value as the refrence gas.
  • flush with air/O2 for two minutes
  • alarms set 3ppm above and below ordered dose
  • splice the flow injector between the ventilator flow outputand the humidifier. (place after O2 analyzer with Bird VIP)
    Splice the sampling port into the inspiratory limb of thecircuit 6-12" before the patient ett connection manifold.

  • Cal tank system


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