Pocket Guide - Microsoft
Hospitalrespiratory carePocket guidePhilips V60 and V60 Plus* ventilatorsA comprehensive noninvasive solution* Not available in USA and may not be available in all markets.
IntroductionPhilips is passionate about providing solutions that lead tohealthier patients and healthier practices. This pocket guideis designed to help familiarize clinicians with the set-up andapplication of the Philips V60 and V60 Plus* ventilators.The V60 and V60 Plus ventilators are microprocessorcontrolled, bi-level, positive airway pressure ventilatoryassist systems that provide noninvasive and invasiveventilatory support for spontaneously breathing adult andpediatric patients ( 20 kg). The V60 also offers the optionof adding a high flow nasal therapy (HFT)* functionality.Use this guide for a step-by-step explanation of how touse the V60 and V60 Plus ventilators, from initial setupto mask and port settings to changing modes. This guidealso includes suggestions for increasing tank life duringtransport.The value of the noninvasive approachNIV has been shown to significantly reduce many of thecomplications associated with conventional mechanicalventilation, including the incidence of ventilator-acquiredpneumonia,1 while at the same time reducing the overallcost of care by shortening lengths of stay.2,3The V60 Plus ventilators enable high flow therapy (HFT),so you can rotate between NIV and HFT,* wean, or escalatetherapy – all while using the same circuit.* HFT, V60 Plus and 3.00 SW are not available in the USA and may not beavailable in all markets.2
Table of ContentsDevice overviewFront4Back4Side4Air inlet filter5Patient circuits5General operationMask and port settings7Setting changes7Setting rate7Rise time8I-Time8Mode changes8Therapy changes8Batch changes9Alarm message navigation9Alarm settings10Low rate10Menu tab11Screen Lock11Patient data and waveforms12Standby13Help button13Mask leak symbols14Exhalation port settings15Exhalation port test15Features, modes, therapies and optionsAuto-Trak/Auto-Trak *16100% O2 key16Ramp16C-Flex17Pressure-controlled ventilation (PCV)17Average volume-assured pressure support (AVAPS)18High flow therapy (HFT)**20Patient transport21* May not be available in all markets.** Not available in the USA and may not be available in all markets.3
Device overviewFrontAlarm status and information barNavigation ringand AcceptPatient data windowWaveform lpressure portVentilatoroutletOn/ShutdownbuttonBattery LEDAlarm LEDSetting tabsBackOption labelsHigh pressure oxygeninlet connectorPower cordand retainerCoolingfan filterRS-232 serial and analog I/O connectorRemotealarm andnurse callconnectorSideBracketholdingfilterAir inletfilter4Air inlet
Air inlet filterThe air inlet filter should be inspected every monthand replaced if needed.To change the air inlet filter1. Power down the V60 or V60 Plus* and disconnectit from AC power.2. Turn the D-ring fastener (bottom of side panel)counter-clockwise one-quarter turn and release.3. Remove the side panel.4. Remove the air inlet filter by pinching it out ofthe recess in the bracket.5. Install the new air filter by tucking it into the recessed area.6. Replace the side panel, push in the D-ring fastener,then turn one-quarter rotation or until it locks.Patient circuit configurationsAssemble the patient circuit, including main flowbacterial filter, proximal line, and humidifier (if desired).1. Standard patient circuitThe standard patient circuit includes a main flow bacterial filter,an exhalation port, and a proximal pressure line. Not for usewith a humidifier.* Not available in the USA and may not be available in all markets.5
2. Invasive patient circuitThe invasive patient circuit includesa main flow bacterial filter, a shortdry tube, a water trap, a proximalpressure line, and an elbow. It ismeant to be used with a humidifier.3. Heated-wire patient circuitThe heated-wire patient circuitincludes a main flow bacterial filter,a short dry tube, a heated-wirecircuit, a proximal pressure line,and an exhalation port.6
General operationOnce the circuit and filter are attached, press the On/Shutdown button. Informational messages are displayedon the screen; one that informs the clinician to ensurea bacterial filter has been added to the machine outlet,*the second message, appearing in NIV modes, indicateswhich mask and leak port have been inputted. Continueto Mode settings. Otherwise, follow the instructionalsteps to change the mask and port settings.Mask and port settings1. Press the Menu setting tab.2. Press the Mask and Port button.3. Press desired patient interface type (see Mask leaksymbols for more information) and press Accept to apply.4. Press the desired exhalation port (see Exhalation portsettings for more information) and press Accept to apply.5. Run the exhalation port test only if required.Setting changes1. In the Settings window, touch the setting to be changed.2. Adjust the setting by using either the arrow keys or thenavigation ring.3. Once the correct value has been chosen, press Accept.Setting rate Because the V60 and V60 Plus** are intended to augmentventilation in patients who are spontaneously breathing,the rate should be set as a back-up rate in the case ofapnea. If the patient fails to trigger a breath throughAuto-Trak within the interval determined by the ratesetting, the ventilator triggers a mandatory breath.* Available with 2.30 or above software only – not available in all markets.** Not available in the USA and may not be available in all markets.7
General operationRise timeRise time is the speed at which inspiratory pressure risesto the set (target) pressure. Set to the fastest rise timetolerated (1 for the fastest rise; 5 for the slowest rise). Too slow of a rise may exacerbate dyspnea in the ARFpatient, possibly depriving the patient of needed flow. If rise time is insufficient to reach the desired inspiratorypressure or time, decrease the rise time setting (e.g., changefrom 5 to 3, therefore resulting in a faster rise time).I-TimeSetting I-Time adjusts the inspiratory time for a machinetriggered breath, therefore influencing the I:E ratio in V60or V60 Plus* machine-triggered breaths. Inspiratory time iscontrolled by the patient in a patient-triggered breath.Mode changesThe active ventilation mode is displayed in the upperleft corner of the screen. To set or change a mode:1. Select the Modes setting tab.2. Select the desired mode (active mode will be displayed.3. Adjust settings as desired. Newly adjusted setting valueswill be displayed in yellow.4. Select Activate Mode to apply.Therapy changes from NIV to HFT*1. Select Standby.2. Remove interface from patient.3. Change interface to a recommended Philips high flow nasal cannula.4. Select HFT.5. Adjust parameters.6. Select Start HFT.* Not available in the USA and may not be available in all markets.8
Batch changesBatch changes are available in only the active mode ortherapy. Batch changes allow simultaneous activationof multiple ventilation setting changes. To make batchchanges follow these steps.1. Press the Modes setting tab.2. Press the active mode (it will state “Batch” and bedisplayed in blue).3. Adjust settings as desired so that newly adjustedvalues are displayed in yellow.4. Press Activate Batch Change to apply all changesat once.Alarm message navigationTo hide alarms or informational messages in the Alarmsor Messages list, press the Alarm button (flashing if highpriority) or the Informational Messages button whenup arrows are present. To display messages, touch theInformational Messages button when down arrows arepresent. For a list of alarms, see the Philips V60 andV60 Plus* Ventilators User Manual.* Not available in the USA and may not be available in all markets.9
General operationAlarm settings*1. Press the Alarm Settings tab.2. Press and change the appropriate alarm value.3. Press Accept.Low rateOn the V60 and V60 Plus**, the low rate alarm may alsoserve as an apnea alarm. It is recommended to set thelow rate alarm higher than the backup rate but lower thanthe patient’s spontaneous rate. If the low rate alarm valueis set at or below the set rate, the low rate alarm cannotbe triggered, and the alarm is essentially disabled. A textwarning will appear on the left side of the Settings screenif the user sets the low rate at or below the set (backup) rate.Set (backup) rateWarning that alarmwill not work withcurrent backup rateLow rate alarm setting* There is no Alarm Settings tab in HFT.** Not available in the USA and may not be available in all markets.10
Menu tabUser preferences can be adjusted using the Menu window.There is a Brightness setting button for day or night view.The Loudness setting button adjusts the volume of alarmsand the audible feedback click. The Alarm Volume Escalationfeature,* if enabled, will escalate alarm volume when ahigh priority alarm is not responded to within 40 seconds.Ventilator alarm volume increases to maximum volumeover a 20-second period. When the function is active anda touchscreen or a button press is detected, the ventilatorautomatically returns the alarm volume to the user setting.There is a Mask/Port menu button to choose various maskleak values and to choose the correct port (see Mask Leaksymbols). The Vent Info menu button displays the softwareversion and other information specific to the ventilator.There is also a Screen Lock button.Screen LockScreen Lock deactivates all buttons and tabs on thetouchscreen except the 100% O2 key, Alarm Silence,Alarm Reset, and Alarm Message buttons, and Help icon.The tabs will be grayed out.To unlock the screen, press the Accept button ( )in the center of the navigation ring.*Available with 2.30 software and above only – not available in all markets.11
General operationPatient data and waveformsThe data screen displays alarms and patient data, whichinclude rate, estimated tidal volume, estimated minuteventilation, peak inspiratory pressure, patient trigger %,TI /TTOT %, and leak. The breath-type indicator colorcorresponds to waveform color: turquoise for spontaneouslytriggered, orange for timed triggered, and blue for exhale. Pt. Trig: Patient-triggered breaths as a percentageof total breaths over the last 15 minutes. Rate: Total breath rate (Spont and Timed), a movingaverage over the last 6 breaths or 15 seconds. TI /TTOT %: Inspiratory time divided by the total cycle timeover the last 8 breaths. Pt. or Tot. Leak: Estimated unintentional leak (Pt. Leak)or total of intentional plus unintentional leak (Tot. Leak). Breath indicator bar: Changes color depending onbreath type and inspiratory phase. Spontaneous breathis turquoise (Spont), machine-triggered breath is orange(Timed), and exhalation is blue (Exhale).12
StandbyStandby suspends ventilation and retains current settingswhen the clinician wants to temporarily disconnect thepatient from the ventilator. Ventilator settings and mostmenu functions can be changed during the standby mode.To activate Standby1. Press the Standby tab.2. Remove the mask.3. Disconnect the circuit from the mask.In ventilation modes, the ventilator will not enter standbyuntil the patient is disconnected. It continues ventilationwhile waiting for the patient to be disconnected. In HFT,*detection of disconnection from the patient is not available,therefore the clinician must select the Standby tab andthen engage standby by selecting Enter Standby.The standby mode gives the clinician up to 60 secondsto disconnect the patient from the ventilator. If after60 seconds no disconnection is detected, the standbymode cancels.Help buttonPress the Help icon (?) to display additional information.Touch the screen anywhere to return to normal operation.* Not available in the USA and may not be available in all markets.13
General operationMask leak symbols*Leak symbol(printed on mask)Patient interfaceLeak 1(no exhalationport on mask)PerformaTrak oro-nasal maskContour Deluxe nasal maskAF811 (CapStrap gel mask)AF531 (EE Leak 1)AF421 (EE Leak 1)AF541 (EE Leak 1)Leak 2(exhalation portwithin mask)PerforMax with entrainment elbowAF531 (EE Leak 2)AF421 (EE Leak 2)AF541 (EE Leak 2)Leak 3AP111 (OptiLife Interface)Leak 4 (exhalationport within mask)Reserved for future useThe Leak symbol represents the intentional leakcharacteristics of the mask, and the proper V60 or V60Plus** mask/port settings will ensure the greatest accuracyand optimum performance. If the Leak symbol does notappear on a Philips patient interface, use the chart aboveto determine the proper setting. When using an interfaceother than a Philips mask, choose the Leak setting Other.This selection results in Total Leak, not Patient Leak, beingdisplayed on the patient data screen.Leak 1 symbol on mask* In HFT, no mask leak symbol or exhalation port selections need to be made.** Not available in the USA and may not be available in all markets.14
Exhalation port settingsAfter pressing the appropriate mask setting, pressthe correct exhalation port setting. The chart belowreferences the various exhalation port settings and whenan exhalation port test is recommended. An exhalationport test is only recommended when using a PEV (plateauexhalation valve) or non-Philips exhalation ports withunknown leak characteristics.PortselectionsExhalation porttest recommendedDisposableExhalationPort (DEP)NoWhisperSwivelNoPlateauExhalationValve (PEV)YesOtherexhalationportYesExhalation port testIf a port test is required, follow the instructions providedon the screen.15
Features, modes,therapies and optionsAuto-Trak/Auto-Trak *Auto-Trak automatically maintains appropriate triggerand cycle thresholds to maintain patient-ventilatorsynchrony even with changing leak. An optional upgrade,Auto-Trak allows the clinician to customize Auto-Trak’strigger and E-cycle sensitivity.100% O2 key*Upon pressing the 100% O2 key, the V60 or V60 Plus**delivers 100% O2 for two minutes. The clinician is also giventhe option to cancel the action or add an additional twominutes of 100% O2.RampThe ramp time allows the patient to adapt to ventilationgradually by increasing inspiratory and expiratory pressures(IPAP and EPAP/CPAP) from sub-therapeutic to user-setpressures over a user-set interval (5-45 minutes).How to set a ramp time1. Press the Ramp Time button in the Mode settings window.2. As the ramp progresses, the Ramp Time button graphicfills in.3. To change the ramp interval or end the ramp, pressthe Ramp Time button again, and the Ramp in Progresswindow opens.4. To end the ramp and apply the full IPAP and EPAP/CPAPpressures immediately, press End Ramp.5. To end the ramp and start a new one, press Start NewRamp, and the Ramp Time setting window opens againto allow a new ramp time to be set.* Available with 2.30 or above software only – not available in all markets.** Not available in the USA and may not be available in all markets.16
C-FlexC-Flex improves the comfort of traditional CPAP byreducing the pressure at the beginning of exhalation andreturning it to the set level before the end of exhalation.C-Flex may not be appropriate for patients where evena transient drop in CPAP is deemed undesirable.The amount of pressure relief is determined by the C-Flexsetting and the expiratory flow of the patient. Pressurerelief is increased with a higher setting number (1, 2, or 3)and greater patient expiratory flow. This applies only duringthe active part of exhalation.Theillustrationcorrelateswith theC-FlexsettingPressure-controlled ventilation (PCV)In PCV, breaths with a user-set IPAP and I-Time aredelivered to the patient. The patient can trigger aninspiration and, therefore, control the rate. However,the patient does not control the inspiratory time.Also be aware that any changes in EPAP without anequal change in IPAP will change the pressure support.17
Features, modes,therapies and optionsAverage volume-assured pressure support (AVAPS)AVAPS is a volume-targeted mode and is intended foruse with stable chronic patients who do not require rapidpressure support changes to maintain a target VT.At start-up, AVAPS applies an inspiratory pressure equalto one of the following, whichever is greater EPAP (target volume/60 ml/cmH2O) EPAP 8 cmH2 O PminThe V60 and V60 Plus* will automatically adjust IPAP (up to2.5 cmH2O per minute), to maintain a tidal volume target.Note: when adjusting AVAPS minimum and maximumpressures, remember that IPAP is adjusted to meet the targetvalue. If calculated target pressure is outside of the setpressure range, the target volume will not be achieved.IPAPMinEPAPTarget VTAVAPS automatically adapts pressure support ( 2.5 cmH2Oper minute) to guarantee an average tidal volume.* Not available in the USA and may not be available in all markets.18
Starting AVAPS1. When switching from S/T mode to AVAPS, set the Min Pat the current IPAP pressure.2. During AVAPS startup, there may be a period of timebefore the target tidal volume is achieved. If the targetVT is not achieved at the current Min P setting, increasethe Min P until the target VT is reached. Remember,the VT displayed on the V60 and V60 Plus* is a six-breathaverage, so the effect of a settings change may not befully reflected for several breaths.3. Once the target VT is reached, reduce Min P slightlyto allow the AVAPS algorithm to adjust.4. If target VT is not achieved due to a low Min P setting,an informational message will appear. Adjust Min Paccordingly unless the maximum pressure for the patienthas been reached.5. If target VT is exceeded because Min P is set too high,an informational message will appear. Adjust Min Paccordingly unless the minimum pressure for the patienthas been reached.6. Set the high and low VT alarms appropriately.7. In AVAPS, the EPAP setting must be at least 1 cmH2O belowthe Min P setting. In some cases, an increase in the Min Psetting is required before increasing the EPAP setting.* Not available in the USA and may not be available in all markets.19
Features, modes,therapies and optionsHigh flow therapy (HFT)*HFT is for spontaneously breathing patients only, ones whorequire oxygen therapy at a flow rate higher than traditionaloxygen delivery options such as a low flow nasal cannula.It should only be used with a heated humidification circuit.Dry gas delivery at a high flow rate may cause patientdiscomfort and may impair the mucociliary function.Flow rate capability and oxygen concentration range Flow 10 l/min – 80 l/min** O2 21% – 100%Upon initiation of therapy, three notifications are displayed.1. No Mask icon, indicating NIV masks are inappropriateinterfaces for HFT.2. High Flow Therapy Active notification, indicatingtherapy has been activated.3. Patient alarms are disabled during HFT notification,indicating that there are no patient alarms (such as highand low RR, pressure, or minute ventilation). There aretwo system alarms, one that target flow has not beenreached and the other that the patient circuit is occluded.The Alarms tab is disabled in HFT. Provide externalmonitoring, including oximetry, to inform the clinicianof a change in the patient’s condition.* Not available in the USA and may not be available in all markets.** The maximum deliverable flow rate varies based on nasal cannula orificesize and on patient nasal passage resistance.20
Philips recommended nasal highflow cannula or high flow trachadaptors may be used. NIV masksor direct connection to ET tubes ortracheostomies are not appropriate.When connecting a high flowinterface, the NIV circuit exhalationport must be blocked via the PhilipsAC611 with FEP connect or removedto adapt a Philips recommendedcannula with a 22 mm connection during HFT.* Failureto block or remove the exhalation port will result in areduction in the delivered flow due to the leak throughthe exhalation port.When administering HFT witha nasal cannula, it is importantto ensure that the set target flowis appropriate for
On the V60 and V60 Plus**, the low rate alarm may also serve as an apnea alarm. It is recommended to set the low rate alarm higher than the backup rate but lower than the patient’s spontaneous rate. If the low rate alarm value is set at or below the set rate, the low rate alarm cannot be triggered, and the alarm is essentially disabled. A text
Pocket WSL-PK-35-XX Same size pocket as Roller 64 6 in. x 9 in. (152 mm x 229 mm) Dual Pocket WSL-PK-6-9-XX Same size pocket as Roller 64 2 in. Flap (51 mm) (must be 3.5 in. pocket compatible) WSL-FLP-2-XX Attached to the hanger that is built into pocket Use 3 in. (76 mm) Flap for Dual Pocket Roller
Pocket PC HP hx 4700 ARM Pocket PC 2003 SE Pocket PC TDS Recon ARM Windows Mobile 5 / 6 Pocket PC TDS Ranger ARM Windows Mobile 5 / 6 Pocket PC Topcon FC-250 ARM Windows Mobile 6 Pocket PC TDS Nomad ARM Windows Mobile 6 Handheld PC Trimble TsCE ARM Windows CE 3.0 Handheld
SDH Pocket Guide revised version Vol. 1 Please ask for: Vol.2 Pocket Guide GSM Fundamentals in Mobile Radio Networks Vol.3 Pocket Guide SONET Fundamentals and SONET Testing Vol.4 Pocket Guide ATM Fundamentals and ATM Testing Vol.5 Pocket Guide E1 The World of E1 Subject to change without notice Nominal charge US 10 - TP/EN/PG01/0400/AE repl .
o Microsoft Outlook 2000 o Microsoft Outlook 2002 o Microsoft Outlook 2003 o Microsoft Outlook 2007 o Microsoft Outlook 2010 o Microsoft Outlook 2013 o Microsoft Outlook 98 o Microsoft PowerPoint 2000 o Microsoft PowerPoint 2002 – Normal User o Microsoft PowerPoint 2002 – Power User o Microsoft PowerPoint 2002 – Whole Test
Business Ready Enhancement Plan for Microsoft Dynamics Customer FAQ Updated January 2011 The Business Ready Enhancement Plan for Microsoft Dynamics is a maintenance plan available to customers of Microsoft Dynamics AX, Microsoft C5, Microsoft Dynamics CRM, Microsoft Dynamics GP, Microsoft Dynamics NAV, Microsoft Dynamics SL, Microsoft Dynamics POS, and Microsoft Dynamics RMS, and
Microsoft, Microsoft Dynamics, logo systemu Microsoft Dynamics, Microsoft BizTalk Server, program Microsoft Excel, Microsoft.NET Framework, program Microsoft Outlook, Microsoft SharePoint Foundation 2010, Microsoft SharePoint Ser
Appointment Diaries 4 Retail Diaries Page-a Day Nappa 5 Page-a-Day Deoflex 5 Week-to-View Journal Combo 6 Page-a-Day Lizzy 6 Page-a-Day Marble 6 Page-a--Day Printed 7 Pocket Diaries H7V Cased Pocket Diary 8 H17 Slimline Pocket PVC Cover 8 Slimline Cased 8 H7 Pocket PVC Cover 9 W7 Pocket PVC Cover 9
8 Timbuk2 Corporate Sales Fall 2018 CUSTOM Custom Fold Messenger Sewn in SF Webbing color is customizable Rear, flap, front and pocket fabrics are all customizable Internal zip pocket fits iPad Mini / Kindle / eBook readers Key lanyard, slip pocket & zipped pocket organization in pocket Dual buckle flap closure 15"
