ICU Medical 16026 Symbiq One Channel Infusion System User Manual mds PHXopsmanual

Hospira, Inc. Symbiq One Channel Infusion System mds PHXopsmanual

Contents

User Manual Part 3

Intermittent Therapy Chapter 7: Advanced Therapies SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 99•BSA OR press Calculate to manually calculate BSA (if available) Figure 92: Intermittent Programming Screen10. Press Enter to accept the dose. The rate is automatically calculated and appears in the rate field. Figure 93: Intermittent Dose Calculation Screen11. Press VTBI field (Volume to be infused) and enter the amount of fluid to be delivered. Time is automatically calculated.
100 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 7: Advanced Therapies Intermittent TherapyNote: Entering two of the three programming parameters (Rate, VTBI, or Time) automatically calculates the third. Figure 94: Intermittent Programming Screen12. 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 Keypad14. When finished entering parameters on the Intermittent Programming screen, press Next to display the Confirm Intermittent screen.Program-level buttons have the following functions:1113
Intermittent Therapy Chapter 7: Advanced Therapies SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 101-Clear restores default field values for current screen-Setup displays the Intermittent Setup screen-Clear All deletes entire program-Back displays the Intermittent Setup screenPress 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. Review the therapy parameters, and then press Start Intermittent. Figure 96: Confirm Intermittent Screen09:21 AMAPiggybackCONFIRM INTERMITTENT (with KVO)Press Start to begin Infusion. Advanced button to editprogram.AdvancedStartIntermittent ABolusICUSettings Logs LockModeProgramAlarmRate:Dose:2.5 mcg / kg / min0 mL/hr0mLVTBI:Time:0.6 mL/ hr0.1 mL00:10 hh:mmCeftriaxone[1 grams / 50 mL]Number ofDeliveries: 2Time BetweenStart ofDeliveries: 00:30 hh:mm!
102 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 7: Advanced Therapies Intermittent Therapy16. 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. Figure 97: Delivering Intermittent Screen X of YNote: Between phases of an Intermittent therapy, WAITING FOR INTERMITTENT X of Y displays on the status line. Each additional phase of an Intermittent therapy updates the status line with DELIVERING INTERMITTENT / X of Y. Between phases of delivery, medication continues to infuse at KVO rate. Figure 98: Waiting for Intermittent X of Y screen; Delivering Intermittent X of Y screen03:38 PMProgramBolusSettings Logs LockModeDELIVERING INTERMITTENT 1 of 2Press Stop to end infusion. Advanced button to viewcurrent program.Rate:Dose:VTBI:Volume Infused:Ceftriaxone[ 1 grams / 250 mL]Time Remaining:StopIntermittent APiggybackICUAlarmAAdvanced2.5 mcg/kg/min0.6 mL / hr0.1 mL0mL00:10 hh:mmCeftriaxone0.6 mL / hr0.1 mL03:38 PMProgramBolusSettings Logs LockModeDELIVERING INTERMITTENT 2 of 2Press Stop to end infusion. Advanced button to viewcurrent program.Rate:Dose:VTBI:Volume InfusedCeftriaxone[ 1 grams / 50 mL]Time RemainingStopIntermittent APiggybackICUAlarmAAdvanced2.5 mcg/kg/min0.6 mL / hr0.1 mL0.4 mL00:10 hh:mmCeftriaxone0.6 mL / hr0.1 mL03:38 PMProgramBolusSettings Logs LockModeWAITING FOR INTERMITTENT 2 of 2Press Stop to end infusion. Advanced button to viewcurrent program.VTBI:Volume InfusedCeftriaxone[ 1 grams / 50 mL]Time RemainingStopIntermittent APiggybackICUAlarmAAdvanced0mL0.1 mL00:20 hh:mmCeftriaxoneKVO:1mL/hr1mL/hr0mL
Intermittent Therapy Chapter 7: Advanced Therapies SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 10317. When the Intermittent program completes and the VTBI is delivered, COMPLETED INTERMITTENT displays on the status line of the Delivering screen. Figure 99: Completed Intermittent Screen03:38 PMProgramBolusSettings Logs LockModeCOMPLETED INTERMITTENTPress Stop to end infusion. Advanced button to viewcurrent program.VTBI:Volume InfusedCeftriaxone[ 1 grams / 50 mL]Time RemainingStopIntermittent APiggybackICUAlarmAAdvanced0mL0.5 mL00:00 hh:mmCeftriaxoneKVO:1mL/hr1mL/hr0mL
104 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 7: Advanced Therapies Intermittent TherapyNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 105Chapter 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 InfusionPress Deliver at End of Infusion and select None, KVO, or Continue Rate.• Select KVO to change to KVO rate at end of infusion. • Select Continue Rate to deliver programmed therapy rate at end of infusion. • Select None for no delivery at end of infusion.Press Done to accept change and exit Options menu. Figure 100: Options Menu screenKVO RatePress KVO Rate and enter rate using numeric keypad. Press Done to accept change and exit Options menu.
106 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program OptionsPower Priming a SetPower 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 setNote: Refer to the SYMBIQ™ administration sets labels for information regarding use with different flow rates.• 3 minutes for a 72" macrobore setWARNING: Always prime the administration set to remove air from the cassette, tubing, and injection sites prior to connecting to the patient. Always disconnect the administration set from the patient prior to priming or purging.To power prime a cassette:1. In the programming screen, fill in infusion information. When completed, press Options to display the Options screen. Figure 101: Programming Screen01:15 PMAProgramPiggybackRateDoseInfusionDose Calculation00--:--VTBITimemL/hrmLhh:mm[ 400 mg / 250 mL]DOPaminePress fields to edit. Clear to delete all entries. Options toedit program settings. Next to continue.BolusAdvancedICU0 mL/hr0mLNextOptionsClearSettings Logs LockModeCancelTitrationAlarm
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 1072. On the Options screen, press Select Amount under the Power Prime label. Figure 102: Options Screen3. The Disconnect Tubing system message activates reminding you to ensure the administration set is disconnected from the patient. Press OK to display the Power Prime screen. Figure 103: Disconnect Tubing System Message4. On the Power Prime screen, select one of these three priming options:• Prime 1 mL • Prime 3 mL • Prime 5 mL APiggybackKVO RateDelayedStartDeliver at Endof InfusionPower PrimeYesStandby--:--hh:mm1mL/hrPress button or field to select option to change. Doneto return to previous screen when finished.AdvancedKVOAlarm OptionsOptionsProgram04:34 PMSelect AmountBolusDoneICULogsSettings LockModeAlarm0mL/hr0mL08:33 AMAPress OK to acknowledge.Advanced0mL/hr0mLPiggybackBolusICUDisconnect TubingEnsure tubing is disconnected from patientbefore proceeding.Power PrimeEnsure tubing is not connectedto the patient.ProgramOKLogsSettings LockModeAlarm
108 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program OptionsNote: The power prime rate is 250 mL/hour. Figure 104: Power Prime Screen5. The Power Prime Progress screen displays showing the cumulative amount of fluid primed measured in mL. To cancel priming, press Cancel. Figure 105: Power Prime Progress ScreenNote: 50 mL is the maximum total primed value allowed. If primed to 50 mL, the priming will stop and the total primed will display for 5 seconds. The Infuser will then return to the Options screen.When priming finishes, press Cancel to return to the Options screen. See Figure 102: "Options Screen" on page 107. Priming is complete when a steady drip of fluid is observed at the end of 10:28 AMAProgramPiggybackEnsure tubing is not connectedto the patient.Power PrimePress button to select amount to prime. Cancel to returnto Options screen.OptionsPrime1mLPrime3mLPrime5mLSettings Logs LockModeAdvancedBolusICUCancelAlarm10:33 AMAProgramPiggybackEnsure tubing is not connectedto the patient.Total Amount Primed2mLPower PrimePress button to select amount to prime. Cancel to returnto Options screen.OptionsSettings Logs LockModeAdvancedBolusICUAlarmCancel
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 109administration 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.Delayed StartYou can delay the start of a programmed therapy (from one minute up to 12 hours) with the Delayed Start programming option. If allowed for the current program and enabled in the selected CCA, Delayed Start is available for all therapies. Once a therapy is started on a channel, Delayed Start is not available on that channel. You cannot select Delayed Start for a channel with an active alarm until the alarm is cleared.To program a delayed start:1. Press the Delayed Start field. Use numeric keypad to enter time period. Press Done to accept change and exit Options menu. Figure 106: Options Screen2. Press Next on the programming screen to display the Confirm Delayed Start screen.3. Review the program parameters. Press the Press Here to Confirm <Therapy> and Start Countdown for Delayed Start button to display the Confirm Program screen.
110 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program Options4. 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. Figure 107: Delayed Start Confirmation ScreenStandby ModeYou can place the SYMBIQ™ Infusion System in Standby mode for up to 24 continuous hours before starting a programmed therapy. Standby is not available for Intermittent. Standby can be selected anytime after programming a therapy except when infusing. You can also place the infuser in Standby mode without a cassette loaded if enabled in the defined device settings in the Drug Library. If the infuser has been in Standby mode for 24 hours, all program settings are cleared, a message box displays confirming settings have been cleared.09:21 AMAPiggybackCONFIRM DELAYED STARTPress Program to edit program. Delayed Start button tobegin countdown.AdvancedDelayedStart ABolusICUSettings Logs LockModeProgramAlarmRate:Dose:5 mcg/kg/min0 mL/hr0mLVTBI:Time:13.1 mL/ hr103 mL08:00 hh:mmDOPamine[400 mg/ 250 mL]
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 111To place an infuser in Standby mode:1. Press the Standby field to display the Standby drop-down list. Figure 108: Options Screen2. Press Yes to place the infuser in Standby mode or No to remove the infuser from Standby mode. Figure 109: Standby Drop-Down ListAPiggybackKVO RateDelayedStartDeliver at Endof InfusionPower PrimeYesStandby--:--hh:mm1mL/hrPress button or field to select option to change. Doneto return to previous screen when finished.AdvancedKVOAlarm OptionsOptionsProgram04:34 PMSelect AmountBolusDoneICULogsSettings LockModeAlarm0mL/hr0mLAPiggybackDeliver at Endof InfusionSelect Yes to activate standby and hold program for laterstart. No to deactivate standby. Cancel for no change.AdvancedKVOProgram03:01 PMPower PrimeSelect AmountKVO RateDelayedStarthh:mmAlarm OptionsStandbyBolusICU0mL0mLYesCancelNoNo--:--1LogsSettings LockModeAlarm
112 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program Options3. Press Done to accept changes and return to the Programming screen. Figure 110: Options Screen4. Press Next to display the Confirm Standby screen.5. Review the program parameters. Press the Standby button to initiate Standby.6. Press Cancel Standby to return to the Confirmation screen.7. Press Start to begin infusion.Alarm OptionsDistal OcclusionTo select the Distal Occlusion alarm:1. Use the vertical scroll bar to scroll down to the Alarm Options section, and then press the Distal Occlusion field.APiggybackKVO RateDelayedStartDeliver at Endof InfusionPower PrimeYesStandby--:--hh:mm1mL/hrPress button or field to select option to change. Doneto return to previous screen when finished.AdvancedKVOAlarm OptionsOptionsProgram04:34 PMSelect AmountBolusDoneICULogsSettings LockModeAlarm0mL/hr0mL
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 113Note: The unit of measure is either psi or mmHg as configured in the Drug Library from the facility’s respective CCA. Figure 111: Options Screen2. Select the desired distal occlusion setting. Figure 112: Distal Occlusion Setting Drop-Down ListAPiggybackDelayedStartDistalOcclusionStandbyKVO Rateof InfusionPress button to select occlusion pressure setting atwhich alarm will sound. Cancel for no change.AdvancedAlarm OptionsProgram03:02 PMBolusICU0mL/hr0mLCancel6psiOptions8. psiOptions8psiOptions7. psiOptions7psiOptions6. psiLogsSettings LockModeAlarm555
114 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program Options3. 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 Box4. Press Done to return to the Programming screen. Figure 114: Options ScreenProximal OcclusionTo select the Proximal Occlusion alarm:1. From any programming screen, press Options to display the Options screen.
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 1151. Use the vertical scroll bar to scroll down to the Alarm Options section, and then press the Proximal Occlusion field. Figure 115: Options Screen2. Select Solution Container or Syringe. Figure 116: Proximal Occlusion Setting Drop-Down List
116 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program Options3. 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 Box4. Press Done to return to the Programming screen.
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 117Infusion Complete CallbackTo 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 Screen2. Select Yes or No. Figure 119: Infusion Complete Callback Drop-Down ListAPiggybackDistalOcclusionStandbyInfusion CompleteCallbackProximalOcclusionSelect Yes to be notified when each step is completed.Cancel for no change.AdvancedAlarm OptionsOptionsProgram10:09 AMBolusICUDone7psiSyringeYes0mL/hr0mLSettings Logs LockModeAlarmCancelYesNo
118 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program Options3. 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 Box4. 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-LineTo select the Air-In-Line alarm setting:1. Use the vertical scroll bar to scroll down to the Alarm Options section. Press the Air-In-Line field to display the Air-In-Line settings list. Figure 121: Options Screen
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 1192. Select the desired air-in-line setting. Figure 122: Air-In-Line Sensitivity Drop-Down List3. 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 Box4. Press Done to return to the Programming screen.
120 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program OptionsNearing End Of InfusionTo 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 Screen2. Select the desired setting. Figure 125: Nearing End of Infusion Alarm Setting Drop-Down List
Chapter 8: Program Options SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 1213. 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 Box4. Press Done to return to the Programming screen. Figure 127: Options Screen
122 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 8: Program OptionsNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 123Chapter 9: BolusOverviewThis chapter describes how to program bolus deliveries and select program options for a therapy. BolusUse 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. If primary container is selected, the VTBI delivered is subtracted from the underlying primary therapy (Basic) VTBI.Note: Bolus may not be selected if a Piggback or Advanced therapy has been entered.To program a Bolus:1. Press Bolus to display the Bolus Setup screen. Figure 128: Bolus Setup Screens2. Press Select infusion field to select medication and concentration (if necessary).3. Press Deliver From and select Primary Container (if available) or Secondary Container.
124 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 9: Bolus Overview4. 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.) Press Enter to accept time period.The lowest displayed time increment is 1 minute. Infusion is delivered in the calculated time.5. Press Next to display the confirm Bolus screen.Note: If delivering a bolus from a secondary container, pressing Next activates the Secondary Container system message.6. Review the program parameters. Press Start Bolus to begin infusion. Figure 129: Confirm Bolus Screen
Overview Chapter 9: Bolus SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 1257. The Delivering Bolus screen displays; to stop the therapy, press Stop Bolus. Figure 130: Delivering Bolus Screen02:30 PMPress Stop to end infusion. Bolus button to view program.Program parameters may be changed after stopping.AdvancedDELIVERING BOLUSDose: 5000 unitsTime Remaining 24.6 mLVTBI: 49.9 mLVolume Infused: 0.1 mL[ 25,000 units / 250 mL]StopProgram ARate: 100 mL / hrSettings Logs LockModeBolusICUAlarmAHeparin100 mL / hr49.9 mLPiggybackProgramHeparin
126 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 9: Bolus OverviewNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 127Chapter 10: Alarm and System MessagesAlarm 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).Operational alarm conditions are defined as low, medium, and high urgencies. All Malfunction alarms are high urgency.If an alarm occurs in Delivery mode, or if a malfunction occurs, the Nurse Call relay activates to notify clinicians at remote locations (e.g., centralized nurse stations) of an alarm condition.During an active alarm, an alarm tab displays on the screen until the alarm is resolved and/or cleared. Malfunction alarms remain active until the infuser is powered off. Pressing the alarm tab displays additional information for assistance in resolving the alarm.For more information on alarm messages, causes, and remedies, see “Appendix B: Alarm Messages and Troubleshooting” on page 171.Alarm UrgencyThe SYMBIQ™ Infusion System has four distinct levels of alarms outlined in Table 10. Each alarm level includes an alarm message, a distinct audible tone, and a detailed troubleshooting tab. The troubleshooting tab contains a full description of the alarm condition and suggested remedies or checklists to assist in resolving the root cause of the alarm. Multiple, simultaneous alarms display in order from highest to lowest priority. During an alarm, the channel LEDs and bag icons take on the alarm’s color treatment and flashing behavior. Table 10: Alarm Conditions and CriteriaAlarm Urgency Alarm Sound Alarm Tab Color Channel LED Color Criteria for AlarmImmediate Single sound of three notes N/A N/A Invalid press or double-key effect occursLow Single two-note melody Solid yellow Solid yellow if alarm is delivery-relatedCondition which does not require immediate attention or resolution.
128 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 10: Alarm and System Messages AlarmAlarm AppearanceIf an alarm occurs while the Near Viewing screen is active, a Near Viewing Alarm overlay like the one shown in Figure 131 displays. This alarm overlay contains information about the alarm name, the reason for the alarm, a suggested remedy for the alarm, and elapsed time of the alarm (if enabled). Figure 131: Near Viewing Alarm OverlayA Far Viewing Alarm overlay is shown in Figure 132. The Far Viewing Alarm overlay displays the alarm name and elapsed time of the alarm. Touching Far Viewing Alarm overlay displays Near Viewing Alarm.Medium Repeating two-note melody Flashing yellow Flashing yellow if alarm is delivery-relatedCondition which, if not resolved promptly, could result in an escalation to a Warning alarm.High Repeating 10-note melody Flashing red Flashing redif alarm is delivery-relatedCondition which disrupts a therapy and/or requires immediate attention. Table 10: Alarm Conditions and Criteria (Continued)Alarm Urgency Alarm Sound Alarm Tab Color Channel LED Color Criteria for AlarmAdvancedSTOPPED PROGRAMBolus ProgramPiggybackICUStartProgram AA!LidocaineInfusion stopped. Remove air from line.Restart infusion. Check air sensitivitysetting if alarm persists.Press hereto minimizeall alarmsAIR-IN-LINE00:00:09Rate:Dose13.1 mL/hr5 mcg/kg/minRepeat?DOPamine[400 mg / 250 mL]VTBIVolume InfusedTime Remaining:105 mL0mL08:00 hh:mmA
Alarm Chapter 10: Alarm and System Messages SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 129A 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. Figure 132: Near and Far Viewing Device-Level Alarm OverlayMinimized Alarm TabsActive alarms may be minimized when acknowledged by the user. This occurs when the user presses the detailed alarm message tab. In this circumstance, the infuser level alarm button changes to the respective alarm color. To restore an alarm overlay to full size, press the alarm button. Figure 133: Low Battery Alarm buttonAlarm SilencingAudible alarms can be silenced for a two-minute interval. Pressing the SILENCE button silences the alarm and Nurse Call Relay (if enabled) for two minutes without affecting the touchscreen alarm message. Pressing SILENCE during a two-minute silence period resets the alarm silence period Note: All operational alarms may be silenced except the Depleted Battery alarm and the Power Loss alarm.AdvancedTimehh:mm13.1 mL / hr24.6 mLDOPamineProgramBolusICUAAICU13.1 mL / hr96.1 mLDOPaminePiggybackStopProgram ALOW BATTERYLess than 5 minutes of battery liferemaining at current rate. Connectpump to A/C power.Press hereto minimize00:00:00RateVTBImL / hr[400 mg / 250 mL]DOPamine13.1196.DELIVERING PROGRAMDOPamineDose: 5 mcg / kg / minVTBI: 24.6 mLTime: 00:04 hh:mmVolume infused: 0.4 mL[ 400mg / 250 mL]Rate: 13.1 mL / hrmLLOWBATTERYPress here formore information00:00:00Settings Logs Lock08:45 AMModeAlarm
130 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 10: Alarm and System Messages AlarmIf 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 ButtonMultiple AlarmsShould multiple alarms occur, the highest priority alarm features both audible and visual priority. The SYMBIQ™ Infusion System can display up to six active alarms simultaneously by layering the alarm overlays from highest priority (i.e., the top or visible tab) to lowest priority. Pressing the alarm tab of a lower-priority alarm will display the associated alarm overlay.
System Messages Chapter 10: Alarm and System Messages SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 131If more than one alarm occurs, resolving or minimizing the highest-priority alarm overlay displays the next highest alarm overlay. Figure 135: Infuser Screen with Multiple Alarm TabsSystem MessagesSystem messages provide feedback about infuser status when powered on and when input requires confirmation. System messages also provide feedback when programming a therapy. For example, violating either a hospital defined rule set or a field range activates a system message alerting you to the problem. The Invalid Key Press tone sounds whenever a system message activates. Until acknowledged, system messages display while the infuser operates in violation of a defined rule set or field range limit.Types of system messages include:• Information or decision point messages• Outside of Soft Limits• Outside of Hard Limits• Invalid Entry For more information on system messages, causes, and remedies, see “Appendix A: System Messages and Troubleshooting” on page 161.0 mL/hr0mLOptionsClearCancelTitrationAAACassette Improperly installed or missing.Reinstall cassette. Contact Biomed ifproblem persists.Press hereto minimize00:00:00CHECK CASSETTEICUProgramPiggybackRateDoseInfusion5mcg/kg/min13.110307:51VTBITimemL / hrmLhh:mmDOPamineBolusAdvancedNext(Calculated)(Calculated)[400 mg / 250 mL]
132 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 10: Alarm and System Messages System MessagesExceeded 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. Figure 136: Soft Limit Outside of Limits System Message When an attempt is made to enter a program value that exceeds the predefined soft limits, the event is recorded to both the Event Log and the Rule Set Override Log.To address a soft alert:1. To change an exceeded limits medication value, press Edit, change the medication value, and then press Enter.2. If allowed by facility pressing Override will take user to the next programming step.04:34 PMABProgramPiggybackAdvancedInfusion5 mg/kg/hr(Programmed Value)OUTSIDE LIMITS[ 400 mg / 250 mL]DOPamine10 5030 70OverrideEditBolusICUPress Override to bypass Limit. Press Edit to re-enter value.LogsSettings LockModeAlarm
System Messages Chapter 10: Alarm and System Messages SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 133Note: When a program is delivering Outside of Soft Limits, an Exceeded Soft Limit icon appears. Figure 137: Delivering Screen with Exceeded Lower Soft Limit Icon Exceeded Hard LimitsThe Outside of Hard Limits system message activates when a medication value exceeds a hard limit for that medication. A Outside of Hard Limits message screen for a value that exceeds a lower hard limit is shown in Figure 138. Figure 138: Outside of Hard Limits System Message09:21 AMAdvancedProgramBolusSettings Logs LockModeDELIVERING PROGRAMPress Stop to end infusion. Program button to edit program.RateDoseTime:Volume Infused:Ampicillin( 2 grams/ 100 mL)VTBI:100 mL/hr100 mL / hr99:9 mL0.1 mL01.00 hh:mmStopProgram APiggybackICUAlarmAICU
134 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 10: Alarm and System Messages System MessagesWhen 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. Figure 139: Override Code ScreenICU
System Messages Chapter 10: Alarm and System Messages SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 135If no valid override passcode is defined for the current CCA, the Invalid Passcode system message activates. Figure 140: Delivery Screen with Exceeded Upper Hard Limit IconInvalid EntryEntering a value that exceeds infuser system limits, e.g., 1100 mL/hr, activates the Invalid Entry system message (Figure 141).For example, entering a patient weight of 1000 kgs in the Patient Weight field when the acceptable patient weight range is between 1 and 999 kgs activates the Invalid Entry system message. Pressing Clear on the Invalid Entry system message, and then entering a valid value in an active field removes the Invalid Entry system message from the touchscreen. Pressing Cancel on the ICU
136 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 10: Alarm and System Messages System MessagesInvalid Entry system message closes the numeric keypad without saving changes. Invalid Entry are recorded to the Event Log. Figure 141: Invalid Entry System MessageICU
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 137Chapter 11: Stored DataThe SYMBIQ™ Infusion System collects and stores data which is available for on-screen viewing. Types of data stored by the infuser and viewable in Clinical mode are:•Patient Information—Last Name, First Name, ID, Weight, Height, BSA (Body Surface Area), Caregiver ID, and CCA (Clinical Care Area, if defined for a hospital or institution)•Program Totals—medication name and concentration, number of boluses, bolus volume infused, bolus medication amount infused (if applicable), primary volume infused, primary medication amount infused (if applicable), total volume infused, and total medication amount infused•Shift Totals—date and time shift totals were cleared, combined total volume infused for all medications, and medication information for medications infused including:- number of boluses- 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 (if applicable)•Logs—three types of logs are available for viewing:-Event Log—programming data, limit overrides, out-of-limit attempts, changes to settings, warnings, alarms, malfunctions, and power events-Alarm Log—malfunction and operational alarms-Rule Set Alert Override Log—all out-of-limit alerts, and overrides•Current Program—parameters of current or most recent program including medication name and concentration, dose, rate, VTBI, duration of therapy, and alarm settings•Default Drug Library (DDL)—factory-installed drug library with at least 99 medications and the manufacturer’s recommended default units of measure and concentration
138 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 11: Stored Data Patient InformationPatient InformationUse 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. Figure 142: Patient Information ScreenThe Patient Information button at the top of the touchscreen displays on all subsequent programming and delivery screens. This button contains the CCA name, patient name, and patient ID. The Patient Information button only displays patient information if configured to do so in the selected CCA.Clinical Care AreasUsing Hospira MedNet® Service Suite (MMS), your hospital or institution can define up to 40 different CCAs. Each CCA can have up to 400 medications to choose from including “Other Drug.”Note: Selection of a CCA is required. All other fields are optional.When you select a CCA, the infuser uses that CCA’s configuration and medication definition settings for all subsequent therapies until a different CCA is selected. When CCAs have been downloaded to the infuser, you must either confirm the current CCA or select a new one each time the infuser is powered on.Changing CCAsYou can change a CCA any time the infuser is powered on. When you change a CCA, the Change CCA system message activates requiring confirmation. The Change CCA system message only 01:54 PMARefer to Manual during use. Press fields to enter patientinformation if desired. Done to continue.0 mL/hr0mLLast NameFirst NameWeightBSAHeightIDcmPATIENT INFOCaregiver IDCCAICUGREENSMITHPAT2HeightClear Patient Informationand Data18080LogsSettings LockModeAlarm976543DoneCalculate(Calculated)ICU
Patient Information Chapter 11: Stored Data SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 139activates 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. To enter information in the Patient Information screen:1. On the Patient Information screen, press the CCA field to select a CCA: Figure 143: Patient Information Screen• select the desired CCA from the CCA selection listNote: If no CCAs have been downloaded to the infuser, the default CCA selection will be No CCA. If one or more CCAs have been downloaded to the infuser, the default CCA field will be Select CCA.2. The facility may restrict access to a CCA by requiring a passcode. In this case, enter the CCA Access passcode on the Enter Code dialog box, if required. Figure 144: Enter Code Dialog Box for CCA Access
140 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 11: Stored Data Patient InformationNote: 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. The Calculate button is only available if both weight and height values are entered.4. Press the Caregiver ID field. Use the touchscreen keypad to enter an ID up to 15 characters long, and then press Enter.5. On the Patient Information screen, press Done to display the Basic Program screen or press Clear to remove all patient values entered. Figure 145: Patient Information and Basic Programming ScreensNote: Pressing Clear Patient Information and Data button clears current patient information, shift totals, program totals, the current program, and all logs visible in Clinical mode.If no keys are pressed for 30 seconds, the Patient Information screen reverts to the screen from which it was accessed. Any values changed by pressing Enter on the Patient Information screen are retained.Note: Clear Patient Information and Data button only displays if Infuser is not in Delivery Mode and a CCA has been selected.02:27 PMAProgramPiggybackRateDoseDose Calculation00--:--VTBITimemL/hrmLhh:mmNextCancelTitrationPress fields to edit. Clear to delete all entries. Options toedit program settings. Next to contine.Settings Logs LockModeOptionsBolus AdvancedICUInfusionSelect InfusionClearAlarm01:54 PMARefer to Manual during use. Press fields to enter patientinformation if desired. Done to continue.0 mL/hr0mL0 mL/hr0mLLast NameFirst NameWeightBSAHeightIDcmPATIENT INFOCaregiver IDCCAICUGREENSMITHPAT2HeightClear Patient Informationand Data18080LogsSettings LockModeAlarm976543DoneCalculate(Calculated)ICU
To display Program Totals Chapter 11: Stored Data SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 141To display Program TotalsThe 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 infusedAll volume infused totals and medication amount infused totals include volumes delivered during KVO and Auto KVO deliveries. Figure 146: Program Totals ScreenClearing Program TotalsEntering new patient information on the Patient Information screen resets program totals to zero. The following actions also reset program totals to zero:• pressing Clear All on the first programming screen of a therapy• changing a medication on an existing program screenThe cleared Program Totals values are logged to the Event Log.04:34 PMBPress arrows to scroll to other entries. Press Exit to returnto prior screen.ALogs: Program Totals[1 grams / 50mL]Volume 1.1 mLTota InfusedlDrug 0 gramsNumber 0Volume 0 mLVolume 1.1 mLDrug 0 gramsDrug 0 gramsCeftriaxonePrimary InfusedBoluses InfusedICUSettings Logs LockModeExitAlarmPress Exit to return to previous screen.
142 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 11: Stored Data Shift Totals DataWARNING: 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 Screen2. From the Logs menu screen, press Program Totals. See Figure 146.3. On the Logs: Program Totals screen, press the scroll bar on the right of the touchscreen to scroll through the log.4. Press Exit to return to the Logs menu screen.Note: If no keys are pressed for two consecutive minutes, the Logs menu screen reverts to the screen from which the Logs button was selected.Shift Totals DataThe Shift Totals screen shown in Figure 148 displays the following:• Date and time shift totals were cleared• Combined total volume infused during a shift• Medications infused during a shiftAll volume infused totals and medication amount infused totals include volumes delivered during KVO and Auto KVO deliveries.
Shift Totals Data Chapter 11: Stored Data SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 143 Figure 148: Shift Totals ScreenClearing Shift TotalsEntering new patient information on the Patient Information screen clears shift totals and causes the infuser to:• update the shift cleared date and time to the current date and time• log the cleared values to the Event Log• reset values to zeroTo clear the Shift Total Logs:1. Press Logs at the bottom of the touchscreen to display the Logs menu screen.2. From the Logs menu screen, press Shift Totals to display the Logs Shift Totals screen.3. On the Logs Shift Totals screen, press the scroll bar on the right of the touchscreen to scroll through the log.4. Press Clear to display the Clear Totals message box. Press Yes to clear the shift totals or press No to return to the Logs Shift Totals Screen.5. On the Logs Shift Totals screen, press Exit to return to the Logs menu screen.Note: If no keys are pressed for two consecutive minutes, the Logs menu screen reverts to the previous screen.04:34 PMBPress arrows to scroll to other entries. Press Exit to returnto prior screen.Press Clear Shift Totals button to delete all shiftinformation. Exit to return to previous screen.ALogs: Shift TotalsShift Cleared Mar 17, 2006Date & Time 10:33 AMInfuser Shift Totals (All Programs)Volume Infused 1.1 mLICUSettings Logs LockModeExit ClearAlarm!
144 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 11: Stored Data Event LogEvent LogThe 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 ScreenEntering new patient information on the Patient Information screen clears the Event Log viewable in Clinical mode.To view the Event Log:1. Press Logs at the bottom of the touchscreen to display the Logs menu screen.2. From the Logs menu screen, press Logs, and then press Event Log to display the Event Log screen.3. On the Event Log screen, press the vertical scroll bar on the right of the touchscreen to scroll through the log. Note: The most recent event recorded displays as the top entry in the Event Log.4. To scroll to the first record of the log, press Beginning of Log. Press End of Log to scroll to the last record of the log. 5. On the Event Log screen, press Exit to return to the Logs menu screen.Note: If no keys are pressed for two consecutive minutes, the Logs menu screen reverts to the screen from which the Logs button was selected.
Alarm Log Chapter 11: Stored Data SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 145Alarm LogThe 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 ScreenEntering new patient information on the Patient Information screen clears the Alarm Log viewable in Clinical mode.To view the Alarm Log:1. Press Logs at the bottom of the touchscreen to display the Logs menu screen.2. From the Logs menu screen, press Logs, and then press Alarm Log to display the Alarm Log screen.3. On the Alarm Log screen, press the vertical scroll bar on the right of the touchscreen to scroll through the log.Note: The most recent alarm recorded displays as the first entry in the Alarm Log.4. To scroll to the first record of the log, press Beginning of Log. Press End of Log to scroll to the last record of the log. 5. On the Alarm Log screen, press Exit to return to the Logs menu screen.Note: If no keys are pressed for two consecutive minutes, the Logs menu screen reverts to the screen from which the Logs button was selected.
146 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 11: Stored Data Rule Set Alert Override LogRule Set Alert Override LogAttempts 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. Figure 151: Rule Set Alert Override Log ScreenAnytime new patient information is entered on the Patient Information screen, the Rule Set Alert Override Log viewable in Clinical mode is cleared.To view the Rule Set Alert Override Log:1. Press Logs at the bottom of the touchscreen to display the Logs menu screen.2. From the Logs menu screen, press Logs, and then press Rule Set Override Log to display the Rule Set Alert Override Log screen.3. On the Rule Set Alert Override Log screen, press the vertical scroll bar on the right of the touchscreen to scroll through the log.Note: The most recent rule set alert override event recorded displays as the first entry in the Rule Set Alert Override Log.4. To scroll to the first record of the log, press Beginning of Log. Press End of Log to scroll to the last record of the log. 5. On the Rule Set Alert Override Log screen, press Exit to return to the Logs menu screen.Note: If no keys are pressed for two consecutive minutes, the Logs menu screen reverts to the screen from which the Logs button was selected.04:34 PMPress arrows to scroll to other entries. Press Exit to returnto prior screen.Press Beginning of Log and End of Log buttons to jump.Exit to return to previous screen.ARule Set Alert/Overide Log: 1 of 40Drug Library: 123456789123456788911:35:23 PM Dose Upper Hard Limit AlertWithout OverrideChannel A - Variable Time Phase 2Lidocaine[25 mg/100 mL]Limit: 5000 mg/kg/hrAttempted: 6000 mg/kg/hrConfirmed: 4000 mg/kg/hrPatient:ID: 1234567890 Dec 30, 2003Height: 100 cm CCA: Med/SurWeight: 40 kg Infuser: 1234567890BSA: 6. m Caregiver:1234567890LogsICUExit Endof LogBeginningof LogSettings LockModeAlarm333 2
Current Program Chapter 11: Stored Data SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 147Current ProgramSelect 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. On the Logs Current Program screen, press the vertical scroll bar at the top of the touchscreen to scroll through the log.Note: Not all Current Program logs have a vertical scroll bar. Only therapies with either multiple steps or phases will have additional screens to scroll through.4. On the Logs Current Program screen, press Exit to return to the Logs menu screen.Note: If no keys are pressed for two consecutive minutes, the Logs menu screen reverts to the previous screen.Default Drug LibraryThe SYMBIQ™ Infusion System has a factory-installed Default Drug Library (DDL) used to program therapies. The DDL is set up as a single CCA drug library and uses the defined CCA defaults for all medication settings. To help differentiate sound-alike or look-alike medication names, the DDL uses TALL-man lettering (Figure 152). Figure 152: Infusion Field Drop-Down List with DDL Medication NamesThe DDL is active and available for use until a new drug library is downloaded to the infuser using Hospira MedNet® Service Suite (MMS). Once a new drug library is successfully downloaded, it replaces the DDL as the active drug library. Medications in the DDL have neither hard limits nor soft limits. Hard limits and soft limits are specified by each facility using Hospira MedNet® Service Suite (MMS). For a list of medications available in the DDL, see “Appendix E: Default Drug Library (DDL)” on page 187.Fluid OnlyCarboplatinCyclosporineDOBUTamineDocelaxelDOPamineCancelInfusionDoseRateVTBITime
148 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 11: Stored Data Default Drug LibraryHigh-Risk MedicationsYour 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. Figure 153: Far Viewing Delivery Screen with High-Risk Medication InfusingTable 11 describes other touchscreen elements that display high-risk medications highlighted in yellow. Table 11: Touchscreen Elements with High-Risk Medications HighlightedElement Highlighted Touchscreen LocationNear Viewing Delivery screen with high-risk medication infusing Infusion field displaying a high-risk medication ICUICU
Using the Hospira MedNet® Service Suite (MMS) Chapter 11: Stored Data SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 149Using the Hospira MedNet® Service Suite (MMS)The Hospira MedNet® Service Suite (MMS) assists with the reduction of medication errors by associating a hospital's predefined dosing limits, both soft and hard limits with each medication. A value—programmed outside the rule sets determined by a facility—triggers an Outside Limits message along with a visual graph indicting the predefined values for the selected medication. Rule sets are applied to medications found in all Therapy listings; Program, Piggyback, Advance and Bolus. To ensure the predefined dosing limits are meeting clinical requirements, the SYMBIQ™ Infuser records the programmed information in the Event Log and Rule Set Override log. Up to 1000 events are stored allowing for continuous monitoring of dosing parameters, availability of medications, and to service as a clinical education tool.The Soft Outside of Limits message notifies the user when a selected medication value is outside the predefined Soft Limit value. (See Figure 136 on page 132.) The user can reprogram or accept the limit. High-risk medication in Infusion Selection drop-down listConfirmation screen Table 11: Touchscreen Elements with High-Risk Medications HighlightedElement Highlighted Touchscreen Location09:21 AMAPiggybackCONFIRM PROGRAMPress Start to begin infusion. Program button to editprogram.AdvancedStartTitration ABolusICUSettings Logs LockModeProgramAlarmRate:Dose:5mcg/kg/min0 mL/hr0mLVTBI:Time:13.1 mL/ hr103 mL08:00 hh:mmDOPamine[400 mg/ 250 mL]DOPamine
150 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 11: Stored Data Using the Hospira MedNet® Service Suite (MMS)Programming a Soft Outside limits MessageIf 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 programmingIf the clinical decision is to bypass the limit message, press Override and proceed with programming. When finished programming verify the programmed information on the Confirm Program screen and press Start to begin the infusion. The icons will appear in the tab on the top left corner of the screen indicating the value is either lower or higher than the pre-defined rule set. Figure 154: Upper and Lower Soft Limit iconsProgramming a Hard Limit Outside Limits MessageThe Hard Outside Limits message notifies the user when the selected value exceeds the pre-defined value. An alarm will sound and a pop-up Outside Message appears. A facility hard limit cannot be overridden.Press Edit to return to programming screen and re-enter programmed value and proceed with programming.Note: Based on a facilities policy selected CCA's may be able to override a hard limit if a valid pass code is entered.
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 151Chapter 12: Cleaning, Maintenance, and StorageThis chapter describes how to clean, store, and service the SYMBIQ™ Infusion System. This chapter also describes battery maintenance and battery disposal.Cleaning the InfuserTo ensure the SYMBIQ™ Infusion System functions properly, practice the cleaning guidelines in this chapter. Establish a routine weekly schedule for cleaning the infuser. Before cleaning the infuser you should:• Power down the infuser using the ON/OFF button• Disconnect the infuser from AC (mains) powerThe exposed surfaces of the SYMBIQ™ Infusion System may be cleaned with a lint-free cloth moistened with one of the cleaning solutions recommended in Table 12 or with mild, nonabrasive soapy water. Use a small, non-abrasive brush to aid in cleaning the cassette carriage. Table 12: Cleaning Solutions for use on the SYMBIQ™ Infusion SystemCleaning Solution Manufacturer PreparationCoverageTM HBV Steris Corporation, a division of Calgon Vestal LaboratoriesPer manufacturer's recommendationDispatch®Caltech Industries Per manufacturer's recommendationPrecise®Caltech Industries Per manufacturer's recommendationHousehold liquid bleach (5.25 sodium hypochlorite)Various manufacturers Use per hospital procedures; do not exceed one part bleach to ten parts waterManu-Klenz®Calgon Vestal Laboratories Per manufacturer's recommendationSani-Wipes PDI, the healthcare division of Nice-Pak Per manufacturer’s recommendations
152 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 12: Cleaning, Maintenance, and Storage Battery MaintenanceCleaning CautionsAvoid 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.USE ONLY the recommended cleaning solutions and follow the manufacturer’s recommendations. Using cleaning solutions not recommended by Hospira may result in product damage. The disinfecting properties of cleaning solutions vary; consult the manufacturer for specific information.DO NOT use compounds containing combinations of isopropyl alcohol and dimethyl benzyl ammonium chloride.NEVER use sharp objects such as fingernails, paper clips, or needles to clean any part of the infuser.DO NOT sterilize by heat, steam, ethylene oxide (ETO), or radiation.Battery MaintenanceCAUTION: Before connecting a patient to the infuser, ensure the infuser has a fully charged battery installed for continuous infuser operation.The SYMBIQ™ Infusion System is designed to use battery power for emergency backup and temporary portable operation. A one-channel infuser with a fully charged battery provides at least four hours of operation at 100 ml/hr with the LCD backlighting set to Power Saving mode. The battery recharges whenever the infuser is connected to AC (mains) power. With the infuser powered off and connected to an AC power source, the battery takes four hours to recharge. Bat-tery recharge takes longer if the infuser is powered on. In general, the more often the battery is partially discharged and then recharged, the sooner it will need to be replaced. Consult a qualified biomedical technician for battery replacement if necessary.Note: Disconnect AC power line prior to opening unit or changing battery.To maintain maximum battery charge and to prolong battery life, connect the infuser to AC (mains) power whenever possible. Battery DisposalDo not discard the infuser’s used lithium ion battery pack with regular trash. Instead, dispose of it in an environmentally sound and approved manner. Contact your local waste management
Storage Chapter 12: Cleaning, Maintenance, and Storage SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 153company for information on environmentally sound ways of collecting, disposing, and recycling used batteries.StorageTo prolong the life of the SYMBIQ™ Infusion System, take the following storage precautions:• Store away from excessive heat (more than 60º C), cold (less than -20º C), and humidity (outside 10% to 90% range)• Store connected to AC (mains) power Infuser Maintenance and ServiceAll maintenance, service, or adjustments to the SYMBIQ™ Infusion System should be referred to qualified technical personnel. A technical service manual may be ordered from your local Hospira sales representative.Product Handling and DisposalDo not discard the infuser’s administration set with regular trash. Instead, follow hospital procedures for disposing and handling of infuser’s administration set.Please comply with local disposal and recycling regulations as appropriate for disposable batteries, rechargeable battery packs, medical electronic components and infusion sets.
154 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 12: Cleaning, Maintenance, and Storage Product Handling and DisposalNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 155Chapter 13: Product SpecificationsPhysical SpecificationsOne-channel infuser dimensions: Width: 9.9 inchesHeight: 10.2 inchesDepth: 8.6 inchesDepth with Pole Clamp: 13.0 inchesWeight: 10.7 poundsCasing: High-impact plasticElectrical SpecificationsPower frequency: Between 47 Hz and 63 HzFuses: T1.6A/250VACAC power rating: 100-240 VAC, 100 VA MAX,Power cord: Hospital-grade AC cord approximately 10 feet in length with a hospital-grade plug at one endRear infuser AC power outlet: Located on the back of the infuser; accommodates one additional SYMBIQ™ Infusion System onlyElectrical safety: The SYMBIQ™ Infuser has been assessed and complies with the following standards: • UL 60601-1• CSA C22.2 No.601.1• IEC/EN 60601-1-2 (2001)• IEC/EN 60601-2-24 (1998)Battery SpecificationsBattery: Rechargeable lithium ion 10.8 voltsBattery life for a one-channel infuser: With a fully charged battery, a one-channel infuser will operate for at least 4 hours at 100 mL/hour with the LCD backlight set to Power Saving modeBattery gauge: Located on the infuser screen, the gauge indicates the amount of battery life remainingBattery recharge: Recharging a depleted battery requires 4 hours or less when infuser is offBattery automatically recharges while infuser operates on AC powerExternal InterfacesExternal communication ports: 1 Ethernet port1 Nurse callback portNurse callback jack: Standard 1/4 inch phone jackNurse call relay: Industry standard type 1 Form C Reed relay
156 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 13: Product SpecificationsWireless ConnectivityTransceiver band: 2.4GHz ISM bandWireless certification: FCC Part 15 Class B compliantCommunications standard: IEEE 802.11bInput Device/KeypadOff-screen: Off-screen buttons including LOAD/EJECT, On/Off, SILENCE, Emergency StopTouchscreen keypad: Thin film transistor (TFT) touchscreen keysLCD DisplayDisplay size: 8.4 inch diagonal color displayViewable angles: Minimum side angle: 45º ± 5ºVertical angle: 60º ± 5ºDisplay adjustments: User-adjustable brightness control and Power Saving modeComputer-controlled backlight brightness levelLED DisplayExternal power LED: Indicates when infuser is on AC power and when charging the batteryInfuser AlarmsChannel LED: LED color indicates infuser alarm states:Solid red—Malfunction alarmFlashing red—High urgencyFlashing yellow—Medium urgencySolid yellow—Low urgencySolid red—Latched alarmInfuser AlarmsAlarm tones: Initial alarm tone (except Latched alarm) sounds at a user-defined level. Alarm tone reverts to maximum level if no user action is taken within time configured for the CCA.Audible TonesAudible tone range is minimum of 45 dB(A) to a maximum of 65 dB(A) or moreSafety FeaturesPower-on diagnostics: Checks all critical infuser components and data at power-on; any component failure is reported and logged as a Malfunction alarmBackground diagnostics: Checks and monitors all critical infuser components and data while powered-on; any component failure is reported and logged as a Malfunction alarm. Component failure during an infusion stops delivery on the appropriate channel.Memory ProtectionNon-volatile memory: Stores data and logs for at least one year after power is removed from the infuser
Chapter 13: Product Specifications SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 157Date and Time SettingsTime of day clock: Displays time of day in either 12-hour or 24-hour formatsTemperature ParametersAmbient Operating temperature range: 5°C to 40°CStorage temperature range: 20°C to 60°CRelative humidity: Operational range of 10% to 90% non-condensingBarometric pressure range: Operational range from 0 to 10,000 feetSurface temperature: Maximum of 50° COcclusion SettingsDistal occlusion: User specified range in either psi (from 1 to 15 in increments of 0.5) or mmHg (from 50 to 775 in increments of 25)Proximal occlusion: -5 psi/250 mmHgAir sensitivity settings: User-specified bubble size threshold levels:•50 mcL•100 mcL•150 mcL•250 mcL•500 mcLSingle bubble automatic threshold of 250 mcL. Cumulative bubble automatic threshold setting of < 1mL/15 minutes.Delivery RateDelivery range: Between 1.1 to 1000 mL/hrKVO SpecificationKVO rate: Between 0.1 and 20 mL/hr programmed in 0.1 mL increments; default is 1.0 mL/hrHemolysisBlood and blood products: During the pumping of red blood cells, the increase in 5 hemolysis shall be less than 1%.
158 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 13: Product Specifications Flow Rate AccuracyFlow Rate AccuracyFlow rate accuracy represents the infuser’s fluid delivery performance under these conditions:The flow rate accuracy of the SYMBIQ™ Infusion System is + 5% for all rates greater than 1.0 mL/hr with 95% confidence. For rates less than or equal to 1.0 mL/hr, the flow rate accuracy is + 10% with 95% confidence.WARNING: Rate accuracy can be affected by variations of fluid viscosity, fluid temperature, head height, back pressure or any combination of these. Additional factors that can have an influence are administration set configuration and use duration.Flow ContinuityAt low flow rates (between 0.1 and 1.0 mL/hr) with microbore tubing, the no-flow period does not exceed 20 seconds and the bolus volume released does not exceed 2 microliters.Trumpet CurvesTrumpet curve graphs show representative maximum and minimum percent flow rate deviation from the programmed rate over time. This information was developed in accordance with IEC 60601-2-24: 1998, Sub-Clause 50.102. Refer to this standard for detailed information.Trumpet curve graphs plot flow rates at 30 second intervals for the first 2 hours and for the 96th hour of delivery. The graphs plot the mean delivery rate error (average of 3 infusers) for the 2nd hour and the 96th hour as a straight line. The graph also presents maximum and minimum average delivery rate errors for this interval by plotting average delivery errors over intervals of 2, 5, 11, 19, and 31 minutes. Table 13: Standard Environmental Conditions and SpecificationsCondition SpecificationAmbient and fluid temperature: 22° C + 5° CBack pressure: + or -1 psigFilling head height: 18 inches of water (+ 4 inches)IV fluid: Sterile water or D25W.Delivery rate range: 0.1 to 1000 mL/hrAdministration set condition: No air trapped in tubing
Trumpet Curves Chapter 13: Product Specifications SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 159Sample Trumpet CurveOn 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. The average delivery rate error over the entire 2nd hour was +1.6% (D).For other time intervals, look at other points at the horizontal axis to determine the corresponding limits. Figure 155: Sample Trumpet CurveA trained professional can use the resulting graphs to select an infuser with the appropriate startup and flow characteristics to suit the clinical application.To illustrate how trumpet curves are used, consider the maximum and minimum deviations at the 5 minute average interval. The upper curve provides the maximum expected delivery rate error over a 5 minute interval, the lower curve provides the minimum expected delivery rate error over a 5 minute interval. Take for example Dopamine administered at 5 mcg/kg/ min. At 5 minutes, the average medication delivery error would be within the range of +2.8% and -0.5% of the expected nominal rate.
160 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Chapter 13: Product Specifications Trumpet CurvesNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 161Appendix A: System Messages and TroubleshootingAppendix 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 RemedyBattery Depleted No Power if A/C Fails.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.Bolus In Progress (Bolus) Piggyback In Progress (Piggyback) Delivery will start when Bolus delivery is complete. (Bolus) Delivery will start when Piggyback delivery is complete. (Piggyback) Delivery Will Start When Bolus/Piggyback CompletesPressing Start for a Basic or Advanced therapy while a bolus or piggyback delivery is in progress for that channel. If bolus, setting to resume primary when complete.Press OK to acknowledge.Bolus In ProgressPrimary infusion can be started by clinician when bolus completes.Delivery Can Be Started When Bolus CompletesPressing Start on the primary confirmation screen or Stop Mode screen while a bolus is infusing that is set to stop when infusion complete.Press OK to acknowledge.BSA Out of RangeCalculated BSA is Out of Range. BSA value has been cleared.BSA Calculated Value Out of Range (invalid value based on updated Height, Weight or pressing Calculate button)The user changes the Height or Weight value on the Patient Information screen after the BSA value has been calculated and the new calculated BSA value is an invalid value.ORThe user changes the Height or Weight value on the Dose Calculation or Bolus Amount widget after the BSA value has been calculated, and the Dosing Units include m2 and the new calculated BSA value is an invalid value.ORThe user presses the Calculate button on the Patient Information Screen or Dose Calculation Widget, and the calculated BSA value is an invalid valuePress to acknowledge. Check height and weight entriesCalculated Rate Out of RangeThe calculated rate is outside the accepted range. Verify program parameters.Calculated Rate Out of RangeThe user enters a parameter on the Dose Calc Complex Pop-up that results in a calculated rate outside of the acceptable range.Press OK to acknowledge.
162 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix A: System Messages and TroubleshootingCalculated VTBI Out of RangeThe calculated VTBI is outside the accepted range. Verify program parameters.Calculated VTBI Out of RangeThe 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.Cancel Delayed Start?Programming Standby will cancel the Delayed Start.Standby when Delayed Start is SelectedSelecting Standby when Delayed Start is already programmed.Press Continue to cancel the Delayed Start and program Standby.Press Cancel to maintain current Delayed Start setting.Cancel Standby?Programming a Delayed Start will cancel Standby.Delayed Start when Standby is SelectedSelecting Delayed Start option when Standby already programmed.Press Continue to cancel Standby and program a delayed start.Press Cancel to maintain current Standby setting.Cassette Eject Not Allowed(Clinical Mode): Channel delivery or power priming must be stopped or Delayed Start must be canceled before cassette can be ejected. (Biomed and Service Mode): Procedure must complete before cassette can be ejected.Cassette Eject Not AllowedPressing LOAD/EJECT when the associated channel is delivering an infusion in Clinical Mode.ORPressing LOAD/EJECT while the associated channel is running an infusion test or a calibration in Biomed or Service Mode.ORPressing Load/Eject button while the associated channel is power priming (mechanism is moving).ORPressing Load/Eject button while the associated channel is in Delayed Start.(Clinical Mode - Delivery Mode) Press Stop to stop delivery. Load/Eject to eject the cassette after delivery is stopped.(Clinical Mode - Power Priming) Press Cancel to stop power priming. Load/Eject to eject the cassette after power priming is stopped."(Clinical Mode - Delayed Start) Cancel CASSETTE REQUIREDA cassette must be loaded to program this channel. Load cassette and press OK to continue.Casette RequiredProgramming screen is displaying, the ability to program without a cassette is configured off, the cassette for the associated channel is missing or improperly installed, and the user touches a program parameter field.Press Load/Eject button and insert cassette.CASSETTE REQUIREDA cassette must be loaded to start this channel. Load or check cassette and press OK to continue.Verify CassetteThe confirmation screen is displaying, the ability to program without a cassette is configured on or off, the cassette for the associated channel is missing or improperly installed, and the user presses the Start button.Press Load/Eject button and insert cassette.Change Air Sensitivity Setting?Change Channel <channel id> Air Sensitivity setting from <old value> to <new value>?Change Air Sensitivity Setting Selecting an Air-In-Line Sensitivity setting that differs from the current setting and then exiting the screen for that setting.Press Yes to continue with new setting.Press No to continue with previous setting.On-Screen Text System Message Message Cause Steps to Remedy
Appendix A: System Messages and Troubleshooting SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 163Change CCA?Change CCA from <old CCA name> to <new CCA name>? Changing the CCA will clear any partially programmed channels.Change CCA Changing the current CCA by selecting a CCA from the CCA Selection drop-down list.Note: Once a CCA has been selected (i.e., the CCA field is displaying a CCA name, not "Select CCA"), this message will display each time a CCA is selected from the drop-down list.Press Yes to change CCA.Press No to retain current CCA.Change Distal Occlusion Setting?Change Channel Distal Occlusion setting from <old value> to <new value>?Change Distal Occlusion Setting Selecting a Distal Occlusion setting that differs from the current setting and then exiting the screen for that setting.Press Yes to continue with new setting.Press No to continue with previous setting.Change Proximal Occlusion Setting?Change Channel <channel id> Proximal Occlusion setting from <old value> to <new value>?Change Proximal Occlusion SettingSelecting a Proximal Occlusion setting that differs from the current setting and then exiting the screen for that setting.Press Yes to continue with new setting.Press No to continue with previous setting.Check BSAChange to height/weight may affect BSA. Check BSA value.Check BSA Entered ValueChanging height or weight values after the BSA value has been entered.Press OK to acknowledge.Check BSABSA will be recalculated using the BSA formula. New BSA is <calculated BSA value>. BSA Calculated Value Affected (Valid value)Changing height or weight values after the BSA value has been calculated and the new calculated BSA is a valid value.Press OK to acknowledge.Cleaning Lock Active.(if no cassette doors are open): Press Cleaning Lock button on the back of the Infuser to unlock.(if one or more cassette doors are open): Ensure tubing is disconnected from patient before proceeding. Press Cleaning Lock button on the back of the Infuser to unlock. Cleaning Lock ActiveActivating the Cleaning Lock. Cleaning Lock will automatically deactivate <user defined time (e.g., 3 minutes)> from activation.Clear All Settings and Data?Clearing the current patient information will also clear the CCA, caregiver ID, shift totals, program totals, medication amount totals, current program and logs.Clear All Settings and DataPressing Clear Patient Information and Data button on the Patient Information screen.Press Cancel to exit without clearing.Press Confirm to clear all settings and data.Clear Program?Continuing will result in loss of current program information.Clear ProgramPressing Clear All on the first programming screen of an advanced therapy or Clear on the Basic Program programming screen.Press Continue to clear all programmed values and proceed. Press Cancel to return to current program.On-Screen Text System Message Message Cause Steps to Remedy
164 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix A: System Messages and TroubleshootingDelete Information?Delete <information to be deleted>Information to be deleted text:Shift Totals Screen: Shift TotalsService Logs Menu Screen: contents of all logsDelete InformationPressing Clear Shift Totals on the Shift Totals Screen in Clinical ModeORPressing Clear All on the Service: Logs Menu Screen in Service ModePress Yes to delete information.Press No to cancel.Disconnect TubingEnsure tubing is disconnected from patient before proceeding.Ensure Tubing is Disconnected from PatientPressing Power Prime on the Program Options screen.Press OK to acknowledge.Door open. Unable to power down.One or more cassette doors are open. Close door(s) and press the On/Off button again.Unable to Power Down With Door OpenPressing Power hard key when at least one cassette carriage is not closed (cassette present) or not in storage (cassette not present).Press OK to acknowledge. Press Force Shutdown to powerdown with the door open.Medication Duplication<Medication Name> is already in use. Medication Name DuplicationSelecting the same medication (excluding “Other Drug”) for more than one program.Note: this applies to a bolus from secondary or piggyback dose. Bolus from primary, by default, uses the same medication.Press Continue to complete program with duplicate Medication Name.Press Cancel to Clear Duplicate Medication.Exceeds VTBIBolus volume exceeds Volume Remaining in primary delivery.Exceeds VTBIPressing Start Bolus after programming a bolus from the primary container on a channel with an underlying primary delivery already confirmed and the bolus VTBI exceeds the primary delivery VTBI.ORPressing Enter on any screen on the Bolus Primary Container Programming screen that causes the Bolus VTBI to be greater than the remaining primary VTBI on a channel with an underlying primary delivery already confirmed.Note: Values on the programming screen will not change - user will have to modify the parameter they want to correct the situation before proceeding.Enter valid value or clear Bolus program and increase primary VTBI.Infuser is initializingStart may be pressed when initialization is complete.Infuser InitializingPressing the Start button while the Infuser is initializing.Press OK to acknowledge.Invalid TitrationOne or more limit has been exceeded.Invalid TitrationPressing Start Titration for an infusion in progress and one or more limits (system or Hard/Soft) are exceeded.Press OK to return to programming screen and resolve before continuing.On-Screen Text System Message Message Cause Steps to Remedy
Appendix A: System Messages and Troubleshooting SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 165MalfunctionA malfunction occurred that might not have displayed. See the logs for additional information. All patient and therapy information has been cleared. Contact Biomed.Malfunction OccurredThe Infuser is powered on after a malfunction occurred during the last power up which may not display.Press OK to acknowledge.Multiple CCAs Multiple CCAsProgramming one or more channels under the current CCA and pressing Yes on the Change CCA system message when no CCA passcode is requiredORProgramming one or more channels under the current CCA and pressing Enter on the CCA Access Passcode Pop-up after entering a valid CCA access codeTherapies in progress will continue operating under the prior CCA rule sets. New therapies will operate under the new CCA rule sets. Press OK to acknowledge.Multiple CCAs Channel <channel ID> is operating under <Old CCA> rule set until program in progress is complete.Old CCA Reminder Pressing any Program level button to change the current program on a channel while that channel is operating under an old CCA after a CCA change.Note: If the Advanced button is pressed and the Advanced therapy screen appears the Old CCA Reminder system message will not appear until the Advanced therapy is selected.Press OK to acknowledge.No Backup BatteryIn the event of A/C power loss, infusion will stop.No Battery Backup (detected at Power On)No battery is detected when the Infuser is powered on.Press OK to acknowledge.No Dose/Amount or Rate LimitsThere are no rule sets applied to the Dose, Bolus Amount or Rate values.No Dose/Amount or Rate Limits - InformationalA 3-D tab has been pressed and a No Dose/Amount or Rate Limits condition exists.Press OK to acknowledge.No Primary ProgramDo you want to infuse this piggyback as a primary IV?No Primary ProgramA piggyback auto-program is scanned for a channel that does not have a confirmed primary program. Note: System Message will display over screen displaying when auto-program was initiated.Press Yes to accept program and deliver as a primary infusion.Press No to reject the auto-program. Enter a primary infusion. Rescan piggyback after primary is programmedOn-Screen Text System Message Message Cause Steps to Remedy
166 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix A: System Messages and TroubleshootingOperation Test DueReturn Infuser to Biomed for Operation Test as soon as possible.Operation Test DueThe 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.Note: Activation of the Operation Test Due System Message will be based on the current Date of the Infuser.Note: Once the “Reminder Test is Due” setting has been reached, this system message will display each time the Infuser is powered down until the Operation Test is completely run.Press OK to acknowledge.Outside Limits(Information will vary.)Outside of Hard LimitsPressing Enter on a Numeric Entry Keypad causes an entered or calculated value on the current programming screen to be outside of a user-specified hard limit and at least one override passcode has been defined for the current CCA.Note: For Lower VTBI limit checking, the Infuser must add the current Volume Infused value with the newly entered/calculated VTBI value and compare that total against the Lower VTBI limit to determine whether or not the lower limit has been violated.Press Override to bypass Limit. Press Edit to re-enter value.Outside Limits(Information will vary.)Outside of Soft LimitsPressing Enter on a Numeric Entry Keypad causes an entered or calculated value on the current programming screen to be outside of a user-specified soft limit, but that value does not violate a hard limit.Note: For Lower VTBI limit checking, the Infuser must add the current Volume Infused value with the newly entered/calculated VTBI value and compare that total against the Lower VTBI limit to determine whether or not the lower limit has been violated.Press Override to bypass Limit. Press Edit to re-enter value.Outside Limits(Information will vary.)Note: If the value that exceeds the hard limit is a calculated value, the Hard Limit Outside of Limits System Message shall be displayed with "(Calculated Value)" instead of "(Programmed Value)".Outside of Hard Limits - InformationalPressing a 3-D touchscreen tab when an Outside of Hard Limits condition exists.ORExceeding a hard limit but no hard limit override passcodes are defined.Press OK to acknowledge.On-Screen Text System Message Message Cause Steps to Remedy
Appendix A: System Messages and Troubleshooting SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 167Outside Limits(Information will vary.)Note: If value that exceeds soft limit is a calculated value, Soft Limit Outside of Limits System Message shall be displayed with <Calculated Value> instead of <Programmed Value>.Outside of Soft Limits - InformationalPressing a 3-D touchscreen tab when an Outside of Soft Limits condition exists.Press OK to acknowledge.Outside of LimitsEnter Bypass Code.Hard Limit OverridePressing Override on the Outside of Hard Limits system message.Enter override code by pressing number buttons and then press Enter. Cancel to exit.Patient Parameter ChangeA Program BSA, Height, and/or Weight differs from its corresponding Master value and there is no impact on a currently programmed rate value due to the change: One or more patient program values (BSA, Height, Weight) differ from Master value(s).A Program BSA, Height, and/or Weight change impacts a currently programmed rate (regardless of relation to corresponding Master value): One or more patient program values (BSA, Height, Weight) have been changed from their previous value(s). Rate and Time parameters have been recalculated.Patient Parameter ChangeChanging the program-specific height, weight, and/or BSA values on the Dose Calculation Complex screen so one or more differs from the associated Master value(s), and then attempting to leave the Dose Calculation Complex screen.ORChanging the program-specific height, weight, and/or BSA values on the Dose Calculation Complex screen so that a previously programmed rate value is affected and then attempting to leave the Dose Calculation Complex screen.ORProgramming one or more channels using program-specific height, weight, and/or BSA values, changing the associated Master value(s), and then attempting to leave the Patient Information screen.Press Continue to change value(s). Press Cancel to keep previous value(s).Power Off Unavailable(Clinical Mode): Infuser cannot be powered down while one or more channels are in Delivery Mode. Stop Delivery on all channels to power down.(Biomed and Service Mode): Procedure must complete before infuser can be powered off.(During Drug Library Transfer from CE to the Infuser): Infuser cannot be powered down while a drug library transfer is in progress. Infuser will power down automatically upon completion.Power Off UnavailableAttempting to turn the Infuser off while in one or more channels are in Delivery mode in Clinical Mode.ORAttempting to turn the Infuser off while it is running an infusion test or a calibration.ORCycling power during a drug library transfer from CE to Infuser.Press OK to acknowledge.(Biomed and Service Mode) NoneOn-Screen Text System Message Message Cause Steps to Remedy
168 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix A: System Messages and TroubleshootingProgram Data Will Be DeletedProgram Data in eliminated steps will be lost.Program Data Will Be DeletedReducing 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.Press Cancel to undo change.Program is Being ClearedPrograms on Channel will now operate within the <New CCA> rule set.Program is Being Cleared Accessing a Programming Mode in the Stop Mode screen after the End of Infusion Alarm has occurred (whether or not the alarm overlay was touched) and the program is operating under the old CCA after a CCA changeORAccessing a Programming Mode for the first time, for a program:• after a power cycle less than 5 hours • occurring after End of Infusion alarm (whether or not the alarm overlay was touched) • not cleared at power on, and• operating under old CCA after a CCA changeORA pending CCA is invoked for a channel.Press OK to acknowledge.Recondition BatteryBattery needs servicing. Contact Biomed.Recondition BatteryInfuser battery needs reconditioning (Conditioning Cycle Request detected at power on).Press OK to acknowledge.Resume Primary Selected.Any remaining volume in secondary container will deliver at primary rate.Resume Primary after SecondaryProgramming a bolus from secondary and setting When Bolus Completes to Resume Primary.Press OK to acknowledge.Secondary on <channel ID>Hang Secondary container higher than Primary container. Open Secondary slide clamp.Note: This pop-up displays over the Confirmation Screen.Secondary ConfirmationPressing Next on the Piggyback or Bolus Programming Screen to access the Confirmation Screen.Press OK to acknowledge.Transfer Drug Library?A new drug library is ready to be transferred to the Infuser. Transfer may take up to 5 minutes.Transfer Drug Library?Pressing On/Off when the Infuser is in Clinical mode and a library is ready to be transferred from the CE to the Infuser.Press Yes to begin Drug Library transfer. Press No to power off without transferring the Drug Library.Use Same Program for Channel?Press Yes to use the same program values that were used for the first delivery in this sequence.Use First Program ParametersPressing Next on the second program screen of a 3-part Interchannel Sequence where the third delivery is on the same channel as the first delivery. Press Yes to automatically enter values used in first program screen. Press No to enter new values.On-Screen Text System Message Message Cause Steps to Remedy
Appendix A: System Messages and Troubleshooting SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 169Values out of RangePatient <Parameter(s) separated by commas (Order: Weight, Height, BSA)> out of allowed range in the new CCA and have been clearedHeight/Weight/BSA Out of RangeInvoking a CCA that results in the current Master patient Weight, Height and/or BSA being out of range.Press OK to acknowledge.Values out of RangeThe changed value has caused one or more values to go out of range. If you continue, all steps will be cleared.Multistep Values Out of RangeIn a Multistep program, pressing the Enter button on a Height, Weight or BSA field numeric entry widget or pressing the Calculate button on the Dose Calculation Complex screen and the resulting value causes at least one value in steps 1 or above to go out of range.Press Continue to accept new value and clear all steps. Press Cancel to continue with current program.On-Screen Text System Message Message Cause Steps to Remedy
170 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix A: System Messages and TroubleshootingNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 171Appendix B: Alarm Messages and TroubleshootingAppendix 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 Message Alarm Cause Steps to Remedy Alarm UrgencyACCUMULATED AIR-IN-LINEANALYSIS: Infusion stopped. REMEDY: Remove air from line. Restart infusion. Check air sensitivity setting if alarm persists. ACTION: Press here to minimize all alarms.Air-in-Line An amount of air, greater than or equal to the current air sensitivity setting, is detected in the line distal to the cassette while the device is infusing.ORAn amount of accumulated air over 15 minutes exceeds the 15 minute threshold.Note: If both thresholds are violated at the same time, the single-bubble messages will display.Restart the infusion to clear the alarm. Clear the current program to clear the alarm.Press the alarm window to minimize the alarm.Press the 1 mL, 3 mL, or 5 mL button on the Power Prime Screen to clear the alarm.High AIR-IN-LINEANALYSIS: Infusion stopped. REMEDY: Remove air from line. Restart infusion. Check air sensitivity setting if alarm persists. ACTION: Press here to minimize all alarms.Air-in-Line An amount of air, greater than or equal to the current air sensitivity setting, is detected in the line distal to the cassette while the device is infusing.ORAn amount of accumulated air over 15 minutes exceeds the 15 minute threshold.Note: If both thresholds are violated at the same time, the single-bubble messages will display.Restart the infusion to clear the alarm. Clear the current program to clear the alarm.Press the alarm window to minimize the alarm.Press the 1 mL, 3 mL, or 5 mL button on the Power Prime Screen to clear the alarm.High BOLUS COMPLETE (Bolus)PIGGYBACK COMPLETE (Piggyback)ANALYSIS: Unable to resume primary infusion.REMEDY: Enter or Start delivery.ACTION: Press here to clear alarm.Infusion Complete (No Primary)A Bolus is set to Resume Primary or a Piggyback is programmed and there is no primary programmed when the Piggyback or Bolus completes.Press alarm window to clear the alarm.Clear associated program to clear the alarm.Confirm a new piggyback dose to clear a Piggyback Infusion Complete (No Primary) alarm.Confirm a new bolus dose to clear a Bolus Infusion Complete (No Primary) alarm.Medium
172 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix B: Alarm Messages and TroubleshootingBOLUS COMPLETE (Bolus)PIGGYBACK COMPLETE (Piggyback)STEP <n> COMPLETE (Multistep)ANALYSIS: Stop Infusion or Callback requested by caregiver.REMEDY: NoneACTION: Press here to clear alarm.Infusion CompleteSetting the Infusion Complete Callback Option for Piggyback, Bolus or Multistep, and the Piggyback, Bolus or any Multistep step 1 through n-1, respectively, completes.ORCallback Option is set to Yes because Stop Infusion during Bolus programming was selected.Press alarm window to clear the alarm.Clear associated program to clear the alarm.Confirm a new piggyback dose to clear a Piggyback Infusion Complete alarm.Confirm a new bolus dose to clear a Bolus Infusion Complete alarm.Activate Multistep Step n Infusion Complete alarm to clear a Multistep n-1 Infusion Complete alarm.MediumCALLBACKANALYSIS: Waiting for user input.REMEDY: NoneACTION: Press here to clear alarm.Callback The Infuser has been waiting for a user keypress on a pop-up for more than the time configured for the current CCA, or the DDL, if being used.ORThe Infuser has been waiting for a user keypress on the Patient Information screen with no CCA selected for 2 minutes ± 2 seconds.OROne or more channels are Active and waiting for input.OROne or more channels are Idle and waiting for input.ORAll channels on a device are idle.Press alarm window to clear alarm for that channel.Note: Any key press in an active area of the touchscreen will reset the Callback Alarm timers (channel and device).MediumCHECK CASSETTEANALYSIS: Alarm occurred in Delivery Mode—Infusion stopped.Alarm occurred outside of Delivery Mode —Cassette improperly installed or missing. REMEDY: Reinstall cassette. Contact Biomed if problem persists.ACTION: Press here to minimize all alarmsCheck CassetteAttempt to access the channel’s Delivery mode and determine the channel’s cassette is improperly installed or missing.ORAttempt to load cassette and the linear pixel array indicates there is a problem.ORFind that the sensors indicate the cassette is improperly loaded while the infuser is in Delivery mode.ORManually eject the cassette.Properly install the cassette to clear the alarm. Close the cassette door with no cassette present to clear the alarm.Press the alarm window to minimize the alarm.Infuser in Delivery mode: HighInfuser not in Delivery mode: MediumOn-Screen Text Alarm Message Alarm Cause Steps to Remedy Alarm Urgency
Appendix B: Alarm Messages and Troubleshooting SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 173CHECK FLOWSTOPANALYSIS: Cassette flowstop may not be closed.REMEDY: Close clamp, open door, and ensure flowstop is closed. Replace set if problem persists.ACTION: Press here to minimize all alarms.Check FlowstopCassette problem bit is set (door is closed with high pressure indicating possible debris present)Open the door to clear the alarm.Press the alarm window to minimize the alarm.HighDISTAL OCCLUSIONANALYSIS: Active Alarm—Delivery stopped.Latched Alarm—Delivery was interrupted during distal occlusion.REMEDY: Active Alarm—Clear occlusion below pump. Restart delivery. If not priming, check occlusion sensitivity setting if alarm persists. Latched Alarm—NoneACTION: Active Alarm—Press here to minimize all alarms.Latched Alarm —Press here to clear alarm.Distal OcclusionThe distal pressure is greater than the selected pressure level and the channel is in Delivery mode.ORThe distal pressure is greater than 10 psi and the Infuser is power priming. If distal pressure becomes less than 50% of the selected pressure level for three seconds within 60 seconds of detection, alarm auto-clears and becomes latched, Distal Alarm Auto-Clears counter increments by 1, and delivery resumes—if the channel has not exceeded the allowed number of auto clears.Stop Mode—Pressing Start clears the alarm.Note: If Occlusion still exists, a new instance of the alarm will activate.Priming—Press Cancel, 1 mL, 3 mL or 5 mL button on Power Prime screen to clear the alarm.Press the active alarm window to minimize the alarm.Press the latched alarm window to clear the alarm.Change the Distal Occlusion threshold setting to a new threshold greater than the current measured pressure to clear the alarm.High EMERGENCY STOPANALYSIS: Emergency Stop button pressed. Infusion(s) stopped.REMEDY: NoneACTION: Press here to clear alarm.Emergency Stop Emergency Stop off-screen button has been activated during infusion. Press alarm window to clear alarm.HighOn-Screen Text Alarm Message Alarm Cause Steps to Remedy Alarm Urgency
174 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix B: Alarm Messages and TroubleshootingEND OF INFUSION (KVO) (KVO is delivering)END OF INFUSION (KVO is not delivering)ANALYSIS:KVO is delivering—Infusion Complete. KVO in progress. KVO is not delivering—Infusion Complete. No KVO.REMEDY: Clear or edit current program.ACTION: Press here to clear alarm.End of InfusionBasic Program - Programmed VTBI delivery completes.ORMultistep/Intermittent—Last Step/Dose delivery completes.Press alarm window to clear alarm.MediumINTERMITTENT CALLBACKANALYSIS: Selected callback time has been reached.REMEDY: NoneACTION: Press here to clear alarm.Intermittent CallbackThe selected callback time before an Intermittent Dose is less than or equal to the programmed Time Between Start of Deliveries and the callback time is reached for any dose (regardless of whether the Infuser is in Programming Mode, Delivery Mode or Stop Mode).ORThe selected callback time before an Intermittent Dose is greater than the programmed Time Between Start of Deliveries and any dose but the last dose begins delivery.ORWhether a callback time or Off is selected for the Intermittent Callback option, the Infuser is in Stop or Programming mode and the start time for the next dose is reached.Press the alarm window to clear the alarm for that channel.MediumLOW BATTERYANALYSIS: Less than <30, 15, 5> minutes of battery life remaining at current rate.REMEDY: Connect pump to AC power.ACTION: Press here to minimize all alarms.Low BatteryThe battery has <= 30 minutes but > 15 minutes of delivery left at the current infusion rate and battery power is the last power source.ORThe battery has <= 15 minutes but > 5 minutes of delivery left at the current infusion rate and battery power is the last power source.ORThe battery has <= 5 minutes of delivery left at the current infusion rate and battery power is the last power source.Infuser detects AC power to clear the alarm.Onset of a higher-priority Low Battery alarm clears a lower-priority Low Battery alarm. Change the delivery so the delivery time is greater than the alarm threshold (e.g., stop one of the channels or reduce the rate) to clear the alarm.Press the alarm window to minimize the alarm.30 minutes:Low15 minutes: Medium5 minutes:HighOn-Screen Text Alarm Message Alarm Cause Steps to Remedy Alarm Urgency
Appendix B: Alarm Messages and Troubleshooting SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 175NEARING END OF INFUSIONANALYSIS: Infusion almost complete.REMEDY: None.ACTION: Press here to clear alarm.Nearing End of InfusionThe 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.ORA bolus or piggyback delivery completes and the Infuser transitions back to a primary infusion that has a total time remaining which is less than or equal to the user-defined Nearing End of Infusion alarm setting.ORThe total time remaining on a primary infusion is less than the Nearing End of Infusion setting on a therapy start or restart.Note: Once a Nearing End of Infusion alarm has been cleared, it will only recur if one of these triggers occurs again.Press alarm window to clear the alarm.Press Start after titrating the associated program to clear the alarm.Change the Nearing End of Infusion alarm setting so a Nearing End of Infusion condition no longer exists clears the alarm when Done is pressed on the Options screen.Activate an End of Infusion alarm for a channel to clear an active Nearing End of Infusion alarm for the same channel.LowNEW DRUG LIBRARYANALYSIS: New library available. Accepting library will clear current patient, programs and totals.REMEDY: When safe, power off Infuser to accept.ACTION: Press here to minimize.New Drug LibraryThe Infuser is currently powered on and a library is ready in the CE for transfer to the infuser.ORAt power on, a library is ready in the CE to transfer to the Infuser.Successfully transfer the library to the Infuser to clear the alarm.Press the alarm window to minimize the alarm.LowNone (no message can be displayed).Depleted BatteryA depleted battery is detected and the infuser is operating on battery power.Restore AC power to clear alarm.Replace battery to clear alarm.High None (no message can be displayed).Power LossThe Infuser is powered by AC only and the power level drops below the level required to operate the Infuser.Restore AC power to clear alarm.Replace battery to clear alarm.High On-Screen Text Alarm Message Alarm Cause Steps to Remedy Alarm Urgency
176 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix B: Alarm Messages and TroubleshootingPROXIMAL OCCLUSIONANALYSIS: Delivery stopped. REMEDY: Active alarm—Clear occlusion above pump. Restart delivery. If not priming, check occlusion sensitivity setting if alarm persists.Latched alarm—NoneACTION: Active alarm—Press here to minimize all alarms.Latched alarm—Press here to clear alarm.Proximal OcclusionThe proximal pressure is less than or equal to the selected pressure level and the channel is in Delivery mode.ORThe proximal pressure is less than --7 psi and the channel is power priming. 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.Stop Mode—press Start to clear the alarm.Note: If Occlusion still exists, a new instance of the alarm will activate.Priming—Press Cancel, 1 mL, 3 mL or 5 mL button on Power Prime screen to clear the alarm.Change the Proximal Occlusion threshold setting for the affected channel to a new threshold less than the current measured pressure to clear the alarm.HighRECURRING OCCLUSIONANALYSIS: CCA-defined number of recurring Proximal Occlusion alarms has been reached.REMEDY: Check occlusion sensitivity.ACTION: Press here to clear alarm.Recurring Proximal OcclusionThe CCA-defined number of auto-reset Proximal Occlusion alarms for the program has been reached.Press alarm window to clear the alarm. LowRECURRING OCCLUSIONANALYSIS: CCA-defined number of recurring Distal Occlusion alarms has been reached.REMEDY: Check occlusion sensitivity. ACTION: Press here to clear alarm.Recurring Distal Occlusion The CCA-defined number of auto-reset Distal Occlusion alarms for the program has been reached.Press alarm window to clear the alarm.LowREINTIALIZING SYSTEM Reinitializ-ing SystemThe device detects the flash memory is not formatted.ORThe device forces the formatting of the flash due to a software download.Touch alarm overlay body to minimize the alarm.HighOn-Screen Text Alarm Message Alarm Cause Steps to Remedy Alarm Urgency
Appendix B: Alarm Messages and Troubleshooting SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 177RESTART REQUIREDANALYSIS: The infuser needs to be restarted.REMEDY: Please restart the infuser.ACTION: Press here to minimize Restart RequiredThe flash memory has completed formatting.Touch alarm overlay body to minimize the alarm.HighSERVICE BATTERYANALYSIS: Battery should be replaced. No battery back-up. In the event of AC power loss, infusion will stop.REMEDY: Replace battery soon.ACTION: Press here to minimize all alarms.Service BatteryBattery shortedORSMBus error/Battery Communication errorORBattery openORBattery missingORBattery will not chargeORBattery under-voltageORBattery Service warningReplace Battery to clear alarm.Press alarm window to minimize the alarm.LowOn-Screen Text Alarm Message Alarm Cause Steps to Remedy Alarm Urgency
178 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix B: Alarm Messages and TroubleshootingNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 179Appendix C: Accessories, Administration Sets, and ComponentsAppendix C outlines the list number and description of accessories, administration sets, and components available for use with the SYMBIQ™ Infusion System. List Number Item Description2006-04-01 Standard I.V. Pole11249-04-01 Heavy Duty I.V. Pole11868-04-01 PlumXL3M I.V. Minipole11986-04-48 Vented Syringe Adapter16000-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 106 Inch, Piggyback with Backcheck Valve, 2 CLAVE Ports, Distal Microbore Tubing and OPTION-LOK, Microdrip, Non-DEHP16001-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 105 Inch with CLAVE Port and OPTION-LOK16002-04-01 LATEX-FREE SYMBIQ™ Pump Set, Yellow Striped Tubing, Convertible Pin, 108.5 Inch with Distal Microbore tubing and OPTION-LOK16003-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump 150mL Burette Set, Convertible Pin, 129 Inch with 3 CLAVE Ports, 0.2 Micron Filter and OPTION-LOK, Soluset, Non-DEHP16004-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump 50mL Burette Set, Convertible Pin, 104 Inch with 3 CLAVE Ports, Distal Microbore Tubing and OPTION-LOK, Microdrip Soluset, Non-DEHP16005-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 104.5 Inch with CLAVE Port and OPTION-LOK, Non-DEHP16006-04-01 LifeShield LATEX-FREE HEMA SYMBIQ™ Pump Blood Set, Nonvented, 110 Inch with 210 Micron Filter, CLAVE Port and OPTION-LOK16007-04-01 LifeShield LATEX-FREE Hemoset SYMBIQ™ Pump 100mL Burette Set, Nonvented, 104 Inch with CLAVE Port, 170 Micron Filter and OPTION-LOK, non-DEHP16008-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 106 Inch, Piggyback with Backcheck Valve, 2 CLAVE Ports and OPTION-LOK16009-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump 50mL Burette Set, Convertible Pin, 100 Inch with 2 CLAVE Ports, 0.2 Micron Filter, Distal Microbore Tubing and OPTION-LOK, Microdrip Soluset, Non-DEHP16010-04-01 LATEX-FREE SYMBIQ™ Nitroglycerin Pump Set, Convertible Pin, 108.5 Inch with Polyethylene-Lined Tubing and OPTION-LOK16011-04-01 LifeShield LATEX-FREE SYMBIQ™ Nutritional Pump Set, Convertible Pin, 103.5 Inch with 1.2 Micron Filter, CLAVE Port and OPTION-LOK, Non-DEHP
180 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix C: Accessories, Administration Sets, and 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-LOK16013-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 104.5 Inch, Piggyback with Polyethylene-Lined Tubing, Backcheck Valve, 2 CLAVE Ports, 0.2 Micron Filter and OPTION-LOK16014-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump 150mL Burette Set, Convertible Pin, 124.5 Inch with 3 CLAVE Ports, Distal Microbore Tubing and OPTION-LOK, Microdrip Soluset, Non-DEHP16015-04-01 Latex-Free SYMBIQ™ Pump Enteral Set, 99 Inch with 40 mm Screw Cap, Non-DEHP16017-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump 150mL Burette Set, Convertible Pin, 115 Inch with 3 CLAVE Ports and OPTION-LOK, Soluset, Non-DEHP16018-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump 150mL Burette Set, Convertible Pin, 138 Inch with 4 CLAVE Ports, 0.2 Micron Filter, Distal Microbore Tubing and OPTION-LOK, Microdrip Soluset, Non-DEHP16019-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 105.5 Inch, Piggyback with Backcheck Valve, 2 CLAVE Ports and OPTION-LOK, Non-DEHP16020-04-01 LifeShield LATEX-FREE HEMA SYMBIQ™ Pump Y-Type Blood Set, Nonvented, 121.5 Inch with 210 Micron Filter, CLAVE Port and OPTION-LOK16021-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 106 Inch, Piggyback with Backcheck Valve, 3 CLAVE Ports and OPTION-LOK, Non-DEHP16022-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 104.5 Inch, Piggyback with Backcheck Valve, 2 CLAVE Ports, 0.2 Micron Filter and OPTION-LOK, Non-DEHP16023-04-01 LifeShield LATEX-FREE SYMBIQ™ Syringe Microbore Pump Set, 83 Inch with Syringe Holder, 2 CLAVE Ports and OPTION-LOK, Non-DEHP16024-04-01 LifeShield LATEX-FREE SYMBIQ™ Pump Set, Convertible Pin, 105 Inch, Orange Polyethylene-Lined Light Resistant Tubing, CLAVE Port, Distal Microbore Tubing and OPTION-LOK16025-04-01 LATEX-FREE SYMBIQ™ Nitroglycerin Pump Set, Convertible Pin, 108 Inch with Polyethylene-Lined Tubing and OPTION-LOK, MicrodripN/A SYMBIQ™ Tips CardsN/A SYMBIQ™ System Operating ManualList Number Item Description
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 181Appendix D: GlossaryTerm DefinitionAC 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.air-in-line Air in the fluid path.Air-In-Line alarm Alarm that occurs if sensors detect the present measured amount of air in the fluid path.alarm Visual and/or audible warning from an infuser indicating a condition requiring attention, e.g., Air-In-Line alarm.alarm analysis message Basic descriptions of the cause of the alarm displayed on the infuser touchscreen.alarm auto-reset condition Condition under which an alarm clears without user intervention.alarm base message Short description of an alarm that appears on the infuser touchscreen.alarm remedy message Helpful hints and suggestions for fixing an alarm condition that display on the infuser touchscreen.alarm system response Any special action other than the alarm annunciation that must be taken in response to an alarm.alarm urgency/priority Level of alarm related to an LED/alarm tab color and behavior. There are three priorities—low, medium, and high.allowed range The minimum and maximum allowable values for a therapy.audible alarm An alarm that can be heard.backcheck valve Prevents fluid from backing up in part of an administration set.backpressure Resistance to fluid flow on the distal or output portion of the administration set, usually expressed in PSIG.backup power source An alternate source of power should the main power source fail.Biomed mode The non-delivery or service mode of infuser operation that allows authorized personnel, typically institution technicians (Biomeds), access to delivery parameter limits and display default settings. bolus A single, uninterrupted, discrete volume of fluid delivered over a discrete period of time.BSA Body Surface Area, a value calculated by the infuser. BSA=0.007184 x Height (cm)0.725 x Weight (kg)0.425.
182 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix D: Glossarycallback 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.cassette loaded A cassette placed in the carriage and the carriage is closed.Caution: A caution appears in front of a procedure or statement. It contains information that could prevent irreversible product damage or hardware failure. Neglecting to pay attention to a caution could result in serious patient or user injury.Caution (medium alarm urgency) An alarm which requires prompt user response, and if not responded to promptly, could result in an escalation of the alarm to the Warning urgency.change a program Adjust the values/selections of the current program.clamp (noun) Device used to restrict flow in the line. clamp (verb) To block off or restrict flow in the line.clear history A function that clears the log files on an infuser.Clinical Care Area (CCA) A subset of a drug library for use in an area or patient population of the hospital, as defined by an authorized user. A CCA can have up to 400 specific medications plus “Fluid Only” and “Other Drug.” The hospital may create up to 40 CCAs and 16,000 specific medications in a drug library.clinical mode General use mode where an infuser can be programmed and medication can be delivered. clock type There are two clock types available: 12-hour and 24-hour.cold boot When the power is first applied to the infuser processor. It occurs when an infuser is off and the AC power is applied, or during battery operation when On/Off is pressed.concentration Consists of medication amount (in nanograms, micrograms [mcg], milligrams [mg], grams, milliequivalents [mEq], units [USP Units]), or diluent (volume in milliliters [mL]). continue rate An option used to provide fluid delivery at the current fluid delivery rate when the VTBI reaches zero.contraindications Conditions under which an infuser should not be used.Default Drug Library (DDL) A drug library with at least 99 medications including the manufacturer’s package insert recommended default units of measure and default unit of concentration. Also includes “Fluid Only” and “Other Drug.”Delivery mode The operational mode during which fluid delivery occurs. delivery rate The speed at which the fluid is delivered, e.g., 125 mL/hr.delivery type Method of infusing: Multistep, Basic therapies, Intermittent, Bolus.diluent (volume) or amount The volume of fluid used with the diluent unit (e.g., 250 mL).Term Definition
Appendix D: Glossary SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 183distal 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.dosing units Dose Rate units that may be selected; for example, mcg/kg/min, mcg/kg/hr, mcg/min, mcg/hr, mg/min, mg/hr, mg/kg/hr, units/min, units/hr, grams/hr, ng/kg/min, units/kg/hr, mUn/min, mEq/hr.download Transfer of data from a computer to an infuser. drip chamber Apparatus for visualizing/monitoring fluid flow in the administration set.drop-down box An element of the infuser touchscreen. Pressing the down arrow of this element displays additional items.drug library A customized library containing medication entries available for use with the SYMBIQ™ Infusion System. Medication entries include the Medication Name/Medication Amount/Medication Unit/Diluent Amount/Diluent Unit/Dosing units, Medication class, and Hard/Soft Limits.duration Period of time used to deliver a VTBI at an existing delivery rate or as set by the user.Ethylene Oxide (ETO) Method of sterilization.Event Log A record that indicates what and when a specific event occurred. The Event Log includes but is not limited to programming, limit overrides, out-of-limits attempts, setting changes, warnings, alarms, malfunctions, and power events.external power source Any external power source like an AC mains.FHH Filling Head Height. The gravity-induced proximal line pressure due to fluid height in source container above the distal line output level.flow rate The resulting rate of fluid flow (see delivery rate and dose rate).flow stop A device on the administration set cassette that toggles to start and stop fluid flow through the tube.hard limit The upper and/or lower dose limits for the selected medication and selected CCA that cannot be overridden. Defined by the hospital for each medication in its drug library. The hard limits for a particular medication may vary across different CCAs.Help Text area Area on the touchscreen that provides context-sensitive information during programming steps and alarm conditions. HIS Hospital Information System.hospital formulary Proprietary list of all medications used by the hospital.inactive screen A programming screen that has been programmed but is not currently selected. Term Definition
184 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix D: Glossaryinfuser 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.JCAHO The Joint Commission on Accreditation of Healthcare Organizations.key Buttons on the keypad or touchscreen.KVO (Keep Vein Open) Minimal delivery rate intended to provide sufficient fluid flow to prevent or reduce the potential for clotting at the IV infusion site. The KVO rate is the lesser of 1 mL/hr or the actual delivery rate.LED Light-Emitting Diode.low flow continuity Infusion of fluids and drugs at very low ratesmalfunction Alarm indication that a software or hardware failure has occurred (e.g., motor over-current.) These conditions usually require repair.medication amount The mass or quantity of the medication premixed with a diluent to express the concentration for the channel being programmed. minimized alarm An active alarm that has been acknowledged and is accessible by touching the alarm tab.mL/hr only A type of delivery expressed as volume divided by hour.non-vented administration sets For use with flexible containers. Not recommended for use with glass containers that are not vented by some other means.occlusion Blockage, may be caused by a kink in administration set tubing.off-screen key A key located on the infuser casing.Options button Button that provides access to the Options menu.override The user acknowledges a hard or soft limit violation prompt, and then proceeds with a program containing a parameter that falls outside the hospital-defined hard or soft limits.PAV Pressure Activated Valve.parenteral Any route other than the GI tract by which drugs, nutrients, or other solutions may enter the body for example IV, IM, or subcutaneously piercing pin Sharp plastic pin on an administration set that pierces the container.piggyback Infusion option that allows the delivery of a secondary container on the same channel.pole clamp Device used to connect an infuser to an I.V. pole.power LED Indicates an infuser is powered by AC mains when LED lit continuously. Indicates an infuser is powered by batteries when LED is off.power priming Used to prime or remove air from an administration set found in Options menu.Power Saving mode Low power state utilized when no keys have been pressed for a specified time period.Term Definition
Appendix D: Glossary SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 185power 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.prime To remove all air from the cassette, tubing, and injection site prior to connecting the infuser to the patient.program (noun) A set of coded instructions for delivering fluids.program (verb) Defining or entering coded instructions for delivering fluids.programmable ranges The minimum and maximum allowable values for a therapy.programming mode Operational mode during which therapy parameters are selected.proximal In relation to the cassette, it refers to the tubing entering the cassette coming from the container.proximal occlusion Blockage between an infuser and the fluid container.psi Pounds per square inch.purge Clear out or purge air from the tubing. Same as prime.PVC plastic Polyvinyl Chloride plastic.rate The infusion speed expressed in mL/hr.rate titration Changing the rate while an infuser is infusing.remote access Connecting to an infuser using a computer via wireless connectivity. rounding Process of making a fractional amount displayed on the screen.rule sets User-defined rules relating to the drug library including minimum and maximum dose, maximum rate and maximum VTBI for each medication, and maximum patient weight.secondary container A container connected to the primary line to infuse additional fluid or medication used in piggyback.Service mode The mode accessible only to Hospira personnel.settings Parameters such as program settings, infuser settings, or configuration settings.set up (verb) To make an infuser ready for use.shift totals Totals for a shift.silence the alarm To silence an infuser alarm in 2 minute intervals, press SILENCE.slide clamp An apparatus in an administration set that can be opened or closed to restrict or allow fluid delivery.soft limit The upper and lower dose limits for the selected medication and selected CCA. Soft limits can be overridden. Defined by the hospital for each medication in its drug library, the soft limits for a particular medication may vary across CCAs. If a given medication has a hard limit, its soft limits, if any, must equal or fall within its hard limits.Term Definition
186 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix D: Glossarystandard 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.subcutaneous A route of delivery just beneath the dermal skin layer.syringe A device for withdrawing, injecting, or instilling fluids.system message—advisory A visual message indicating infuser status.system message—prompt While entering a program, a visual warning that informs the user of the violation of a hospital-defined rule set or a field range, e.g., a dose limit for a specific medication.system setup The process of preparing an infuser for use.TALL-Man lettering TALL-Man lettering uses upper case letters to help differentiate sound-alike or look-alike medication names. Default Drug Library medication names are displayed in TALL-Man lettering where appropriate.therapy A type of program that can be entered into an infuser. Available therapies include Basic Program,Taper, Multistep, Intermittent, and Interchannel Sequencing.touchscreen key Any key rendered on the touchscreen to facilitate interaction with an infuser.units A medication amount (without a quantity of mass referent) adopted as the USP standard of measure for use in a concentration.unlock No cleaning or program locks are active.volume totals Section of event history that stores volumes delivered from either the fluid container or a specified time.VTBI Volume To Be Infused.Warning! A warning message contains special safety emphasis and must be observed at all times. Failure to observe a warning message is potentially life threatening.Warning (high alarm urgency) An alarm condition which requires immediate operator response. For example, an infusion delivery disruption or a severely low battery.weight The parameter entry required with dosing units that include kg.weight dosed A type of therapy that uses a calculated dose amount based on the patient’s weight.y-sites A port on the administration set tubing to inject medications via a syringe.Term Definition
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 187Appendix E: Default Drug Library (DDL)Medication Name Medication Name Medication NameFluid Only DOXOrubicin MorphineOther Drug Epinephrine NafcillinAbciximab Epoprostenol NaloxoneAcyclovir Eptifibatide NitroGLYCERINAlbumin Erythromycin NitroPRUSSIDEAldesleukin Esmolol NorepinephrineAlfentanil Etomidate OfloxacinAlteplase (rt-PA) Etoposide OndansetronAmikacin Famotidine Other DrugAminocaproic acid Fentanyl OxacillinAminophylline Fluconazole OxytocinAmiodarone Fluid Only PaclitaxelAmphotericin B Flumazenil PancuroniumAmpicillin-sublactam Fluorouracil PantoprazoleAtracurium Furosemide PenicillinAzithromycin Gatifloxacin PentobarbitalBleomycin Gentamicin PhenylephrineBretylium Heparin Piperacillin-bactamCarboplatin Hetastarch/NaCl Potassium Infusion Cefazolin Hextend ProcainamideCefepime Hydromorphone PropofolCefoPERAZONE Ifosfamide RanitidineCefoTAXIME Imipenem Cilastatin STREPTOkinaseCefoTETAN Immune Globulin IV TeniposideCefoXITIN Insulin TheophyllineCeftAZIDime Isoproterenol HCl Ticar-clavulanateCeftIZOXime Labetalol TirofibanCeftriaxone Lepirudin TobramycinCefuroxime Leucovorin UROkinaseCimetidine Levofloxacin VancomycinCiprofloxacin Lidocaine VecuroniumCisplatin Lorazepam VerapamilClindamycin Magnesium Infusion VinCRIStineCo-trimoxazole MannitolCyclophosphamide MesnaCyclosporine MethoHEXITALCytarabine MethoTREXATEDexmedetomidine HCl MethylprednisoloneDiltiazem MetoclopramideDOBUTamine MetronidazoleDocetaxel MidazolamDOPamine Milrinone
188 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)Appendix E: Default Drug Library (DDL)NOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 189IndexAAC power 33Active button 16administration setsgeneral information 54loading 62non-blood sets 57preparing 55with syringe holder 60advanced therapiesoverview 87Air-In-Line 118alarm 118alarmAir-In-Line 118conditions and criteria (table) 127Distal Occlusion 112Infusion Complete Callback 117log 145messages 127minimized tabs 129multiple 130Nearing End of Infusion 120Proximal Occlusion 114silence audible 130silencing 129touchscreen appearance 128urgency 127alarm messages 127alarm tabEnd of Infusion (figure) 80Nearing End of Infusion (figure) 80Bbackcheck valve 59, 83barvertical hot scroll 17vertical short scroll 17Basic programprogramming 71screen 78Basic therapyend of infusion 80overview 71Battery Indicator icons 36battery power 36Biomed Mode 47Bolus 123bolusclinician-activated, programming 123icon 18Bolus Deliveryunintended 11Bolus Setup screen 123buttonActive 16Depressed 16drop-down list field 17Emergency Stop 42end-of-list indicator 17horizontal navigation arrow 17on infuser body 16patient information 17Selected 16SILENCE 130Start Multistep 93Start Program 45touchscreen 16Unavailable 16Ccalculated field value screen 45calculated values 45Cassette Eject Lever (figure) 68Cautionsadministration sets 9battery operation 10cleaning 11general 8CCA 138access passcode (figure) 73changing 138list (figure) 72channel LED 35color and conditions 36channel level feature 24availability 24screen 24Clinical Care Area see CCAClinical ModesDelivery 41Power 33Programming 40Stop 42Clinician-Activated Bolusprogramming 123Current Program logview 147
Index 190 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)DDefault Drug Library (DDL) 137, 147, 187delayed startprogramming 109Depressed button 16disposalproduct 153Distal Occlusion 112alarm 112document conventions 7Eelectrical artifacts 12Emergency Stop button 42end-of-list indicator 17Ffeatureschannel level 23, 24device level 23, 26infuser 23program level 23, 25flow continuity 158flow rate accuracy 158standard specifications (table) 158fluid container compatibility 56Gglossary 181grasping infuser (figure) 51Hhard limit override 134high-risk medications 148II.V. poleattach to infuser 49, 50clamp knob (figure) 51clamp screw (figure) 50detaching infusers from 51infuseracceptable configurations (figure) 49configurations 49pole clamp (figure) 50Rapid Travel Release button (figure) 52removing infuser 53iconbasic program 18Battery Indicator 36bolus 18Exceeded Upper Hard Limit 135Exceeded Upper Soft Limit 133infusion running drip 18Intermittent therapy 18Multistep therapy 18piggyback 18infuseracceptable configurationsI.V. pole (figure) 49buttons 16features 23front view and touchscreen 15grasping (figure) 51I.V. poleattach 50configurations 49overview 15power on 33SILENCE button 130Standby mode 111Infuser Basic Operations 33infuser cassettesemergency eject 67power priming 106removing 66infuser layoutbottom 22front 15rear 20infuser specifications (table) 155audible tones 156battery 155date, time settings 157delivery rate 157electrical 155external interfaces 155infuser alarms 156input device, keypad 156KVO 157LCD display 156LED display 156memory protection 156occlusion settings 157physical 155safety features 156temperature parameters 157wireless connectivity 156Infusion Complete Callback 117alarm 117intended audience 7intended use 7Intermittent therapy 95icon 18programming 95Invalid Entry 135system message 46
Index SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 191system message (figure) 136invalid value handling 45KkeypadIntermittent Time Numeric 100LlabelSterile Parts and Pathways 54list numbersaccessories 179administration sets 179loading administration sets 62logsAlarm Log 137, 145Event Log 137, 144Rule Set Alert Override Log 137, 146Mmaintenancebattery 152battery disposal 152cleaning solutions 151cleaning the infuser 151medication concentration, specifying 76messagesalarm 127system 127minimized alarm tabs 129multiple alarm tabs (figure) 131Multistep Setup screen 88Multistep therapyicon 18programming, part II 87NNearing End of Infusion 120Nearing End of Infusion alarm 120New Patient dialog box 35non-blood setsadministration sets 57Number of Stepsdrop-down list (figure) 88numeric keypadTime touchscreen 77OOutside of Hard Limits 133system message 133overridehard limit 134Ppatient information 138patient information button 17performance trumpet curves 158piggybackpreparing for secondary delivery 59piggyback icon 18Piggyback infusionhow to program 85pole clampplacing I.V. pole (figure) 50powerAC 33battery 36power LED 38primingsets 106product disposal 153program (Basic) 71Program Lock 29activate 30Enter Code dialog boxactivating 31program options 83, 105alarm settings 112Delayed Start 109Standby Mode 110program totalsaccessing screen 141clearing 141view log 142programmingdelayed start 109Proximal Occlusion 114alarm 114RRapid Travel Release button (figure) 52Rule Set Alert Override Log 146view 146SscreenAdvanced Therapy Selection 87, 95Alarm Log 145Basic Program 74Basic program, filled 78Basic programming 75, 140Bolus Setup 123calculated field value 45
Index 192 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)channel LED location 35channel level feature 24Completed Intermittent 103Completed Multistep 94Concentration drop-down list 76Confirm Bolus 124Confirm Program 78Delivering Bolus 125Delivering Intermittent X of Y 102Delivering Multistep 94Delivering Program 85device level features 26Disconnect Tubing system message 107Dose Calculation 77End of Infusion, alarm tab 80Enter Code dialog boxactivating 31unlocking 32Event Log 144Exceeded Upper Hard Limit icon 135Exceeded Upper Soft Limit icon 133Far Viewing Delivery 42, 148Far Viewing device-level alarm tab 129High-Risk Medication Infusing 148infuserbottom view and layout 22rear view and layout 20startup 34Infusion Field Drop-Down List 147Infusion Selection drop-down list 75Intermittent Callback 98Intermittent Dose Calculation 99Intermittent Programming 99, 100Intermittent Setup 1 of 2 96Intermittent Setup 2 of 2 98multiple alarm tabs 131Multistep 1 of X 89Multistep 1 of X programming 90Multistep 2 of X Programming 91Multistep Programming 92Multistep scroll bar 93Multistep Setup 88, 89Multistep Summary 92Near Viewing Alarm tab 128Near Viewing Delivery 41Near Viewing device-level alarm tab 129Nearing End of Infusionalarm tab 80No Battery system message 38On/Off button 34OptionsStandby field 111, 112Patient Information 72, 74, 138, 140Piggyback Programming 85power LED location 38Power Prime 108Power Prime Progress 108power priming optionsinfuser cassettes 107program level features 25Program Lock 30activated 31deactivated 32Program Totals 141programmingpower prime cassette 106Rule Set Alert Override Log 146Settings 27, 29Brightness 28Date & Time 29Sound Volume 27Stop ModeAlarm State 43Manual Stop 43Time touchscreen 77touchscreenfront view 15Waiting for Intermittent X of Y 102Selected button 16setspower priming 106settings buttonsound volume settings 27shift totalsclearing 143view logs 143shift totals data 142SILENCE button 130sound volume settingssettings button 27specifications see infuser specificationsStandby Drop-Down list 111Standby modeplace infuser in 111Start Program button 45Sterile Parts and Pathways label 54Stop infuserEmergency Stop button 44Stop Program button 44stored data 137stored informationcurrent program 137, 147logs 137patient data 137program totals 137shift totals 137, 142storing the infuser 153supplemental deliveries 83syringe holderadministration sets 60system message 131Invalid Entry 46, 135
Index SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 193Invalid Entry (figure) 136Outside of Hard Limits 133Soft Limit Outside of Limits 132Soft Limit Outside of Limits (figure) 132system messages 127Ttabminimized alarm 129multiple alarm 131Time touchscreen 77titrateinfusion 81titration 105touchscreenbutton 16front view 15icons 17symbols 17troubleshootingalarm messages 171system messages 161UUnavailable button 16Vvalue rounding 46VTBIpiggyback VTBI 84Wwireless communication 22workflowBasic program 71
Index 194 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 195SYMBIQ™ Infusion System License & WarrantySubject 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. Hospira makes no other warranties, express or implied, as to merchantability, fitness for a particular purpose, or any other matter.Purchaser's exclusive remedy shall be, at Hospira's option, the repair or replacement of the product. In no event shall Hospira's liability arising out of any cause whatsoever (whether such cause be based in contract, negligence, strict liability, other tort, or otherwise) exceed the price of such product, and in no event shall Hospira be liable for incidental, consequential, or special damages or losses or for lost business, revenues, or profits. Warranty product returned to Hospira must be properly packaged and sent freight prepaid.The foregoing warranty shall be void in the event the product has been misused, damaged, altered, or used other than in accordance with product manuals so as, in Hospira's judgment, to affect its stability or reliability, or in the event the serial number or lot number has been altered, effaced, or removed.The foregoing warranty shall also be void in the event any person, including the Purchaser, performs or attempts to perform any major repair or other service on the product without having been trained by an authorized representative of Hospira and using Hospira documentation and approved spare parts. For purposes of the preceding sentence, “repair or other service” means any repair or service other than the replacement of accessory items such as batteries and detachable mains power cords.In providing any parts for repair or service of the product, Hospira shall have no responsibility or liability for the actions or inactions of the person performing such repair or service, regardless of whether such person has been trained to perform such repair or service. It is understood and acknowledged that any person other than a Hospira representative performing repair or service is not an authorized agent of Hospira.
196 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)SYMBIQ™ Infusion System License & WarrantyNOTES:
SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06) 197Hospira, 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.This document and the subject matter disclosed herein are proprietary information. Hospira retains all the exclusive rights of dissemination, reproduction, manufacture, and sale. Any party using this document accepts it in confidence, and agrees not to duplicate it in whole or in part nor disclose it to others without the written consent of Hospira.The SYMBIQ™ Infusion System is Wide Fidelity (WiFi) enabled and complies with the IEEE 802.11b communications standard.The SYMBIQ™ Infusion System provides an adequate degree of protection against electrical shock and is suitable for application to a patient.Protected against dripping water.The SYMBIQ™ Infusion System complies with ul60601-1 with respect to Protective Earthing (ground). Copyright 2006All Rights ReservedHospira North Chicago, Illinois 60045www.hospira.com
198 SYMBIQ™ Infusion System Operating Manual 430-10599-001 (MDS DRAFT 04/06)

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