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Users Manual Part I HTML Version

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Users Manual Part I

430-95597-001 (Rev. 06/05)

ABOptions/

Vol Inf

Back

Prime

For use with List Numbers:

20677, 20678, 20679-04

System Operating Manual

for use

with

for use

with

HOSPIRA, INC., LAKE FOREST, IL 60045, USA

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i 430-95597-001 (Rev. 06/05)

Change History

Title

Description of

Changes Pages Affected

430-95597-001

(Rev. 06/05)

First Release All

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Plum A+® Infusion Systems

Contents

Section 1, Descriptive Information . . . . . . . . . . . . . . . 1-1

PRODUCT DESCRIPTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-1

INDICATIONS FOR USE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

user qualification . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

CONVENTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-2

warnings, cautions, and notes . . . . . . . . . . . . . . . . . . . . . 1-3

PRECAUTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-4

healthcare professionals and patient related . . . . . . . . . . 1-4

concurrent flow . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-5

epidural administration . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-7

battery operation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-8

sets and accessories . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

backpriming . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-9

cleaning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10

bolus related . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-10

artifacts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-11

GUIDENCE ON EMC COMPATIBILITY . . . . . . . . . . . . . . . . . . . . . . 1-13

FCC INFORMATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1-14

Section 2, Principles of Operation . . . . . . . . . . . . . . . 2-1

FEATURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

programs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

line programming options . . . . . . . . . . . . . . . . . . . . . . . . . 2-1

plumset capabilities . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

air management . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

battery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

biomedical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

options . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

other features . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-2

communication . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-3

Section 3, Equipment Description . . . . . . . . . . . . . . . 3-1

OPERATING KEYS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-2

INDICATORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-4

DISPLAY SYMBOLS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-5

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REAR CASE CONTROLS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-6

ADMINISTRATION SETS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-7

PREPARING THE ADMINISTRATION SET . . . . . . . . . . . . . . . . . . . . 3-7

PRIMING THE ADMINISTRATION SET . . . . . . . . . . . . . . . . . . . . . . 3-8

LOADING THE CASSETTE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3-9

PREPARING THE SECONDARY LINE . . . . . . . . . . . . . . . . . . . . . 3-10

DISCONTINUING ELECTRONIC FLOW

CONTROL & SETTING GRAVITY FLOW . . . . . . . . . . . . . . . . . . . 3-11

DISCONTINUING FLUID ADMINISTRATION . . . . . . . . . . . . . . . . . . 3-12

Section 4, Basic Operation . . . . . . . . . . . . . . . . . . . . .4-1

GETTING STARTED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

unpacking . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-1

tandem carrier instructions . . . . . . . . . . . . . . . . . . . . . . . . 4-2

system self-tests . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-2

data retention . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-3

POWER ON . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-4

SIMPLE DELIVERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-6

TITRATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-8

PIGGYBACK DELIVERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-12

CONCURRENT DELIVERY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-15

STOP AND START WITH ONLY 1 LINE PUMPING . . . . . . . . . . . . . 4-18

STOP AND START WITH BOTH LINES PUMPING . . . . . . . . . . . . . 4-19

BACKPRIMING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-20

CLEARING SETTINGS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-21

UPDATING DRUG LIBRARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4-23

Section 5, Advanced Programs . . . . . . . . . . . . . . . . . . 5-1

DOSE CALC (MCG/KG/MIN ON A) . . . . . . . . . . . . . . . . . . . . . . . . 5-2

DOSE CALC (MG/MIN ON B) . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-9

LOADING DOSE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-15

MULTISTEP PROGRAMMING . . . . . . . . . . . . . . . . . . . . . . . . . . . 5-22

Section 6, Additional Features . . . . . . . . . . . . . . . . . . .6-1

SIMPLE DELIVERY USING DELAYED START . . . . . . . . . . . . . . . . . 6-1

PIGGYBACK WITH NURSE CALLBACK . . . . . . . . . . . . . . . . . . . . . 6-2

POSSIBLE NON-DELIVERY PROGRAMMED . . . . . . . . . . . . . . . . . . 6-4

USING THE STANDBY FEATURE . . . . . . . . . . . . . . . . . . . . . . . . . 6-4

SELECT OPTION- VOLUMES INFUSED, PRESSURE/POST INFUSION

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RATE, AND LIGHTING/CONTRAST . . . . . . . . . . . . . . . . . . . . . . . . 6-6

VARIABLE RATE CAP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

EXAMPLES OF AUTOMATIC CALCULATION . . . . . . . . . . . . . . . . . 6-10

at startup . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

while running (titration) . . . . . . . . . . . . . . . . . . . . . . . . . . 6-10

at kvo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-11

CHANGING CCA WHILE INFUSING . . . . . . . . . . . . . . . . . . . . . . 6-12

AUTO-PROGRAMMING . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6-13

Section 7, Alarms and Troubleshooting . . . . . . . . . . . 7-1

WARNING MESSAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-1

RESPONSE TO ALARMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-2

GENERAL ALARMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-3

LINE A ALARMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-5

LINE B ALARMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-7

MALFUNCTIONS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-8

GENERAL MESSAGES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7-9

Section 8, Cleaning, Maintenance, and Storage . . . . 8-1

cleaning and sanitizing . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-1

battery maintenance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-3

storage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4

service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8-4

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Section 9, Specifications . . . . . . . . . . . . . . . . . . . . . . .9-1

PHYSICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1

ELECTRICAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-1

WIRELESS LAN DEVICE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2

VTBI RANGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-2

ENVIRONMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3

DELIVERY RATE RANGE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3

AIR-IN-LINE ALARM . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-3

OCCLUSION ALARM AND LIMITS . . . . . . . . . . . . . . . . . . . . . . . . . 9-4

TIME TO DETECT DOWNSTREAM OCCLUSIONS . . . . . . . . . . . . . . 9-5

BOLUS VOLUME RELEASED AFTER DOWNSTREAM

OCCLUSIONS ARECORRECTED . . . . . . . . . . . . . . . . . . . . . . . . . 9-5

DELIVERY ACCURACY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-6

ENTERAL & HIGH VISCOSITY FLUIDS EFFECTS . . . . . . . . . . . . . . 9-6

TRUMPET CURVES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7

example . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9-7

Section 10, Supplies and Accessories . . . . . . . . . . . .10-1

ADMINISTRATION FLUIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

administration fluids . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

enteral and high viscosity fluids . . . . . . . . . . . . . . . . . . . 10-1

containers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-1

ACCESSORIES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2

general . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2

networked application . . . . . . . . . . . . . . . . . . . . . . . . . . . 10-2

Section 11, Warranty . . . . . . . . . . . . . . . . . . . . . . . . . 11-1

Section 12, Default Drug Library (DDL) . . . . . . . . . . .12-1

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.

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Plum A+® Infusion Systems

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SECTION 1

Descriptive Information

NOTE: In this manual, references to Plum A+ apply to both

systems unless otherwise noted.

Plum A+®

List # 20679-04

NOTE: This operating

manual may also be

used with Device List

Numbers 12391-04 &

11971-04-03+ which

use Module List

Number 20677-04.

Plum A+®3

List # 20678-04

CAUTION: THIS

DEVICE IS TO BE USED

WITH AN IV POLE WITH A

6-WHEEL BASE AND A

SHELF.

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The Plum A+ and Plum A+3 Volumetric Infusion Systems are

designed to meet the fluid delivery requirements of today’s

evolving healthcare environments. Both are cassette based

multi-function infusion systems. The Plum A+ allows two lines in

and one line out while the Plum A+3 allows six lines in and three

lines out. Each pump can be used for standard, piggyback, or

concurrent delivery. Delivery modes include:

• Standard Infusions

• Multistep Programming

• Loading Dose

• Dose Calculation

The Plum A+ and Plum A+3 are designed to deliver parenteral,

enteral, or epidural infusions over a broad range of infusion

rates from multiple fluid container types.

Both are designed to be used in most areas of patient care,

including, but not limited to:

Product Description

Each system includes a pumping module (hereafter called the

infuser) and an assortment of disposable IV sets (hereafter

called a set), optional accessories, and this operator’s manual.

The Plum A+ host device contains a Connectivity Engine

peripheral module that provides wired Ethernet and wireless

802.11b local area networking capabilities. This allows the

• General Floor • Labor/Delivery/

Post Partum

• Burn Unit

• Medical/Surgical • OR/Anesthesia • Hemodialysis

• ICU/CCU • Post Op/Recovery • Oncology

• Pediatrics • Cardiac Cath Lab • Mobile Intensive

Care

• Neonatology • Emergency • Nutritional

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 1- 3

Hospira MednetTM networked application software for drug

library downloads and Auto-programming to the infuser.

Indications for Use

USER QUALIFICATION

The Plum A+ is intended for use at the direction or under the

supervision of licensed physicians or certified healthcare

professionals who are trained in the use of the infuser and the

administration of parenteral, enteral, and epidural fluids and

drugs and whole blood or red blood cell components. The

training should emphasize preventing related IV complications,

including appropriate precautions to prevent accidental infusion

of air. The epidural route can be used to provide anesthesia or

analgesia.

WARNING

ADMINISTER ONLY ANESTHETICS/ANALGESICS

APPROVED FOR EPIDURAL ADMINISTRATION (AS

INDICATED OR ALLOWED BY THE DRUGS’ FDA

APPROVED LABELING). EPIDURAL ADMINISTRATION OF

DRUGS OTHER THAN THOSE INDICATED FOR EPIDURAL

USE COULD RESULT IN SERIOUS INJURY TO THE PATIENT.

Conventions

This section describes the conventions used throughout this

manual, as follows:

CONVENTION APPLICATION EXAMPLE

Italic Reference to a

section, figure, or

table

Function or mode

specific instructions

(See Figure 3-1,

Priming Cassette)

Primary Only:

Attach an empty

container.

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WARNINGS, CAUTIONS, AND NOTES

Alert messages used throughout this manual are described

below. Pay particular attention to these messages.

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.

CAUTION: A CAUTION USUALLY APPEARS IN FRONT OF A

PROCEDURE OR STATEMENT. IT CONTAINS INFORMATION THAT

COULD PREVENT IRREVERSIBLE PRODUCT DAMAGE OR HARDWARE

FAILURE. FAILURE TO OBSERVE A CAUTION COULD RESULT IN

SERIOUS PATIENT OR USER INJURY.

[BRACKETED

ALL CAPS]

Keys or buttons on

the device are

displayed in

[BRACKETED ALL

CAPS] or with a

graphic.

[START]

[Italic] Softkey Options

[Choose]

Initial Caps

lowercase

Screen displays and

device labels (as

appropriate)

Program

Dose Calculation

Bold Emphasis ...sets are supplied

Sterile and are

for....

CONVENTION APPLICATION EXAMPLE

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Plum A+® Infusion Systems

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NOTE: A Note highlights information that helps explain a

concept or procedure.

This symbol directs the user to consult accompanying

documents.

When visible on the display, this symbol informs the

user to use CAUTION because the specified drug has

NOT been programmed with specified safety limits.

NOTE: Figures are rendered as graphic representations to

approximate the actual product. Therefore, figures may not

exactly reflect the product.

Precautions

The Plum A+ has been designed and manufactured to be safe,

reliable, and easy to use. This section details precautions and

possible hazards.

For safe operation of the Plum A+, observe the following

precautions and hazards.

HEALTHCARE PROFESSIONALS AND PATIENT RELATED

• In vitro studies have suggested that packed red blood cells

with unusually high hematocrit be diluted with blood-

compatible fluids, such as 0.9% sodium chloride injection, to

decrease hemolysis and increase flow rate.

• Setting the primary rate greater than the secondary rate will

result in a more rapid infusion of any residual secondary drug

remaining in the line and the cassette.

• Consult drug labeling to confirm drug compatibility,

concentration, delivery rates, and volumes are all suitable for

secondary, concurrent and piggyback delivery modes.

• Arrange tubing, cords, and cables to minimize the risk of

patient strangulation or entanglement.

• Before opening the door, close clamp on the primary line or

remove the secondary container from the secondary port to

prevent mixing of primary and secondary fluids.

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1- 6 430-95597-001 (Rev. 06/05)

• Although unlikely, failure of certain robust mechanical

components such as the anti-free flow mechanism or valve

control springs could cause fluid delivery limited to the

contents of the fluid container. Single fault failure of certain

electronic/motor control components would result in no more

than 5 mL of unexpected fluid delivery.

• A small amount of fluid is expelled from the set (less than

0.05 ml) each time the door is opened or closed with a set

installed. If potent drugs are being used, take appropriate

action to guard against overmedication of the patient.

• Before disconnecting a syringe from the cassette, pull up the

plunger slightly to avoid spilling the fluid. For rigid containers,

close the upper slide clamp, open the cassette door, then

remove and invert the cassette (ports down).

• Air bubbles may form distal to the cassette as result of

normal outgassing of dissolved air in the fluid. This may

occur if chilled solution is in use, if the infuser is mounted

significantly above the patient, or when using certain fluids

known to routinely outgas. In these cases, an air eliminating

filter may be used.

• Repeated opening and closing of the door may defeat the

proximal air-in-line alarm and may cause a distal air-in-line

alarm, requiring repriming.

• The screen displays the VTBI (volume to be infused) in

integers when value is above 99.9. Any fraction of a milliliter

delivered is not displayed, but is retained in memory.

• For Plum A+3 users, be aware that changing the weight on

one device does NOT change the weight on the other two

devices. Patient weight must be changed on each device

when delivering weight-based therapy dependent on

medication requirements.

CONCURRENT FLOW

GUIDELINES

When delivering short half-life critical drugs (see Critical Drugs,

this section) using the Plum A+ in the Concurrent mode, the

following delivery rate guidelines should be observed:

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 1- 7

• If the critical drug (with half-life less than 6 minutes) is to be

infused at less than 2 mL/hr, the other infusion should be no

faster than 5 times the critical drug’s rate. Dopamine, for

example, delivered at 1.5 mL/hr should not be accompanied

by an infusion programmed any faster than 7.5 mL/hr.

• If the critical drug (with half-life less than 6 minutes) is to be

infused at 2 - 5 mL/hr the other infusion should be no faster

than ten times the critical drug’s rate. Dopamine, for example,

delivered at 3.5 ml/hr should not be accompanied by an

infusion programmed any faster than 35 mL/hr.

• If the critical drug (with half-life less than 6 minutes) is to be

infused at 5.1 mL/hr or greater, the other infusion can be

programmed at any desired rate.

NOTE: The total of the primary rate plus the secondary rate

cannot exceed 500 mL/hr.

These guidelines apply only when infusing short half-life critical

drugs in Concurrent mode. Individual patient responses may

vary requiring adjustment of delivery rates.

DELIVERY RATE GUIDELINES

SHORT HALF-LIFE (LESS THAN

6 MINUTES) CRITICAL DRUG

INFUSION RATE

MAXIMUM RATE OF

ACCOMPANYING INFUSION

0.5 - 1.9 mL/hr 5 Times the Critical Drug Rate

2 - 5 mL/hr 10 Times the Critical Drug Rate

5.1 or Greater Any Desired Ratio

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CRITICAL DRUGS

Examples of drugs with a short half-life (approximately 6

minutes or less when given IV) include:

For these drugs, the concurrent flow guidelines should be

followed when the infusion rate of the drug will be 5 mL/hr or

less.

NOTE: This list of critical drugs is not intended to be all-

inclusive of critical drugs or drugs with a short half-life.

The clinician should become familiar with the

pharmacodynamics of any critical drug before administration.

This information is presented to inform clinicians of a rare

situation that could be misinterpreted if they are unfamiliar with

this phenomenon.

EPIDURAL ADMINISTRATION

• Recommended use of the epidural route is to provide

anesthesia or analgesia for periods up to 96 hours.

• This device can be used to administer only those anesthetics/

analgesics approved for epidural administration (as indicated

or allowed by the drugs’ FDA approved labeling). Epidural

administration of drugs other than those indicated for epidural

use could result in serious injury to the patient.

• For epidural administration, the use of Hospira catheters,

Plum sets without Y-sites, and "epidural" stickers indicating

ongoing epidural administration are recommended.

Dobutamine Lidocaine

Dopamine Nitroglycerin

Epinephrine Nitroprusside

Epoprostenol Norepinephrine

Esmolol Oxytocin

Isoproterenol Procainamide

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• Administration of drugs via the epidural route should be

limited to personnel familiar with associated techniques and

patient management problems. Proper epidural placement of

the catheter is essential since catheter migration could result

in intravascular or intrathecal administration. Facilities

practicing epidural administration must be equipped with

resuscitative equipment, oxygen, naloxone, and other

resuscitative drugs. Adequate monitoring equipment (e.g.,

Oximetry) is recommended for continuous monitoring of the

patient during epidural administration. Patients must be

observed frequently for side effects in a fully-equipped and

staffed environment for at least 24 hours following completion

of drug administration by the epidural route. DELAYED

RESPIRATORY DEPRESSION FOLLOWING

CONTINUOUS EPIDURAL ADMINISTRATION OF

PRESERVATIVE-FREE MORPHINE SULFATE HAS BEEN

REPORTED.

• The epidural space has 58 openings through which fluid can

exit. Pressure buildup during administration is transient.

However, if a large volume of fluid is administered over a

short time period, the pressure will take longer to return to

normal. If overdelivery occurs during administration, observe

the patient closely for signs of spinal cord compression

(disorientation, headache, transient neuralgias) and drug

overdose.

BATTERY OPERATION

• When the battery is removed from the Plum A+, do not

operate on patients. Use of a properly maintained and

charged battery helps confirm proper operation.

• The battery may not be fully charged upon receipt. Connect

the infuser to AC power for at least six hours.

• Use AC power whenever possible. Connect to AC power

during storage to ensure a fully charged battery for

emergencies. If the quality of the earth grounding source is in

doubt, use battery power.

• If the low-battery alarm sounds, connect the infuser to AC

power immediately.

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SETS AND ACCESSORIES

• Only compatible LifeCare PlumSets can be used with the

Plum A+. See individual set instructions for additional

information.

• Administration sets should be changed per CDC guidelines

or healthcare provider policy. Discard after use.

• LifeCare IV infusion sets with integral nonblood filters are not

for use in the administration of blood, blood products,

emulsions, suspensions, or any medications not totally

soluble in the solution being administered. These

medications may be administered through the lower Y-

injection site, below the filter.

• When infusing at low delivery rates (5 mL/hr or less) the use

of thick-walled microbore PlumSets is recommended. This

will reduce the amount of the fluid bolus that may be

delivered when a distal line occlusion is released.

• Syringes must be larger than 3 cc. Use syringe adapter (List

11986-48) when using syringes smaller than 10 cc. Some 10

cc syringes may require use of a syringe adapter. Syringes

larger than 10 cc may be attached directly to the secondary

port of the cassette. Use of a syringe adapter may decrease

the occurrence of proximal occlusion alarms.

• Use a 19-gauge or larger needle or catheter at the

venipuncture site for viscous fluids if operating at rates

greater than 500 ml/hr.

See Section 10 for information on sets and accessories.

BACKPRIMING

• Backpriming is not recommended for reconstituting

secondary containers containing dry powders.

• To avoid pressurization when backpriming into a syringe, the

user must confirm there is sufficient empty space to accept

the backprimed fluid.

GENERAL

• Possible explosion hazard exists if used in the presence of

flammable anesthetics.

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• Do not place Plum A+ in service if it fails the self-test.

• Do not operate the Plum A+ with the case opened.

• Keep the cassette door securely closed while the infuser is

not in use, to avoid cassette door damage.

• Values beyond a fields maximum hard limit will be diplayed

as dashes (-- -- --). The user must clear these fields using the

[CLEAR] key prior to entering new values.

• The Plum A+3 is to be used with an IV pole with a 6-wheel

base and a shelf.

CLEANING

For more information on cleaning the infuser, see Section 8.

• To avoid mechanical or electronic damage, do not immerse

the Plum A+ in any fluids or cleaning solutions.

• Do not spray cleaning solutions toward any opening in the

instrument.

• Certain cleaning and sanitizing solutions may slowly degrade

components made from some plastic materials. Using

abrasive cleaners or cleaning solutions not recommended by

Hospira may result in product damage. 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.

• To avoid infuser damage, cleaning solutions should only be

used as directed. The disinfecting properties of cleaning

solutions vary; consult the manufacturer for specific

information.

BOLUS RELATED

Use the following procedure to avoid the administration of a

bolus following a distal occlusion (i.e., a closed distal clamp):

• If a secondary container is in use, clamp proximal tubing

before opening cassette door.

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• Open cassette door and remove the cassette.

• Open the flow regulator briefly to dissipate the pressure

and then close it.

• Eliminate the source of occlusion (closed clamp).

• Reinsert the cassette and close the cassette door.

• Open all clamps and resume infusion.

NOTE: When troubleshooting an occlusion where all clamps

are in the OPEN position, use care to avoid delivery of a bolus

by opening the flow regulator to release any built-up pressure.

Close the clamp between the cassette and the patient before

opening the flow regulator to relieve the pressure. See Section

7, Alarms and Troubleshooting, for more information.

ARTIFACTS

• Nonhazardous, low-level electrical potentials are commonly

observed when fluids are administered using infusion

devices. These potentials are well within accepted safety

standards, but may create artifacts on voltage-sensing

equipment such as ECG, EMG, and EEG machines. These

artifacts vary at a rate that is associated with the infusion

rate. If the monitoring machine is not operating correctly or

has loose or defective connections to its sensing electrodes,

these artifacts may be accentuated so as to simulate actual

physiological signals. To determine if the abnormality in the

monitoring equipment is caused by the infusion device

instead of some other source in the environment, set the

infusion device so that it is temporarily not delivering fluid.

Disappearance of the abnormality indicates that it was

probably caused by the electronic noise generated by the

infusion device. Proper setup and maintenance of the

monitoring equipment should eliminate the artifact. Refer to

the appropriate monitoring equipment system documentation

for setup and maintenance instructions.

• The Plum A+ system is designed to operate normally in the

presence of most encountered electromagnetic interference

(EMI) conditions. In the event of extreme levels of

interference, such as encountered next to an electrosurgical

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generator, it is possible that the normal operation of a sensor

or microcomputer might be disrupted. Even in this event, the

outcome would likely be a false alarm or detected system

malfunction and would not result in a hazard to patient or

operator.

• This equipment has been tested and found to comply with the

EMC limits for the Medical Device Directive 93/42/EEC (EN

55011 Class B and IEC/EN 60601-1-2:2001). These limits

are designed to provide reasonable protection against

harmful interference in a typical medical installation. The

equipment generates, uses and can radiate radio frequency

energy and, if not installed and used in accordance with the

instructions, may cause harmful interference to other devices

in the vicinity. However, there is no guarantee that

interference will not occur in a particular installation. If this

equipment does cause harmful interference with other

devices, which can be determined by turning the equipment

off and on, the user is encouraged to try to correct the

interference by one or more of the following measures:

• Reorient or relocate the receiving device

• Increase the separation between the equipment

• Connect the equipment into an outlet on a circuit

different from that to which the other device(s) is

connected

• Consult the manufacturer or field service technician for

help

• Portable and mobile RF communications equipment, such as

cellular telephones, 2-way radios, Bluetooth devices,

microwave ovens, in close proximity to this device may affect

wireless and wired communications with the Infusion pump

and/or the operation of the Infusion pump. Special

precautions need to be exercised regarding EMC, These

include:

• Use of a shielded Ethernet cable (CAT5 STP or better)

for plugging into the RJ45 Ethernet connector. Using

an unshielded Ethernet cable may result in increased

emissions.

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• Maintaining a minimum separation distance of 2 ½ ft

between the Infusion pump system and portable/

mobile RF communications equipment

• List Numbers 12391 and 11971 are compliant to IEC/EN

60601-1-2 (1993)

List Numbers 20678 & 20679 are compliant to IEC/EN

60601-1-2 (2001) and have been tested and found to comply

with EMC limits for the Medical Device Directive 93/42/EEC

(EN 55011 Class B and EN 60601-1-2:2001).

Guidance on EMC Compatibility

• There is a shared responsibility between manufacturers,

customers and users to ensure that Medical Equipment and

Systems are designed and operated as intended. Medical

electrical equipment needs special precautions regarding

electromagnetic compatibility and needs to be installed and

used according to the electromagnetic compatibility

information provided in this manual.

• The device is suitable for use in all establishments, including

domestic establishments. If extended operation during

power mains interruption is needed, use battery power.

• Always manage the electromagnetic environment.

• The guidance included in this manual provides information

needed to:

• Determine the device’s suitability for use in the

intended environment.

• Manage the electromagnetic environment to permit the

device to perform as intended without disturbing other

equipment.

• Separate the device from all other electronic equipment. If

the device must be used near other electrical equipment,

monitor the equipment to ensure there is no electromagnetic

interference.

• Devices should not be used adjacent to or stacked with other

equipment. If the device must be used adjacent to or stacked

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430-95597-001 (Rev. 06/05) 1- 15

with other equipment, monitor the devices to verify normal

operation.

• USE ONLY components specifically labeled for use with the

Plum A+ Infusion System to help ensure the device operates

as intended.

• If you suspect external RF sources or other equipment are

influencing device operation, contact the biomedical

engineering department for additional guidelines concerning

electromagnetic immunity.

• Contact the biomedical engineering department for additional

information in the technical service manual concerning

operating devices near RF sources.

FCC Information

US FCC (FEDERAL COMMUNICATIONS

COMMISSION) STATEMENT

• This device complies with part 15 of the FCC Rules.

Operation is subject to the following two conditions: (1) This

device may not cause interference, and (2) This device must

accept any interference, including that may cause undesired

operation of these devices.

FCC INTERFERENCE STATEMENT

• This equipment has been tested and found to comply with the

limits for a Class B digital device, pursuant to Part 15 of the

FCC Rules. These limits are designed to provide reasonable

protection against harmful interference in a residential

installation. This equipment generates, uses, and can radiate

radio frequency energy. If not installed and used in

accordance with the instructions, it may cause harmful

interference to radio communications. However, there is no

guarantee that interference will not occur in a particular

installation. If this equipment does cause harmful interference

to radio or television reception, which can be determined by

turning the equipment off and on, the user is encouraged to

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try and correct the interference by one or more of the

following measures:

• Reorient or relocate the receiving antenna.

• Increase the distance between the equipment and the

receiver.

• Connect the equipment to an outlet on a circuit

different from that to which the receiver is connected.

• Consult the dealer or an experienced radio/TV

technician for help.

• Changes or modifications not expressly approved by Hospira

could void the user's authority to operate the equipment.

RADIO FREQUENCY EXPOSURE STATEMENT

• The Wireless LAN radio device in the Connectivity Engine

peripheral board with this infusion device has been evaluated

and found compliant to the requirements of the following

Radio Frequency exposure standards:

• Federal Communications Commission, OET Bulletin

65 (Edition 97-01), Supplement C (Edition 01-01),

Evaluating Compliance with FCC Guidelines for

Human Exposure to Radio frequency Electromagnetic

Fields, July 2001.

• Industry Canada, Evaluation Procedure for Mobile and

Portable Radio Transmitters with respect to Health

Canada's Safety Code 6 for Exposure of Humans to

Radio Frequency Fields, Radio Standards

Specification RSS-102 Issue 1 (Provisional):

September 1999.

• The radiated output power of this Wireless LAN device is far

below the FCC radio frequency exposure limits. The Wireless

LAN device has been evaluated with zero inches separation

of human body from the antenna and found to be compliant

with FCC RF exposure limits.

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SECTION 2

Principles of Operation

Features

The Plum A+ is a dual-line volumetric infusion system designed

to meet the growing demand for hospital-wide, as well as

alternate site and home healthcare, standardization. With its

primary line, secondary line, and piggyback fluid delivery

capability, the Plum A+ is suited for a wide range of medical/

surgical and critical care applications. Full compatibility with

LifeCare Plum Series administration sets and accessories and

the LifeShield® and CLAVE® needleless protection systems,

makes the Plum A+ a convenient and cost-effective infusion

system.

PROGRAMS

• Standard Programming

• Loading Dose

• Multistep Programming

LINE PROGRAMMING OPTIONS

• Drug List

• Nurse Call Back

• Delayed Start/Standby Setting

• Concurrent delivery

•Titration

• Micro 0.1-99.9 mL/hr (in 0.1 mL increments) flow rate range

for both lines

• Macro 100-999 mL/hr (in 1 mL increments) flow rate range for

both lines

• Automated Secondary drug delivery (Piggyback)

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PLUMSET CAPABILITIES

• Anti Free-Flow Protection

• Direct Connection for syringe delivery

AIR MANAGEMENT

•Air Trap

• Air Removal/Backpriming

• Air Detection-Proximal

• Air Detection-Distal

BATTERY

NOTE: The Plum A+3 utilizes three batteries.

• Battery Gauge

• Less than 8-Hour Battery Recharge Time

• Long battery life (3 hours) for emergency backup and

temporary portable operation

BIOMEDICAL

• Upgradability (Field- Single Channel Devices Only)

• Variable Rate Cap

• Alarm History

• Nurse Call Relay Connector

OPTIONS

• Volumes Infused (A, B, Total Volume)

• KVO at dose end (1 ml/hr or less depending on delivery rate)

or Continue Rate (CR) to continue at the current rate

• Variable Distal Pressure Settings

OTHER FEATURES

• Nonpulsatile volumetric accuracy

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• Microprocessor control

• Large liquid crystal display (LCD) screen

• Panel back illumination on mains power

• Lockout switch

• Standard syringe use

• Parenteral and nonparenteral (enteral) fluid delivery

• Blood and blood products delivery

• Wide range of Standard and Specialty administration sets

• Password protected keypad lock

COMMUNICATION

• Networked Communication (Ethernet & Wireless)

• Autoprogramming

• Drug Library Download

Definitions

TERM DEFINITION

Administration

Set

The sterile, disposable assembly with

flexible tubing that connects to a source

fluid container for input to the Cassette

pumping chamber and to some output

device for administration to the patient.

Alarm A condition requiring operator

intervention that invokes both audible

and visible alarm indicators. Confirmation

of the condition usually is required.

Alert While entering a program, a visual

warning that informs the clinician of the

violation of a hospital-defined rule set,

e.g., a dose limit for a specific drug.

Alternate Units Dose Rate units that may be selected.

Alternate Units are any units other than

mL/hr.

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Alternate Units

Parameters

Drug Amount, Diluent, Patient Weight (if

applicable), and Dose Rate.

Auto-Program A physician order sent to the infuser.

Auto-Program

(new)

An auto-program is considered “new” if

either of the following conditions are met:

A) There is no program on the associated

line. B) The drug and concentration in the

auto-program is different from a

currently-programmed drug and

concentration.

Auto-Program

(titration)

An auto-program is considered a

“titration” if the drug and concentration in

the auto-program match the currently-

programmed drug and concentration.

Non-promotion titration programs include

some subset of the following: Rate, Dose,

Duration. Promotion titration programs

include some subset of the following:

Rate, Dose, Duration, Patient Weight,

Dosing Units, Drug Amount, Drug Units,

Diluent Amount.

Awake CE The CE is considered awake when the

infuser is powered on with battery power

and the battery is above the low battery

threshold or is plugged into AC.

Backpressure Resistance to fluid flow on the Distal or

output portion of the Administration Set,

usually expressed as PSIG.

Backprime Removal of air or fluid from the proximal

tubing and Cassette air trap by rapid

pumping of fluid from Line A to an output

receptacle on Line B. No fluid delivered

distal to the cassette during a Backprime.

Basic Delivery A single-step delivery specifying rate,

VTBI, and duration only. Drug name may

or may not be specified.

TERM DEFINITION

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Biomed Mode The name for the non-delivery or service

mode of Infuser operation.

Bolus A single uninterrupted discrete volume of

fluid delivered over a discrete period of

time.

Cassette A Hospira standard Plum Macro Cassette

that contains the actual pumping

chamber with inlet and outlet valves. It

also contains access ports to diaphragms

for proximal and distal line pressure

sensing and chambers for air trapping

and air quantity measurement.

Caution Contains information which could

prevent hardware failure, irreversible

damage to equipment, or loss of data.

Channel Distal Line output to the patient.

Cleared Program Same as Cleared Settings, but restricted

to the program delivery settings for an

individual line.

Cleared Settings Programmed delivery settings for both

lines and the general control parameters

are at their default values.

Clinical Care

Area (CCA)

An area of the hospital for which

authorized hospital staff has allowed use

of up to 149 specific drugs, plus No Drug

Selected. The clinician selects a CCA

after turning on the Infuser. The hospital

may create from one to eighteen CCA’s.

TERM DEFINITION

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Concentration For Dose Calculation based Line A or B

delivery programming of premixed drugs,

the concentration consists of Drug

Amount (in micrograms [mcg], milligrams

[mg], grams, milliequivalents [mEq],

millimols [mmols], or units [USP Units])

and Diluent (Volume in milliliters [mL]).

Abbreviated on screen displays as

“Conc”.

Concurrent

Delivery

Simultaneous delivery of two fluids at

independent flow rates.

Concurrent Mode The Line B control selection mode that

allows either Line A or Line B (or both) of

the Mechanism to be programmed for

delivery that completes with KVO or CR.

Line A operation is unaffected by Line B

delivery.

Connectivity

Engine (CE)

A component of the infuser that controls

ethernet and wireless communication

between the MMU and Infuser processor.

Continue Rate

(CR)

An option used to provide fluid delivery at

the current fluid delivery rate when the

VTBI becomes zero.

Default Drug

Library (DDL)

A drug list of 99 drug names, default units

and default concentrations, plus ‘No Drug

Selected’. Does not contain Soft or Hard

Limits. The DDL is a subset of Plum A+

Version 11.3 drug list. The Infuser

functions initially with the DDL.

Deliver Together A Biomed Delivery option setting, which

selects default of Piggyback or

Concurrent delivery mode.

Delivery Mode The normal operational mode for the

Infuser, either Concurrent or Piggyback,

during which fluid delivery may occur.

TERM DEFINITION

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Delivery Rate The delivery rate (as Volume/Time)

assigned by the operator or calculated

from other delivery parameters.

Device The Plum A+ IV Infusion Device (Infuser),

not including the disposable

administration sets.

Diluent (Volume) The volume of fluid used with the Diluent

Unit (e.g., 250 mL), which dilutes the drug

to be infused.

Distal Downstream (output) from the Cassette

portion of the Administration Set.

Door The lever-operated, bottom-hinged,

Cassette holder on the front of the

Mechanism.

Dose (Rate) Delivery rate times drug concentration.

Dose Calculation Allows programming Dose Rates in

alternative units of measure. Dose

Calculation can be used in Simple

Delivery, Loading Dose, and Multistep.

Drug Amount The mass or quantity of the drug

premixed with a Diluent to express the

Concentration for the Line being

programmed.

Drug Library Drug names available for use with the

Infuser in the selected CCA, and each

drug’s concentration, units of measure,

and dose limits, as determined by

authorized hospital staff. The Drug

Library is based on hospital-defined best

practices. The Drug Library is customized

and downloaded into the Infuser by

authorized hospital personnel using

Hospira MedNet Networked software.

TERM DEFINITION

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Duration The time period used to deliver a VTBI at

an existing Delivery Rate or as set by the

operator.

Enteral Delivery via an intestinal route.

Error A condition resulting in an audible

warning and often an accompanying

message, such as an invalid key press,

resulting from an operator attempt to

make an input that is not valid for the

current operational context. Not a

Malfunction.

Filling Head

Height (FHH)

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 Rate

and Dose.)

Fluid Delivery

Begin

The time required, measured from the

initial start of a keypad press, for a digit in

the third decimal place of a scale

measuring grams to change when

pumping water, the delivery tube is fluid

filled, and the end of the delivery tube is

immersed.

Hard Limit The dosing amount (upper and/or lower

amount) that when assigned to a drug

cannot be overridden. Defined by the

hospital for each drug in its Drug Library.

The hard limits for a particular drug may

vary across different CCAs.

Infuser A Plum A+ device, not including the

disposable administration set.

Initialized

Position

The plunger is in the Plunger Park

Position, and each valve is in the Valve

Home Position.

TERM DEFINITION

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Key Any of the marked locations on the front

panels intended for user input via a

pressing action.

KVO (Keep Vein Open) Internally selected

minimal delivery rate, the lesser of 1.0

mL/Hr or actual Rate, intended to provide

sufficient fluid flow to decrease the

potential for clotting at the IV infusion

site.

Line A Inlet tubing on the top center of Cassette

when viewed after it has been loaded in

Mechanism Door.

Line B Inlet connector on the top right of

Cassette when viewed after it has been

loaded in Mechanism Door.

Loading Dose Allows programming of an initial infusion

rate for a specific volume, followed

automatically by a maintenance rate from

the same container (e.g., a fluid

challenge). If Dose Calc is used, the

Loading Dose and Maintenance Dose are

in the same unit of measure, over the

same period of time (mcg/min), from the

same container.

Macro Cassette The Plum Cassette as part of an

Administration Set whose attainable

delivery performance is for general

purpose uses.

Malfunction One of a number of conditions that

indicate a failure of the Infuser. These

conditions usually require a repair action.

TERM DEFINITION

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Mechanism The provider of the physical activities of:

1) valve control for Line selection and

inlet to or outlet from the Cassette; 2)

Plunger extension and retraction for

changing fluid volume of the Cassette

pumping chamber.

MedNet software Networked application software used to

define and download the custom drug

library to the Infuser.

Multistep Allows a sequential program to deliver up

to 10 steps; fluid volumes and delivery

rates may be programmed for each step.

The program may be entered based on

Rate and Volume or Volume and Time. If

Dose Calc is used, the delivery steps are

in the same unit of measure, over the

same period of time, from the same

container.

MMS Medication Management Suite- a product

suite that will be used to support safe and

efficient caregiver administration of

intravenous medications.

MMU Medication Management Unit- the MMU is

a product of the MMS and provides

external communications with infusers

and other systems supporting medication

management. It supports drug library

downloads and status/log updates to the

infusers. MMU also delivers a variety of

pre-built and custom reports related to

the infuser activities.

Network-Enabled

Module

The hardware that facilitates

communication between the infuser and

the network.

TERM DEFINITION

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Note A Note explains something new, gives

tips on performing an activity, or provides

a reminder of necessary preparations.

Override The clinician acknowledges an Alert,

confirms and proceeds with a program

containing a parameter that falls outside

the hospital-defined Soft Limits.

Parenteral Delivery via other than an intestinal route,

such as intravenous (IV) injection.

Patient Weight The Alternate Units Parameter whose

value entry is required with Dose rates

(quantity/time) having the third parameter

of weight, such as mcg/kg/min.

Piggyback

Delivery

Infusion will stop Line A and infuse Line

B until VTBI completes.

Piggyback Mode The Line B control selection mode that

requires Line A delivery suspension while

Line B delivers and then its resumption

when Line B VTBI completes. If Line A is

not programmed and started, Line B

delivery just stops when its VTBI

completes. Line A operation is delayed

for duration of its interruption by Line B.

Plunger Park

Position

The position of the pumping plunger that

allows the cassette to be withdrawn from

the Infuser without restriction, with an

opened Door.

POST Power On Self Tests. Startup initialization

and test of critical hardware modules and

software functions, to determine Infuser

readiness for its Intended Use.

Power On When the power is first applied to the

Infuser processor. It occurs when Infuser

is in the off condition and the AC power is

applied or during battery operation when

the ON/OFF key is pressed.

TERM DEFINITION

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Pressure The measured fluid pressure for Proximal

Line A, Proximal Line B, or the Distal line

when a fully primed administration set is

loaded into a Mechanism with the

Cassette Door closed.

Programs A Concentration-based extension to

basic Volume/Rate delivery for Dose Rate

applications. Softkey-selected types are:

1) Standard Program for single rate

delivery; 2) Loading Dose for up to two

steps of delivery at differing rates; 3)

Multistep for up to ten steps of delivery at

differing rates. Loading Dose and

Multistep include the basic Delivery Rate

option.

Protocol In the medical field, hospital-approved

procedures. For devices with an

electronic communications interface, the

format and content of messages being

exchanged.

Proximal Upstream (input, as Line A and/or B) with

respect to the Cassette portion of the

Administration Set.

Rate See Delivery Rate

Rounding To round-off to the closest whole number

(e.g., 25.5 would round to 26, but 25.4

would round to 25).

Rule Sets The compilation of Soft and Hard Limits

associated with a drug entry.

Screen That active portion of the LCD assigned

to a delivery or other user interactive

display operation.

TERM DEFINITION

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 2- 13

Softkey A front panel key whose function label is

on the bottom portion of the display

screen just above its location, so that

label may be changed to indicate differing

key functions within the operational

context of the defined screens.

Soft Limit The dosing amount (upper and/or lower

amount) that when assigned to a drug can

be overridden based on confirmation.

Defined by the hospital for each drug in

its Drug Library. The soft limits for a

particular drug entry may vary across

CCAs.

Standard

Programming

(see Basic Delivery)

Standby A delivery program state that resembles a

delayed start for a line in all respects, but

status display of STANDBY instead of

DELAYED. A press of the START key (and

a Start Softkey if necessary) will begin the

programmed delivery.

System The Plum A+ Infuser system with its

associated accessories and

Administration Sets.

Tall-Man

Lettering

Tall-Man lettering uses upper-case letters

in combination with lower-case letters to

help clinicians differentiate among

sound-alike or look-alike drug names.

Certain Hospira Default Library drug

names are displayed in Tall-Man lettering.

Truncate To round-down to the last whole number

(e.g., 103.7 would be 103).

Units A Drug Amount (without a quantity of

mass referent) adopted as the United

States Pharmacopoeia (USP) standard of

measure for use in a Concentration.

TERM DEFINITION

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2- 14 430-95597-001 (Rev. 06/05)

VI Volume Infused.

VTBI Volume To Be Infused – The volume of

fluid or IV solution (remaining) for

delivery by a program or Therapy step

from a Line.

Warning Audible indication at the defined Warning

sound level, often accompanied by a brief

message, to advise operator that: 1. Input

was attempt to use a function in wrong

sequence, with wrong values, or at wrong

time (resulting in an Invalid Key Warning);

2. Input was properly related to a function

(resulting in a Valid Key Warning). (The

Low Battery Warning is an exception,

using the Alarm Indication sound level.)

Weight The Alternate Units Parameter whose

value entry is required with Alternate

Units for Dose that include /kg/.

TERM DEFINITION

sec02.fm Page 14 Wednesday, June 8, 2005 8:18 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 3- 1

SECTION 3

Equipment Description

Front Panel Display and Keypad

Back

Prime

Options/

Vol Inf

Line A Flow

Indicator

Status Region

Working Region

Message Region

Status

Region

Working

Region

Message

Region

Start and

Stop Keys

Charging/

Line

Indicator

ON/OFF

Key

Line B Flow

Indicator

LCD

Battery

Charge

Indicator

Numeric

Keys

(Up/Left)

Selection

Key

(Down/

Right)

Silence

Key

Numeric Field

Clear Key Decimal Point

Key

Softkey Label

Softkey

Selector

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3- 2 430-95597-001 (Rev. 06/05)

Operating Keys

NOTE: For Plum A+3, all three pumps act as individual Plum

A+’s.

The [ON/OFF] key is used to

control the power of the Plum A+.

NOTE: All deliveries must be

stopped in order to turn the

power off.

NOTE: To confirm proper

shutdown of infuser, do not

unplug until “double beep” is

heard (approximately 5

seconds). If “double beep” is

not heard, the infuser will turn

itself back ON sensing the AC

power was lost and revert to

battery back-up power.

The [START] key is used to begin

infusion. It brings up the

Confirmation screen. If all

information appears correct, select

[Yes] to start program.

The [STOP] key is used to stop the

current delivery on one line; used

in conjunction with soft keys to stop

delivery on both lines.

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 3- 3

The [SILENCE] key is used to

silence an audible alarm during

actions to correct its cause.

The [SELECT] key (or ) is used

to move the highlighting cursor

between the programming fields.

The numeric keys are used to enter

values for any highlighted field

requiring numeric data.

The [CLEAR] key will cause a

highlighted numeric field to be

cleared in preparation for data

entry. It is also used to clear the

displayed dashes (-- -- --) that

occur when entering values

beyond the pre-programmed hard

limits. It WILL NOT clear the entire

program.

The [DECIMAL POINT] key is used

to manually enter numbers other

than whole numbers (i.e., 1.2 mL).

sec03.fm Page 3 Wednesday, June 8, 2005 8:19 AM

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3- 4 430-95597-001 (Rev. 06/05)

Softkeys are located at the bottom

of the main display and serve a

variety of functions. What each key

does is indicated by the text in the

display above the actual softkey.

Indicators

The Charge/Line Indicator is

illuminated to indicate the battery is

currently charging.

NOTE: If the device is plugged

into AC power, with a battery

installed, and the Charge

Indicator is not illuminated,

contact technical support.

The fluid drop symbol, when

flashing, indicates an active

infusion on Line A and/or Line B.

Cancel/

Back

Standby Enter

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 3- 5

Display Symbols

Battery Capacity Symbol (located

on right side of message region on

display) indicates relative charge

with number of white boxes from

left to right.

Cautionary Symbol is displayed to

alert the user that the infuser is

being operated without rule sets

(soft or hard limits). Read the drug

package insert for information on

proper usage.

Soft Limit Override Symbol

indicates the programmed soft

limits upper (up arrow) or lower

(down arrow) have been

overridden.

NOTE: The infuser will display

the rule set icon from the first step in a situation where a 2-step

process is completed and the infuser is stopped after going to

KVO.

The "Wireless Connection

Available" icon is displayed when

the device is receiving a wireless

signal. The infuser will connect to

the network if a wireless network

access point is recognized.

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3- 6 430-95597-001 (Rev. 06/05)

It may appear on any Main Delivery

Screen whether pumping or stopped. It

also may appear regardless of Auto-

Programming. However, in a wireless

network environment, Auto-

Programming will not be successful if

the icon is not visible during the Auto-

Program transfer. If wireless Auto-

Programming is desired and the icon is

not displayed on the Main Delivery

Screen, try relocating the pump

towards the wireless access point until the icon is displayed.

The icon will not be displayed if the infuser is communicating

via an ethernet connection.

Rear Case Controls

NOTE: For Plum A+3, each control applies to all three pumps

The audio level rotary knob,

located on the back, adjusts the

alarm audio level.

The toggle switch, located below

the audio level control, activates

the lockout function when the lever

is placed in the “up” position,

disabling all front panel keys

except [STOP].

Password Protected Keypad Lock

may also be used. It both locks and

unlocks the keypad by pressing the

decimal key, followed by 9, 6, & 3.

STOPPED PUMPING

Rate

mL/hr

Vol Inf

Options/

Vol Inf

26.3

10.

Dose

mg/min

mcg/kg/min

MedSurg

Lidocaine

Dose Calculation

DOPamine

Dose Calculation

sec03.fm Page 6 Wednesday, June 8, 2005 8:19 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 3- 7

NOTE: For Plum A+3, keypad lock applies to individual pump in

use.

NOTE: Pressing of a key while lockout is active results in the

display of the lockout enabled message. This action is

recommended to confirm each lockout activation.

NOTE: If the lockout switch is put in the “Locked” position while

the infuser is off, the [ON/OFF] key allows the unit to turn on.

The connector located below the

lockout switch is the Nurse Call

Relay Connector, for providing

remote notification of a nurse call

event.

The Ethernet port is used to

connect to a local area connection.

sec03.fm Page 7 Wednesday, June 8, 2005 8:19 AM

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3- 8 430-95597-001 (Rev. 06/05)

Administration Sets

The Plum A+ is compatible with a wide range of LifeCare Plum

series administration sets. Become familiar with the set

components before preparing the administration set.

Preparing the Administration Set

NOTE: For detailed instructions, see administration set

packaging.

WARNING

ARRANGE TUBING, CORDS, AND CABLES TO MINIMIZE

THE RISK OF PATIENT STRANGULATION OR

ENTANGLEMENT.

Use the aseptic technique to prepare the administration set for

priming, then proceed as follows:

1Make sure flow regulator is closed.

Primary Line

Flow Regulator

Pumping Chamber

Secondary

Inlet Port

(Capped)

Finger Grip

Patient Line

Air Trap

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 3- 9

2Insert piercing pin into container outlet with

a twisting motion.

3Fill Drip chamber to about 1/2 full or to the

score mark. Do not completely fill.

NOTE: To avoid getting Distal Air Alarms,

confirm the fluid bag is positioned higher than

the infuser. This should be set up prior to

priming the cassette.

Priming the Administration Set

1Invert the cassette.

2Turn the flow regulator counter-clockwise

until a drop of fluid is seen in the pumping

chamber.

3Turn the cassette upright, then prime the

remainder of the administration set.

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3- 10 430-95597-001 (Rev. 06/05)

4Push in the flow regulator to close. Confirm

there is no flow.

Loading the cassette

To load the primed cassette into the plum A+, proceed as

follows.

1Open the cassette door by lifting up the

handle.

2Insert cassette into door guides. Close the

cassette door. Confirm there is no flow and

no kinks appear in tubing.

NOTE: If flow is observed, close the tubing

clamps and replace the administration set.

NOTE: The administration set should be

changed per CDC guidelines or healthcare

provider policy. Discard after use.

Preparing the Secondary Line

CAUTION: CONSULT THE DRUG LABELING TO CONFIRM DRUG

COMPATIBILITY, CONCENTRATION, DELIVERY RATES, AND VOLUMES

ARE ALL SUITABLE FOR CONCURRENT DELIVERY OR PIGGYBACK

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 3- 11

DELIVERY (SECONDARY FOLLOWED AUTOMATICALLY BY PRIMARY)

MODES.

The Plum A+ features concurrent or piggyback delivery modes

when program requires administering more than one fluid.

In addition to standard containers, the Plum A+ can use

syringes on the secondary port. The secondary line can be

prepared without removing or repriming the cassette.

Before preparing the secondary line, observe the following

guidelines:

• Review the backpriming function.

• Attach the secondary container using an 18- or 19-

gauge, 31 mm (or shorter) needle, if the cassette

secondary inlet port has a piercing reseal.

• Syringes must be larger than 3 cc. Use syringe

adapter (List 11986-48) when using syringes smaller

than 10 cc. Some 10 cc syringes may require use of

a syringe adapter. Syringes larger than 10 cc may be

attached directly to the secondary port of the

cassette. Use of a syringe adapter may decrease the

occurrence of proximal occlusion alarms.

• When using a syringe adapter, retract the plunger to

draw approximately 1 mL of fluid into the syringe to

clear air from the adapter filter.

To prepare the secondary line, use aseptic technique and

proceed as follows:

1With cassette door closed: Loosen and

remove white cap, then discard. Add

secondary tubing or syringe.

2Open all proximal clamps before pressing

[START].

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3- 12 430-95597-001 (Rev. 06/05)

3Set up per operating instructions.

(See Sections 4 - 6 of this manual.)

4Syringe: Secure the container to the

cassette door using the optional container

support arm (List 12095-03).

Discontinuing Electronic Flow

Control & Setting Gravity Flow

CAUTION: BEFORE OPENING DOOR, CLOSE CLAMP ON PRIMARY

OR SECONDARY SET OR REMOVE SECONDARY CONTAINER FROM

SECONDARY PORT TO PREVENT MIXING OF PRIMARY AND SECONDARY

FLUIDS.

If electronic flow needs to be stopped, the precision flow

regulator on the cassette can be used to manually set and

maintain fluid flow in a gravity mode (see the following

graphics).

PRESS STOP

OPEN DOOR & REMOVE CASSETTE

SET GRAVITY RATE BY

TURNING FLOW REGULATOR

COUNTER-CLOCKWISE

NOTE: FLOW REGULATOR CLOSES

AUTOMATICALLY WHEN DOOR IS OPENED

TO PREVENT ACCIDENTAL FREE FLOW

NOTE: CASSETTE SHOULD BE

IN UPRIGHT POSITION

NOTE: IF DOOR OPEN ALARM OCCURS, TURN PUMP OFF

STOP

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 3- 13

Discontinuing Fluid Administration

PRESS STOP

CLOSE DOOR

DISCARD SET AND FLUID

CONTAINER PER HOSPITAL

PROCEDURE

OPEN DOOR, REMOVE CASSETTE

STOP

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For Systems With Hospira MedNetTM Software

3- 14 430-95597-001 (Rev. 06/05)

NOTES

sec03.fm Page 14 Wednesday, June 8, 2005 8:19 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 1

SECTION 4

Basic Operation

Getting Started

UNPACKING

CAUTION: PRODUCT DAMAGE MAY OCCUR UNLESS PROPER

CARE IS EXERCISED DURING UNPACKING AND INSTALLATION. DO NOT

USE THE PLUM A+ IF IT APPEARS DAMAGED IN ANY WAY. THE

BATTERY MAY NOT BE CHARGED UPON RECEIPT.

Inspect the Plum A+ packaging for possible shipping damage. If

damage is found, contact the delivery company immediately.

Use care when unpacking the infuser. Retain the packing slip

and save all packing material in case the infuser is damaged or

fails the infuser self-test and has to be returned to Hospira.

Inspect thoroughly for damage.

CAUTION: IF THE PLUM A+ APPEARS TO BE DAMAGED, CONTACT

HOSPIRA, INC.

To set up, connect the AC (mains) cord to a properly grounded

receptacle, unless temporary battery operation is desired.

NOTE: Use AC (mains) power whenever possible. Store the

infuser connected to AC (mains) to confirm a fully charged

battery for emergencies.

NOTE: If the quality of the earth grounding source is in

doubt, use battery power.

CAUTION: THE PLUM A+ SYSTEM IS DESIGNED TO OPERATE

NORMALLY IN THE PRESENCE OF MOST ENCOUNTERED

ELECTROMAGNETIC INTERFERENCE (EMI) CONDITIONS. IN THE

EVENT OF EXTREME LEVELS OF INTERFERENCE, SUCH AS

ENCOUNTERED NEXT TO AN ELECTROSURGICAL GENERATOR,

CELLULAR TELEPHONES, OR 2-WAY RADIOS, IT IS POSSIBLE THAT

THE NORMAL OPERATION OF A SENSOR OR MICROCOMPUTER MIGHT

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For Systems With Hospira MedNetTM Software

4- 2 430-95597-001 (Rev. 06/05)

BE DISRUPTED. OPERATION OF THE INFUSER UNDER THESE

CONDITIONS SHOULD BE AVOIDED.

TANDEM CARRIER INSTRUCTIONS

NOTE: The Plum A+3 is NOT to be used with the tandem

carrier. It is only to be used with the Plum A+ and other single-

channel devices.

The Plum A+ may be safely and conveniently mounted on an IV

stand or on a tandem carrier mounted on an IV stand.

Always mount the tandem carrier

(List# 12270-01) to the pole before

attaching the infuser(s) to the tandem

carrier.

Make sure tandem carrier clamp is

attached firmly to pole.

Make sure infusers are firmly

attached to tandem carrier.

This section details the Plum A+

instrument setup procedures.

SYSTEM SELF-TESTS

The infuser performs a suite of System Self-Tests when power

is applied to confirm readiness for use.

Failure during the Self-Tests is reported as a Malfunction

Condition.

CAUTION: DO NOT PLACE THE PLUM A+ IN SERVICE IF IT FAILS

THE SYSTEM SELF-TESTS.

Connect the AC power (mains) cord to an AC power receptacle,

then confirm that the Charging/Line indicator illuminates (above

the [ON/OFF] key on the front panel).

A systematic self-testing of the processing, delivery, and safety

systems is performed whenever the Plum A+ is turned on, to

verify readiness for operation.

sec04.fm Page 2 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 3

NOTE: If the quality of the earth grounding source is in doubt,

use battery power.

Press the [ON/OFF] key to turn the power on. Check screen

display and listen for a beep to indicate the audio is working.

Wait for the self-tests to complete. If successful, put a fully

primed macro cassette into the cassette door and close the

door. See Loading Cassette in Section 3 for details of correct

procedure.

When the Charging/Line indicator is off and the battery symbol

on the display is flashing, this indicates that the Plum A+ is

operating on low battery power and should be recharged.

CAUTION: WHEN THE BATTERY IS REMOVED FROM THE PLUM A+,

DO NOT OPERATE ON PATIENTS. USE OF A PROPERLY MAINTAINED

AND CHARGED BATTERY HELPS CONFIRM PROPER OPERATION.

To confirm battery is fully charged, connect the Plum A+ to AC

(mains) power for a minimum of six hours while in the OFF

mode.

If an alarm occurs during the power on self-test, identify the

alarm message, then take corrective action (see Section 7,

Alarms and Troubleshooting).

Turn infuser OFF, then back ON. If the self-test alarm recurs,

remove the infuser from service and contact the local Hospira

representative.

The infuser performs a suite of System Self-Tests when power

is applied to confirm readiness for use.

Failure during the Self-Tests is reported as a Malfunction

Condition.

DATA RETENTION

Delivery program settings and programming option selections

are retained in non-volatile memory. If the Plum A+ has been

turned off for longer than four hours, all delivery settings are

cleared and programming option selections are restored to their

default selections for next use.

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4- 4 430-95597-001 (Rev. 06/05)

Power On

1Press to Power On the

Plum A+ and the System Self-

Tests Screen is displayed.

After self-testing successfully

completes, the display will

proceed to the next screen.

Programming the infuser may

begin during the cassette

check phase of the start-up

testing.

NOTE: If battery is missing or defective, a “Battery not installed”

message with a “Continue without battery” prompt will appear

(AC power only).

CAUTION: WHEN THE BATTERY IS REMOVED FROM THE PLUM A+,

DO NOT OPERATE ON PATIENTS. USE OF A PROPERLY MAINTAINED

AND CHARGED BATTERY HELPS CONFIRM PROPER OPERATION.

2To set up the Plum A+, insert

selected Plum Set and close

cassette holder door lever.

NOTE: If cassette is already inserted,

this screen is skipped.

If Infuser ID Entry screen appears,

consult your hospital’s biomed

personnel.

HOSPIRA Plum A+

13.X Jan 31 2005 12:30:30

2005

System Self Test

In Progress

**SCREENS SHOWN IN THIS MANUAL

ARE EXAMPLES ONLY AND DON’T

NECESSARILY REFLECT ACTUAL

CLINICAL PRACTICE**

SETUP

Insert PLUM Set

Close Lever

sec04.fm Page 4 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 5

The Area Selection screen will

appear if your system has been

programmed with the Hospira

MedNet accessory. Use to

choose. If only one CCA has

been entered, it becomes the

default and this screen is

skipped.

NOTE: To change the CCA while infusing, see page 6-12,

Changing CCA While Infusing.

If not using MedNet, the display will go straight to the

“Clear Settings?” option.

Example of Clear Settings

Screen

3The on-screen message “Clear

Settings?” may appear. Select



[Yes] to clear all settings.

Clear ALL settings when

changing patients or multiple

programming parameters.

NOTE: This clears all delivery parameters, such as Rate and

VTBI on both lines, as well as setting items, such as the KVO

and Nurse Callback options, to their default values.

NOTE: If no settings currently exist or all settings are zero, this

screen will be bypassed.

Area Selection

Enter

Select, then Enter

Any Hospital, USA

MM/DD/YY XXYYZZ- 123456

ICU

MedSurg

Cardio

Urology

Psych

Recov

L&D

5 West

Renal

Neo ICU

OB/GYN

Oncol

Ad ICU

7 South

3 North

4 North

SETUPA B

Clear Settings?

Yes clears ALL settings

Yes N o

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4- 6 430-95597-001 (Rev. 06/05)

Simple Delivery

Example of MedNet Main

Delivery Screen (with cleared

settings). The selected area is

displayed at the bottom.

NOTE: For clarity, whole number font

sizes will appear larger than fractional

number font sizes (numbers on the right-side of the decimal).

1To Program a delivery rate, select



[A].

2To enter delivery rate, use

numeric keypad.

3Use to move down to the

VTBI field.

4To enter VTBI amount, use

keypad.

NOTE: While the VTBI is being

entered, the duration is automatically

computed. If the computed value is

greater than 99:59, dashes (- -)

appear in place of hours.

STOPPED STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

Back

Prime

MedSurg

**SCREENS SHOWN IN THIS MANUAL

ARE EXAMPLES ONLY AND DON’T

NECESSARILY REFLECT CURRENT

ACTUAL PRACTICE**

APROGRAM

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Drug

List

Enter Value using keypad

00:00

MedSurg

APROGRAM

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Drug

List

Enter value using keypad

5.5

00:00

MedSurg

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 7

5Use to move down to the DURATION field.

If auto-calculated Duration is acceptable, skip to step

6Use keypad to change/enter

the hours part of duration if

desired.

NOTE: When all parameters are

displayed, changing any one

parameter will result in other

parameters automatically being

computed. To understand the

Automatic Calculation feature, see

Examples of Automatic Calculation on page 6-10.

7Use to move from hours to minutes.

NOTE: The maximum hours allowed is 99 and the maximum

minutes is 59.

8Use keypad to enter minutes.

9Press .

CAUTION: VERIFY ALL VALUES

BEFORE STARTING INFUSION.

Program Confirmation screen

will appear. If correct, press



[Yes] to begin infusion.

APROGRAM

Rate

VTBI

Duration

Program

Options

Cancel/

Back

Drug

List

Enter value using keypad

5.5

0.5

00:05

mL/hr

hr : min

MedSurg

APROGRAM

Drug

Rate

VTBI

Delivery will be:

5.5

0.5

mL/hr

Confirm Program?

No Drug Selected

Yes No

MedSurg

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4- 8 430-95597-001 (Rev. 06/05)

Example of Main Delivery

Screen just after being

programmed and started.

NOTE: The Line A Fluid Flow

Indicator also will flash to indicate

pumping.

NOTE: VTBI (volume to be infused)

values over 100 mL are displayed

truncated. This means that the

number displayed rounds-down to the last whole number (e.g.,

105.7 would be displayed as 105). An example would be the

Programming or Pumping screens.

NOTE: VI (volume infused) values over 100 mL are displayed

rounded. This means that the number displayed rounds-off to

the nearest number (e.g., 105.7 would be displayed as 106, but

105.3 would be displayed as 105). An example would be the

Program Options screen.

Titration

1Select Line



[A] (or



[B]) at

the Main Delivery Screen.

PUMPING STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

MedSurg

PUMPING PUMPING

Rate

mL/hr

Vol Inf

Options/

Vol Inf

41 20

MedSurg

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Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 9

2Enter the desired Rate using

the keypad.

NOTE: When Rate is changed, the

duration is automatically recomputed

using the current VTBI. To

understand the Automatic Calculation

feature, see Examples of Automatic

Calculation on page 6-10.

3Press .

CAUTION: VERIFY ALL VALUES

BEFORE STARTING INFUSION.

Program Confirmation screen

will appear. If correct, press



[Yes] to begin infusion.

NOTE: During Titration, infuser

continues to deliver at previous parameters until new program is

confirmed.

Example of Main Delivery

Screen after being titrated.

NOTE: Volume Infused is an

incrementing value which is cleared



[Options/Vol Inf].

The following 3 screens are

examples of changed values.

APROGRAM

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Drug

List

Enter Value using keypad

03:20

MedSurg

APROGRAM

Drug

Rate

VTBI

Delivery will be:

mL/hr

Confirm Program?

No Drug Selected

Yes No

MedSurg

PUMPING PUMPING

Rate

mL/hr

Vol Inf

Options/

Vol Inf

41.

MedSurg

sec04.fm Page 9 Wednesday, June 8, 2005 8:22 AM

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4- 10 430-95597-001 (Rev. 06/05)

Example of changed rate.

4From the Main Delivery

Screen, select



[A].

5Use keypad to change the

RATE value.

NOTE: The display time is only

accurate to ± one minute. As shown in this example, the

delivery shows 3 hours and 20 minutes (not 3 minutes and 20

seconds).

6Press .

Program Confirmation screen will appear. If correct,

press



[Yes] to begin infusion.

NOTE: [START] accepts the change. Delivery is changed to the

new RATE and DURATION and display returns to Main Delivery

Screen.

Example of Changed VTBI

value.

7Use to highlight the VTBI

field.

8Use the keypad to change the

VTBI value.

NOTE: When the VTBI is changed, the Duration is recomputed

with respect to the current Rate. To understand the Automatic

APROGRAM

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Drug

List

Enter Value using keypad

03:20

MedSurg

APROGRAM

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Enter Value using keypad

100

06:40

MedSurg

Drug

List

sec04.fm Page 10 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 11

Calculation feature, see Examples of Automatic Calculation on

page 6-10.

9Press .

Program Confirmation screen will appear. If correct,

press



[Yes] to begin infusion.

NOTE: [START] accepts the change. Delivery is changed to the

new VTBI and DURATION and the display brings up the

Confirmation screen before returning to the Main Delivery

Screen.

Example of changed

DURATION field.

10 Use to highlight the

Duration field, then use the

keypad to change its value.

NOTE: When DURATION is

changed, RATE is automatically

recomputed using the current VTBI

value. To understand the Automatic

Calculation feature, see Examples of

Automatic Calculation on page 6-10.

11 Press .

CAUTION: VERIFY ALL VALUES BEFORE STARTING INFUSION.

Program Confirmation screen will appear. If correct,

press



[Yes] to begin infusion.

APROGRAM

Rate

VTBI

Duration

Program

Options

Cancel/

Back

Enter Value using keypad

150

100

00:40

mL/hr

hr : min

MedSurg

Drug

List

sec04.fm Page 11 Wednesday, June 8, 2005 8:22 AM

For Systems With Hospira MedNetTM Software

4- 12 430-95597-001 (Rev. 06/05)

NOTE: [START] accepts the change. Delivery is changed to the

new DURATION and RATE and the display brings up the

Confirmation screen before returning to the Main Delivery

Screen.

Piggyback Delivery

PIGGYBACK DELIVERY-

Infusion will stop Line A and

infuse Line B until VTBI

completes. Line A will

automatically restart.

1With Line A pumping, to

program a Piggyback delivery,

select



[B].

The Delivery Mode field is

highlighted.

NOTE: If an entry was previously

programmed, RATE is highlighted. If

no previous entries, MODE is

highlighted.

2If field reads “Concurrent”,

select



[Change Mode] to switch to

“Piggyback”.

PUMPING STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

20 0

! !

MedSurg

PROGRAM

Mode

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Change

Mode

Cancel/

Back

Change using Change Mode

Piggyback

00:00

MedSurg

Drug

List

sec04.fm Page 12 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 13

3Select to highlight the

RATE field.

4To enter delivery rate, use

numeric keypad.

5Use to move down to the

VTBI field.

6To enter VTBI amount, use

keypad.

NOTE: While the VTBI is being

entered, the duration is automatically

computed. If the computed value is

greater than 99:59, dashes (- -)

appear in place of hours. To

understand the Automatic Calculation

feature, see Examples of Automatic

Calculation on page 6-10.

PROGRAM

Mode

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Enter value using keypad

Piggyback

200

00:00

MedSurg

Drug

List

PROGRAM

Mode

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Enter value using keypad

Piggyback

200

100

00:30

MedSurg

Drug

List

sec04.fm Page 13 Wednesday, June 8, 2005 8:22 AM

For Systems With Hospira MedNetTM Software

4- 14 430-95597-001 (Rev. 06/05)

7Use to move down to the

DURATION field.

(Optional) Use keypad to

change duration.

When all parameters are

displayed, changing any one

parameter will result in other

parameters automatically being

computed.

8Press .

CAUTION: VERIFY ALL VALUES BEFORE STARTING INFUSION.

Program Confirmation screen will appear. If correct,

press



[Yes] to begin infusion.

NOTE: If Line A has a Delay Start remaining or is stopped, a

message will appear warning of a possible non-delivery (see

page 6-4).

Example of Main Delivery

Screen just after being

programmed and started.

PROGRAM

Mode

Rate

VTBI

Duration

Program

Options

Cancel/

Back

Enter value using keypad

Piggyback

133

100

00:45

mL/hr

hr : min

MedSurg

Drug

List

DELAYED PUMPING

Rate

mL/hr

Vol Inf

Options/

Vol Inf

5.5

20 0.

133

! !

MedSurg

sec04.fm Page 14 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 15

Concurrent Delivery

CONCURRENT DELIVERY-

Simultaneous delivery of two fluids at

independent flow rates.

CAUTION: CONSULT DRUG

LABELING TO CONFIRM DRUG

COMPATIBILITY, CONCENTRATION,

DELIVERY RATES, AND VOLUME ARE ALL

SUITABLE FOR CONCURRENT AND

PIGGYBACK DELIVERY MODES. SEE

SECTION 8 FOR INFORMATION ON

CONCURRENT FLOW, SEE SECTION 9

FOR DELIVERY RATE RANGES.

NOTE: In concurrent mode with certain alarm conditions, one

line may stop while the other line may continue to deliver.

1With pumping started on line A, to program a

Concurrent delivery rate, select



[B].

The Delivery Mode field is

highlighted.

NOTE: If an entry was previously

programmed, RATE is highlighted. If

no previous entries, MODE is

highlighted.

If field reads “Piggyback”,

select



[Change Mode] to

switch to “Concurrent”.

PUMPING STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

MedSurg

PROGRAM

Mode

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Change

Mode

Cancel/

Back

Change using Change Mode

Piggyback

00:00

MedSurg

Drug

List

sec04.fm Page 15 Wednesday, June 8, 2005 8:22 AM

For Systems With Hospira MedNetTM Software

4- 16 430-95597-001 (Rev. 06/05)

Verify change to “Concurrent”

mode.

2Use to highlight Rate field.

3To enter delivery rate, use

numeric keypad.

NOTE: When Rate for Line A plus

Rate for Line B is greater than valid

rate ranges, a “Concurrency violation”

message will explain why second line

did not start. See Section 9 for valid

delivery rate ranges.

NOTE: “Concurrency violation” may not be displayed if unit is

displaying “VTBI Complete”. The device will not start and an

invalid keypress sound will occur when [START] is pressed.

4Use to move down to the VTBI field.

5To enter VTBI amount, use

keypad.

NOTE: While the VTBI is being

entered, the duration is automatically

computed. If the computed value is

greater than 99:59, dashes (- -)

appear in place of hours. To

PROGRAM

Mode

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Change

Mode

Cancel/

Back

Change using Change Mode

Concurrent

00:00

MedSurg

Drug

List

PROGRAM

Mode

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Enter value using keypad

Concurrent

00:00

MedSurg

Drug

List

PROGRAM

Mode

Rate

VTBI

Duration

Program

Options

Cancel/

Back

Enter value using keypad

Concurrent

100

10:00

mL/hr

hr : min

MedSurg

Drug

List

sec04.fm Page 16 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 17

understand the Automatic Calculation feature, see Examples of

Automatic Calculation on page 6-10.

6Use to move down to the DURATION field.

(Optional) Enter values for desired hours and

minutes.

NOTE: When Duration is entered, Rate is automatically

computed.

7Press .

CAUTION: VERIFY ALL VALUES BEFORE STARTING INFUSION.

Program Confirmation screen will appear. If correct,

press



[Yes] to begin infusion.

Example of a concurrent

delivery.

PUMPING PUMPING

Rate

mL/hr

Vol Inf

Options/

Vol Inf

20.

! !

MedSurg

sec04.fm Page 17 Wednesday, June 8, 2005 8:22 AM

For Systems With Hospira MedNetTM Software

4- 18 430-95597-001 (Rev. 06/05)

Stop and Start with only 1 Line

Pumping

1Press at the Main

Delivery Screen.

NOTE: If



[A] (or



[B]) is selected

prior to pressing [STOP], the display

will return to the programming

screen. Select



[Cancel/Back] to return to the Main

Delivery screen.

Example of STOPPED

delivery.

2To discontinue infusion, press

3Clamp secondary tubing if

connected.

4Open door, remove set and close door. Or, press

to resume infusion.

PUMPING STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

Back

Prime

100

MedSurg

STOPPED STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

Back

Prime

100

MedSurg

sec04.fm Page 18 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 19

Stop and Start with Both Lines

pumping

1Press at the Main

Delivery Screen.

2Select



[Stop A],



[Stop B],



[Stop All].

NOTE: If



[A] (or



[B]) is selected

prior to [STOP], the display will show

the programming screen. Select



[Cancel/Back] to return to the Main

Delivery screen.

Example of stopped infusion.

NOTE: This is an example using



[Stop All].

CAUTION: VERIFY ALL VALUES

BEFORE STARTING INFUSION.

PUMPING PUMPING

Rate

mL/hr

Vol Inf

Options/

Vol Inf

3 20.

! !

MedSurg

PUMPING PUMPING

Rate

mL/hr

Vol Inf

Cancel

3 20.

Stop

All

Stop

Choose line(s) to stop:

! !

MedSurg

STOPPED STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

3 20.

Back

Prime

! !

MedSurg

sec04.fm Page 19 Wednesday, June 8, 2005 8:22 AM

For Systems With Hospira MedNetTM Software

4- 20 430-95597-001 (Rev. 06/05)

3To resume infusion,

press .

4Select



[Start A],



[Start B], or



[Start All].

Or, to discontinue infusion,

press .

5Clamp secondary tubing if connected.

6Open door, remove set and close door.

Backpriming

BACKPRIMING- Removal of air or

fluid from the proximal line and

cassette airtrap.

1To initiate a backprime, select



[Back Prime].

NOTE: Backpriming is available only

when all delivery is stopped.

Secondary container is necessary to

receive the air.

STOPPED STOPPED

Rate

mL/hr

Vol Inf

Cancel

3 20.

Start

All

Start

Choose line(s) to start:

! !

MedSurg

STOPPED STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

5.5

Back

Prime

MedSurg

sec04.fm Page 20 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 21

2Select and hold



[Back Prime] until fluid

pumped from line A to line B

has expelled the air from

cassette air trap into

Secondary container.

NOTE: Fluid flow is at maximum rate

possible.

3Upon release of



[Back Prime], the cassette test is

performed to confirm readiness for pumping.

Pressing will resume programmed delivery.

Clearing Settings

1Press at the Main

Delivery Screen.

Clear ALL settings when

changing patients or multiple

programming parameters.

BACKPRIMING

Rate

mL/hr

Vol Inf

Options/

Vol Inf

5.5

Back

Prime

Release Backprime to Stop

MedSurg

PUMPING STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

MedSurg

sec04.fm Page 21 Wednesday, June 8, 2005 8:22 AM

For Systems With Hospira MedNetTM Software

4- 22 430-95597-001 (Rev. 06/05)

2Select Line



[A] (or B if active)

from the stopped Main Delivery

Screen.

NOTE: If Line A or B is programmed

with a Therapy (i.e., Dose

Calculation), Rate, VTBI and

Duration will not display values. The

values to be cleared may be viewed

in applicable programming screen

under



[Drug List].

3Select



[Yes].

Clear ALL settings when

changing patients or multiple

programming parameters.

Example screen of “Cleared

Settings”.

4Select



[Cancel/Back] to

return to the Main Delivery

screen or program new

settings.

STOPPED STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

5.5

Back

Prime

MedSurg

PROGRAMA

Clear Line A Settings?

Yes N o

APROGRAM

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Enter Value using keypad

00:00

MedSurg

Drug

List

sec04.fm Page 22 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 4- 23

Updating Drug Library

If a new Drug Library is

available, the New Drug Library

Install screen will be displayed.

1Select



[Yes] to begin the

installation (It may take up to

an hour).

Select



[No] to skip the

installation and continue using

the current library.

Example screen of Library

Installing.

Library Install

Yes No

New Drug Library

Available

The Installation may

take up to an hour.

Ensure AC power cord

is plugged in.

Install Now?

Library Install

Installing

New Drug Library

The Installation may

take up to an hour.

Ensure AC power cord

is plugged in.

sec04.fm Page 23 Wednesday, June 8, 2005 8:22 AM

For Systems With Hospira MedNetTM Software

4- 24 430-95597-001 (Rev. 06/05)

NOTES

sec04.fm Page 24 Wednesday, June 8, 2005 8:22 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 5- 1

SECTION 5

Advanced Programs

NOTE: During programming, user must identify desired drug

with softkey Drug List prior to setting program parameters.

Use drug manufacturer recommendations for IV administration

when using the Plum A+ infuser.

Standard

Program

(Dose Calculation)

Allows programming Dose Rates in alternative

units of measure. Dose Calculation can be used

in Simple Delivery, Loading Dose, and

Multistep.

Dose

Allows programming of an initial infusion rate

for a specific volume, followed automatically by

a maintenance rate from the same container

(e.g., a fluid challenge).

If Dose Calc is used, the Loading Dose and

Maintenance Dose are in the same unit of

measure, over the same period of time

(mcg/min), from the same container.

Multistep

Allows a sequential program to deliver up to 10

steps; fluid volumes and delivery rates may be

programmed for each step. The program may

be entered based on Rate and Volume or

Volume and Time. If Dose Calc is used, the

delivery steps are in the same unit of measure,

over the same period of time, from the same

container.

sec05.fm Page 1 Wednesday, June 8, 2005 8:31 AM

For Systems With Hospira MedNetTM Software

5- 2 430-95597-001 (Rev. 06/05)

Dose Calc (mcg/kg/min on A)

DOSE CALCULATION- Allows programming Dose

Rates in alternative units of measure. Dose

Calculation can be used in Simple Delivery, Loading

Dose, and Multistep.

Clear ALL settings when changing patients or

multiple programming parameters.

The Area Selection screen will

appear if your system has been

programmed with the MedNet

accessory.

Use to select CCA and

bring you to the Main Delivery

Screen.

NOTE: To change the CCA while

infusing, see Changing CCA While Infusing on page 6-12.

1Select



[A] at the Main

Delivery Screen.

Area Selection

Enter

Select, then Enter

Any Hospital, USA

MM/DD/YY XXYYZZ- 123456

ICU

MedSurg

Cardio

Urology

Psych

Recov

L&D

5 West

Renal

Neo ICU

OB/GYN

Oncol

Ad ICU

7 South

3 North

4 North

STOPPED STOPPED

Rate

mL/hr

Vol Inf

Options/

Vol Inf

Back

Prime

MedSurg

**SCREENS SHOWN IN THIS MANUAL

ARE EXAMPLES ONLY AND DON’T

NECESSARILY REFLECT CURRENT

ACTUAL PRACTICE**

sec05.fm Page 2 Wednesday, June 8, 2005 8:31 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 5- 3

The Line A Programming

screen appears.

2Select



[Drug List] for Dose

Calculation programming.

The Drug List Screen appears,

in mainly alphabetical order.

NOTE: Default entry is “No Drug

Selected”.

3Use to highlight desired

drug name.

When list does not contain

desired generic drug name or

group name select



[Page Down] (or



[Page

Up]) until it shows, then use

to highlight choice.

4Select



[Enter] to indicate selection and advance to

the Therapy selection screen.

Based on this selection, assume the hospital has set

the following rules for the Med/Surg Area:

APROGRAM

Rate

VTBI

Duration

mL/hr

hr : min

Program

Options

Cancel/

Back

Drug

List

Enter Value using keypad

00:00

MedSurg

AMedSurg

Page

Down

Cancel/

Back

Enter

Select, then Enter

No Drug Selected

Albumin 5%

Aldesleukin

Alfentanil

Alteplase

Amikacin

Amiodarone

25 grams/500 mL

2.6 mg/50 mL

10 mg/250 mL

50 mg/50 mL

100 mg/100 mL

100 mL

150 mg/100 mL

AMedSurg

Page

Down

Cancel/

Back

Enter

Select, then Enter

Antibiotic

DOBUTamine

Docetaxel

DOPamine

Heparin

250 mg/500 mL

500 mg/500 mL

100 mg/250 mL

___ ___/___ mL

400 mg/250 mL

800 mg/250 mL

25,000 units/500 mL

sec05.fm Page 3 Wednesday, June 8, 2005 8:31 AM

For Systems With Hospira MedNetTM Software

5- 4 430-95597-001 (Rev. 06/05)

Soft upper limit of 8 mcg/kg/min

Hard upper limit of 12 mcg/kg/min

NOTE: The SOFT and HARD limits are not displayed. However,

the limit is provided if a value is programmed outside the

acceptable range. Typically, the pharmacy will set the limit.

The Select Therapy screen for

Line A appears.

5Select



[Choose] to select

Standard Program (Dose Calc)

and continue.

If selected drug has been

programmed with established

dosing units and concentration,

skip to step 8.

The Program Dose Calc

screen appears.

NOTE: Cursor defaults to package

insert (or hospital) recommended

dose units associated with the

selected drug.

6Select



[Choose] to continue.

Or, use to change the units

to use in the delivery.

If desired, select



[Page Down] to see more units of

measure.

APROGRAM

Choose Back

Select, then Choose

Standard Program

Loading Dose

Multistep

DOPamine

AProgram Dose Calc

Choose Back

Select, then Choose

mL/hr

mcg/kg/min

mcg/kg/hr

mcg/min

mcg/hr

mg/kg/hr

mg/min

mg/hr

grams/hr

ng/kg/min

mmol/min

mmol/hr

mEq/hr

DOPamine

Page

Down

sec05.fm Page 4 Wednesday, June 8, 2005 8:31 AM

Plum A+® Infusion Systems

430-95597-001 (Rev. 06/05) 5- 5

The Container Concentration

Selection screen appears

whenever the selected Dose

Units are gram-based (e.g.,

grams, mg, mcg, or ng),

otherwise this screen is

skipped.

NOTE: Cursor defaults to package

insert (or hospital) recommended

concentration units associated with

the selected drug.

7Select



[Choose] to continue. Or, use to change

the Container Concentration units to use in the

delivery.

The next page of the Program

Dose Calc screen appears to

provide for entry of delivery

program parameters.

The Concentration and Volume

fields are filled in per drug

selection.

8Use keypad to enter desired

values. Once each value is entered, use to

highlight the next programming field.

NOTE: The Concentration elements and weight value must be

entered before the [SELECT] key allows access to remaining

fields.

AProgram Dose Calc

Choose Back

Select, then Choose

Drug Conc in Container

mcg

grams

DOPamine

AProgram Dose Calc

Program

Options

Cancel/

Back

Enter value using keypad

Conc

Weight

400

250 mL

Dose

VTBI

Duration

Rate

00: 00

mcg/kg/min

hr : min

mL/hr

DOPamine

sec05.fm Page 5 Wednesday, June 8, 2005 8:31 AM

For Systems With Hospira MedNetTM Software

5- 6 430-95597-001 (Rev. 06/05)

9Continue to enter values using

the keypad, and advancing to

the next field using .

NOTE: As the Dose value is entered,

the Rate is automatically calculated.

To understand the Automatic

Calculation feature, see Examples of

Automatic Calculation on page 6-10.

10 Use to scroll down to the

VTBI field.

11 Enter a value for VTBI using

the keypad.

NOTE: As the VTBI value is entered

or changes, Duration is automatically

updated.

NOTE: At this point, programming is complete unless



[Program Options] are desired. See Section 6, Additional

Features, for more information.

12 Press .

CAUTION: VERIFY ALL VALUES BEFORE STARTING INFUSION.

AProgram Dose Calc

Program

Options

Cancel/

Back

Enter value using keypad

Conc

Weight

400

250 mL

Dose

VTBI

Duration

Rate

00: 00

26.

mcg/kg/min

hr : min

mL/hr

DOPamine

AProgram Dose Calc

Program

Options

Cancel/

Back

Enter value using keypad

Conc

Weight

400

250 mL

Dose

VTBI

Duration

Rate

250

09: 30

26.

mcg/kg/min

hr : min

mL/hr

DOPamine

sec05.fm Page 6 Wednesday, June 8, 2005 8:31 AM

ICU Medical 20678-04-01 Infusion System with Hospira MedNet (TM) Software User Manual Cover

Hospira, Inc. Infusion System with Hospira MedNet (TM) Software Cover

Contents

Users Manual Part I

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