MIR Medical Research MIR040 Portable multipurpose and multifunction spirometer User Manual spiro

MIR Medical International Research Portable multipurpose and multifunction spirometer spiro

UserMan

 Spirodoc      cod. 980156   Rev 1.3      EN 1/67  ENGLISH  Spirodoc  User Manual Rev. 1.3    Issued on     27/04/2010 Approved on    27/04/2010   INDEX  1. EQUIPMENT AND ACCESORY LIST ................................................................ 3 2. INTRODUction ................................................................................................... 4 2.1 Intended use ................................................................................................ 4 2.1.1 User category .......................................................................................... 5 2.1.2 Ability and experience required ............................................................... 5 2.1.3 Operating Environment ........................................................................... 5 2.1.4 Who can or must make the installation.................................................... 6 2.1.5 Patient effect on the use of the device .................................................... 6 2.1.6 Limitations of use - Contraindications...................................................... 6 2.2 Important safety warnings............................................................................ 6 2.2.1 Danger of cross-contamination ............................................................... 7 2.2.2 Turbine .................................................................................................... 7 2.2.3 Mouthpiece .............................................................................................. 8 2.2.4 I Oximetry sensor .................................................................................... 8 2.2.5 Device ................................................................................................... 10 2.3 Unforeseen errors ...................................................................................... 11 2.4 Lithium-ion battery pack warning ............................................................... 11 2.5 Labels and symbols ................................................................................... 14 2.5.1 Identification label.................................................................................. 14 2.5.2 CE mark for medical devices ................................................................. 14 2.5.3 Electrical safety symbol ......................................................................... 14 2.5.4 Warning symbol for the RS232 serial port ............................................. 14 2.5.5 Warning symbol for the USB serial port ................................................ 14 2.5.6 Warning symbol for the SpO2 port for oximetry .................................... 15 2.5.7 Warning symbol for the WEEE .............................................................. 15 2.5.8 FDA and FCC Warnings ........................................................................ 15 2.5.9 Product description................................................................................ 16 2.6 Technical specifications ............................................................................. 18 2.6.1 Features of the spirometer .................................................................... 18 2.6.2 Oximeter features .................................................................................. 19 2.6.3 Other features ....................................................................................... 23 3. Functioning of the SPIRODOC .......................................................................... 23 3.1 Display ....................................................................................................... 23 3.2 Accensione e spegnimento di SPIRODOC ................................................ 24 3.3 Symbols and Icons .................................................................................... 24 3.4 Energy saving ............................................................................................ 25 3.5 Information ................................................................................................. 25 3.6 Service menu ............................................................................................. 26 3.6.1 Patient Mode ......................................................................................... 31 3.6.2 Reusable turbine calibration .................................................................. 32 3.7 Patient Data ............................................................................................... 34 3.7.1 Inserting data of a new patient .............................................................. 34
 Spirodoc      cod. 980156   Rev 1.3      EN 2/67  ENGLISH 3.7.2 Patient data modification ....................................................................... 35 3.8 Visualization of memory data ..................................................................... 36 3.8.1 Database research modality .................................................................. 36 3.8.2 Visualization of database info ................................................................ 36 3.9 Display of last session from current patient. .............................................. 37 3.10 PC On line mode (connected to a PC) ...................................................... 37 3.11 Spirometry testing ...................................................................................... 38 3.11.1 FVC test ................................................................................................ 39 3.11.2 Test VC ................................................................................................. 40 3.11.3 MVV Test .............................................................................................. 40 3.11.4 POST test, after drug administration ..................................................... 40 3.12 Viewing the spirometric results .................................................................. 41 3.12.1 Spirometry Test Interpretation ............................................................... 41 3.13 Oximetry Testing ....................................................................................... 43 3.13.1 Walk test (6MWT).................................................................................. 46 3.13.2 Sleep Oximetry ...................................................................................... 48 3.13.3 Oximetry SpO2/BPM ............................................................................. 49 3.13.4 Instructions for Adult Single Patient Sensor .......................................... 49 4. datA TRANSMISSION ...................................................................................... 50 4.1 Data Transmission via Bluetooth to a cell phone ....................................... 51 4.1.1 Preliminary Operations .......................................................................... 51 4.1.2 Bluetooth data transmission. ................................................................. 51 4.2 Data transmission via Bluetooth for printing .............................................. 52 WARNING ............................................................................................................... 52 4.2.1 How to print a test saved in the database ............................................. 52 4.3 PC connection via USB port ...................................................................... 52 4.4 PC connection via Bluetooth ...................................................................... 53 4.5 Internal software upgrade .......................................................................... 53 5. MAINTENANCE ............................................................................................... 53 5.1 Cleaning and checking the reusable turbine .............................................. 54 5.1.1 Proper turbine operation check ............................................................. 55 5.2 Oximetry sensor cleaning .......................................................................... 55 5.3 Changing the adhesive wrap sensor ......................................................... 56 5.4 Battery charging ........................................................................................ 56 6. PROBLEM SOLVING ....................................................................................... 56 6.1 Causes and solutions ................................................................................ 56 LIMITED WARRANTY CONDITIONS ......................................................................... 59 ALLEGATO 1 OXIMETRY TEST REPORTS EXAMPLES .................................. 60 ALLEGATO 2 SPIROMETRY TEST REPORT EXAMPLE .................................. 63 ANNEX 3 INFORMATION  FOR  CORRECT  USE  IN  AN  ELECTROMAGNETIC ENVIRONMENT.......................................................................................................... 64
 Spirodoc      cod. 980156   Rev 1.3      EN 3/67  ENGLISH 1.  EQUIPMENT AND ACCESORY LIST  Thank you for choosing a MIR product  MEDICAL INTERNATIONAL RESEARCH  The original packaging of the product contains one of the following spirometers with the following accessories:  spirometer configuration  Spirometer and oximeter configuration Accesssories sold with SPIRODOC COD.  Accessories sold with SPIRODOC COD. Carrying bag SPIRODOC 672690 Carrying bag SPIRODOC 672690 Device SPIRODOC 910575 Device SPIRODOC with oximetry function 910570 User manual SPIRODOC 980205 User manual SPIRODOC 980205 USB cable  532365 USB cable  532365 Lithium-ion battery pack 970080 Lithium-ion battery pack 970080 winspiroPRO CD 920100 winspiroPRO CD 920100 1 noseclip 910320 1 noseclip 910320 4 paper mouthpieces * 910300 4 paper mouthpieces * 910300 1 reusable turbine 910002 1 reusable turbine 910002 3 disposable turbines 910001 3 disposable turbines 910001   1 oximetry sensor 919010     Accessori COD. Accessori COD. Battery  charger  with  micro USB connector 920680 Battery charger with micro USB connector 920680   Disposable  adult  oximetry sensor  for  extended  length  of time screening* 919007    Extension  cable  for  oximetry sensor 919090  *  disposable accessory: all other accessories are reusable  Before using your SPIRODOC  Read carefully  your  User Manual and pay  attention  to all the warnings and  labels including all relevant information included with the product.  If necessary pay attention to the correct polarity “+” & “-“ when inserting the battery pack as indicated in the battery housing  Set the device configuration (date, hour, predicted set, language,  ecc) as described in paragraph 2.4   WARNING Before connecting the SPIRODOC to the PC, the winspiroPRO PC software supplied with  the  device  must  be  installed  correctly in  the  PC.  The  device may be connected to the PC only after the winspiroPRO software has been installed. Once the new hardware is "recognised" by the PC the device may now be used with the winspiroPRO software.
 Spirodoc      cod. 980156   Rev 1.3      EN 4/67  ENGLISH  Keep the original packaging! In the unlikely event that you have a problem with your device please use the original packaging and return it to the distributor or manufacturer.  Should this be the case, please follow these guidelines:    Return the complete device in the original packaging.   Shipping costs any any customs duties must be paid by the sender.  Manufacturer‟s address:  MIR SRL VIA DEL MAGGIOLINO, 125 00155 ROME (ITALY)  Tel ++ 39 0622754777 Fax ++ 39 0622754785 Web site: www.spirometry.com Email: mir@spirometry.com  MIR has a policy of continuous product development and improvement. MIR reserves the right to modify and update the information in this User’s Manual as  deemed  necessary.  Any  suggestions  and  or  comments  regarding  this product may be sent via email to: mir@spirometry.com.  MIR accepts no responsibility for any loss or damage caused by the user of the  device  due  to  instructions  contained  in  this  Manual  and/or  due  to  incorrect use of the product. Please  note that  due  to  printing  limitations,  the  screenshots shown in  this manual may differ from the display of the machine and/or from the keyboard icons.  Copying this manual in whole or in part is strictly forbidden.  FEDERAL LAW RESTRICTS THIS DEVICE TO SALE BY OR ON THE ORDER OF A PHYSICIAN  2.  INTRODUCTION  2.1  Intended use  The Spirodoc spirometer and pulse oximeter is intended to be used by a physician or by a patient under the supervision/instruction of a physician or paramedic. The lung function testing device is capable of performing:    spirometry testing in people of all ages, excluding infants and neonates   oximetry testing in people of all ages.  It can be used in any setting.
 Spirodoc      cod. 980156   Rev 1.3      EN 5/67  ENGLISH  2.1.1  User category SPIRODOC spirometer + oximeter calculates a series of parameters relating to human respiratory function. Typically the doctor “prescribes” a spirometry test and is responsible for analysing and checking the results obtained.  2.1.2  Ability and experience required The correct use of the device, the interpretation of the results and the maintenance of the device all require qualified personnel. In the event that the device is to be operated by a patient, sufficient training must first be given to the patient by the doctor or by a trained paramedic under the supervision of a doctor.   WARNING The manufacturer cannot be held responsible for any damage caused by the user of the device failing to follow instructions and warnings in this manual.  If the user of the device is a person considered to be cognitively impaired the operation  of  the  device  must  be  made  under  the  supervision  and responsibility of whoever is legally responsible to supervise this person.   WARNING When  used  as  a  pulse-oximeter,  the  SPIRODOC  is  intended  for  spot-checking,  overnight  sleep  screening  and/or  continuous  monitoring  when used by a trained healthcare professional.  2.1.3  Operating Environment SPIRODOC has been designed for use in the doctor‟s office, in a hospital or directly by the  patient  to  continuously  monitor  her/his  physical  conditions  during  routine  daily activities.  All  information  necessary  for  the  proper  use  of  the  device  in  an electromagnetic environment (as required by the EN 60601-1-2 Standard) is available in Annex 3 of this manual. Used at home, at work, at school or during physical activity, day after day the device records data and functional respiratory parameters for weeks or even months, helping the patient  to better assess her/his own health. The procedures for using the device at home are described according to the type of test  to  be  made;  the  display  will  show  all  instructions  (messages,  suggestions  etc.) step-by-step,  which  allows  the  patient  to  correctly  perform  tests  and  obtain  correct results, to be analysed by the doctor. The  device  is  not  intended  for  use  in  an  operating  theatre  nor  in  the  presence  of inflammable  liquids  or  detergents,  nor  in  the  presence  of  inflammable  anaesthetic gases (oxygen or nitrogen). The device is not designed to be used in direct air drafts (e.g. wind), sources of heat or cold, direct sunlight  or  other sources  of  light  or energy, dust, sand or any    chemical substances.  The user and/or doctor is responsible for ensuring that the device is stored and used in appropriate  environmental conditions; in  this  regard  reference  is  made  to  the specifications described in paragraph 2.7.3 below.
 Spirodoc      cod. 980156   Rev 1.3      EN 6/67  ENGLISH   WARNING Exposure  to  unsuitable environmental  conditions  may  cause  the device  to malfunction, and to provide incorrect results.  2.1.4  Who can or must make the installation The device requires installation by  qualified personnel. The doctor will  configure the device before handing it over to the patient for homecare use.  2.1.5  Patient effect on the use of the device A spirometry test should only be  carried  out  when the patient  is at rest and in good health, in suitable testing conditions. A spirometry test requires the full collaboration of the patient since she/he must perform a complete forced expiration, in order to obtain a reliable test result.   2.1.6  Limitations of use - Contraindications An  analysis  of  the  results  of  a  spirometry  test  is  not  by  itself  sufficient  to  make  a correct  diagnosis  of  the  patient‟s  clinical  condition.  A  detailed  clinical  history  of  the patient is also required together with the results of any other test(s) suggested by a doctor. Test  comments,  a  test  interpretation  and  suggested  therapeutic  treatment  must  be given by a doctor. Any symptoms that the patient has at the time of the test must be carefully considered before a spirometry test is made. The user is responsible to assess both the  mental and the physical condition of the patient in order to perform a proper test, furthermore, in the evaluation of test results, the user must also assess the degree of collaboration of each test carried out. A spirometry test requires the full collaboration of the patient. The results depend on the person‟s ability to inspire as much air  as possible and to expire  all of the air as fast and for as long as possible. If these fundamental conditions are not achieved the results  obtained  during  spirometry  testing  may  not  be  considered  accurate,  and  “acceptable”.  The acceptability of a test is the responsibility of the doctor. Special attention should be given when testing elderly patients, children and handicapped people. The device should not be used if any conceivable or actual anomalies or malfunctions appear which may compromise the accuracy of the results.   WARNING When used as a pulse oximeter the SPIRODOC has limited alarms, therefore the device requires that the user frequently observe the SpO2 and pulse rate on the display.  2.2  Important safety warnings  SPIRODOC has  been  examined  by an  independent  laboratory  which  has  certified the  compliance  of  the  device  to  the  European  Safety  Standards  EN  60601-1  and guarantees  the  EMC  Requirements  within  the  limits  laid  down  in  the  European Standard EN 60601-1-2.
 Spirodoc      cod. 980156   Rev 1.3      EN 7/67  ENGLISH SPIRODOC is continuously checked  during manufacturing and therefore the product complies  with  the established security levels and  quality standards laid down by  the Council Directive 93/42/EEC for MEDICAL DEVICES. After  removing  the  device  from  its  packaging,  check  to  see  that  there  is  no  visible damage. In case of damage do not use the device and return it to the manufacturer for repair. WARNING    The safety and the correct performance of the device can only be assured if the user respects all of the relevant safety rules and regulations.  The  manufacturer  will  not  be  held  responsible  for  damage  due  to  user’s neglect to correctly to follow these instructions.  The device must be used only and exclusively as a spirometer following the indications  given  by  the  manufacturer  with  particular  attention  to  the paragraph  on  INTENDED  USE,  and  utilizing  only  original  spare  parts  and accessories. Use of non-original parts such as the turbine flow sensor and oximetry  sensor  or  other  accessories  may  cause  errors  in  measurement and/or compromise the correct functioning of the device, and is therefore not permitted. The device should not be used beyond the declared life span. The life span is strictly  related  to  the  life  of  the  internal  lithium  battery  pack.  In  normal conditions  the  lifespan  of  the  battery  pack  is  estimated  to  be  around  10 years. The device constantly monitors the state of charge of this battery and a message informs the user when the battery is discharged.  In the event of any incident or accident of any kind resulting from the use of the device, the user is required to inform the manufacturer without delay, this procedure is laid down in Article.9 of the European Regulations No. 46/1997, which implemented the EC Directive No. 93/42.  2.2.1  Danger of cross-contamination Two different types of turbine sensors can be used with the device, one is reusable and  the  other  is  single-patient  disposable.  A  disposable  mouthpiece  is  required  in order to connect a patient to the spirometer. In order to avoid exposing the patient to the  critical  danger of cross-contamination,  the reusable flow sensor  must always be cleaned before each spirometry test, and a new disposable mouthpiece must always be used for each patient. The use of an anti-bacterial filter is at the discretion of the doctor. If a single-patient disposable turbine is used, then a new one must be used for each patient.  2.2.2  Turbine  Disposable turbine  WARNING If  you  are  going  to  perform  a  spirometry  test  with  a disposable turbine  it  is important  to  use a  new turbine for  each  new  patient.  The  features,  accuracy  and  hygiene  of  the  disposable  turbine  can  only  be guaranteed  if  it  has  been  conserved  beforehand  in  its original sealed packaging.
 Spirodoc      cod. 980156   Rev 1.3      EN 8/67  ENGLISH The disposable turbine is made of plastic and its disposal after use should adhere to the local regulations and norms in force.  Reusable turbine The correct functioning of the re-usable turbine can only be guaranteed if it has been cleaned in the correct manner and is free from foreign bodies which could alter its movement. If  the  turbine  has  not  been  cleaned  sufficiently  this  could cause  cross-contamination  from  one  patient  to  another. Periodic cleaning should only be  done when the device is for personal use and will only be used by one patient. The cleaning  of  the  turbine  should  be  performed  according  to the instructions contained in the User’s Manual.  The following information applies to both turbine models. The turbine must never be held under running water or direct air pressure and must never come into contact with hot fluids.  Do not allow dust or foreign bodies to enter the turbine sensor which may alter the correct functioning and possibly cause damage. The presence of any impurities such as  hair,  sputum,  threads  etc.  within  the  body  of  the  turbine  sensor  may  seriously compromise the accuracy of the measurements.  2.2.3  Mouthpiece Any  disposable  mouthpieces included  with  the  spirometer are  only  to be used  as a reference guide to purchase the correct size mouthpiece required. These mouthpieces are clean but not sterile. To purchase appropriate mouthpieces, generally either paper or plastic, single-use/disposable, we suggest that you contact your local distributor.   WARNING  Use  a  bio-compatible  mouthpiece  to  avoid  any  problems  to  the  patient; unsuitable  materials  could  cause  the  device  to  malfunction,  consequently providing incorrect test results.  The  user  is  responsible  for obtaining  the  proper  mouthpieces  for  the  device.  Those required are a standard type with an outside diameter of 30 mm, they are commonly used and in general easily procured.    WARNING To  avoid  environmental  contamination  caused  by  the  disposal  of  used mouthpieces, the user must follow all the relevant local regulations.  2.2.4  I Oximetry sensor The oximetry sensors which can be used with SPIRODOC are the following:  Manufacturer Code Description BCI 1300 adult sensor (disposable) BCI 3026 wrap-around sensor for infants
 Spirodoc      cod. 980156   Rev 1.3      EN 9/67  ENGLISH BCI 3043 universal Y sensor BCI 3078 ear sensor BCI 3178 pediatric finger sensor, reusable BCI 3444 adult sensor reusable (Comfort Clip) BCI 3044 adult finger sensor, reusable  These  sensors  require  the  use  of  an  extension  cable  (product  code  919200)  for  a proper connection to the device. The same sensors are also available with a microconnector for a direct connection.  Prolonged  use  and/or  the  patient‟s  condition  may  require  changing  the  sensor  site periodically. Change sensor site and check skin integrity, blood circulation, and correct sensor alignment at least every 4 hours.    WARNING  Incorrectly  applied  oximetry  sensors  or  damaged  cables  may  cause inaccurate  readings.  Using  a  damaged  oximetry  sensor  may  cause inaccurate  readings,  possibly  resulting  in  patient  injury  or  death.  Inspect each oximetry sensor before use.  If an oximetry sensor appears damaged, do not use it. Use another oximetry sensor or contact your authorized repair center for assistance.  Use only MIR oximetry sensors supplied with, or specifically intended for use with  SPIRODOC.  Use  of  oximetry  sensors  not  intended  for  use  with  the SPIRODOC may cause inaccurate readings.  Oximetry measurements may be inaccurate in the presence of high ambient light. Shield the sensor area (with a surgical towel, for example) if necessary.    WARNING Dyes introduced into the bloodstream, such as methylene blue, indocyanine green, indigo carmine, patent blue V (PBV), and fluorescein  may adversely affect the accuracy of the oximetry reading.   Any condition that restricts blood flow, such as the use of a blood pressure cuff or a device for systemic vascular resistance, may cause an inability to determine accurate pulse rate and SpO2 readings. Remove  fingernail  polish  and/or  false  fingernails  before  applying  SpO2 sensors. Both may cause inaccurate oximetry measurement.  Significant levels of dysfunctional hemoglobins, such as carboxyhemoglobin or  methemoglobin,  may  adversely  affect  the  accuracy  of  the  oximetry measurement.  Optical cross-talk can occur when two or more sensors are placed in close proximity.  Optical  cross-talk  may  adversely  affect  the  accuracy  of  the oximetry readings. The danger can be eliminated by covering each site with opaque material.
 Spirodoc      cod. 980156   Rev 1.3      EN 10/67  ENGLISH Obstructions  or  dirt  on  the  sensor’s  emitter  and/or  detector  may  cause  a sensor failure or inaccurate readings. Make sure there are no  obstructions and the sensor is clean.  Autoclaving,  ethylene  oxide  sterilizing,  may  cause  sensor  damage.  Do  not attempt to sterilize the sensor.  Unplug  the  sensor  from  spirodoc before  cleaning  or  disinfecting  to prevent damaging sensor or device, and to prevent safety hazards for the user.  2.2.5  Device  WARNING The  maintenance  operations  detailed  in  this  manual  must  be  fully  and accurately carried out. If these instructions are not followed this may cause measurement errors and/or an incorrect test interpretation.  Any modifications,  adjustments,  repairs  or  reconfigurations  must  be  made by the manufacturer or by personnel authorised by the manufacturer. Never attempt to make a repair on your own. The set-up of configurable parameters should only be made by qualified personnel. However, an incorrect set-up of the parameters in no way endagers the patient’s health. High-frequency  emissions  from  “electronic”  devices  may interfere  with  the correct operation of the device. For this reason, certain minimum clearances (a few meters) should be observed when high-frequency appliances such as a TV, radio, portable phone, etc. and other electronic units are operated at the same time in the same room.  The  device  may  give  inaccurate  readings  if  operated  in  the  presence  of strong electromagnetic sources, such as electrosurgical equipment, or in the presence of computed tomography (CT) equipment.  Do not use the device in the presence of magnetic resonance imaging (MRI) equipment.  MRI  equipment  may  cause  an  induced  current  to  the  oximetry sensor, resulting in patient injury. If the PC and/or the printer connected  to  the SPIRODOC come into contact with  the  area  containing  patient  data,  ref.  directive  EN  60601-1-1,  it  is necessary that they conform to the directive EN 60601-1. To  dispose  of  the  SPIRODOC,  the  accessories,  any  plastic  consumable materials  (mouthpieces)  as  well  as  the  battery,  use  only  appropriate containers or return all such parts to the dealer or to a recycling center. All applicable local regulations must be followed.  If any of these rules are not followed then MIR will decline all responsibility for any direct or indirect damages, however caused. Use only the battery type indicated in the § Technical specifications. Remove  the  battery  from  the  device  if  the  machine  is  not  used  for  a  long period (several months). The device may be powered through a PC by a USB cable. By this means, the device works both on line with the PC, or individually powered by the PC. Keep  the  device  out  of  reach  of  children  and  of  any  person  with  mental handicap.
 Spirodoc      cod. 980156   Rev 1.3      EN 11/67  ENGLISH 2.3  Unforeseen errors  In case device internal memory data is damaged, when the device is switched on, the following message appears:  Error on RAM memory Recovery data Please wait  If data has been successfully recovered, the device  completes the standard turn on procedure, otherwise please contact an authorized technical assistance center or the manufacturer. In case of a problem with the device, a message indicating the nature of the problem will appear on the screen, together with a warning “beep”. Operation of the device beyond its declared life (see §  1.6 Technical Specifications) could cause a loss of data in the memory of the device (SRAM memory). Errors in measurement or in interpretation can also be caused by:    use by non-qualified or non-trained personnel, lacking ability or experience   user error   use of the device outside the guidelines described in this User's Manual   use of the device even when some operational anomalies are encountered  non-authorised servicing of the device.  2.4  Lithium-ion battery pack warning  The device is powered by a rechargeable lithium-ion battery pack. A charger is also supplied with the device which delivers 3.7 volts.  For proper use of the battery pack please read carefully the warning below     WARNING Do not use the battery pack for any purposes different from those specified. The battery  characteristics  may  change,  consequently  the  battery  life  may  be reduced  significantly.  The  battery pack  may generate  an  electrical  overcharge which may cause acid leakage, overheating, smoke, breakage and fire. Improper  use  of  the  battery  pack  may  cause  leakage,  overheating,  smoke, breakage and fire. This may cause performance deterioration and damage. This may also damage the protector installed in the battery pack. This may damage the device and harm the user. Please read the following instructions carefully. If  acid  from  the  battery  pack  comes  into  contact  with  skin  or  clothing immediately wash with running water to avoid skin inflammation. If the battery acid inadvertently enters  the eyes do not rub  the eyes, instead wash  the eyes with clean running water and call a doctor immediately.  If upon first use there is a bad smell, overheating or other anomalies do not use the battery pack and return it to the supplier or manufacturer. Only use suitable battery chargers and follow the instructions. Do not connect the battery to an electric plug or lighter.  During charging Before charging the battery pack carefully read the user manual.
 Spirodoc      cod. 980156   Rev 1.3      EN 12/67  ENGLISH Do not charge near electric static generators, Do not charge near a fire or extreme heat. High  temperatures  may  alter  the  characteristics of  the internal  protector,  stop recharging or actually cause recharging with higher voltages. This may result in abnormal  chemical  reactions, acid  leakage,  overheating, smoke, breakage  and fire. The battery pack comes with an internal safety protector. Do not use the device near static electricity (superior to what is declared by the manufacturer). Static electricity may damage the internal protector causing acid leakage, overheating, smoke, breakage and fire. Do not leave the battery pack charging longer than the average charging length of time specified. Do not recharge near electric static generators  During battery pack use Recharge  the  battery  pack  with  a  specifically  designated  battery  charger  and observe the charging procedure as specified by the manufacturer.  Recharging  without  adhering  to  proper  recharging  conditions  may  cause  the battery  to  overcharge  at  extremely  high  voltage.  Various  abnormal  chemical reactions  may  occur  such  as  acid  leakage,  overheating  of  the  battery,  smoke emission, breakage and fire.   The  battery  pack  may  be  used  within  a  temperature  range  from  −20°C  e  to approximately 60°C. Do not heat or throw the battery in a fire. Do not use or store the battery near a fire or if the temperature inside a vehicle may reach 60°C or become higher. Do not immerge the battery pack in water or salt-water, and do not leave it wet. Such  events  may  damage  the  inner  safety  functions  which  could  cause  the battery  to  be  charged  at  high  voltage  thus  triggering  abnormal  chemical reactions leading to acid leakage, overheating, smoke, and fire. Do  not  place  the  battery  pack  in  your  pocket  or  in  a  bag  with  other  metallic objects such as coins, necklaces, scissors and screws. Do not store the battery pack anywhere near these objects. Do not short-circuit the positive (+) and negative (-) poles with metallic objects. Do  not  connect  the  battery  pack  to  an  electric  socket  or  to  an  automobile Sigarette lighter, ecc. If the battery is connected to a source of high voltage this high current surge may cause acid leakage, overheating, smoke, breakage and fire.  Do not mount the battery pack inside the device with the + and – poles inverted.  If the battery leads do not connect easily to the battery charger or to the device do not  apply excessive force. Check to see that the leads are properly aligned. If the leads are inverted, an inverse polarity may be caused by the connection thus   creating  the  possibility  for  acid  leakage,  overheating, smoke,  breakage  and/or fire.  Do not puncture the battery pack with sharp objects such as a nail. Do not hammer, step-on, throw or cause a forceful impact to the battery-pack. A damaged or deformed battery pack may cause internal short-circuits thus
 Spirodoc      cod. 980156   Rev 1.3      EN 13/67  ENGLISH creating  the  possibility  for  acid  leakage,  overheating,  smoke,  breakage  and/or fire.  Do  not  in  any  way  disassemble  or  modify  the  battery-pack;  the  battery  pack comes with an internal safety protector, which if tampered with may cause acid leakage, overheating, smoke, breakage and/or fire. Do not solder the battery pack. Do not use a heavily scratched or deformed battery back as this may be cause for acid leakage, overheating, smoke, breakage and/or fire.  If the battery pack emanates a bad odor, if it generates heat, if it fades/deformes or  if  anything  abnormal  happens  during  storage,  usage  and  recharging immediately remove the battery pack from the device or the battery charger and do  not  use  any  further,  as  any  of  these  events  may  cause  acid  leakage, overheating, smoke, breakage and/or fire.   When the battery pack is disconnected from the device or the charger verify the correct position of the (+) and (-) poles without forcing the connection. Store  the  battery  pack  away  from  children’s  reach  so  as  not  to  accidentally swallow the battery pack.  If a child uses the battery pack an adult must explain the proper use to the child.  Before using the battery pack carefully read the manual paying attention to all the recommendations for proper handling.  For  information  concerning  the  installation  and  removal  of  the  battery  pack carefully read the manual of the device. The cycle-life of the battery pack is definite. If  you notice a much shorter time usage between charges please substitute the battery pack with a new one. Remove the battery pack if its cycle life has expired.  When the battery pack has been  removed from the device, ensure  that  the  (+) and (-) leads have been isolated with electrical tape; to properly dispose of the battery pack please follow the local regulations or hand over the battery pack to a battery recycling center.  Prior to storage or for long periods of disuse of the device remove the battery pack  and  store  in  a  place  where  the  temperature  and  humidity  fall  within specified ranges.  Keep  the  battery  pack  away  from  objects  which  may  emit  static  electrical charges.  If the battery pack leads are dirty clean with a dry cloth prior to usage. The battery pack may be stored within a temperature range between −20°C and 60°C Do  not  place  the  battery  in  a  micro-wave  oven  or  in  a  pressurized  container. Rapid  overheating  or  loss  of  proofing  may  cause  acid  leakage,  overheating, smoke, breakage and/or fire. If the battery pack leaks acid or gives off a bad smell, move it away from flames.
 Spirodoc      cod. 980156   Rev 1.3      EN 14/67  ENGLISH Electrolyte leakage  may cause  a  fire and  the  battery  pack  may emit  smoke or even explode and ignite.  2.5  Labels and symbols  2.5.1  Identification label   The label shows:   Serial number of the device   Product name   Name and address of the manufacturer   Electrical safety symbol   CE mark in compliance with the Directive 93/42 EEC.  WEEE symbol  2.5.2  CE mark for medical devices 0476 This  product  is  certified  to  conform  to  the  Class  II  requirements  of  the  93/42/EEC medical device directive.  2.5.3  Electrical safety symbol  In accordance with the IEC 60601-1 Standard, this product and its component parts are  of  type  BF  and  therefore  protected  against  the  dangers  of  direct  and  indirect contact with electricity.  2.5.4  Warning symbol for the RS232 serial port RS232 To connect to other devices such as PC or printer.  Use  only  the  serial  cable  supplied  by  the  manufacturer  and  observe  the  safety regulations of IEC 60601-1-1.  2.5.5  Warning symbol for the USB serial port  To connect to other devices such as PC or printer.
 Spirodoc      cod. 980156   Rev 1.3      EN 15/67  ENGLISH Use  only  the  USB  cable  supplied  by  the  manufacturer  and  observe  the  safety regulations of IEC 60601-1-1.  2.5.6  Warning symbol for the SpO2 port for oximetry SpO2 2.5.7  Warning symbol for the WEEE  As  laid  down  in  the  European  Directive  2002/96/EEC  requirements  regarding  the disposal of electrical and electronic devices (WEEE), at the end of its useful life this device must not be thrown away together with normal domestic waste as it contains materials  which  would cause  damage  to  the  environment and/or  represent  a  health risk. Instead it must be delivered to a WEEE authorised collection  center, where the device will then be disposed of correctly.  An alternative is to return the device without charge to the dealer or distributor, when a new equivalent device is purchased. Due to the materials used in the manufacturing of the device, disposing it as a normal waste product could cause harm to the environment and/or health. Failure to observe these regulations can lead to prosecution.  2.5.8  FDA and FCC Warnings SPIRODOC…. complies  with  Part  15  of  the  FCC  Rules.  The  correct  operation  is subject to the following conditions: (1) this device must not cause harmful interference (2) this device must accept any interference received, including interference that may cause undesired operation.  Any  modifications  not  expressly  approved  by  this  company  could  void  the  user's authority to operate the equipment. NOTE: This device 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 and, if  not installed and used in accordance with the instructions, 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 simply turning the equipment off and on, the user is encouraged to try to correct the interference with one or more of the following ways:     Reposition the receiving antenna.   Increase separation between the equipment and receiver.   Connect the equipment into an outlet on a circuit different from that to which the receiver is connected.   Consult the dealer or an experienced radio/TV technician for assistance.
 Spirodoc      cod. 980156   Rev 1.3      EN 16/67  ENGLISH Labels and symbols are displayed on the device as shown in the following images:    2.5.9  Product description  SPIRODOC…. is a pocket spirometer, with an optional pulse oximetry module. It can operate either in stand alone mode or it can be connected to a PC or to a printer using any one of several methods: RS232, USB, Bluetooth.   Spirodoc… is specifically designed to measure a range of respiratory parameters and to monitor the saturation of oxygen in the blood and the heart beat. A quality control check  is  carried  out  internally  on  the  measured  parameters  and  the  device  has  an internal memory sufficient for over 6000 spirometry tests or for 1000 hours (or 40 days) of oximetry monitoring.  Spirodoc… is  a  powerful  and  compact  measurement  device,  intended  for  use  by  a respiratory  specialist  or  by  a  suitably  trained  general  practitioner.  The  spirometer calculates up to 30 functional respiratory parameters providing the pharmacodynamic effects, i.e. the data comparison after the administration of a drug (PRE/POST) for a bronchodilator  test  or  for  a  bronchial  challenge test.  A  comparison of  data  is  made between POST (after-drug) and PRE (before drug administration).  The flow and volume measurement sensor is a digital turbine, based on the infrared interruption principal. This principal ensures the accuracy and the reproducibility of the measurements, without requiring periodic calibration.  The sensor features are listed below:    Accurate measurement even at very low flow rates (end of expiration)   Not affected by relative humidity and air density    Shockproof and unbreakable   Inexpensive to replace.  The  turbine  flow  measurement  sensor  is  available  both  in  reusable  and  in  single-patient disposable versions.
 Spirodoc      cod. 980156   Rev 1.3      EN 17/67  ENGLISH  REUSABLE TURBINE  DISPOSABLE TURBINE  The following precautions must be observed to ensure that the characteristics of the turbine remain unaltered over time:    for the disposable turbine: must always be substituted from one patient to the other.   for  the  reusable turbine: always clean the turbine between patients,  to ensure the maximum level of hygiene and safety of the patient.  For  a  correct  interpretation  of  a  spirometry  test,  the  measured  values  must  be compared  either  to the so-called  normal or predicted  values which are  calculated from the anthropometric details of the patient or, alternatively, to  the  personal best values from the clinical history of the subject. The personal best values can vary considerably from the predicted values, which are taken from “healthy” subjects.  Spirodoc….  is  also  able  to  transfer  the  stored  test  data  through  a  simple  acoustic coupling  to  a  PC,  so  the  patient  can  send  test  data  by  phone  to  the  doctor.  This method allows the doctor can check the patient‟s condition remotely. SPIRODOC  consente  al  paziente  di  trasferire  i  dati  immagazzinati  all‟interno  del dispositivo, utilizzando la connessione Bluetooth , al PC del medico. Pertanto il medico può valutare a distanza i parametri legati alla patologia del paziente.  SPIRODOC can also be connected to a PC (or to another computerised system) to configure the system. All spirometric test results plus the related subject details stored inside the device can be transferred from the device to the PC and then viewed on the PC (Flow/volume curves, spirometry parameters, plus optional oximetry parameters). The connection to the PC can be made in the following ways:    via USB connection   via Bluetooth connection  SPIRODOC  can  perform  FVC,  VC  &  IVC,  MVV  and  breathing  profile  tests,  and calculates an index of test acceptability (quality control) plus the reproducibility of the spirometry tests carried out. The automatic test interpretation follows the latest 11 level ATS  (American  Thoracic  Society)  classification.  Each  test  can  be  repeated  as required. The best parameters are always available for review. The normal (predicted) values can be selected from several normal “sets”. For example, within the European Union the majority of doctors use the ERS (European Respiratory Society) predicted values.  Oximetry function The  oximetry  sensor  has  two  light  emitting  diodes  (LEDs),  one  emits  in  the  visible spectre and one infrared. Both lights then pass through the finger and are “read” by the
 Spirodoc      cod. 980156   Rev 1.3      EN 18/67  ENGLISH receiver. As these lights pass through the finger, a proportion of the light is absorbed by the blood and by the soft tissue, in function of the concentration of heamoglobin. The  quantity  of  light  absorbed,  at  each  frequency,  depends  on  the  degree  of oxygenation of the haemoglobin inside the soft tissue.  This  measurement  principal  ensures  accuracy  and  reproducibility,  without  requiring regular calibration.  The oximetry sensor can be disinfected with isopropilic alcohol.  2.6  Technical specifications  A comprehensive description of the main features of the device, the flow and volume measurement turbine and also of the oximetry sensor follows:  2.6.1  Features of the spirometer Measured parameters: SYMBOL DESCRIPTION Units *FVC Best FVC L *FEV1 Best FEV1 L *PEF Best PEF L/s FVC Forced Vital Capacity L FEV1 Volume expired in the 1st second of the test L FEV1/FVC FEV1/FVC x 100 % FEV1/VC FEV1 / best between EVC and IVC x 100 % PEF Peak expiratory flow L/s FEF2575 Average flow between 25% and 75% of the FVC L/s FEF25 Forced Expiratory Flow at 25% of FVC L/s FEF50 Forced Expiratory Flow at 50% of FVC L/s FEF75 Forced Expiratory Flow at 75% of FVC L/s FEV3 Volume expired in the initial 3 seconds of the test L FEV3/FVC FEV3/FVC x 100 % FEV6 Volume expired in the initial 6 seconds of the test L FEV6% FEV1/FEV6 x 100 % FET Forced expiratory time s EVol Extrapolated volume mL FIVC Forced inspiratory volume L FIV1 Volume inspired in the 1st second of the test L FIV1/FIVC FIV 1 % % PIF Peak inspiratory flow L/s MVVcal Maximum voluntary ventilation calculated on FEV1 L/s VC Slow vital capacity (expiratory) L EVC Slow espiratory vital capacity L IVC Slow inspiratory vital capacity L IC Inspiratory capacity (max between EVC and IVC) - ERV L ERV Expiratory reserve volume L TV Current volume L VE Ventilation per minute, at rest L/min RR Respiratory frequency Breath/min tI Average time of inspiration, at rest s tE Average time of expiration, at rest s
 Spirodoc      cod. 980156   Rev 1.3      EN 19/67  ENGLISH TV/tI Average flow of inspiration, at rest L/min tI/Ttot tE/(tI+tE) \ MVV Maximum voluntary ventilation L/min ELA Estimated lung age year  *= best values  Flow/volume measurement system Bi-directional digital turbine Temperature sensor semiconductor (0-45°C) Measurement principle  Infrared interruption Volume range 10 L Flow range  16 L/s Volume accuracy  3% or 50 mL Flow accuracy  5% or 200 mL/s Dynamic resistance at 12 L/s <0.5 cmH2O/L/s  2.6.2  Oximeter features Definitions: Desaturation Event Desaturation events SpO2 fall  4% in a limited period of 8-40 sec and successive rise  2% within a total period of 150 sec. Total  Pulse  rate Variation Pulse  rate  rise    10  BPM  in  limited  period  of  8-40  sec  and successive fall  8 BPM during a total period of 150 sec.  Parameters measured during sleep oximetry: SYMBOL DESCRIPTION Units SpO2 Baseline SpO2 Average in first three minutes % SpO2 Min SpO2 Minimum during period of analysis % SpO2 Max SpO2 Maximum during period of analysis % SpO2 Mean SpO2 Average during period of analysis % BPM Baseline Average pulse frequency in the first 3 minutes BPM BPM Min Minimum  pulse  frequency  during  the  period  of analysis BPM BPM Max Maximum  pulse  frequency  during  the  period  of analysis BPM BPM Mean Average  pulse  frequency  during  the  period  of analysis BPM Recording time Total time measure of SpO2 hh:mm:ss T < 90% Time passed with SpO2 < 90 % % hh:mm:ss T < 89% Time passed with SpO2 < 89 % % hh:mm:ss T < 88% Time passed with SpO2 < 88 % % hh:mm:ss T < 87% Time passed with SpO2 < 87 % % hh:mm:ss N°  Events  SpO2 <89% Fall of SpO2 below 89% for at least 20 seconds \  Index [12s] Index of SpO2 fluctuation calculated in intervals of 12 seconds \ T< 40 BPM Time passed with pulse frequency < 40 BPM % hh:mm:ss T> 120 BPM Time passed with pulse frequency > 120 BPM % hh:mm:ss N°  Events  <  40 BPM Bradycardia  events  during  the  entire  period  of analysis \
 Spirodoc      cod. 980156   Rev 1.3      EN 20/67  ENGLISH N°  Events  >  120 BPM Tachycardia  events  during  the  entire  period  of analysis \ Tot. Desat. Events Desaturation  events  during  the  entire  period  of the analysis \ ODI Desaturation events by hour of analysis 1/h Mean Duration Average duration of desaturation events s Longest Duration Longest duration of desaturation events s Desaturation Peak Minimum Sp02 during desaturation events % Mean Desaturation Average duration of desaturation events % Mean Drop ∆SpO2 Average  SpO2  fall  with  respect  to  baseline during the desaturation events % Max Drop ∆SpO2 Maximum  fall  of  SpO2  with  respect  of  baseline during the desaturation events % N°  Pulse Variations Variation  of  pulse  frequency  events  during  the entire period of the analysis \ Pulse Index Variation of pulse frequency by hour of analysis 1/h NOD 4% Time  passed  with  SpO2  <  4  %  with  respect  to SpO2  base  for  continual  periods  above  5 minutes \ hh:mm:ss NOD 89% Time  passed  with  SpO2  <  89  %  for  continued periods above 5 minutes \ hh:mm:ss NOD 90% Time  passed  with  SpO2  <  90  %  for  continued periods above 5  minutes with minimum value < 86 % (Nadir) \ hh:mm:ss =DELTA Parameters measured for six minute walk test analysis: SYMBOL DESCRIPTION Units SpO2 Baseline SpO2 average before walking % SpO2 End SpO2 after walking % SpO2 Min SpO2 minimum during walking % SpO2 Max SpO2 maximum during walking % SpO2 Mean SpO2 average during walking % BPM Vaseline Average pulse frequency before walking BPM BPM End Pulse frequency after walking BPM BPM Min Pulse frequency minimum during walking BPM BPM Max Pulse frequency maximum during walking BPM BPM Mean Pulse frequency average during walking BPM T < 90% Time passed with SpO2 < 90 % % hh:mm:ss T < 89% Time passed with SpO2 < 89 % % hh:mm:ss T < 88% Time passed with SpO2 < 88 % % hh:mm:ss T < 87% Time passed with SpO2 < 87 % % hh:mm:ss T2 [SpO2≥ 2%] Time passed during walking test with SpO2 < 2 % with respect to SpO2 base hh:mm:ss T4 [SpO2 ≥ 4%] Time passed during SpO2 walking test < 4 % with respect to SpO2 base hh:mm:ss T< 40 BPM Time passed with pulse frequency < 40 BPM hh:mm:ss T> 120 BPM Time passed with pulse frequency > 120 BPM hh:mm:ss N° Events < 40 BPM Bradycardia  events  during  the  entire  period  of analysis \
 Spirodoc      cod. 980156   Rev 1.3      EN 21/67  ENGLISH N° Events > 120 BPM Tachycardia  events  during  the  entire  period  of analysis \ Recording time Total time measure of SpO2 hh:mm:ss Baseline Time Duration of baseline phase hh:mm:ss Walking Time Duration of walking phase hh:mm:ss Recovery Time Time  for  SpO2  value   99%  of  the  average base value  calculated  during the initial phase of the test. hh:mm:ss Predicted Predicted standard distance m Pred. Min Predicted minimum distance m % Predicted Standard % in variations of the distance covered with respect to predicted standard distance % % Pred. Min % of variations of distance covered with respect to predicted minimum distance % AUC/Distance Area  under  SpO2  curve  base  relative  to  distance covered \ Dyspnea Borg CHG Variation in grade of dyspnea during walking \ Fatigue Borg CHG Variations in level of fatigue during walking \ =DELTA *There follows a description of  the  method  for  calculating  the  area  below  the  SpO2 baseline curve:    Parameters requested for six minute walk test analysis  SYMBOL DESCRIPTION Units Dyspnea Borg Baseline Grade of dyspnea before walking \ Dyspnea Borg End Grade of dyspnea after walking \ Fatigue Borg Baseline Level of fatigue before walking \ Fatigue Borg End Level of fatigue after walking \ Walked  Distance covered during walking m  Parameters measured with SpO2 Analysis: SYMBOL DESCRIPTION Units SpO2 Baseline SpO2 Average in first three minutes % SpO2 Min SpO2 Minimum during period of analysis % SpO2 Max SpO2 Maximum during period of analysis % SpO2 Mean SpO2 Average during period of analysis %
 Spirodoc      cod. 980156   Rev 1.3      EN 22/67  ENGLISH BPM Baseline Average pulse frequency in the first 3 minutes BPM BPM Min Minimum  pulse  frequency  during  the  period  of analysis BPM BPM Max Maximum  pulse  frequency during  the  period  of analysis BPM BPM Mean Average  pulse  frequency  during  the  period  of analysis BPM Recording time Total time measure of SpO2 hh:mm:ss T < 90% Time passed with SpO2 < 90 % % hh:mm:ss T < 89% Time passed with SpO2 < 89 % % hh:mm:ss T < 88% Time passed with SpO2 < 88 % % hh:mm:ss T < 87% Time passed with SpO2 < 87 % % hh:mm:ss N°  Events  SpO2  < 89% Fall of SpO2 below 89 % for at least 20 seconds \  Index [12s] Index of SpO2 fluctuation calculated in intervals of 12 seconds \ T< 40 BPM Time passed with pulse frequency < 40 BPM % hh:mm:ss T> 120 BPM Time passed with pulse frequency > 120 BPM % hh:mm:ss N°  Events  <  40 BPM Bradycardia  events  during  the  entire  period  of analysis \ N°  Events  >  120 BPM Tachycardia  events  during  the  entire  period  of analysis \ =DELTA  Measurement method: Red and infrared absorption Range of measurement %SpO2: 0 – 100% (with 1% increments) SpO2 Resolution 1% %SpO2 accuracy:  2% between 70-100% SpO2 Average  number  of  heart  beats  for  the %SpO2 calculation: 8 beats Range of measurement of cardiac pulse: 20 – 300 BPM (with 1 BPM increments) Cardiac pulse relolution 1 BPM Accuracy of cardiac pulse:  2 BPM or 2% whichever is greater Average  interval  for  the  calculation  of cardiac pulse: 8 seconds Signal quality indication: 0 - 8 segments on display  Acoustic signals:  “Beep” with frequency of the cardiac pulse   Continuous beep in the case of either %SpO2 or cardiac pulse going outside of the programmed levels of alarm   Continuous beep during oximetry measurement in the case of a low battery level.  If  the  patient‟s  finger  is  not  inserted  correctly  or  the  connecter  is  not  properly attached there will be an intermittent beeping sound for 10 seconds   If the test has been interrupted due to low battery power an intermittent beeping will be heard for 10 seconds when the device is switched on again  The  specifications  for  both  the  oximetry  and  for  the  cardiac  pulse  are  the  same regardless of which of the above mentioned oximetry sensors is used.
 Spirodoc      cod. 980156   Rev 1.3      EN 23/67  ENGLISH  2.6.3  Other features Memory Memory  capacity  for  over  6000 spirometric tests The  precise  number  depends  on  the individual  configuration,  so  it  cannot  be determined more closely Display STN graphic LCD,128x64 Pixel Keyboard Membrane keyboard with 6 keys Interface RS232, USB, Bluetooth Duration of the CR2032 3V lithium battery (memory backup) Circa 10 years, under normal conditions of use Power supply 4 x AAA batteries 1.5V DC (type AAA), or through USB connection Dimensions 60x145x30 mm Weight 180 grams (including batteries) Type of electrical protection Class II device Type of electrical protection BF Grade of protection against water ingress IPX1  device,  protected  against  water drops Safety level in the presence of inflammable anaesthetic gas, oxygen or nitrogen Device not suitable Conditions of use Device for continuous use Storage conditions Temperature: MIN -20 °C, MAX + 60 °C Humidity :MIN 10% RH; MAX 95%RH Operating conditions Temperature: MIN + 10 °C, MAX + 40 °C;  Humidity: MIN 10% RH; MAX 95%RH Applied norms Electrical Safety Standard IEC 60601-1 Electro  Magnetic  Compatibility  IEC 60601-1-2  3.  FUNCTIONING OF THE SPIRODOC  3.1  Display The  device  does  not  have  a  keyboard.  The touchscreen type display allows access to all functions by simply touching the display. The controls  on  the  touchscreen  change dynamically  based  on  the  functions performed. To  access  a  specific  function  touch  the corresponding icon on the display.
 Spirodoc      cod. 980156   Rev 1.3      EN 24/67  ENGLISH To  visualize  the  list  of  information  flick through the left part of the screen.   3.2  Accensione e spegnimento di SPIRODOC  To  turn  on  the  SPIRODOC  press  and release  the  key placed in  the  middle on the side of the device.  To  turn  off  the    SPIRODOC  press  the same key for at least two seconds.    3.3  Symbols and Icons  The icons used in the various function screens  are shown in the following table:  ICON DESCRIPTION  To access the default settings (service menu)  To access patient data from the main display  To perform a new test of a patient recalled from the patient records.  To insert new patient data  To modify patient data.  To display the most recent tests of a patient  To go back  To send data to a mobile phone via Bluetooth  To access the database of the performed tests.  To search a test with the date of birth of a patient  To search a test starting from a specific date onwards..(partial database)  To flick through a database from beginning to end and viceversa (complete database)  Patient search through family name.  Male sex patient selection   Female sex patient selection
 Spirodoc      cod. 980156   Rev 1.3      EN 25/67  ENGLISH  To access all oximetry test options / To perform an SpO2/BPM test  To perform a sleep oximetry test  To perform a 6MWT/ to move on to the walking phase of the test  Tom move on to the recovery phase of the 6MWT  To access spirometry testing type  to perform a forced vital capacity test FVC  To perform a slow vital capacity spirometry test VC  To perform a maximum voluntary ventilation spimetry test MVV  To perform a spirometry test with a broncodilator  To print via Bluetooth connection  3.4  Energy saving  WARNING  When  the  device  is  on  after  approximately  10  seconds  of  disuse  the  display enters  energy  saving  mode  thereby  lowering  the  display  contrast  level automatically.   If the device remains in disuse for approximately 5 minutes an acoustic signal will  be  emitted,  furthermore  if  the  display  is  not  touched  within  another  10 seconds the device will turn off by itself. The device can be turned off in any moment by pressing the   key.  The charging level of  the battery pack  is  shown upon turning on the device with the symbol:    This image indicates that the battery pack is fully charged(6 indicators). A drop of the battery pack charge is displayed with a reduction of the indicators.  3.5  Information Turn on the SPIRODOC by pressing   . The display will read:  device name  information Current date        Current time
 Spirodoc      cod. 980156   Rev 1.3      EN 26/67  ENGLISH Without touching the display, after a few seconds the device will automatically return to the main screen. The main screen can be customized by choosing one of two types of menus: “simplified menu” or “extended menu”.  To choose the desired setting read the following parapraph 3.6.  3.6  Service menu To access the menu touch the display when the following icon appears    The service menu provides the following information:    Language selection (English default)   Turbine calibration   Predicted values selection   Delete Memory   Change Date/Time   Date Format   Unit Format   Turbine selection   Standards setting   LCD setting   BLUETOOTH setting   Firmware information   Oximetry alarms   SpO2 sampling rate   Spirodoc mode   Parameter settings   Menu type  Scroll  through  the  various  options  in  the menu  as  per  paragraph  3.1;  once  the option  of  interest  is  visualized,  touch  the display next to it.   Language selection Select  the  language  select  option  by  touching  the  display  and  choose  the  desired language; automatically the desired language is  set  and  the  device  will  return  to the service menu. Turbine calibration Once the option is highlighted the following password needs to be inserted: 1 2 2 3 3 3  Please  refer  to  paragraph  3.6.1  per  il  corretto  svolgimento  di  tale  attività  si  faccia riferimento al paragrafo 3.6.1.
 Spirodoc      cod. 980156   Rev 1.3      EN 27/67  ENGLISH Selection of the Predicted values Select the option by touching the display. A list of Predicted values is visualized; select the desired Predicted value.  Adults Pediatric ERS Knudson Knudson Knudson USA Knudson ERS Zapletal MC-Barcelona Zapletal  Select the pair of Predicted values; automatically the desired predicted values are set and the device will return to the service menu.   WARNING If  the  NAHNES  III  standard  is  chosen  the  Predicted  values  cannot  be  set  or modified.  Delete Memory Select the option by touching the display.  To  delete  the  memory  of  the  device  insert  the  following  password  by  touching  the numbers starting from left to right: 1 2 2 3 3 3  If an error occured during insertion of the password, the following message will appear: Password Error Press OK and try again If you fail to insert the password again the device automatically returns to the service menu.  If instead the password was inserted correctly, the following message will appear: Memory has been deleted Afterward the device will automatically return to the service menu. Change date and time Select the option by touching the display. In the date/time setting, the cursor _ indicates the item which will be modified. Use the visualized numbers to modify item of interest, move on to the next item with OK. Lastly  by  touching  OK    the  settings  will  take  effect  and  the  device  will  return  to  the service menu; to return to the service menu without modifying any options touch  . Date format Select the option by touching the display.
 Spirodoc      cod. 980156   Rev 1.3      EN 28/67  ENGLISH  day  month  year month  day  year year  month  day  Select the desired format; this will be set automatically and the device will return to the service menu.  Unit format Select the option by touching the display.  Imperial   (in,lb) Metric    (cm kg)  Scegliere  la  modalità  desiderata;  automaticamente  questa  viene  impostata  ed  il dispositivo torna al menu di servizio.  Turbine selection Select the option by touching the display. Select the  type  of  turbine to be used  (reusable  or  disposable). The selection will be saved automatically and the device will return to the service menu.  Standards setting Select the option by touching the display. Select    the  standard    (ATS/ERS  or  NHANES  III);  The  selection  will  be  saved automatically and the device will return to the service menu.  LCD setting This menu allows for:   Setting of display luminance and contrast.  Two scales ranging from 0 to 31 allow to set these display parameters and see the effects in real time. Once the best combination has been obtained touch OK in the bottom right-hand of the display.  Touch screen calibration function This  function  allows  to  check  the  proper  response  of  the  touch  screen;  the procedure is comprised of three parts:  - touch the white dot on the upper right  side - touch the white dot on the lower left side  - touch the white dot in the center  The touch screen will be calibrated according to the dimensions of the screen.  Bluetooth setting Access  the  menu  to  search  for  available  devices,  touch  the  option  “Search  Device”; Spirodoc will  start  to  search  for  Bluetooth  devices  in  the  area;  once  one  or  more
 Spirodoc      cod. 980156   Rev 1.3      EN 29/67  ENGLISH devices  are  found  the  display  will  list  these  devices  with  their  respective  names. By touching the device of interest it can be memorized as a printer, a phone, or as a PC – On line; select an option. In the “Bluetooth setting” menu the memorized  devices can be  viewed in the “printer” list,  “telephone” list and the “PC – On line” list. Any device from these lists can be set as  the  default  device  (the  device  that  SPIRODOC  will  automatically  connect  to  via Bluetooth) by entering in the lists, touching the display and selecting the device. A listed device can be  eliminated from the list.  (in this specific case the user will confirm the deletion with the OK icon.) So as not to make any modifications touch the   icon in the bottom left side. In the “Bluetooth  setting”  menu  the  “Bluetooth  ON/OFF” option allows to  enable/disable the Bluetooth function thereby improving the battery consumption of the device.  Firmware Information The  user  can  access  the  menu  to  view  information  of  the  version  control  of  the following components:  Spirodoc   Bluetooth After approximately 10 seconds the device  automatically displays the Service Menu, otherwise press  .  Oximetry Alarms Access  to  this  function  allows  the setup  of  reference  values  for  SpO2 and BPM; an acoustic alarm will warn the user if the SpO2 and BPM during a test fall below the minimum or rise above  the  maximum  set  reference SpO2 and BPM values.   The  cursor  “_”  in  the  beginning  will  be  set  on  the  minimum  SpO2  value,  use  the visualized numbers to select the desired value. Move on to the next value by touching OK; once all four values have been set the user may activate or deactivate the acoustic alarm: Touch ON to activate the acoustic alarm during oximetry testing, or touch OFF to deactivate the acoustic alarm. To confirm the desired selection touch OK in the bottom right side of the display, automatically the device will return to the service menu.  SpO2 sampling rate This function allows to set the time that elapses between values memorised between consecutive oximetry parameters; touch one of the two visualized icons: 2 seconds or 4 seconds,  then  touch  OK  to  set  the  selected  value  and  the  device  will  automatically return to the service menu.  Spirodoc mode The device can be setup in one of the following modes:
 Spirodoc      cod. 980156   Rev 1.3      EN 30/67  ENGLISH   Personal mode   Doctor mode  Personal  mode  is  set  by  the doctor  when  the  device  will  be used  by  the  patient  for home care use; for health condition screening. Doctor mode enables full use of the device for expert use. By touching the desired mode the device is set and automatically returns to the service menu.  Parameter Settings Three  different  types  of  parameter  calculations  can  be  selected  for  spirometry  and oximetry testing.     simplified   personalized   complete  With the simplified mode  the user can  only view  the main parameters as per actual standards. The personalized mode allows to select the parameters of interest.  The  complete  mode  allows  to  view  all  the  parameters  that  the  device  is  capable  of calculating.  Type of menu The last item allows to personalize the menu of the main screen, the options are:    simplified menu    extended menu   Only the following icons can be viewed with the simplified menu:    patient management   spirometry   oximetry   database   The extended menu includes the same icons  of  the  simplified  menu  and  the icons representing the various types of the  tests  that  the  device  is  capable  of performing.   To exit the settings of the service menu touch   in the bottom left hand side.
 Spirodoc      cod. 980156   Rev 1.3      EN 31/67  ENGLISH  3.6.1  Patient Mode This mode allows to simplify the use of the device for a patient during the day and lets the doctor setup  various functions  useful  to  assess  the patient‟s state  of  health  as  it evolves in time. In patient mode the main screen appears as follows.  The simplified service menu can be accessed by touching the icon in the bottom right-hand side, the following items are shown:    Patient data   Change date/time   LCD setup   Bluetooth setup   Insert password  To access the service menu select the item “Inser password” and enter the following password:  1 2 2 3 3 3  In this mode the service menu displays the following items:    Spirodoc mode   Personal best   Turbine setup   Turbine calibration   Oximetry setup   Switch-on setup   Questions setup   Symptoms setup   Predicted source selection   Standard setup   Language selection   Memory deletion   Communication type   Units format   Date format  Furthermore to the items in the previous paragraph the device allows to setup the following items:    Personal best   Questions setup   Symptoms setup  Personal Best One of the following four parameters can be used as a reference to be compared with at the end of a spirometry test:    FVC    FEV1    PEF    F2575
 Spirodoc      cod. 980156   Rev 1.3      EN 32/67  ENGLISH  For each of the above four parameters it is possible to check the corresponding value of the test with a personal value set by the doctor or a predicted value taken from a predicted source, by selecting one of the two following items:    Personal best value setup   Use predicted source  Questions Setup Specific questions can be written so that when the patient turns-on the device a table will be displayed with a series of questions. The following table displays the items which can be selected and the response options which can be used by the patient.  A multiple selection can also be implemented.  Symptoms Setup Every time that a patient records a test the symptoms setup will have the patient answer a series of questions; the following table displays the items which can be selected and the response options that can be chosen by the patient:  Domanda Possibili risposte Tiredness on waking NO MED MAX Daytime drowsiness NO MED MAX Breathless on waking NO MED MAX Troubled sleep NO MED MAX Wheezing NO MED MAX Cough NO MED MAX Sputum production NO LIGKT DARK Sputum increasing NO  YES breathlessness NO Effort At rest Fatigue NO MED MAX Chest tightness NO MED MAX  Also in this case a multiple selection can be implemented.  3.6.2  Reusable turbine calibration  WARNING The  turbine  flow  sensor  does  not  require  calibration,  however  regular cleaning of the turbine is necessary . If a calibration must be performed the following guidelines should be carefully noted. A calibration can only be performed with the reusable turbine.  Calibration of the turbine is performed using a calibration syringe to make a FVC test for the expired parameters and a FIVC test for the inspired parameters. To  access  the  calibration  function,  select  the  “Turbine  Calibration”  option  from  the Service Menu as explained in paragraph 3.6. Once the password has been inserted correctly the following screen will appear:
 Spirodoc      cod. 980156   Rev 1.3      EN 33/67  ENGLISH VOL. 300  BTPS  %Corr. Ultima FVC 300  0.00 UltimaFIVC 300  0.00 Nuova FVC 000 ◄  Nuova FIVC    FVC=0 CALIBR. DI FABBRICA  The  Old  FVC  and  the  Old  FIVC  values    shown  are  those  values  from  the  last calibration performed. The values under the %Corr. column indicate the correction factor. These are pre-set or 0 by default.  To perform a  calibration: 1 - Insert the volume in cL of the calibration syringe in use (e.g. for a 3L syringe, insert 300 cL).  2 - Insert in both fields New FVC and New FIVC  the FVC & FIVC values obtained by a measurement made with the calibration syringe, by using the numbers that appear in the bottom of the screen. After inserting the values of each parameter touch the OK icon.  Insert  both  the  FVC  and  the  FIVC  values.  If  the  calculated  correction  factors  are acceptable  (<10%),  these  are  displayed  next  to  the  New  FVC  and  New  FIVC parameters. The message ENTER OK TO CONFIRM will appear. By  touching  the  ESC  icon  the  device  will  automatically  return  to  the  service  menu without applying any correction.  If the FVC and FIVC values produce  a correction factor that is >10%, the FVC and FIVC values will not be accepted. This means that the device cannot correct such a large calibration error. In this case: - Check the correct functioning of the Spirodoc with a new turbine and/or - Clean the turbine.  To erase the calibration in use and to reset the original factory calibration, insert the number 0 in the New FVC and New FIVC fields. With the OK icon  return to the Service Menu.  NOTE Each time a calibration is made the new correction factors are algebraically added  to  the  previous  correction  factor.  Therefore,  before  making  a  new calibration  make  sure  to  delete  the  actual  calibration  in  use  as  described above. For an accurate and reliable calibration the syringe volume must be at least 3 L.    WARNING
 Spirodoc      cod. 980156   Rev 1.3      EN 34/67  ENGLISH In  line  with  the  publication  "Standardised  Lung  Function  Testing"  of  the European  Respiratory  Society  (Vol  6,  Supplement  16,  March  1993),  the  air expired from the mouth is at a temperature of circa 33/34 °C. The  expired  flow  and  volume,  to  be  converted  to  BTPS  conditions  (37  °C) must be increased by 2.6% - this is derived from the BTPS factor of 1.026 at a temperature of 33°C, which represents a correction of 2.6%. In practice the BTPS factor for the expired flow and volumes is therefore constant and equal to 1.026. For  the  inspired  volumes  and  flows,  the  BTPS  factor  depends  upon  the ambient temperature as the air inspired is at ambient temperature. For instance at an ambient temperature of 20°C with relative humidity at 50%, the BTPS factor is 1.102, a correction of  +10.2%. The correction of the inspired volumes and flows is made automatically as the machine has an internal temperature sensor; the BTPS values are thus calculated. If  a  3L  syringe  is  used  to  make  the  calibration  and  if  the  spirobank  II  is calibrated correctly then the FVC (syringe) value will be: 3.00  (FVC)  x  1.026  (BTPS)  =  3.08  L  (FVC at BTPS). If the ambient temperature is 20°C, the FIVC (syringe) value will be: 3.00  (FIVC)  x  1.102  (BTPS)  =  3.31  L  (FIVC at BTPS). The  user  must  be  aware  that  the  volume  of  the  syringe  shown  by  the machine  is  converted  to  BTPS  conditions,  so  that  the  "increase"  of  the results with respect to the expected values does not constitute an error.  For instance, if the calibration procedure is carried out with measured data: FVC  =  3.08  L  and  FIVC  =  3.31  L  at  an  ambient  temperature  of  20°C  the resulting correction factor becomes: EXPIRATION    .00% INSPIRATION   .00% This does not represent an error, but is a logical consequence of the above detailed explanation.  3.7  Patient Data From the main screen the user can access the patient data  management by using the icon .  . By entering in the menu it is possible to:   Modify the current patient data  Create a new patient   3.7.1  Inserting data of a new patient Touch the icon   and insert the patient information in the required sequence. First screen (name) Write the name of the patient with the touchscreen keyboard. Touch the OK icon to move on to the next screen  Second screen (sirname) As above insert the sirname of the patient and touch the OK icon.
 Spirodoc      cod. 980156   Rev 1.3      EN 35/67  ENGLISH Third screen (date of birth, weight, height and sex) By using the visualized numbers in the bottom of the screen, set the day, month, year of birth, height and weight of the patient. The last data to insert is the sex of the patient, which can be chosen by selecting one of the following icons:   Male  Female  To move from one item to the next touch the OK icon.  Fourth screen (ethnic group)  Setting of the correction factor: these values allow to adjust the test data as a function of the ethnic group of the patient (it is possible to opt for “without correction” );  standard ATS/ERS  Standard NAHNES III Group % correction   Without correction 100%  Caucasian Caucasian 100%  Mexican-American Oriental 100%  Afro-American Hong Kong Chinese 100%  Other Giapanese 89%   polinesian 90%   North Indian 90%   South Indian 87%   Pakistani 90%   African descendant 87%    For  ATS/ERS  standards,  the  correction  is  applied  to  the  predicted  values  of  the following parameters: FVC, FEV1, FEV3, FEV6, VC For NAHNES III standards, the correction is based on several theoretical formulas (as described in the publication).  Once the ethnic group is set the device saves the data and autonmatically returns to the main screen.  To interrupt  the data insertion, touch the ESC icon and the device will automatically return to the main screen.  3.7.2  Patient data modification The icon   allows to  modify  current  patient data;  by  accessing this function    the patient  data  is  presented  on  the  various  screens;  modify  the  data  by  using  the alfanumerical key which are shown time and again.  Touch the   icon to return to the main screen without modifying any data
 Spirodoc      cod. 980156   Rev 1.3      EN 36/67  ENGLISH   3.8  Visualization of memory data  3.8.1  Database research modality  From the main screen it is possible to access the database of the device by using the  icon. Four methods of research are available:   Reseach by patient date of birth.  Research by the date of testing.  Visual of all tests in the database starting form the most recent.  Research by patient sirname.  Research by patient date of birth: patient date of birth must be inserted; after all the data  has  been  inserted  touch  the  OK  icon.  All  data  visualized  concerns  tests performed by patients whose date of birth corresponds to the inserted date of birth.  Database  by date  of  testing: requires  the  insertion of the date  when  the  test was performed;  once  all the date information  has  been  inserted touch the  OK  icon.  The data  returned by the  device are  all  the test  sessions  performed during  that  specific day.  Complete database: shows data starting from the  most recent session. The end of the database is signalled by a double beep. The database search is resumed from the last session.  Research by surname: requires insertion of patient sirname or sirname initial; once having inserted the sirname touch the OK icon. Visualized data corresponds to all test sessions of that particular patient.  NOTE Test session refers to (spirometry PRE, POST and oximetry) tests gathered from one patient on the same day.  So a visualized session in the database can be composed of different tests which as a whole allow the doctor to evaluate the health of a patient at that specific date.  3.8.2  Visualization of database info The result of a search performed in one  of  the  described  methods  in paragraph  3.8.1  can  be  viewed  in the  adjacent  image.  By  touching the  desired  session  one  may access the performed tests
 Spirodoc      cod. 980156   Rev 1.3      EN 37/67  ENGLISH Once  a  testing  session  has  been selected  the  database  screen  will show  the  adjacent  image.  By scrolling the screen as in paragraph 3.1 the user may select the desired test of a session.  The three icons on the lower part of the  screen  allow  access  to  the following functions:     To perform a new testing session with the selected patient.  To send via Bluetooth to a printer the parameters of a selected test.  To view the parameters of a selected test.  The user may return to the previous screen by using the   icon.   WARNING Printing  via  Bluetooth  is  possible  only  after  setting  at  least  one  printer  from  the   Bluetooth  printer  list.  Refer  to  paragraph  3.6  for  proper  setup  of  this  function.  If  no printer has been selected the device will show the following message: EMPTY LIST Device search Touch OK to confirm By touching the OK icon the device will search for any nearby devices; if any devices are found these can be memorized in the specific Bluetooth list.   3.9  Display of last session from current patient.  Case Io : simplified menu To view the last spirometry tests performed by the current patient touch the   icon. In the spirometry menu the icon     allows to access the most  recently perfomed tests To display the most recent oximetry tests performed by the current patient touch the icon. Inside the oximetry menu the   icon allows to access all data from the most recent tests.  3.10  PC On line mode (connected to a PC)   In the PC on-line mode the spirometer becomes a fully functional laboratory spirometer which works in real-time connected to a PC.  PC interface is via USB cable or Bluetooth connection.   The Spirodoc  becomes an intelligent transducer  for the measurement of volume and flow while the PC controls the device including the on and off function.
 Spirodoc      cod. 980156   Rev 1.3      EN 38/67  ENGLISH Connected  to  a  portable  PC  the  Spirodoc  can  be  used  for  epidemiological  studies conducted in occupational environment, schools, etc etc..  Other than the usual spirometric parameters and the F/V in real-time the Spirodoc also plots  the  most  refined  indices  such  as  the  ventilatory  profile  and  the  extrapolated volume (Vext). The  PC  software  incorporates  the  most  up  to  date  bronchial  provocation  protocols displaying the dose-response and time-response of the FEV1   WARNING  When  the  device  is  connected  to  the  PC  it  cannot  be  remotely  controlled  from  the device itself. The default settings of the PC software will be transferred to the device and will remain in the device even when used in stand-alone mode; for example when the  Spirodoc  is  connected  to  the  PC  and  the  user  selects  the  type  of  turbine (disposable or reusable) the selection will be saved in the device and remain effective even when the Spirodoc is used in stand-alone mode. So pay attention to the type of turbine setting.    3.11  Spirometry testing  In  order  to  perform  proper  spirometry  testing  the  following  instructions  are  to  be followed carefully.    Insert the turbine in the appropriate housing until it reaches the mechanic stop and successively rotate the turbine clockwise until it stops. Insert the mouthpiece at least 0.5 cm inside the groove of the turbine.     Place the noseclips on the nose so as not to let any air out of the patient‟s nostrils.    Hold the Spirodoc from both ends with both hands or grasp it like a mobile phone. The touchscreen must always face the patient taking the test.    Place the upper part of the mouthpiece in the mouth making sure that no air leaks from the sides of the mouth.   If possible it is recommended to stand up while performing the test. During expiration it is recommended  to bend forward the upper part of the body so as to release all the air out with the aid of the abdominal muscles.  WARNING  While performing a test make sure not to interrupt the test prematurely or turn off the device by accidentally touching  the screen.  By touching the   icon the user may access the spirometry testing area from the simplified  menu  mode.  With  the  extended  menu  the  main  screen  will  display  the different types of spirometry tests as follows:   FVC spirometry testing  VC type spirometry test
 Spirodoc      cod. 980156   Rev 1.3      EN 39/67  ENGLISH  MVV type spirometry test  test with broncodilator  Once  a  test  is  selected  the  screen  will  display  information  concerning  the  type  of turbine in use (reusable or disposable) including the  necessary info to complete the test in the correct manner.   WARNING  A  test  is  saved  with  the  name  of  the  last  patient  displayed.  If  a  test  refers  to  a previously  saved  patient,  then  prior  to  performing  a  test  the  user  must  recall  that patient from the database as described in paragraph 3.8.2  3.11.1  FVC test  Proper execution of a FVC test must take into account the phases as described on the screen, more specifically:  INSPIRE slowly EXPIRE quickly INSPIRE slowly  It  is  possible  (and  may  be  helpful)  to  start  the  test  by  breathing  at  rest  for  a  few moments. When ready to start inspire slowly as much air as possible (made easier by holding the arms wide apart) and then make a complete expiration as fast as possible. Then  with  the  mouthpiece  always  held  firmly  in  the  mouth,  complete  the  cycle  by inspiring  again  as  quickly  as  possible.  This  final  inspiration  may  be  left  out  if  the inspiratory parameters (FIVC, FIV1, FIV1%, PIF) are not of interest. The  optional  initial  inspiration  phase  can  also  be  performed  before  inserting  the mouthpiece in the mouth. After  inspiring  slowly  and  deeply,  the  following  expiration  must  be  made  with  the maximum effort by expiring all the air in the lungs as fast as possible. After 6 seconds of expiration the device will emit a continuous beep, this helps the user to understand when the minimum expiry time has been reached.   WARNING  Accurate spirometry testing requires that the patient expire absolutely all the air in the lungs.  The  test  may  be  carried  out  several  times by  repeating  the  cycle  without  taking  the mouthpiece  out  of  the  mouth,  in  which  case  Spirodoc  recognises  the  best  test (FVC+FEV1) and will automatically display the results of this best test. To end the test touch the OK icon. During  the  test  the  Spirodoc emits  "beeps",  the  frequency  of  which  are  directly proportional  to  the  inspired  and  expired  velocity  of  the  air..  This  helps  the  doctor understand when the velocity of the air is approaching zero, and the patient has almost exhausted all of the inspired or expired volume. In  the  maintenance  section  an  explanation  is  given  as  to  how  this  feature  can  also function as a very simple check system for the correct operation of the mobile “rotor” of
 Spirodoc      cod. 980156   Rev 1.3      EN 40/67  ENGLISH the turbine. For the FVC test to be judged as acceptable, besides breathing as deep as possible, it is also required that the forced expiratory time (FET) is sufficiently long to allow for the complete expiration of all air contained in the lungs.  Six  seconds  from  the  start  of  the  forced  expiratory  test,  the  Spirodoc  emits  a continuous beep. This is useful for the doctor to understand if the patient has reached the  minimum  expiry  time,  as  per  the  requirements  of  the  major  international pneumology associations.  3.11.2  Test VC   Ventilatory Profile The  slow  vital  capacity  test  can  be  started  by  carrying  out  several  breaths  at  tidal volume. After three or four such breaths  an acoustic signal will be emitted to confirm that  the  ventilatory  profile  has been  measured  and  that  the  patient  may  immediately proceed to perform the VC or IVC test.  Expiratory Slow Vital Capacity: VC After the acoustic signal inspire slowly as much as air as possible and expire slowly as much air as possible.  Inspiratory Slow Vital Capacity: IVC  After the acoustic signal exspire slowly as much as air as possible and inspire slowly as much air as possible. To end the test touch the OK icon.  Follow the indications on the display to carry out the test properly.  3.11.3  MVV Test  Start the test by carrying out a series of  forced inspirations and expirations with the maximum possible amplitude. The suggested frequency is 30 breaths per minute. The test will end automatically after 12 seconds.   WARNING  The disposable mouthpiece and the disposable turbine must be replaced after a single patient test session.  3.11.4  POST test, after drug administration  WARNING  To carry out a POST test it is necessary to have carried out at least one PRE FVC  test the same day; it is not possible to do a POST test on the PRE VC or MVV tests; it is however possible to do a POST VC or MVV test if the database already contains at least one PRE test carried out on the same day.
 Spirodoc      cod. 980156   Rev 1.3      EN 41/67  ENGLISH To carry out a POST test please follow the instructions below:  Simplified menu  To  access  the  spirometry  area  touch  the    icon  on  the  main  screen  and subsequently touch the   icon.  A  “POST”  test  refers  to  a  spirometry  test  after  having  administered  to  a  patient  a pharmacological bronchodilation protocol. Before carrying out the test is is necessary to indicate the drug dosage administered as a reference when checking the results of the measured parameters.  The following parameters will be displayed related to the selected patient:    Those values related to the test performed   Those  values  related to  the  best  PRE  test  performed  by  the  same  patient  the same day.(that is in the same test session)   The  percentage  variation  between  the  PRE  and  POST  values(  in  the  CHG column)   It is  not possible  to perform a POST test with a patient whose PRE testing was not carried out on the same day.  If  during  a  POST  session  a  new  patient  is  inserted  or  another  is  recalled  from  the archive the device will automatically exit the current POST session.  3.12  Viewing the spirometric results  Following a FVC test, the spirometry test results are shown. The first screen displays:    The main parameters FVC, FEV1, FE1%, PEF of the best trial from all the tests performed durin the session.   The percentage change compared to the predicted values.   A Flow/Volume graph of the Forced Vital Capacity  The  graph  is  a  preview,  to  view  the  whole  test  simply  touch  the  graph  and automatically the device will  show  the  entire graph rotated 90° clockwise on the display. By touching the graph again the device will return to the original preview.  By  scrolling  on  the  right  hand  side  of  the  screen  it  is  possible  to  view  all  the parameters next to the chosen predicted values.  3.12.1  Spirometry Test Interpretation Spirometry test interpretation is based on  the Forced Vital Capacity (FVC) test. The test interpretation is indicated with one the following messages:    Normal obstruction   Mild obstruction   Moderate obstruction   Moderately severe obstruction   Severe obstruction   Very severe obstruction
 Spirodoc      cod. 980156   Rev 1.3      EN 42/67  ENGLISH  For  a  POST  test  the  messages  are  the  same  but  instead  of  dealing  with  an “obstruction” the POST test refers to a “restriction”.  Through the use of a mathematical analysis applied to certain indices and parameters calculated in  the FVC test , the  SPIRODOC is capable of producing a list of quality control  comments  useful  to  assess  the  quality  and  reproducibility  of  the  manouvers performed.  The  quality  control  check  assigns  a  letter  for  the  current  spirometry  session  as described below:  PRE test A = At least to acceptable manouvers, with the highest two FEV1 values matching to within 100 mL and the largest two FEV6 values within 100 mL B= At least two acceptable manoeuvres, with the FEV1 values matching to within 101 to 150 mL C= At least two acceptable manoeuvres, with FEV1 values matching to within 151 to 200 mL  D=  only  one  acceptable  manoeuvres,  or  more  than  one,  but  the  FEV1  values  not matching to within 200 mL (with no interpretation). F= No acceptable manoeuvres (with no interpretation).   POST test A = two acceptable (1) FEV1 values matching within 100 mL B= two acceptable (1) FEV1 values matching within 200 mL C= two acceptable (1) FEV1 values that do not match within 200 mL D= only one acceptable (1) FEV1 manoeuvre  F= No acceptable (1) FEV1 manoeuvres  An acceptable manoeuvre means: good start and satisfactory exhalation (duration and flow)  Several comments related to the single test are calculated, however SPIRODOC will only point out the most relevant to facilitate the test interpretation.   ERROR IN Vext and PEFT If the extrapolated volume Vext is greater than 500 mL or more than 5% of the FVC, or if the PEFT (time to peak flow) is greater than 200 ms, this message is shown: Repeat test and blow faster FLOW DROP 50%  If  there  is  a  drop  in  the  flow  of  50%  and  a  recovery  within  the  first  second.  The following message appears: Coughing during test FET ERROR If the FET is less than the minimum (6 seconds), this message is shown: Expiry time insufficient < 6s
 Spirodoc      cod. 980156   Rev 1.3      EN 43/67  ENGLISH FLOW ERROR If  the  last  point  of  the  F/V  curve  is  greater  than  200  mL/s,  this  indicates  that  the expiration was not complete and thus this message is shown: Blow out all air in lungs Between tests, the SPIRODOC  checks the repeatability of the following parameters:   PEF repeatable when the difference between the two largest PEF is ≤ 0.67 L/s; VC repeatable when the difference between the two largest  VC ≤ 150 mL;  If FVC is > 1.0 L then: FEV1  repeatable  when  the  difference  between  the  two  largest  FEV1 is  ≤  150 mL; FVC  repeatable when the difference between the two largest FVC is ≤ 150 mL;  if FVC is ≤ 1.0 L then: FEV1  repeatable  when  the  difference  between  the  two  largest  FEV1  is  ≤  100 mL; FVC  repeatable when the difference between the two largest FVC is ≤ 100 mL;  3.13  Oximetry Testing  SPIRODOC  is  able  to  perform  3  different  types  of  oximetry  tests,  which  will  be described in the following paragraphs.   WARNING If SPIRODOC has been purchased without the oximetry option only spirometry testing can be performed.  If the oximetry option is purchased afterwards, please contact a service center or the manufacturer to activate the oximetry function.   WARNING The  oximetry sensor  used  in  the  manual  is  only one  of  the  different  types of sensors which can be used listed in paragraph 2.2.4. MIR does not recommend any particular sensor; the doctor will chose the sensor which she/he believes to be more suitable.  During  oximetry  testing  the  SPIRODOC  cannot  be  turned  off.  To  turn  off  the device the oximetry test must be stopped first. This has been implemented so as to avoid any unwanted interruptions which could compromise  the accuracy of the data.  Il  sensore  descritto  di  seguito  rappresenta  solamente  un  esempio.  Con SPIRODOC possono essere utilizzati tutti i sensori descritti nel paragrafo 2.2.4. MIR non raccomanda l’uso di un particolare sensore; viene lasciata al medico la scelta in merito. Durante i test di ossimetria SPIRODOC non può essere spento, per spegnere il dispositivo  bisogna  prima  interrompere  il  test  che  è  in  esecuzione,  questo
 Spirodoc      cod. 980156   Rev 1.3      EN 44/67  ENGLISH permette  di  evitare  interruzioni  indesiderate  che  potrebbero  compromettere  la veridicità dei dati ottenuti.  For the non-invasive measurement of  SpO2  oxygen  saturation and blood pulse rate, utilize the re-usable finger sensor. This sensor is recommended for patients weighing more than 20 Kg while remaining still during testing. For the 6 minute walk test other types of sensors are recommended which are less influenced by the movement of the hand.  To carry out an oximetry test:  Connect the sensor to the device: insert the connector with the arrow (printed on the connector) face-up, as shown:    Choose  a  high  perfusion  site,  easily adaptable to the sensor. Insert the finger into  the  sensor  until  the  finger  touches the  end  of  the  probe.  Ensure  that  the bottom  part  of  the  finger  completely covers  the  detector. If  the  finger  cannot be placed properly inside  the sensor try another  finger.  Position  the  sensor  so that the cable is underneath the palm of the hand. This enables the light source to remain on the fingernail and the detector on the bottom part of the finger.  Select one of the tests that can be performed with SPIRODOC  To access the oximetry area touch the   icon on the main screen and subsequently select the type of oximetry test to carry out.   SpO2/BPM spot test  Sleep oximetry test (ODI)  Six minute walk test  If the following message appears upon start-up:  WARNING OXIMETER NOT PRESENT This means that your device does not have this function. If instead the following message appears: WARNING THE OXIMETER IS NOT ENABLED This means that the oximetry function is included, however the internal application has yet to be enabled. In this case please contact a service center or the manufacturer.
 Spirodoc      cod. 980156   Rev 1.3      EN 45/67  ENGLISH  WARNING Before  carrying  out  a  test,  if  the  power  supply  value  is  low  the  following message will appear:  Low battery level  Touch the ESC icon to exit the test, otherwise after a seconds will start the test. In the event that a test is interrupted due to a complete battery discharge, the next time the device is turned on the following message is displayed:  WARNING Wrong interruption of last oximetry test  At the same time an intermittent beep is emitted for ten seconds. Subsequently the SPIRODOC returns to the main screen.   WARNING Avoid  twisting  the  sensor’s  cable  as  this  may  compromise  measurement accuracy and the integrity of the sensor itself, also do not apply excessive force when using, connecting, disconnecting or storing the oximetry sensor.   The  first  few  seconds  are  used  to  find  the  best  signal  possible;  after  which  the SPIRODOC timer resets itself and the device starts recording data. For  any  type  of  oximetry  test  if  the  sensor  is  not  properly  connected  the  following message will be displayed on screen after a few seconds: WARNING Sensor not inserted  At the same time SPIRODOC emits an acoustic signal for 10 seconds. If  the  sensor  has  been  connected  properly  but  the  finger  has  not  been  properly inserted in the sensor the following message will be displayed on screen. WARNING FINGER not inserted  At the same time SPIRODOC emits an acoustic signal for 10 seconds. If the signal reaches the sensor properly, after a few seconds the device will emit an acoustic signal while also displaying the values on screen.  At the same time SPIRODOC emits an acoustic signal for 10 seconds.  The  alarms  can be  customized for  any  oximetry test,  the  procedure  is  described in paragraph 3.6.  During  oximetry  testing  if  the  SpO2  and  blood  pulse  rate  fall  below  the  bottom threshold or raise above the threshold, the SPIRODOC will emit a continuous acoustic signal  „beep‟  until  such  situation  persists.  This  function  can  be  disabled  for  sleep oximetry testing.
 Spirodoc      cod. 980156   Rev 1.3      EN 46/67  ENGLISH If the alarms are activated during oximetry testing the    icon will always show up on screen. The  alarms  function  can  be activated/deactivated even during oximetry testing.  By  touching  the        icon  the screen  on  the  right-hand  side  will  appear which allows to check the threshold values; to  activate/deactivate  the  alarms  function simply  touch  the  ON  or  OFF  icons.  If  the screen  remains  untouched  for  a  few seconds the device will return to the screen of  the oximetry test in progress.  For information concerning the proper setup of this function please refer to paragraph 3.6.  WARNING A  test  is  saved  with  the  name  of  the  last  patient  displayed.  If  a  test  refers  to  a previously  saved  patient,  then  prior  to  performing  a  test  the  user  must  recall  that patient from the database as described in paragraph 3.8.2   WARNING  During any oximetry testing in stand-alone mode the display will always show the battery pack level:   The numeric values display the hours and minutes left.  During a test the display will show the following information:   3.13.1  Walk test (6MWT)  Access the oximetry area by touching the   icon from the main screen, next select the test by touching the   icon.  The walk test is comprised of three stages:     Initial rest
 Spirodoc      cod. 980156   Rev 1.3      EN 47/67  ENGLISH   walking   recovery  Initial Rest In  this  stage  the  display  will  show  the following data:    Test time duration   Signal quality indication   Current stage   SPO2  percentage  value  and  the cardiac pulse rate (heart symbol)  The “initial rest” stage must continue for a minimum of 2 minutes, after which the   icon will appear on screen. Simply touch the   icon to move on the next “walking” stage.  If  the  user  does  not  move  on  to  the  “walking”  stage,  a  few  seconds  before reaching the 6 minute mark the  SPIRODOC will  emit  an  acoustic  signal “beep” as a warning, and automatically enter the “walking” stage. The number of bars (▬ symbol), on the right upper of the screen is proportional to the quality of the oximetry signal: the higher the quality of the signal the more bars will be shown  (maximum  7).  Place  a  finger  into  the  sensor  in  order  to  obtain  the  highest quality signal possible.  Walking Stage At the beginning of the “walking” stage the timer is reset to zero so that the user can immediately see of the duration of each single phase. The data on the display is the same as shown before. This stage will continue for a minimum of 2 minutes, after which the   icon appears on  screen.  To  move  to  the  next  “recovery”  stage  touch  the    icon  for  a  few seconds. If the “walking” stage continues for more than 6 minutes SPIRODOC will emit an acoustic signal “beep” and after 6 minutes are up the device will automatically move on to the “recovery” stage and the timer will be reset to zero again.  Recovery stage The duration of  this stage is  left up to the doctor. The device does  not indicate  this stage. (at the beginning of this stage the timer is reset to zero).To end the test simply touch the STOP icon.  At the  end of  the test  the data required for  the calculation  the following  parameters must be inserted;    Baseline DYSPNEA   Final DYSPNEA   Baseline FATIGUE   Final FATIGUE   Distance (meters)  These parameters follow the Borg scale and can have the following values: 0, 0.5, 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, the distance covered is indicated in meters.  The Borg scale coefficients represent the following severity values:
 Spirodoc      cod. 980156   Rev 1.3      EN 48/67  ENGLISH SCALE SEVERITY 0 None 0.5 Very Very Slight (Just Noticeable) 1 Very Slight 2 Slight  3 Moderate 4 Some What Severe 5 Severe 6     “ 7 Very Severe  8       “ 9 Very Very Severe (Almost Maximum) 10 Maximum  All the data from the walk test can be viewed in the following 6 screen shots and can also be printed by following the instructions found in paragraph 4.2.   If the test results are printed, the paper report will only show the data related to the “walking” stage of the test; please view the examples attached in this user manual. Touch the STOP icon to end the test at any time.   WARNING One of the parameters calculated during a walk test is the so-called Recovery Time. The Recovery Time is defined as the time taken for the SpO2 value to return to at least 99% of the average base value calculated during the initial stage of the test.   3.13.2  Sleep Oximetry  To access the oximetry area from the main screen touch the    icon, next select the   icon to select the test.  This test records overnight patient parameter variations. After approximately 5 minutes, SPIRODOC will enter standby (energy saving) mode; it stops beeping and the display turns off. The led signal remains on. To check that the device  is  functioning  properly  during  standby  mode,  press  ,  after  1  minute SPIRODOC will return to standby mode.   Should  the  signal  die  during  standby  mode  the  device  will  automatically  exit  the standby  mode  and  a  warning  message  will  appear  (sensor  unplugged  or  finger  not detected correctly). The data shown is the same as described in the previous test, except for information in this present mode, which has not been envisaged for this test. After the required time the test can be interrupted as previously described. To print data see Paragraph 4.2.; an example of a test printout report can be found in this user manual.
 Spirodoc      cod. 980156   Rev 1.3      EN 49/67  ENGLISH  3.13.3  Oximetry SpO2/BPM  To access the oximetry area form the main screen touch the   icon, next select the   icon.  The test duration is unlimited and the aim is to record variations of the oximetry values during a length of time decided by the doctor.   During  the  test  the  display  shows  the information that appears in the image to the right. The BEEP and ALARM icons allow to modify the following settings:  BEEP,  allows  to  activate/deactivate  the heart  beat  acoustic  signal  during  the test.   ALARM,  allows  to  activate/deactivate  the  thershold  alarms  as  descrive  in paragraph 3.6.  Unlike the sleep oximetry test, the display does not enter standby mode, thus always remaining on. To end the test simply touch the STOP icon. Please  refer  to  paragraph  4.2  for  a  data  printout;  an  example  can  be  found  in  the attachments inside this user manual.  3.13.4  Instructions for Adult Single Patient Sensor  WARNING The  oximetry sensor  used  in  the  manual  is  only  one  of  the  different  types of sensors which can be used with SPIRODOC listed in paragraph 2.2.4. MIR does not recommend any one particular sensor, the decision is left to the doctor who will choose the sensor which she/he believes to be more suitable.   To  perform  a  non-invasive  continuous  monitoring of  arterial  oxygen  saturation  it  is recommended to use the reusable "wrap" type sensor.   WARNING  The  materials  used  for  manufacturing  the  sensor  are  NATURAL  LATEX PROTEIN FREE, and are subject to biocompatibility tests.   WARNING The adult single patient sensor is ideal for patients weighing more than 30 kg. It should not be used on patients who suffer from  allergic reactions to adhesive tape. The sensor is specifically designed for single use only.
 Spirodoc      cod. 980156   Rev 1.3      EN 50/67  ENGLISH   Choose an application site on the patient‟s finger or toe where the light source will be directly over and in-line with the detector. The preferred sites are the forefinger or smaller thumb.     Remove nail polish or artificial fingernails.   Insert    the  patient‟s  digit in the sensor nail-side up,  lining  up  the  digit‟s  pad  over  the  detector. The sensor‟s positioning line runs across the mid axis of the fingertip      Wrap the bottom adhesive around the digit, being careful not to cover the nail.    Fold the sensor‟s top over the digit, making sure the  light  source  is  directly over and  in-line with the  detector.  Wrap  the  adhesive  around  the finger  or  toe  to  secure  the  sensor.  Route  the cable along the palm or the bottom  of the foot, and secure with adhesive tape if necessary.    Connect  the  sensor  to  the  device:  insert  the  connector  with  the  arrow  on  the connector face-up and check the proper functioning of the sensor according to the previous instructions.  WARNING Do  not  twist  the  cable  or  use  excessive  force  when  using,  connecting, disconnecting, or storing the sensor. Avoid over tightening the  adhesive tape; a  sensor wrapped  too  tightly  can produce inaccurate saturation measurements.  .  To reduce chances of entanglement it is recommended to fasten the cable to the wrist with a bandage.  4.  DATA TRANSMISSION  WARNING  Please  read  carefully  and  make  sure  to  have  properly  understood  the instructions before commencing the data trasmission.    WARNING
 Spirodoc      cod. 980156   Rev 1.3      EN 51/67  ENGLISH The BT wireless communication is intended as an add-on functionality. In case of transmission failure, we recommend to use the more reliable USB technology.  4.1  Data Transmission via Bluetooth to a cell phone  SPIRODOC incorporates a “Bluetooth” wireless data  transmission system. This  radio wave  connection  allows  SPIRODOC to connect  to  a suitable mobile  phone.  All  the data in SPIRODOC can be transferred with this method of data transmission. The step by step procedure is described below.  4.1.1  Preliminary Operations  WARNING Data transmission through Bluetooth connection requires the phone number of the  center where  the  data  will  be  received  (the  doctor’s  office,  a  telemedicine service  center,  etc.)  The  telephone  number  setup  is  done  by  means  of  the service menu. (please see paragraph 3.6) Furthermore it is necessary to setup a mobile phone to create a connection; for this matter also refer to paragraph 3.6.  4.1.2  Bluetooth data transmission.   Turn on the SPIRODOC   Touch the   icon on the main screen   The type of transmission selected is shown, if this is correct then confirm with OK to activate the connection to the default device that was initially setup    Upon request from the mobile phone insert the PIN code which corresponds to the Serial  number,  SN,  of  the  SPIRODOC  which  can  be  found  on  a  label  on  the bottom-side of the device.    The next stages of the connection are performed   Once the connection is up and running the data is transferred to the mobile phone   At  the  end  of  the  data  transfer  the  following  message  is  shown  “transmission complete”  At this stage the screen will show the following information:    The device with which the connection  was implemented  (described in  the  initial setup)   The PIN  code (which corresponds to the device serial number)  To stop the Bluetooth connection during the data transfer simply touch the STOP icon, by doing so the connection will be terminated and the device will return to the main screen. If  no  device  was  setup  for  the  data  transmission  a  message  will  appear  on  screen which allows the device to search for compatible devices. Once the device is setup the connection commences automatically.
 Spirodoc      cod. 980156   Rev 1.3      EN 52/67  ENGLISH Should  there  be  any  errors  during  the  data transfer the message on the right will appear on screen. The  device  will  automatically  return  to  the main screen; repeat the procedure again.   4.2  Data transmission via Bluetooth for printing   WARNING Data printing from the patient management function will only work if the printer too has a Bluetooth connection; another possible solution is with the use of a USB adaptor installed on the printer, thus enabling a Bluetooth connection.  The Bluetooth system enables SPIRODOC to transfer test data directly to a Bluetooth enabled printer. The procedure is listed below:  4.2.1  How to print a test saved in the database   From the main screen touch the   icon   Select a search method   Select the test session in which the test of interest was performed   Upon entering the test session select the test and touch the    icon.  If no device was setup to print via Bluetooth a message will appear on screen which allows  the  device  to  search  for  compatible  devices.  Once  the  device  is  setup  the connection commences automatically for the printout.  During the search for compatible devices to connect via bluetooth, SPIRODOC always checks  the  address  of  the  device.  If  a  previously  registered  device  should  change name it will be automatically upgraded. Should  there  be  any  errors  during  the data  transfer  the  message  on  the  right will appear on screen. The  device  will  automatically  return  to the  main  screen;  repeat  the  procedure again.   4.3  PC connection via USB port  WARNING  Before connecting spirobank II by USB to a PC, winspiroPro must be installed to interface with the device. It is important prior to initiating the following procedure to know the version of the operating  system installed  on the PC used for the connection  (from
 Spirodoc      cod. 980156   Rev 1.3      EN 53/67  ENGLISH control panel click on “System”, where the type of operating system installed on the PC can be checked). If winspiroPRO is already installed on the PC then a new installation is not required.  Before connecting the SPIRODOC via USB to the PC, the WinspiroPRO software must  be  installed  on  the  PC  first  to  enable  the  software  to  interface  with  the device.  Before  initiating the following  procedure  it is important to  know the  operating system version installed on the PC used for the connection (from control panel click on “System”, where the  type of  operating system  installed on the PC  can be checked). If  winspiroPRO  is  already  installed  on  the  PC  then  a  new  installation  is  not required.  To make the connection, insert the mini USB connector supplied with SPIRODOC as shown in the picture and attach the other connector to the USB port of the PC. When initially making a connection, depending on the version  of  the  operating  system,  the  PC  will  either make an automatic driver installation (for Windows 98, 2000,  ME)  or request  some  information  (for Windows XP, Vista and  Seven).  To avoid making any  errors at this  stage  please  read  the  Advanced  section  of  the winspiroPRO User Manual carefully.  4.4  PC connection via Bluetooth The bluetooth connection to the PC allows for the USB ports to remain unused while still  having  a  connection  whereby  the  SPIRODOC  is  directly  managed  by  the winspiroPRO software (as with a USB connection) SPIRODOC is capable of performing on-line real time spirometry tests via Bluetooth connection.   WARNING To  function  properly  the  PC  must  have  Bluetooth  connectivity  embedded  or must  be  equipped with  an  external  Bluetooth  USB dongle.  Before  starting the Bluetooth  connection  procedure  it  is  necessary  to  have  previously  performed the procedure described in paragraph 3.6 (BLUETOOTH setup).  For proper peripheral management please refer to the software user manual on line.  4.5  Internal software upgrade SPIRODOC  internal  software  can  be  upgraded  from  a  PC  via  USB  connection. Upgrades  can  be  downloaded  by  registering  on  www.spirometry.com.  For  further information on software upgrading please read the “winspiroPro” software manual.   5. MAINTENANCE
 Spirodoc      cod. 980156   Rev 1.3      EN 54/67  ENGLISH SPIRODOC requires very little maintenance  The operations to perform periodically are:     Cleaning and checking the reusable turbine.   Changing the disposable turbine before each test.   Cleaning the oximetry sensor (for reusable sensors).  Changing the adhesive tape of the oximetry wrap sensor.   Changing the battery.  The maintenance operations described in the User‟s Manual must be carried out with extreme care. Failing to observe the instructions may cause errors in measurement or the  misinterpretation of the measured values. Modifications,  adjustments,  repairs,  and reconfigurations  must be carried  out  by the manufacturer or by qualified personnel. In the unlikely event of a problem do not attempt to repair the unit. The parameter configuration setup must be carried out by qualified personnel. In any case the risks pertaining to an incorrect configuration setting in no way endangers the patient.  5.1  Cleaning and checking the reusable turbine  Two  types  of  turbines  can  be  used  with  SPIRODOC.  The  disposable  turbine  or  the reusable  turbine.  Both guarantee precise measurements and have the  advantage of requiring no periodic calibration. In order to maintain the default characteristics of the reusable turbine a simple cleaning procedure is required before use.  Cleaning of the disposable turbine is not required, as it is supplied clean in a sealed plastic bag. It must be disposed of after use.   ATTENZIONE È  buona  norma  controllare  periodicamente  che  all'interno  della  turbina  non siano  depositate  impurità  o  corpuscoli  estranei  come  peli  o  peggio  capelli. Questa eventualità infatti potrebbe frenare o bloccare l'equipaggio mobile della turbina compromettendo l'accuratezza della misura.  Prima  di  ogni  utilizzo  effettuare  il  test  descritto  al  paragrafo  5.1.1  seguente  che permette  di  controllare  lo  stato  di  efficienza  della  turbina,  se  il  risultato  del  test  è negativo operare come segue. Per  pulire  la  turbina  riutilizzabile estrarla  dall‟apposito  alloggiamento  ricavato  su SPIRODOC ruotando  in  senso  antiorario ed esercitando una  semplice trazione.  Per facilitare  l‟estrazione  è  utile  esercitare  una  lieve  spinta  sulla  base  della  turbina aiutandosi con un dito. Immergere  la  turbina  in  un  liquido  detergente  a  freddo  ed  agitarla  in  maniera  da rimuovere  le  possibili  impurità  depositate  all‟interno;  lasciarla  immersa  per  il  tempo suggerito dal produttore della soluzione detergente e riportato nelle istruzioni d‟uso.   WARNING
 Spirodoc      cod. 980156   Rev 1.3      EN 55/67  ENGLISH To avoid damage beyond remedy to the reusable turbine please do not use any alcoholic  or  oily  detergent  solutions,  and  do  not  immerge  the  turbine  in  hot water or hot liquids. Do not place the turbine under a direct water jet or other liquid. If no detergent solution is available, clean the turbine in clean water. MIR  suggests  the  use  of  Perasafe,  manufactured  by  Dupont,  which  has  been tested on all MIR sensors.  Rinse the turbine by immerging it in clean water (not hot). Shake off the excess water from the turbine and let it dry, position the turbine vertically on a dry surface.  Before inserting the reusable turbine in the device it is good practice to visually check that the rotor inside turns freely. Hold the turbine horizontally and slowly  move it left and  right  and  vice  versa.  You  should  be  able  to  see  the  mobile  equipment  (blade) rotate freely. If this is not the case then the measurement accuracy can no longer be guaranteed and as such the turbine must be replaced.  Having  completed  the  turbine  cleaning  procedure,  insert  the  turbine  in  its  housing making  sure  to  turn  it  clockwise  as  shown  by  the  symbol  of  the  lock  printed  on SPIRODOC.  The turbine is inserted properly by pushing it all the way in and subsequently rotating it clockwise until  it stops; this bayonet  mechanism  ensures  that  the turbine is blocked inside the plastic casing.   To be absolutely certain that the turbine is functioning properly perform the checklist in paragraph 5.1.1;  if the turbine is still malfunctioning please replace it with a new one.  WARNING When  using  disposable  turbines,  do  not  carry  out  any  cleaning  procedure.  A new disposable turbine must be used for a new patient.  5.1.1  Proper turbine operation check   Turn on SPIRODOC and setup the device to perfom a spirometry test (for example FVC).   Hold the SPIRODOC with one hand and move it slowly sideways, having the air pass through the turbine.  If the rotor spins properly the device will emit a series of acoustic signals “beeps”. The beeping frequency is a function of the air flow passing through the turbine.   If no beeps are heard while moving the device, proceed to clean the turbine  5.2  Oximetry sensor cleaning  Clean the sensor with a soft cloth moistened with water or a mild soap solution. To disinfect the sensor, rub with isopropylic alcohol. Allow the sensor to dry completely after cleaning.
 Spirodoc      cod. 980156   Rev 1.3      EN 56/67  ENGLISH  WARNING Do not sterilize by irradiation, steam or by using ethylene oxide. Unplug the sensor from the device before cleaning or disinfecting it.  5.3  Changing the adhesive wrap sensor  The adhesive tape is made with latex-free material.    Gently remove the used adhesive tape from the sensor and dispose of it.   The back of the sensor has alignment pins. Place the sensor with the alignment pins facing the adhesive part of the tape and align the pins to the holes on the tape.   Push the sensor so as to insert the pins into the holes of the tape. Lift both the sensor and the tape and check that the pins of the sensor are properly aligned.   WARNING It is highly suggested to use a new piece of adhesive tape for each patient, or as required.  5.4  Battery charging  Turn on SPIRODOC and the following icon will appear on the main screen showing the charge level of the battery pack:   The maximum charge level is displayed with all 6 bars inside the battery. If only one bar is shown or if the device will not even turn on the battery pack must be recharged in the following manner:    Plug the battery charger into a socket and the battery charger cable into the micro USB connector of the device; the device in this phase is always turned on   When the charging is complete the battery icon will display all six bars.   At this point disconnect the battery charger from the device.     WARNING It is recommended not to use the device while the battery is charging. Always disconnect the battery charger from the  device when the charge cycle has terminated.  6.  PROBLEM SOLVING  Please find below a list of problems that may arise when using SPIRODOC.  Diagnostic messages are also shown on the display indicating the type of malfunction:  6.1  Causes and solutions  The SPIRODOC  will not turn on
 Spirodoc      cod. 980156   Rev 1.3      EN 57/67  ENGLISH - The battery pack could be completely discharged; recharge the device by connecting it to the battery charger. -  The  device  internal  software  is  lost.  Connect  the  device  to  the  PC  via  USB  and proceed to download the internal software. For further information please refer to the winspiroPRO user manual available inside the software itself.  While in use the device turns off and on again. - An internal error has occured, please check on the website www.spirometry.com for new  internal  software  upgrades.  Should  there  be  a  newer  internal  software  version please upgrade the device by using the winspiroPRO software. For further information please refer to the winspiroPRO user manual available inside the software itself.  At the end of a spirometry test the data measurements are not reliable. - Clean the turbine as shown in paragraph 5.1; if necessary replace the turbine with a new one.  Memory loss due to an unexpected event -  The database has been lost. Contact a local technical service center.   WARNING Before  contacting  a  technical  assistance  center,  please  try  downloading  the database  from  the  device  to  the  PC  using  the  winspiroPRO  software.  This procedure  is  necessary  as  a  backup  in  case  all  the  data  is  accidentally  lost during device repair. Furthermore the database could be of confidential nature and as such not accessible by authorized personnel and also subject to privacy laws.
 Spirodoc      cod. 980156   Rev 1.3      EN 58/67  ENGLISH   srl MEDICAL INTERNATIONAL RESEARCH Via del Maggiolino 125, 00155 Roma - ITALY    Declaration of CE Conformity  Quality Management System according to the requirements of Annex II of the Medical Device Directive 93/42/EEC implemented by the Legislative Decree 46 dated 24/02/97  Notified Body CERMET  No. 0476   -   Certificate  No. MED – 9826  MIR srl Medical International Research, declares that the Device subject of this declaration together with its standard accessories conforms to the requirements of the Council Directive 93/42/EEC Annex I.  Device Description    Spirometer/Oximeter Device Name    spirobank II Classification    IIa This Device is marked        Any modifications to the Device which are not authorised by MIR will invalidate this Declaration  Roma  01 / 01/ 2006   Paolo Sacco Bochetti President of the Board of Trustees.   Rev.0  – Mod. PO-10DDC_SPIRODOC
 Spirodoc      cod. 980156   Rev 1.3      EN 59/67  ENGLISH LIMITED WARRANTY CONDITIONS  spirobank II, together with its standard accessories is guaranteed for a period of:   12 months if intended for professional use (doctors, hospitals, etc.)   24 months if the product has been purchased directly by the end user. The  warranty  is  effective  from  the  date  of  purchase  shown  on  the  relevant  sales invoice or proof of purchase.  The warranty is effective from date of sale which must be shown on the relevant sales invoice or proof of purchase.  The device must be checked at the time of purchase, or upon delivery, and any claims must be made immediately in writing to the manufacturer.  This  warranty  covers  the  repair  or  the  replacement  (at  the  discretion  of  the manufacturer) of the product or of the defective parts without charge for the parts or for the labour.  All batteries and other  consumable parts are specifically excluded from the  terms of this guarantee.  This warranty is not valid, at the discretion of the manufacturer, in the following cases:    If the fault is due to an improper installation or operation of the machine, or if the installation  does  not  conform  to  the  current  safety  norms  in  the  country  of installation.  If the product is utilised differently from the use described in the User‟s Manual.   If  any  alteration,  adjustment,  modification  or  repair  has  been  carried  out  by personnel not authorised by the manufacturer.   If the fault is caused by lack of or incorrect routine maintenance of the machine.   If the machine has been dropped, damaged or subjected to physical or electrical stress.   If the fault is caused by the mains, or by a product to which the device has been connected.   If  the  serial  number  of  the  device  is  missing,  tampered  with  and/or  not  clearly legible.  The repair or replacement described in this warranty is supplied for goods returned at the  customers‟  expense to our certified service centers.  For details of these centers please  contact  your  local  supplier  of  the  spirometer  or  contact  the  manufacturer directly.  The customer is responsible for the transportation and for all transport and customs charges  as  well  as  for  delivery  charges  of  the  goods  both  to  and  from  the  service center.  Any  device  or  accessory  returned  must  be  accompanied  by  a  clear  and  detailed explanation  of  the  defect  or  problem  found.  If  units  are  to  be  returned  to  the manufacturer then written or  verbal  permission must be received  before any  devices are returned to MIR.
 Spirodoc      cod. 980156   Rev 1.3      EN 60/67  ENGLISH MIR  –  Medical  International  Research  reserves  the  right  to  modify  the  device  if required,  and  a  description  of  any  modification  made  will  be  sent  along  with  the returned goods.   ALLEGATO 1  OXIMETRY TEST REPORTS EXAMPLES
 Spirodoc      cod. 980156   Rev 1.3      EN 61/67  ENGLISH
 Spirodoc      cod. 980156   Rev 1.3      EN 62/67  ENGLISH
 Spirodoc      cod. 980156   Rev 1.3      EN 63/67  ENGLISH  ALLEGATO 2  SPIROMETRY TEST REPORT EXAMPLE
 Spirodoc      cod. 980156   Rev 1.3      EN 64/67  ENGLISH  ANNEX 3  INFORMATION  FOR  CORRECT  USE  IN  AN ELECTROMAGNETIC ENVIRONMENT  Guidance and manufacturer’s declaration – electromagnetic emissions  The spirobank II is intended for use in the electromagnetic environment specified below.  The customer or the user of the Spirobank II should assure that it is used in such an environment. Emissions test  Compliance  Electromagnetic environment – guidance RF emissions CISPR 11  Group 1  The SPIRODOC uses RF energy only for its internal function.  Therefore,  its  RF  emissions  are  very  low and are not likely to cause any interference in nearby electronic equipment. RF emissions CISPR 11 Class B   Harmonic emissions IEC 61000-3-2 Not applicable  Voltage fluctuations/ flicker emissions  IEC 61000-3-3 Not applicable
 Spirodoc      cod. 980156   Rev 1.3      EN 65/67  ENGLISH   Guidance and manufacturer’s declaration – electromagnetic immunity  The spirobank II is intended for use in the electromagnetic environment specified below. The customer or the user of the spirobank II should assure that it is used in such an environment. Immunity test  IEC 60601 test level Compliance level  Electromagnetic environment – guidance Electrostatic discharge (ESD)  IEC 61000-4-2 6 kV contact 8 kV air6 kV contact 8 kV airFloors should be wood, concrete or ceramic tile.  If  floors  are  covered  with  synthetic material,  the  relative  humidity  should  be at least 30 %. In the event of disruption due to ESD during oximetry test, the device recovers from any disruption  within  30  s.  (according  to  ISO 9919). Electrical fast transient/burst  IEC 61000-4-4 ±1 kV for input/output lines  Mains  power  quality  should  be  that  of  a typical commercial or hospital environment. Surge  IEC 61000-4-5 1  kV  differential mode 2 kV common modeNot  Applicable Mains  power  quality  should  be  that  of  a typical commercial or hospital environment. Voltage  dips, short interruptions and voltage variations on power supply input lines  IEC 61000-4-11 <5 % UT (>95 % dip in UT) for 0,5 cycle  40 % UT (60 % dip in UT) for 5 cycles  70 % UT (30 % dip in UT) for 25 cycles  <5 % UT (>95 % dip in UT) for 5 sec Not  Applicable  Power frequency (50/60 Hz) magnetic field  IEC 61000-4-8 3 A/m  3 A/m  Power frequency magnetic fields should be at  levels  characteristic  of  a  typical  location in  a  typical  commercial  or  hospital environment.              Conducted RF  IEC 61000-4-6   Radiated RF  IEC 61000-4-3              3 Vrms  150 kHz to 80 MHz   3 V/m  80 MHz to 2,5 GHz              [3 ] V     [3 ] V/m Portable  and  mobile  RF  communications equipment should be used no closer to any part  of  the  spirobank  II,  including  cables, than the recommended separation distance calculated  from  the  equation  applicable  to the frequency of the transmitter. Recommended separation distance  d=[ 3.5   ]  √P         3   d=[ 3.5   ]  √P  80 MHz to 800 GHz       3  d=[ 7    ]  √P  800 MHz to 2,5 GHz       3  where  P  is  the  maximum  output  power rating  of  the  transmitter  in  watts  (W) according  to  the  transmitter  manufacturer and  d  is  the  recommended  separation
 Spirodoc      cod. 980156   Rev 1.3      EN 66/67  ENGLISH distance in metres (m).  Field  strengths  from  fixed  RF  transmitters, as  determined  by  an  electromagnetic  site survey,  should be less than the compliance level in each frequency range.  Interference  may  occur  in  the  vicinity  of equipment  marked  with  the  following symbol:  NOTE UT is the a.c. mains voltage prior to application of the test level.  NOTE 1 At 80 MHz and 800 MHz, the higher frequency range applies.  NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.  a) Field strengths from fixed transmitters, such  as base stations for radio (cellular/cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the spirobank II is used exceeds the applicable RF compliance level above, the spirobank II should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or relocating the spirobank II.  b) Over the frequency range 150 kHz to 80 MHz, field strengths should be less than [3] V/m.
 Spirodoc      cod. 980156   Rev 1.3      EN 67/67  ENGLISH  Recommended separation distances between portable and mobile RF communications equipment and the spirobank II  The spirobank II is intended for use in an electromagnetic environment in which radiated RF disturbances are controlled.  The  customer  or  the  user  of  the  spirobank  II  can  help  prevent  electromagnetic  interference  by maintaining  a  minimum  distance  between  portable  and  mobile  RF  communications  equipment  (transmitters) and the spirobank II as recommended below, according to the maximum output power of the communications equipment.    Rated  maximum output power  of transmitter  W  Separation distance according to frequency of transmitter m 150 kHz to 80 MHz   d=[ 3.5   ]  √P         3 80 MHz to 800 MHz   d=[ 3.5   ]  √P         3 800 MHz to 2,5 GHz   d=[   7   ]  √P         3 0.01 0.12 0.24 0.24 0.1 0.37 0.37 0.74 1 1.17 1.17 2.34 10 5.28 5.28 1.056 100 11.66 11.66 23.32  For transmitters rated at a maximum output power not listed above, the recommended separation distance d in metres (m) can be estimated using the equation applicable to the frequency of the transmitter, where  P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.  NOTE 1 At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.  NOTE 2 These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects and people.

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