BREEZESUITE ULTIMA PFX USER MANUAL

The MedGraphics BREEZESUITE PFX Ultima User Manual is Part No. 142152-
001Rev C.

Caution: Federal (USA) law restricts this device to sale by or on the order of a
physician if it is to be used for diagnosis and/or prescribing of therapy.

MedGraphics is a registered trademark of Medical Graphics

Corporation. Medical Graphics Corporation makes no claim for use of the
product other than for those uses specified herein and disclaims any
liability resulting from other uses. Observe all warnings and cautions.

Copyright Medical Graphics Corporation 2005. All rights reserved.

Unauthorized use, copying or distribution is prohibited.

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Devices are compliant with the European Medical Directive
(93/42/EEC) regarding safety and EMC.

2
 INDEX

Start Up and Shut Down .................................................................................................. 6

System Start Up.............................................................................................................. 6
Shutting Down ............................................................................................................... 7
After Gas Exchange (GX) Analyzer Calibration ................................................... 7
At end of test ............................................................................................................. 7
At end of day............................................................................................................. 7
System Calibration............................................................................................................ 8
Pneumotach Calibration ............................................................................................. 8
Gas Analyzer Calibration........................................................................................... 12
Maximal Inspiratory and Maximal Expiratory (MIP/MEP) Calibration .................. 14
DLCO ................................................................................................................................. 17
DLCO Overview ........................................................................................................... 17
DLCO Screen ................................................................................................................ 18
DLCO Trace .................................................................................................................. 19
DLCO Data Grid........................................................................................................... 20
DLCO Toolbar ............................................................................................................... 21
DLCO Test Procedure .................................................................................................. 22
Instructing the Patient............................................................................................. 22
Pre-Test Procedure .................................................................................................. 22
Test Procedure ......................................................................................................... 23
Automatic Gas Analysis ......................................................................................... 25
Repeating Test Efforts ............................................................................................. 25
Selecting Efforts ........................................................................................................... 26
Using Auto Select .................................................................................................... 26
Manually Selecting Efforts ...................................................................................... 26
Selecting a Report Loop ........................................................................................ 26
Drawing Efforts ......................................................................................................... 26
Printing Reports ........................................................................................................ 26
DLCO Options............................................................................................................... 27
Configuration........................................................................................................... 27
Lock-out Time........................................................................................................... 27
Anatomic Dead Space.......................................................................................... 27
DL/VA........................................................................................................................ 27
Inspiratory Time ........................................................................................................ 28
Keystroke to Start Test ............................................................................................. 28
Perform Auto-Select................................................................................................ 28
Evaluate Reproducibility ........................................................................................ 28
Display Acceptability Message............................................................................. 28
Helium Shut Off Warning ........................................................................................ 28
Pressure Indicator On.............................................................................................. 28
Correct TLC for FEV1/FVC ....................................................................................... 28
Collection Protocol ................................................................................................. 29
Hemoglobin Author ................................................................................................ 29
Start Collect Volume............................................................................................... 29

3
 Stop Collect Volume............................................................................................... 29
Patient Valve Lockout ............................................................................................ 31
FRC TESTING..................................................................................................................... 32
FRC Overview .............................................................................................................. 32
Using the FRC N2 Toolbar ........................................................................................... 33
Using the FRC N2 Data Grid ....................................................................................... 34
FRC Test Procedure..................................................................................................... 35
Instructing the Patient............................................................................................. 35
Pre-Test Procedure .................................................................................................. 35
Test Procedure ......................................................................................................... 35
Repeating FRC N2 Washout Efforts ....................................................................... 36
Selecting FRC (N2) Efforts and Printing Reports....................................................... 38
Using Auto Select .................................................................................................... 38
Manually Selecting Efforts ...................................................................................... 38
Selecting a Report Loop ........................................................................................ 38
Selecting SVC Efforts Done in Spirometry............................................................. 38
Drawing Efforts ......................................................................................................... 38
Printing Reports ........................................................................................................ 38
FRC Options ................................................................................................................. 39
Configuration........................................................................................................... 39
Keystroke to Start Test ............................................................................................. 39
Perform Auto-Select................................................................................................ 39
Individual SVC Maneuvers ..................................................................................... 39
Average IC/ERV ...................................................................................................... 39
Evaluate Reproducibility ........................................................................................ 41
TLC Calculation ....................................................................................................... 41
MIP/MEP ........................................................................................................................... 42
MIP/MEP Overview ..................................................................................................... 42
MIP/MEP Test Bar ......................................................................................................... 42
MIP MEP Data Grid ..................................................................................................... 43
MIP/MEP Testing Procedure....................................................................................... 43
Instructing the Patient............................................................................................. 43
Test Procedure ......................................................................................................... 45
MIP/MEP Options......................................................................................................... 47
Keystroke to Start Test ............................................................................................. 47
Maximum Occlusion ............................................................................................... 47
Measurement Mode............................................................................................... 47
MIP/MEP Test Screen .................................................................................................. 49
VO2 Test Procedure ........................................................................................................ 50
Preparing for a Test..................................................................................................... 50
Test Procedure............................................................................................................. 50
Direct Connect preVent Pneumotach for Ventilator Patients................................. 52
Metabolic Assessment with Ventilators Review...................................................... 52
Example of a patient on Direct Connect for Metabolic/Nutritional Assessment
....................................................................................................................................... 53
Setup and Calibration of the Direct Connect preVent Pneumotach............. 53
Patient Setup ............................................................................................................... 54
Notice to PB 840 Users:............................................................................................ 55

4
 References................................................................................................................... 55
Replacing the Drying Line and Cartridge................................................................... 56
Replacing the Drying Sample Line ........................................................................... 56
Replacing the Drying Cartridge ............................................................................... 56
Sample Line Maintenance............................................................................................ 58
Procedure .................................................................................................................... 58
Refreshing The O2 Cell.................................................................................................... 60
Replacing the O2 Cell .................................................................................................... 61
Cleaning CO2 Analyzer.................................................................................................. 63
Required Equipment................................................................................................... 63
Procedure .................................................................................................................... 63
Gases/Regulators/Pressures ...................................................................................... 64

5
 START UP AND SHUT DOWN

System Start Up
1. Before turning the power on, plug a power conditioner into the wall
outlet. Connect the power cords to the Ultima system and PF
module, and plug the system and module into the power
conditioner. Ensure all communication cables are securely
attached between Ultima and PF module, as well as the PF arm
cable and tubing connections.
2. Push the main power rocker switch on the back of both systems.
The power light on the front of the Ultima system will turn from
amber to green when the system is completely warmed up.
3. Flip the computer power switch to “On.”
4. Turn the monitor power to “On.” The Windows™ desktop menu
displays on the screen.
5. Open Breeze.
6. Turn on the gas exchange (GX) vacuum pump in Breeze.
7. If using a drying cartridge, check to see if the blue drying crystals
are still evident before calibrating or testing.
8. Wait 30 minutes for the system to warm up and stabilize. Wait 10
minutes for vacuum pump to stabilize and 12 minutes for DLCO
helium (concurrent with the system warm up).

Note: If the system power is turned off for a short duration (less than 15 minutes),
analyzer warm-up time will be double the power-down time.

9. Turn on the printer and other external devices installed with the
system.
10. Open all gas tanks by turning the gas cylinder’s top pressure valve
to the left. The calibration and reference gas for the Ultima system
should be set to deliver 15 psi. Ultima WD tanks are preset to 15 psi
and have only one adjustment knob to open and close. Open the
tanks by turning the black knob counterclockwise.
11. Set the PF module gases to 135 psi for both diffusion (DLCO), and
oxygen (O2). Helium is an adjustable regulator setting between 10 –
25 psi.
12. Calibrate the pneumotach at the start of the day.
13. Automatically calibrate the gas analyzers (O2 and CO2) before
each test.

6
Shutting Down
After Gas Exchange (GX) Analyzer Calibration
Note: Gas exchange calibration (GX Autocal) calibrates the oxygen and carbon
dioxide analyzer (O2 & CO2) that is used for all GX and FRC testing. The calibration
and reference gases should be turned off only if there are no further GX or FRC
tests performed in the next two hours.

Close the Ultima gas tanks (turn the gas cylinder pressure valve to right).
For WD tanks, turn the black knob clockwise on each cylinder after
completing the gas analyzer calibration process. The calibration and
reference gases connected to the Ultima are used only for the calibration
of the O2 and CO2 analyzers for all gas exchange and pulmonary testing.

At end of test
To avoid the 30-minute gas analyzer warm-up and stabilization, allow the
system to remain turned on throughout the day. Prolong the life of the
vacuum pump and analyzers by turning the pump off whenever possible
(the software timer will display “Ready” when the gas auto calibration
can be performed). The system requires a 10-minute stabilization time
when the pump is turned on.

At end of day
The system’s main power switch may remain turned on overnight. To
prolong the life of the oxygen analyzer, turn the vacuum pump off
whenever possible. To prolong the life of the DLCO gas column, turn off the
helium flow whenever possible. Close the gas cylinders by turning the
valve (on top of the tank) clockwise until tight or turn the black knob
clockwise on the WD tanks.

7
 SYSTEM CALIBRATION

Allow the system to warm-up and stabilize:

• 30 minutes for the Ultima system and PF module (concurrent)

• 10 minutes for the vacuum pump (prior to gas calibration)

Pneumotach Calibration
1. Install the pneumotach into the clip and connect it to the rubber
coupler (screen toward coupler).

Figure 1: Pneumotach clipped into the

umbilical.

2. Connect the rubber coupler/pneumotach assembly to the

calibration syringe.
3. Select “Calibrate” at the top of the screen to enter the calibration
screen.

Note: You must have the patient entry screen closed to select Calibration.

4. The software defaults to 3 liters for the calibration syringe size. If you
are utilizing a different volume syringe, enter this value in place of
the default value of three liters.

8
 5. Enter the current temperature, barometric pressure, and humidity
at the bottom of the screen. Verify the units of measurement.

Flow Zero

Ambient conditions must be

entered daily.

Figure 2: Ambient conditions must be entered

daily

6. Click “Zero Flow” to zero the pneumotach. If the calibration is

unsuccessful, a message appears stating that the flow offset is out
of range. Repeat the procedure. If the zero continues to fail, try a
different pneumotach and ensure the umbilical tubing is not
occluded.
7. Click “Start” or press the spacebar to begin volume calibration.
8. The software will first prompt to withdraw the syringe. Withdraw the
complete volume of the syringe. Use the guides/markers to assist
you with the variance/speed of your calibration syringe withdraws
and injections.

Note: Within pneumotach calibration the flow should trace downward for all
withdraws and upwards for all injections. If it does not trace downward, the
pneumotach or pneumotach umbilical could be connected incorrectly or the
pneumotach may have been inserted in the syringe incorrectly.

9. Push in smoothly and evenly on the plunger. Be certain to inject

the complete volume of the syringe.
10. Repeat steps eight and nine until five injections and withdrawals
are recorded. Withdrawals and injections should be performed at
varied rates. The sequence stops automatically after five injections
and withdrawals.

9
 Figure 3: Example of syringe
calibration

10
 Syringe volume
set-up
Flow zero

Dotted lines are for reference so

different flow rates will be
withdrawn and injected.

Figure 4: Different features of the calibration

page

11
Gas Analyzer Calibration
The CPX Ultima gas calibration uses an automatic calibration (AutoCal)
feature. AutoCal measures the signals and automatically adjusts the gain
and offset values to accommodate the signal values. Ensure the vacuum
pump has been on for a minimum of 10 minutes and displays “Ready.”

1. Gas calibration begins by placing the umbilical clip into the

cal/home port on the front of the Ultima.

Figure 5: Placing the umbilical clip

2. Align the bump on the umbilical so that it matches the circle

located on the cal/home port of the system.
3. Select “GX AutoCal” in the software.

Figure 6: Selecting “GX AutoCal”

4. Results are displayed when the calibration is complete.

Figure 7: Calibration results

12
An out-of-range result will display in RED. Click “Retry” if a measured
result is displayed in red. If the gas analyzer calibration continues to fail,
verify the following:

• The clip is properly seated in the Cal/Home port.

• The calibration and reference gases fully open and the tanks are
full.
• The pink sample line is secure in the umbilical silver compression
fitting. To secure the sample line, pull back the rubber strain relief
by pushing inward on the side tabs and slide the tabs back from
the clip.
• The compression fitting that secures the dry line on the front of the
Ultima is not crimped.
• The drying sample line is securely connected to the pink sample
line on the front of the system.
• The luer fitting is in working order. If the filter needs to be replaced,
first use the purge pump to purge the sample line from the luer
fitting to the clip end.

Breeze uses AutoCal to measure the gain. AutoCal sets the offset to
achieve optimal min phase percentage values. Breeze may be
indicating a failing O2 cell when:

• offsets go out of range

• 2-90% response time goes out of range before the min phase % for
O2 goes out of specification.

If the offsets continue to fail in AutoCal, the cal gas readings may be out
of range and may require adjustments in the manual calibration of O2
and CO2 analyzers.

13
Maximal Inspiratory and Maximal Expiratory
(MIP/MEP) Calibration

To calibrate for MIP/MEP testing, select “MIP/MEP” in the calibration menu.

The MIP/MEP transducer requires a digital or water-type manometer to
apply a pressure or signal to the transducer.

1. Select “Zero” to zero the MIP/MEP Transducer.

2. Enter the reference value of pressure that will be applied to
transducer.

Note: The MIP/MEP reference pressure may be set to any value less than 500 cm
H2O. The default value is 20 cm H2O (see figure 8).

Figure 8: MIP/MEP
calibration

3. Disconnect the luer fitting and apply the above-entered reference

pressure to the transducer (see figure 9).

14
 Figure 9: Luer fitting

4. Apply pressure with a manometer (see figure 10) to the position of

the three-way stopcock.

15
 Figure 10: Applying pressure with a manometer

5. Press spacebar to calibrate the MIP/MEP transducer.

Note: Lung Diffusion (DLCO) does not contain an individual calibration. The
calibration of DLCO testing is performed during the initial system pre-analysis.

16
 DLCO

DLCO Overview
The ability to measure lung diffusion (DLCO) is important for a number of
reasons. Most importantly, diffusion capacity is the only non-invasive
means of determining the functional integrity of the alveolar-capillary
membrane.

The diffusing capacity measurement provides a means of differentiating

pathologies by the damage that they inflict on the lung parenchyma,
such as the reduction in alveolar-capillary surface area in emphysema or
the alveolar-capillary membrane permeability changes seen with diffuse
interstitial processes. The ability to differentiate between processes greatly
facilitates treatment.

Note: The helium gas must be turned on at least 12 minutes before attempting a
diffusion test. The helium gas flow is activated from the “Helium” button at the top
of the patient test screen.

17
DLCO Screen

Figure 11: DLCO

screen

18
DLCO Trace

Figure 12: DLCO

trace

19
DLCO Data Grid

Figure 13: DLCO data

grid

20
DLCO Toolbar

Figure 14: DlCO

toolbar

21
DLCO Test Procedure
DLCO testing is performed using the preVent pneumotach and a
mouthpiece connected to the pneumotach umbilical. The pneumotach
must also be connected to the patient circuit in the arm of the Ultima PF
or PFX.

Note: If both diffusion and nitrogen washout tests are to be conducted, the
diffusion test should be performed first. Inhaling 100% oxygen during a nitrogen
washout test may saturate the hemoglobin and decrease the patient’s diffusion
capacity values.

Instructing the Patient

Standard testing procedures begin with instructing the patient and
demonstrating proper technique. The greatest potential source for error is
the failure of the patient to perform the test properly.

Pre-Test Procedure
1. Be sure you have warmed up the system and performed the daily
complete pneumotach calibration. Before testing Helium gas must
be on for twelve minutes. Warm up time is displayed on the
associated timer at the top of the screen.

Tip: The volume of He passing through the gas chromatograph column will effect
the column’s deterioration. To prolong the life of the gas chromatograph column,
turn on the He gas no more than 12 minutes before performing a diffusion study.
Turn off the He gas as soon as diffusion testing is completed.

2. Click to enter a new patient or click to open an existing

patient. Enter the appropriate information. Required fields are
accented with color. See Opening a Patient File and Starting a
Visit.
3. When you have finished entering patient information, click to
enter a new visit and begin a new test session.
4. Fill out the Visit Demographics and Patient History tabs. Required
fields are accented with color.
5. Select the DLCO Tab.
6. When you click the DLCO tab, the only active button is Analyze.
Click the Analyze button to begin diffusion testing. The program
flushes the patient circuit with diffusion gas from your source tank.
The message bar on your computer screen displays the status of
the pretest analysis procedure. After analyzing the diffusion gas,
the sample chamber is evacuated and a pre-analysis graph is
displayed.

22
 The program checks the DLCO analyses generated by your system against
these criteria:

• The Ne peak should be between 8 and 9.5 volts.

• The start of the Ne peak should occur between 0-15 seconds on
the time axis.
• The trace between the N2 and CO peaks should fall to within +1
volt of the baseline, using the left hand scale.
• There should be 15 seconds between the end of the N2 peak (point
B) and the beginning of the CO peak.

If your system meets these criteria, patient testing may begin. If your
system does not meet these criteria, see Gas Chromatograph Column
Maintenance and Troubleshooting the DLCO Trace.

Test Procedure
1. Before beginning the test, click “Zero Flow” to zero the
pneumotach. There must be no flow through the pneumotach
during this procedure.
2. If you are not testing using the Pre/Post protocol, click the
“Protocol/Log” tab and choose a test protocol from the protocol
pull down menu. Pre/Post is the default protocol for all new visits.
3. Ensure that the pneumotach is attached to the pneumotach
umbilical clip and that the unit is attached to the patient circuit in
the Ultima arm.
4. Place a nose clip on the patient and instruct the patient to begin
tidal breathing through the mouthpiece.
5. Press the spacebar to begin data collection.
6. Instruct the patient to exhale slowly and maximally to residual
volume (RV). While the patient is exhaling, or at the end of this
exhalation, click “Next” or press the spacebar. When the computer
detects zero flow, the patient valve closes for the start of
inspiration. The patient circuit opens to the source gas (diffusion
gas).
7. After the valve system is activated, instruct the patient to rapidly
inhale maximally to total lung capacity, filling the lungs with
diffusion gas. The valve will close automatically when zero
inspiratory flow is sensed.

Note: If the patient begins to inhale before the valve system is activated, the
patient’s inspired volume will not be measured correctly. The numeric data
displayed in the “Vol. Inspired” row will be lower than the trace displayed on the
volume/time graph.

8. When the valve system closes, the patient is locked out for the time
specified in the setup menu. Instruct the patient to relax against the
closed valve for this period. The end of lockout is shown as a

23
 vertical dotted line on the volume/time graph. During lockout,
watch the graph to see when the valve is about to open.
9. At the end of lockout, the valve opens. Instruct the patient to
exhale rapidly until the sample is collected.
10. The test ends automatically. Have the patient relax and remove
the nose clips.

24
Automatic Gas Analysis
At the end of each effort, a gas sample is collected automatically into the
chromatograph for analysis. Analysis of the patient sample is
superimposed on the preanalysis graph and all measured values are
displayed on the data collection screen. While the sample is being
analyzed, the diffusion circuit is flushed. Once the results from the previous
effort are displayed, the system is ready for additional efforts.

Repeating Test Efforts

Each patient should perform at least two diffusion efforts. Allow a four-
minute interval between efforts. This ensures clearance of the trace gases.
The results of the two efforts should agree within 10%. If the first two efforts
do not show repeatability, attempt a third effort.

25
Selecting Efforts
Using Auto Select
If the “Perform Auto-Select” option is on, the computer selects
acceptable efforts automatically. Selected efforts are indicated by a
check in the select column. The computer does not automatically save
any efforts with error messages in the codes column. If all efforts have
performance codes, no efforts are automatically saved; you must save
the desired effort(s) manually.

Manually Selecting Efforts

To manually select an effort, click the select column. You may select more
than one effort per stage. Data for all selected efforts for each stage are
averaged in the AVG row.

Selecting a Report Loop

A check box in the RpLp column allows you to select the stage effort that
will be used for report graphs. Only one effort may be used for each test
stage.

Drawing Efforts
Double-click on an effort’s time stamp to draw the effort. You can draw
several efforts as a montage to compare efforts of interest without
clearing the screen between selections. Double-click the graph to
enlarge it in a zoom dialog. Click to clear the review graphs.

Tip: Any time you click an effort’s time stamp to draw it, the system switches to
Review mode. You will need to click the icon to re-enter the Test mode. Also
see About Review and Test Modes.

Printing Reports
To print a report after testing is complete, select the Reports Menu. You
may choose from a list of the most recently generated report formats or
you may select Report Switchboard to select from all reports available on
your system.

26
DLCO Options

To access the DLCO test options, select the DLCO tab and choose
“Options” from the tools menu or press F5. The following options are
available from the diffusion setup menu:

Configuration
Changes made to either the test options or the test view (splitter bar
positions, column width, display variables and graph properties) can be
saved to a configuration file that can then be selected for future tests.
Several preset configurations are available for each test. You may select
one of these or create a new configuration. The default DLCO
configuration is locked at the time of installation.

Note: Configuration changes are saved automatically unless the configuration is

locked. To unlock the preset DLCO configuration, select the configuration, click on
the right arrow and select “Unlock” and enter the password “MGC”.

To create a new test configuration:

1. Open a patient visit and select the appropriate test tab.
2. From the tools menu, select “Options.”
3. In the options menu, click the arrow in the configuration area and
select “Create New.”
4. Enter a name for the configuration and click “OK.”
5. Modify the test configuration as necessary. Your changes are
automatically saved.

Lock-out Time
Enter the desired time (in seconds) to specify the period for which the
patient is locked out of the system for breath holding. The lockout time
may be changed to account for slow exhalations by obstructed patients.
Lockout time should be approximately six to eight seconds.

Anatomic Dead Space

Input the desired value (in milliliters) for the patient’s anatomical dead
space. The default value for adults is 150 mL (a value specified by ATS
recommendations).

DL/VA
The DL/VA option allows for the VA used in the DL/VA calculation to be
either BTPS or STPD (the default is BTPS).

27
Inspiratory Time
There are two options available for the evaluation of inspiratory time:

1. ATS measures the time required to inspire 90% of the final inspired
volume.
2. STD uses the entire inspiratory time (Default is ATS).

Note: The “Inspiratory Time” setting refers to the evaluation of inspiratory time for
acceptability and does not affect the calculation of breath-holding time.

Keystroke to Start Test

When Keystroke to Start Test is off, breathing on the system initiates the
start of data collection. When on, the spacebar must be pressed to start a
test (the default command is the spacebar to start a test).

Perform Auto-Select
If Effort Analysis is on, all acceptable and reproducible efforts are
averaged and saved automatically for generated reports.

Evaluate Reproducibility
When selected, new efforts are evaluated for reproducibility. Select which
variable to use as criteria for reproducibility. Use the spinner control to
adjust the margin of reproducibility.

Display Acceptability Message

Displays messages for each effort to indicate whether the effort meets ATS
performance criteria (default is on).

Helium Shut Off Warning

If selected, upon exiting DLCO, the system displays a message reminding
you to turn off the helium gas if you did not do so in the DLCO program.

Pressure Indicator On
Displays mouth pressure during lock out.

Correct TLC for FEV1/FVC

Applies a correction factor to the TLC based upon the patient’s FEV1/FVC
ratio.

28
Collection Protocol
The following four options are available for collection protocol: Jones-
Meade (ATS), Ogilvie (ATS), ESP, and User-Defined:
1. Using Jones-Meade, total breath-holding time consists of: two-thirds
of the inspiratory time; the entire lockout time; and one-half of the
collection time.
2. Using Ogilvie, breath-holding time is calculated from the onset of
inspiration to the onset of collection.
3. Using ESP, breath-holding time begins when half of the inspired
volume has been inhaled and ends at the onset of collection.
4. User-defined protocols allow you to set the volume to be used for
determining the start and stop collect volumes. If the user-defined
configuration is selected, the start and stop collect volumes
become accessible from the setup menu. (default value is Jones-
Meade, ATS)

Note: Changes in collection protocol may make significant changes in

recovered results, particularly with flow-limited patients.

Hemoglobin Author

Displays the author whose formula is used to calculate a corrected

diffusing capacity based upon the hemoglobin value entered in the
Manual Entry screen.
Four authors are available: Cotes, Dinakara, Burgess, or Mosenifar. If
hematocrit is entered, Mosenifar’s correction will be applied. The default
correction is Cotes (ATS).

Start Collect Volume

Breeze automatically enters the volume of exhaled gas (in liters) that is
discarded before collecting the measured sample.

The start collect volume defaults to 0.75 liters if the patient’s VC is greater
than 2.00 liters. This volume defaults to 0.50 liters if the patient’s VC is less
than 2.00 liters (ATS recommendation).

Stop Collect Volume

Automatically entered by the software: This is the total volume (in liters)
exhaled by the patient at which time the sample collection stops.

29
The default volume is 1.25 liters if the patient’s VC is 2.00 liters or more. The
default value decreases to 1.00 liter if the patient’s VC is less than 2.00
liters (ATS recommendation).

30
Patient Valve Lockout
Set to either Automatic or Manual mode to specify how the patient is
switched-in to breathing the diffusion gas mixture and how the lockout
period is initiated during testing:

In Automatic mode, the system switches-in the patient automatically at

residual volume based on a zero-flow threshold and locks the patient out
at full inspiration.

Note: In Manual mode, press the spacebar to trigger switch-in and lock out while
conducting the test.

31
 FRC TESTING

FRC Overview
The Ultima PF and PFX use an open circuit nitrogen washout technique,
functional residual capacity (FRC), to measure lung volume. The nitrogen
washout procedure calculates lung volume by (1) assuming an initial
concentration of nitrogen in the lungs, (2) removing the nitrogen by
“washing it out” with pure oxygen, (3) measuring the volume of air expired
during “washout,” (4) measuring nitrogen concentration in that volume to
determine the actual volume of the lung and (5) using O2 and CO2 to
measure the oxygen and carbon dioxide gas concentrations of each
exhaled breath. Nitrogen gas concentrations are then indirectly
calculated by subtracting the O2 and CO2 concentrations from 100%. The
remaining gas would be N2.

Example: If the exhaled breath contained 19% O2 and 5% CO2, the

remaining gas concentration would contain ~76% N2. In this example, 76%
N2 would be used to calculate the patient’s exhaled N2 volume.

All other calculations and test considerations would remain the same as
nitrogen washout testing.

Note: The GX vacuum must be turned on 10 minutes before attempting to perform

a washout test. If the pump is not on, click “GX Vacuum” on at the top of the
patient test screen.

32
Using the FRC N2 Toolbar

Figure 15: FRC N2 toolbar

33
Using the FRC N2 Data Grid

Figure 16: FRC N2 data

grid

34
FRC Test Procedure
Instructing the Patient
Standard testing procedures begin with instructing the patient and
demonstrating proper technique. The greatest potential source for error is
the failure of the patient to perform the test properly. If the patient is
relaxed, the end-expiratory volume will represent true resting end-tidal
volume (FRC).

Pre-Test Procedure
1. Be sure you have warmed up the system and performed the daily
complete pneumotach calibration. Before testing, the GX vacuum
pump must be on for 10 minutes. Warm-up time is displayed on the
associated timer at the top of the screen.
2. Click to create a new patient or click to open an existing
patient. Enter the appropriate information. Required fields are
accented with color. See Opening a Patient File and Starting a
Visit.
3. When you have finished entering patient information, click to
enter a new visit and begin a new test session.
4. Fill out the visit demographics and patient history tabs.
5. Select the FRC tab.
6. The system samples room air. If the room air N2 level is not within the
system’s allowable range (79.6% +2%), flush the system with room
air using a calibration syringe.
7. The GX AutoCal is all that is required to be performed before a N2
Washout Test (FRC).
8. Attach the patient circuit to the arm of Ultima PF or PFX. Connect
the pneumotach and umbilical clip to the patient circuit so the
umbilical tubing is in a straight up (12 o’clock) position.

Note: In order to calculate RV and TLC, an SVC test should be conducted prior to
performing a nitrogen washout test. An optional SVC test may be performed
within the Nitrogen Washout test. Select “Individual SVC Maneuver” from the FRC
N2 options tab to allow SVC efforts within FRC N2 testing.

Test Procedure
1. Before beginning the test, click “Zero Flow” to zero the
pneumotach. There must be no flow through the pneumotach
during this procedure.
2. If you are not testing using the pre/post protocol, click the
protocol/log tab and choose a test protocol from the protocol pull
down menu. Pre/post is the default protocol for all new visits.
3. Ensure the preVent pneumotach with rubber mouthpiece and clip
assembly are attached to the patient circuit in the arm of the

35
 Ultima PF or PFX. The umbilical tubing should be positioned in a
straight up (12 o’clock) position.
4. Place nose clip on patient and instruct patient to breathe normally
on the mouthpiece. Press the spacebar to begin testing.
5. Instruct the patient to relax as much as possible and, breathing
normally, perform a minimum of four stable tidal breaths. The
volume/time graph displays the patient’s breathing pattern while
the patient is breathing on the system.

Note: If the patient’s breathing pattern is unstable, have the patient continue to
breathe tidally beyond the minimum four breaths.

6. After four stable tidal breaths, press the spacebar or click “Next”
during an exhalation to begin the washout process. At the end of
that exhalation, the computer automatically switches the patient
to 100% oxygen. The graph on the right of the screen displays the
percent nitrogen of each breath the patient exhales.

Note: After switching to 100% O2, observe the switch-in error and N2 indicators on
the screen. The nitrogen concentration of each breath is displayed in real time.

7. Instruct the patient to continue tidal breathing throughout the test.

Have the patient occasionally take a deep breath to ensure
complete nitrogen washout. Ensure that the patient’s lips remain
tightly closed around the mouthpiece. If there are any leaks, the
values from the washout test will be invalid and the study must be
repeated.
8. When nitrogen concentration is reduced to 1.7%, the program
prompts you to sigh the patient (inspire deeply and exhale
maximally). The test stops automatically when the program senses
three consecutive breaths with nitrogen concentrations of 1.7% or
less.

Note: The less uniform the distribution of ventilation, the more time will be required
to wash out the nitrogen from the lungs. Chronic obstructive patients may not be
able to obtain a nitrogen reading less than 1.7%. In these cases your lab should
have a protocol to end the test at different nitrogen percentages or after a
specified time (usually 7 to 8 minutes).

Repeating FRC N2 Washout Efforts

If the procedure needs to be repeated, allow sufficient time for the
patient to washout excess oxygen in the lungs before attempting the next
effort. Wait twice as long as the patient was breathing 100% oxygen. If
the patient has chronic obstructive lung disease, wait three to four times
as long as the patient was breathing 100% oxygen.
Before retesting the patient, flush the circuit with a syringe and re-zero the
pneumotach.

36
37
Selecting FRC (N2) Efforts and Printing Reports
Using Auto Select
If “Perform Auto-Select” is on, the computer selects acceptable efforts
automatically. The computer does not automatically save any efforts with
error messages in the codes column. If all efforts have performance
codes, no efforts are automatically saved; you will then have to save the
desired effort(s) manually.

Manually Selecting Efforts

To manually select an effort, click in the select column. You may select
more than one effort per stage. Data for all selected efforts for each
stage are averaged in the AVG row.

Selecting a Report Loop

A check box in the RpLp column allows you to select which effort in a
stage will be used for report graphs. Only one effort may be used for
each test stage.

Selecting SVC Efforts Done in Spirometry

If SVC efforts were performed and saved in spirometry, those results will be
available in the FRC N2 data grid.

Drawing Efforts
Double-click on an effort’s time stamp to draw the effort. You can draw
several efforts as a montage to compare efforts of interest without
clearing the screen between selections. Double-click on the graph to
enlarge it in a zoom dialog. Click to clear review graphs.
Tip: Any time you click an effort’s time stamp to draw it, the system switches to
Review mode. You will need to click the icon to re-enter Test mode. Also see
About Review and Test Modes.

Printing Reports
When testing is complete, select the reports menu. You may choose from
a list of the most recently generated report formats, or select “Report
Switchboard” to select from all reports available on your system.

38
FRC Options
To access the FRC test options, select the FRC tab and choose “Options”
from the tools menu or press F5. The following options are available from
the FRC Setup menu:

Configuration
Changes made to either the test options or the test view (splitter bar
positions, column width, display variables, and graph properties) can be
saved to a configuration file that can then be selected for future tests.
Several preset configurations are available for each test. You may select
an existing configuration file or create a new configuration. Configuration
changes are automatically saved unless they are locked.
To create a new test configuration:
1. Open a patient visit and select the desired test tab.
2. From the Tools menu, select Options.
3. In the Options menu, click the arrow in the Configuration area and
select Create New.
4. Enter a name for the configuration and click OK.
5. Modify the test configuration as necessary. Your changes are
automatically saved.

Keystroke to Start Test

When selected, the spacebar must be pressed to start a test. When not
selected, breathing on the system initiates the start of data collection.

Perform Auto-Select
If selected, the software automatically selects efforts that are both
acceptable and reproducible.

Individual SVC Maneuvers

This option allows an SVC to be performed within the N2 washout test.
When this option is selected, the patient must perform four stable tidal
breaths then an SVC prior to switching into breathing 100% oxygen. SVC
data from both spirometry and N2 washout testing are displayed in the
data grid. The operator can then select SVC data from spirometry or from
N2 washout testing in the SVC tab.
If this option is not selected, the computer will automatically use the SVC
data saved in spirometry to calculate RV and TLC.

Average IC/ERV

39
When selected, the RV and TLC values for average efforts are calculated
from the average IC and ERV and the average FRC. This option is not
available if “Individual SVC Maneuvers” is not selected.

40
Evaluate Reproducibility
When selected, new efforts are evaluated for reproducibility. Select which
variable to use as criteria for reproducibility. Use the spinner control to
adjust the margin of reproducibility.

TLC Calculation
Click on the arrow to select from a list of options for calculating TLC.

41
 MIP/MEP
MIP/MEP Overview
Patients can be tested to determine their Maximal Inspiratory Pressure
(MIP) and Maximal Expiratory Pressure (MEP) using the BREEZESUITE software.
The graph on the left of the data collection screen displays the
volume/time and pressure tracing as the patient is breathing on the
system. The graph on the right displays pressure vs. %TLC for each patient
effort. The yellow highlighted message bar in the upper-right displays
operating messages throughout the test. The table beneath the message
bar displays the predicted value and the values obtained as each effort is
performed.

MIP/MEP Test Bar

Figure 17: MIP/MEP test bar

42
MIP MEP Data Grid

Figure 18: MIP/MEP data

grid

MIP/MEP Testing Procedure

Note: Inspiratory and expiratory pressure measurements must be performed in
separate maneuvers.

Instructing the Patient

Standard testing procedures begin with instructing the patient and
demonstrating proper technique. The greatest potential source for error is
the failure of the patient to perform the test properly.
MIP/MEP testing requires the patient to provide a full and sustained effort.
Substantial coaching may be required to obtain a proper effort.
If the patient is relaxed, the MIP/MEP results will represent his or her true
inspiratory and expiratory pressure capabilities.
General procedures for this test include the following:
• Instruct the patient to loosen any tight clothing.
• Have the patient use nose clips and a rubber mouthpiece.

43
44
Test Procedure
1. Autozero the pneumotach.
2. Ensure that the pneumotach is attached to the pneumotach clip
and umbilical and that this unit is attached to the patient circuit in
the Ultima PF or PFX arm.
3. Place nose clips on the patient and instruct the patient to breathe
normally through the mouthpiece.
4. Press the spacebar or click “Next” to display the tracing of the
patient’s tidal breathing.

The graph on the left of the Data Collection screen displays the
volume vs. time tracing of the patient’s breathing. After a minimum of
three tidal breaths, a MIP or a MEP pressure measurement can be
obtained with one of the following steps:

5. MIP:
• Instruct patient to exhale slowly to residual volume (RV).
• When the patient appears to be at RV, press the spacebar
or click "Next." The Distal occlusion piston will immediately
close.
• When the piston closes, have the patient inhale as hard as
possible to produce maximal negative pressure. The
occlusion piston reopens in four seconds, ending the test.
• To open the piston prior to this time, press the spacebar or
click "Next" as soon as pressure measurement is made.

6. MEP:
• Instruct the patient to inhale slowly to total lung capacity
(TLC).
• When the patient appears to be at TLC, press the spacebar
or click "Next." The distal occlusion piston will immediately
close.
• When the piston closes, have the patient exhale as hard as
possible to produce a maximal positive pressure.
• The occlusion piston reopens in four seconds, ending the
test. To open the piston prior to this time, press the spacebar
or click "Next" as soon as the pressure measurement is made.

The graph on the left half of the screen also displays the pressure vs.
time tracing for each patient effort. The graph’s lower half is negative
pressure (inspiratory maneuver); the top half is positive pressure
(expiratory maneuver).

7. Repeat Steps 3 through 5 until all inspiratory and expiratory test

efforts have been made.

45
Note: Pressure measurements can be obtained at any lung volume.
Measurements do not have to be taken at RV or TLC.

46
MIP/MEP Options
Keystroke to Start Test
When “Keystroke to Start Test” is not checked, breathing on the system
initiates the start of data collection. When “Keystroke to Start Test” is
checked, the spacebar must be pressed to start a test.

Maximum Occlusion
Displays the amount of time before the shutter will reopen when making a
MIP/MEP measurement. The shutter can be opened manually by pressing
the spacebar before the maximum occlusion time has elapsed (default is
4 seconds).

Measurement Mode
Displays the method used to measure the MIP and MEP pressures:
• Peak: takes the greatest value, negative or positive.
• Peak after one second: takes the greatest value after 1 second,
negative or positive.
• Sustained one second: Takes the pressure measurement that is
sustained for 1 second.

47
48
MIP/MEP Test Screen

Figure 19: MIP/MEP test

screen

49
 VO2 TEST PROCEDURE

Exercise testing requires special attention to detail and must be prepared

with care. Because exercise testing includes some risk to the subject, it is
essential to properly prepare both the equipment and the subject for a
successful test. All personnel involved in the test must be are aware of all
safety considerations.

Preparing for a Test

1. Warm up the system.
2. Perform the daily complete pneumotach calibration and the GX Auto
Cal.
3. Open an Existing Patient File or create a new patient file as required.
4. On the Patient Tab. Click Add Visit to begin a new test session.
5. Fill out the Visit Demographics and Patient History tabs.
6. Select the GX Tab.
7. Select the GXScript from the Settings tab and adjust the settings (if
necessary).
8. Select Zero Flow, then GXAutoCal.
9. Instruct the subject to loosen any tight clothing. Describe the testing
process and demonstrate proper technique prior to testing.
10. Prepare pneumotach for testing:

• Inspect the pneumotach.

• Install the pneumotach into clip, aligning clip tab/dot with the
pneumotach notch.
• Position the preVent pneumotach in the patient’s mouth so that
the umbilical clip enters from the top of the pneumotach.

Test Procedure
1. Select the Test tab.
2. Select PWave from the Tools menu to check the physiologic
waveforms to verify that the equipment is set up and operating
properly. Close the PWave window after verifying the waveforms.
3. Click Start on the Test Pad to begin resting data collection.
4. Click Exercise to manually activate exercise testing. Exercise testing
begins when starting the protocol by clicking Exercise. While testing,
use the Test Pad to:

• Skip to the next protocol stage by clicking Next Stage.

• Pause at the current stage by clicking Hold Stage.
• Manually control the ergometer by clicking Manual.
• Monitor phase and stage timers and the current device
workload on the Test Pad.

50
5. Click Recovery to end exercise and begin the recovery phase of
testing.
6. Click Stop to end data collection.
7. Review Anaerobic Threshold achieved from the AT tab.
8. Select and print report.

51
 DIRECT CONNECT preVent PNEUMOTACH FOR
VENTILATOR PATIENTS

This topic provides an overview of the application of metabolic

assessment of ventilated patients and describes the proper configuration
and use of the Direct Connect preVent pneumotach.

Metabolic Assessment with Ventilators Review

Performing quality metabolic assessments on ventilators can be a
challenging endeavor. BREEZESUITE software has made the testing
procedure easier by eliminating the need to correct for continuous bias
flow. The term bias flow goes by a variety of different names and is an
integral component of a new generation of ventilators. Bias flow
minimizes the work of breathing by allowing the patient to tap into a
continuous gas flow rather than initiating flow through a delivery circuit.
While this approach is clear from a clinical standpoint, it can greatly
complicate metabolic measurements when the system differentiates
between gas delivery to the patient’s lungs and gas continuously flowing
through the circuit.

The Direct Connect preVent Pneumotach is the first metabolic assessment

interface to allow direct measurement of a patient’s metabolism without
compensating, diverting or turning off bias flow. Metabolic assessment
using the Direct Connect preVent Pneumotach has been successfully
studied at a number of clinical sites and has been proven accurate and
reliable. This advance in metabolic assessment allows early and
improved nutritional management of ventilator patients on a wide range
of ventilators typically found in the ICU/CCU.

A number of studies have demonstrated that patients who present with

complex ventilator weaning problems and limited pulmonary reserve
require many of the same principles common to muscle exercise training.
Optimizing nutritional states has been proven to decrease the number of
ventilator days and ultimately to the length of stay in the ICU. This
translates into improved patient outcomes and significant cost savings to
the health care facility.

52
Example of a patient on Direct Connect for
Metabolic/Nutritional Assessment

Figure 20: Direct Connect

Setup and Calibration of the Direct Connect preVent Pneumotach

1. Attach the Direct Adaptor (701067-001) to the umbilical clip.

2. Attach the Direct Connect preVent Pneumotach (750051-002) to
the umbilical clip.
3. Connect the Direct Connect preVent Pneumotach to the
Reducing Adapters (541178-001 &541179-001) as shown in Figure 21
(below).
4. Insert the assembly from step 3 into the calibration syringe.
5. For BREEZESUITE, select “Direct Connect” by using the drop down box
in the calibration menu.
6. Perform a pneumotach calibration using only the medium and slow
flow rates.

53
 Figure 21: Direct connect
setup

Patient Setup
1. Connect the Direct Connect pneumotach into the ventilator
circuit.
2. Use the Direct Connect ventilator script. Scripts are located in
the Settings Tab under the GX tab.
3. Select the Test tab and begin testing.

Note: In order to test with a standard preVent Pneumotach after testing with the
Direct Connect, a 3L pneumotach calibration must be completed.

54
 Figure 22: Direct connect
setup
While there have been no reported incidents of nosicomial infections or
cross contamination related to the metabolic cart, these options may be
considered for issues of infection control.

Option 1: Direct connect to be used as single patient use only

Replace Pink sample line between patients.

Clean clip of umbilical with standard cold sterilization
technique and flush pressure lines after cleaning procedure.

Option 2: Use HME Filter MGC P/N 536606-001 See Figure 22.

Notice to PB 840 Users:

1. PB 840 ventilators operating in modes with Pressure Support induce a
large amount of variability in FiO2, which can cause error in
measurements of VO2 and RQ values. Although RQ is affected and
substrate utilization may not be reliable, REE will remain reasonably
accurate, with appropriate windowing of data to minimize FiO2
fluctuations. ( i.e. REE Covar £ 10%)
2. The REE CO2 variable may also be used in place of standard REE at
higher FiO2 levels.

Puritan Bennett has recommended the use of pre-blended gas, turning off
the pressure support during the study, or using alternative modes of
ventilation.

References
1. Benotti PN, Bistrian B: Metabolic and nutritional aspects of weaning
from mechanical ventilation, Critical Care Medicine 1989; 17:2 181-
185.
2. Anderson CF, Loosbrock LM, Moxness KE: Nutrient Intake in the
Critically Ill Patients: Too Many or Too Few Calories, Mayo Clinic
Proceedings 1986; 61:853-858.
3. D’Attellis NP, Bursztein S, Askanazi J, Kvetan V: Tailoring nutritional
support: What, when, and why, Journal of Critical Illness 1988; 3: 49-68.
4. Twomey PL, Patching SC: Cost Effectiveness of Nutritional Support,
JPEN 1985; 9:3-10.

55
 REPLACING THE DRYING LINE AND CARTRIDGE

Replacing the Drying Sample Line

1. Remove the drying sample line assembly (750020-002) from its
shipping bag.
2. Attach the short piece of silicone tubing to the pump exhaust
port labeled “OUTLET” on the front of the Ultima.
3. Attach the umbilical luer fitting to the drying sample line luer
lock ring.
4. Install the remaining length of tubing into the “SAMPLE” fitting.
5. Lightly secure drying sample line to Ultima with provided cable
tie. Refer to Figure 23 for additional details.

Note: When installing drying sample line tubing into the SAMPLE fitting, loosen
compression screws and gently insert the tubing into the tubing fitting until the
tubing cannot be inserted any further. Tighten compression screws (finger tight)
and tug gently on the tubing to ensure a proper seal.

Replacing the Drying Cartridge

1. Install Clip (523012-001) onto front of Ultima using two (2) 4-40 x ¼”
screws (534150-002)
2. Obtain a Drying cartridge holder assembly (750010-002) and a
drying cartridge assembly box (750011-001). Attach a drying
cartridge holder to both the top and bottom of the drying
cartridge. Attach the supplied silicone tubing to one end (bottom)
of the drying cartridge assembly.

Note: Use a twisting motion when “pushing” the clear acrylic end plugs (part of
the “drying cartridge holder”) onto the drying cartridge. Pushing plugs straight
into the cartridge without twisting may damage the O-ring on the acrylic plugs.
3. Place the drying cartridge assembly into the clip, keeping the end
with attached tubing towards the bottom of the Ultima. Attach the
other end of the silicone tubing to the “OUTLET” port on the front of
the Ultima.
4. Obtain a drying sample line (750020-002). Install the end of the
drying sample line with the short piece of silicone tubing onto the
barb fitting on top of the drying cartridge assembly.
5. Attach the umbilical luer fitting to the drying sample line luer lock
ring. Install the remaining length of tubing into the “SAMPLE” fitting.
Lightly secure the drying sample line to Ultima with the provided
cable tie.

56
Figure 23: Drying sample line

Figure 24: Drying cartridge assembly

57
 SAMPLE LINE MAINTENANCE

The sample line from the system to the pneumotach must be 7 feet long
and must be purged or replaced when saliva enters and clogs the sample
line.

Procedure
1. Unscrew the luer fitting between the pink sample line and the
drying line.
2. Ensure the Ultima pink sample line assembly (# 701068-001) is
available as a replacement.
3. Pull back the rubber strain relief from the clip by pushing in on the
side tabs to reveal the sample line.
4. Loosen the compression screw that holds the sample line inside the
clip and pull the pink sample line out of the fitting.
5. Attach the end of the new line to the luer fitting of the old sample
line and pull both lines through the protective sleeve from the boot
end to the clip.
6. Insert the new pink sample line into the compression screw,
ensuring it is inserted through o-rings inside of the clip.
7. Reattach the luer fitting on the drying line fitting.

The design of the umbilical is such that the pink sample line is located
inside a protective sleeve to minimize any kinking or crimping of the
sample line. The purge pump is used to clear the lines of any saliva or
debris that may have seeped into the sample line.

58
The connection between the drying line and the pink sample line is a luer
fitting. The sample line filter is located inside the luer fitting. Use a blunt
needle to extract the filter for replacement. A quality control check
should be performed on the sample line every month, along with any
necessary maintenance or filter maintenance.

59
 REFRESHING THE O2 CELL

The O2 cell may be refreshed, as needed, depending on the frequency of

system testing, or the duration the pump is left running. The need for an
O2 cell refresh is indicated by calibration failures (minimum O2 failing)
during the AutoCal, or during manual calibration.
Note: The vacuum pump does not need to be on while performing a cell refresh.
1. Turn off gas exchange vacuum (GC VAC). Ensure the system is
stable/ready (green light illuminated).
2. Press the black “cell refresh” button located at the front of the
system behind the access panel. The LED will change from green
to amber.
3. Wait 45 minutes before calibrating the system. The amber light will
be Illuminate to green upon completion.
4. Turn GX vacuum on, wait 10 minutes for vacuum to reach stabilized
status, and perform AutoCal.

Note: It is good practice to perform a manual calibration after an O2 cell refresh

has been performed.

60
 REPLACING THE O2 CELL

Replace the O2 cell when the cell refresh process no longer provides
acceptable performance.

Caution: The O2 cell components can be very hot if not properly cooled. Use
caution when removing them. Place items on a non-combustible surface.

Caution: Turn the system power off and allow the system to cool for at least one
hour. Always unplug the power cord when working inside the system.

1. Ensure the system power has been off for at least one hour.
2. Unplug the device from the wall outlet.
3. Locate the O2 assembly cell plate behind the access panel.
4. Loosen four large screws (1/4 turn) from the corners of the O2 cell
assembly plate with a large standard-head screwdriver.
5. Carefully slide the assembly out of the cavity. Ensure the entire O2
cell, including both contact rings, slides out. If one gold contact
ring remains in the cavity, bend a straightened paperclip into a
hook shape and carefully remove the remaining contact ring. The
white ceramic extension manifold may remain in place when the
O2 cell is removed. If the extension manifold remains inside the O2
cell when the O2 cell and heater core are removed:

• Remove the manifold extension from the O2 cell.

• Inspect the manifold extension for cracks or chips.

Note: Some discoloration of the manifold extension is normal.

6. Place the manifold extension on the stainless steel sample tube

coming from the O2 manifold.
7. Prepare a new O2 cell as follows (if it is not already assembled):

• Place the outer (small) gold contact ring over the open end of
new O2 cell.
• Notice there is a small flat area on the rim of the cell contact.
Place this part of the gold contact onto the cell first. Use the
thumb to firmly press the gold contact ring onto the cell until the
contact is fully seated onto the cell.

Note: The small gold contact ring must be replaced whenever the O2 cell is
removed. The seal is formed when the O2 cell is seated. Do not reuse the small
gold ring.

61
8. Place the large gold contact ring over the conical end of the new
O2 cell and slide the ring down until the shoulder of new O2 cell fits
tightly inside larger gold contact ring.
9. Insert the new O2 cell, with the gold contact rings attached, onto
the manifold extension bracket until the sensor touches the
manifold.
10. Install the O2 heater assembly gently over the O2 cell inside the
heater enclosure, ensuring the card-edge connector of the O2
heater PCB aligns with the mating connector on the O2 heater
assembly.
11. Sequentially tighten the four screws in an “X” pattern until the plate
is secure.
12. Plug in the power cord. Turn the power to on. Wait at least 30
minutes for stabilization before calibrating. Turn the vacuum pump
to on 10 minutes prior to calibrating system.
13. Calibrate the analyzer after the system has stabilized. If there is any
difficulty in calibration, the cell still may not be properly sealed. If
resealing is necessary, use the provided spare gold contact rings.

62
 CLEANING CO2 ANALYZER
Required Equipment
• 1 Small beaker or other container.
• 1 Medium-sized flat-blade screwdriver.
• 1 25-50 cc syringe with hypodermic needle.
• Distilled water.
• Absolute ethanol or 98% isopropyl alcohol.
• 1 Small gold contact seal for O2 cell (P/N 535093-001).
• Mild cleaning solution (this may be any gentle household product such
as Ivory dish soap or baby shampoo. Any product containing bleach
or ammonia should NOT be used).

Procedure
1. Turn system power to OFF and allow the system to cool for at least one
hour. Make sure power cord is unplugged.
2. Remove the sample line bulkhead by unscrewing both sections from
the sample port. The metal sample tube should be exposed.
3. Release ¼-turn screws from O2 assembly plate behind the front access
panel.

Caution: The O2 cell components can be VERY HOT if not properly cooled. Use
caution when removing them. Place items on a non-combustible surface.

4. Carefully slide the assembly out of the cavity and ensure the entire cell
(both gold ring contacts and the extension manifold) is removed.
5. Place a small beaker or other container under the sample needle
protruding from inside O2 cell cavity.
6. Inject at least 20 cc of mild cleaning solution into the exposed metal
sample tube using a syringe fitted with hypodermic needle.
7. Repeat Step 6 using distilled water.
8. Repeat Step 6 using absolute ethanol, 98% isopropyl alcohol, or any
alcohol that does not leave film or crystal residue.

Caution: Alcohol may be combustible. Purge all alcohol from the system before
subsequent operation.

9. Place the reference gas hose over the exposed metal sample tube
and run the reference gas through system at approximately 15 psi for
minimum of 2 minutes to dry sample chamber.
10. Prepare the new O2 cell, if replacing the O2 cell, as follows:
• Place the large gold ring contact over the pointed end of new
O2 cell and slide the ring down until the contact fits snugly onto
the cell.

63
 • Place the small gold ring contact over the open end of cell until
it fits snugly.
• Remove the defective O2 cell and insert the replacement cell
as described in Steps 11 through 14.
• Replace the manifold extension center over the stainless steel
tube coming from O2 manifold.
Note: The small gold ring contact must be replaced when the O2 cell is removed,
even if the cell is not replaced. When a seal is created but will no longer form a
tight seal, the ring is deformed.

12. Slide the O2 cell with gold ring contacts attached onto the extension
manifold.
13. Insert the O2 heater into the O2 cavity by gently sliding it over the O2 cell,
(be sure to align the screws to the holes). The metal plate must be flush
against the sheet metal for proper seating of the O2 cell.
14. Tighten ¼-turn screws in “X” pattern (left screw followed by lower right,
lower left, and upper right screw).
15. Reconnect the power cord and sample line. Restore power to the system
and allow approximately 30 minutes for stabilization.
16. Check the vacuum pump gauge on the front of system to ensure proper
vacuum level after the stabilization light on the front of the system has
changed from amber to green.
17. Calibrate the analyzer when a good seal is established. A problematic
calibration indicates the O2 cell may not be properly sealed.

Gases/Regulators/Pressures

The Ultima requires two calibration gases, referred to as Calibration and

Reference.

O2 Calibration Gas Specifications: 14.00% +/- 20 % (11.20 – 16.80). Mixture purity

0.05% of label marking. Regulator delivery pressure 15 psi.

O2 Reference Gas Specifications: 21.00% +/- 3% ( 20.37 - 21.63). Mixture purity

0.05% of label marking. . Regulator delivery pressure 15 psi

CO2 Calibration Gas Specifications: 5.00% +/- 40% (3.00 – 7.00). Mixture purity
0.05% of label Marking. . Regulator delivery pressure 15 psi

CO2 Reference Gas Specifications: 0.0% CO2. Mixture purity 0.05% of label
marking. Regulator delivery pressure 15 psi

The Ultima PF Module requires three specific gases:

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Oxygen (O2): 99.995% Medical Grade. Regulator delivery pressure 135 psi.

Diffusion (DLCO): 0.5 Neon (NE) +/- 0.05% purity. 0.03 Carbon Dioxide (CO) +/-
0.15% purity. Regulator delivery pressure 135 psi.

Helium (HE): 99.95% Medical Grade. <50 ppm CO2, <50 ppm CO, <15 ppm H2O.
Regulator delivery pressure 10 – 30 psi.

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