VOCSN Clinical Manual
VOCSN Clinical Manual
COUGH
SUCTION
CAUTION: Federal law restricts this device to sale and use by or on the order of a physician.
1
    ISO 80601-2-12
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                                     Table of Contents
Table of Contents
 Introduction12
   Therapy Overview  12
   VOCSN Configurations  13
       Leak+ Performance  13
       Ventilation  14
       Oxygen Direct  14
       Touch Button Cough  15
       Suction  15
       Nebulization  15
       Portability  16
   Indications for Use  16
   VOCSN Training  16
   Suggested Environments of Use  17
       Home Environments  17
       Hospital Environments  17
       Institutional Environments  17
       Transport Environments  17
   Getting Started  18
       Package Contents  18
       Contraindications   18
       System Overview  19
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                                                                                   Table of Contents
 Setup20
   VOCSN Placement  21
   Power Setup  22
       The Power Supply  23
       The Optional 24 Volt Wheelchair Power Cable  24
       The Removable, Rechargeable Batteries  24
   Ventec One-Circuit Setup  25
       Using a Trach, ET Tube, or Non-Vented Mask  26
       Using a Vented Mask  26
       Using a High Flow Nasal Cannula  26
       Connecting an Active, Passive, or Valveless Ventec One‑Circuit  27
           Ventec One-Circuit Component Connection Order  28
           Connecting an External Bacterial Filter  29
           Connecting a Ventec One-Circuit Without a Humidifier  29
           Connecting a Humidifier and Heated Wire Ventec One-Circuit  30
           Connecting a Ventec One-Circuit to a Humidifier (Without the Ventec Humidifier Bypass)  31
           Connecting a Ventec One-Circuit, Humidifier, and Ventec Humidifier Bypass  32
           Connecting a Ventec One-Circuit O2 Tube  33
           Connecting an Active Ventec One-Circuit  34
   Connecting Ventec One-Circuit Components  35
       Connecting an HME (Heat-Moisture Exchanger)  35
       Connecting a Nebulizer Cup to the Patient Circuit  36
       Connecting a Ventec Secretion Trap to the Patient Circuit  38
       Connecting a Closed-Suction Catheter to the Patient Circuit  39
   Setting up Ventilation therapy with a Speaking Valve  39
   Mouthpiece Patient Circuit Setup  40
   Oxygen Therapy Setup   41
       Setting Up the Internal O2 Concentrator  42
       Setting Up External Oxygen Sources  42
           Connecting External High-Pressure Oxygen  43
           Connecting External Low-Pressure Oxygen  44
   Suction Setup  45
       Removing and Reattaching the VOCSN Suction Cap  45
       Connecting the Ventec Travel Suction Canister  46
       Connecting Suction Tubing to the Travel Canister  47
       Connecting the External Suction Canister Adapter  48
       Connecting Suction Tubing to Suction Interfaces  48
   Connecting a Nurse Call System or Remote Alarm  49
   Running the Pre-Use Test  50
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                                                                              Table of Contents
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                                                  Table of Contents
 The Touchscreen                                               66
   Locking the Touchscreen  66
   The Status Bar  67
   The Home Screen  68
      Night Mode and Day Mode  68
   The Therapy Screen  69
   The Monitors Screen  70
      The Customization Button  70
      The Waveforms Button  70
   The Menu Screen  71
      The Pre-Use Test Button  71
      The Settings & Alarms Button  72
      The Device Settings Button  72
      The Logs Button  72
      The Clinician Access Button  72
      The Enable Prescribed Therapies Button  73
      The Permissions Button  73
      The My VOCSN Button  73
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                                              Table of Contents
 Alarms103
   Alarm Silence Button  104
   Changing Alarm Settings  104
   Alarm Conditions and Settings  105
   The Alarm Log  113
   The Event Log  114
       Clearing an Alarm  115
   Remote Alarms and Nurse Call Systems (Optional)  115
 Monitors116
   Ventilation Monitors  117
       Waveform Monitors  119
       Monitor Screen Customization  120
   Oxygen Therapy Monitors  121
       FiO2 Monitor  121
       Calculated FiO2 Monitor  122
   Cough Therapy Monitors  123
   Suction Therapy Monitor  124
   Nebulizer Therapy Monitor  125
   System Monitors  126
 Multi-View127
   Exporting Multi-View Data to a USB Drive  128
   Generating Multi-View Reports  129
   Reading Multi-View Reports  130
      Report Information  130
      Trend Summary  131
      Compliance Calendar  131
      Therapy Use  132
      Settings Overview  132
      Monitor Details  133
      Logs  134
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                                                                             Table of Contents
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                                                                        Table of Contents
 Glossary170
   Glossary of Symbols  170
   Glossary of Indicators  174
   Glossary of Terms  176
 Troubleshooting177
   Troubleshooting Alarms  177
   Device Troubleshooting  183
   Ventilation and Cough Troubleshooting  184
   Oxygen Troubleshooting  185
   Suction Troubleshooting  186
   Nebulizer Troubleshooting  186
   Multi-View Troubleshooting  187
   Patient Circuit Troubleshooting  187
   Recalibrating Batteries  188
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                                                                 Table of Contents
 Accessories200
   Available from Ventec Life Systems  200
   Available from Other Manufacturers  205
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                                                                  Table of Contents
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                                                                                                            Introduction
Introduction
Therapy Overview
Using the Ventec One-CircuitTM, clinicians, home caregivers, and patients can use VOCSN to ventilate, provide air
enriched with oxygen to the patient, simulate natural coughs to clear secretions, remove those secretions from the
patient airway or circuit, and administer nebulized medication, minimizing the need to connect additional medical
equipment or reconfigure the patient circuit.
 NOTE: This manual describes the features included with version 4.06. Not all functionality is available in previous
 versions of the VOCSN software. See “Software Updates” on page 168 for a description of features included in each
 release, and instructions to check the software version of your device. To view revisions of the Clinical and Technical
 manual associated with previous software versions, see VentecLife.com/resources.
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                                                                                                                 Introduction
VOCSN Configurations
VOCSN offers mechanical Ventilation, Oxygen, Cough, Suction, and Nebulizer therapies in one compact, portable,
lightweight device. VOCSN is customizable and may be purchased in various configurations of the available integrated
therapies. There are many possible VOCSN configurations. This allows patients and caregivers to select a device that
provides therapies that meet the patient’s individual needs.
Your device may include all five therapies and all the features described in this manual, or just the set of therapies and
features purchased or prescribed by the treating physician. Depending on its configuration, VOCSN will be able to
provide Ventilation, +Oxygen Concentration, +Cough, +Suction, and/or +Nebulizer therapy. It may also be able to
provide oxygen from an external high-pressure source and FiO2 monitoring (+Pro configurations) or low-pressure oxygen
(all configurations). The configuration name is based on the therapies VOCSN can provide. For example, the V+C
configuration provides Ventilation+Cough therapies. The configuration name is printed on the back of the device, and is
also visible on the My VOCSN screen.
                                                                                                High-Pressure  Low-Pressure
Configuration                             O2                                                  External Oxygen    External
(Located on Device      Ventilation   Concentration       Cough       Suction    Nebulizer    and FiO2 Monitor   Oxygen
Rear Label)                (V)             (+O)           (+C)         (+S)        +(N)            (+Pro)
V+O+C+S+N+Pro
                           Yes              Yes             Yes         Yes          Yes             Yes             Yes
(or “VOCSN”)
V+C+Pro
                           Yes              No              Yes         No           No              Yes             Yes
(or “VOCSN-VC”)
Leak+ Performance
The Leak+ feature allows VOCSN to deliver High Flow ventilation, as well as provide compensation for leaks up to
175 L/min at 20 cmH2O. The improved Leak Compensation may be particularly useful during non-invasive ventilation.
Leak+ is available on devices with compatible hardware running software version 4.06R and newer.
                                                                                                                     V
To see if your VOCSN is capable of Leak+ performance, install the latest software and check for the “V”
icon with a white background in the status bar. The availability of this feature can also be found on the
My VOCSN screen next to “Leak+.”
For more information about VOCSN leak compensation, see “Leak Compensation” on page 212.
WARNING: Delivered and monitored ventilation therapy may be affected by large leaks around the patient interface.
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                                                                                                             Introduction
Ventilation
VOCSN provides invasive or non-invasive ventilation. Using one of six ventilation modes, and an active, passive,
valveless, or mouthpiece Ventec One-Circuit, VOCSN delivers configurable pressure, volume, and/or spontaneous
breaths.
The configurable Flow Trigger control, in combination with the powerful integrated Leak Compensation feature, allows
VOCSN to perform well for both invasive and non-invasive applications, even with significant leaks in the patient circuit.
VOCSN devices with the Leak+ feature can compensate for leaks up to 175 L/min at 20 cmH2O. Ventilation controls such
as Rise Time and Pressure Control Flow Termination can be adjusted to improve patient comfort.
The Ventilation therapy Presets feature allows clinicians to set up, label, and store up to three unique Ventilation therapy
configurations. Using the touchscreen, clinicians, home caregivers, and patients can switch between these three pre-
configured therapies as needed. For example, some patients may benefit from one ventilation Preset while awake,
another Preset while active, and a third Preset during sleep.
The Permissions feature allows clinicians to lock VOCSN control settings. VOCSN controls can be set to User and
Clinician, or Clinician Only. Controls set to Clinician Only cannot be modified until the Clinician Access Passcode is
entered. Controls set to User and Clinician will remain adjustable at all times.
Optional integrated oxygen blending provides a configurable FiO2 to the patient, utilizing an external high-pressure
oxygen source. The internal FiO2 monitor continuously monitors the FiO2 of the delivered gas as it flows to the Ventec
One-Circuit, to ensure the accuracy of delivered Oxygen therapy. The VOCSN also includes an internal O2 Concentrator,
which may be used to provide Oxygen DirectTM therapy to the patient. Alternatively, oxygen can be flowed into the
Ventec One-Circuit through the low-pressure oxygen port.
Oxygen Direct
The VOCSN internal O2 Concentrator delivers Oxygen Direct therapy to the patient without requiring an external
oxygen source. It is intended for the administration of non-life-sustaining, supplemental oxygen to stable individuals.
Using the O2 Flow Equivalent control, the internal O2 Concentrator delivers the equivalent of up to 6 L/min as pulse
doses through a small integrated oxygen tube in the Ventec One-Circuit.
Traditional, portable oxygen concentrators include a pulse dose oxygen mode, used to deliver oxygen through a high
flow nasal cannula, but do not have a way to trigger pulsed doses of oxygen through a patient circuit for ventilation.
VOCSN unifies ventilation and oxygen concentration to deliver oxygen as pulse doses through a small oxygen tube in
the Ventec One-Circuit, in synchronization with patient breathing.
VOCSN can also be connected to an external source of high-pressure oxygen to deliver oxygen through the Ventec One-
Circuit as a configured FiO2, or in pulse dose mode using an integrated Ventec One-Circuit O2 tube.
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                                                                                                          Introduction
The Cough+Suction feature allows VOCSN to activate Suction therapy automatically when Cough therapy is initiated, to
simultaneously move secretions out of the patient airway, and from the Ventec One-Circuit.
The Breath Sync feature synchronizes cough maneuvers with patient effort to improve patient comfort. VOCSN also
monitors Peak Cough Flow and Cough Volume to help ensure Cough therapy is delivered effectively.
Suction
VOCSN includes a high-flow suction system designed to safely aid in effective airway clearance for both pediatric and
adult patients. If enabled, Suction therapy can be initiated at any time during Ventilation or Cough therapy, to help
remove secretions from the patient airway or Ventec One-Circuit.
The Cough+Suction feature allows VOCSN to activate Suction therapy automatically when Cough therapy is initiated, to
simultaneously move secretions out of the patient airway, and from the Ventec One-Circuit.
Suction therapy can be used with a Ventec Secretion Trap, or closed- or open-suction catheter. The Ventec Secretion Trap
collects secretions as they enter the Ventec One-Circuit during Cough therapy. Suction tubing connected to the Ventec
Secretion Trap vacuums those secretions out of the Ventec One-Circuit and into the detachable Ventec Travel Suction
Canister.
Nebulization
Optional Nebulizer therapy provides an integrated 6 L/min nebulizer drive, to power a nebulizer connected to the
Ventec One-Circuit. Nebulization can be initiated using the VOCSN touchscreen, and turns off automatically when the
configured Nebulizer therapy duration has elapsed. While Nebulizer therapy is active, VOCSN automatically adjusts the
delivered Ventilation therapy to compensate for nebulization flows.
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                                                                                                               Introduction
Portability
VOCSN is designed to support the transport of mechanically ventilated patients. VOCSN includes two removable,
rechargeable batteries and an internal rechargeable battery, used to power the device when no external source of
continuous power is available.
Using the power supply, VOCSN can be connected to a wall outlet or other AC power source. Ventec Life Systems also
offers an optional 24 Volt Wheelchair Power Cable, which can be used to power VOCSN from wheelchair outlets. VOCSN
batteries charge whenever an external power source is applied.
The integral oxygen concentrator is intended for the administration of supplemental oxygen. The integral suction
pump is intended for airway fluid removal and oral/pharyngeal hygiene. The integral cough assist option is intended for
patients who are additionally unable to cough or clear secretions effectively.
VOCSN Training
The VOCSN clinician or caregiver must be capable of responding to alarm conditions, and trained to use VOCSN. A list
of available VOCSN training options is available at VentecLife.com.
  CAUTION: Clinicians responsible for configuring and operating VOCSN must be trained to use it and should review
  this manual in its entirety before using VOCSN to administer therapy. Home caregivers must also receive training,
  and must review the Home Caregiver and Patient Guide (available at VentecLife.com) prior to setting up or operating
  VOCSN.
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                                                                                                    Introduction
Home Environments
  •	 Home care
• Home-based transport
Hospital Environments
  •	 Emergency departments
• Step-down units
• Military hospitals
 WARNING: Do not use VOCSN within magnetic resonance (MR) environments. Using VOCSN within MR environments
 may affect VOCSN or MR device performance, damage the devices, or harm individuals.
Institutional Environments
  •	 Long-term acute care
Transport Environments
  •	 Intra-hospital transport
• Inter-hospital transport
• Military transport
 NOTE: VOCSN that include an airplane symbol on the back label are compliant with the regulations
 for device use on board aircraft.
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                                                                                                          Introduction
Getting Started
Package Contents
VOCSN includes the following items:
• Bacterial filters
• One Ventec Travel Suction Canister (included with VOCSN configurations with Suction therapy)
• One Nebulizer Filter (included with VOCSN configurations with Nebulizer therapy)
 NOTE: Contact Ventec Life Systems at 1-844-MY-VOCSN for assistance with setup, maintenance, or to report
 unexpected device operation.
See “Accessories” on page 200 for a list of VOCSN components and accessories available from Ventec Life Systems.
Contraindications
Consult the patient’s healthcare professional before using a non-invasive interface with VOCSN if the patient experiences
any of the following medical conditions:
• Hypotension
Consult the patient’s healthcare professional before using Cough therapy if the patient experiences any of the following
medical conditions:
• Recent barotrauma
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                                                                                                                     Introduction
System Overview
                                         12
                                                                                                                            25
                                                                       13
                                                             11
                                                                       14
                                                             10
                                                                       15
      1                                                                                                                      24
                                                             9
                                                             8         16
      2
                                                             7
                                                                                    18
                                                                            17                 20
                 3                                                                       19                 22       23
                        4      5            6                                                          21
Description Description
3 Alarm Silence button 15 Cooling air outlet and Cough therapy exhaust
 7        Active exhalation valve connection port                 19   USB port for use by trained personnel only. See “Exporting
                                                                       Multi-View Data to a USB Drive” on page 127 for
                                                                       instructions.
 8        Ventec One-Circuit O2 tube connection port (+O          20   Cooling air intake and filter
          configurations only)
 10       External bacterial filter and Ventec One-Circuit        22   Patient air inlet and filter
          connection port
 12       Cooling air outlet                                      24   Suction canister cap to protect suction canister interface
                                                                       port (+S configurations only)
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                                                                                                                  Setup
Setup
This chapter includes instructions for placing and setting up VOCSN, including instructions for connecting Ventec One-
Circuits, and additional Ventec One-Circuit components. VOCSN was designed for use with Ventec One-Circuits from
Ventec Life Systems. Do not use third-party patient circuits with VOCSN.
 WARNING: Put VOCSN into service in accordance with the information provided in this Clinical and Technical Manual.
 VOCSN operation may be impaired or become unsafe by failure to follow setup and operating instructions, the
 connection of unauthorized accessories, or the unauthorized modification of VOCSN. All modifications made, and
 accessories used with VOCSN, must meet the requirements of IEC 60601-1. The organization responsible for device
 setup must ensure the compatibility of VOCSN and all parts and accessories used to provide therapy to the patient
 prior to use.
 WARNING: VOCSN should be set up, configured, and used by trained clinicians and caregivers under the direction
 of a physician. Patients and caregivers should be instructed not to modify the VOCSN setup or configuration without
 direction and/or supervision from a clinician.
 WARNING: Do not use lubricants on VOCSN or on any part of the Ventec One-Circuit. Lubricating fittings, connections,
 tubing, or other accessories may result in fire and burns to the patient or caregiver.
 WARNING: Use only spare parts recommended by Ventec Life Systems. Using spare parts not recommended by the
 VOCSN manufacturer may result in fire and burns to the patient or caregiver.
 WARNING: Only use carrying cases approved by Ventec Life Systems. Use of unauthorized carrying cases may result in
 damage to VOCSN, impaired device performance, and risk to the patient.
 NOTE: The VOCSN Ethernet and USB ports are intended for use by trained personnel only. The remote alarm port
 and power connection port can be used with third‑party equipment. However, it is the responsibility of the person
 connecting the third-party equipment to ensure the system complies with clause 16 of IEC 60601-1, 3rd ed., as well as
 any local laws.
 NOTE: When using VOCSN to provide non-invasive ventilation, Ventec Life Systems recommends use of CO2
 monitoring equipment compliant with ISO 80601-2-55. To connect and use CO2 monitoring with VOCSN, follow all
 instructions from the equipment manufacturer.
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                                                                                                                     Setup
VOCSN Placement
Place VOCSN in a well-ventilated area, ensuring air flows freely around its inlets and vents.
 WARNING: Incorrect placement of VOCSN may affect device performance. Do not cover VOCSN, place it in an area
 in which the vents may become obstructed (such as on its back or on top of compliant bedding), or use it in hazardous
 environments (such as atmospheres containing pollutants).
NOTE: VOCSN emits heat and gas, including nitrogen, during normal operation. Use VOCSN in a well-ventilated area.
When used in a home environment, VOCSN should be kept away from concentrations of lint, dust, pet dander, and
pests. Small particles and/or pests can clog VOCSN filters over time and become lodged inside VOCSN. Clean the
air and fan filters regularly to prevent clogging, and move VOCSN to a new location if large volumes of particulate are
pulled into the filters. Place VOCSN somewhere it will not be easily accessible by children or pets, such as on a roll stand.
 WARNING: Keep VOCSN out of reach of children to avoid the risk of strangulation by cords and tubes, as well as the
 risk of inhalation or swallowing of small parts. VOCSN includes a hook-and-loop strap to wrap power adapter cabling
 when not in use.
Over time, direct sunlight may compromise the integrity of VOCSN plastic housing or the Ventec One-Circuit. Place
VOCSN in a location that is not exposed to extended periods of direct sunlight.
 WARNING: Use of VOCSN outside its recommended range of temperature, altitude, and/or relative humidity may
 adversely affect the ventilation flow rate and oxygen concentration from VOCSN, and may result in patient harm. See
 “Environmental” on page 190 for details.
 WARNING: Do not use VOCSN in contaminated, hazardous, or explosive environments. Use of VOCSN can be
 hazardous in these conditions.
 WARNING: Accidental button presses could result in inadvertent alteration of the VOCSN configuration or its
 operation. To reduce the possibility of accidental button presses, do not place in areas that might result in inadvertent
 touching of the VOCSN touchscreen or its buttons. Use the touchscreen lock feature during cleaning or transport.
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                                                                                                                     Setup
Power Setup
VOCSN operates using external power (such as a wall outlet), or VOCSN batteries. Ventec Life Systems recommends
connecting VOCSN to a continuous external power source whenever possible. During transport, Ventec Life Systems
recommends the use of external power or the removable batteries. Use the internal (non-removable) battery in case of
power failure or power transition only.
 NOTE: Use only the power supply approved by Ventec Life Systems to connect VOCSN to external sources of power.
 Ensure the external source of power is rated for use with VOCSN. See “External Power Requirements” on page C-3 for
 more information.
The VOCSN batteries will begin charging whenever an external power source is applied. All VOCSN features and
functions operate normally during battery charging. The charge status indicator light on the front of VOCSN will
illuminate orange when the batteries are charging, and illuminate green when the batteries are fully charged. In the
status bar, a lightning bolt will appear on the battery indicator of the charging battery.
 NOTE: When VOCSN is disconnected from external power and transitions to running on battery power, or switches from
 running on removable battery to internal battery power, the medium-priority Battery Use alarm will activate.
 WARNING: Check the batteries and external power supply regularly to ensure functionality. VOCSN power failure may
 interrupt ventilation therapy and result in patient harm or death. See “Power Testing Procedures” on page 136 for
 instructions.
If the internal battery depletes fully, VOCSN Date and Time settings will reset to their default values. To ensure the Alarm
and Event logs record information accurately, verify the VOCSN Date and Time settings before use, and set them to the
correct values if necessary.
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                                                                                                                      Setup
Before and during use, periodically inspect the power supply for damage
or frays, and to ensure the power supply cords are firmly connected. Do
not use damaged power supplies. Replace the power supply if necessary.
The power supply includes a wire retention clip. To ensure the cabling
remains seated in the adapter, rotate the retention clip so that it
secures the cable to the adapter.
 NOTE: Do not use portable (e.g., external 115-volt AC) power supplies
 to power VOCSN, unless the power supply voltage variations are known to be within VOCSN operating limits. See
 “External Power Requirements” on page 191.
   1	   Plug the power supply into the power connection port on the back of VOCSN, and screw the connector
        clockwise to secure it in place.
   2	   Plug the power supply into a power socket, such as a wall outlet, and verify the external power indicator (    )
        appears on the touchscreen.
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                                                                                                                Setup
The 24 Volt Wheelchair Power Cable comes with a hook-and-loop strap to manage excess cabling. Coil extra cabling
between the outlet and VOCSN, and then wrap the strap around the cabling to secure it.
 NOTE: Before connecting the 24 Volt Wheelchair Power Cable to a power source, you must verify the voltage and
 current emitted from the DC power source are within the range of VOCSN operating limits, and that the power source
 has the correct connection type. See “External Power Requirements” on page 191.
To remove a battery:
2 Use the tab to pull the battery out of the well gently.
To install a battery:
   2	   Gently press the battery into the well. Place the base                                2
        of the battery into the well first, and then press the
        top of the battery toward VOCSN and into the well.
                                                                                                            1
   3	   Press the battery tab down so that it is flat against
        the battery.
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                                                                                                                      Setup
NOTE: See “Mouthpiece Patient Circuit Setup” on page 40 for detailed setup instructions for that circuit type.
Ventec Life Systems offers single-patient use adult and pediatric Ventec One-Circuits for use with VOCSN, which
incorporate an optional active or passive exhalation valve, an optional Ventec One-Circuit O2 tube (to deliver pulse dose
Oxygen Direct therapy), and an optional heated wire (for connection to a humidifier). See “Accessories” on page 200
for a list of Ventec One-Circuits available from Ventec Life Systems.
Each time the Ventec One-Circuit or its configuration is changed, or the Circuit Type control is modified, run a Pre‑Use
Test before initiating therapy. The Pre-Use Test will calculate the resistance, and leak of the Ventec One-Circuit to ensure
Ventilation therapy is delivered accurately.
 WARNING: Adding unauthorized attachments, components, or sub-assemblies to the Ventec One-Circuit can change
 the pressure gradient of the Ventec One-Circuit and adversely affect the performance of VOCSN.
 WARNING: Ventec One-Circuit accessories (including but not limited to filters, nebulizers, and humidifiers) may
 increase the resistance of the Ventec One-Circuit and affect the accuracy of delivered Ventilation therapy. Inspect all
 patient circuit filters frequently for signs of increased resistance or blockages, and ensure alarms are set appropriately
 to verify the accuracy of delivered Ventilation therapy.
 WARNING: To reduce the risk of electric shock, do not use anti-static or electrically conductive patient circuits or hoses
 with the VOCSN system. Only Ventec One-Circuits are approved for use with VOCSN.
 WARNING: To ensure patient safety, check the Ventec One-Circuit and verify that all system settings and Presets are
 appropriate before providing therapy, and on a routine basis during therapy.
 WARNING: Any components added to the breathing circuit between the Ventec One-Circuit exhalation valve and the
 patient will increase the amount of gas that the patient rebreathes with each breath. The addition of components into
 the breathing circuit should be considered carefully, especially for small pediatrics.
 NOTE: When providing non-invasive ventilation, use CO2 monitoring equipment compliant with ISO 80601-2-55 to
 ensure patient safety.
Ventec One-Circuits may be connected to a humidifier and/or other patient circuit components as needed. See
“Connecting Ventec One-Circuit Components” on page 35 for detailed instructions.
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                                                                                                                   Setup
 NOTE: Masks with an anti-asphyxia valve should not be used with an Active Ventec One-Circuit, because bias flow may
 not be sufficient to close the valve when needed. Active circuit valves open automatically when there is no pressure in
 the circuit, serving the same purpose as anti-asphyxia valves.
 NOTE: Vented masks used with VOCSN must be connected with a Valveless or Passive Ventec One-Circuit and have an
 integrated leak of 20 to 50 L/min at 10 cmH2O to ensure proper device performance.
 WARNING: Masks are not recommended for use with patients <7 kg, due to the unavailability of masks sized to
 provide a seal tight enough to deliver effective Ventilation therapy.
 NOTE: When using a Valveless Ventec One-Circuit, leave the circuit connected to VOCSN, and disconnect the mask or
 high flow nasal cannula while running the Pre-Use Test.
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                                                                                                                    Setup
   2	   Connecting the Ventec One-Circuit depends on whether you are using an HME or a humidifier, and whether or
        not you are connecting the Ventec Humidifier Bypass (for Touch Button Cough therapy). Follow the instruction
        below the corresponds to the Ventec One-Circuit configuration:
        •	 To configure the Ventec One-Circuit with an HME instead of a humidifier, see “Connecting a Ventec
           One-Circuit Without a Humidifier” on page 29.
        •	 To configure the Ventec One-Circuit with a humidifier, without connecting a Ventec Humidifier Bypass,
           see “Connecting a Ventec One-Circuit to a Humidifier (Without the Ventec Humidifier Bypass)” on page
           31.
        •	 To configure the Ventec One-Circuit with a humidifier and the Ventec Humidifier Bypass (for Touch
           Button Cough therapy), see “Connecting a Ventec One-Circuit, Humidifier, and Ventec Humidifier
           Bypass” on page 32.
   3	   If the Ventec One-Circuit includes an integrated O2 tube, connect it to VOCSN. See “Connecting a Ventec One-
        Circuit O2 Tube” on page 33 for instructions.
   4	   If you are using an active Ventec One-Circuit, connect the flow sensor (multilumen) tubing to VOCSN. See
        “Connecting an Active Ventec One-Circuit” on page 34.
   5	   To attach other components to the Ventec One-Circuit, such as a nebulizer or closed suction catheter, see
        “Connecting Ventec One-Circuit Components” on page 35.
   6	   The diagram on the next page illustrates the Ventec One-Circuit and optional components in the correct
        configuration. Consult “Ventec One-Circuit Component Connection Order” on page 28 to verify that
        everything is connected in the correct order.
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                                                                                                                           Setup
 VOCSN Bacterial         Required                See “Connecting a Bacterial Filter” on page 29 for instructions.
 Filter
 Ventec Humidifier       Required for using      The Ventec Humidifier Bypass prevents water damage to VOCSN during Cough
 Bypass                  Touch Button Cough      therapy.
                         therapy with a
                         connected humidifier
 Ventec One-Circuit      Required                Use either an Active, Passive, or Valveless Ventec One-Circuit. Ventec One-
                                                 Circuits may include an integrated O2 tube and/or a heated wire. Active
                                                 Ventec One-Circuits include flow sensor tubing. (For Mouthpiece Patient Circuit
                                                 instructions, see “Mouthpiece Patient Circuit Setup” on page 40.)
 Heat-Moisture           Optional                Include a form of humidification (either an HME or humidifier). See “Connecting
 Exchanger (HME)                                 an HME (Heat-Moisture Exchanger)” on page 35 for instructions.
 Nebulizer               Optional                Connect a nebulizer to the nebulizer drive port. See “Connecting a Nebulizer
                                                 Cup to the Patient Circuit” on page 36 for instructions.
 Ventec Secretion Trap   Optional                Connect a Ventec Secretion Trap, using suction tubing, to a suction canister.
                                                 See “Connecting a Ventec Secretion Trap to the Patient Circuit” on page 38
                                                 for instructions.
 Patient interface       Required                Examples of a patient interface include a mask, trach, or ET tube. Active and
                                                 Passive Ventec One-Circuits include an exhalation valve and are intended for
                                                 use with non-vented masks, trach, or ET tubes. Valveless Ventec One-Circuits
                                                 are intended for use with vented masks, or nasal cannulas for High Flow
                                                 therapy.
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                                                                                                                        Setup
Fit the bacterial filter against VOCSN, aligning the icons on the filter and VOCSN, then twist the filter to lock it into place.
VOCSN contains a secondary, internal bacterial filter to help protect against cross-contamination in case of external
bacterial filter failure. The internal bacterial filter should be replaced whenever it may have become cross-contaminated,
such as when the external bacterial filter becomes compromised, or if an infectious disease specialist recommends its
replacement. See “Replacing the Internal Bacterial Filter” on page 165 for instructions.
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                                                                                                                 Setup
 WARNING: Do not use heated wire Ventec One-Circuits on, within, or under localized heat sources or insulating
 materials such as blankets or thermal chambers. External sources of heat or insulation may impair the performance of
 heated wire Ventec One-Circuits.
  CAUTION: Before delivering Cough therapy when using a heated humidifier, verify a Ventec Humidifier Bypass is
  installed, or disconnect the humidifier from the Ventec One-Circuit. Cough therapy may cause water damage to
  VOCSN when a humidifier is attached to the Ventec One-Circuit without an installed Ventec Humidifier Bypass. See
  “Connecting a Ventec One-Circuit, Humidifier, and Ventec Humidifier Bypass” on page 32 for installation instructions
  and more information. The Ventec Humidifier Bypass was designed to remain connected to the Ventec One-Circuit
  during Ventilation therapy, allowing the delivery of Touch Button Cough therapy while using a humidifier, without
  reconfiguring the Ventec One-Circuit.
 NOTE: Using humidifiers or other accessories not specified for use with this system may impair VOCSN performance.
 Ventec Life Systems recommends use of the Fisher & Paykel HC550, the Fisher & Paykel MR850, or equivalent.
 Humidifiers connected to the VOCSN Ventec One-Circuit should comply with ISO 8185.
Depending on whether you will use Touch Button Cough therapy with a connected humidifier, follow the setup
instructions as described in “Connecting a Ventec One-Circuit to a Humidifier (Without the Ventec Humidifier Bypass)” on
page 31 or “Connecting a Ventec One-Circuit, Humidifier, and Ventec Humidifier Bypass” on page 32 to connect a
humidifier, humidifier bypass (if necessary), and heated wire Ventec One-Circuit to VOCSN.
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                                                                                                                         Setup
To connect a humidifier to the Ventec One-Circuit (without the Ventec Humidifier Bypass):
   1	   Connect a length of patient circuit tubing (sold separately) to the open end of the external bacterial filter.
        Connect the other end to the humidifier.
   2	   Connect a heated wire Ventec One-Circuit to the humidifier. Follow instructions from the humidifier manufacturer
        to connect heated wire and temperature sensor lines from the humidifier to the Ventec One-Circuit.
                                                                 1
                                                                                               2
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                                                                                                                 Setup
To connect a humidifier and Ventec Humidifier Bypass to a heated wire Ventec One-Circuit, follow setup instructions
provided by the humidifier manufacturer, and:
1 Connect the flexible Ventec Humidifier Bypass tubing to the external bacterial filter.
3 Connect the heated wire Ventec One-Circuit to the Ventec Humidifier Bypass.
   4	   Follow instructions from the humidifier manufacturer to connect heated wire and temperature sensor lines from
        the humidifier to the Ventec One-Circuit.
1 3
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                                                                                                                Setup
 NOTE: To ensure proper Oxygen therapy performance, make sure the O2 tube is fully connected. The end of the blue
 connector should be flush against VOCSN.
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                                                                                                                    Setup
1 Fit the oval connector tube into place in the Active connection port.
2 Then, fit the connecting screw cap over the port and twist it clockwise until it is firmly secured.
  CAUTION: Ensure that no part of the active exhalation valve flow sensor tubing becomes pinched during setup or use.
  Pinched tubing can affect VOCSN performance, including its ability to provide accurate breath triggering, cycling, and
  monitoring.
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                                                                                                                 Setup
 NOTE: Ventec Life Systems recommends including a humidifier or heat-moisture exchanger (HME) as part of active,
 passive, and valveless Ventec One-Circuit configurations.
NOTE: Any HME attached to the VOCSN Ventec One-Circuit should comply with ISO 9360-1 or ISO 9360-2.
 NOTE: When used with a vented mask, exhaled, humidified air exits the mask instead of traveling through the HME,
 greatly reducing its efficacy.
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                                                                                                                    Setup
VOCSN may also be configured to compensate for the flow added to the patient circuit from an external 6 L/min
nebulizer. Follow all instructions from the manufacturer to connect an external nebulizer cup to the patient circuit, and
see “Starting Nebulizer therapy” on page 156 for instructions on compensating Ventilation therapy for the flow from an
external 6 L/min nebulizer.
 NOTE: To ensure proper device operation, all nebulizer parts connected to VOCSN should comply with the relevant
 requirements of ISO 27427.
Follow all setup and operating instructions provided by the nebulizer manufacturer, including any indications for use or
contraindications regarding fluid types for use with the nebulizer.
 WARNING: Use only 6 L/min nebulizer cups with VOCSN. VOCSN ventilation compensates for 5.9 L/min of nebulizer
 flow while the nebulizer drive is active. When gas is added to the Ventec One-Circuit from a nebulizer producing a flow
 less or more than 6 L/min, the accuracy of delivered ventilation may be temporarily affected.
   2	   Connect one end of the nebulizer tubing to the VOCSN Nebulizer Filter, and the other end to the bottom of the
        nebulizer cup.
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                                                                                                                       Setup
3 Add medication to the nebulizer cup by following all instructions from the nebulizer cup manufacturer.
  4	   Configure nebulizer therapy by pressing the Therapy tab, and then the Nebulizer button. If needed, set the
       Nebulizer duration control by using the plus (+) and minus (-) buttons. The Nebulizer Duration should be set to
       provide ample time for all medication in the cup to be delivered to the patient. See “Starting Nebulizer therapy”
       on page 156 for more information.
  5	   Before connecting the nebulizer cup to the patient circuit, press START to begin therapy, and confirm an aerosol
       mist is created from the nebulizer cup.
       NOTE: During the brief period while Nebulizer therapy is running without the nebulizer connected to the patient
       circuit, delivered Tidal Volumes may be affected.
  6	   Attach the nebulizer cup and tee between the exhalation valve and the patient interface (or, if the tee is already
       in place, attach the nebulizer cup to it). Verify the nebulizer cup is vertical to ensure that all medication in the cup
       is properly nebulized.
       NOTE: If an HME is used, connect the nebulizer cup between the HME and the patient to prevent the HME from
       trapping nebulized medication.
       NOTE: If a passive Ventec One-Circuit is used, Ventec Life Systems recommends connecting a filter between the
       distal end of the circuit and the nebulizer tee to ensure nebulized material does not collect in the passive valve
       and obstruct airflow.
  7	   When nebulizer therapy is complete, disconnect the nebulizer from the VOCSN nebulizer port, and then from
       the patient circuit. Clean the nebulizer cup following all instructions from the nebulizer manufacturer.
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                                                                                                                   Setup
 WARNING: The internal volume of the Ventec Secretion Trap is 19.5 mL. Any components added to the breathing
 circuit between the patient circuit exhalation valve and the patient will increase the amount of gas the patient
 rebreathes with each breath. The addition of components into the breathing circuit should be considered carefully,
 especially for small pediatric patients.
To keep secretions from clogging an HME or other Ventec One-Circuit accessories, connect a Ventec Secretion Trap as
close to the patient interface as possible.
   1	   Connect the Ventec Secretion Trap to the Ventec One-Circuit exhalation valve, HME (if used), or nebulizer (if
        used).
   2	   Connect suction tubing to the Ventec Secretion Trap and a connected suction canister. See “Suction Setup” on
        page 45 for instructions.
 NOTE: If suction tubing is disconnected from the Ventec Secretion Trap during Ventilation therapy, cap the connection
 port in the base of the Ventec Secretion Trap to avoid unintended leak in the Ventec One-Circuit.
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                                                                                                                   Setup
NOTE: If used, suction catheters should comply with ISO 8836 to ensure proper VOCSN performance.
NOTE: To connect an open-suction catheter, see “Connecting the External Suction Canister Adapter” on page 48
   1	   Connect the closed-suction catheter to the Ventec One-Circuit exhalation valve, HME (if used), or nebulizer (if
        used).
   2	   Connect suction tubing to the closed-suction catheter and a connected suction canister. See “Suction Setup” on
        page 45 for instructions.
Gas exiting the mouth through a speaking valve rather than through the Ventec One-Circuit exhalation valve will cause
the monitored Vte and Minute Volume to appear smaller than expected. In addition, the Leak monitor will likely appear
larger than expected as the patient speaks. This may cause the activation of the Low Minute Volume or Patient Circuit
Disconnect alarm.
 WARNING: If the Low Minute Volume and/or Patient Circuit Disconnect alarm cannot be set appropriately for the
 patient condition because of a connected speaking valve or other reason, use an alternate respiratory monitor such as
 an oximeter or cardio-respiratory monitor to detect hypoventilation.
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                                                                                                                    Setup
 WARNING: Using a mouthpiece for Ventilation or Cough therapy is not recommended for patients <5 years of age, due
 to the requirements for physiological and neurological development, as well as neuromuscular coordination necessary
 for the application of effective therapy.
Setting the Circuit Type control to Mouthpiece will limit the available ventilation modes and controls to those that are
suitable for use with this type of patient circuit. See “Setting VOCSN Controls for Mouthpiece Ventilation” on page 87
for additional information.
To connect a mouthpiece patient circuit to VOCSN, begin by connecting an external bacterial filter. Connect the
Mouthpiece Circuit Kit components in the order depicted below.
   1	   Reducer cuff                                                                     6
   2	   15mm circuit tubing (one piece)
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                                                                                                                    Setup
  •	 Using an external low-pressure oxygen source, which can be used alone or in as an additive in combination
     with another source.
NOTE: The oxygen source options available on VOCSN will depend on its configuration.
  •	 Using FiO2 mode to deliver a continuous stream of oxygen into the Ventec One-Circuit from an external
     source of high-pressure oxygen.
  •	 Using the Oxygen Direct system to deliver oxygen in Pulse Dose mode through the Ventec One-Circuit O2
     tube. The Oxygen Direct system can be used with oxygen from the internal O2 Concentrator, or from an
     external source of high-pressure oxygen connected to the VOCSN high-pressure oxygen port.
  •	 Using a connected external source of low-pressure oxygen to flow oxygen through VOCSN and into the
     Ventec One-Circuit. Low-pressure oxygen is additive and can be used in addition to oxygen from the internal
     O2 Concentrator or an external high-pressure oxygen source.
This means that in total, there are seven possible ways oxygen may be delivered using VOCSN:
Ext. High Pressure Pulse Dose Yes: Additive low pressure O2 bleed in
 NOTE: Do not bypass the oxygen ports in the back of VOCSN to bleed oxygen directly into the Ventec One-Circuit from
 an external oxygen source. Any source of external oxygen used with VOCSN should be connected to the appropriate
 port on the back of the device. Bleeding oxygen into the Ventec One-Circuit can adversely affect the efficacy of
 delivered therapy.
 WARNING: If the patient’s prescribing healthcare professional determines Oxygen therapy is critical to patient care,
 provide continuous monitoring, such as pulse oximetry or proximal FiO2 monitoring.
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                                                                                                                 Setup
   1	   If needed, enable the internal O2 Concentrator. See “Enabling and Disabling Prescribed Therapies” on page
        88.
   2	   Connect a Ventec One-Circuit O2 tube to the O2 output port on the right side of VOCSN. See “Connecting a
        Ventec One-Circuit O2 Tube” on page 33 for instructions.
3 Verify VOCSN is not near open flame, ignited cigarettes, or flammable gases.
   4	   Configure Pulse Dose mode and set the O2 Flow Equivalent control to provide the prescribed therapy to the
        patient. See “Changing Oxygen Settings” on page 90 for configuration instructions.
 WARNING: The internal O2 Concentrator is not intended for life support. Where the prescribing healthcare professional
 has determined that an interruption in the supply of oxygen, for any reason, may have serious consequences to the
 user, an alternate source of oxygen should be available for immediate use.
  CAUTION: Using unauthorized accessories not specified for use with the internal O2 Concentrator may adversely
  affect the effective delivery of Oxygen Direct therapy.
NOTE: Hot, humid environments may reduce the oxygen generation capacity of the internal O2 Concentrator.
  •	 External oxygen sources are connected to the proper port on the back of VOCSN, not directly to the Ventec
     One-Circuit, and if possible, are turned off when not in use.
  •	 If the FiO2 control is used, that the FiO2 monitor is enabled, and the High and Low FiO2 alarms are set
     appropriately for the patient condition.
  •	 The oxygen source meets the pressure or flow specification requirements described in “Inputs and Outputs”
     on page 190.
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                                                                                                             Setup
 NOTE: Whenever the FiO2 control is set above 21%, use the FiO2 monitor and set the High FiO2 and Low FiO2 alarms
 appropriately for the patient condition.
   1	   Connect the oxygen hose from the oxygen source to the high-pressure O2 port on the back of VOCSN. Twist the
        connector on the oxygen tubing clockwise until it is tight.
   2	   Configure VOCSN to provide Oxygen therapy using either Pulse Dose or FiO2 mode. See “Changing Oxygen
        Settings” on page 90.
        •	 If using Pulse Dose mode, verify that the integrated Ventec One-Circuit O2 tube is connected to the
           O2 output port on the right side of VOCSN. See “Connecting a Ventec One-Circuit O2 Tube” on page
           33 for instructions.
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                                                                                                                              Setup
 NOTE: The FiO2 Monitor and FiO2 alarms are not available while using an external source of low‑pressure oxygen.1
 When an external low-pressure oxygen source is applied, use external O2 monitoring equipment (which may be
 included with the oxygen source) compliant with ISO 80601‑2‑55 to verify oxygen delivery before putting the system into
 service. To connect external O2 monitoring equipment to VOCSN, follow all instructions provided by the monitoring
 equipment manufacturer.
 NOTE: To prevent oxygen accumulation in and around the device, ensure the low-pressure oxygen source is off while
 VOCSN is off.
1	 When High Flow therapy is On, the FiO2 monitor and FiO2 alarms are also active. Deactivating High Flow therapy will also
   deactivate the FiO2 monitor and alarms while using low-pressure oxygen.
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                                                                                                                   Setup
Suction Setup
Depending on your device configuration, VOCSN may include an internal suction pump and a detachable Ventec Travel
Suction Canister with a 300 mL capacity. When the Ventec Travel Suction Canister is full, disconnect and dispose of it as
a contaminated component. The Ventec Travel Suction Canister includes a water-phobic filter that will render Suction
therapy inoperable if the Ventec Travel Suction Canister overfills.
The optional Ventec External Suction Canister Adapter can be used to connect larger third-party suction canisters. See
“Accessories” on page 200 for information.
Capable of medium vacuum and high flow, the VOCSN suction pump can be used to clear secretions from a Ventec
Secretion Trap in the Ventec One-Circuit, or the mouth, nose, or airway of a patient using an open- or closed-suction
catheter.
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                                                                     Setup
                                                        Travel or
                                                        Remove
                                                          Filter
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                                                                                                                    Setup
Connect the other end of the suction tubing to a Ventec Secretion trap, closed- or open-suction catheter.
 NOTE: The Ventec Travel Suction Canister is intended for use with 1/4” diameter suction tubing compliant with ISO
 10079-1. See “Accessories” on page 200 for more information.
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                                                                                                                        Setup
1 Attach and detach the adapter by twisting it to the left (unlock position) or right (lock position).
1 Connect the tubing firmly to the suction interface, ensuring an air-tight seal.
To connect suction tubing to an interface used as part of the patient circuit, see “Connecting a Closed-Suction Catheter
to the Patient Circuit” on page 39 or “Connecting a Ventec Secretion Trap to the Patient Circuit” on page 38.
NOTE: If used, suction catheters should comply with ISO 8836 to ensure proper VOCSN performance.
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                                                                                                                   Setup
 WARNING: To reduce the risk of electrical shock, ensure the Nurse Call System connected to VOCSN meets the Safety
 Extra Low Voltage (SELV) requirements as described in IEC 60601-1 (1988).
 Safety Extra-Low Voltage (SELV): Voltage which does not exceed nominal values of 25 VAC or 60 V DC at rated
 supply voltage on transformer or convert, between conductors in the earth-free circuit which is isolated from the supply
 mains by a safety extra low voltage transformer, or by a device with equivalent separation.
 Safety Extra-Low Voltage Transformer: Transformer with an output-winding which is electrically separated from earth
 and the body of the transformer by at least basic insulation and which is electrically separated from the input winding
 by an insulation at least equivalent to double insulation or reinforced insulation and which is designed to supply Safety
 Extra-Low Voltage circuits.
 WARNING: To reduce the risk of electrical shock in the event of a failure of Nurse Call System’s electrical separation
 from supply mains, operator should not simultaneously touch the patient and any exposed metal on the VOCSN rear
 housing, including: the DC power connector shell, either high or low pressure oxygen connectors, and/or the exposed
 metal screw above the Nurse Call/USB port.
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                                                                                                                       Setup
To ensure therapy is delivered accurately, you must perform a Pre-Use Test whenever prompted, the patient circuit is
changed, or the device is powered on.
 WARNING: Ventilation therapy is paused during the Pre-Use Test. If Ventilation therapy is critical to patient care,
 provide backup ventilation for the duration of the test. To ensure patient safety, always verify Ventilation therapy is
 resumed when the Pre-Use Test is complete.
 NOTE: Though accuracy may be reduced, VOCSN may still be used to provide ventilation therapy when the Pre-Use
 Test fails. If time constraints make running the test inadvisable, press the EXIT button to immediately initiate Ventilation
 therapy.
 NOTE: To calculate resistance correctly, the Pre-Use Test must be performed without an HME connected to the Ventec
 One-Circuit.
Some control changes cause VOCSN to prompt you to run a Pre-Use Test. You may also press the
Menu tab and then the PRE-USE TEST button to begin a Pre-Use Test at any time.
To run a Pre-Use Test, carefully follow the on-screen instructions. When instructed, use a clean,
gloved hand to obstruct the circuit completely, as follows:
                                                                                                           PRE-USE TEST
  •	 If you are using an Active, Passive, or Valveless Ventec One-Circuit, disconnect the patient
     interface and block the circuit at its end.
  •	 If you are using a Mouthpiece patient circuit, leave the mouthpiece connected, and block the open end.
If the test completes successfully, reconnect the Ventec One-Circuit to the patient and resume Ventilation therapy. If the
test fails, inspect the Ventec One-Circuit configuration for leaks or improper setup. Resolve any issues with the Ventec
One-Circuit, and then press RESTART to run the Pre-Use Test again.
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                                                                                  Breath Types and Therapy Modes
Breath Types
Breaths can be initiated (started) and cycled (ended) by either VOCSN or the patient. Depending on the Ventilation
Mode and breath control settings chosen, VOCSN may provide the patient with mandatory, assist, or spontaneous
breaths.
 Mandatory       VOCSN           VOCSN           Mandatory breaths are initiated by VOCSN based on the set Breath Rate and
                                                 delivered as pressure or volume breaths. Breaths cycle at the end of the set
                                                 Inspiratory Time. If Pressure Control Flow Termination is enabled, mandatory
                                                 breaths may be cycled by the patient when the flow drops to the set Flow
                                                 Cycle percentage.
 Assist          Patient         VOCSN           Assist breaths are initiated by the patient and delivered as pressure or volume
                                                 breaths. Breaths cycle when they reach the end of the set Inspiratory Time. If
                                                 Pressure Control Flow Termination is enabled, breaths may be cycled by the
                                                 patient when the flow drops to the set Flow Cycle percentage.
Spontaneous Patient Patient Spontaneous breaths are initiated and cycled by patient effort.
Depending on the Ventilation Mode setting, mandatory and assist breaths may be delivered to the patient as either
pressure or volume breath types. When triggered, spontaneous breaths provide a set pressure to support patient
demand.
 NOTE: When used with active, passive, or valveless Ventec One-Circuits, VOCSN was designed for use with a humidifier
 or HME. All volumes and flows are expressed in BTPS unless stated otherwise.
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                                                                                 Breath Types and Therapy Modes
Pressure Breaths
Mandatory and assist breaths are delivered as pressure breaths in pressure ventilation modes. VOCSN delivers pressure
breaths by elevating the pressure of the Ventec One-Circuit to the set Pressure Control limit for the set Inspiratory Time.
NOTE: The maximum pressure delivered is limited to the High Pressure alarm setting minus 5 cmH2O.
VOCSN will deliver flow during the set Inspiratory Time to reach and maintain the set Pressure Control limit. Adjusting
the Rise Time control will modify the rate of flow and rate of pressure elevation.
Pressure breaths cycle at the end of the set Inspiratory Time, or when flow drops to the set Flow Cycle percentage of
peak flow when PC Flow Termination is set to On.
Flow
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                                                                                Breath Types and Therapy Modes
Volume Breaths
Mandatory and assist breaths are delivered as volume breaths in volume ventilation modes. Volume breaths deliver the
set Tidal Volume over the set Inspiratory Time. Airway pressure is a function of patient lung resistance and compliance.
 NOTE: Delivery of volume breaths to patients with extremely high airway resistance (e.g., 200 cmH2O/L/s) and lung
 compliance requires high circuit pressure, which may cause the High Pressure alarm to activate before the target tidal
 volume is reached.
The set Tidal Volume and Inspiratory Time determine the peak flow (limited to 120 L/min). The final flow will be 50% of
the peak flow, unless peak flow is below 20 L/min. When peak flow is below 20 L/min, the final flow will be 10 L/min.
                                           Set                                         Set
                                       Inspiratory                                 Inspiratory
                                          Time                                        Time
              Airway
             Pressure
                                                                                         50% of
                                             10 L/min                                  initial flow
Flow
Spontaneous Breaths
Spontaneous breaths are initiated and cycled by the patient. Depending on the set Ventilation Mode, spontaneous
breaths will be delivered at a set IPAP (in Bi-Level and Spontaneous modes) or at a set Pressure Support (in SIMV modes).
Spontaneous breaths cycle at the set Flow Cycle percentage of peak flow, or at the Time Cycle setting, whichever is
reached first.
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                                                                                 Breath Types and Therapy Modes
A breath period is the window of time used by VOCSN to determine when mandatory breaths will be delivered to the
patient. A breath period is 60 seconds divided by the set Breath Rate. Breath periods begin at the start of a breath,
whether patient-triggered or mandatory.
Bi-Level Mode
Bi-Level mode provides the patient with two configurable levels of pressure: IPAP (above ambient) during inhalation, and
EPAP during exhalation.
NOTE: Bi-Level ventilation is not intended for use with Mouthpiece patient circuits.
In Bi-Level therapy, the patient may initiate a spontaneous breath at any time at the set Flow Trigger. If the patient does
not initiate a spontaneous breath within a breath period, VOCSN will deliver a mandatory pressure breath to ensure the
patient breathes at a minimum rate, set using the Breath Rate control.
Both spontaneous and mandatory breaths will be delivered at the set IPAP (above ambient). When a breath cycles,
VOCSN will deliver the set EPAP.
                                                           Breath Period
 IPAP
 EPAP
               Mandatory         Spontaneous Spontaneous                                Mandatory            Spontaneous
Spontaneous Mode
Spontaneous mode is used with mouthpiece patient circuits only. All breaths are spontaneous (initiated and cycled by
the patient). When VOCSN detects patient effort through the mouthpiece patient circuit, the set IPAP (above ambient) is
delivered. When a breath cycles, the pressure of the patient circuit drops to zero (ambient).
IPAP
    0
           Spontaneous        Spontaneous                      Spontaneous Spontaneous                       Spontaneous
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                                                                                         Breath Types and Therapy Modes
Assist/Control-Pressure Mode
Assist/Control-Pressure works one way with active, passive, and valveless circuits, and differently when VOCSN is
connected to and configured to use a mouthpiece Ventec One-Circuit.
Both mandatory and assist breaths are delivered at the set Pressure Control (above PEEP)1 over the set Inspiratory Time.
When a breath cycles, the pressure of the Ventec One-Circuit drops to the set PEEP.
   PEEP
              Mandatory                             Mandatory          Assist                                 Mandatory
Assist breaths are delivered at the set Pressure Control over the set Inspiratory Time. Since mouthpiece circuits are not
always held in the mouth, the pressure of the patient circuit drops to zero when a breath cycles.
Pressure
Control
       0
              Assist                                 Assist                 Assist                                   Assist
1	 In Assist/Control-Pressure mode, the peak pressure delivered is the set Pressure Control plus the set PEEP. Set the Pressure Control
   to the prescribed pressure to be delivered during inspiration, as an addition to the set PEEP. For example, a PEEP setting of 5
   cmH2O and Pressure Control setting of 10 cmH2O will result in a peak pressure of 15 cmH2O.
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                                                                                         Breath Types and Therapy Modes
SIMV-Pressure Mode
SIMV-Pressure mode delivers pressure and spontaneous breaths through an active, passive, or valveless circuit. When
patient effort is detected during a breath period, one assist breath will be delivered. Subsequent patient triggers within a
breath period will result in spontaneous breaths.
If patient effort is not detected during a breath period, VOCSN will provide a mandatory pressure breath at the
beginning of the next breath period.
Both mandatory and assist breaths are delivered at the set Pressure Control (above PEEP),2 over the set Inspiratory Time.
Spontaneous breaths are delivered at the set Pressure Support (above PEEP), and cycle with patient effort. When a
breath cycles, the pressure of the Ventec One-Circuit drops to the set PEEP.
    PEEP
                   Mandatory Assist           Spontaneous Assist              Spontaneous                              Mandatory
CPAP Function
VOCSN does not include a separate mode setting for CPAP. The CPAP function is achieved by setting the ventilator to
SIMV-Pressure (or SIMV-Volume) mode, and setting the Breath Rate and Pressure Support to zero. All breaths are
spontaneous, and are delivered at the set PEEP level.
PEEP
     0
                             All breaths are Spontaneous
Flow
2	 In SIMV-Pressure mode, the peak pressure delivered during pressure breaths is the set Pressure Control plus the set PEEP. The peak
   pressure delivered during spontaneous breaths is the set Pressure Support plus the set PEEP. Set the Pressure Control and Pressure
   Support to the prescribed pressure to be delivered during inspiration, as an addition to the set PEEP. For example, a PEEP setting of
   5 cmH2O and Pressure Control setting of 10 cmH2O will result in a peak pressure of 15 cmH2O for pressure breaths.
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                                                                                   Breath Types and Therapy Modes
Assist/Control-Volume Mode
Assist/Control-Volume works one way with active, passive, and valveless circuits, and differently when VOCSN is
connected to and configured to use a mouthpiece Ventec One-Circuit.
Both mandatory and assist breaths deliver the set Tidal Volume over the set Inspiratory Time. When a breath cycles, the
pressure of the Ventec One-Circuit drops to the set PEEP.
PEEP
           Mandatory                            Mandatory                Assist                              Mandatory
Assist breaths deliver the set Tidal Volume over the set Inspiratory Time. When a breath cycles, the pressure of the
patient circuit drops to zero.
0
        Assist                                 Assist                  Assist                             Assist
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                                                                                       Breath Types and Therapy Modes
SIMV-Volume Mode
SIMV-Volume mode delivers volume and spontaneous breaths through an active, passive, or valveless Ventec One-
Circuit. When patient effort is detected during a breath period, one assist breath will be delivered. Subsequent patient
triggers within a breath period will result in spontaneous breaths.
If patient effort is not detected during a breath period. VOCSN will provide a mandatory volume breath at the beginning
of the next breath period.
Both mandatory and assist breaths deliver the set Tidal Volume over the set Inspiratory Time. Spontaneous breaths are
delivered at the set Pressure Support plus PEEP,3 and cycle with patient effort. When a breath cycles, the pressure of the
Ventec One-Circuit drops to the set PEEP.
Pressure
Support
(above PEEP)
     PEEP
                   Mandatory       Assist       Spontaneous Assist            Spontaneous                             Mandatory
CPAP Function
VOCSN does not include a separate mode setting for CPAP. The CPAP function is achieved by setting the ventilator to
SIMV-Volume (or SIMV-Pressure) mode, and setting the Breath Rate and Pressure Support to zero. All breaths are
spontaneous, and are delivered at the set PEEP level.
PEEP
    0
                             All breaths are Spontaneous
3	 In SIMV-Volume mode, the peak pressure delivered during spontaneous breaths is the set Pressure Support plus the set PEEP. Set
   the Pressure Support to the prescribed pressure to be delivered during inspiration, as an addition to the set PEEP. For example,
   a PEEP setting of 5 cmH2O and Pressure Support setting of 10 cmH2O will result in a peak pressure of 15 cmH2O for pressure
   breaths.
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                                                                                          Breath Types and Therapy Modes
In Volume Targeted modes, VOCSN delivers a an initial breath to the patient, and then automatically adjusts the therapy
to achieve and maintain the target Tidal Volume. The first breath is delivered as a pressure control breath at the set Pres.
Minimum. VOCSN then measures and calculates the pressure required to deliver the set Tidal Volume to the patient for
subsequent breaths.
With each breath, VOCSN makes adjustments to the delivered pressure to achieve the target Tidal Volume. The
adjustment rate can be set using the Pres. Adj. Rate control. Setting the Pres. Adj. Rate control to Slow will increment
breaths by up to ±1 cmH2O per breath. The Fast setting will increment breaths by up to ±3 cmH2O per breath.
  NOTE: VOCSN will pause calculations during activation of the High Pressure, Check Patient Circuit, or Patient Circuit
  Disconnect alarm, and then resume them once the alarm is resolved.
During Volume Targeted ventilation, the delivered pressure is limited to 5 cmH2O below the High Pressure alarm setting,
or 50 cmH2O (whichever is less).
  NOTE: In some cases, the High Pressure limit may prevent VOCSN from delivering the entirety of the set Tidal Volume
  to the patient. Ventec Life Systems recommends using the Low Minute Volume alarm as a way to detect this condition.
  NOTE: The Pres. Minimum setting may cause VOCSN to deliver more volume than intended by the Tidal Volume
  setting. Ventec Life Systems recommends using the High Minute Volume alarm to detect this condition.
         First breath                To deliver the target volume,      Pressure stabilizes   To maintain the target volume as patient
       delivered at set            pressure changes each breath at     at the target volume    compliance shifts, pressure changes at
      Min. Insp. Pressure          Pressure Adjustment rate setting:                          Pressure Adjustment rate (but will not fall
                                  Slow (1 cmH2O) or Fast (3 cmH2O)                               below Min. Insp. Pressure setting)
Min. Insp.
 Pressure
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                                                                                         Breath Types and Therapy Modes
Both spontaneous and mandatory breaths are delivered and adjusted on a breath-to-breath basis to achieve and
maintain the target Tidal Volume. When a breath cycles, VOCSN will deliver the set PEEP.
Breath Period
   PEEP
                    Mandatory                Spontaneous Spontaneous                             Mandatory      Spontaneous
        0
                 Spontaneous             Spontaneous                    Spontaneous Spontaneous                 Spontaneous
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                                                                                  Breath Types and Therapy Modes
Both mandatory and assist breaths are delivered and adjusted on a breath-to-breath basis to achieve and maintain the
target Tidal Volume. When a breath cycles, the pressure of the Ventec One-Circuit drops to the set PEEP.
   PEEP
                 Mandatory                      Mandatory        Assist                              Mandatory
Assist breaths are delivered and adjusted on a breath-to-breath basis to achieve and maintain the target Tidal Volume
over the set Inspiratory Time. When a breath cycles, the pressure of the mouthpiece patient circuit drops to zero
(ambient).
        0
                 Assist                          Assist               Assist                                 Assist
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                                                                                 Breath Types and Therapy Modes
If patient effort is not detected during a breath period, VOCSN will provide a mandatory pressure breath at the
beginning of the next breath period.
Both mandatory and assist breaths are delivered and adjusted to achieve the set Tidal Volume, over the set Inspiratory
Time. Spontaneous breaths are delivered at the set Pressure Support (above PEEP), and cycle with patient effort. When a
breath cycles, the pressure of the Ventec One-Circuit drops to the set PEEP.
PEEP
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                                                                             Breath Types and Therapy Modes
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                                                                          Breath Types and Therapy Modes
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                                                                               Breath Types and Therapy Modes
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                                                                                                    The Touchscreen
The Touchscreen
Use the VOCSN touchscreen to configure and operate the device, as well as monitor the patient. This chapter provides
an overview of the information and controls available on each of the four main tabbed navigation screens.
 NOTE: If VOCSN controls become difficult to select, use the Calibrate Touchscreen control to recalibrate the
 touchscreen sensor. See “Available Device Settings” on page 101.
To unlock the touchscreen, press and hold the lock screen icon in the
status bar for 3 seconds again.
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                                                                                                                      The Touchscreen
No Alarms V O SIMV-VOL
0 L 5 10 15 20 H 25 30
PRESSURE (cmH20)
9 10 11 12
The status bar remains at the top of the screen during VOCSN use. The status bar includes the following indicators:
             Description
      1      Alarm indicator. If an alarm condition occurs, the name of the alarm will display, along with a visual (color) indicator of
             alarm severity. Press the alarm indicator at any time to access the VOCSN Alarm and Event Logs. See “The Alarm Log”
             on page 112 and “The Event Log” on page 114 for more information.
2 Therapy indicator. The active therapy (Ventilation, Oxygen, Cough, Suction, and/or Nebulizer) will appear as an icon.
      3      Ventilation Mode indicator. The active Ventilation Mode control setting displays as an abbreviation. See “VOCSN
             Ventilation Modes” on page 54 for a description of each available mode.
      4      Clinician Unlock indicator. When VOCSN is in Clinician Unlock mode, an unlocked padlock appears on the top of the
             touchscreen. While VOCSN is locked, a locked padlock is displayed.
      5      Screen Lock button. Press and hold the icon for 3 seconds to lock or unlock the VOCSN touchscreen. When locked, an
             orange “X” will appear in the icon, and the screen will be protected from accidental button presses.
      6      External power indicator. A plug icon will appear and remain on the top of the screen when VOCSN is connected to
             external power.
      7      Removable battery indicators. Two battery icons indicate the charging status and remaining battery power of each of
             the two removable batteries. The icon on the left indicates the status of the battery installed in the left battery well.
             The icon on the right indicates the status of the battery installed in the right battery well. See “Glossary of Indicators”
             on page 174 for more information.
      8      Internal battery indicator. A battery icon indicates the charging status and remaining battery power of the internal
             battery. If the icon fill is below 50% (turns yellow) or below 33% (turns red), find an external source of power
             immediately. See “Glossary of Indicators” on page 174 for more information.
9 Patient triggered indicator. This icon will appear if the current breath is triggered by patient effort to breathe.
10 Low Pressure alarm indicator. This icon marks the set Low Pressure alarm limit.
      11     Pressure monitor. This pressure manometer will increase (to the right) and decrease (to the left) as breaths are delivered
             to the patient. The dark blue bar represents the pressure delivered during the current breath. The light blue bar
             represents the peak pressure delivered during the previous breath.
12 High Pressure alarm indicator. This icon marks the set High Pressure alarm limit.
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                                                                                                   The Touchscreen
The three monitors configured to display on the top row of the Monitors tab will appear on the Home screen.
No Alarms V O SIMV-VOL
0 L 5 10 15 20 H 25 30
PRESSURE (cmH20)
NIGHT MODE
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                                                                                                                             The Touchscreen
0 L 5 10 15 20 H 25 30
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                                                                                                                                        The Touchscreen
To aid clinicians charting activities, an additional page of control settings is visible from the Monitors screen. Press
the down arrow at the bottom of the Monitors screen to view currently active Ventilation and Oxygen therapy control
settings The controls listed on this page are configurable using the CUSTOMIZATION button.
0 L 5 10 15 20 H 25 30 0 L 5 10 15 20 H 25 30
MAP I:E RATIO LEAK PRESSURE SUPPORT INSPIRATORY TIME LEAK COMPENSATION
CONTROL SETTINGS
The three monitors configured to display on the top row of the Monitors tab will appear on the
Home screen. See “Monitor Screen Customization” on page 120 for detailed instructions.                                                 CUSTOMIZATION
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                                                                                                           The Touchscreen
No Alarms V O SIMV-VOL
0 L 5 10 15 20 H 25 30
PRESSURE (cmH20)
                                                   O C
                                                                                    RX               i
                                                   C C
                                                   COUGH   COUGH
                                                   S N
                                                     N     NEBULIZE
 NOTE: If Ventilation therapy is critical to patient care, provide the patient with backup                 PRE-USE TEST
 ventilation prior to initiating the Pre-Use Test.
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                                                                                                      The Touchscreen
See “The Alarm Log” on page 112 and “The Event Log” on page 114 for more information.
                                                                                                            LOGS
Each VOCSN has a unique Clinician Access passcode. The passcode is the last four digits of the
device serial number. This number is printed on the VOCSN back label. It is also visible from the Service section of the
MY VOCSN screen.
When VOCSN is unlocked, pressing the unlocked padlock button will lock the device again. VOCSN will also
automatically lock again after 15 minutes, regardless of user interaction with the device.
 NOTE: Only controls set to “User and Clinician” in the Permissions screen will remain configurable when VOCSN is
 locked.
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                                                                                                 The Touchscreen
                                                                                                    S N
                                                                                                      N     NEBULIZE
VOCSN therapies are not configurable or usable (and will appear grayed out on the
Therapy tab) unless enabled here. This feature allows clinicians to enable a suite of
therapies appropriate for the patient condition, and disable any unnecessary therapies.
                                                                                            ENABLE PRESCRIBED
                                                                                               THERAPIES
See “Enabling and Disabling Prescribed Therapies” on page 88 for more information.
 NOTE: The Enable Prescribed Therapies menu button is only available when VOCSN is in Clinician Access mode. See
 “Entering the Clinician Access Passcode” on page 98 for instructions.
 NOTE: The Permissions menu button is only available when VOCSN is in Clinician Access mode.     PERMISSIONS
 See “Entering the Clinician Access Passcode” on page 98 for instructions.
                                                                                                               i
configuration, serial number, and installed software version.
MY VOCSN
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                                                                                               Controls and Settings
VOCSN controls are used to configure how the device behaves and delivers therapy. This chapter describes each of the
VOCSN controls, lists the available settings, and provides configuration instructions.
After configuring a control, press ACCEPT to confirm and activate your selection. While modifying Ventilation and Cough
settings, controls will operate normally at the last confirmed setting until you press the ACCEPT button to confirm the
change.
 WARNING: To ensure patient safety, check the Ventec One-Circuit and verify that all system settings and Presets are
 appropriate before providing therapy, and on a routine basis during therapy.
 NOTE: If the VOCSN Permissions are configured for Clinician Only access to controls, those controls will be unavailable
 until entry of the Clinician Access password. See “Clinician Access Mode” on page 98 for more information.
The sections that follow provide configuration instructions, and list the adjustable control settings available on VOCSN.
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                                                                                                                                    Controls and Settings
Changing Ventilation
                                                                                                                START
                                                                                                              ACTIVE NOW
   1	   Press the Therapy tab under the status bar, and then press the VENTILATION therapy
        button.
   2	   Press the SETTINGS & ALARMS button on the right side of the screen. The Ventilation
        therapy Preset configuration screen will appear. To modify any of the three Ventilation
        therapy Presets, select the relevant Preset name from the tabs at the top of the                                                         SETTINGS
        configuration screen.                                                                                                                    & ALARMS
 NOTE: To enable a disabled Ventilation therapy Preset, press the Preset name, and then the
 [Preset Name] Enable control. Press EDIT >, and then select Enabled, and press ACCEPT.
   3	   Scroll through the list of available Ventilation controls, and press the name of the control requiring configuration.
        Press the EDIT > button on the right side of the screen.
4 Enter the new control setting using the numeric keypad, the slider bar, or the +/- buttons.
6 Follow the procedure above to modify additional controls. When configuration is complete, press the < EXIT tab.
 NOTE: To configure VOCSN alarms, scroll past the ventilation controls until you see the ALARMS banner. Alarm controls
 are listed below the banner. See “Changing Alarm Settings” on page 104 for configuration instructions.
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                                                                                                    Controls and Settings
 NOTE: Controls that cannot be edited will appear in gray. Controls may be locked because of the Permissions and
 Clinician Unlock feature. In addition, the Mode and Circuit Type controls will appear in gray and cannot be edited while
 the selected Ventilation Preset is running. These three controls can only be modified in an inactive Preset.
NOTE: The resolution of each control with numerical settings is 1, unless otherwise stated in the control description.
 Ventilator
                 Settings                    Description
 Control
 Apnea Rate      4 to 60 BPM Backup          The Apnea Rate control sets the breath rate at which mandatory breaths will be
                 12 BPM Backup               delivered to the patient while the Apnea alarm is activated.
                                                NOTE: The Apnea Rate control is not available when Circuit Type is set to
                                                Mouthpiece.
 Breath Rate     0 to 60 BPM                 The Breath Rate control configures the minimum number of breaths per minute
                                             (BPM) delivered to the patient.
                 12 BPM
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                                                                                                       Controls and Settings
 Ventilator
                Settings                      Description
 Control
 Circuit Type   Active,                       Set the Circuit Type control to correspond with the type of patient circuit used
                Active with O2,               during Ventilation therapy.
                Passive,
                Passive with O2,                NOTE: The Circuit Type control cannot be modified for the running Ventilation
                Mouthpiece,                     therapy Preset. To modify the Circuit Type control, select an inactive ventilation
                Valveless
                                                Preset, set the Circuit Type control (and all other relevant controls) as desired,
                                                and then activate the Preset.
                                                NOTE: Circuit Type settings that include an O2 tube are available only with
                                                VOCSN configurations that include an internal O2 Concentrator.
 EPAP           Active circuit: 0 to 25       Expiratory Positive Airway Pressure. The set EPAP will determine the pressure
                cmH2O                         maintained between breaths and during the expiratory phase of breaths when the
                Passive circuit: 4 to 25      Ventilation Mode is set to Bi‑Level.
                cmH2O
                5 cmH2O
 Flow           15 to 60 L/min when the       During High Flow therapy, the Flow control is used to set the rate of gas flow in
                Patient Type control is set   L/min through a high flow nasal cannula or other interface.
                to Adult
                30 L/min                        NOTE: The Flow control is only available when the High Flow control is set to
                                                On.
                4 to 25 L/min when the
                Patient Type control is set
                to Pediatric
                                                PRECAUTION: VOCSN Nebulizer therapy is not recommended during High
                                                Flow therapy for pediatric patients receiving <15 L/min. At Flow settings of
                                                <15 L/min, the accuracy of the delivered flow may be affected by Nebulizer
                                                therapy. While not recommended, Flow settings of 4 or 5 L/min will display as
                                                6 L/min during Nebulizer therapy (and may not accurately represent the actual
                                                flow delivered) because of added flow through the nebulizer.
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                                                                                                        Controls and Settings
 Ventilator
                   Settings                     Description
 Control
 Flow Cycle        10 to 90%                    Spontaneous breaths will cycle at the set Flow Cycle percentage of peak
                   25%                          inspiratory flow. Setting the Flow Cycle control to 90% will result in a shorter
                                                inspiratory time; setting the Flow Cycle control to 10% will result in a longer one.
                                                When PC Flow Termination is set to On, mandatory and assist pressure breaths
                                                will cycle at the set Inspiratory Time or the set Flow Cycle percentage of the peak
                                                inspiratory flow, whichever comes first.
 Flow Trigger      Active or Passive circuit:   The set Flow Trigger will determine the flow differential necessary to initiate
                   0.5 to 9.0 L/min, Off        patient-triggered assist and spontaneous breaths.
                   Mouthpiece circuit:
                   0.5 to 3.0 L/min               NOTE: The Flow Trigger control is adjustable in increments of 0.5.
2.0 L/min
 High Flow         On, Off                      High Flow therapy provides a continuous flow of gas through a high flow nasal
 (available                                     cannula or other interface. Set this control to On to access the Flow control.
 on English                                     The High Flow control is available on Leak+ compatible devices when the Mode
 configurations                                 control is set to SIMV-Pressure, SIMV-Volume, or Vol. Targeted-SIMV. Like the
 with Leak+                                     CPAP function in SIMV modes, during High Flow therapy there is no set Breath
 compatible                                     Rate and all breaths are spontaneous.
 hardware,
 and Japanese                                     NOTE: Cough therapy and Oxygen Direct (Pulse Dose) therapy are disabled
 configurations)
                                                  during High Flow therapy.
                                                  NOTE: For more information about the availability of the VOCSN Leak+ feature
                                                  (including High Flow therapy), see “Leak+ Performance” on page 13.
 High              None, 1 Breath, 2 Breaths    High Inspiratory Pressure Alarm Delay. When enabled (1 Breath or 2 Breaths), the
 Pressure                                       auditory and visual indicators for the High Pressure alarm will not activate until
 Delay                                          after the set number of consecutive breaths have exceeded the High Pressure
                                                alarm setting.
                                                  NOTE: The H indicator in the status bar will flash red, and VOCSN will limit the
                                                  pressure of the Ventec One-Circuit every time the High Pressure alarm setting is
                                                  exceeded, regardless of the High Pressure Delay setting.
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                                                                                                  Controls and Settings
 Ventilator
               Settings                 Description
 Control
 Humidifica-   Humidifier, HME          Set the Humidification control to correspond to the type of humidification used
 tion                                   during Ventilation therapy.
                                          NOTE: Based on the set Patient Type and Humidification Type, VOCSN
                                          automatically adjusts delivered therapy to compensate for differences in the
                                          compliance and volume of the Ventec One-Circuit.
                                          NOTE: When used with active, passive , and valveless Ventec One-Circuits,
                                          VOCSN was designed for use with a humidifier or HME. If used with neither, set
                                          the Humidification control to HME.
 Inspiratory   0.3 to 5.0 seconds       The Inspiratory Time control configures the duration over which the set pressure or
 Time          1.0 second               volume is delivered to the patient during the inspiratory phase of each mandatory
                                        or assist breath.
 IPAP          4 to 40 cmH2O above      Inspiratory Positive Airway Pressure. The set IPAP will determine the pressure
               ambient                  delivered during the inspiratory phase of mandatory and spontaneous breaths
               10 cmH2O above ambient   when the Ventilation Mode is set to Bi‑Level or Spontaneous.
 Leak Com-     Off, On                  The Leak Compensation control is available for active circuits. When set to On, the
 pensation                              Leak Compensation algorithm runs continuously in the background to calculate
                                        and compensate VOCSN triggering, monitors, and waveforms for leaks in an
                                        active Ventec One-Circuit.
                                          NOTE: The Leak Compensation control is always On when the Circuit Type
                                          control is set to Passive or Valveless. It is always Off when the Circuit Type
                                          control is set to Mouthpiece.
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                                                                                                        Controls and Settings
 Ventilator
                Settings                        Description
 Control
 Mode           Bi-Level,                       The set ventilation Mode determines how breaths are delivered to the patient. See
                Spontaneous,                    “Breath Types and Therapy Modes” on page 51 for a description of how breaths
                Assist/Control-Pressure,        are delivered in each available mode.
                SIMV-Pressure,
                Assist/Control-Volume,            NOTE: The Mode control cannot be modified for the active Ventilation therapy
                SIMV-Volume                       Preset. To modify the Mode control, select an inactive ventilation Preset, set the
                Vol. Targeted-PS
                Vol. Targeted-PC                  Mode control (and all other relevant controls) as desired, and then activate the
                Vol. Targeted-SIMV                Preset.
 Patient Type   Adult, Pediatric                Set the Patient Type control to correspond to the type of Ventec One-Circuit (adult
                                                or pediatric) used during Ventilation therapy.
                                                  NOTE: Based on the set Patient Type and Humidification Type, VOCSN
                                                  automatically adjusts delivered therapy to compensate for differences in the
                                                  compliance and volume of the Ventec One-Circuit.
                                                  NOTE: Because of the circuit diameter, set the Patient Type control to Pediatric
                                                  whenever the Circuit Type control is set to Mouthpiece.
 PC Flow        Off, On                         Pressure Control Flow Termination. When the PC Flow Termination Control is
 Termination                                    set to On, mandatory and assist pressure breaths will cycle if the set Flow Cycle
                                                percentage of the peak inspiratory flow is reached, if the set Inspiratory Time has
                                                not yet elapsed.
 PEEP           Active circuit:                 Positive End-Expiratory Pressure. The set PEEP will determine the pressure
                0 to 25 cmH2O                   maintained between breaths and during the expiratory phase of breaths.
                Passive or Valveless circuit:
                4 to 25 cmH2O                     NOTE: When the Circuit Type control is set to Mouthpiece, the PEEP control is
                                                  disabled.
                5 cmH2O
 Preset         Disabled, Enabled               The Preset [1, 2, or 3] Enable control enables or disables the configuration and use
 [1, 2, 3]      Preset 1: Enabled               of any of the three configurable Ventilation therapy Presets.
 Enable
                Preset 2 and 3: Disabled
 Preset         Preset 1, Preset 2,             Use the [Preset Name] Label control to rename any of the three configurable
 [1, 2, 3]      Preset 3                        Ventilation therapy Presets. Each Preset can be renamed using up to 10
 Label                                          alphanumeric characters.
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                                                                                              Controls and Settings
 Ventilator
              Settings               Description
 Control
 Pres. Adj.   Slow, Fast             In Volume Targeted ventilation modes, the Pres. Adj. Rate control determines the
 Rate                                rate of pressure adjustments made to achieve the set Tidal Volume. Setting the
                                     Pres. Adj. Rate control to Slow will increment breaths by up to ±1 cmH2O per
                                     breath. The fast setting will increment breaths by up to ±3 cmH2O per breath. For
                                     more information, see “Volume Targeted Ventilation Overview” on page 59.
 Pres.        1 to [40-PEEP] cmH2O   In Volume Targeted ventilation modes, the Pres. Minimum setting determines
 Minimum      5 cmH2O                the minimum pressure of all Volume Targeted breaths. For more information, see
                                     “Volume Targeted Ventilation Overview” on page 59.
                                       NOTE: The Pres. Minimum setting may cause VOCSN to deliver more volume
                                       than intended by the Tidal Volume setting. Ventec Life Systems recommends
                                       using the High Minute Volume alarm to detect this condition.
 Pressure     1 to [50-PEEP] cmH2O   The set Pressure Control will determine the pressure above PEEP delivered during
 Control      above PEEP             mandatory and assist breaths when the Ventilation Mode is set to Assist/Control-
              10 cmH2O above PEEP    Pressure or SIMV‑Pressure.
 Pressure     0 to [40-PEEP] cmH2O   The set Pressure Support will determine the pressure above PEEP delivered during
 Support      above PEEP             the inspiratory phase of spontaneous breaths during SIMV ventilation modes.
              10 cmH2O above PEEP
 Rise Time    1 to 6                 The Rise Time setting adjusts the speed of pressure elevation for pressure breaths.
                                     Lower settings (such as 1) raise the pressure quickly. Higher settings (such as 6) will
              4
                                     slow the rate of pressure elevation.
                                     A high Rise Time setting in conjunction with a low Inspiratory Time setting may
                                     result in a lower peak inspiratory setting than expected. Adjust the Rise Time
                                     control as needed to both maximize patient comfort, and ensure that the target
                                     peak inspiratory pressure is reached.
 Sigh         Off, On                When the Sigh control is set to On, a volume mandatory or assist breath is
                                     delivered at 150% the set Tidal Volume every 100th mandatory or assist breath.
                                       NOTE: The Sigh control is only available in volume Ventilation Modes (Assist/
                                       Control-Volume and SIMV-Volume).
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                                                                                            Controls and Settings
 Ventilator
                Settings             Description
 Control
 Tidal Volume   50 to 1500 mL        The Tidal Volume control adjusts the volume delivered to the patient during
                500 mL               the inspiratory phase of volume breaths, or of pressure breaths when in Volume
                                     Targeted ventilation modes.
                                       NOTE: When delivering a Tidal Volume between 250 and 300 mL, an adult
                                       or pediatric Ventec One-Circuit may be used. Tidal Volumes ≥250 mL are
                                       typically appropriate for an adult Ventec One-Circuit. Tidal Volumes ≤300 are
                                       typically appropriate for a pediatric Ventec One-Circuit. Follow your healthcare
                                       institution’s protocol for Ventec One-Circuit use and Tidal Volume delivery.
                                       NOTE: PEEP settings of 3 cmH2O or less may reduce the accuracy of Tidal
                                       Volumes of 50 to 70 mL. For the best VOCSN performance, set PEEP to 4
                                       cmH2O or greater when the set Tidal Volume is 50 to 70 mL.
 Time Cycle     0.3 to 3.0 seconds   Spontaneous breaths will cycle if the set Time Cycle has elapsed without the set
                1.5 seconds          Flow Cycle causing a breath to cycle.
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                                                                                                       Controls and Settings
Control Limiting
VOCSN restricts the availability of some control settings when the set value of another interdependent control creates
a limit. For example, available PEEP and Pressure Control settings are interdependent and control limited. If the PEEP
control is set to 25 cmH2O, the available Pressure Control settings are automatically limited to 25 cmH2O or less to
prevent VOCSN from delivering a total maximum pressure exceeding 50 cmH2O.
If a limit is reached during control configuration, VOCSN will display a message on the configuration screen, indicating
which interdependent control is limiting available settings. To adjust the setting of a control beyond its control limit, the
interdependent control setting must be changed first.
The table below lists controls that are interdependent and control-limited, and describes the reason for the limit
 Breath Rate (including Apnea   The maximum inspiratory time will not exceed 0.5, multiplied by 60, divided by the set Breath Rate
 Rate) and Inspiratory Time     (or Apnea Rate). This is to prevent inverse I:E ratios.
 EPAP and IPAP                  The set IPAP is greater than the set EPAP, and the total delivered pressure will not exceed
                                40 cmH2O.
FiO2 and Pulse Dose Only one oxygen delivery method is used at a time.
 High Pressure alarm and        The High Pressure alarm is not set less than 3 cmH2O above the set Pressure Control or Pressure
 Pressure Control or Pressure   Support.
 Support
 Mode and Circuit Type          Controls are configured at intended settings before beginning therapy.
 controls for the active
 Ventilation Preset
PEEP and Pressure Support The total delivered pressure will not exceed 40 cmH2O.
PEEP and Pressure Control The total delivered pressure will not exceed 50 cmH2O.
 Pres. Minimum, PEEP, and       To ensure the minimum pressure of breaths is less than the maximum pressure of breaths during
 High Pressure alarm            Volume Targeted ventilation.
 Tidal Volume and Inspiratory   Volume breaths will not deliver a flow greater than 120 L/min, or less than 10 L/min.
 Time
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                                                                                                                                                   Controls and Settings
NOTE: Controls available regardless of the set Ventilation Mode are not listed in the following table.
                                                Assist/                        Assist/
                                                Control-       SIMV-           Control-       SIMV-            Vol, Targeted- Vol-Targeted-       Vol. Targeted-
Control            Bi-Level       Spontaneous   Pressure       Pressure        Volume         Volume           PS             PC                  SIMV             High Flow
                    Yes, when
                      Circuit
                    Type is set
 Apnea Rate                           No                                  Yes, when Circuit Type is set to Active, Passive, or Valveless                               No
                    to Active,
                    Passive, or
                     Valveless
EPAP Yes No No No No No No No No No
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                                                                                                                                               Controls and Settings
                                           Assist/                         Assist/
                                           Control-        SIMV-           Control-       SIMV-             Vol, Targeted- Vol-Targeted-      Vol. Targeted-
Control          Bi-Level   Spontaneous    Pressure        Pressure        Volume         Volume            PS             PC                 SIMV              High Flow
                                                                                                                                                                Yes, if device
 High                                                      Yes,if device                   Yes, if device                                      Yes, if device     has Leak+
                     No         No              No          has Leak+          No           has Leak+            No                No           has Leak+        hardware, or
 Flow
                                                            hardware                         hardware                                            hardware       is a Japanese
                                                                                                                                                                configuration
 Inspiratory
                     Yes        No              Yes             Yes            Yes              Yes              Yes               Yes              Yes              No
 Time
 PC Flow
                     No         No              Yes             Yes            No               No               No                Yes              Yes              No
 Termination
 Pres. Adj.
                     No         No              No              No             No               No               Yes               Yes              Yes              No
 Rate
 Pres.
                     No         No              No              No             No               No               Yes               Yes              Yes              No
 Minimum
 Pressure
                     No         No              Yes             Yes            No               No               No                No               No               No
 Control
 Pressure
                     No         No              No              Yes            No               Yes              No                No               Yes              No
 Support
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                                                                                                                     Controls and Settings
                                          Assist/               Assist/
                                          Control-   SIMV-      Control-   SIMV-     Vol, Targeted- Vol-Targeted-   Vol. Targeted-
Control          Bi-Level   Spontaneous   Pressure   Pressure   Volume     Volume    PS             PC              SIMV             High Flow
 Rise
                     Yes        Yes           Yes        Yes        No         Yes        Yes            Yes             Yes             No
 Time
 Tidal
                     No         No            No         No         Yes        Yes        Yes            Yes             Yes             No
 Volume
 Time
                     Yes        Yes           No         Yes        No         Yes        Yes            No              Yes             No
 Cycle
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                                                                                                Controls and Settings
 NOTE: Because of the circuit size, set the Patient Type control to Pediatric during mouthpiece ventilation, even when
 VOCSN is used with an adult patient. For more information on mouthpiece circuit configuration, see “Mouthpiece
 Patient Circuit Setup” on page 40.
Setting the Circuit Type control to Mouthpiece will limit the available VOCSN ventilation modes, controls, monitors, and
alarms as follows:
  •	 The ventilation Mode control is limited to Spontaneous, Assist/Control-Pressure, and Assist/Control Volume.
     In Assist/Control ventilation modes, only assist breaths will be provided to the patient.
• The Breath Rate, Apnea Rate, PEEP, and Leak Compensation controls are unavailable.
• The Patient Circuit Disconnect, Low Minute Volume, and High Minute Volume alarms are unavailable.
• The Exhaled Tidal Volume, Minute Volume, and Leak monitors are unavailable.
• The Humidification control is unavailable, because humidification is not used with mouthpiece patient circuits.
 NOTE: In some cases, setting the High Pressure or Apnea alarm and using the Breath Rate monitor may help ensure
 patient safety.
 NOTE: For more information on using High Flow therapy with a nasal cannula, see “Using a Nasal Cannula” on page
 26.
The High Flow control is available in SIMV ventilation modes. Setting the High Flow control to On will limit the available
VOCSN controls, so that only the Flow control is configurable, and only the Flow monitor displays a value. In addition,
the available Ventilation therapy alarms will be limited to Patient Circuit Disconnect.
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                                                                                               Controls and Settings
 NOTE: VOCSN is customizable and may be purchased in various configurations of the five available integrated
 therapies. Your device may include the option to enable all five therapies, or just the therapies purchased or prescribed
 by the treating physician.
   1	
                                                                                                           COUGH   COUGH
7 Follow the procedure above to modify additional controls. When configuration is complete, press the < EXIT tab.
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                                                                                                    Controls and Settings
The following controls and settings are available from the ENABLE PRESCRIBED THERAPIES Menu button.
 Cough                 Disabled,          The Cough option enables or disables the configuration and use of Touch Button
                       Enabled            Cough therapy.
 Nebulizer             Disabled,          The Nebulizer option enables or disables the configuration and use of Nebulizer
                       Enabled            therapy.
 O2 Concentrator       Disabled,          The O2 Concentrator option enables or disables the configuration and use of the
                       Enabled            VOCSN internal O2 Concentrator.
 Suction               Disabled,          The Suction option enables or disables the configuration and use of Suction therapy.
                       Enabled
 FiO2 Monitor          Disabled,          The FiO2 Monitor option enables or disables the use of VOCSN internal FiO2 monitor.
                       Enabled
                                            NOTE: The FiO2 monitor is active only when the Oxygen Delivery Mode control is
                                            set to FiO2. See “Oxygen Controls” on page 90 for more information.
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                                                                                                                                                       Controls and Settings
Oxygen Controls
VOCSN can be configured to provide Oxygen therapy in either Pulse Dose or FiO2 mode. Oxygen may be delivered
from the internal O2 Concentrator (using Pulse Dose mode only), or an external source of high-pressure oxygen. Oxygen
may also be provided using the VOCSN low-pressure oxygen port. See “Oxygen Therapy Setup” on page 41 for
oxygen source setup instructions.
                                                  No Alarms                                        V     O SIMV-VOL
To change oxygen controls for any of the three Oxygen therapy Presets:
   2	   Select the Preset you want to modify, and then press the SETTINGS & ALARMS button on the right side of the
        screen. The Oxygen therapy Preset configuration screen will appear. You may select and configure any of the
        three Oxygen therapy Presets.
        NOTE: To enable a disabled Oxygen therapy Preset, press the applicable Preset tab at the top of the settings
        screen, and then the [Preset Name] Enable control. Press EDIT >, and then select Enabled, and press ACCEPT.
3 Select any of the available Oxygen controls. Press the EDIT > button on the right side of the screen.
   4	   Enter the new control setting by selecting it from the list, using the numeric keypad, the slider bar, or the +/-
        buttons.
6 Follow the procedure above to modify additional controls. When configuration is complete, press the < EXIT tab.
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                                                                                                    Controls and Settings
 NOTE: The O2 FLUSH button may be used during Oxygen therapy to deliver either 100% FiO2, or 6 L/min O2 Flow
 Equivalent (depending on the selected O2 Delivery Mode) for 3 minutes.
 Preset              Disabled, Enabled           The Preset [1, 2, or 3] Enable control enables or disables the configuration
 [1, 2, 3] Enable                                and use of any of or all of the three configurable Oxygen therapy Presets.
 Preset              [up to 10 alphanumeric      Use the Preset [1, 2, or 3] Label control to rename any of the three
 [1, 2, 3] Label     characters]                 configurable Oxygen Presets. Each Preset can be renamed using up to 10
                                                 alphanumeric characters.
 Oxygen Source       Internal O2 Concentrator,   The Oxygen Source control can be configured to provide oxygen to the
                     External High-Pressure,     patient from one of three sources.
                     Low Pressure O2             The internal O2 Concentrator is used to provide Pulse Dose Oxygen therapy
                                                 only. If the Oxygen Source control is set to Internal O2 Concentrator, the
                                                 Oxygen Delivery Mode control will be set to Pulse Dose.
                                                 When the Oxygen Source control is set to External High Pressure, the Oxygen
                                                 Delivery Mode control may be set to either FiO2 or Pulse Dose.
                                                 The Low Pressure O2 setting is designed to be used when a low‑pressure
                                                 source of external oxygen is connected to VOCSN and is used as the sole
                                                 source of oxygen delivered to the patient.
 Oxygen              FiO2, Pulse Dose,           FiO2 Oxygen therapy is delivered as a continuous stream through the Ventec
 Delivery Mode       O2 Bleed In                 One-Circuit connection port from an external high-pressure oxygen source.
                                                 Pulse dose Oxygen Direct therapy is delivered through a small, integrated O2
                                                 tube in the Ventec One-Circuit, connected to the O2 port on the right side of
                                                 VOCSN.
                                                 See the descriptions of the FiO2 and O2 Flow Equivalent oxygen controls in
                                                 this table for more information.
                                                 The O2 Bleed In setting is automatically displayed when Oxygen Source is set
                                                 to Low Pressure O2 (see above).
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                                                                                             Controls and Settings
 FiO2             21 to 100%              Fraction of Inspired Oxygen. The FiO2 control adjusts the percentage of
 (continuous)                             oxygen delivered continuously through the Ventec One-Circuit during
                                          ventilation.
                                            NOTE: Whenever the FiO2 control is set above 21%, use the FiO2 monitor
                                            and set the High FiO2 and Low FiO2 alarms appropriately for the patient
                                            condition.
 O2 Flow          Off, 0.5 to 6.0 L/min   Use the O2 Flow Equivalent control to deliver pulse dose Oxygen Direct
 Equivalent                               therapy through a Ventec One-Circuit O2 tube. Set the O2 Flow Equivalent
 (pulse dose)                             control as if using an oxygen concentrator to add a continuous stream of
                                          oxygen into a patient circuit. Based on the O2 Flow Equivalent setting,
                                          VOCSN will calculate and produce pulse doses of oxygen that mimic the
                                          oxygenation resulting from a continuous stream of oxygen in L/min STPD.
                                          For additional technical information about oxygen delivery using the O2 Flow
                                          Equivalent control, see “The Oxygen Direct System” on page 214.
                                           WARNING: The O2 Flow Equivalent control setting may not result in a flow
                                           that corresponds exactly to bleeding a continuous flow of oxygen into a
                                           ventilator. Set the O2 Flow Equivalent control appropriately for the patient
                                           condition and verify adequate oxygenation to ensure patient safety.
                                            NOTE: A Calculated FiO2 monitor will display while using or the O2 Flow
                                            Equivalent control. This calculation is based on the current ventilation and
                                            oxygen settings. See “Calculated FiO2 Monitor” on page 122 for more
                                            information.
                                            NOTE: While the O2 Flow Equivalent control is enabled, the FiO2 control,
                                            monitor, and alarms will be disabled.
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                                                                                                                            Controls and Settings
the SETTINGS button on the Cough                                      Prepare patient circuit for Cough therapy,
                                                                      select preset, and press START to begin.
screen.
                                                                                                                                           Press here to
                                                                     LOW              MEDIUM                HIGH
                                                                                                                                              change
                                                                  -30 / +30          -35 / +35          -40 / +40
                                                EXIT                cmH2O              cmH2O                cmH2O          SETTINGS          controls
Changing Cough
                                                                  Cough+Suction
                                                                                                           START
                                                                                                        STOP THERAPY
Therapy Settings
                                        Press here to                       This preset has                            To start Cough therapy,
To change Cough therapy Preset                                             Cough + Suction                             select a preset and then
                                          EXIT this
settings:                                                                      enabled                                       press START
                                           screen
  1	   Press the Therapy tab, and then press the COUGH therapy button.
  2	   Press the SETTINGS button on the right side of the screen, and then press one of the three Preset tabs for the
       Cough therapy Preset requiring configuration
 NOTE: To enable a disabled Cough therapy Preset, press the applicable Preset tab at the top of the settings screen, and
 then the [Preset Name] Enable control. Press EDIT >, and then select Enabled, and press ACCEPT.
  7	   Press another Cough therapy control or Preset tab to change additional settings, following the procedure above,
       or press the < EXIT tab near the top of the screen when configuration is complete.
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                                                                                                     Controls and Settings
NOTE: The resolution of each control with numerical settings is 1, unless otherwise stated in the description.
 Cough
 Control             Settings              Description
 Breath Sync         Off, On               When the Breath Sync control is set to On, VOCSN will initiate a cough when patient
                                           effort is detected, regardless of the Pause Time setting.
 Cough Cycles        1 to 10               The Cough Cycles control sets the number of coughs delivered by Touch Button
                                           Cough therapy each time it is activated.
                     3
 Cough+              Off, On               When the Cough+Suction control is set to On, VOCSN will automatically initiate
 Suction                                   Suction therapy during Cough therapy. Suction will begin at the start of the first
                                           Cough therapy insufflation, at the default set Suction setting, and run throughout the
                                           configured number of Cough Cycles plus an additional 2 minutes.
                                           To set the default Suction therapy setting for Cough+Suction, use the Set Default
                                           button on the Suction therapy screen. See “Changing Suction Settings” on page
                                           5-23 for more information.
 Exsufflation        -10 to -70 cmH2O      The Exsufflation Pressure control sets the delivered pressure during the exsufflation
 Pressure            -25 cmH2O             phase of Cough therapy.
                                             NOTE: If no Exsufflation Pressure is desired, you may instead set the Exsufflation
                                             Time to 0.0 seconds, and use the Pause Time setting to control the duration
                                             between cough insufflations.
 Exsufflation        0.0 to 5.0 seconds    The Exsufflation Time control sets the duration over which the set Exsufflation
 Time                1.5 seconds           Pressure is delivered.
 Insufflation        10 to 70              The Insufflation Pressure control sets the delivered pressure during the insufflation
 Pressure            cmH2O                 phase of Cough therapy.
                     25 cmH2O
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                                                                                                    Controls and Settings
 Cough
 Control             Settings             Description
 Insufflation Rise   1 to 6               The Insufflation Rise Time setting adjusts the duration over which VOCSN raises the
 Time                4                    pressure of the Ventec One-Circuit during cough insufflation. Lower settings raise
                                          the pressure quickly. Higher settings will slow the rate of pressure elevation.
 Insufflation Time   0.0 to 5.0 seconds   The Insufflation Time control sets the duration over which the set Insufflation
                     1.5 seconds          Pressure is delivered.
 Pause Time          0.0 to 5.0 seconds   The Pause Time control sets the duration of the pause (at 0 cmH2O) between each
                     1.5 seconds          cough. Pause Time is the period after exsufflation and before the next insufflation.
                                          When the Breath Sync control is set to On, VOCSN will initiate a cough when patient
                                          effort is detected, regardless of the Pause Time setting.
 Preset              Disabled, Enabled    The Preset [1, 2, or 3] Enable control enables or disables the configuration and use
 [1, 2, 3] Enable                         of any of or all of the three configurable Cough therapy Presets.
 Preset              [up to 10            Use the Preset [1, 2, or 3] Label control to rename any of the three configurable
 [1, 2, 3] Label     alphanumeric         Cough Presets. Each Preset can be renamed using up to 10 alphanumeric characters.
                     characters]
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                                                                                                    Controls and Settings
1 Click the Therapy tab, and then press the Suction button.
   2	   Press the plus and minus buttons on the right side of the screen
        to configure the vacuum intensity in mmHg.                                    VACUUM
   3	   To set the default Suction setting (the Vacuum setting when
        entering the Suction therapy screen and running Cough+Suction,
        if enabled), press the SET DEFAULT button when the Vacuum                                              SET
        control is set to the desired level.                                                                 DEFAULT
   4	   Press the EXIT button to return to the Therapy screen.
 Set Default         N/A             Pressing the Set Default button will configure the default Vacuum setting, which will appear
                                     when the Suction therapy screen is accessed, and run when the Cough+Suction feature is
                                     used.
 Vacuum              -95 to -450     The Vacuum control sets the intensity of suction in mmHg.
                     mmHg
                     -180 mmHg          NOTE: The resolution of the Vacuum control is 5 mmHg.
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                                                                                                                                             Controls and Settings
   1	
                                                                           THERAPY                       COMPENSATION
   3	   Before starting therapy, select Internal Neb. Therapy to provide therapy from the VOCSN nebulizer drive, or
        External Neb. Compensation to compensate for the flow from an external nebulizer. See “Starting Nebulizer
        therapy” on page 9-13 for more information. While Nebulizer therapy is running, you may use the plus (+) button
        to add more time if needed.
   4	   Press the EXIT button to return to the main menu. The next time you access the Nebulizer therapy screen, the
        Nebulizer Duration setting will remain at whatever it was last set to.
NOTE: Every 10 minutes, internal Nebulizer therapy will pause for 6 seconds, and then automatically resume.
 Nebulizer           5 to 60             The Nebulizer Duration control sets the duration over which VOCSN drives a connected
 Duration            minutes             nebulizer, or compensates for the flow from an external one.
                     6 minutes           The resolution of the Nebulizer Duration control is 1 minute.
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                                                                                                                  Controls and Settings
When VOCSN is unlocked, all therapies and device settings are configurable. Unlocking
VOCSN using the Clinician Access Passcode also allows access to the Permissions feature,                               CLINICIAN
where each control can be set to allow only clinician access (by first using the passcode), or                          ACCESS
set to allow configuration by all users at all times. See “Configuring Permissions” on page
99 for more information.
Once the Clinician Access Passcode is entered, VOCSN will remain unlocked for 15 minutes. VOCSN will automatically
lock again after 15 minutes, regardless of user interaction with the device. VOCSN can also be locked again at any time
by pressing the Clinician Access button in the Menu tab.
        button.
                                                                                                                        1          2       3
   3	
                                                PRESSURE (cmH20)
        Enter the four-digit Clinician                                        Therapy                   Monitors                   Menu
                                                                                                                                     Menu
                                                       Home
        Access Passcode. The Clinician                                                                                  4          5     6
                                                                       Please enter   passcode
                                                                                    Click OK to enter Clinician
        Access Passcode is the last                                      for clinician access
                                                                                          Access mode.
        four digits of the device serial                                                                                7          8       9
        number. This number is printed
        on the VOCSN back label, and is              PRE-USE TEST             SETTINGS                  DEVICE                     0LOGS
                                                                              & ALARMS                 SETTINGS
        also visible from the MY VOCSN
        screen.
                                                                                                                       CANCEL          i
                                                                                                                                       ACCEPT
 NOTE: When the Unlock Required? device setting is set to Yes, VOCSN will automatically lock after 15 minutes. To lock
 VOCSN manually, press the CLINICIAN ACCESS button on the Menu screen.
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                                                                                               Controls and Settings
Configuring Permissions
The Permissions feature allows clinicians to configure which VOCSN controls are locked (cannot be changed) until the
device is unlocked using the Clinician Access Passcode.
Control permissions set to User and Clinician are configurable at all times; they can be changed by anyone interacting
with VOCSN. When a control permission is set to Clinician Only, the control will remain locked until the Clinician Access
Passcode is entered.
NOTE: Locked control settings will display in the configuration screen in gray.
   1	   If not already unlocked, enter the Clinician Access mode by following the procedure in
        “Entering the Clinician Access Passcode” on page 98.
                                                                                                               RX
   2	   Press the PERMISSIONS button on the Menu screen.                                             PERMISSIONS
   3	   Select the appropriate tab and scroll to the control you want to lock
        or unlock. Slide the toggle to switch between User and Clinician and
                                                                                                 User and Clinician
        Clinician Only access to the selected control.
   4	   When Permissions configuration is complete, press the < EXIT tab                         Clinician Only
        near the top of the screen.
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                                                                                            Controls and Settings
Device Settings
VOCSN device settings are modifiable, and include controls such as Alarm Volume, whether Clinician Access mode is
enabled on the device, and the displayed date and time.
7 Follow the procedure above to modify additional controls. When configuration is complete, press the < EXIT tab.
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                                                                                                     Controls and Settings
 NOTE: If the internal battery depletes fully, VOCSN Date and Time settings will reset to their default values. To ensure
 the Alarm and Event logs record information accurately, verify the VOCSN Date and Time settings before use, and set
 them to the correct values if necessary.
The Alarm Volume control sets the loudness of auditory alarm indicators.
                   Low, Medium,        WARNING: Set the Alarm Volume loud enough to be heard over expected ambient noise
 Alarm Volume
                   High
                                       (such as a vacuum cleaner). Failure to hear and respond to an alarm condition may result in
                                       patient harm or death.
                                     Use the Calibrate Touchscreen control to recalibrate the VOCSN touchscreen. Perform a
 Calibrate                           touchscreen recalibration if VOCSN controls become difficult to select. After confirming the
                   N/A
 Touchscreen                         touchscreen recalibration and turning off the device, you will be asked to touch several areas
                                     on the screen when VOCSN restarts.
                                     Set the Unlock Required? control to Yes to require the use of a configuration password to
                                     access VOCSN controls. Using the Permissions feature, you can configure which controls
                                     cannot be modified without first entering the Clinician Unlock password. See “Clinician
                                     Access Mode” on page 98 for more information.
 Unlock            No, Yes
                                     Whenever VOCSN will be outside of the immediate control of a clinician, set the Clinician
 Required?
                                     Unlock Required control to Yes to prevent the accidental activation of unintended therapies.
                                       NOTE: Depending on the optional features purchased for use with VOCSN, the default
                                       Clinician Unlock Required setting may be Yes.
                   [Language
                                     Use the Language control to change the text displayed in the VOCSN operating system to a
 Language          name in target
                                     different language.
                   language]
 Reset Settings                      Selecting Reset Settings for New Patient will revert all VOCSN controls to their default
                                     settings, and also reset trending data exported for Multi-View reporting. See “Multi-View”
 for New           N/A
                                     on page 127 for more information. VOCSN will prompt you to confirm the reset before
 Patient
                                     restoring factory default settings and resetting trend data.
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                                                                                                                                                               Controls and Settings
   0
        No Alarms
                L     5      10
                                       V     O SIMV-VOL
                                            15            20     H 25          30
                                                                                                                      Effect of Starting Another Therapy:
   PRESSURE (cmH20)
                                                                                                                           Oxygen
                                                                                    Oxygen (Pulse       Oxygen
           VENTILATION    OXYGEN           COUGH       SUCTION    NEBULIZER
   Oxygen                                             Controlled
                                                                                     Therapies run    Therapies run                        Therapies run     Therapies run     Therapies run
  (Ext. Low-                                          by Oxygen                                                               N/A
                                                                                    simultaneously   simultaneously                       simultaneously    simultaneously    simultaneously
   Pressure)                                            Source
                                                                                                                                                             Therapies run
                                                                                                                          Therapies run                     simultaneously
        Cough                                                    C                       N/A              N/A
                                                                                                                         simultaneously
                                                                                                                                               N/A
                                                                                                                                                             with Cough +
                                                                                                                                                                                   N/A
                                                                                                                                                            Suction feature
                                                                                                                                             Nebulizer
                                                                                                                          Therapies run    pauses, then
                                                                 N
  Nebulizer1                                                                        Nebulizer ends   Nebulizer ends                                         Nebulizer ends         N/A
                                                                                                                         simultaneously    automatically
                                                                                                                                             resumes
1	 Although only one Oxygen Source selection can be selected and activated at a time, external low-pressure oxygen is additive and
   can be bled in through VOCSN while other therapies (including oxygen) are running.
2	 This table describes the effects of internal Nebulizer therapy. External Nebulizer Compensation does not cancel or pause any other
   active therapy. If you are using an external nebulizer, disconnect it and stop nebulizer compensation before starting Cough therapy
   to prevent nebulized material from reaching VOCSN.
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                                                                                                                                                                        Alarms
Alarms
A VOCSN alarm will activate whenever the device detects a condition that requires clinician or caregiver attention.
Alarms will generate an audible tone, and/or a blue, yellow, or red alert banner across the top of the VOCSN screen.
VOCSN has three alarm priority categories:
 NOTE: An Inop alarm will generate a consistent audible tone and cause the On/Off button to flash red. In case of
                  PRESSURE (cmH20)
                                                                                          CLEAR LIST
                       EXIT                     ALARMS                     EVENTS
 VOCSN Inop alarm, immediately provide the patient with an alternate source of ventilation, and restart VOCSN.
                       Battery Use                       10/23/2013        7:35 AM
Set the Alarm Volume control so that alarm conditions are audible over ambient noise at all times, and at any anticipated
                       High Inspiratory Pressure         10/23/2013        6:05 AM
distance away from VOCSN the caregiver may travel. Ventec Life Systems recommends ensuring the Alarm Volume
control is set appropriately by simulating these conditions and verifying the alarm can be heard. See “Device Settings”
on page 100 for Alarm Volume configuration instructions. Similarly, if you are using an optional remote alarm, ensure it is
placed somewhere it can be heard at all times.
 WARNING: In environments containing multiple VOCSN devices, or similar devices set with different alarm limits (such
 as an intensive care unit), alarm conditions may be confused with other alarm sources. Failure to respond to an alarm
 condition quickly may result in patient harm.
 NOTE: Auditory alarm indicators may be delayed for more than 10 seconds depending on the ventilation therapy
 configuration and the Patient Circuit Disconnect alarm setting, or the High Pressure Delay control setting.
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                                                                                                                 Alarms
 NOTE: The visual alarm (indicating the alarm condition and priority) will remain on
 the VOCSN screen.
 NOTE: The Internal Battery Critically Low alarm cannot be silenced until VOCSN is plugged into an external source of
 power. To silence the alarm after plugging in VOCSN, access the Alarm Log (by pressing the alarm banner in the upper
 left-hand corner of the screen or pressing LOGS in the Menu tab), and then select CLEAR LIST.
1 Press the Menu tab, or the VENTILATION button on the Therapy screen.
3 A Settings banner appears in the list first. Scroll down to the Alarms section.
   6	   If the alarm has both low and high alarm limits, press the L icon to modify the low alarm limit, or the H icon
        to modify the high alarm limit. Enter the new alarm setting and press ACCEPT to save your selection.
7 Follow the procedure above to modify additional alarms. When configuration is complete, press the < EXIT tab.
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                                                                                                                          Alarms
 Apnea             Off,           High       The Apnea alarm activates when VOCSN has not             Monitor the patient closely
                   10 to 120                 delivered assist or spontaneous breaths (or coughs)      to ensure adequate
                   seconds                   for the set Apnea alarm duration. When this alarm        ventilation therapy is
                                             activates, mandatory breaths will be delivered to        delivered.
                   20 seconds
                                             the patient at the set Apnea Rate.                       Check to ensure patient-
                                             The Apnea alarm will deactivate when the patient         triggered breaths are not
                                             triggers two consecutive assist and/or spontaneous       delivered less often than
                                             breaths.                                                 necessary, and adjust the
                                                                                                      Flow Trigger control setting
                                             The Apnea alarm can also be deactivated by
                                                                                                      if needed.
                                             pressing the Clear List button twice from the Alarm
                                             Log screen. See “Clearing an Alarm” on page 115
                                             for detailed instructions.
 Battery Use       N/A            Medium     The Battery Use alarm activates whenever VOCSN           Monitor battery charge
                                             switches from external power to battery power,           status, and connect an
                                             or from any power source (including removable            external source of power
                                             battery) to internal battery power.                      when available.
                                             The Battery Use alarm remains active until it is reset
                                             by clearing the Alarm Log, or external power is
                                             connected to VOCSN.
 Check O2          On, Off        Medium     The Check O2 Source alarm activates when a               Monitor the patient closely
 Source                                      connected source of external low-pressure oxygen         to ensure adequate
                                             is used and the monitored FiO2 falls below 24%.          Oxygen therapy is
                                                                                                      delivered.
                                             Use the Check O2 Source alarm to detect oxygen
                                             source disconnects when the Oxygen Source                Verify the connected
                                             control is set to Low Pressure O2 and High Flow          low‑pressure oxygen
                                             therapy is Off.                                          source is on and is
                                                                                                      functioning correctly.
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                                                                                                                            Alarms
 Check Patient   N/A             High       The Check Patient Circuit alarm activates when            Check the Ventec One-
 Circuit                                    VOCSN detects an inadequate leak in a passive or          Circuit to ensure the flow
                                            valveless circuit, or an error in the flow sensor of an   sensor tubing is connected
                                            active circuit.                                           to the Active exhalation
                                                                                                      valve connection port
                                                                                                      in VOCSN (for active
                                                                                                      circuits) or that the
                                                                                                      passive exhalation valve is
                                                                                                      unobstructed (for passive
                                                                                                      circuits).
                                                                                                      Run a Pre-Use Test.
                                                                                                      Monitor the patient closely
                                                                                                      to ensure adequate
                                                                                                      Ventilation and Oxygen
                                                                                                      therapy is delivered.
                                                                                                      If the problem persists,
                                                                                                      connect the patient to
                                                                                                      an alternate source of
                                                                                                      ventilation and contact
                                                                                                      your local Ventec Life
                                                                                                      Systems representative for
                                                                                                      service.
 High Breath     Off, 10 to 99   Medium     The High Breath Rate alarm will activate when the         Monitor the patient closely
 Rate            BPM                        monitored breath rate is higher than the set High         to ensure adequate
                                            Breath Rate alarm limit.                                  ventilation therapy is
                                                                                                      delivered.
 High FiO2       Off, 24 to      Medium     The High FiO2 alarm activates when the monitored          Monitor the patient closely.
                 99%                        FiO2 percentage is higher than the set High FiO2
                                                                                                      If the problem persists,
                                            alarm limit.
                                                                                                      contact your local Ventec
                                            Set the High FiO2 alarm appropriately for the             Life Systems representative
                                            patient condition whenever the FiO2 control is set        for service.
                                            above 21%, or when using Low Pressure O2 with
                                            High Flow therapy.
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                                                                                                                      Alarms
 High Minute      Off,           Medium     The High Minute Volume alarm activates when the       Monitor the patient closely.
 Volume           1 to 59 L                 monitored Minute Volume is larger than the set
                                                                                                  If the monitored Breath
                                            High Minute Volume alarm limit.
                                                                                                  Rate is high, check to
                                                                                                  ensure patient-triggered
                                              NOTE: The High Minute Volume alarm will not         breaths are not delivered
                                              activate when the Circuit Type control is set to    more often than necessary,
                                              Mouthpiece.                                         and adjust the Flow Trigger
                                                                                                  control setting if needed.
                                                                                                  If you are using an active
                                                                                                  Ventec One-Circuit and
                                                                                                  humidifier, clear any
                                                                                                  condensation from the
                                                                                                  active exhalation valve.
 High PEEP        Off, 3 to 20   Medium     The High PEEP alarm activates when the monitored      Monitor the patient closely.
 (High EPAP in    cmH2O                     PEEP is greater than PEEP plus the set High PEEP      Check for breath auto-
 Bi-Level Mode)   above set                 alarm limit.                                          cycling or breath stacking.
                  PEEP
                                                                                                  If the problem persists,
                  5 cmH2O                                                                         replace the Ventec One-
                                                                                                  Circuit.
 High Pressure    10 to 80       High       The High Pressure alarm activates when the            Monitor the patient closely
                  cmH2O                     monitored Airway Pressure exceeds the set High        and check for reduced
                                            Pressure alarm limit for more than the number of      patient lung compliance
                  20 cmH2O
                                            consecutive breaths set with the High Pressure        during volume ventilation.
                                            Delay control.
                                                                                                  Check the Ventec One-
                                            When used with High Flow therapy, set the alarm       Circuit for occlusions.
                                            above the normal operating pressure to detect
                                            circuit occlusions.
 Inop             N/A            [Tech-     The Inop alarm activates when VOCSN experiences       Immediately provide the
                                 nical      a loss of power without available battery backup      patient with an alternate
                                 Alarm]     power, when the battery depletes and is the only      source of ventilation.
                                            available source of power, or when a software or      Press the On/Off button
                                            hardware failure renders VOCSN unable to safely       again to restart VOCSN.
                                            deliver therapy and/or monitor the patient.           If the device remains
                                                                                                  inoperative, contact your
                                                                                                  local Ventec Life Systems
                                                                                                  representative for service.
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                                                                                                                       Alarms
 Internal         N/A           High       The Internal Battery Critically low alarm activates      Immediately connect
 Battery                                   when the internal battery is disconnected, faulty,       VOCSN to a continuous
 Critically Low                            or when the battery is critically low (charged to less   source of external power
                                           than 33% its capacity).                                  and verify the charge status
                                                                                                    indicator light on the front
                                             NOTE: The Internal Battery Critically Low alarm        of VOCSN illuminates.
                                             condition cannot be cleared or silenced until          Clear the alarm by
                                             VOCSN is connected to external power. Connect          selecting CLEAR LIST in
                                                                                                    the Alarm Log.
                                             external power and press the Clear List button
                                             twice from the Alarm Log screen to silence and         If alarm persists after
                                                                                                    application of external
                                             clear the alarm.                                       power, provide the patient
                                                                                                    with an alternate source of
                                                                                                    ventilation therapy.
 Internal         N/A           Medium     The Internal Battery Low alarm activates when            Promptly connect VOCSN
 Battery Low                               VOCSN internal battery charge status falls below         to a continuous source of
                                           50%.                                                     external power.
                                                                                                    Clear the alarm by
                                             NOTE: The Internal Battery Low alarm may be            selecting CLEAR LIST in
                                             silenced, but the condition cannot be cleared          the Alarm Log.
                                             until VOCSN is connected to external power.            If the alarm persists after
                                                                                                    several hours of external
                                                                                                    power connection, contact
                                             NOTE: Because the battery capacity diminishes          your local Ventec Life
                                             over time, this alarm may activate more quickly        Systems representative for
                                             as the battery ages.                                   service.
 Low Breath       Off,          Medium     The Low Breath Rate alarm activates when the             Monitor the patient closely
 Rate             4 to 80 BPM              monitored Breath Rate is less than the set Low           to ensure adequate
                                           Breath Rate alarm limit.                                 Ventilation therapy is
                  5 BPM
                                                                                                    delivered.
                                                                                                    Check to ensure patient-
                                                                                                    triggered breaths are not
                                                                                                    delivered less often than
                                                                                                    necessary, and adjust the
                                                                                                    Flow Trigger control setting
                                                                                                    if needed.
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                                                                                                                    Alarms
 Low FiO2        Off, 19 to    Medium     The Low FiO2 alarm activates when the monitored       Monitor the patient closely
                 92%                      FiO2 falls below the set Low FiO2 alarm limit.        to ensure adequate
                                          Set the Low FiO2 alarm appropriately for the          Oxygen therapy is
                                          patient condition whenever the FiO2 control is set    delivered.
                                          above 21%, or when using Low Pressure O2 with         Verify the connected
                                          High Flow therapy.                                    high‑pressure oxygen
                                                                                                source is on and is not
                                            NOTE: If the FiO2 monitor is inactive, the Low      depleted.
                                            FiO2 alarm is disabled. See “FiO2 Monitor” on
                                            page 121 for more information.
 Low             Off,          High       The Low Inspiratory Pressure alarm activates when     Check the Ventec One-
 Inspiratory     1 to 40                  the monitored Peak Inspiratory Pressure falls below   Circuit for leaks or
 Pressure        cmH2O                    the set Low Inspiratory Pressure alarm limit.         disconnection.
                 10 cmH2O                                                                       Monitor the patient closely
                                            NOTE: Ventec Life Systems recommends using          to ensure adequate
                                            the Low Inspiratory Pressure and Low Minute         ventilation therapy is
                                            Volume alarms to detect hypoventilation.            delivered.
                                                                                                If the problem persists,
                                                                                                connect the patient to
                                                                                                an alternate source of
                                                                                                ventilation and contact
                                                                                                your local Ventec Life
                                                                                                Systems representative for
                                                                                                service.
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                                                                                                                            Alarms
 Low Minute       Off,            High       The Low Minute Volume alarm activates when the             Monitor the patient closely
 Volume           0.1 to 9.9 L,              monitored Minute Volume falls below the set Low            to ensure adequate
                  10 to 50 L                 Minute Volume alarm limit.                                 ventilation therapy is
                                                                                                        delivered.
                  2.5 L
                                               NOTE: Ventec Life Systems recommends                     Check the Ventec One-
                                               using the Low Minute Volume and Low                      Circuit for leaks or
                                               Inspiratory Pressure alarms to detect patient            disconnection.
                                               hypoventilation.                                         During pressure-control
                                                                                                        ventilation, check the
                                                                                                        patient for reduced lung
                                              WARNING: If the Low Minute Volume alarm                   compliance or airway
                                              cannot be set appropriately for the patient               occlusion.
                                              condition because of a connected speaking valve
                                              or other reason, use an alternate respiratory
                                              monitor such as an oximeter or cardio-respiratory
                                              monitor to detect hypoventilation.
 Low PEEP         On, Off         Medium     The Low PEEP alarm activates when the monitored            Check the Ventec One-
 (Low EPAP in                                PEEP falls 5 cmH2O below the set PEEP control for          Circuit for leaks.
 Bi-Level Mode)                              3 consecutive breaths.                                     Monitor the patient closely.
                                                                                                        If the problem persists,
                                                                                                        replace the Ventec One-
                                                                                                        Circuit.
 Maintenance      N/A             Low        The Maintenance Due alarm activates when the               Contact your local Ventec
 Due                                         Sys. PM Due In monitor falls below 0, indicating           Life Systems representative
                                             that VOCSN is due for maintenance. This alarm can          for service.
                                             be reset for up to 8 hours by clearing the alarm.
 O2               N/A             Medium     The O2 Concentration alarm activates after                 If using an external source
 Concentration                               five minutes or more (depending on VOCSN                   of oxygen, check the
                                             configuration settings) when the internal O2               high-pressure source for
                                             Concentrator produces less than 82% oxygen, or             depletion.
                                             less than 80% of the target pulse dose volume. It          If using the internal O2
                                             will also activate if there is a fault with the internal   concentrator, check the
                                             oxygen sensor that measures gas created by the             patient circuit O2 tube to
                                             internal O2 Concentrator, or if the monitored              ensure it is fully connected
                                             oxygen tank pressure is less than 4 PSI when using         and is not blocked.
                                             an external source of high-pressure oxygen.
                                                                                                        If the problem persists,
                                                                                                        contact your local Ventec
                                                                                                        Life Systems representative
                                                                                                        for service.
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                                                                                                                          Alarms
 Patient Circuit   Off,            High       The Patient Circuit Disconnect alarm activates when     Check the Ventec One-
 Disconnect        1-15 breaths               VOCSN detects a large leak in an active, passive, or    Circuit for leaks or
 (see below for    (leak up to                valveless Ventec One-Circuit.                           disconnection.
 modified alarm    75 L/min),                 The toggle at the top of the control editing window     Monitor the patient closely
 settings during   1-15 breaths               can be used to turn the alarm on or off.                to ensure adequate
 High Flow         (leak 75 to                                                                        Ventilation therapy is
                                              Use the numeric keypad to set the alarm delay. The
 therapy)          175 L/min)                                                                         delivered.
                                              Patient Circuit Disconnect alarm will activate in one
                   2 breaths                  breath plus the set number of breath cycles. For        If the problem persists,
                   (leak 75 to                example, when set to 3, the alarm will activate on      connect the patient to
                   175 L/min)                 the 4th disconnect breath.                              an alternate source of
                                                                                                      ventilation and contact
                   NOTE: If the               The SENSITIVITY toggle changes the threshold
                                                                                                      your local Ventec Life
                   sensitivity                at which the Patient Circuit Disconnect alarm
                                                                                                      Systems representative for
                   toggle is not              activates. The 0-75 setting is intended for use with
                                                                                                      service.
                   available,                 small and medium leaks, to ensure the alarm is
                   the more                   sensitive enough to detect disconnects and most
                   sensitive                  decannulations. The 75-175 setting desensitizes the
                   setting                    alarm to reduce nuisance alarms when used with
                   (0-75) is                  large leaks around the patient interface.
                   always active
                                                PRECAUTION: Always test the Patient Circuit
                                                Disconnect alarm before use to verify it detects
                                                disconnects and/or decannulations with the
                                                specific patient conditions, patient interface, and
                                                VOCSN settings.
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                                                                                                                          Alarms
 Patient Circuit    Off, Low       High       During High Flow therapy, the Patient Circuit           Ensure the high flow nasal
 Disconnect         Sensitivity,              Disconnect alarm will activate when no patient          cannula (or other interface)
 (during High       Medium                    breathing is detected for 20 seconds.                   is properly fitted to the
 Flow therapy)      Sensitivity,                                                                      patient.
                                              The Low Sensitivity setting is appropriate for use
                    High
                                              with smaller patients with smaller spontaneous          Monitor the patient closely.
                    Sensitivity
                                              breathing efforts. High Sensitivity makes the
                                                                                                      If the problem persists,
                                              alarm more sensitive, and is appropriate for larger
                                                                                                      connect the patient to
                                              patients with larger spontaneous breathing efforts.
                                                                                                      an alternate source of
                                                PRECAUTION: During High Flow, the Patient             ventilation and contact
                                                                                                      your local Ventec Life
                                                Circuit Disconnect alarm may not work for all
                                                                                                      Systems representative for
                                                patients (such as those with small spontaneous        service.
                                                breathing efforts). Always test the Patient Circuit
                                                Disconnect alarm before use with High Flow
                                                therapy to verify it functions with the specific
                                                patient conditions, patient interface, and VOCSN
                                                settings.
 Service            N/A            Low        The Service Concentrator Soon alarm activates           Contact your local Ventec
 Concentrator                                 when the VOCSN O2 Concentrator maintenance              Life Systems representative
 Soon                                         should be scheduled. This alarm can be reset for up     for service.
                                              to 8 hours by clearing the alarm.
 System Fault       N/A            High       The System Fault alarm activates if VOCSN detects       Use the Event Log to
 (all conditions)                             any one of multiple system fault conditions.            determine the System
                                                                                                      Fault number, and then see
                                                                                                      “System Fault Detection
                                                                                                      Criteria and Recommended
                                                                                                      Action” on page 219 and
                                                                                                      take the corresponding
                                                                                                      action.
 Very Low FiO2      N/A            High       The Very Low FiO2 alarm activates when the              Remove any gas source
                                              monitored FiO2 is less than 18%.                        connected to VOCSN and
                                                                                                      monitor the patient.
                                                NOTE: If the FiO2 monitor is inactive, the Very
                                                Low FiO2 alarm will be disabled. See “FiO2
                                                Monitor” on page 121 for more information.
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                                                                                                                   Alarms
To view the VOCSN Alarm Log at any time, press the alarm banner in the status bar, or:
To clear the list of all but the active alarm conditions, press the CLEAR LIST button from the Alarm Log screen.
Information about the alarm will also be stored in the VOCSN Event Log, which cannot be deleted.
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                                                                                                                                        Alarms
 NOTE: The Event Log, including information about activated alarms, is retained through VOCSN shut down. The Event
 Log will be stored for at least 365 days after a total loss of device power.
   1	
                                                       0              L    5           10               15                20   H 25         30
        Press the Menu tab.
   2	
                                                      PRESSURE (cmH20)
   3	   If needed, press the Events tab.                   High Pressure Alarm Resolved          04/30/2018     7:35 PM        201-250
                                                           High Pressure Alarm                   04/30/2018     7:34 PM
 NOTE Timestamps on events in the VOCSN Event Log (and Alarm Log) are based on the configured VOCSN Date and
 Time setting at the time the event occurred. If the VOCSN Date and Time settings are incorrect, the timestamps shown
 in the log will also be incorrect, and cannot be corrected. However, VOCSN Multi-View timestamps are relative, and will
 recalculate based on the most recent VOCSN Date and Time setting when data is exported and a report is generated.
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                                                                                                                    Alarms
Clearing an Alarm
Visual indicators of an alarm condition remain on the screen as a count in the status bar and a list in the Alarm Log until
the alarm condition is resolved and the list is cleared. To clear an activated alarm:
1 Press the Alarm Silence button on the front of VOCSN to silence the alarm tones, if desired.
   2	   Resolve the alarm condition by taking the appropriate action. When an alarm condition is resolved, the alarm will
        clear. A log of the alarm activation will be recorded in the Alarm Log and the Event Log.
   3	   Access the Alarm Log through the Menu tab, or by pressing the Alarm banner in the upper left corner of the
        VOCSN touchscreen, then select CLEAR LIST to remove all but active alarms from the Alarm Log.
NOTE: A record of recent alarm conditions will remain in the Event Log, even when the Alarm Log has been cleared.
 NOTE: The delay between an alarm condition and activation of the remote alarm port is <1 s. Refer to the remote alarm
 manufacturer’s instructions for use to determine the maximum possible delay between VOCSN alarm and remote alarm
 activation.
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                                                                                                                                                       Monitors
Monitors
VOCSN monitors multiple parameters. View monitored VOCSN Ventilation therapy data by pressing the Monitors tab.
Oxygen, Cough, Suction, and Nebulizer therapy monitors are available by navigating to the relevant therapy screen.
 NOTE: Monitored data depends on the set Circuit Type, Mode, and the number of breaths delivered. Monitors will
 display “--” if they are not available for the set Circuit Type or Mode. VOCSN will display a spinning circle graphic while
 it is calculating a monitored value.
From the Monitors tab, press the CUSTOMIZATION button to configure which monitors display on the screen. The three
monitors configured to display on the top row of the Monitors tab will appear on the Home screen.
Press the WAVEFORMS button to view real-time flow, volume, and pressure Ventilation therapy waveforms.
 NOTE: When used with active, passive, and valveless Ventec One-Circuits, VOCSN was designed for use with a
 humidifier or HME. All volumes and flows are expressed in BTPS unless stated otherwise.
                                                                                       No Alarms                        V   O SIMV-VOL
      No Alarms                     V   O SIMV-VOL
                                                                                  0              L   5       10             15           20          H 25            30
 0              L   5   10              15           20      H 25            30
                                                                                  PRESSURE (cmH20)
 PRESSURE (cmH20)
                                                                                         Home                Therapy              Monitors                  Menu
        Home            Therapy              Monitors               Menu
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                                                                                                                           Monitors
Ventilation Monitors
Monitored Ventilation therapy parameters and active control settings can be viewed using the Monitors tab on the
VOCSN touchscreen. The displayed monitors and controls are customizable. To change which monitors and control
settings display on the Monitors tab, see “Monitor Screen Customization” on page 120.
Press the down arrow at the bottom of the Monitors screen to view currently active Ventilation and Oxygen therapy
control settings.
VOCSN will only display the monitors applicable to the delivered therapy. The table below lists these dependencies.
For more information about the monitors available during mouthpiece ventilation, see “Setting VOCSN Controls for
Mouthpiece Ventilation” on page 87.
 Breath Rate             0 to 100       Breath Rate. Provides a calculation of the average number of breaths per minute (BPM)
                         BPM            delivered to the patient based on the previous 8 breaths.
 EPAP                    0 to 45        Expiratory Positive Airway Pressure. The EPAP monitor displays the pressure maintained
 (Bi-Level ventilation   cmH2O          between breaths (from the end of exhalation).
 modes only)
                                          NOTE: The EPAP monitor is only available when the Ventilation Mode is set to Bi-Level.
 Estimated Vte           0 to 2000 mL   Estimated Exhaled Tidal Volume. When Circuit Type is set to Passive or Valveless, VOCSN
 (Passive and                           will calculate the estimated volume of the last patient exhalation. This monitor is based on
 Valveless Ventec                       internal VOCSN calculations, rather than a measurement.
 One-Circuits only)
                                         WARNING: The accuracy of Vte measurements may be affected by large leaks at the
                                         patient interface.
 Flow Setting            4 to 60 L/     During High Flow therapy, the Flow Setting monitor displays the Flow control setting.
                         min
 Flow waveform           User           Real-time Ventilation therapy flow waveforms are visible by pressing the WAVEFORMS
                         Scalable       button from the Monitors tab. See “Waveform Monitors” on page 119 for more information.
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                                                                                                                        Monitors
 I:E Ratio             9.9:1 to    The I:E Ratio monitor displays the average ratio between inspiratory and exhalation time
                       1:9.9       over the last 8 breaths.
 Leak                  0 to 200    The Leak monitor displays the flow of gas leaking during each breath in L/min.
                       L/min
 MAP                   0 to 50     Mean Airway Pressure. The MAP monitor displays the average pressure delivered
                       cmH2O       throughout the breath period of the last eight breaths.
 Minute Volume         0 to 60 L   The Minute Volume monitor displays the calculated volume of air delivered to the patient
                                   over one minute, based on the average breath rate and Vte (for active circuits) or Estimated
                                   Vte (for passive and valveless circuits) of the last eight breaths.
 Patient Effort        N/A         The patient effort icon appears on the left side of the airway pressure manometer in the
                                   status bar when VOCSN delivers a patient-triggered breath.
                                     NOTE: Ventec Life Systems recommends periodically verifying that the Patient Effort
                                     indicator in the status bar appears in synchrony with actual patient effort to breathe.
 Patient Triggered     0 to 100%   The Patient Triggered monitor displays the percentage of the last 100 breaths that were
                                   initiated by the patient.
 PEEP                  0 to 45     Positive End Expiratory Pressure. The PEEP monitor displays the pressure maintained
                       cmH2O       between breaths (from the end of exhalation).
 PIP                   0 to 85     Peak Inspiratory Pressure. The PIP monitor displays the maximum pressure delivered during
                       cmH2O       the last breath.
 Pressure              0 to 80     Airway Pressure is monitored using a manometer in the status bar. The dark blue bar
 (during Ventilation   cmH2O       represents the pressure of the current breath. The light blue bar represents the peak
 therapy)                          pressure delivered during the previous breath.
 Pressure              User        Real-time pressure waveforms are visible by pressing the WAVEFORMS button from the
 waveform              Scalable    Monitors screen. See “Waveform Monitors” on page 119 for more information.
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                                                                                                                   Monitors
 Volume                User           Real-time Ventilation therapy volume waveforms are visible by pressing the WAVEFORMS
 waveform              Scalable       button from the Monitors tab. See “Waveform Monitors” on page 119 for more information.
 Vte                   0 to 2000 mL   Exhaled Tidal Volume. The volume of the last patient exhalation. When Leak Compensation
 (Active Ventec One-                  is set to On, VOCSN compensates for leaks to monitor the volume of the last patient
 Circuits only)                       exhalation.
                                       WARNING: The accuracy of Vte measurements may be affected by large leaks at the
                                       patient interface.
Waveform Monitors
Press the WAVEFORMS button from the Monitors screen to access real-time, scalable Ventilation
therapy waveforms. The screen displays any two of the following three available waveforms:
pressure, flow, and volume.
To vertically scale the waveforms, click the up and down button next to the waveform. Use the
left and right button to modify the time scale of the waveform. Use the pause button to stop the           WAVEFORMS
waveform at any time. When the play button is pressed, the waveforms will resume displaying
real-time monitored waveform data. Press the waveform button again to switch between
pressure, flow, and volume waveforms.
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                                                                                                                                                         Monitors
 NOTE: The monitors selected for the top row of the Monitors tab will display on both the                                             CUSTOMIZATION
 Monitors and the Home tab.
   2	   Press EDIT > on the right side of the screen.                   EXIT                     MONITORS
                                                                                               CUSTOMIZATION
   3	   Press the name of the monitor you want to                 13.5cmH2O                       15   BPM             430    mL
        appear in the highlighted screen location.                PIP                             BREATH RATE          TIDAL VOLUME
                                                                  10.0cmH2O                       1:3                  0
   4	
                                                                                                                          L/min
        Press ACCEPT to confirm your selection.                   MAP                             I:E RATIO            LEAK
                                                              0                    L       5              10          15              20          H 25                 30
                                                                                                                                                        PIP
                                                              PRESSURE (cmH20)
                                                                                                                                                        MAP
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                                                                                                                                                             Monitors
therapy screen as a green fill above the                                     CALCULATED FiO2 MONITOR (%)
                                                                                                                                                             O2 FLUSH
Presets.                                                                        PRESET 1                   PRESET 2                      PRESET 3
                                                                                4 L/min                       40%                        6 L/min
                                                                               Pulse Dose                       FiO2                     Pulse Dose
FiO2 Monitor
                                                           EXIT                Ext. High-Pressure         Ext. High-Pressure        Int. O2 Concentrator     SETTINGS
                                                                                NOW ACTIVE
                                                                                                                                                             & ALARMS
                                                                                                                                        START
                                                                                                                                     STOP THERAPY
If enabled and active, the FiO2 monitor is visible from the Monitors tab, or from the Oxygen therapy screen when the
FiO2 control is set above 21%. Use the FiO2 monitor to ensure the accuracy of delivered Oxygen therapy whenever the
FiO2 control is used.
To activate and use the FiO2 monitor, it must be enabled (see “Enabling and Disabling Prescribed Therapies” on page
88), the Oxygen Delivery Mode control must be set to FiO2 (see “Oxygen Controls” on page 90), and the FiO2
control must be set above 21%. When the FiO2 monitor is inactive, the High FiO2, Low FiO2, and Very Low FiO2 alarms
are also inactive.
 NOTE: The FiO2 monitor requires time to warm up. During the first five minutes of use, the FiO2 monitor will display
 “--” as the FiO2 value. The FiO2 monitor will also display dashes if the FiO2 monitor is disabled, or the Oxygen Delivery
 Mode control is set to Pulse Dose.
NOTE: The FiO2 monitor is equipped with automatic barometric pressure compensation.
 NOTE: Performance of the FiO2 monitor may be affected by high humidity, cyclical pressure, or other sources of
 interference.
1 The FiO2 monitor and alarms are also available when using low-pressure oxygen during High Flow therapy.
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                                                                                                                Monitors
Because the Calculated FiO2 monitor is an average, it is important that the patient receive stable Ventilation therapy for
at least 8 breaths before using the Calculated FiO2 monitor to make decisions about adjusting Oxygen Direct therapy.
The monitor may fluctuate based on the number of mandatory, assist, or spontaneous breaths delivered over the last 8
breaths.
 NOTE: The Calculated FiO2 monitor may fluctuate. These fluctuations are based on the type of breaths delivered
 (mandatory, assist, or spontaneous), and are consistent with changes in FiO2 delivered to patients using traditional
 oxygen delivery methods.
 NOTE: O2 Flow Equivalent delivery is dependent on the patient’s minute volume. Because oxygen delivery may be
 limited by minute volume, increasing the O2 Flow Equivalent control may not result in a corresponding increase to the
 Calculated FiO2 monitor.
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                                                                                                                         Monitors
During Touch Button Cough therapy, VOCSN monitors and displays the following parameters:
 Cough Cycles        0 to 10        The Cough Cycles monitor displays the number of Cough Cycles delivered to the patient, as
                                    well as the total number of Cough Cycles configured.
Cough Volume 0 to 4000 mL The Cough Volume monitor will display the volume of last cough delivered in mL.
 Peak Cough          0 to 350       The Peak Cough Flow monitor will display the maximum flow through the Ventec One-Circuit
 Flow                L/min          during the last cough in L/min.
 Pressure            -80 to 80      Airway Pressure during Cough therapy is monitored using a manometer in the status bar. The
 (during Cough       cmH2O          dark blue bar represents the positive (insufflation) pressure. The orange bar represents the
 therapy)                           negative (exsufflation) pressure.
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                                                                                                                                                   Monitors
No Alarms V O SIMV-VOL
0 L 5 10 15 20 H 25 30
PRESSURE (cmH20)
                                                                            300        250
                                                                     350                         200
400 150
                                                    450                         12                              100
                                                                                             8
                                                                       16                                                  VACUUM
                                              500                                                  4                  50
                                                                            185
                    EXIT                                        20                                                                    SET
                                             550                                                         0           0              DEFAULT
                                                                                mmHg                   inHg        mmHg
                                                                        START
                                                                     STOP START
                                                                           THERAPY
During Suction therapy, VOCSN monitors and displays the following parameter:
 Vacuum              -550 to 0         A Vacuum monitor is available during Suction therapy. During Suction therapy, the monitored
                     mmHg              Vacuum level will display as a color fill inside the control arc on the Suction therapy screen.
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                                                                                                                              Monitors
No Alarms V N SIMV-VOL
0 L 5 10 15 20 H 25 30
                PRESSURE (cmH20)
                                                        NEBULIZER DURATION
                                                                      60
                                                            55              5
50 10
                                                  45                 25               15
                                                                     mins
                                                       40                        20                           MINUTES
                     EXIT                                   35              25
                                                                      30
                                                            INTERNAL NEB.
                                                               THERAPY
                                                                                           15  MIN
                                                                                           NEBULIZER MINUTES REMAINING
                                                                     STOP
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                                                                                                                      Monitors
System Monitors
VOCSN monitors the following system parameters. To view these monitors, press the MY VOCSN button from the Menu
tab.
 Date             2016-01-01     The Date monitor displays the configured date. Periodically check that the date setting is
                  to             correct. To update the set Date setting, see “Changing Device Settings” on page 100.
                  2030-12-31
 O2               0 to 99,999    On VOCSN configurations that include an internal O2 Concentrator, the Concentrator Usage
 Concentrator     hours          monitor displays the total time Oxygen therapy has been active while set to deliver oxygen
 Usage                           from the internal O2 Concentrator.
 Sys. PM Due In   -99,999 to     The Sys. PM Due In monitor displays the time remaining in hours until the next preventative
                  99,999 hours   maintenance activities should be performed. A negative number indicates how many hours the
                                 maintenance is past due. Resetting this monitor requires service-level access to the system.
                                 Contact your local Ventec Life Systems representative for service.
 Pump Usage       0 to 99,999    The Pump Usage monitor displays the total duration VOCSN compressor usage as the total
                  hours          time therapies using the pump have been active.
 System Usage     0 to 99,999    The System Usage monitor displays the total duration of VOCSN operation over its life.
                  hours
 Time             12:00 AM to    The Time monitor displays the configured time. Periodically check that the time setting is
                                 correct. To update the Time setting, see “Changing Device Settings” on page 100.
                  11:59 PM
 VPSA Usage       0 to 99,999    The VPSA Usage monitor shows the total duration of VOCSN compressor usage to provide
                  hours          oxygen from the internal O2 Concentrator. Because the compressor may not need to run
                                 continuously to produce enough oxygen during therapy, this value may be a fraction of total
                                 time Oxygen therapy has been running (as displayed by the O2 Concentrator Usage monitor).
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                                                                                                            Multi-View
Multi-View
 NOTE: Multi-View reports are for informational purposes only. Clinical decisions should be made based on observations
 of the patient, not solely the report.
 NOTE: Use the Reset Settings for New Patient control in the Device Settings to restore VOCSN factory defaults and also
 reset Multi-View calculations. Reports generated after this event will display data from the time of this event forward.
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                                                                                                           Multi-View
1 Install a USB drive into the USB port in the back of VOCSN.
        NOTE: USB drives used with VOCSN must be USB 2.0 compatible, and formatted to
                                                                                                          EXPORT
        FAT32. Do not plug anything else into the VOCSN USB port. To purchase a VOCSN
        compatible USB drive, see VentecLife.com/usbdrive.
2 Navigate to the Event Log by pressing Menu and then the LOGS button. Press the Events tab.
   3	   Select the EXPORT button to begin exporting Multi-View data to the connected USB drive. When the export is
        complete, press OK and remove the USB drive.
        NOTE: VOCSN stores and exports Multi-View data for the past 90 calendar days of use. Previous data is
        overwritten.
   4	   Insert the USB drive into a computer, and open the “VOCSN” folder on the drive. Ensure you’re connected to
        the Internet and double-click the “Click to open Multi-View.html” link to open the Multi-View portal. Follow
        the instructions on the Multi-View portal, and see “Generating Multi-View Reports” on page 129 for more
        information.
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                                                                                                         Multi-View
1 Use the “Click to open Multi-View.html” link or use a web browser to navigate to VentecLife.com/Multi-View.
4 Make your selections and then click the “Create Reports” button to begin generating reports.
       NOTE: To generate multiple reports with different durations from the same export file, create and download/
       email the first report, then select “Clear Uploads” and create the second.
  5	   The portal will begin processing the selected files immediately. When the “Status” column shows “Complete,”
       you can download the report PDFs individually, as a group, or email them directly from the portal using the
       buttons on the right-hand side of the page.
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                                                                                                               Multi-View
Report Information
The first page of VOCSN Multi-View reports contain
information about the VOCSN device, as well as
the report itself. This page includes the device
serial number, its configuration and the software
version installed at the time of the Multi-View
export. It also includes information about the report
creation date, duration, and the date and time
range of data included.
 NOTE: If you need to ensure that the data you enter into the form fields cannot be edited again, use a PDF reader to fill
 in the fields, and then select “Print” to print the file to PDF and lock your entries in place in the new file.
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                                                                                                                                                                         Multi-View
Trend Summary
The Multi-View Trend Summary section provides information on all five VOCSN therapies (Ventilation, Oxygen, Cough,
Suction, and Nebulizer), including daily usage information, monitor averages, and trends.
Each box shows a different monitored parameter. The displayed average is calculated over the selected report duration.
7-day reports will include a 7-day average, 60-day reports will include a 60-day average, and so on.
Vte Breath Rate Set Pulse Dose Set FiO2 Cycles/Session Vacuum Neb. Duration
        ###units
                                       Minute Vol.                 MAP                  Calc. FiO2         Mon. FiO2            Peak Flow             Min/Max                 Min/Max
                                        6.6 mL                    9cmH2O                  34%                   ---           152 L/min             Sessions/Day            Sessions/Day
                    %
                                                                                                                 ---
                                        Pt. Trigger                 Leak                                                      Peak -/+ Pres.
                                          98%                     1 L/min                                                     -43/+46
    (Last 7 Days Trend)                     2%                       ---                                                            cmH2O
Ventilation and Oxygen are shown with a number below representing how                                                    HOURS/DAY SESSIONS/DAY
many hours these therapies were used each day. Cough, Suction, and
Nebulizer are shown with a number       9/1       9/2        9/3                                          9/4                 9/5                  9/6                    9/7
                                            24 24           1      24 24          1       24 24 1 1 1         24 24       1    24 24           1    24 24 2 2 1            24 24 2 2 1
 NOTE: If the V, O, C, S, or N            9/15                    9/16                  9/17              9/18                9/19                 9/20                   9/21
24 2 2 24 3 3
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                                                                                                                                               Multi-View
Therapy Use
Graphed therapy use provides instant insight into multi-therapy use and trends over time. In the example below, you can
see how an increase in Cough therapy correlated with a decrease in Oxygen use.
These charts also show the time and duration of alarm activations during the reported period. Therapy use charts appear
at the tops of pages to provide insight into settings changes and monitor values in the context of the frequency of all
therapy uses over the reported period. The gray shaded area indicates the period of time trend values are calculated
from.
Trend Period
        +
    +       +
                                                     +
Settings Overview                               +        +
The settings overview             Ventilation Settings
chart provides a visual              Mode                                 Bi-Level
over the report duration are Exsufflation Pressure (cmH2O) -25 -30
                                  Suction Settings
graphed on the chart to show
                                   Vacuum (mmHg)                          -180                                                        -195
when they occurred, and what      Nebulizer Settings
the setting was changed to.        Nebulizer Duration (minutes)           20                                            15
                                  Device Settings
                                   Alarm Volume                           Medium                                                                       High
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                                                                                                                     Multi-View
Monitor Details
Use the Monitor Details section to view detailed information about changes in delivered therapies over time, in the
context of multi-therapy use.
monitor indicates the trend 9/1 9/5 9/10 9/15 9/20 9/25 9/30
                                     26%          20
                                                   9/1   9/5         9/10        9/15         9/20            9/25                  9/30
+2 L/min 150
                                     1.3%        140
                                                  9/1    9/5        9/10        9/15         9/20             9/25                 9/30
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                                                                                                             Multi-View
Logs
At the end of the report, you may choose to include detailed logs that include information about every user interaction
with the VOCSN device over the report period. Multi-View provides four different optional Logs selections when
generating a report:
  •	 Therapy Log - The Therapy Log details the duration and start/stop times of all delivered VOCSN therapies
     including Ventilation, Oxygen, Cough, Suction, and Nebulizer.
• Alarm Log - The Alarm Log section shows every alarm activation, with its start/stop time and duration.
  •	 Configuration Log - The Configuration Log includes detailed information about all VOCSN settings changes
     made over the report duration. It shows the time of the configuration event, as well as the previous and
     updated control values. Detailed sub-sections for System, Ventilation, Cough, Suction, and Nebulizer organize
     this information by therapy.
  •	 Event Log - The Event Log is a combination of all three other logs, showing every user interaction with
     VOCSN over the report duration.
NOTE: To prevent generating reports that are too long to be usable, report Logs sections are limited in size.
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                                                                                            Checkout Procedure
Checkout Procedure
Ventec Life Systems recommends a series of checks and tests to ensure VOCSN is ready to use safely. Perform these
tests before using VOCSN for the first time, and periodically during use. See “Recommended Maintenance Schedule” on
page 10-7 for the maintenance schedule recommended by Ventec Life Systems.
 NOTE: This chapter describes checkout procedures for Ventilation, Oxygen, Cough, Suction, and Nebulizer therapies.
 Test only those therapies that are enabled for use with VOCSN.
Visual Inspections
Inspect the exterior of VOCSN for signs of damage.
 WARNING: Do not use VOCSN if it has evident signs of damage. External damage may be an indication of internal
 damage, and could adversely affect the performance of VOCSN. Contact your local Ventec Life Systems representative
 for service.
   1	   Each time you power on VOCSN, listen for two audio tones. These tones verify the VOCSN backup alarm, which
        is used in case of an Inop alarm condition or an issue with the VOCSN speaker.
   2	   If you do not hear two audio tones when powering on VOCSN, contact your local Ventec Life Systems
        representative for service.
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                                                                                                   Checkout Procedure
1 Verify that the two removable, rechargeable batteries are properly installed in the VOCSN battery wells.
        •	 VOCSN operates.
        •	 The charge status indicator light on the front of VOCSN is lit (green or orange).
        •	 The three battery icons on the VOCSN touchscreen display a fully-charged status, or a lightning bolt
           appears on one of the three battery icons to indicate charging.
        •	 The external power icon (      ) appears in the status bar.
   4	   Disconnect VOCSN from external power and verify:
        NOTE: The VOCSN batteries will not charge when overheated. Battery overheating may occur when VOCSN
        is run at settings that consume maximum power, and/or when it is operated in conditions outside its top
        environmental temperature range.
        NOTE: Periodically verify that the batteries are functional, and that the Internal Battery Low and Internal Battery
        Critically Low alarms are functional, by disconnecting VOCSN from external power until the batteries drain and
        these alarms activate.
   6	   Reinstall the removable batteries, and plug VOCSN into an external source of power. Keep VOCSN plugged in
        until all batteries are fully charged. The charge status indicator light on the front of VOCSN will illuminate green
        when all VOCSN batteries are fully charged.
NOTE: Other steps in this checkout procedure may be performed while VOCSN batteries are charging.
 NOTE: VOCSN battery icons on the touchscreen show the charge status of the batteries relative to when they were new.
 As the batteries age, their capacity will diminish. Ventec Life Systems recommends replacing batteries when they will no
 longer charge above 50%.
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                                                                                                   Checkout Procedure
NOTE: See “Changing Ventilation Therapy Settings” on page 75 for configuration instructions.
NOTE: If testing VOCSN between patient uses, begin by restoring it to its factory default settings.
 NOTE: If VOCSN is in long-term use with a patient, these testing procedures may be performed using the existing
 VOCSN configuration. Periodically verify the monitors and alarms described in this chapter are functioning correctly.
 NOTE: Some settings and alarms may not be applicable to a mouthpiece patient circuit setup. Configure and test only
 those settings and alarms that are available when the Circuit Type control is set to Mouthpiece.
Control Setting
PEEP 10 cmH2O
Leak Compensation On
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                                                                                               Checkout Procedure
NOTE: For mouthpiece patient circuit setups, these verification steps are not applicable.
NOTE: These ranges represent the combined tolerances of the delivered therapy and their independent monitor.
1 Run a Pre-Use Test. See “Running the Pre-Use Test” on page 50 for instructions.
2 Verify the Vte monitor reads between 374 and 642 mL.
5 Count the number of breaths delivered over one minute to verify the delivered Breath Rate is 12 BPM.
        •	 If using an external source of high-pressure oxygen and the FiO2 control, verify the delivered FiO2
           reads between 24% and 36%.
        •	 If using the internal O2 Concentrator and the O2 Flow Equivalent control, let the concentrator run for 5
           minutes and verify no O2 Concentration alarm activates.
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                                                                                                   Checkout Procedure
 NOTE: When performed as a maintenance step during patient use, the VOCSN alarm system may be performed using
 existing VOCSN control settings.
Follow the procedures in the following pages, and verify the following while testing each alarm:
• The name of the alarm condition appears in the upper left-hand corner of the touchscreen.
• A blue, yellow, or red banner flashes across the top of the touchscreen.
  •	 When an alarm deactivates, verify that the flashing blue, yellow, or red banner disappears from the top of the
     touchscreen, and that the audible alarm tones stop.
Test each alarm as described in the sections below.
 NOTE: VOCSN tests High PEEP, High Pressure, and High/Low FiO2 alarms automatically. The Patient Circuit Disconnect
 and decannulation tests are designed to ensure the Patient Circuit Disconnect and Low Minute Volume alarms are
 functioning correctly. Activation of the Low Minute Volume alarm serves as verification the High Minute Volume is also
 functional.
   1	   Connect the remote alarm to VOCSN and follow all testing instructions provided by the remote alarm
        manufacturer.
   2	   Verify that the remote alarm activates with each of the alarm conditions described in the remainder of this alarm
        testing procedure.
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                                                                                                     Checkout Procedure
1 If VOCSN is in use with a patient, provide an alternative means of Ventilation therapy to the patient.
2 Disconnect the Ventec One-Circuit from the patient’s tracheostomy tube or from the test lung.
   3	   With a clean, gloved hand, connect the patient’s emergency tracheostomy tube to the Ventec One-Circuit
        (without a test lung) and verify the appropriate alarms activate (Patient Circuit Disconnect and/or Low Minute
        Volume and/or Low Inspiratory Pressure).
        NOTE: If alarms do not activate during the decannulation alarm verification procedure described, alarm settings
        may need to be adjusted, or other means of decannulation detection may need to be added to the VOCSN
        system.
4 Reconnect the Ventec One-Circuit to the patient tracheostomy tube or test lung.
1 If VOCSN is in use with a patient, provide an alternative means of Ventilation therapy to the patient.
   2	   Disconnect the Ventec One-Circuit from VOCSN at the bacterial filter and verify the appropriate alarms activate
        (Patient Circuit Disconnect and/or Low Minute Volume and/or Low Inspiratory Pressure).
3 Reconnect the Ventec One-Circuit and verify all active alarms deactivate.
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                                                                                             Checkout Procedure
1 Change the VOCSN Cough control settings to those listed in the table below.
NOTE: See “Changing Cough Therapy Settings” on page 93 for configuration instructions.
Control Setting
   3	   Verify the pressure manometer reads between 27 and 54 cmH2O during insufflation, and between -27 and -54
        cmH2O during exsufflation.
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                                                                                                 Checkout Procedure
1 Set the Vacuum control for Suction therapy to -180 mmHg and start Suction therapy.
2 Completely occlude the suction port or connected suction tubing so that it creates an air-tight seal.
3 Verify that the Suction therapy vacuum monitor reads between -132 and -228 mmHg.
   1	   Connect the nebulizer that will be used to provide therapy to the Ventec One-Circuit, a test lung, and the
        nebulizer drive port on the right-hand side of VOCSN. See “Connecting a Nebulizer Cup to the Patient Circuit”
        on page 36 for instructions.
   2	   Set the Nebulizer Duration control to 15 minutes, and start Nebulizer therapy. See “Starting Nebulizer therapy”
        on page 156 for instructions.
3 Verify the Vte monitor (available on the Monitors tab) reads between 374 and 642 mL.
 NOTE: If the nebulizer is connected to a tee for use in a patient circuit, verifying the output flow from the connected
 nebulizer may require the occlusion of one end of the patient circuit connection port while measuring the output flow.
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                                                                                                              Checkout Procedure
Checkout Worksheet
The checkout procedures listed in the following worksheet should be performed before using VOCSN on a patient,
and periodically during use. Print and complete a copy of this worksheet to verify VOCSN checkout procedures were
completed.
 NOTE: If VOCSN is in long-term use with a patient, these testing procedures may be performed using the existing
 VOCSN configuration. Periodically verify the monitors and alarms described in this chapter are functioning correctly.
Signature:__________________________________________________________________________________________________
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                                                                                             Operating Instructions
Operating Instructions
Depending on the mix of therapies available and enabled on the device, VOCSN can be used to provide Ventilation,
Oxygen, Cough, Suction, and/or Nebulizer therapy to the patient. This chapter describes how to start and use each of
the therapies. See “Controls and Settings” on page 74 for therapy configuration instructions.
 IMPORTANT NOTE: Only one of the following therapies can be delivered at a time: Oxygen, Suction, or Nebulizer. See
 “VOCSN Therapy Interactions” on page 102 “for details. If continuous Oxygen therapy is critical to patient care, use an
 alternate means of delivering Suction and/or Nebulizer therapy.
 WARNING: When in use for a prolonged period at its maximum environmental operating temperature, VOCSN may
 reach a temperature at the patient connection port of 43°C. To ensure patient safety, avoid prolonged use at maximum
 operating temperatures, and move the patient and the device to a cooler location if necessary. Use of VOCSN outside
 its recommended range of temperature, altitude, and/or relative humidity may adversely affect the ventilation and
 oxygen concentration flow rate from VOCSN, and may result in patient harm. See “Environmental” on page 190 for
 details.
 WARNING: If critical to patient care, always have an alternative means of ventilation, oxygen, nebulization, and
 secretion management available. In case of unexpected VOCSN operation, failure to have alternative means of therapy
 available may result in patient harm or death.
 WARNING: Do not use VOCSN within magnetic resonance (MR) environments. Using VOCSN within MR environments
 may affect VOCSN or MR device performance, damage the devices, or harm individuals.
 WARNING: If the patient feels discomfort or experiences a medical emergency during Ventilation or Oxygen therapy,
 seek medical assistance immediately. Patients unable to communicate discomfort (such as geriatric or pediatric
 patients) may require additional monitoring and/or a distributed alarm system to alert the caregiver to the discomfort
 and ensure patient safety.
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                                                                                               Operating Instructions
Powering On VOCSN
VOCSN will run on external power (such as a wall outlet), or on its internal and removable batteries. Ventec Life Systems
recommends powering VOCSN with an external, continuous source of power whenever possible. See “Power Setup” on
page 22 for instructions on connecting VOCSN to external power.
NOTE: After pressing the On/Off button, VOCSN will be ready to deliver therapy in ≤30 seconds.
1 Press the On/Off button on the front of VOCSN to power on the device.
        •	 If VOCSN is connected to external power, the power connection icon appears on the touchscreen, and
           the charge status indicator light on the front of VOCSN is illuminated.
   3	   Check the VOCSN Date and Time settings, and adjust them if needed. See “Changing Device Settings” on page
        100 for instructions.
If the internal battery depletes fully, VOCSN Date and Time settings will reset to their default values. To ensure the Alarm
and Event logs record information accurately, verify the VOCSN Date and Time settings before use, and set them to the
correct values if necessary.
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                                                                                            Operating Instructions
It is of vital importance that a caregiver or other supervisor capable of responding to any VOCSN alarms be present
during VOCSN therapy. The VOCSN clinician or caregiver must be capable of responding to alarm conditions, and
trained to use VOCSN. A list of available VOCSN training options is available at VentecLife.com.
To ensure the delivered therapy is adequate, monitor the patient each time VOCSN is started, control settings are
modified, an accessory is attached, or the Ventec One-Circuit is reconfigured. The operator of VOCSN should be within
range of the audible VOCSN alarm tones. Place VOCSN so that any monitors critical to patient care are visible.
 WARNING: Do not use VOCSN with helium (including mixtures with helium), nitric oxide, or in a hyperbaric chamber.
 VOCSN has not been validated for safe use with helium, nitric oxide, or for use in a hyperbaric chamber.
 NOTE: If VOCSN performs unexpectedly, prepare an alternate means of ventilation, monitor the patient, and contact
 your local Ventec Life Systems representative for service.
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                                                                                                                              Operating Instructions
                                                           No Alarms                            V   O SIMV-VOL
 WARNING: Always have a backup means
                                                      0            L     5               10         15           20               H 25          30
 of ventilation available (such as a backup
 ventilator or manual resuscitator) in case           PRESSURE (cmH20)
 of VOCSN failure. Inability to immediately                                       Prepare patient circuit for ventilation,                            Press here
 access an appropriate alternative means of
                                                                                select preset, and press START to begin.
                                                                                                                                                     if you need
 ventilation may result in death for patients                                                                                                        to change a
                                                                               DAY               NIGHT                MOBILE
                                                                                                                                                        control
 dependent on Ventilation therapy.                                            SIMV-VOL           AC-PRES              SIMV-PRES
                                                          EXIT                                                                           SETTINGS
                                                                                                                                         & ALARMS
                                                                             NOW ACTIVE
 NOTE: When VOCSN is used to provide                                                                                 START
                                                                                                                   ACTIVE NOW
 NOTE: If a speaking valve is used, Ventec Life Systems recommends use of an active Ventec One-Circuit and/or pressure
 mode of ventilation. See “Setting up Ventilation therapy with a Speaking Valve” on page 39 for more information.
1 Connect the Ventec One-Circuit and any patient circuit components. See “Setup” on page 20 for instructions.
   3	   Verify that the set Ventilation therapy controls and alarms are set correctly, and that the correct Ventilation
        therapy Preset is active.
        NOTE: To verify or change Ventilation therapy settings, press the EXIT button on the Pre-Use Test screen. Follow
        the instructions described in “Changing Ventilation Therapy Settings” on page 75.
        NOTE: If the Pre-Use Test screen does not appear automatically, run a user-initiated Pre-Use Test by pressing the
        Menu tab, and then the PRE-USE TEST button.
        NOTE: If used, remove the HME from the Ventec One-Circuit to ensure the Pre-Use Test passes and correctly
        calculates the Ventec One-Circuit resistance.
   5	   Ventilation therapy will begin. For information about monitored Ventilation therapy parameters, see “Ventilation
        Monitors” on page 117.
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                                                                                                      Operating Instructions
1 Press the Therapy tab, and then press the Ventilation therapy icon.
   3	   Press START on the bottom of the screen to begin Ventilation therapy using the selected Preset control and
        alarm settings.
 NOTE: If the Circuit Type control of the selected ventilation Preset is set to a value different than the existing Preset, you
 will be prompted to modify the Ventec One-Circuit accordingly and run a Pre-Use Test prior to reinitializing Ventilation
 therapy. If time constraints make running the test inadvisable, press the EXIT button to immediately initiate Ventilation
 therapy with the selected Preset.
No Alarms V O SIMV-VOL
0 L 5 10 15 20 H 25 30
PRESSURE (cmH20)
                                                                                 START
                                                                               ACTIVE NOW
 NOTE: To change Ventilation therapy settings press the Preset name and then the SETTINGS & ALARMS button. Follow
 the instructions described in “Changing Ventilation Therapy Settings” on page 75 to modify Ventilation therapy
 settings. When configuration is complete, press < EXIT to return to the Ventilation therapy screen.
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                                                                                                                                                      Operating Instructions
 NOTE: A low-pressure oxygen source may also be used as an additive or alternate source of Oxygen therapy, not
 controlled using the VOCSN Oxygen therapy settings.
 WARNING: The O2 Concentration alarm may take more than five minutes to activate, depending on VOCSN therapy
 settings. If the patient’s prescribing healthcare professional determines Oxygen therapy is critical to patient care,
 provide continuous monitoring, such as pulse oximetry or proximal FiO2 monitoring.
 NOTE: Oxygen therapy can be hazardous to patients with certain medical conditions. Always seek professional medical
 advice before using VOCSN to provide oxygen therapy to a patient
NOTE: Hot, humid environments may reduce the oxygen generation capacity of the internal O2 Concentrator.
 NOTE: Oxygen therapy (from the internal O2 Concentrator or a source of external high-pressure oxygen) will suspend
 during Suction or Nebulizer therapy. Pulse dose Oxygen Direct therapy will pause during Cough. Oxygen therapy
 automatically resumes once these therapies complete.
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                                                                                               Operating Instructions
 WARNING: Do not smoke near elevated oxygen levels. Smoking near elevated oxygen levels greatly increases the
 risk of fire, and may result in facial burns or death. Do not smoke in the same room as, or produce open flames within
 2 meters of, a running oxygen concentrator or other oxygen sources or accessories that are in use. Leave the room
 containing the oxygen source if smoking. If the patient is smoking, remove the patient circuit or mask. If the patient or
 caregiver intends to smoke but cannot leave the room, turn off the oxygen concentrator and wait ten minutes before
 smoking.
 WARNING: Do not bleed oxygen into the Ventec One-Circuit from an external source not connected to one of the
 VOCSN oxygen input ports. Bleeding oxygen directly into the Ventec One-Circuit may increase the patient’s tidal
 volume, or affect breath triggering.
 WARNING: The O2 Flow Equivalent control setting may not result in a flow that corresponds to bleeding a continuous
 flow of oxygen into a ventilator. Monitor patient oxygenation and adjust the O2 Flow Equivalent control appropriately
 for the patient condition to ensure patient safety.
Using O2 Flush
The O2 FLUSH button on the Oxygen screen delivers either
100% FiO2, or 6 L/min O2 Flow Equivalent (depending on the
selected O2 Delivery Mode) for 3 minutes.
A blue fill around the button indicates the approximate time                100                               6
                                                                               %                            L/min
remaining. After 3 minutes, the O2 Flush will stop, and oxygen
will resume delivery at the activated preset setting.
During delivery, use the STOP O2 FLUSH button under the timer            O2 FLUSH                      O2 FLUSH
to cancel the O2 Flush and resume delivery at the activated
preset setting.
 NOTE: To help ensure patient safety, active Oxygen therapy presets cannot be stopped until O2 Flush is completed or
 canceled. Starting a new Oxygen therapy preset will automatically cancel an active O2 Flush session, and instead begin
 Oxygen therapy at the new preset settings.
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                                                                                             Operating Instructions
Using the Internal O2 Concentrator to Provide Pulse Dose Oxygen Direct Therapy
The VOCSN internal O2 Concentrator is used to provide Oxygen Direct therapy to the patient in Pulse Dose mode,
through a Ventec One-Circuit O2 tube. To use the VOCSN internal O2 Concentrator:
1 If not already enabled, set the O2 Concentrator control in the Enabled Prescribed Therapies menu to Enabled.
  2	   Verify a Ventec One-Circuit O2 tube is connected to the O2 port on the right side of VOCSN. See “Connecting a
       Ventec One-Circuit O2 Tube” on page 33 for setup instructions.
NOTE: See “Changing Oxygen Settings” on page 90 for detailed configuration instructions.
5 If not already active, start the configured Oxygen therapy Preset, and run the Pre-Use Test if prompted.
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                                                                                             Operating Instructions
       NOTE: Whenever the FiO2 control is set above 21%, use the FiO2 monitor and set the High FiO2 and Low FiO2
       alarms appropriately for the patient condition.
5 If not already active, start the configured Oxygen therapy Preset, and run the Pre-Use Test if prompted.
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                                                                                                                           Operating Instructions
 NOTE: Cough therapy and Suction                                          Prepare patient circuit for Cough therapy,
 therapy can be initiated at the same                                     select preset, and press START to begin.
  CAUTION: To prevent nebulized material from reaching VOCSN, Cough therapy should not be activated during
  External Nebulizer Compensation. Remove the connected external nebulizer and pause External Nebulizer
  Compensation before activating Cough therapy.
   2	   If needed, set the Cough controls to provide the prescribed therapy. See “Cough Therapy Controls” on page
        93.
3 Ensure the desired Cough Preset is selected, and then press START to begin Touch Button Cough therapy.
        NOTE: If Breath Sync is set to On, coughs will be delivered when triggered by the patient as determined by the
        Flow Trigger setting configured using the Ventilation therapy controls.
   4	   Cough therapy will deliver the configured number of Cough Cycles, unless Cough therapy is stopped using
        the STOP button. During Cough therapy, the VOCSN will display a monitors screen with information about the
        delivered therapy. See “Cough Therapy Monitors” on page 123 for more information.
5 When the configured Cough therapy completes, Ventilation therapy will resume automatically.
        NOTE: Masks with an integrated leak may impair the effective delivery of Cough therapy. Temporarily replace
        a connected mask incorporating an integrated leak with a mask that does not incorporate an integrated leak
        during Cough therapy.
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                                                                                                                                                   Operating Instructions
Pressure modes of ventilation automatically compensate for the negative flow generated by Suction therapy. Ventilation
therapy delivered in volume modes (Assist/Control-Volume or SIMV-Volume) may be affected by Suction therapy. When
using a volume mode of ventilation with Suction therapy, monitor the patient to ensure ventilation flow is sufficient, or
switch to pressure ventilation mode while suctioning.
Follow your healthcare institution’s protocol to ensure Suction therapy is delivered safely. To help ensure safe suctioning
of the patient, Ventec Life Systems recommends following the American Association for Respiratory Care (AARC)
Guidelines when appropriate for the patient condition, which suggest -80 to -100 mmHg for infants, -100 to -120 mmHg
for children, and -100 to -150 mmHg for adults.
 NOTE: Cough therapy and Suction therapy can be initiated at the same time. On the Cough therapy screen, press the
 Settings icon and set the Cough+Suction control to On for any or all of the three Cough Presets. Suction will begin at
 the start of the first Cough therapy insufflation at the default set Suction setting, and run throughout the configured
 number of Cough Cycles plus an additional 2 minutes.
 NOTE: If running, Oxygen therapy (from the internal O2 Concentrator or a source of external high-pressure oxygen) will
 suspend during Suction therapy. Oxygen therapy automatically resumes once Suction therapy is complete. See “VOCSN
 Therapy Interactions” on page 102 for more information.
No Alarms V O SIMV-VOL
0 L 5 10 15 20 H 25 30
PRESSURE (cmH20)
                                                                                                                                                    apply to
                                          500                                                                     50
                                                                        185
                      EXIT                                  20                                                                    SET
                                                                                                                                               Cough+Suction)
                                         550                                                         0           0              DEFAULT
                                                                            mmHg                   inHg        mmHg
                                                                    START
                                                                 STOP START
                                                                       THERAPY
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                                                                                              Operating Instructions
   1	   If the Ventec One-Circuit is not already set up to provide Suction therapy, follow the instructions in “Oxygen
        Therapy Setup” on page 41.
2 Press the Therapy tab, and then press the SUCTION button.
   3	   If needed, set the Vacuum control to provide the prescribed suction intensity by using the up and down arrows.
        See “Changing Suction Settings” on page 96 for more information.
   5	   Verify there are no leaks and that Suction therapy is functioning as intended by occluding the suction tubing or
        attached catheter with a clean, gloved hand. Observe the suction monitor (indicated by the solid fill inside the
        arc) and verify it matches the set vacuum value (displayed as a numeric value inside the arc, and a black line).
        NOTE: At high altitudes, the delivered vacuum may be lower than the set value. If necessary, set the vacuum
        control higher to achieve the desired suction at high altitudes.
   6	   Suction therapy will run at the set Vacuum intensity for two minutes, or until deactivated by pressing the STOP
        button.
NOTE: Suction therapy automatically stops two minutes after the last user interaction with the VOCSN touchscreen.
 NOTE: If the Ventec Travel Suction Canister overfills, Suction will stop. Replace the Ventec Travel Suction Canister by
 following the instructions in “Emptying the Ventec Travel Suction Canister and Replacing Suction Components” on page
 162 before resuming Suction.
 NOTE: If any liquid or solid secretions have been drawn into the VOCSN internal vacuum pump, discontinue use of the
 system and contact your local Ventec Life Systems representative for service.
 NOTE: The suction pump includes an electronic sensor that monitors the pressure created by VOCSN and the pressure
 generated inside the suction collection container. If the pressure in the container and VOCSN become unequal, suction
 will stop automatically. This feature prevents the backup of fluid to the pump or patient.
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                                                                                                                       Operating Instructions
 NOTE: If running, Oxygen therapy (from the internal O2 Concentrator or a source of external high-pressure oxygen) will
 suspend during internal Nebulizer therapy. Oxygen therapy automatically resumes once internal Nebulizer therapy is
 complete. Nebulizer therapy from VOCSN will terminate if Suction therapy is activated, and pause if Cough therapy is
 activated. External Nebulizer Compensation is not affected by other therapies. See “VOCSN Therapy Interactions” on
 page 102 for details.
 NOTE: If Oxygen therapy is critical to patient care, it is important to understand the effect of External Nebulizer
 Compensation on oxygenation, particularly for patients receiving small Tidal Volumes. For a detailed description
 of the External Nebulizer Compensation feature, including recommendations for maintaining the intended patient
 oxygenation, see “External Nebulizer Compensation” on page 216.
  CAUTION: To prevent nebulized material from reaching VOCSN, Cough therapy should not be activated during
  External Nebulizer Compensation. Remove the connected external nebulizer and pause External Nebulizer
  Compensation before activating Cough therapy.
  CAUTION: VOCSN Nebulizer therapy is not recommended during High Flow therapy for pediatric patients receiving
  <15 L/min. At Flow settings of <15 L/min, the accuracy of the delivered flow may be affected by Nebulizer therapy.
  While not recommended, Flow settings of 4 or 5 L/min will display as 6 L/min during Nebulizer therapy (and may not
  accurately represent the actual flow delivered) because of added flow through the nebulizer.
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                                                                                              Operating Instructions
When activated, the nebulizer drive or compensation runs continuously for the set Nebulizer Duration, during both
inhalation and exhalation. To provide Nebulizer therapy:
   1	   Connect a nebulizer by following the instructions in “Connecting a Nebulizer Cup to the Patient Circuit” on page
        36.
2 Press the Therapy tab, and then press the NEBULIZER button.
   3	   If needed, set the Nebulizer Duration control by using the plus (+) and minus (-) buttons. See “Changing
        Nebulizer Settings” on page 97 for more information.
   4	   Select Internal Neb. Therapy to provide therapy from the VOCSN nebulizer drive (available on configurations
        with Nebulizer therapy), or External Neb. Compensation to compensate for the flow from an external nebulizer
        (available on all configurations). Press START to begin Nebulizer therapy.
5 Nebulizer therapy will run for the set Nebulizer Duration, or until deactivated by pressing the STOP button.
NOTE: Every 10 minutes, internal Nebulizer therapy will pause for 6 seconds, and then automatically resume.
        NOTE: High Pressure alarms will cause internal Nebulizer therapy delivery to briefly pause, though the Nebulizer
        Minutes Remaining monitor will continue to decrement. Frequent high pressure alarms may cause material in the
        cup to nebulize more slowly than expected.
   6	   When Nebulizer therapy is complete, disconnect the nebulizer from the VOCSN nebulizer port, and then from
        the patient circuit.
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                                                                                            Operating Instructions
Responding to Alarms
The VOCSN operator must be capable of responding to alarm conditions and promptly performing the necessary
corrective actions. See “Alarms” on page 103 for information on each alarm condition. In case of VOCSN malfunction,
the operator must be able to promptly provide an alternative means of ventilation.
If the VOCSN touchscreen is not accessible, you may also press and hold the On/Off button for at least ten seconds. A
pop-up will appear while the backup alarm sounds and the Alarm Silence button flashes. Within 10 seconds, press and
hold the Alarm Silence button until the VOCSN touchscreen indicates the device is shutting down.
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                                                                                         Cleaning and Maintenance
The organization responsible for the use and maintenance of VOCSN should perform all adjustments, cleaning, and
disinfection of VOCSN. Follow all instructions provided in this Clinical and Technical manual to prevent damage to
VOCSN during cleaning and maintenance procedures.
 NOTE: All VOCSN single-patient use components and Ventec One-Circuits, including the Ventec Travel Suction
 Canister, suction tubing, Ventec Secretion Trap, and Ventec Humidifier Bypass are not intended for cleaning, sterilization,
 or re-use. Replace VOCSN single-patient use components and Ventec One-Circuits regularly, following your healthcare
 institution’s protocol.
Cleaning VOCSN
Before cleaning any part of VOCSN, disconnect external power sources.
 WARNING: Do not perform maintenance or service on VOCSN while it is powered on or in use. Maintenance, or
 service procedures performed during use may temporarily alter the performance of VOCSN and result in patient harm.
 WARNING: Do not touch the patient and parts inside the VOCSN enclosure simultaneously. High flows of electricity are
 present inside VOCSN enclosure and may be an electrocution hazard.
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                                                                                       Cleaning and Maintenance
  1	   Unplug VOCSN from any connected external power sources. Abrasive cleaners and materials may damage the
       casing or display. Use only cleaning materials recommended in this manual. Clean the entire exterior surface with
       one of the following wipes or solutions with a soft cloth:
        •	 Solutions: Water (including water mixed with soap or a mild detergent), 70% isopropyl alcohol,
           MadaCide FD, Metrex CaviCide1
        •	 Wipes: MadaCide FDW, Metrex CaviWipes, PDI Super Sani-Cloth, PDI Sani-Cloth Plus, Diversey Oxivir,
                                                                                                  UNLOCKED                   LOC
           or Safetec SaniZide Plus
 NOTE: Pay close attention to the LCD screen while cleaning, to ensure buttons on the
 touchscreen are not unintentionally pressed. Ventec recommends locking the touchscreen using
 the lock screen button in the status bar, and then gently wiping over the top of and across the
 touchscreen to clean it. This technique helps prevent inadvertent button presses.
  2	   Do not allow liquid to drip through VOCSN exterior casing or into the removable battery well. Use a soft, dry
       cloth to remove any residual moisture after cleaning.
3 Let VOCSN dry completely after cleaning before plugging it in to an external power source.
  4	   Visually inspect VOCSN to verify it is clean. Repeat the cleaning steps described above until VOCSN passes a
       visual inspection.
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                                                                                           Cleaning and Maintenance
1 Power off and unplug VOCSN, and take out the removable, rechargeable batteries.
   7	   Inspect the filters for signs of damage or contamination. Replace the filters if they appear damaged. Repeat the
        cleaning steps described above until the filters pass a visual inspection for cleanliness.
NOTE: Replacement air filters are available from Ventec Life Systems.
NOTE: Check to ensure the black o-ring is installed around the exterior of the fan filter cover grate.
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                                                                               Cleaning and Maintenance
Replacing Components
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                                                                                       Cleaning and Maintenance
Connect the new AC adapter to the VOCSN and power outlet. For more information, see “Power Setup” on page 22.
The patient condition, damage to the Ventec One-Circuit, or contamination may be conditions that require Ventec One-
Circuit replacement. Follow your healthcare institution’s protocol for Ventec One-Circuit and Ventec Humidifier Bypass
replacement criteria.
 NOTE: Replacement parts are available from Ventec Life Systems. Contact your Ventec Life Systems representative
 to order a replacement Ventec One-Circuit or Ventec Humidifier Bypass. See “Accessories” on page 200 for a list of
 accessories available from Ventec Life Systems.
   2	   Disconnect the Ventec One-Circuit or Ventec Humidifier Bypass from VOCSN. Disconnect all Ventec One-Circuit
        components.
   3	   Connect a new Ventec One-Circuit or Ventec Humidifier Bypass, and reconnect all components. See Chapter 2,
        “Setup” for instructions.
5 Run a Pre-Use test. See “Running the Pre-Use Test” on page 50 for more information.
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                                                                                            Cleaning and Maintenance
The Ventec Secretion Trap is intended for single-patient use. Replace the Ventec Secretion Trap between patient uses,
or whenever it becomes contaminated. The patient condition, damage to the component, or contamination may be
conditions that require Ventec Secretion Trap replacement. Follow your healthcare institution’s protocol for Ventec
Secretion Trap replacement criteria.
 NOTE: Ventec Life Systems recommends running a Pre-Use Test each time the Ventec One-Circuit configuration is
 modified. See “Running the Pre-Use Test” on page 50 for instructions.
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                                                                                        Cleaning and Maintenance
 NOTE: It may be necessary to replace the internal bacterial filter more often in some environments, such as those with
 cigarette smoke. VOCSN may fail its Pre-Use Test if the internal bacterial filter becomes heavily contaminated.
   1	   If needed, provide the patient with backup ventilation, and then remove the patient circuit and the external
        bacterial filter. See “Replacing the External Bacterial Filter” on page 164 for detailed instructions.
  CAUTION: Do not let anything enter the cavity behind the filter during the replacement process. Do not re-install the
  Internal Bacterial Filter screws without using a calibrated torque driver. Foreign material inside VOCSN or using too
  much torque on these screws may severely damage VOCSN.
   5	   Confirm the Internal Bacterial Filter was replaced correctly by performing the “Ventilation and Oxygen Testing
        Procedures” on page 137.
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                                                                                                    Cleaning and Maintenance
 NOTE: VOCSN includes an internal clock that monitors the time elapsed since the device was last serviced. The Sys. PM
 Due In monitor counts down to the next time periodic maintenance should be performed on VOCSN by an authorized
 service representative. Contact your VOCSN representative when the Maintenance Due or Service Concentrator Soon
 alarm activates.
 NOTE: A service manual containing detailed technical information required by authorized service technicians to repair
 and replace serviceable parts of VOCSN is available from Ventec Life Systems on request. Only authorized service
 technicians should repair VOCSN.
Before storage Fully charge removable and internal batteries. Patient, Caregiver, or Clinician
 Every thirty days during    Fully charge removable and internal batteries.                           Patient, Caregiver, or Clinician
 storage
 Every day during use        Inspect the Ventec Travel Suction Canister, if used. Replace the         Caregiver or Clinician
                             container if it is full.
                             Inspect and clean the air and fan filters. Replace the filters as
                             needed.
                             Inspect the Nebulizer Filter. Replace the filter if it is damaged or
                             contaminated.
                             Inspect the VOCSN exterior, including all connection ports and
                             connected components, for signs of damage.
 Every month during use      Test the VOCSN alarm system. See “Ventilation Alarm Verification”        Caregiver or Clinician
                             on page 139 for instructions.
                             Test the VOCSN batteries and power cord. See “Power Testing
                             Procedures” on page 136 for instructions.
                             Replace the VOCSN Bacterial Filter and Nebulizer Filter.
 Every three months          Clean the exterior of VOCSN. See “Cleaning VOCSN Exterior” on            Caregiver or Clinician
 during use                  page 160 for instructions.
 “Service Concentrator       Contact Ventec Life Systems to have VOCSN serviced by a trained          Caregiver or Clinician
 Soon” alarm                 technician.
 Every two years, or every   Contact Ventec Life Systems to have VOCSN serviced by a trained          Caregiver or Clinician
 10,000 hours                technician.
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                                                                                           Cleaning and Maintenance
Battery icons in the status bar display a battery’s charge status relative to its capacity (which diminishes over time). When
plugged into external power for an extended period, these status bar indicators will always report a 100% charge, even
when the absolute battery capacity has decreased with use and time.
The battery Absolute Charge status (shown on the My VOCSN screen) reports how the battery capacity is diminishing
over time. Over time, the battery icons in the status bar will display a full (100%) charge, and the absolute charge status
displayed on the My VOCSN screen will read <100%, even when VOCSN is plugged into external power for an extended
period.
Battery replacement is recommended when the battery icons in the status bar show 100%, but the battery Absolute
Charge status on the My VOCSN screen shows 50% or less. This means the battery has half (or less) of the charge
capacity it did when new. Removable battery replacements are available from Ventec Life Systems. The internal battery
must be replaced by Ventec Life Systems service personnel.
NOTE: Ensure the batteries are fully charged before storing VOCSN.
 NOTE: The removable batteries are intended to charge while installed in VOCSN or the Removable Battery Quick
 Charger. Do not attempt to charge the VOCSN batteries while removed from the VOCSN or the charger.
NOTE: Use batteries from Ventec Life Systems. Do not use batteries from other manufacturers to power VOCSN.
 WARNING: Do not damage the rechargeable Lithium-ion battery. A damaged battery may cause an explosion or fire,
 and may result in personal injury and/or property damage. To prevent injury or damage:
   •	 Do not use or charge the battery if it appears to be damaged. Signs of damage include, but are not limited to,
      discoloration, warping, and leaking battery fluid.
   •	 Do not expose the battery to fire, high temperature.
   •	 Do not immerse the battery in water.
   •	 Do not use or store the battery inside a vehicle during hot weather.
   •	 Do not drop or puncture the battery.
   •	 Do not open the battery or short-circuit its contacts.
 WARNING: Avoid contact with the rechargeable lithium-ion battery if it appears to be leaking. Battery fluid is corrosive.
 Contact with battery fluid can result in personal injury and/or property damage. To prevent injury or damage:
   •	 If the battery leaks, avoid contact with the battery fluid.
   •	 If the battery fluid gets into your eyes, immediately rinse your eyes with clean water and seek medical attention.
      Do not rub your eyes.
   •	 If battery fluid gets onto your skin or clothing, immediately use clean water to wash off the battery fluid.
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                                                                                                          Cleaning and Maintenance
Software Updates
Ventec Life Systems periodically releases VOCSN software updates, which may include new features and extended
functionality. Software updates occur in the field as needed, or when VOCSN is serviced. Contact Ventec Life Systems for
additional information about software releases and upgrades.
This Clinical and Technical manual describes the features available with the latest version of software. VOCSN devices
operating using a previous revision may not include all features and controls described in this manual. The following
table provides a high-level overview of the major features released with each software version (listed newest to oldest).
 SW Version          Features
 4.06R               •	   Introduced Multi-View support.
                     •	   Added Leak+ performance for compatible devices.
                     •	   Released three new ventilation modes to replace “Volume Targeted” control: Vol. Targeted-PS, Vol. Targeted-PC,
                          and Vol. Targeted-SIMV.
 4.05R               •	   Corrected occasional black screen on startup.
 4.04R               •	   Protection against potential hardware issues that may arise in rare cases.
                     •	   Increased battery icon resolution to show greater charge status detail.
                     •	   Optimized graphics memory usage to improve touchscreen performance.
                     •	   Minimum PEEP setting for Valveless circuits increased from 0 to 4 cmH2O.
 4.03R               •	   External Nebulizer Compensation feature introduced.
                     •	   New Volume Targeted controls for increased patient comfort: Pres. Minimum and Pres. Adj. Rate.
                     •	   Flow Trigger control resolution and minimum setting changed to 0.5 L/min.
                     •	   “Maintenance Required” alarm changed to “Maintenance Due” and now only occurs when the Sys. PM Due In
                          monitor falls below 0. A new “Service Concentrator Soon” alarm activates when service should be scheduled for
                          the internal O2 Concentrator.
                     •	   “O2 Concentrator Usage” monitor modified to display total hours oxygen therapy has been active, rather than
                          incrementing only when the concentrator activates to fill the oxygen tank. (Concentrator activation is intermittent
                          during normal oxygen delivery, and is counted and displayed using the new “VPSA Usage” monitor).
 4.02R               •	   Add time to the Nebulizer while running.
                     •	   Pre-Use Test timeout after 20 seconds.
 4.01.06R            •	   Nebulizer resumes after Cough.
 4.01.03R            •	   O2 Flush feature.
                     •	   Touchscreen lock/unlock.
 NOTE: In VOCSN documentation, software after 4.02 is referred to by the first digit and decimal. For instance, version
 4.03.02R is known as 4.03R.
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                                                                                        Cleaning and Maintenance
Environmental Considerations
To minimize the environmental impact of VOCSN use during its service life, follow all setup, operation, cleaning, and
maintenance instructions and recommendations provided in this manual.
VOCSN contains lithium-ion (Li-Ion) batteries and other potentially biohazardous materials. Dispose of VOCSN and any
potentially biohazardous parts or accessories in accordance with local regulations.
Follow your local governing ordinances for disposal and recycling of the Li-ion Battery Pack and its accessories. If
Waste Electrical and Electronic Equipment (WEEE) directive regulations apply, do not dispose of the battery in unsorted
municipal waste. Within Europe, contact the EU Authorized Representative for disposal instructions. The battery contains
Lithium Ion cells and should be recycled. The battery must not be incinerated.
Shipping Considerations
To ensure the device is not damaged during shipment, and that the shipment meets all applicable regulations, always
use packaging approved by Ventec Life Systems when shipping VOCSN. Contact Ventec Life Systems with questions,
and to obtain packaging materials.
Do not ship batteries with signs of mechanical damage by aircraft. Damaged batteries should be discarded or recycled in
accordance with local regulations.
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                                                                                                               Glossary
Glossary
Glossary of Symbols
The following symbols appear on the exterior of VOCSN.
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                                                                                                      Glossary
                 Lithium-Ion battery. Recycle in accordance with local   Li-Ion Battery Recyclable Symbol
                 regulations                                             ISO 7000 Symbol 1135
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                                                                                                             Glossary
YYYY-MM-DD
                 Caution                                                        Caution
                                                                                ISO 7000 Symbol 0434A
                 The VOCSN isolates the patient from live voltage in the        Type BF Applied Part
                 device                                                         IEC 60417 Symbol 5333
                 Indicates external power and battery charging status           External Power Indicator Light
                                                                                Industry standard
                 The IP32 rating indicates that the VOCSN enclosure             Degree of Ingress Protection Provided
                 protects it against ingress from wires and tools >2.5mm,       by Enclosure
                 and dripping water                                             IEC 60601-1, Table D.3, Symbol 2
                 Federal law restricts this device to sale by or on the order   Prescription Only
                 of a physician                                                 21 CFR 801.15(c)(1)(i)F
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                                                                                                        Glossary
                 Indicates that the VOCSN has been certified by TUV for       TUV Certification Mark
                 safety according to Canadian and US regulations              TUV Rheinland
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                                                                                                    Glossary
Glossary of Indicators
The following icons and indicators may appear on the VOCSN touchscreen:
    L                                                               H
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                                                                                             Glossary
This icon appears in the status This icon appears in the status
This icon appears in the status This icon appears in the status
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                                                                                                                Glossary
Glossary of Terms
 Term                 Definition
 AC                   Alternating Current. VOCSN can be connected to external, continuous sources of AC power, such as
                      a wall outlet.
Apnea The temporary cessation of a patient’s ability to initiate breaths on their own.
Assist breath A breath that is initiated by patient effort and cycled by VOCSN.
 DC                   Direct Current. VOCSN can be connected to external sources of DC power, such as wheelchair
                      outlets.
 MAP                  Mean Airway Pressure. The MAP is the average patient airway pressure as measured over one full
                      breath cycle.
 Sigh                 The Sigh control can be set to deliver a breath at 150% the normal breath volume every 100th
                      mandatory or assist breath.
 SIMV                 Synchronous Intermittent Mandatory Ventilation. Depending on the frequency of patient effort,
                      mandatory, assist, and spontaneous breaths will be delivered to the patient as either volume or
                      pressure breaths (depending on the ventilation mode selected).
Tidal Volume The total volume of gas entering the lungs during one breath.
Vte Exhaled Tidal Volume. The total volume of gas leaving the lungs during one breath.
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                                                                                                                   Troubleshooting
Troubleshooting
Some issues with VOCSN can be resolved quickly by following the steps described in this chapter. Others may require
service from an authorized Ventec Life Systems service technician. In case of VOCSN malfunction, the clinician or
caregiver must be able to provide an alternative means of ventilation promptly when necessary.
Troubleshooting Alarms
The VOCSN operator must be capable of responding to alarm conditions and promptly performing the necessary
corrective actions. See “Alarms” on page 103 for information on each alarm condition, including the recommended
actions associated with each.
                                           •	 Ensure the Apnea alarm is set appropriately given the patient’s Breath Rate
                                              and spontaneous rate.
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                                                                                                                     Troubleshooting
                                             •	 To clear the Battery Use alarm while using removable, rechargeable battery
 Battery Use activates whenever
                                                power, navigate to the Alarm Log and select “Clear List” twice.
 VOCSN switches from external
 power to battery power, or from any       When using AC power, check to ensure there’s a power connection symbol in the status
 power source (including removable         bar. If the power symbol is present, VOCSN is powered.
 battery) to internal battery power.         •	 Clear the alarm by navigating to the Alarm Log and selecting “Clear List”
                                                twice.
 Internal Battery Low activates            If there is no power connection symbol in the status bar:
 when VOCSN internal battery charge
                                             •	 If the green light on the power adapter block is illuminated, check that all
 status falls below 50%.
                                                power adapter cabling is securely connected, and that the cable is securely
                                                connected to the power port in the back of VOCSN.
 Internal Battery Critically Low
 activates when the internal battery         •	 If the green light on the power adapter block is off (not illuminated):
 is disconnected, faulty, or when the
                                                 •	 Ensure power adapter is plugged into the wall outlet.
 battery is critically low (charged to
 less than 33% its capacity).                    •	 Ensure the AC power cord is securely plugged into the power adapter
                                                    block.
• Plug something else into the same wall outlet to ensure it is powered.
 Check O2 Source activates when              •	 Check to ensure the low‑pressure oxygen source is connected.
 a connected source of external low-
 pressure oxygen is used and the             •	 Make sure the low-pressure oxygen source is turned on and is producing
 monitored FiO2 falls below 24%.                oxygen, or is not depleted.
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                                                                                                                 Troubleshooting
                                           •	 Ensure the High Breath Rate alarm is set above the patient Breath Rate plus
                                              spontaneous rate.
 High Breath Rate activates when           •	 Check for patient secretions, and use Suction therapy to clear them if needed.
 the monitored breath rate is higher       •	 Empty any excess condensation in the patient circuit.
 than the set High Breath Rate alarm
 limit.                                    •	 Check the VOCSN Leak monitor. If it is high, locate and resolve any
                                              unintentional leaks in the patient circuit (and around the patient interface).
 High FiO2 activates when the              •	 Check to ensure there are no unintended sources of gas or oxygen connected
 monitored FiO2 percentage is higher          to VOCSN or the patient circuit.
 than the set High FiO2 alarm limit.
                                           •	 Ensure the alarm is set appropriately for the patient Breath Rate plus
                                              spontaneous rate.
 High Minute Volume activates              •	 Check to see if the monitored Breath Rate is high. If so:
 when the monitored Minute Volume
 is larger than the set High Minute            •	 Check for auto-triggering and adjust the Flow Trigger control setting if
 Volume alarm limit.                              needed.
                                               •	 If you are using an active Ventec One-Circuit and humidifier, clear any
                                                  condensation from the active exhalation valve.
 High PEEP (or High EPAP in                •	 Note that if the alarm occurs while the patient is breath stacking, it is working
 Bi-Level Mode) activates when the            as intended.
 monitored PEEP is greater than PEEP
 plus the set High PEEP alarm limit.       •	 Check for auto-triggering and adjust the Flow Trigger control setting if
                                              needed.
                                           •	 Ensure the High Pressure alarm is set appropriately for the patient as their
 High Pressure activates when the             condition changes (for example, through sneezes, coughs, and/or yawns).
 monitored Airway Pressure exceeds
 the set High Pressure alarm limit for     •	 Check for blockages or obstructions in the circuit and patient airway. (For
 more than the number of consecutive          example, saturated or clogged HME or bacterial filters, in-line suction
 breaths set with the High Pressure           catheters, or patient secretions during volume ventilation.)
 Delay control.
                                           •	 If the problem persists, replace the patient circuit.
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                                                                                                                Troubleshooting
                                          •	 Ensure the alarm limit is set appropriately for the patient Breath rate plus
                                             spontaneous rate.
• Ensure the Low FiO2 alarm setting is appropriate for the delivered FiO2.
 Low FiO2 activates when the              •	 Check to ensure the high‑pressure oxygen source is connected, and is not
 monitored FiO2 falls below the set          depleted.
 Low FiO2 alarm limit.
                                          •	 Make sure the high-pressure oxygen source is turned on, and is delivering
                                             oxygen.
                                          •	 Ensure the Low Inspiratory Pressure alarm is set below the patient peak
 Low Inspiratory Pressure                    inspiratory pressure, taking into account changes in airway resistance and/or
 activates when the monitored Peak           lung recruitment.
 Inspiratory Pressure falls below the
                                          •	 Check the VOCSN Leak monitor. If it is high, locate and resolve any
 set Low Inspiratory Pressure alarm
                                             unintentional leaks in the patient circuit (and around the patient interface).
 limit.
                                          •	 If the problem persists, replace the patient circuit.
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                                                                                                                   Troubleshooting
                                            •	 Ensure the Low Minute Volume alarm is set appropriately, taking into account
                                               changes in patient breathing habits at night.
 Low Minute Volume activates                •	 Check the VOCSN Leak monitor. If it is high, locate and resolve any
 when the monitored Minute Volume              unintentional leaks in the patient circuit (and around the patient interface). If
 falls below the set Low Minute                using a trach tube, ensure the cuff is properly inflated.
 Volume alarm limit.
                                            •	 During pressure-control ventilation, check the patient for reduced lung
                                               compliance or airway blockages.
 Low PEEP (or Low EPAP in Bi-               •	 Check the VOCSN Leak monitor. If it is high, locate and resolve any
 Level Mode) activates when the                unintentional leaks in the patient circuit (and around the patient interface).
 monitored PEEP falls 5 cmH2O               •	 Run a Pre-Use Test.
 below the set PEEP control for 3
 consecutive breaths.                       •	 If the alarm continues, replace the patient circuit.
 Patient Circuit Disconnect                 •	 Check the VOCSN Leak monitor. If it is high, locate and resolve any
 activates when VOCSN detects a                unintentional leaks in the patient circuit (and around the patient interface).
 large leak in an active, passive, or       •	 Run a Pre-Use Test and ensure the Circuit Type control matches the type of
 valveless Ventec One-Circuit. (See            circuit connected to VOCSN.
 below for alarm behavior during High
 Flow therapy.)                             •	 If the problem persists, replace the patient circuit.
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                                                                                                                Troubleshooting
 Patient Circuit Disconnect               •	 Ensure the high flow nasal cannula (or other interface) is properly fitted to the
 (during High Flow therapy) activates        patient.
 when no patient breathing is
 detected for 20 seconds.                 •	 If the problem persists, replace the high flow nasal cannula.
                                          •	 Use the Event Log to determine the System Fault number, then see “System
 System Fault activates if VOCSN             Fault Detection Criteria and Recommended Action” in the Clinical and
 detects any one of multiple system          Technical Manual, available at VentecLife.com/VOCSNManual, and then take
 fault conditions.                           the corresponding action.
                                          •	 Ensure there the VOCSN air inlets are not blocked, and that there is adequate
                                             air flow around the device.
                                              •	 If the Very Low FiO2 persists there may be a problem with the VOCSN
                                                 oxygen sensor. Contact your local Ventec Life Systems representative for
                                                 service.
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                                                                                                         Troubleshooting
Device Troubleshooting
 Problem                              Cause                                       Solution
 VOCSN enclosure is abnormally warm   Air and/or fan filter is clogged            Clean and replace the air and fan filter. If
                                                                                  the filters appear damaged, replace them
 VOCSN will not power on              The internal and removable batteries are    Plug VOCSN into a wall outlet. Ensure
                                      fully discharged                            the wall outlet is functional and not
                                                                                  controlled by a switch
 VOCSN will not power off             Touchscreen is not responsive               Press and hold the power button for
                                                                                  more than 10 seconds
 Batteries are not charging           VOCSN is operating at a temperature         Verify that VOCSN is not close to a heat
                                      outside its environmental specifications,   source. Move VOCSN to a cooler location
                                      or the batteries are overheated             if required
 Device performance changes           Electrical interference                     Move VOCSN away from any potential
                                                                                  sources of electromagnetic interference
                                                                                  (EMI) including MRI equipment, medical
                                                                                  imaging systems, security systems,
                                                                                  appliances, wireless communications
                                                                                  equipment (such as cellular phones),
                                                                                  computers, and televisions
                                      VOCSN requires a restart                    Press the On/Off button and power off
                                                                                  VOCSN. Press the On/Off button again
                                                                                  to restart VOCSN
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                                                                                                                 Troubleshooting
Patient tubing and flow sensor lines        Use of a humidifier requires water
                                                                                          Use a Ventec One-Circuit with heated wire
contain condensation                        management
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                                                                                                        Troubleshooting
Oxygen Troubleshooting
 Low or no delivered oxygen from the   O2 Concentrator is attempting to run at    Move VOCSN to a location within its
 internal O2 Concentrator              a temperature outside its environmental    environmental operating range and wait
                                       specifications                             15 minutes for the device to cool down
                                                                                  or warm up. Restart the O2 Concentrator
                                       Loose oxygen tubing connection             Check and tighten all oxygen tubing
                                                                                  connections and the Ventec One-Circuit
                                                                                  connection
The VOCSN has an internal leak Contact Ventec Life Systems for service
 VOCSN makes a hissing sound while     The external high-pressure oxygen source   Tighten the high-pressure oxygen hose
 high-pressure oxygen is connected     is not firmly connected to the VOCSN       connector
                                       oxygen port
The VOCSN has an internal leak Contact Ventec Life Systems for service
                                       Oxygen is seeping from the O2 Low          Disconnect the O2 Low Pressure Inlet
                                       Pressure Inlet Adapter.                    Adapter.
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                                                                                                            Troubleshooting
Suction Troubleshooting
 Problem                                   Cause                                       Solution
Low or no suction Loose tubing connection Check and tighten all tubing connections
                                           Ventec Travel Suction Canister is full      Replace the Ventec Travel Suction
                                                                                       Canister
                                           Open port on external suction canister      Close any open ports on the external
                                                                                       suction canister
 High suction pressure while catheter is   Suction filter inside the Ventec Travel     Replace the Ventec Travel Suction
 open or disconnected                      Suction Canister or External Suction        Canister or External Suction Canister
                                           Canister Adapter is clogged                 Adapter
 Suction therapy will not start when       Ventec Travel Suction Canister is full      Replace the Ventec Travel Suction
 selected                                                                              Canister
Nebulizer Troubleshooting
 Problem                                   Cause                                       Solution
 The Patient Circuit Disconnect alarm      Exhalation valve is blocked or              Remove any obstructions around or in the
 activates during Nebulizer therapy        disconnected                                passive exhalation valve, and verify that
                                                                                       it is connected to the Ventec One-Circuit
                                                                                       correctly
                                           Incorrect flow for nebulizer manufacturer   Refer to the instructions for use provided
                                                                                       by the nebulizer manufacturer
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                                                                                                             Troubleshooting
Multi-View Troubleshooting
 Export stalls while writing to USB drive   USB drive is corrupt                        Use a new USB 2.0 drive formatted to
                                                                                        FAT32.
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                                                                                                     Troubleshooting
Recalibrating Batteries
Over time, the VOCSN batteries (the removable, rechargeable batteries and/or the internal battery) may require
recalibration to report their charge status correctly in the VOCSN status bar.
If the three relative state of charge icons in the VOCSN status bar do not report that the batteries are fully charged
even after VOCSN has been plugged in for 24 hours or more, disconnect VOCSN from the patient and recalibrate the
batteries by following these steps:
                                                                    VOCSN is                 Internal battery
   1	   Plug VOCSN into external power and charge the
                                                                    plugged in
        batteries until the charge status LED on the front of
                                                                                             is fully charged
        the device turns green.
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                                                                                                  Technical Specifications
Technical Specifications
This chapter provides VOCSN technical specifications, including environmental requirements and the accuracy
specifications of all controls and monitors.
NOTE: VOCSN will continue to meet its stated performance specifications when operating on battery power.
Physical
 Physical Category       Specification
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                                                                                                  Technical Specifications
Environmental
 NOTE: Unless otherwise specified, the following environmental specifications apply to all VOCSN components, controls,
 alarms, and monitors.
 Environmental
 Category                 Specification
 Temperature and          Operating: +5 °C to +40 °C; 15% to 90% relative humidity, non-condensing
 Relative Humidity        Storage and transport: -25 °C at any humidity to +70 °C at up to 90% relative humidity, non-condensing
Ingress IP32 per IEC 60529. Protected against dripping water and ingress of tools and thick wires
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                                                                                           Technical Specifications
                    NOTE: The power supply provided with VOCSN is >14 V. Charging time increases if a <14 V external
                    power source is applied.
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                                                                                                    Technical Specifications
 VOCSN                    Expected Service Interval: 2 years or 10,000 hours of use (whichever is less)
                          Expected Service Overhaul Interval: 30,000 hours of use
                          Expected Service Life: With regular servicing, approximately 10 years.
Audible Volume
 Category                 Volume
O2 Concentrator
 Category                 Specification
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                                                                         Technical Specifications
Nebulizer Drive
 Category            Specification
FiO2 Monitor
 Category            Specification
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                                                                                                 Technical Specifications
Control Accuracy
 NOTE: Negative (subatmospheric) pressure is not available during the expiratory phase of ventilation therapy breaths
 delivered by VOCSN.
 NOTE: When used with active, passive, or valveless Ventec One-Circuits, VOCSN was designed for use with a humidifier
 or HME. All volumes and flows are expressed in BTPS unless stated otherwise.
Control Accuracy
Humidification N/A
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                                                                                                Technical Specifications
Control Accuracy
 O2 Flow Equivalent    Oxygen bolus accuracy: ±(10% of setting or 3 mL, whichever is greater)
                       Percentage oxygen accuracy: 90+6/-3%
                         NOTE: The O2 Flow Equivalent control accuracy specifications above apply to VOCSN use within its
                         specified range of environmental operating conditions. See “Environmental” on page 190.
Sigh N/A
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                                                                                                      Technical Specifications
 NOTE: Monitors incorporating pressure measurements are calculated using a pressure sensor inside VOCSN, which
 calculates the pressure at the Ventec One-Circuit connection port.
 NOTE: Unless otherwise stated, monitor accuracy specifications are met when VOCSN is used as recommended by
 Ventec Life Systems.
                                            NOTE: Air contaminants and pollutants (including methane) may have an adverse
                                            effect on the accuracy and long-term performance of the FiO2 monitor.
 I:E Ratio                   0.1          Calculated from the average monitored inspiratory time and average monitored
                                          exhalation time accuracies of ±50 ms or 5%, whichever is greater
 Minute Volume               0.1 L when   Calculated (for active circuits) or estimated (for passive and valveless circuits) from the
                             ≤9.9         average exhaled tidal volume (Vte) and number of breaths per minute (BPM) for the last
                                          8 breaths
                             1.0 L when
                             ≥10
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                                                                                               Technical Specifications
Vte / Est. Vte 1 mL ±(4.0 mL [Vtes >50 mL] or 15 mL [Vtes ≤50 mL] + 15% of actual)
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                                                                              Technical Specifications
Classifications
 Category                        Classification
Standards Applied
 Category                                                    Standard
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                                                                                                         Technical Specifications
Biocompatibility
 Category                    Compliance
 Biocompatibility            Meets the requirements of ISO 10993-1 for Tissue/Bone/Dentin Externally Communicating Devices with
                             a permanent contact duration
 Volatile Organic            <10% of the American Conference of Industrial Hygienists (ACGIH) Threshold Limit Values
 Compounds (VOCs)
 delivered to the patient
 Particulate matter          <12 µg/m3 per the EPA Fine Particle PM2.5 requirements
 delivered to the patient
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                                                                                                                   Accessories
Accessories
                             24 Volt            The 24 Volt Wheelchair Power Cable can be used to connect VOCSN to
                             Wheelchair         wheelchair power outlets.
                             Power Cable
                             AC Power           10-foot, two-prong AC power cable and 3-foot AC/DC power adapter. The
                             Adapter            power connector includes a threaded locking mechanism to reduce the risk
                                                of accidental disconnects. Wire retention clip ensures the power supply cord
                                                remains firmly connected to the adapter. LED on the power adapter indicates
                                                proper power connection. The power supply also comes with a hook-and-
                                                loop strap to manage excess cabling. This power adapter recharges the three
                                                lithium-ion batteries while VOCSN is on or off.
                             Carry Bag          The VOCSN Carry Bag supports everyday mobility with an included shoulder
                                                strap and multiple attachment points to secure VOCSN to a wheelchair, bed
                                                rail, or other mount. The Carry Bag is designed to accommodate full VOCSN
                                                functionality while attached. It is compatible with the Roll Stand, Travel Suction
                                                Canister, and allows access to both removable, rechargeable batteries.
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                                                                                                            Accessories
                 External Bacterial   The Ventec Bacterial Filter helps to protect both the patient and VOCSN from
                 Filter               contamination from airborne microorganisms. The bacterial and viral filtration
                                      efficiency (BFE and VFE) is >99.99%.
                 External Suction     The External Suction Canister Adapter connects VOCSN to any third-party
                 Canister Adapter     external suction canister. The external suction canister adapter includes an
                                      internal water-phobic filter that will self-seal to protect VOCSN if the external
                                      suction canister overfills.
                 Fan Filter           The washable and reusable foam fan filter cleans air entering the cooling fan
                                      intake.
                 Internal Bacterial   The secondary, low resistance, internal bacterial filter eliminates 99.99% of
                 Filter               bacteria and viruses to protect against cross-contamination. Serviceable by
                                      trained technicians, typically during 10,000-hour scheduled maintenance.
                 Nebulizer Filter     The Nebulizer Filter connects to the VOCSN Nebulizer port. It contains an
                                      antimicrobial bacterial filter and an internal water-phobic filter that will self-seal
                                      if liquid touches it, protecting VOCSN from damage if liquid travels down the
                                      nebulizer tubing.
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                                                                                                       Accessories
                 Nurse Call Cable     Connects VOCSN to normally closed remote alarm, nurse call, or other alarm
                 (Normally Closed     systems that sense contact closure through a 1/4 in. (.6 cm) phono jack.
                 - White)
                 Nurse Call Cable     Connects VOCSN to normally open remote alarm, nurse call, or other alarm
                 (Normally Open -     systems that sense contact closure through a 1/4 in. (.6 cm) phono jack.
                 Black)
                 O2 Low-Pressure      The O2 Low-Pressure Inlet Adapter inserts into the low-pressure oxygen port
                 Inlet Adapter        on the back of VOCSN to connect to a low-pressure oxygen source.
                 Patient Air Intake   This washable and reusable foam HEPA filter cleans air entering the patient air
                 Filter               intake.
                 Removable,           Set of two lithium-ion 14.4V 5.8AHr hot-swappable batteries with integrated
                 Rechargeable         push button charge indicator. Batteries can be charged in VOCSN or with the
                 Batteries,           detachable battery quick charger. (Battery Quick Charger sold separately.)
                 Lithium-Ion
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                                                                                                      Accessories
                 Removable          60W desktop charger for two VOCSN detachable batteries. Indicator lights
                 Battery Quick      display battery charge status. Each battery charges fully in three hours. The
                 Charger            charger is powered by a standard two-prong AC cord. (Batteries not included)
                 Roll Stand         The Ventec Roll Stand is a mobile, wheeled mount for VOCSN, and includes
                                    a mounting bracket, utility bracket, straps, and a cable hook for cord
                                    management.
                 Suction Canister   The Suction Canister Rollstand Holder easily mounts to the VOCSN Rollstand
                 Rollstand Holder   center pole or drop pole accessory to securely hold third-party suction
                                    canisters up to 1,200 mL. A convenient clip holds suction tubing (suction
                                    tubing not included).
                 Travel Suction     The 300 mL detachable Travel Suction Canister attaches to VOCSN to provide
                 Canister           suction therapy on the go. Includes a water-phobic filter that will self seal to
                                    protect VOCSN if the Travel Suction Canister overfills.
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                                                                                                            Accessories
                 Ventec One-           Passive Ventec One-Circuits are single-limb circuits with a fixed-leak passive
                 Circuit, Passive:     exhalation port.
                 adult or pediatric,   Adult and pediatric passive Ventec One-Circuits can be purchased with or
                 single-patient use    without the following optional features:
                                       •	   Heated wire, used to manage the accumulation of water in the Ventec One-
                                            Circuit when connected to a humidifier.
                                       •	   Ventec One-Circuit O2 tube, used to deliver pulse dose Oxygen Direct
                                            therapy.
                 Ventec One-           Active Ventec One-Circuits are single-limb circuits with an active exhalation
                 Circuit, Active:      valve and proximal flow sensor.
                 adult or pediatric,   Adult and pediatric active Ventec One-Circuits can be purchased with or
                 single-patient use    without the following optional features:
                                       •	   Heated wire, used to manage the accumulation of water in the Ventec One-
                                            Circuit when connected to a humidifier
                                       •	   Ventec One-Circuit O2 tube, used to deliver pulse dose Oxygen Direct
                                            therapy.
                 Ventec One-           Adult and pediatric Valveless Ventec One-Circuits are single-limb circuits
                 Circuit, Valveless:   without an exhalation valve for use with vented masks.
                 adult or pediatric,   Adult and pediatric valveless Ventec One-Circuits can be purchased with or
                 single-patient use    without the following optional features:
                                       •	   Heated wire, used to manage the accumulation of water in the Ventec One-
                                            Circuit when connected to a humidifier.
                 Ventec Humidifier     The Ventec Humidifier Bypass prevents moisture from splashing into VOCSN
                 Bypass, single-       during Touch Button Cough therapy when using a Ventec One-Circuit
                 patient use           connected to a humidifier.
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                                                                                                                   Accessories
 Third-party component or
 accessory                       Requirement for safe use with VOCSN
 Humidifier                      Compliant with ISO 8185. Ventec Life Systems recommends use of the Fisher & Paykel HC550,
                                 the Fisher & Paykel MR850, or equivalent.
 Mouthpiece Circuit Kit,         The Mouthpiece Circuit Kit is a third-party accessory available through Ventec Life Systems. It
 single-patient use              includes a 15 mm patient circuit, a mouthpiece, flexible extension, connection adapters, and a
                                 support arm.
Nebulizer 6 L/min cup compliant with the relevant requirements of ISO 27427.
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                                                                                                 EMC Information
EMC Information
The EMC information provided in this chapter applies to VOCSN and its accessories, including the AC Adapter, 24 Volt
Wheelchair Power Cable, and Nurse Call Cable.
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                                                                                                    EMC Information
Electromagnetic Emissions
VOCSN is intended for use in the electromagnetic environment specified below. The user of this device should make
sure it is used in such an environment.
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                                                                                                             EMC Information
Electromagnetic Immunity
VOCSN is intended for use in the electromagnetic environment specified below. The user of this device should make
sure it is used in such an environment.
Immunity Test IEC 60601 Test Level Compliance Level Guidance: Electromagnetic Environment
 Electrical fast           ±2 kV for power supply        ±2 kV for supply mains      Mains power quality should be that of a
                                    lines                                            typical home or hospital environment.
 Transient/burst                                         ±1 kV for input/output
                         ±1 kV for input/output lines             lines
 IEC 61000-4-4
 Surge                     ±1 kV differential mode       ±1 kV differential mode     Mains power quality should be that of a
                                                                                     typical home or hospital environment.
 IEC 61000-4-5             ±2 kV common mode              ±2 kV common mode
 Voltage dips, short     <5% UT (>95% dip in UT) for    <5% UT (>95% dip in UT)      Mains power quality should be that of a
 interruptions, and               0.5 cycle                 for 0.5 cycle            typical home or hospital environment. If
 voltage variations on     40% UT (60% dip in UT)        40% UT (60% dip in UT)
                                                                                     the user of the device requires continued
 power supply input                                                                  operation during power mains interruptions,
                               for 5 cycles                  for 5 cycles
 lines                                                                               it is recommended that the device be
                         70% UT (30% dip in UT) for     70% UT (30% dip in UT) for   powered from an uninterruptible power
 IEC 61000-4-11
                                 25 cycles                      25 cycles            supply or battery.
                         <5% UT (>95% dip in UT) for    <5% UT (>95% dip in UT)
                                 5 seconds                  for 5 seconds
                          NOTE: UT is the AC mains
                         voltage prior to application
                               of the test level.
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                                                                                                                 EMC Information
                                  10 Vrms                     10 V             d = 1.2 √P
                           150 kHz to 80 MHz in
                                ISM bandsa
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.
1	 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 device is used exceeds the applicable RF compliance level above, the device should be observed to verify
   normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating
   the device.
2	 Over the frequency range 150 kHz to 80 MHz, the field strengths should be less than 3 V/m.
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                                                                                                              EMC Information
100 12 12 6 12
 For transmitters rated at a maximum output power not listed above, the recommended separation distance d in meters (m) can
 be estimated using the equation applicable to the frequency of the transmitter, where P is the maximum output power of the
 transmitter manufacturer.
Note 1: At 80 MHz and 800 MHz, the higher frequency range applies.
 Note 2: The ISM (industrial, scientific, and medical) bands between 150 kHz and 80 MHz are 6.765 MHz to 6.795 MHz; 13.553 MHz
 to 13.567 MHz; 26.957 MHz to 27.283 MHz; and 40.66 MHz to 40.70 MHz.
 Note 3: An additional factor of 10/3 is used in calculating the recommended separation distance for transmitters in the ISM
 frequency bands between 150 kHz and 80 MHz and in the frequency range of 80 MHz and 2.5 GHz to decrease the likelihood that
 mobile/portable communications equipment could cause interference if it is inadvertently brought into patient areas.
 Note 4: 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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                                                                                                                                                         Technical Description
Technical Description
Theory of Operation
The sections that follow detail the theory of operation of each of the five VOCSN therapies. A pneumatic schematic of
each therapy is also provided.
The gas passes through the internal flow transducer, which measures flow, and then moves through the blower and
through the bacterial filter. Gas flows through the connected patient circuit to deliver the configured Ventilation therapy.
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                                                                                                     Technical Description
Leak Compensation
With Leak+ hardware configurations, the powerful VOCSN leak compensation algorithm can compensate for leaks
up to 175 L/min at 20 cmH2O. Leak compensation works differently depending on the type of patient circuit and the
ventilation mode used. The following table illustrates when VOCSN leak compensation is active. The sections that follow
include a detailed description of how leak compensation works with each circuit type.
WARNING: Delivered and monitored ventilation therapy may be affected by large leaks around the patient interface.
                                                                                                      Volume Targeted
                                                               Pressure Ventilation                       Ventilation
                         Volume Ventilation
  Circuit Type                                             (Bi-Level, AC-Pressure, and                (Vol. Targeted-PS,
                    (AC-Volume and SIMV-Volume)
                                                                  SIMV-Pressure)                    Vol. Targeted-PC, and
                                                                                                     Vol Targeted-SIMV)
• Bias flow, to maintain PEEP (also compensated when Leak Compensation is set to Off).
  •	 Pressure breaths, to ensure the pressure at the patient end of the circuit is accurate (also compensated when
     Leak Compensation is set Off).
  •	 The Vte and Minute Volume monitor, as well as the flow and volume waveforms, to display the actual therapy
     delivered to the patient.
 IMPORTANT NOTE: When used with an active Ventec One-Circuit, VOCSN does not compensate for leaks during
 volume breaths (including in Volume Targeted ventilation modes). This means that if the Tidal Volume control is set to
 500 mL, and there is a 100 mL leak in an active circuit, the patient will receive a tidal volume of 400 mL. Patients with a
 frequently changing circuit leak (such as patients with an inflated trach tube for only part of the day) who receive volume
 ventilation may find use of a passive or valveless Ventec One-Circuit more convenient, because of its automatic leak
 compensation.
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                                                                                                  Technical Description
• PEEP, to maintain the set pressure for any leak up to 50 L/min @ 10 cmH2O.
  •	 Pressure breaths, to ensure the pressure at the patient end of the circuit is accurate for any leak up to
     50 L/min @ 10 cmH2O.
  •	 The Estimated Vte and Minute Volume monitor, as well as the flow and volume waveforms, to display the
     actual therapy delivered to the patient.
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                                                                                                                  Technical Description
                                                              Shut Off
                                      Outlet      Polarity     Valve
                      Exhaust
                                     Silencer    Selection                         VOCSN Oxygen Direct Therapy
                                                   Valve     Media Bed
                                       Inlet
                      Air Inlet      Silencer
                       Filter                                   O2
                                                             Regulators
                                                Compressor
The pulse dose Oxygen Direct delivery method allows the actual oxygen output in L/min to be lower than necessary with
traditional oxygen concentrators, while still providing the patient with the targeted FiO2.
The O2 Flow Equivalent control allows clinicians to prescribe oxygen using the same prescription in
L/min used with traditional concentrators. VOCSN calculates the amount of oxygen to deliver during each breath,
equivalent to a continuous stream in L/min.
The following graph describes the relationship between oxygen bolus volume delivered by VOCSN and the patient
breath rate at various O2 Flow Equivalent settings:
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                                                                                                                                                                          Technical Description
During ventilation or insufflation, the Ventec Humidifier Bypass allows gas to flow from VOCSN, through the humidifier,
and to the patient normally. During Cough therapy exsufflation, the Ventec Humidifier Bypass blocks gas from entering
the humidifier by routing it from the patient, through the bypass, and away from the device. This prevents water in the
humidifier from splashing through the Ventec One-Circuit and damaging VOCSN.
Gas flows from the inlet filter into the blower, which adds energy to the gas stream to achieve the target insufflation
pressure. After the insufflation phase, the cough valve changes position and the blower speed increases to achieve the
target exsufflation pressure. If configured to do so, the process repeats at the end of a set period of pause.
Suction
The negative pressure produced by VOCSN Suction therapy is measured inside the device. This measurement is
displayed on the Suction screen when the therapy is active.
When Suction therapy is activated, gas and secretions are pulled through suction tubing and trapped in an attached
suction canister. A hydrophobic filter inside the canister prevents secretions from entering VOCSN. VOCSN controls the
pump speed to achieve the target Vacuum setting.
                                                                                                                                                                Suction Interface
                                                                                                                                                                   (pick one)
                                                                                                                                                                 Secretion Trap
                                                      Outlet
                                     Exhaust                              Polarity                     Function               Suction         Filter               (optional)
                                                     Silencer
                                                                         Selection                      Select                 Port
                                                                                                                                                Suction
                                                                           Valve                        Valve
                                                                                                                                                Canister            Suction
                                                                                                                                                                    Catheter
                                             VOCSN                                                                                                               (not provided)
                                                                        Compressor
                                             Suction                                         Pressure
                                             Therapy                                        Transducer
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                                                                                                                     Technical Description
Nebulization
VOCSN can be used to drive a 6 L/min nebulizer cup (+N configurations only), or compensate for the added flow to the
patient circuit from an external nebulizer.
                                         Outlet
                      Exhaust                        Polarity                     Function
                                        Silencer                                                   Nebulizer     Nebulizer
                                                    Selection                      Select
                                          Inlet                                                      Port      (not provided)
                                                      Valve                        Valve
                                        Silencer                 Pressure
                                                                Transducer
                                                   Compressor
                     Air Inlet Filter
                                                                         VOCSN Nebulizer Therapy
The VOCSN nebulization drive is designed to work with most nebulizer cups, though the flow produced is dependent on
the specifications of the nebulizer cup connected to the Ventec One-Circuit. Ensure the nebulizer cup connected to the
Ventec One-Circuit is compatible with the VOCSN nebulization drive.
Gas flows from the inlet filter into the VOCSN compressor, and then to the nebulizer. A relief valve prevents back flow
from the patient circuit through the nebulizer drive line when the nebulizer is not running.
Because the VOCSN FiO2 monitor measures gas delivered through the device, FiO2 oxygen delivery during External
Neb. Compensation may be higher or lower than monitored by VOCSN, depending on the source driving a connected
external nebulizer. If the external nebulizer is driven by air, the FiO2 to the patient will be lower than the set and
monitored FiO2. If the external nebulizer is driven by oxygen, the FiO2 to the patient will be higher than the set and
monitored FiO2. If a precise FiO2 is required during External Neb. Compensation, Ventec Life Systems recommends
using an ultrasonic nebulizer instead.
Pulse Dose oxygen delivery during External Neb. Compensation may not be significantly affected for an adult patient
when using an external nebulizer driven by air. However, the nebulizer adds deadspace and flow to the patient circuit
that may prevent the entire oxygen bolus from reaching patients with small tidal volumes. Therefore, for pediatric
patients, the total delivered FiO2 may be significantly less than the Calculated FiO2 monitor displayed. If a pediatric
patient receiving small Tidal Volumes requires a minimum FiO2 during nebulizer therapy, Ventec Life Systems
recommends using an oxygen source to drive the external nebulizer (which will provide a higher total delivered FiO2
than the displayed Calculated FiO2 monitor).
If the patient is oxygen dependent, Ventec Life Systems recommends use of patient oxygen monitoring (e.g., an SpO2
monitor), especially during nebulization.
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                                                                                               Technical Description
VOCSN Measurements
Airway Pressure Measurements
A transducer inside VOCSN takes pressure measurements to help assure the accuracy of delivered breath pressure,
including PEEP. VOCSN also contains a second, redundant transducer to ensure accurate, reliable measurements.
The pressure measurements taken by transducers inside VOCSN are then combined with measurements taken while
running the Pre-Use Test (to determine the resistance, compliance, and leak of the Ventec One-Circuit). Using these two
measurements, VOCSN calculates the airway pressure at the patient interface (mask, tracheal tube, or mouthpiece).
To ensure the set PEEP is maintained when an active circuit is used, the VOCSN leak compensation algorithm detects
and compensates for any leaks in the Ventec One-Circuit. Pressure on the back side of the valve allows the active
exhalation valve to open when the PEEP setting is reached, ensuring that the set PEEP is not exceeded. When using a
passive or valveless circuit, VOCSN calculates and delivers the flow required to reach and maintain the set PEEP.
In addition, Ventec Life Systems recommends the use of appropriate alarms to ensure the accuracy of delivered breath
pressure. For example, the High Pressure and Low Inspiratory Pressure alarms, as well as the Low Minute Volume alarm
can be set to ensure breaths are accurately delivered during pressure-control ventilation.
 NOTE: If the High Pressure and Low Inspiratory Pressure alarms, and/or Low Minute Volume alarms are not set to detect
 problems with Ventilation therapy, ensure the rest of your alarm suite is configured appropriately to detect any problems
 with the delivered ventilation.
Flow Measurements
When using a passive or valveless Ventec One-Circuit or mouthpiece patient circuit, VOCSN calculates flows using
measurements from its internal transducers and the Pre-Use Test.
When using an active valve, inhalation flows are similarly calculated using measurements from inside VOCSN and from
the Pre-Use Test. Flows during exhalation are measured at the active exhalation valve.
Volume Measurements
Exhaled volumes are calculated using measurements from transducers inside VOCSN (or from an active valve), and
measurements from the Pre-Use Test.
FiO2 Measurements
VOCSN includes an integrated FiO2 monitor, which takes measurements as gas travels to the Ventec One-Circuit
connection port.
The Calculated FiO2 monitor calculates the estimated FiO2 delivered to the patient, based on VOCSN settings and
the patient’s breathing patterns. The calculation will change as breathing patterns change, or when VOCSN Ventilation
settings are modified.
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                                                                                                        Technical Description
                                •	 When the average O2 accumulator pressure is less than 4 PSI for more than 5±1 minutes
                                   while the O2 Flow Equivalent control is active
                                •	 When a fault is detected with the oxygen flow sensor that measures gas created by the
                                   internal O2 Concentrator.
 Patient Circuit Disconnect   When High Flow is Off and the Circuit Type control is set to Active, Passive, or Valveless:
                              •	 If Sensitivity is set to “0-75,” the alarm activates when the measured leak persists at more
                                 than 15.4 L/min/(cmH2O^0.59)
                              •	 If Sensitivity is set to “75-175,” the alarm activates when the measured leak persists at more
                                 than 30 L/min/(cmH2O^0.59)
                              When High Flow is On, when patient breathing of 20 L/min is not detected for more than 20
                              seconds.
 System Fault                 If VOCSN detects any of the conditions described in the “System Fault Detection Criteria and
 (all conditions)             Recommended Action” on page 219, the System Fault alarm will activate. Depending on the System
                              Fault condition, some therapies may be suspended or terminated.
                              Use the Event Log to determine the System Fault number. Some System Fault conditions require
                              providing the patient with backup therapy, while others may be resolved by following the
                              recommended actions described below.
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                                                                                                 Technical Description
 System Fault 3   When the monitored Cough             The current Cough therapy          Ventilation, Oxygen, Suction,
                  Airway Pressure is greater than      session will terminate and         and Nebulizer therapies continue
                  the set Insufflation Pressure plus   Ventilation therapy will resume.   functioning normally.
                  20 cmH2O, or the monitored
                  Cough Airway Pressure is less                                           Try Cough therapy again. If the
                  than the set Exsufflation Pressure                                      problem persists, contact Ventec
                  minus 20 cmH2O.                                                         Life Systems for service.
 System Fault 4   When the monitored Suction           Suction therapy will terminate.    Do not use Suction therapy on
                  therapy vacuum exceeds its                                              the patient.
                  setting by more than 100 mmHg.
                                                                                          With the suction tubing away
                                                                                          from the patient, start suction
                                                                                          therapy and occlude the end of
                                                                                          the Suction tubing. If the Suction
                                                                                          therapy Vacuum monitor is higher
                                                                                          than the Vacuum setting, use
                                                                                          backup suction equipment and
                                                                                          contact Ventec Life Systems for
                                                                                          service.
 System Fault 6   When positive pressure is            Suction therapy will terminate.    Do not use Oxygen, Cough,
                  generated during Suction                                                Suction, or Nebulizer therapy
                  therapy.                                                                on the patient. Provide the
                                                                                          patient with backup therapies if
                                                                                          necessary.
                                                                                          Contact Ventec Life Systems for
                                                                                          service.
 System Fault 7   When Oxygen, Suction, or             All three therapies will be        Try starting Oxygen, Suction, or
                  Nebulizer therapy output             suspended.                         Nebulizer therapy again.
                  selection fails internal integrity
                  tests.                                                                  If the problem persists, contact
                                                                                          Ventec Life Systems for service.
 System Fault 8   When negative pressure is            The active Nebulizer therapy       Do not use Oxygen, Cough,
                  generated during Nebulizer           session will terminate.            Suction, or Nebulizer therapy
                  therapy.                                                                on the patient. Provide the
                                                                                          patient with backup therapies if
                                                                                          necessary.
                                                                                          Contact Ventec Life Systems for
                                                                                          service.
 System Fault 9   When the Ventilation therapy fan     Oxygen concentration, Suction      Provide the patient with backup
                  does not turn.                       and Nebulizer therapy will be      Ventilation (and other therapies if
                                                       suspended.                         necessary). Restart VOCSN. If the
                                                                                          problem persists, contact Ventec
                                                                                          Life Systems for service.
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                                                                                                   Technical Description
 System Fault 10   When the redundant transducers      All therapies except Cough will      Provide the patient with backup
                   in VOCSN detect pressures that      continue to operate using the        Ventilation (and other therapies if
                   differ by >5 cmH2O.                 higher measurement of the two.       necessary). Restart VOCSN. If the
                                                                                            problem persists, contact Ventec
                                                                                            Life Systems for service.
 System Fault 11   When the patient circuit pressure   Oxygen concentration, Suction,       Provide the patient with backup
                   is negative for more than 100       and Nebulizer therapy will be        Ventilation (and other therapies if
                   milliseconds during ventilation.    suspended.                           necessary). Restart VOCSN. If the
                                                                                            problem persists, contact Ventec
                                                                                            Life Systems for service.
 System Fault 12   When the monitored Cough            Cough therapy will be                Ventilation, Oxygen, Suction,
                   Airway Pressure is >80 cmH2O or     suspended.                           and Nebulizer therapies continue
                   <-80cmH2O                                                                functioning normally.
                                                                                            Try Cough therapy again. If the
                                                                                            problem persists, contact Ventec
                                                                                            Life Systems for service.
 System Fault 13   When O2 metering fails its          No action.                           Ventilation, Cough, Suction, and
                   integrity checks while Oxygen                                            Nebulizer therapies will continue
                   therapy is active.                                                       functioning normally.
                                                                                            Verify Oxygen therapy is
                                                                                            functioning as intended.
                                                                                            If the problem persists, contact
                                                                                            Ventec Life Systems for service.
 System Fault 14   When all VOCSN settings are         Entry of the Clinician Access        Immediately provide the patient
                   reset to factory defaults because   Passcode is required to reset this   with backup therapy.
                   of a corruption of the stored       condition.
                   settings.                                                                Enter the Clinician Access
                                                                                            Passcode and then manually re-
                                                                                            enter all patient settings.
 System Fault 15   When the alarm process and/         No action.                           Immediately provide the patient
                   or alarm tones do not activate                                           with backup therapy. Restart
                   and are unrecoverable for >30                                            VOCSN. If the problem persists,
                   seconds.                                                                 contact Ventec Life Systems for
                                                                                            service.
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                                                                                                Technical Description
• Breath Rate
The following graphs illustrate the expected FiO2 based on the patient minute volume when using the FiO2 control to
bleed a low-pressure external oxygen source through VOCSN and into an active Ventec One-Circuit.
 NOTE: Increasing the Flow Trigger control setting requires additional oxygen (in L/min) to achieve the target FiO2. In
 addition, any leaks in the Ventec One-Circuit will require a higher flow of oxygen input to achieve the target FiO2.
The following four graphs display the expected FiO2 with low-pressure O2 blending at various minute volumes, with an
input flow of 93% or 100% O2, and a Flow Trigger setting of 1 to 3 or 9 L/min. Graphs are also provided for blending
during High Flow therapy.
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About Ventec Life Systems
Ventec Life Systems is defining integrated respiratory care to improve patient outcomes and reduce caregiver challenges
in the hospital and home. Ventec’s leading product, VOCSN, seamlessly integrates five separate devices including a
ventilator, oxygen concentrator, cough assist, suction, and nebulizer into one unified respiratory system. The team’s
history of patient-centric design brings care changing innovations to life for patients, medical professionals, and
caregivers.