OPERATING INSTRUCTIONS & TROUBLESHOOTING GUIDE ECO MODELS FLUID WARMING CABINETS BLANKET WARMING CABINETS

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1 OPERATING INSTRUCTIONS & TROUBLESHOOTING GUIDE ECO MODELS FLUID WARMING CABINETS & BLANKET WARMING CABINETS QED Scientific Ltd. Unit 21 Botany Business Park Whaley Bridge High Peak SK23 7AD Tel: Fax:

2 WARMING BAGS OR BLANKETS IN QED WARMING CABINETS You must NEVER warm blood or blood products in a fluid or blanket warming cabinet. (You MUST use an in-line coil type or cassette warmer). This is the guidance from NICE, the BBTS and the MHRA. If you are planning on using this cabinet for storing bags of fluid or blankets you should use the baskets that we supply. Baskets ensure that nothing blocks the movement of air around the chamber. Note: On cabinets with bottom controls never place anything on the base of the chamber. Plastics can melt and spillages can cause damage; blankets can cause overheating. Keep the lowest shelf at least 30mm above the chamber base to allow adequate airflow around the product and to aid warming. Cabinets with top controls are designed to have bottles or baskets placed directly on the base of the chamber. If you experience temperature instability incorrect loading will probably be the cause - over filling the shelves causes low airflow. If in doubt, please call us we re here to help! We supply special baskets for use with bags of fluid. They are used to keep the bag outer wraps away from the cabinet walls. If in doubt, please call us we re here to help!

3 NEVER WARM BLOOD OR BLOOD PRODUCTS IN A FLUID CABINET We have encountered instances where theatre staff are warming blood or blood products in fluid warming cabinets. This is a practice that is disallowed by all relevant guidance bodies. NICE guideline: On page 46 the end of the first paragraph reads (GDG=Guideline Development Group): The GDG also considered it clinically negligent not to warm intravenous fluids, other than those for the delivery of drugs. Taking all these things into consideration, they recommended that when IV fluids of 500ml or more are given, they should be warmed using a fluid warming device and not taken from a warming cabinet. It s not made explicit that blood must not be placed in a warming cabinet, but then NICE isn t trying to point out obvious and dangerous misuse of equipment. However, when NICE say fluid warmer they do not mean warming cabinet, so it s implicit that nobody should warm blood in a cabinet. MHRA Guidance: We are currently regulating freezers, fridges and transport coolers intended to preserve tissues, fluids and blood intended for re-introduction, as they satisfy the definition of a medical device in Article 1 of Directive 93/42/EEC. We do consider that the same should happen to fluid warming cabinets where the fluids are intended for infusion. In-line warmers certainly provide the most common and recommended practice for warming blood and blood products. Handbook of Transfusion Medicine 4th edition, page 21 Blood warmers Hypothermia impairs blood clotting. Studies in surgical patients have found an association between hypothermia at the end of surgery and an increased incidence of post-operative infections and myocardial ischaemia. Hypothermia during surgery should be avoided. Blood and other infused fluids should be warmed. Rapid infusion of cold fluids (> 100 ml/minute) has been reported to cause potentially lethal cardiac arrhythmias. Infusion through a central catheter terminating in or near the right atrium may increase the risk. Only CE-marked commercial blood warmers should be used and the manufacturer s instructions must be strictly followed. Some blood warmers operate at up to 43 C but are safe provided they are used and serviced according to manufacturer s instructions. Blood must never be warmed in an uncontrolled way (e.g. in a microwave, in hot water, or on a radiator). Rapid infusion devices Rapid infusion devices that are CE marked may be used when large volumes have to be infused rapidly. Typical devices can infuse from 6 l/hr up to 30 l/hr. Rapid infusers usually incorporate a blood-warming device.

4 SAFETY, CLEANING & OPERATING INSTRUCTIONS ELECTRICAL This is a Class 1 appliance. The wires in the mains lead are coloured in accordance with the following code: GREEN & YELLOW BLUE BROWN = EARTH = NEUTRAL = LIVE As the colours of the wires in the mains lead of this appliance may not correspond with the coloured markings identifying the terminals in your plug, proceed as follows: * The wire that is coloured GREEN & YELLOW must be connected to the terminal in the plug which is marked by the letter E, coloured GREEN or GREEN & YELLOW. * The wire that is coloured BLUE must be connected to the terminal that is marked by the letter N or coloured BLACK. * The wire that is coloured BROWN must be connected to the terminal that is Marked with the letter L or coloured RED A fused mains plug or distribution board must protect this apparatus (maximum 13 amp fuse). THIS APPARATUS MUST BE EARTHED FOR A COMPLETE ELECTRICAL DISCONNECTION PULL OUT THE MAINS PLUG If the supply cord is damaged, it must be replaced by a special cord or assembly available from the manufacturer or its service agent. There are no user repairable parts inside - all repairs must be carried out by trained personnel CLEANING INSTRUCTIONS This is an electrical appliance. The chamber and outside cabinet should only be cleaned with a damp detergent cloth or 70% alcohol wipe when disconnected from the mains supply. Leave the door open to aid safe drying before switching the appliance on again. This meets with the recommendations of the AAGBI Guidelines for cleaning surfaces in and around operating theatres. SPILLAGES Any spillage must be cleaned up immediately. If it is suspected that fluids may have entered the fan or control area, the appliance must immediately be disconnected from the mains supply, taken out of use, cleaned and checked for electrical safety before being put into use again.it is against all accepted good practices to place opened bottles of fluid back into a warming cabinet, especially if lying on their side, even if the lid has been put back on securely. It is usual for the bottles / bags to mention this specifically on their labels. Any damage caused by leaking fluids is misuse, and is not covered by the guarantee. MAINTENANCE It is accepted practice that this equipment receives a preventative inspection and calibration once annually by a qualified engineer. This is to ensure that the equipment is known to be working correctly and is fit for purpose. Please contact your supplier to discuss this. WARNING THIS APPLIANCE MUST NOT BE USED IN THE PRESENCE OF FLAMMABLE VAPOURS OR ANAESTHETIC GASES. NOTE The fan in the cabinet is designed to run continuously, even with the door open.

5 OPERATING INSTRUCTIONS 1 Site the appliance on an even, level surface, QED stand or wall fixing kit as supplied by QED Scientific. Ensure that the door is level. 2 Connect to the mains supply. Ensure that that the plug is accessible, so that it can be removed if necessary. 3 Turn on the mains power switch (the green power light will come on). The safety overheat is automatically set 3 C above the set operating temperature. 4 The cabinet has been factory calibrated and set to control at +37 C. Fluid warming cabinets are factory limited to a maximum of 60 C. This is factory set. Media warming cabinets have a fixed operating temperature of 37 C. This is factory set. Blanket warming cabinets are factory limited to a maximum of 80 C. This is factory set. Digital Controller: K49 digital controllers - Push the P button once then use the /\ and \/ buttons to set the new temperature as shown on the lower digits. Press the P button to save the new setting. Do not push any other buttons. The overheat safety cut out is automatically set 3 C above the operating temperature. On initial switching on the chamber temperature may go above the set temperature. This is normal and does not occur during normal use. Once the air temperature in the chamber has reached the set temperature, the heat light will go out. As the chamber temperature stabilises, the amber heat light will periodically switch on and off. This is known as cycling and shows correct operation of the heater system. If the WARNING light comes on, first check that the operating temperature has not exceeded the control set point. This is indicated by the set and measured temperature being very different. If you experience a temperature control problem, empty the bags / bottles from the cabinet and check again that there really is a problem before contacting your estates department. If you wish you can phone QED Scientific direct for telephone assistance. Remember that all call-outs that are the result of operator error or mis-use are fully chargeable even within the warranty period. Do Not Over-Fill The Shelves. Baskets should be used when warming bags of fluid or blankets. These prevent the outer pouch or blanket from blocking the air flow. If bench space is at a premium, we supply stands and wall fixing brackets. MAINTENANCE AND SERVICE CONTRACTS AVAILABLE. PLEASE CALL.

6 TROUBLESHOOTING GUIDE CABINET APPEARS DEAD - ie no lights are working Check that the plug is in a suitable working power socket (check the wall socket with some other equipment that you know is working). Check that the power lead is pushed firmly into the receptacle on the cabinet. Changing the power lead sometimes works. If this works then discard the suspect power lead. Check the fuse in the power lead or distribution board. Replace if faulty. Check that the power switch on the front of the cabinet is in the ON position and illuminated. If there are still no lights/controllers lit then initially call your site electrician for assistance such as checking the fuse again. If none of these works then call QED Scientific or your supplier. TEMPERATURE CONTROL IS ERRATIC / NOT WARMING EFFECTIVELY The cause of this is almost certainly over-filling the cabinet and blocking the flow of warm air around the cabinet. Resolve this by removing excess product in the cabinet. Also see item 2 below. CABINET IS NOT HEATING AT ALL 1 Is the heat light ON or pulsing with the set temperature at 37 C? If yes then this shows that power is being supplied correctly to the cabinet controller. Is the cabinet warming up? If yes, then the problem is solved. If no, then check again with the set temperature of the cabinet now at 45 C. The heater light should come on constantly for a while and then start pulsing. Is the cabinet now warming up? If yes, then the problem is solved. If the heat light is on constantly and never pulses then the heating element is probably at fault. Replace the element and test to factory standard. 2 If the cabinet is only just warm at the top but the base is hot (or vice-versa) then the problem will be that the cabinet is over filled. Remove excess product to allow adequate air movement. 3 If Items 1 & 2 above have been tried unsuccessfully and the cabinet is only just about warm (< 32 C) then the heating element has probably failed and must be replaced. 4 The digital controller has two sets of numbers displayed. The lower number is the temperature that has been set. The upper number is the measured temperature. If you have a readout that does not correspond to this then either the controller is faulty or someone has been fiddling with the settings and de-programmed the controller. In either case it is most cost-effective to simply replace the controller with a new one that has been pre-programmed in our factory and then return the faulty controller to us. THERE IS A NASTY SMELL It is most likely that you have had a spillage in the cabinet. The smell is the hot fluid that has reached the heating element. Get your engineer to clean the fluid residue away, both on the false base and under it around the heating element. Another cause can be the outer plastic pouch getting too hot. Blankets must not block the airflow in the cabinet so use the basket provided. Make sure that nothing is on or close to the false base of the cabinet - it is not a storage shelf! HEATER LIGHT PULSES ON AND OFF This is normal and shows when the controller is applying power to the heating element. Remember that the overheat safety is automatically set during programming of the controller in our factory. If replacing any electrical components ALWAYS use a competent electrician.

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8 SPARE PARTS LIST - FOR ALL ECO FLUID, MEDIA & BLANKET WARMERS K49 Controller, digital, dual display SSR Solid state relay K type thermocouple Mains on/off switch, illuminated, green Fan motor, complete Roller catch & stud Heating element - model specific Mains supply cable Mains input filter 1/30357 Door handle, pull type Spare shelf - model specific * Alternative equivalents may be substituted *

9 Suppliers of Equipment for Hospitals and Laboratories. MEDICAL PRODUCTS Blood Bank Refrigerators Filtered Specimen Storage NICE Patient Warming Blankets Capacities from 20 to 700 bags For safe storage of specimens in theatre areas Theatre and recovery warming blankets to meet NICE Guidelines. Alternative to forced air warming Blanket Warming Cabinets Fluid Warming Cabinets (For theatre recovery) 4-40 blankets (For operating theatres) 9 to litre bottles Custom build options Combination Warming Cabinets Contrast Media Warming Cabinets Heated theatre mattresses Neonate Warming Theatre Warming Mattresses Combined fluid and blanket warming cabinets Warming media & lotions in radiology, CT, etc Durable, sterilizable patient warming mattresses Heated swaddling blankets, mattresses Adult, infant & neonate heated mattresses Ripple Mattresses RippleHeat & RippleCool DVT Prophylaxis Pharmacy Refrigerators Medical Refrigerators Sequential compression with disposable sleeves Ward & clinic models 36 to 155 litres Pharmacy models 36 to 2040 litres Safe storage at +4C From 36 litres upwards Unit 21 Botany Business Park. Whaley Bridge. High Peak. SK23 7DQ. UK Telephone: +44 (0) Fax: +44 (0) info@qedscientific.co.uk. Web: