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mxr flowmeter user s manual instructions and safety considerations mxr models of porter conscious sedation flowmeters and bag tee accessory wall mount models 2000 2000-os 3000 bag tee models p1407a p2407a p1407b cabinet mount models cabinet mount models 2050w 2055w 2060w 2066w 2065w 2070w 3065w and 3066w porter parker hannifin corporation porter instrument division 245 township line rd p.o box 907 hatfield pa 19440-0907 usa 215 723-4000 fax 215 723-5106

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porter flowmeter model no serial number table of contents features and specifications 2 partial listing of reference materials 2 warnings and precautions 3 cross lines warning 4 do not allow crossed lines to defeat equipment safety features illustration 5 safety ada guidelines nfpa codes 6 intended use ­ flowmeter for analgesia delivery system 6 use scavenging 6 gas supply connection 6 monthly leak check 6 flowmeter mounting options 7 8 wall mount 7 cabinet mount 7 slide away 7 mobile stand and e-stand 8 mxr flush mount flowmeter 8 oral surgery mxr model 2000-os 8 flowmeter accessories 8 ­ 9 three liter bag 8 positive pressure demand valve 8 gas scavenging breathing circuit 9 automatic vacuum switch avs 9 in-line vacuum control kit 9 flowmeter features 10 safety feature checks 11 nitrous oxide failsafe system check before each use 11 concentration control knob valve check monthly 11 power oxygen flush check monthly 12 quick test to check 3 liter bag rubber goods for leaks 12 bag tee 12 ­ 13 non-rebreathing valve check monthly 13 emergency air valve check monthly 13 monthly calibration check 13 directions for use 14 ­ 15 basic delivery technique 15 maintenance and service 15 cleaning methods 15 troubleshooting chart 16 warranty and returns 17 1

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mxr flowmeter features and specifications flow meter t yp e upright cabinet mount special cabinet mount model n u mb e r s 2000 2000-os 3000 2050w 2055w 2060w 2065w 2070w 3065w 2066w 3066w maximum n2o concentration 70 65 50 flow meter indicates flow in l/min and percent n2o of total flow with accuracy of ± 5 includes diameter index safety system diss for n2o and o2 connectors flow meter tubes direct reading flow tubes for oxygen and nitrous oxide for accurate visual flow readings dual seal fail-safe automatically reduces n2o if o2 is shut off or pressure is reduced gas control block one-piece solid aluminum construction eliminates internal gas leaks gas flow adjustment knobs control knob-type knobs for quick accurate one-hand adjustment of gas flows emergencyairval ve automaticallyprovidespatientwithambientairifgasflowis interrupted for any reason n o n rebreathingcheckval ve prevents rebreathing of used gases and guards against co2 build-up positi ve o n offswitch eliminatespossibilityofaccidentallyleavingthemachine on color coded for oxygen o x yg enpowerflushbutton providesextradeliveryofo 2 buttonisaccessibleto override all other gas flows and deliver 100 o2 color-coded for oxygen flow control knob total flow adjustment knob which controls flow of both n2o and o2 at any desired concentration total flow can be adjusted without affecting concentration includes posi-stop needle valves for adjustment of all flows prevents damage to valves and seats o x yg enquickconnect facilitates connection of resuscitation equipment to the c e n tr a l s ys te m partial listing of reference material 1 handbook of nitrous oxide and oxygen sedation ­ morris clark · ann brunick dentists desk reference materials instruments equipment american dental as socia ti o n relative analgesia in dental inhalation analgesia and sedation with nitrous oxide harry langa d.d.s conscious sedation in dental practice c richard bennett sedation a guide to patient management stanley f malamed the practical use nitrous oxide oxygen conscious sedation robert e hamric d.m.d 2

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important read manual completely be foreoperatingthisdevice basic delivery technique is described also this manual contains instructions on periodically required checks to be performed by the user these checks are necessary to insure the proper performance of this device and its safety features retain this manual for future reference warnings and precautions these warnings and precautions are to help you to understand how to safely operate the mxr flowmeter a warning alerts you to a possible hazard to people a caution alerts you to the possibility of equipment damage warning do not use this device for the administration of general anesthesia or as a part of or in conjunction with a general anesthesia administration system warning dental workers are exposed to n2o during administration of n2o/o2 conscious sedation analgesia niosh has recommended that exposures should be minimized contact niosh 1-800-35-niosh to receive niosh publications on control of nitrous oxide in dental operatories exposure can be minimized by effective controls national institute for occupational safety and health niosh publications state that controls including system maintenance ventilation and work practices can effectively reduce n2o concentrations in dental operations your flowmeter accessory porter scavenger system is an important part of the system of controls warning porter instrument equipment utilizes the cross+protection system the flexible hose and connectors that connect to the flowmeter are diameter indexed 3/8 o.d for nitrous oxide and ½ for oxygen the cross+protection system is designed to prevent misconnection of oxygen and nitrous oxide piping do not attempt to change the diameters or connectors of the flowmeter tampering with the cross+protection system constitutes acceptance of liability by the installer warning new or modified installations properly connected gas pipelines are absolutely essential to patient safety the dealer or contractor should provide written documentation that all gas pipelines are connected properly and that the system has been pressure tested prior to use while this is a good business practice it is important that the user verify by their own test independent of the dealer or contractor that all gas pipelines are connected correctly prior to using the system the ultimate responsibility of assuring that lines are not crossed rests with the user warning during any power outage remember to turn off the flowmeter and manually turn off the tank valves with centralized electrically powered gas systems if gas was flowing when the power went out and the flowmeter is left on gas will be flowing when the power is restored caution federal law requires this device for use by or on the order of a physician or dentist caution always use clean dry medical grade gases introduction of moisture or other contaminants into this device may result in defective operation caution do not attempt to repair alter or calibrate this device unauthorized repair alteration or misuse of this device is likely to adversely affect the performance and will void the warranty caution never oil or grease any part of this system minimize fire or explosion potential 3

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warning new or modified installations always assure that lines are not crossed warning new or modified installations properly connected gas pipelines are absolutely essential to patient safety the dealer or contractor should provide written documentation that all gas pipelines are connected properly and that the system has been pressure tested prior to use while this is a good business practice it is important that the user verify by their own test independent of the dealer or contractor that all gas pipelines are connected correctly prior to using the system the ultimate responsibility of assuring that lines are not crossed rests with the user do not allow crossed lines to defeat the safety features of the dental flowmeter and/or central gas supply manifold systems crossed lines will create a dangerous and hazardous condition where 100 nitrous oxide will be delivered through the oxygen dental flowmeter tube and subsequently to the patient in addition the resuscitator quick connect would deliver 100 nitrous oxide to an oxygen demand valve maintain patient observation during procedures prevent over sedation if a patient becomes over sedated when being delivered 100 oxygen it is a definite indication of crossed lines if crossed lines are suspected remove the nasal mask immediately and encourage mouth breathing deliver pure oxygen from an oxygen demand valve only if the oxygen source is independent from the suspected crossed lines area to check for crossed lines of an installed porter vanguard or sentinel manifold system 1 at the manifold system in the tank room start the check from an operating system with 50 psi showing on both gauges and the indicator lights turned on ­ electrical operation and alarms needed for the vanguard test then turn off both oxygen tanks and leave both nitrous oxide tanks on for the sentinel only one tank of each gas is on at a time turn off the one open oxygen tank leave on the one nitrous oxide tank turn off the indicator lights ­ eliminates alarms during the sentinel test 2 in the operatory where the flowmeter is installed flow 5 to 6 liters per minute of o2 only verify that the n2o flowmeter valve is in the off position and that there is no indicated flow of n2o by observing the ball float resting at the bottom of the glass n2o flow tube this action will bleed the oxygen copper tubing lines 1/2 od from the manifold through the office walls to the flowmeter note this action does not cause a quick bleed down as there is a fair sized volume in the lines o2 flow would be observed by the position of the ball float in the o2 flow tube for several minutes 3 rather than waiting for the o2 flow to decrease go back to the manifold tank room and observe the o2 pressure gauge on the manifold normally showing approximately 50 psig pressure the line pressure should start to decrease indicating bleeding of the o2 that is no longer being replenished by the tanks on vanguard systems the alarm will beep at 40 psig a switch will occur from one tank to the second tank at 30 psig increasing the gauge back to 40 psig the gauge then should eventually go down to zero if the o2 pressure does not go down as described above and remains at about 50 psig it indicates a crossed lines condition 4 if o2 pressure does not go down proceed to the next crossed line determination check turn n2o tanks off in the manifold tank room and watch the n2o gauge given a crossed line condition the n2o gauge will now go down the vanguard system will show a switching similar to step 2 above this shows the o2 valve of the flowmeter is bleeding the crossed n2o lines the n2o gauge will go down to zero 4

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do not allow crossed lines to defeat equipment safety features crossed lines in wall structure piping creates hazardof 1 0 0 nitrousoxidedeli ve rytonasalmaskandox yg endemand va l ve whenflowmeterissetfor 1 0 0 o x yg enresultingino ve r sedation over sedation 5 1 the initial installation potential problem diss diameter index safety system is modified at tank room wall when 3/8 inch nitrous oxide pipe is increased to 1/2 inch pipe size oxygen pipe remains at the normal 1 /2 inchsize both nitrous oxide and oxygen piping is maintained at a common 1/2 inch size throughout the building walls leading to operatories at gas outlet station the oxygen 1/2 inch pipe is incorrectly decreased down to the diss 3/8 inch size reserved for nitrous oxide lines oxygen is fed into the nitrous oxide lines 4 5 6 7 at gas outlet station the common run of 1/2 inch nitrous oxide is incorrectly allowed to remain at inch size and is then falsely connected to the diss outlet station nitrous oxide is fed into the oxygen pipe for the 1/2 1/2 inch lines 2 dental flowmeter valve is set for 100 oxygen only but will deliver 100 nitrous oxide because of the crossed lines a patient will become over sedated and may appear to fall asleep when the flowmeter is set for 100 oxygen an oxygen demand valve connected to the resuscitator quick connect of the flowmeter will also deliver 100 nitrous oxide because of the crossed lines 3

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safety ada guidelines in addition to the fail-safe and other safety features found on most sedation machines effective august 1976 the following specifications were added to those required for acceptance by the ada council on dental materials and devices 1 emergency air valve 2 non-rebreathing check valve and 3 resuscitator quick connect in addition the ada council requires that 1 the gas storage and delivery system meet the recommendations of the national fire protection association nfpa 2 the system be installed by a competent supplier of gases and equipment nfpa codes to assure safe operation and conformation to local fire codes porter instrument nitrous oxide sedation systems meet or exceed the guidelines established by the national fire protection association for nonflammable medical gas systems nfpa 99 copies of nfpa 99 or portions thereof may be obtained by writing to national fire protection association batterymarch park quincy ma 02269-9904 usa or call 1-800344-3555 use scavenging monitor for n2o in the operatory to insure that controls are effective in achieving low levels of ppm parts per million exposure contact your porter dealer for details on monitors and testing gas supply connection after installation of the flowmeter connect the nitrous oxide and oxide supply lines to the diameter indexed safety system diss fittings located on the back of the flowmeter unit it is important that the regulators for both gases be set to give pressures in the range of 50 psig ±2 psig confirm the absence of leaks at pressure connections on the unit bubbles will appear at leaking locations when a soap water solution is used this procedure is recommended each time a cylinder is changed intended use flowmeter for analgesia delivery system this device is intended for patient use by an attending physician or dentist properly trained in its use porter instrument recommends the user be thoroughly familiar with the use of nitrous oxide oxygen conscious sedation for patient analgesia and be properly trained in its administration prior to using this product for training requirements on the administration of nitrous oxide oxygen conscious sedation contact the appropriate regulatory authority in your country state or province training is recommended to provide a practical hands-on capability and an understanding of the behavioral aspects of nitrous oxide sedation and will complement the safety features of this device monthly leak check or if connections to flowmeter are disconnected and then reconnected such as after a flowmeter service at the factory or if the diss/diss hose is replaced leak test the flowmeter system for working pressure leaks after all hose connections are tightened turn the flow control knobs to the off position and the on/off switch to the off position confirm that the diss shut-off valves are in the open position pressurize the sedation gas supply lines with 50 psi observe any pressure decay after an overnight time period 5 psi drop allowed monitor o2 gas pressures at the beginning of each procedure to assure sufficient gas remains in the tank to complete the procedure 6 flowmeter mounting options

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the dental flowmeter may be mounted to a telescoping wall mount using the existing hanger on the back of the flowmeter or to a mobile stand using the threaded hole at the bottom of the failsafe block there are various options for mounting the flowmeter within cabinets the location selected for mounting of the slide assembly should provide easy access to reach and unobstructed view of the flowmeter when mounted on the slide assembly there should be adequate space at the rear of the flowmeter for o2 and n2o gas delivery hoses contact your local dental dealer for mounting options solid wall mount ­ telescoping model 2020 1 remove cap from the mounting post assembly 2 insert mounting post through mounting bracket on back of flowmeter 3 replace cap on top of mounting post a position small diameter cap down to allow for swivel mounting figure a b position small diameter cap up to fix direction of flowmeter figure b 4 tighten screw securely figure a cap position down cabinet mount slide model 2036 figure c 1 loosen knob on side of mounting block 2 remove mounting post from block 3 insert post through mounting bracket on back of flowmeter 4 replace post with flowmeter attached into mounting block 5 tighten knob on side of mounting block figure c slide away mount model 2035-1 for ease of accomplishing the dual sliding motion hold the meter toward the top half and lift slightly while sliding the arm in and out this will reduce the load on the slide and promote a smoother action figure d figure b cap position up figure d mobile stand 1 loosen thumb-screw knob 7 2 slide shaft up.

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3 insert flowmeter hole in bottom of black failsafe block onto top of mobile stand pole figure e 4 while holding the flowmeter still screw shaft into bottom of the flowmeter 5 to telescope meter loosen thumbscrew knob on side of mobile stand position flowmeter then retighten knob figure e flowmeter models 2065w 3065w and 2070w have universal connectors that are easily switched in the field from back to bottom or bottom to back position to suit the installation if the connectors are switched the flowmeter should be completely function tested after installation to the user instructions contained in this manual caution the position of the connectors may be switched by an authorized porter representative only unauthorized repair alteration or misuse of this device is likely to adversely affect the performance and will void the warranty oral surgery mxr model 2000-os the oral surgery flowmeter can achieve 20 lpm n2o maximum flow this model includes a special p2407a oral surgery threaded bag tee with adapter accessory includes a directional y valve that attaches to the threaded bag tee refer to fm-631 for directional y valve instructions mobile e stand ­ figure f refer to installation and instructions fm-916 for mounting flowmeter to mobile e tank stand figure f flowmeter accessories three liter bag install the 3 l reservoir bag by sliding the opening over the outside of the bag tee downspout the bag moves in and out with each inhalation and exhalation and becomes a visual barometer for monitoring the patient s respiration rate refer to fm-809 for user instructions assembly installation and cleaning positive pressure demand valve the porter flowmeter is equipped with a resuscitator quick connect which allows for the attachment of an oxygen demand valve the demand valve resuscitator provides a fast simple and effective means to ventilate nonbreathing patients and provide 100 oxygen on demand the resuscitator flow rate is limited up to 40 lpm in line with the 1992 american heart association recommendations and guidelines for resuscitation refer to the user instructions supplied with this product for complete details 8 mxr flushmount flowmeter

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gas scavenger breathing circuit gas scavenger system is used to remove exhaled gases during a dental analgesia conscious sedation procedure in a dental operatory the breathing circuit consists of a 22mm 90° elbow connector fresh gas coaxial tubing a corrugated hose and hood assembly attach the nasal inhaler to the coaxial tubing assembly using the diameter-indexed connectors attach one end of the fresh gas corrugated tubing to the coaxial tubing assembly at the fresh gas y connector and the other end to the 22mm right angle adapter press fit the 22mm right angle adapter onto the bag tee attach the 3l bag to the bottom downspout of the bag tee attach the vacuum hoses to the vacuum control source avs or in-line vacuum control block refer to fm-809 for user instructions assembly installation and cleaning 5061 connector installation automatic vacuum switch [avs option the avs is used to control the vacuum flow in the gas scavenger breathing circuit and assure that the scavenging system is activated as soon as n2o o2 is turned on adjust the vacuum flow using the control knob vacuum flow is most effective when the ball float is set within the green bar area installation of avs to flowmeter screw avs 5000 knurled seal nut down tight onto flowmeter making sure the rubber washer is inside the seal nut when tight the avs should not rotate then screw the bag tee seal nut onto the avs bag tee should not rotate connecting avs to vacuum hoses attach one end of the vacuum hose to the vacuum hose y connector and the other end to the mask port of the avs attach a second vacuum hose to the vac port of the avs and the other end to the vacuum source porter recommends that effective scavenging can be achieved with the ball float in the green bar area of the acrylic sight glass however niosh publications conclude that higher vacuum flows of up to 45 l/min are most effective to meet the niosh recommendation of 45 l/min adjust the ball above the green bar area in-line vacuum control kit option the kit includes a vacuum control block with sight glass vacuum tube holder adapter t and straight fitting the vacuum control block can be inserted directly into the high volume evacuation hve line or may be placed in-line by cutting the vacuum hose and attaching the cut ends of the tubing to both ends of the vacuum control block adjust the vacuum flow using the control knob vacuum flow is most effective when the ball float is set within the green bar area refer to fm-809 for user instructions assembly installation and cleaning 9

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figure 1 flowmeter features 2 2 1 6 3 7 9 5 11 4 10 12 8 1 oxygen flowmeter tube indicatestheflowofo 2 i n l m i n ± 5 2 nitrous oxide flowmeter tube indicatesflowofn 2 oinl m i n ± 5 3 nitrous oxide failsafe system dual seal oxygen-piloted valve system that automatically maintains the n2o concentration setting with any change in the o2 flow or pressure n2o flow is proportionately reduced if o2 is shut off or the pressure is reduced check before each use controls the combined flow of o2 and n2o or o2 flow only when the concentration control knob is set to 0 6 emergency air valve automatically provides the patient with ambient air if gas flow is interrupted check monthly 7 non-rebreathing valve guardsagainst co2 build-up and rebreathing of used gases check monthly 8 positive on off switch reducesthe possibility of accidentally leaving the machine on 9 power flush providesextradeliveryofo 2 to the breathing bag check monthly 4 flow control knob 10 o 2 quick connect left side of machine facilitates connection of positive pressure demand valve for emergency oxygen tubing 5 concentration control knob controls the concentration of n2o but does not change the o2 flow rate 70 maximum n2o delivery check monthly 11 bag tee outlet connectstofreshgas 12 3 l bag connection 10

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power oxygen flush check monthly o2 supply pressure at 50 psig disconnect the corrugated rubber tubing from the bag tee outlet figure 1 item 11 with both control knob valves off depress the power o2 flush button while blocking the flow from the front of the bag tee for proper operation the gas reservoir bag should fill within about 5 seconds also test for bag rubber goods leak following steps 1 through 6 2 with the other plastic connector join the two duplex hoses together making a closed system 3 taking care not to fill the bag too much bag could burst open the oxygen control valve until the 3 liter bag starts to overinflate or balloon then close the valve 4 observe the 3 liter bag for five minutes 5 the bag should stay inflated if so the test has been successful and there are no excessive leaks if the bag does not stay inflated the 3-liter bag or rubber goods have an excessive leak replace any parts that leak and retest until results are successful 6 disconnect one of the duplex hoses from the plastic connector and re-install the nosepiece figure 2 remove one connector and join hoses together cabinet mount model o2 flush knob bag tee the bag tee assembly features a nonrebreathing valve and an emergency air intake located on the bag tee which comply with american dental association guidelines the non-rebreathing valve has a back flow check valve which prevents exhaled gases from entering the breathing bag no carbon dioxide buildup the emergency air intake has a valve that allows room air to be inhaled into the breathing circuit by the patient a breathing bag is attached to the metal portion of the bag tee and is a reservoir bag for the delivered analgesia gases which when taken together with the two valves above becomes the visual barometer for monitoring the patient s respiration rate the bag moves in and out with each inhalation and exhalation bag tee installation to flowmeter screw knurled seal down tight onto flowmeter quick test to check 3 liter bag rubber goods for leaks 1 with the flowmeter bag tee and porter rubber goods in place remove the nosepiece and one of the two plastic connectors from the porter rubber goods refer to figure 2 12

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