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NoxBox NOxBOXi Operating Instructions Manual

Made by: NoxBox
Type: Operating Instructions
Category: Medical Equipment
Pages: 22
Size: 3.51 MB

 

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NOx

BOX

i

  Operating Instructions

®

1

www.noxboxltd.com

Bedfont Scientific Ltd, Station Road, Harrietsham, Maidstone, Kent, ME17 1JA

 +44 (0)1622 854868 

 +44 (0)1622 854860 

 ask@noxboxltd.com   

 www.noxboxltd.com

Issue 6.0 (Software V.17.1)  September 2015. Part No: LAB636

© NOxBOX Ltd 

NOxBOX Limited reserves the right to change or update this literature without prior notice.  Registered office: England and Wales. Registered No: 9563860

ISO 9001:2008 

Cert No. FM 31664 

ISO 13485:2003 

Cert No. MD 502905

Set- Up

 

 

Before you use the Bedfont NOxBOX

i

 intelligent Nitric Oxide delivery and monitoring system it is important to follow these steps:

Ensure the device does not require maintenance (monthly) and that the maintenance is not due during the expected duration of the therapy such as:

•  NO sensor high calibration

•  NO

sensor high calibration

•  Pump calibration

•  Vent calibration

Checklist

•  Ensure the device is clean and free from damage

•  Ensure the water trap is empty and has been cleaned from previous use

•  Ensure all single use items from previous patient have been discarded

Equipment  you will need for set-up:

•  A NOxBOxi system test kit (NOXBOX-I TEST)

•  A NOXKIT (inspiratory limb size dependant)

•  Two cylinders of delivery gas

•  A 22mm one-way valve for HFO ventilator circuits (FXS555)

Additional items

•  NOxAIR Environmental monitors

•  Manual bagging kit

NOTE: If you do not have the parts listed above or the device has not been maintained the NOxBOX

i

 may not be suitable for use and you may be unable to 

set-up the device. Failure to follow these procedures may result in harm to to the operator or the patient.

 


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Setup

Engage trolley brakes to

stabilise system prior to use.

To attach monitor to trolley,

carefully drop the monitor

over the attachment plate.

Connect power supply to

suitable rated mains outlet.

Press power button to start

system.

Once zero test is complete,  

follow instructions on

screen to set-up system.

Experienced users may

choose to skip directly to

system tests or skip to dose.

System test circuit set-up:

NOxFlowTM arrow points in

direction of flow. 1m vent

tubing between sample

point and NOxFlow

TM

.

Perform system

test to ensure correct system

functionality prior to

connecting to patient.

Connect to patient circuit;

sample near patient Y-piece.

Retain NOxFlowTM

orientation for flow and 1m

distance from sample point.

1

2

3

4

5

6

7

8

 


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Perform   a   leak   test:   open   the   

cylinder   valve   then   close.   

Observe   gauge   for   30   

seconds,   needle   should   

remain   sta>onary.   

Engage trolley brakes to

stabilise system prior to

changing cylinder.

Check cylinder concentration

matches the setting for the

system.

Check regulator surfaces and  

O rings are damage free. Do 

not use damaged equipment.

Attach regulator to cylinder.

Screw firmly by hand. Attach

supply line to regulator.

Apply supply line to port on rear 

of monitor

1

2

3

5

Slowly open cylinder valve. 

Read gauge. If needle in red 

zone, replace cylinder before

starting treatment.

Perform a leak test: open the

cylinder valve then close.

Observe gauge for 30

seconds, needle should

remain stationary.

4

6

8

Cylinder setup

7

Load cylinders onto trolley.

Secure with straps.

1000

 


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System tests

System test circuit set-up:

NOxFlow arrow points in

direction of flow. 1m vent

tubing between sample

point and NOxFlow.

Re-open NO cylinder.

Connect O

2

 supply to

NOxFlow

TM

 inlet. Set O

flow

to 10 L/min. Press “Next” on

system screen to run test.

System test takes approx.

5 minutes to run. This purges

NO

2

 and ensures correct

NOxBOX

i

 operation.

System test passed. Stop O

2  

flow 

and disconnect from NOxflow. 

Ready to connect to patient.

System test failed. Check:

NOxFlow orientation; O2

flow at 10 L/min, NO cylinder

connected and valve open.

Re-run test. 

If not using in next 10 mins: Unit 

may time out and may require 

you to repeat step 4.

Connect to patient circuit.

Enter dose and check alarm

levels before commencing

treatment.

1

2

3

4

5

6

7

 


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Ventilator connections

The NOxFlow

TM

 is single 

patient use. Unwrap and 

carefully uncoil the lines.

Push and click-to-lock twin

sensor line to unit.

Twist dose line luer to unit.

Select a vent connector with

luer port from the NOXKITTM.

Connect the male luer of the

sample line.

1

2

3

4

NOxFlow

TM

  is situated in the inspiratory limb,  

before the humidifier.

The sample line  is up to 30cm from patient to the patient Y-piece.

NOxFlow should be approx. 1 metre back from the sample

point. Ideal range 0.7 m – 1.3 m.

For system test, high frequency and manual bagging circuit

diagrams please refer to Technical Guide.

5

Change sample line and  

hydrophobic fliter.

 


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Dose setting & main screen features

The navigation tabs access the alarm history and user settings screens.

Alarm history: shows last 10 alarms for current treatment. Unresolved 

alarms are listed at the top.

User settings: change user settings, access Manual Override  

calculator, Sensor Zero and Service Engineer area.

To set or change dose press  ‘edit 

dose’ . The NOxBOX

will then 

guide you through setting the 

dose and high/low alarms. Once 

confirmed the delivery and  

monitoring will adjust  

accordingly.

Maximum dose - 80ppm

Minimum dose - 0.1ppm

dose setting

edit dose

monitored gas

units

upper alarm 

adjustment

upper alarm value

lower alarm 
adjustment

lower alarm value

mute button (inactive)

monitored 
value

supply 

indicator 

(depleated)

cylinder 2

supply concentration

supply  
indicator
 (gas available)

cylinder 1

time at 

current dose

days:hours:mins

second timing marker

total treatment 
time
days:hours:mins

 


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Cylinder replacement

Engage trolley brakes to  

stabilise system prior to  

changing cylinder.

Fully close cylinder valve.

Check regulator gauge 

pressure is relieved and

remove regulator from 

depleted cylinder.

Remove depleted cylinder from 

trolley and replace with new  

supply cylinder. Check the  

concentration matches the value 

displayed on-screen.

Check O rings and attach 

regulator to new  

cylinder.

1

2

5

Perform a leak test: Slowly open 

the cylinder valve then close. 

Observe gauge for 30 seconds, 

needle should remain  

stationary.

Purge pressure from hose, then 

reconnect the hose to inlet port 

monitor. Open valve on cylinder 

fully. 

7

8

3

4

Perform   a   leak   test:   open   the   

cylinder   valve   then   close.   

Observe   gauge   for   30   

seconds,   needle   should   

remain   sta>onary.   

6

Detach hose from monitor and 

depressurise on purge needle.

 


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Confirm on-screen that  

shutdown is required. Follow  

on-screen instructions.

Fully close each cylinder and  

depressurise the supply lines  

using the purge needle. 

Check regulator gauge 

pressure is relieved and 

remove regulator from each 

cylinder and stow on system 

trolley.  

Remove all single patient use 

devices from monitor and 

dispose of according to local 

regulations.

Drain water trap and dispose of 

drainage syringe. 

On completion of last  

instruction screen, system will 

purge and shutdown safely 

ready for storage.

2

3

4

5

6

7

Shutdown

Remove power supply and 

store on trolley for transport. 

Ensure system is attached to 

suitable mains supply whilst in 

storage.

8

When ready to shutdown the 

system, briefly press the power 

button on the monitor.

1

 


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Troubleshooting Guide

ALARMS TROUBLESHOOTING 

The NOxBOX

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 is equipped with audible and visible alarm notifications; this chapter is a guide to the alarm conditions that can occur and common actions for alarm resolution. All alarms 

are graded into high priority or medium priority alerts.
   
NOTE: In all instances of alarms sounding, the health and condition of the patient must be ensured before attempting to resolve any issue with the NOxBOX

i

 system.

Alarm Priorities

The system alarms are colour coded to help identify priority of detected issue. Additionally, the two alarm priorities each have an audible warning to help differentiate them. 

Priority

Colour & Tone

Meaning

High

Red

5 tone pattern & Red L.E.D. 

alarm strip.

Critical problem detected. Condition poses immediate threat to patient health or correct 
functioning of the NOxBOX

monitor. Alarm condition should be diagnosed and resolved 

immediately.

Medium

Amber

3 tone pattern

Problem detected. Condition may impair the functioning of the NOxBOX

i

. If left unresolved, problem may 

worsen and cause a high priority alarm condition.

 


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Notifications at Switch on

The below are a series of notifications which may be seen at start-up (before the home screen) if an issue is detected with the NOxBOX

i

Troubleshooting Guide

Notification

Priority

Possible Cause

Recommended 

NOxBOXi System 

Diagnostics

High

The NOxBOXi performs self-tests at start-up and during operation 
to ensure safe performance is maintained. In the event that a 
critical test fails, the system will display a full-screen notice
 indicating that the system can no longer be used safely.

Press the on screen reset button.

Sensor Bias Lost

High

The Nitric Oxide sensor requires a constant very low trickle charge 
to maintain its calibration. In the event that the system is not stored 
on mains power charge, after an extended period of time the 
battery may completely discharge and the sensors will lose their 
calibration bias.

In the event of power loss, connect the unit to mains power and allow 
6 hours for the unit to charge before 
calibrating the NO sensor and re-commissioning the unit.
If another system is not readily available and patient 
requires therapy, engage the manual override mode, replace the 
system as soon as practically possible and alert the Service Engineer.

The Nitric Oxide sensor is sensitive to extreme 
temperature variation, contact with VOCs (such as 
alcohol based cleaning products), strong fragrances, direct contact 
with moisture or vibrations (such as during transit in a vehicle).

Follow setup steps as normal, if sensor zero fails re 
attempt until the unit passes, this can take up to 30 
minutes in some cases.

The NO sensor may require replacing.

If another system is not readily available and patient 
requires therapy, engage the manual override mode, replace the 
 system as soon as practically possible and alert the Service Engineer.

 


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High Priority Alarms during therapy 

The below are a series of alarms which may be seen during therapy (once the device has been setup) if an issue is detected with the NOxBOX

i

.

Troubleshooting Guide

Alarm

Priority

Possible Cause

Recommended Action

NO Low

High

Monitored levels of NO gas being delivered to 
the patient have dropped below the alarm 
setting boundary. NOxBOX

i

 delivery system 

cannot maintain correct dose setting.

Check sample line is correctly attached to ventilator circuit and NOxBOX

i

 water trap inlet.

Check sample line for blockages.
Check water trap (including barrel thread) for damage and/or leaks.
Check no ventilator circuit breaks or leakages have occurred.
Check supply cylinder is connected, open; there are no leaks and the concentration matches the 
system settings.
Check correct orientation of NOxFLOW.
Check NOxFLOW dose line and connection is connected and there are no blockages or leaks. 
Check NOxFLOW flow detection lines and connection (including O rings) are connected and there 
are no blockages or leaks.

The ventilator minute volume may be too low.

Check ventilator minute volume (see NOxBOX

i

 technical guide for flow specifications), you may 

need to increase the ventilator bias flow.

The NO low alarm may be inappropriately set 
by user.

Check NO low alarm value and reduce value if ventilator settings deem necessary.

The NO sensor may require replacing.

If another system is not readily available and patient requires therapy, engage the manual  
override mode, replace the system as soon as practically possible and alert the Service Engineer. 

NO High

High

Monitored levels of NO gas being delivered to 
the patient have risen above the alarm setting 
boundary. NOxBOXi delivery system cannot 
maintain the correct dose setting.

Check supply cylinder concentration matches the system settings. If possible, change the NO  
supply cylinder for the correct concentration. If not, call Service Engineer to resolve.
Check no ventilator circuit break/leakage has occurred that may cause build-up of NO 
concentration due to lack of ventilator flow.
Check correct orientation of NOxFLOW.

Check NOxFLOW connection (and O rings) to NOxBOXi.

The NO high alarm may be inappropriately set 
by user.

Check NO high alarm value and increase value if ventilator settings deem necessary.

The NO sensor may require replacing.

If another system is not readily available and patient requires therapy, engage the 
manual override mode, replace the system as soon as practically possible and alert the Service 
Engineer.

 


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NO

2

High

Monitored levels of NO

2

 gas being 

delivered to the patient have risen 
above the alarm setting boundary.

High NO dose settings on low ventilator flows with High O

2

 content may cause higher NO

2

 build-up than  

expected. Increase ventilator bias flow to help reduce stagnation in delivery.

Poor quality NO cylinders can 
contain high levels of NO

2

.

Connect a second supply cylinder to the alternate inlet port. Open the cylinder and 
disconnect the previous cylinder, forcing a cylinder changeover to see if this resolves the issue.

The NO

high alarm is set to a default 

value of 1.0ppm. NO

is extremely 

toxic and poses risk to patient health.

The alarm value can be increased to a maximum of 5.0ppm if required. Please see INO guidelines for more  
information on maximum NO

2

 values during INO therapy.

Incorrect placement of 
NOxFLOW and sample line.

See ventilator circuit diagram for correct placement of NOxFLOW and sample line.

Whilst in standby mode NO

2

 can build 

up in supply lines.

Purge supply lines (see cylinder change procedure).

Stagnant gas in manual bag circuit 
causing NO

2

.

Purge manual bag circuit before connecting to
patient (see manual bagging procedure).

The NO

2

 sensor may require

replacing.

If another system is not readily available and patient requires therapy, engage the manual override mode, 
replace the system as soon as practically 
possible and alert the Service Engineer.

O

2

 Low

High

Monitored levels of O

gas being 

delivered to the patient have fallen 
below the alarm setting boundary.

Check sample line for blockages.
Check water trap (including barrel thread) for 
damage and/or leaks.
Check sample line is correctly attached to ventilator circuit and NOxBOX

water trap inlet.

Check no ventilator circuit breaks or leakages have occurred.

The NO gas is balanced in N2, this is 
an asphyxiant gas. At high NO dose 
levels for low concentration cylinders 
(e.g. 200 ppm) the level of gas 
delivered into the ventilator stream 
can reduce the % v/v of O

2

 being 

delivered to the patient.

Check O

2

 concentration setting at ventilator.

Adjust O

alarm value if deemed necessary.

The O

2

 sensor may require 

replacing.

If another system is not readily available and patient requires therapy, engage the manual override mode, 
replace the system as soon as practically possible and alert the Service Engineer.

Troubleshooting Guide

 


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NO

2

High

Monitored levels of NO

2

 gas being 

delivered to the patient have risen 
above the alarm setting boundary.

High NO dose settings on low ventilator flows with High O

2

 content may cause higher NO

2

 build-up than  

expected. Increase ventilator bias flow to help reduce stagnation in delivery.

Poor quality NO cylinders can 
contain high levels of NO

2

.

Connect a second supply cylinder to the alternate inlet port. Open the cylinder and 
disconnect the previous cylinder, forcing a cylinder changeover to see if this resolves the issue.

The NO

high alarm is set to a default 

value of 1.0ppm. NO

is extremely 

toxic and poses risk to patient health.

The alarm value can be increased to a maximum of 5.0ppm if required. Please see INO guidelines for more  
information on maximum NO

2

 values during INO therapy.

Incorrect placement of 
NOxFLOW and sample line.

See ventilator circuit diagram for correct placement of NOxFLOW and sample line.

Whilst in standby mode NO

2

 can build 

up in supply lines.

Purge supply lines (see cylinder change procedure).

Stagnant gas in manual bag circuit 
causing NO

2

.

Purge manual bag circuit before connecting to
patient (see manual bagging procedure).

The NO

2

 sensor may require

replacing.

If another system is not readily available and patient requires therapy, engage the manual override mode, 
replace the system as soon as practically 
possible and alert the Service Engineer.

O

2

 Low

High

Monitored levels of O

gas being 

delivered to the patient have fallen 
below the alarm setting boundary.

Check sample line for blockages.
Check water trap (including barrel thread) for 
damage and/or leaks.
Check sample line is correctly attached to ventilator circuit and NOxBOX

water trap inlet.

Check no ventilator circuit breaks or leakages have occurred.

The NO gas is balanced in N2, this is 
an asphyxiant gas. At high NO dose 
levels for low concentration cylinders 
(e.g. 200 ppm) the level of gas 
delivered into the ventilator stream 
can reduce the % v/v of O

2

 being 

delivered to the patient.

Check O

2

 concentration setting at ventilator.

Adjust O

alarm value if deemed necessary.

The O

2

 sensor may require 

replacing.

If another system is not readily available and patient requires therapy, engage the manual override mode, 
replace the system as soon as practically possible and alert the Service Engineer.

 

Water Trap 

Full

High

Water trap is filled with condensate from sample line. 
If the water trap is allowed to overflow, the sample 
path will block and water ingress to the NOxBOX

system could damage the internal mechanisms and 
gas sensors. Delivery accuracy is compromised and 
patient safety could be put at risk. 

Use disposable male-luer lock syringe contained in NOXKIT to empty fluid from 
water trap via the self-sealing drain tap located at the bottom of the water trap. 
Dispose of entire syringe and contents according to local directives (e.g. sharps waste).
The water trap uses a small float to activate the alarm, if no
moisture is present gently tap the barrel to see if the alarm float is  
in the off position.  

If issues persist, remove the barrel and check position of alarm float.
Removing the water trap barrel will dilute NO sample causing inaccurate dose and readings. 
Take care not to damage/cross thread the water trap thread when 
replacing the barrel.

Sample Line 

block

High

Sample line to monitor has become blocked, pinched 
or occluded. Sample monitoring is 
affected which may compromise deliveryaccuracy 
and patient safety.

Check sample line for any pinch/crush points from external bodies, or blockages that may have 
occurred.
Check water trap does not require emptying.
Change sample line and hydrophobic filter.
If another system is not readily available and patient requires therapy, engage the manual  
override mode, replace the system as soon as practically possible and alert the Service Engineer. 

Battery 

Critical

High

NOxBOX

i

 is running from internal battery and battery 

charge level has been detected as critical. System 
power could fail within the next 10
minutes. Power failure will stop automatic 
intelligent delivery of NO.

Reconnect the NOxBOX

i

 system to the mains using the NOxBOX

i

 power supply. This will ensure 

continued powered operation of the NOxBOXi and will start to recharge the internal battery.

Check green (mains power) L.E.D on mains power plug is lit indicating mains supply OK. If not, 
try a different mains power socket/supply.
Disconnect power supply and reconnect, check blue (charging) L.E.D is lit indicating mains  
supply OK. If not, try a different mains power/supply.
If possible replace NOxBOX

i

 power supply and alert service engineer.

Troubleshooting Guide

 


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Troubleshooting Guide

In the event that no mains power can be restored to the device, be prepared to engage the 
manual override mode.

Cylinder 

Supply 
Critical

High

NOxBOX

i

 detects that available NO gas 

supply is running low, and no alternate 
cylinder supply is detected. Without action to 
replenish the NO gas supply treatment 
delivery will cease.

Install a new gas cylinder supply and connect to the alternate gas inlet port at the rear of 
NOxBOX

i

.

If a new gas cylinder is already installed, ensure the cylinder valve is fully open and 
connected to inlet port at rear to allow the device to use the supply for delivery.
Check the supply cylinder regulator gauges indicate adequate cylinder pressure (>20bar). If 
regulator gauge indicates adequate pressure, check for leaks. If issues persist, replace regulator and 
alert service engineer.

Vent Flow 

Idle

High

The NOxFLOW has not detected any vent flow 
activity for an extended period of time (typically 
over 30 seconds) during delivery.

Check correct orientation of NOxFLOW; the green arrow printed on the NOxFLOW should be 
 pointing towards the patient in the direction of the ventilator flow.
Check NOxFLOW flow detection lines and connection (including O rings) are connected and there 
are no blockages or leaks.
Check there is not a serious leak or break in the ventilator circuit. Attend to the ventilator circuit 
requirements.
Check the ventilator is connected and supplying sufficient flow.

Critical

 Delivery 

Fault

High

The NOxBOX

i

 has detected a critical fault within 

the intelligent delivery system, and can no 
longer guarantee safe delivery function.

If another system is not readily available and patient requires therapy, engage the 
manual override mode, replace the system as soon as practically possible and alert the 
Service Engineer.

Occlusion on NO outlet.

Check for occlusions on the NO outlet, delivery line or NOxFLOW. Once resolved, reset the dose to 
resume delivery.

Touch screen 

won’t 

respond.

High

The NOxBOX

i

 has detected a critical fault within 

the intelligent delivery system, and can no  
longer guarantee safe delivery function. NO 
delivery to the patient may have stopped.

If another system is not readily available and patient requires therapy, engage the 
manual override mode, replace the system as soon as practically possible and alert the 
Service Engineer.

 


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Troubleshooting Guide

Medium Priority Alarms during therapy 

Alarm

Priority

Possible Cause

Recommended Action

Zero 

Calibration

Medium

Every 24 hours during use the NOxBOX

prompts 

the user to perform a sensor zero. This operation 
ensures the most accurate system performance by 
checking the gas sensor 
reading performance. 

NOTE: This test takes up to 2 minutes to perform. 
During this time the monitored patient gases will 
be offline. The NOxBOX

i

 continues to deliver NO 

during this time.

No special connections are required; the zero calibration is fully automatic. 

Press the tick to start the zero calibration.

The zero calibration can be delayed if the system is not currently in a stable dose delivery state: 
e.g. If the patient dose has recently been changed and the system is still stabilising to the new 
dose level, dismiss this alarm message and perform the zero when the notice next appears.

Zero

Calibration 

Fail

Medium

One or all of the sensors have failed the zero (low) 
calibration. 

Ambient conditions may be affecting the zero 
sample.

Check ambient NOxAIR monitor for high levels of NO. If high levels are detected, check the 
regulator(s) and supply line(s) for leaks.

A sensor may have become unstable or residual 
gas may be present in the system.

Repeat zero calibration.
Check the zero port (rear) has not been blocked.
If another system is not readily available and patient requires therapy, engage the manual 
override mode, replace the system as soon as practically possible and alert the Service Engineer.

Cylinder Low

Medium

This will appear when an alternate viable gas 
supply is detected, but the current feed cylinder is 
nearly depleted.

Replace the cylinder with a fresh supply to resolve this alarm.
Alternatively, once the cylinder is empty, close the cylinder valve fully, remove the feed hose from 
the rear of the system and release the pressure using the purge needle on the monitor. Please 
note, once the second cylinder begins to deplete, if this first cylinder has not been 
replaced in the interim period, the ‘cylinder supply critical’ alarm will be triggered.

 


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Troubleshooting Guide

High 

Calibration 

Overdue

Medium

To keep the NOxBOX

i

 functioning accurately, it is

important that the system sensors be fully calibrated by 
a suitably qualified Service Engineer once a month. 

The system records the last date of each successful 
calibration in the service engineer section.

This action may be performed whilst the system is in use via the service 
engineer area. However Bedfont strongly recommend that the sensor high 
calibrations are not performed during therapy to minimise risk to the patient.
To resolve, the system sensors must be calibrated by the appointed Systems Engineer using 
calibration gases.

Manual

Override

Medium

Manual Override mode is engaged.

The system alarms to alert the user that the system is not 
delivering in intelligent mode. Changes to the ventilator 
setting or patient demand cannot be automatically  
corrected on the system. A specific dose setting cannot 
be dialled in and achieved.
 
The patient must be closely monitored and ensure the 
gas alarms are correctly set to alert for any 
abnormal gas delivery behaviour.

This alarm will resolve when the system is returned to normal Intelligent 
Delivery Mode.

 

 


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General Troubleshooting

Issue

Possible Cause

Recommended Action

NOxBOX

i

 turns on and off 

immediately. NOxBOX

attempts to start up but shuts 
down. 
NOxBOX

i

 won’t turn on at all.

Low battery power.

Connect NOxBOX

i

 to mains power and turn on NOxBOX

i.

Check mains power is connected and battery is charging (see battery critical).

An internal fault has occurred; the system shuts 
down to protect integral components.

If another system is not readily available and patient requires therapy, engage the 
manual override mode, replace the system as soon as practically possible and alert the 
Service Engineer.

Zero Calibration Fail

One or all of the sensors have failed the zero (low) 
calibration. 

Ambient conditions may be affecting the zero 
sample.

Check ambient NOxAIR monitor for high levels of NO. If high levels are detected, check the 
regulator(s) and supply line(s) for leaks.

One or all of the sensors may have become unstable 
or residual gas may be present in the system.

Repeat zero calibration.
Check the zero port (rear) has not been blocked.
If another system is not readily available and patient requires therapy, engage the 
manual override mode, replace the system as soon as practically possible and alert the 
Service Engineer.

System Test Fail

The NOxBOX

i

 has failed the safety test and 

cannot accurately deliver and monitor Nitric Oxide 
inintelligent mode.

Check the Oxygen source is flowing.
Check the NOxFLOW is connected to the Oxygen source and the NOxBOX

i

-TEST kit.

Check the correct orientation of NOxFLOW.
Check the NOxFLOW is connected to the NOxBOX

i

.

Check NOxFLOW flow detection lines and connector O rings for damage.
Check sample line is connected to the water trap and the NOxBOX

i

-TEST kit.

Check water trap (including barrel thread) for damage.
Repeat the system test.
If second test fails, replace the NOxFLOW and sample line.

One or all of the sensors may have become unstable. If another system is not readily available and patient requires therapy, engage the 

manual override mode, replace the system as soon as practically possible and alert the 
Service Engineer.

Fluctuations/ Oscillations in  

excess of 3ppm.

May be due to noxflow.

Ensure O-ring and NOxFLOW are present and connected.

Mass flow sensor due for service.

Contact Service Engineer. 

HFO frequency.

Adjust the frequency slightly based upon your clinical judgement.

 


background image

NOx

BOX

i

  Operating Instructions

®

18

www.noxboxltd.com

Conventional ventilator circuit

NOTE: To improve accuracy it is recommended to have up to 30cm between the patient Y-Piece (8) and the sample line (7).

1.   Ventilator
2.  Ventilator Inspiratory Port
3.  NOxFLOW

TM

 (use 22F or 15M to vent tube adaptors)

4.  Humidifier
5.  0.7m-1.3m Corrugated Tubing (15mm or 22mm)
6.  NOxBOX

Sample Line

7.  10M - 10F, 12M - 12F, 15M - 15M luer port or 22M-22F luer port connector
8.  Patient Y-piece
9.  Expiratory limb
10. NOxBOX

i

 


background image

NOx

BOX

i

  Operating Instructions

®

19

www.noxboxltd.com

Manual override

NOTE: All dose information for the Manual Override are 

approximations. Monitoring must be used to ensure the 

patient is receiving the correct dose. 

B

If Manual Override is required:

 

First check suitable flow rate is set. 

Then engage mode selection valve to the    

position seen on right hand side image.

2

A

A

B

B

Using on-screen 

calculator access the

 manual override 

calculator from Settings.

Adjust vent flow to best match 

patient settings.  Table displays 

approx. dose per valve setting.

Use the look-up tables in this 

guide.  To set flow rate, find the 

table matching NO 

supply concentration.

Find the vent flow setting to 

best match patient settings.  

The column lists the approx. 

dose per valve setting.

A

A

B

To set flo

w r
at

es

1

OR

600

B

 


background image

NOx

BOX

i

  Operating Instructions

®

20

www.noxboxltd.com

All dose information shown in these tables is for guidance only. The patient monitored gas levels should be used for actualy dose delivery information. All nitric oxide (NO) doses shown in parts per million 

(ppm) when introduced to continuous flow rates indicated. Doses of NO above 40 ppm are not recommended. Doses above 20ppm are considered clinically high.

Flow valve setting

Minute flow volume

Clinder Concentration (ppm)

800

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

6.5

7

7.5

8

8.5

9

9.5

10

10.5

11

11.5

12

12.5

13

13.5

14

14.5

15

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

50

73

38

26

20

16

13

11

9.9

8.8

7.9

7.2

6.6

6.1

5.7

5.3

5

4.7

4.4

4.2

4

3.8

3.6

3.5

3.3

3.2

3.1

3

2.8

2.7

2.7

2.6

2.5

2.4

2.3

2.3

2.2

2.2

2.1

2

2

100

133

73

50

38

31

26

22

20

17

16

14

13

12

11

11

9.9

9.3

8.8

8.3

7.9

7.5

7.2

6.9

6.6

6.3

6.1

5.9

5.7

5.5

5.3

5.1

5

4.8

4.7

4.5

4.4

4.3

4.2

4.1

4

200

229

133

94

73

59

50

43

38

34

31

28

26

24

22

21

20

18

17

16

16

15

14

14

13

13

12

12

11

11

11

10

9.9

9.6

9.3

9

8.8

8.6

8.3

8.1

7.9

300

300

185

133

104

86

73

63

56

50

45

41

38

35

33

31

29

27

26

24

23

22

21

20

20

19

18

17

17

16

16

15

15

14

14

13

13

13

12

12

12

400

356

229

168

133

110

94

82

73

65

59

54

50

46

43

41

38

36

34

32

31

29

28

27

26

25

24

23

22

21

21

20

20

19

18

18

17

17

16

16

16

500

400

267

200

160

133

114

100

89

80

73

67

62

57

53

50

47

44

42

40

38

36

35

33

32

31

30

29

28

27

26

25

24

24

23

22

22

21

21

20

20

600

436

300

229

185

155

133

117

104

94

86

79

73

68

63

59

56

53

50

48

45

43

41

40

38

37

35

34

33

32

31

30

29

28

27

27

26

25

24

24

23

1000

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

6.5

7

7.5

8

8.5

9

9.5

10

10.5

11

11.5

12

12.5

13

13.5

14

14.5

15

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

50

91

48

32

24

20

16

14

12

11

9.9

9

8.3

7.6

7.1

6.6

6.2

5.8

5.5

5.2

5

4.7

4.5

4.3

4.1

4

3.8

3.7

3.6

3.4

3.3

3.2

3.1

3

2.9

2.8

2.8

2.7

2.6

2.6

2.5

100

167

91

63

48

38

32

28

24

22

20

18

16

15

14

13

12

12

11

10

9.9

9.4

9

8.6

8.3

7.9

7.6

7.4

7.1

6.8

6.6

6.4

6.2

26

5.8

5.7

5.5

5.4

5.2

5.1

5

200

286

167

118

91

74

63

54

48

43

38

35

32

30

28

26

24

23

22

21

20

19

18

17

16

16

15

15

14

14

13

13

12

12

12

11

11

11

10

10

9.9

300

375

231

167

130

107

91

79

70

63

57

52

48

44

41

38

36

34

32

31

29

28

27

25

24

23

23

22

21

20

20

19

18

18

17

17

16

16

16

15

15

400

444

286

211

167

138

118

103

91

82

74

68

63

58

54

51

48

45

43

40

38

37

35

34

32

31

30

29

28

27

26

25

24

24

23

22

22

21

21

20

20

500

500

333

250

200

167

143

125

111

100

91

83

77

71

67

63

59

56

53

50

48

45

43

42

40

38

37

36

34

33

32

31

30

29

29

28

27

26

26

25

24

600

545

375

286

231

194

167

146

130

118

107

98

91

85

79

74

70

66

63

59

57

54

52

50

48

46

44

43

41

40

38

37

36

35

34

33

32

31

31

30

29

WARNING: Dose >40 ppm

Dose over 20ppm

Minute Volume (L/Min)

Minute Volume (L/Min)

Dial

Dial

Minute Volume (L/Min)

Dial

500

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

6.5

7

7.5

8

8.5

9

9.5

10

10.5

11

11.5

12

12.5

13

13.5

14

14.5

15

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

50

45

24

16

12

9.8

8.2

7

6.2

5.5

5

4.5

4.1

3.8

3.5

3.3

3.1

2.9

2.8

2.6

2.5

2.4

2.3

2.2

2.1

2

1.9

1.8

1.8

1.7

1.7

1.6

1.6

1.5

1.5

1.4

1.4

1.3

1.3

1.3

1.2

100

83

45

31

24

19

16

14

12

11

9.8

8.9

8.2

7.6

7

6.6

6.2

5.8

5.5

5.2

5

4.7

4.5

4.3

4.1

4

3.8

3.7

3.5

3.4

3.3

3.2

3.1

3

2.9

2.8

2.8

2.7

2.6

2.6

2.5

200

143

83

59

45

37

31

27

24

21

19

18

16

15

14

13

12

11

11

10

9.8

9.3

8.9

8.5

8.2

7.9

7.6

7.3

7

6.8

6.6

6.4

6.2

6

5.8

5.6

5.5

5.3

5.2

5.1

5

300

188

115

83

65

54

45

39

35

31

28

26

24

22

21

19

18

17

16

15

15

14

13

13

12

12

11

11

10

10

9.8

9.5

9.2

8.9

8.7

8.4

8.2

8

7.8

7.6

7.4

400

222

143

105

83

69

59

51

45

41

37

34

31

29

27

25

24

22

21

20

19

18

18

17

16

16

15

14

14

13

13

13

12

12

11

11

11

11

10

10

9.8

500

250

167

125

100

83

71

63

56

50

45

42

38

36

33

31

29

28

26

25

24

23

22

21

20

19

19

18

17

17

16

16

15

15

14

14

14

13

13

13

12

600

273

188

143

115

97

83

73

65

59

54

49

45

42

39

37

35

33

31

30

28

27

26

25

24

23

22

21

21

20

19

19

18

18

17

17

16

16

15

15

15

Dial

Minute Volume (L/Min)

Dose look-up table 

1000ppm, 900ppm, 800ppm, 500ppm

 


background image

NOx

BOX

i

  Operating Instructions

®

21

www.noxboxltd.com

All dose information shown in these tables is for guidance only. The patient monitored gas levels should be used for actualy dose delivery information. All nitric oxide (NO) doses shown in parts per million 

(ppm) when introduced to continuous flow rates indicated. Doses of NO above 40 ppm are not recommended. Doses above 20ppm are considered clinically high.

Flow valve setting

Minute flow volume

Clinder Concentration (ppm)

WARNING: Dose >40 ppm

Dose over 20ppm

Dose look-up table 

450ppm, 400ppm , 300ppm, 250ppm

400

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

6.5

7

7.5

8

8.5

9

9.5

10

10.5

11

11.5

12

12.5

13

13.5

14

14.5

15

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

50

36

19

13

9.8

7.8

6.6

5.6

4.9

4.4

4

3.6

3.3

3.1

2.8

2.6

2.5

2.3

2.1

2.1

2

1.9

1.8

1.7

1.7

1.6

1.5

1.5

1.4

1.4

1.3

1.3

1.2

1.2

1.2

1.1

1.1

1.1

1

1

1

100

67

36

25

19

15

13

11

9.8

8.7

7.8

7.1

6.6

6.1

5.6

5.3

4.9

4.7

4.4

4.2

4

3.8

3.6

3.4

3.3

3.2

3.1

2.9

2.8

2.7

2.6

2.6

2.5

2.4

2.3

2.3

2.2

2.2

2.1

2

2

200

114

67

47

36

30

25

22

19

17

15

14

13

12

11

10

9.8

9.2

8.7

8.2

7.8

7.5

7.1

6.8

6.6

6.3

6.1

5.8

5.6

5.4

5.3

5.1

4.9

4.8

4.7

4.5

4.4

4.3

4.2

4.1

4

300

150

92

67

52

43

36

32

28

25

23

21

19

18

16

15

14

14

13

12

12

11

11

10

9.8

9.4

9

8.7

8.4

8.1

7.8

7.6

7.4

7.1

6.9

6.7

6.6

6.4

6.2

6.1

5.9

400

178

114

84

67

55

47

41

36

33

30

27

25

23

22

20

19

18

17

16

15

15

14

13

13

12

12

12

11

11

10

10

9.8

9.5

9.2

8.9

8.7

8.5

8.2

8

7.8

500

200

133

100

80

67

57

50

44

40

36

33

31

29

27

25

24

22

21

20

19

18

17

17

16

15

15

14

14

13

13

13

12

12

11

11

11

11

10

10

9.8

600

218

150

114

92

77

67

59

52

47

43

39

36

34

32

30

28

26

25

24

23

22

21

20

19

18

18

17

16

16

15

15

14

14

14

13

13

13

12

12

12

Minute Volume (L/Min)

Dial

Minute volume (L/Min)

Dial

300

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

6.5

7

7.5

8

8.5

9

9.5

10

10.5

11

11.5

12

12.5

13

13.5

14

14.5

15

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

50

27

14

9.7

7.3

5.9

4.9

4.2

3.7

3.3

3

2.7

2.5

2.3

2.1

2

1.9

1.8

1.7

1.6

1.5

1.4

1.4

1.3

1.2

1.2

1.1

1.1

1.1

1

1

1

0.9

0.9

0.9

0.8

0.8

0.8

0.8

0.8

0.7

100

50

27

19

14

12

9.7

8.3

7.3

6.5

5.9

5.4

4.9

4.5

4.2

3.9

3.7

3.5

3.3

3.1

3

2.8

2.7

2.6

2.5

2.4

2.3

2.2

2.1

2.1

2

1.9

1.9

1.8

1.8

1.7

1.7

1.6

1.6

1.5

1.5

200

86

50

35

27

22

19

16

14

13

12

11

9.7

9

8.3

7.8

7.3

6.9

6.5

6.2

5.9

5.6

5.4

5.1

4.9

4.7

4.5

4.4

4.2

4.1

3.9

3.8

3.7

3.6

3.5

3.4

3.3

3.2

3.1

3

3

300

113

69

50

39

32

27

24

21

19

17

16

14

13

12

12

11

10

9.7

9.2

8.7

8.3

8

7.6

7.3

7

6.8

6.5

6.3

6.1

5.9

5.7

5.5

5.4

5.2

5.1

4.9

4.8

4.7

4.5

4.4

400

133

86

63

50

41

35

31

27

24

22

20

19

17

16

15

14

13

13

12

12

11

11

10

9.7

9.3

9

8.6

8.3

8.1

7.8

7.5

7.3

7.1

6.9

6.7

6.5

6.3

6.2

6

5.9

500

150

100

75

60

50

43

38

33

30

27

25

23

21

20

19

18

17

16

15

14

14

13

13

12

12

11

11

10

10

9.7

9.4

9.1

8.8

8.6

8.3

8.1

7.9

7.7

7.5

7.3

600

164

113

86

69

58

50

44

39

35

32

30

27

25

24

22

21

20

19

18

17

16

16

15

14

14

13

13

12

12

12

11

11

11

10

9.9

9.7

9.4

9.2

9

8.7

Minute Volume (L/Min)

Minute Volume L/Min)

Dial

Dial

 


background image

NOx

BOX

i

  Operating Instructions

®

22

www.noxboxltd.com

All dose information shown in these tables is for guidance only. The patient monitored gas levels should be used for actualy dose delivery information. All nitric oxide (NO) doses shown in parts per million 

(ppm) when introduced to continuous flow rates indicated. Doses of NO above 40 ppm are not recommended. Doses above 20ppm are considered clinically high.

Minute Volume (L/Min)

Minute Volume (L/Min)

Dose look-up table 

225ppm, 200ppm, 100ppm

Dial

Dial

Flow valve setting

Minute flow volume

Clinder Concentration (ppm)

WARNING: Dose >40 ppm

Dose over 20ppm

100

0.5

1

1.5

2

2.5

3

3.5

4

4.5

5

5.5

6

6.5

7

7.5

8

8.5

9

9.5

10

10.5

11

11.5

12

12.5

13

13.5

14

14.5

15

15.5

16

16.5

17

17.5

18

18.5

19

19.5

20

50

9.1

4.8

3.2

2.4

2

1.6

1.4

1.2

1.1

1

0.9

0.8

0.8

0.7

0.7

0.6

0.6

0.6

0.5

0.5

0.5

0.5

0.4

0.4

0.4

0.4

0.4

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.3

0.2

100

17

9.1

6.3

4.8

3.8

3.2

2.8

2.4

2.2

2

1.8

1.6

1.5

1.4

1.3

1.2

1.2

1.1

1

1

0.9

0.9

0.9

0.8

0.8

0.8

0.7

0.7

0.7

0.7

0.6

0.6

0.6

0.6

0.6

0.6

0.3

0.3

0.3

0.3

200

29

17

12

9.1

7.4

6.3

5.4

4.8

4.3

3.8

3.5

3.2

3

2.8

2.6

2.4

2.3

2.2

2.1

2

1.9

1.8

1.7

1.6

1.6

1.5

1.5

1.4

1.4

1.3

1.3

1.2

1.2

1.2

1.1

1.1

1.1

1

1

1

300

38

23

17

13

11

9.1

7.9

7

6.3

5.7

5.2

4.8

4.4

4.1

3.8

3.6

3.4

3.2

3.1

2.9

2.8

2.7

2.5

2.4

2.3

2.3

2.2

2.1

2

2

1.9

1.8

1.8

1.7

1.7

1.6

1.6

1.6

1.5

1.5

400

44

29

21

17

14

12

10

9.1

8.2

7.4

6.8

6.3

5.8

5.4

5.1

4.8

4.5

4.3

4

3.8

3.7

3.5

3.4

3.2

3.1

3

2.9

2.8

2.7

2.6

2.5

2.4

2.4

2.3

2.2

2.2

2.1

2.1

2

2

500

50

33

25

20

17

14

13

11

10

9.1

8.3

7.7

7.1

6.7

6.3

5.9

5.6

5.3

5

4.8

4.5

4.3

4.2

4

3.8

3.7

3.6

3.4

3.3

3.2

3.1

3

2.9

2.9

2.8

2.7

2.6

2.6

2.5

2.4

600

55

38

29

23

19

17

15

13

12

11

9.8

9.1

8.5

7.9

7.4

7

6.6

6.3

5.9

5.7

5.4

5.2

5

4.8

4.6

4.4

4.3

4.1

4

3.8

3.7

3.6

3.5

3.4

3.3

3.2

3.1

3.1

2

2.9

Minute Volume (L/Min)

Dial