with FLASH TIPS PLUM A+ INFUSION SYSTEM OPERATING INSTRUCTIONS REFER TO SYSTEM OPERATING MANUAL FOR COMPLETE OPERATING INSTRUCTIONS

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with

FLASH TIPS

FLASH TIPS

PLUM A+ INFUSION SYSTEM OPERATING INSTRUCTIONS REFER TO SYSTEM OPERATING MANUAL FOR COMPLETE OPERATING INSTRUCTIONS ®

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2 444-95536-002 (06/05) 444-95536-002 (06/05) 3 DEFINITION OF TERMS

• Hospira MedNet™ Software

— Network based application software used to upload event logs and download the custom Drug Library to the infuser

• Hard Limit

— The dosing value (upper and/or lower amount) that when assigned to a drug cannot be overridden. Defined by the hospital for each drug in its Drug Library. The hard limits for a particular drug may vary across different CCAs

• Soft Limit

— The dosing value (upper and/or lower amount) that when assigned to a drug can be overridden based on hospital policy. Defined by the hospital for each drug in its Drug Library. The soft limits for a particular drug may vary across different CCAs • Auto-Programming

— Complete or partial program received from a barcode enabled point of care system requiring clinician confirmation prior to administration

DEFINITION OF HARD KEYS AND ICONS used to control power on the infuser used to begin confirmation of programming used to stop the current delivery on one line; used in conjunction with soft keys to stop delivery on both lines

used to move the highlighting cursor between the programming fields - down/right, up/left used to clear values highlighted on screen used to silence an audible alarm during actions to correct its cause

used to indicate that the upper soft limit has been overridden for a particular drug infusion parameter used to indicate that the lower soft limit has been overridden for a particular drug infusion parameter the infuser is being operated without drug rule sets the “Wireless Connection Available” icon is displayed when the device is receiving a wireless signal. The infuser will connect to the network if a wireless network access point is recognized.

FLASH TIPS

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TO SETUP PLUMSET®®

1. Prime set according to package instructions 2. Push in flow regulator to close

3. Insert primed cassette into infuser, close door 4. Press to power on infuser

5. Select YESto clear settings or NOto retain settings* 6. Confirm drip chamber is filled to halfway mark 7. Confirm NO FLOW in drip chamber

* NOTE: Infuser will retain its memory for 4 hours when turned off.

NOTE: Clear all settings when changing patients or multiple programming parameters.

NOTE: Use CLEAR PROGRAM when changing only line A or B. NOTE: For Plum A+®3 the Lockout Switch controls all three devices.

______________________________________________ CLINICAL CARE AREA (CCA) SELECTION

1. Use the to select and highlight the desired Clinical Care Area (CCA) at AREA SELECTION screen 2. Select ENTER to confirm the selection

NOTE: Infuser will retain the last CCA selected when turned off. ______________________________________________ CHANGING CCA WHILE INFUSING

1. Select OPTIONS/VOL INF 2. Select CHANGE CCA 3. Use the to select desired CCA 4. Select ENTER to confirm the selection

NOTE: The delivery continues until VTBI equals 0 or the program is stopped and settings cleared.

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DEFINITION OF SOFT KEYS PROGRAMMING OPTIONS DISPLAYED ABOVE THE ACTUAL SOFT KEYS

STOPused in combination with to stop delivery

STARTused in combination with to begin delivery

CHOOSEused to choose between several alternatives

presented on the screen

ENTERused to enter and retain desired programming

data on the screen

CANCELto cancel programming data on the screen

prior to “entering” and to return the user to a previous screen

BACKreturn to previous screen

CHANGE MODEused to change between piggyback

and concurrent mode onLINE B

YES/NOused to change between yes and no

when programming a callback

KVO/RATEused to change between rate and KVO

when programming Continue Rate

NOTE: Hard limits will be either minimum or maximum dose values. Infuser will beep 3 times with message of min/max dose allowed. Value in dose field changes to dashes (“----”). Press before entering another value.

TO MAINTAIN BATTERY CHARGE, KEEP PLUGGED IN AT ALL TIMES. SOME 10CC SYRINGES MAY REQUIRE USE OF A SYRINGE ADAPTER.

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SIMPLE DELIVERY USING HOSPIRA MEDNET™™ SOFTWARE (Manual Programming)

1. Select LINE AorBat main delivery screen to select line to program

2. Select DRUG LIST to display available drugs 3. Use the to highlight the desired drug on the

Program Drug List screen

4. Select ENTER to indicate selection (is used for maintaining drug identification). Select STANDARD

PROGRAMMING and select CHOOSE to go to

PROGRAMscreen

5. EnterRATEusing keypad

6. Use the to highlight the VTBIor DURATIONfield 7. Enter value

8. VERIFY rate, VTBI, and duration 9. Press to begin program

10.If a program parameter exceeds a soft limit, select YESto override the soft limit if appropriate, select NOto return to programming screen

NOTE: Hard limits cannot be overridden. See page 4 for additional information.

11.Confirmation screen will appear - if all information is correct, select YESto begin infusion

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SIMPLE DELIVERY TITRATE RATE USING HOSPIRA MEDNET™™ SOFTWARE (Manual Programming) 1. Select LINE AorBat main delivery screen 2. Use the to select programming field 3. Enter numeric value

4. Press to begin titration

5. If a program parameter exceeds a soft limit, select YESto override the soft limit if appropriate, select NOto return to programming screen

6. Confirmation screen will appear - if all information is correct, select YESto begin infusion

NOTE: When changing the duration, the rate will change, but VTBI will not. When changing the rate, VTBI will not change, but duration will. When changing VTBI, duration will change, but the rate will not. For additional information refer to System Operating Manual.

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8 444-95536-002 (06/05) 444-95536-002 (06/05) 9 STOP & START WITH ONLY 1 LINE PUMPING

1. Press

2. Press to resume infusion

______________________________________________ STOP & START WHEN LINE A AND B ARE PUMPING To stop infusion

1. Press

2. Select STOP Aor STOP Bor STOP ALL To resume infusion

1. Press

2. Select START ALL, START Aor START Bif both lines were stopped

______________________________________________ BACKPRIME

1. Stop infusion on all lines

2. Secondary container or syringe is necessary to receive the air

3. Select and hold BACK PRIMEuntil air is cleared from cassette into secondary container

4. Release when complete 5. Restart infusion

______________________________________________ CLEAR VOLUME DELIVERED (TOTAL, LINE A, LINE B) 1. Select OPTIONS/VOL INFat main delivery screen 2. Select CHOOSEto select Volumes Infused 3. Use to highlight desired value

4. Select CLEAR, repeat as desired

5. Select ENTERto confirm change and to return to main delivery screen

SIMPLE DELIVERY WITHOUT HOSPIRA MEDNET™™SOFTWARE NOTE: Use drug manufacturer recommendations for IV administration when using the Plum A+®Infusion System.

1. Select LINE AorBat main delivery screen 2. EnterRATEusing keypad

3. Use the to highlight the VTBIor DURATIONfield 4. Enter value

5. VERIFY rate, VTBI, and duration 6. Press to begin infusion

If Programming Line B 1. Use the to highlight Mode

2. Choose Piggyback or Concurrent using CHANGE MODE NOTE: Piggyback infusion will delay Line A and infuse Line B until VTBI Complete. Line A will automatically restart.

WARNING! Before infusing drugs in concurrent mode, consult the System Operating Manual.

______________________________________________ SIMPLE DELIVERY TITRATE RATE WITHOUT HOSPIRA MEDNET™™ SOFTWARE

1. Select LINE AorBat main delivery screen 2. Enter numeric value

3. Press to begin titration

NOTE: When changing the duration, the rate will change, but VTBI will not. When changing the rate, VTBI will not change, but duration will. When changing VTBI, duration will change, but the rate will not. For additional information refer to System Operating Manual.

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CLEARING SETTINGS

1. Specific line must be STOPPED prior to clearing the settings

2. Select LINE AorBat main delivery screen 3. Select YESto clear settings

4. Select CANCEL/BACKto return to main delivery screen or enter a new program

NOTE: Clear all settings when changing patients or multiple programming parameters.

______________________________________________ DISCONTINUE INFUSION

1. Press

2. Select STOP ALLif both lines are pumping 3. Press

4. Clamp secondary tubing if connected 5. Open door, remove set and close door

______________________________________________ DELAY START (To delay infusion for a specific time period) 1. Specific line must be STOPPED prior to programming

DELAY START

2. Prior to starting infusion, select PROGRAM OPTIONS

LINE AorBprogramming screen

3. Enter values for desired hours and/or minutes 4. Select ENTERto confirm delayed start 5. Press to begin infusion

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SET OR CANCEL NURSE CALLBACK

(An alarm to alert the completion of the infusion) 1. Prior to starting infusion, select PROGRAM OPTIONS

LINE AorBprogramming screen

2. Use to highlight CALLBACK

3. Select YES/NOto change between yes and no 4. Select ENTERto begin program option 5. Press to begin infusion

NOTE: Nurse callback cannot be changed while a delivery is in progress.

______________________________________________ STANDBY

1. Specific line must be PROGRAMMED to put in standby 2. Select PROGRAM OPTIONS

3. Select STANDBYkey

4. Answer confirmation of programming question -device placed in standby

5. To remove standby status press

6. To return to standby select LINE Aor B, select PROGRAM OPTIONS, select STANDBY, confirm by selecting YES

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FUNCTIONS UNDER OPTIONS/VOL INF

• Volumes Infused - LINE A, LINE B, and Total Volume • Pressure/Post Infusion Rate

— Continue Rate -The rate programmed will continue instead of reverting to KVO of 1mL/hr when VTBI complete

— Distal Pressure Limit - Set between 1-15 PSI — Distal Pressure - Actual pressure on distal line • Lighting/Contrast

— Backlight Intensity — Display Contrast • Change CCA

FUNCTIONS UNDER PROGRAM OPTIONS

• Delayed Start of LINE AorB

• Callback - alarm to call user back to infuser • Standby

PROGRAMMING

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SELECT DRUG (Manual Programming)

NOTE: If DRUG LIST is chosen, the drug library will automatically appear.

1. Select LINE AorBat main delivery screen 2. Select DRUG LIST

3. Use PAGE UPorPAGE DOWNto scroll alphabetically to appropriate screen 4. Use to highlight desired drug 5. Select ENTERto select

6. Select CHOOSEto return to the line Programming Screen

7. Enter value

8. VERIFY rate, VTBI, and duration 9. Press to confirm programming

NOTE: If in auto-programming environment, the drug may already be selected. See System Operating Manual for auto-programming.

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14 444-95536-002 (06/05) 444-95536-002 (06/05) 15 AVAILABLE PROGRAMS

• Standard Programming - mL per hour or alternative unit of measure for programming rate

• Loading Dose - Program an initial infusion rate for a specific volume followed automatically by a maintenance rate from the same container

• Multistep - Allows programming to deliver up to 10 steps from the same container

NOTE: Dose calculation can be used in Standard Programming, Loading Dose, and Multistep. NOTE: Clear all settings when changing patients or multiple programming parameters.

NOTE: The container concentration selection screen appears whenever the selected dose unit is gram based (grams, mg, mcg, or ng)

______________________________________________ ADVANCED PROGRAMMING (Auto-Programming) 1. Scan required elements. Program screen is auto-filled 2. Verify all parameters

3. Press to confirm programming

NOTE: Auto-programming not available for Loading Dose and Multistep.

NOTE: If an auto-program is received and is incomplete, use manual programming to change or complete the order prior to the start of infusion.

WARNING! Plum A+®3 users must be aware that changing the weight on one device does not change the weight on the other two devices. Patient weight must be changed on each device when delivering weight based therapy dependent on medication requirements.

PROGRAM DOSE CALCULATION WITH OR WITHOUT HOSPIRA

MEDNET™™ SOFTWARE(Manual Programming) 1. Select LINE Aor Bat main delivery screen 2. Select DRUG LIST

3. Use to highlight drug, use PAGE UPorPAGE DOWNfor more drugs and ENTER

4. STANDARD PROGRAMMINGwill be highlighted and

CHOOSEto select. If drug selected has rule sets, go

to #8, if it has NO rule sets, continue with #5

5. UNIT OF DELIVERYassociated with drug chosen

is highlighted and CHOOSEto select

6. CONTAINER CONCENTRATIONunit to use in delivery

is highlighted and CHOOSEto select 7. Use keypad to enter desired drug concentration

and container volume if necessary

8. Use to highlight patient weight if required. Use keypad to enter patient weight. Once entered, use to highlight next programming field 9. Continue by entering dose values using keypad 10. Use to scroll down to the VTBI field 11. Use keypad to enter desired VTBI value 12. VERIFY dose, rate, VTBI and duration 13. Press to begin infusion

NOTE: Any auto-program received for a drug not listed in the active CCA will be entered as “no drug selected”.

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PROGRAM LOADING DOSE

1. Select LINE Aor Bat main delivery screen 2. Select DRUG LIST

3. Use to highlight drug, use PAGE UPor

PAGE DOWNfor more drugs and ENTER

4. Use to scroll down to LOADING DOSE and

CHOOSEto select. If drug selected has rule sets, go to #8, if it has NO rule sets, continue with #5

5. UNIT OF DELIVERYassociated with drug chosen is

highlighted and CHOOSEto select

NOTE: If unit of delivery selected is other than mL/hour, follow prompts to enter drug parameters and dose value.

7. Enter rate using keypad

8. After desired value has been entered, use to highlight VTBI 9. Using keypad enter VTBI

10. After the values for LOADING DOSEStep-1 are entered, use to highlight maintenance dose values Step-2 11. Using keypad enter rate

12. Use to highlight the VTBI 13. Using keypad enter VTBI

14. VERIFY dose, rate, VTBI and duration 15. Press to begin infusion

See WARNING on page 14.

PROGRAM MULTISTEP

1. Select LINE A at main delivery screen 2. Select DRUG LIST

3. Use to highlight drug, use PAGE UPor

PAGE DOWNfor more drugs and ENTER

4. Use to scroll down to MULTISTEPand CHOOSE

to continue

5. UNIT OF DELIVERYassociated with drug chosen is

highlighted and CHOOSEto select. If drug selected has rule sets, go to #8, if it has NO rule sets, continue with #6

NOTE: If unit of delivery selected is other than mL/hour, follow prompts to enter drug parameters and dose value.

7. Enter rate using keypad

8. Use to highlight the duration or VTBI. Enter either value using keypad

9. Use to highlight next steps and complete as above 10.When Step-4 is programmed, select MORE STEPS

to program up to 10 steps as above 11.VERIFY dose, rate, VTBI and duration 12.Press to begin infusion

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3. Identify/Observe alarm condition 4. Correct alarm condition (see chart below) 5. Press to resume infusion

ALARMS

MESSAGE POSSIBLE CAUSE(S) CORRECTIVE ACTION(S)

Line A (B) VTBI is complete _{➔ • Program new VTBI} VTBI

Complete

Depleted Too much time on ➔ • Plug into AC power Battery battery power

Cassette Faulty cassette, proximal _{➔ • Check clamps, manually} Test or distal occlusion or air reprime set, close door Failure in cassette detected at _{➔ • Backprime into Line B}

startup container or syringe

➔ • If alarm recurs on retest, replace set

➔ • If alarm repeats, replace infuser

Door Infuser door opened ➔ • Close door with

Opened while operating cassette inserted

While Infusing

Lockout The use of the stop key _{➔ • Unlock lockout switch} Violation during delivery, or opening _{➔ • Unlock using}

the door while lockout keypad enabled

Lockout Pressing of any key except ➔ • Unlock lockout switch Enabled stop during delivery while ➔ • Unlock using

any alarm is active and keypad lockout is enabled

Malfunction A failure has occurred in _{➔ • Record malfunction} Message the infuser internal systems error code

➔ • Infuser must be turned OFF to clear malfunction ➔ • If alarm repeats, replace

infuser

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MESSAGE POSSIBLE CAUSE(S) CORRECTIVE ACTION(S)

Distal Distal line kinked, IV site _{➔ • Check distal tubing} Occlusion clotted or positional, _{➔ • Check IV site}

pressure limit set too low _{➔ • Reset pressure limit} Prox Occl Proximal line obstructed ➔ • Examine line A (B) for A (B) at (line A (B) container (or kinks or closed clamps Startup syringe) disconnected or ➔ • Open any closed

obstructed during startup) proximal clamps ➔ • Open and close door ➔ • For syringe, select

[BACKPRIME] Prox Occl Proximal line obstructed _{➔ • Examine line A (B) for} A (B) Air (line A (B) container kinks, closed clamps

disconnected or obstructed) or air in cassette ➔ • Open any closed proximal clamps ➔ • Press [START] Prox Air Empty container or ➔ • Check for clamps or

A (B) excess air in line empty container

Backprime ➔ • Backprime into line B

container or syringe Distal Air Air detected distally due _{➔ • Remove and reprime}

to excess air in air trap, cassette using standard

incomplete priming technique

➔ • If alarm recurs, replace the set

No Action Infuser programming ➔ • Press [START]

Alarm incomplete ➔ • Continue programming

Infuser Idle Infuser is ON without _{➔ • Resume programming}

2 Minutes operator input or turn infuser OFF

RESPONSE TO ALARMS

1. Disable Lockout by confirming

back switch is in down position 2. Press

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For customer information or technical assistance call: Hospira 1-800-241-4002

HOSPIRA, INC. Lake Forest, IL 60045 USA

www.hospira.com

with FLASH TIPS PLUM A+ INFUSION SYSTEM OPERATING INSTRUCTIONS REFER TO SYSTEM OPERATING MANUAL FOR COMPLETE OPERATING INSTRUCTIONS

CONTENTS

FLASH TIPS

RESPONSE TO ALARMS