Instructions for use: Ikus - Berlin Heart

Standard form: EXCOR emergency log
Appendix
13.7 Standard form: EXCOR emergency log
1) General
Ikus serial no.: 0 -
Elapsed operating hours:
Date of next maintenance:
Location (clinic):
2) Malfunction
Notify hotline! +49(0)30 8187 2772
This log helps to record malfunctions in the Ikus.
What is happening / has happened?
How did the error occur?
When did the error occur?
Age of patient:
3) Current status: How is the Ikus working since the error occurred?
Currently displayed parameters in the monitoring program
Status of the patient: O stable O deteriorated
Support by O UVAD O BVAD
Parameter Systole Diastole Rate % systole
Left
Right
Are the pump membranes still moving? LVAD
O yes
O no
RVAD
O yes
O no
BVAD: How are the pump membranes moving in relation to each other? O synchronously O asynchronously
Power supply via … O mains power operation O battery mode (indicator lamp “Battery mode” lit up)
How many LEDs are lit up on the charge level indicator? (please enter the number of LEDs)
4) Laptop function: How is the monitoring program working since the error occurred?
Are the running curves displayed in the monitoring program? O yes O no
Are messages being shown in the message window? O yes O no
What operating status is shown in the parameter table? O Normal O Backup O Failure
5) Settings (before the malfunction occurred)
Parameters set in the monitoring program (see EXCOR parameter log if necessary)
Parameter Systole Diastole Rate % systole
Left
Right
Operating mode O LVAD O RVAD O BVAD, operating mode:O synchronous mode,O asynchronous O separate
Power supply via … O mains power operation O battery mode (indicator lamp “Battery mode” lit up)
96 1000002 Rev. 4.9.1