AlarisÂ® PCA Module Guide

Alaris® PCA Module Guide 

Syringe Loading and Set-Up 

WARNING: TO PREVENT UNREGULATED FLOW, CLOSE 

SET TUBING CLAMP BEFORE LOADING OR UNLOADING 

SYRINGE. 

Loading: 

1. Open syringe barrel clamp (clear piece) until it clears syringe 

chamber. 

2. Raise drive head 

(gray) to fully extended 

position. 

3. Insert syringe barrel 

flange between barrel 

flange grippers 

(see drawing). 

4. Lock syringe in place 

by closing barrel 

clamp. 

5. Twist gripper control 

clockwise, lower 

drive head, lock 

plunger in place with 

plunger grippers. 

Priming: 

1. If priming using PCA 

module, this feature 

is available when viewing Infusion Mode screen during 

programming of PCA module. At this screen 

Press OPTIONS, then press PRIME SET WITH SYRINGE. 

2. Once tubing set is primed, close slide clamp. 

Note: At the start of an infusion program, the system prompts to 

select and confirm syringe type and size. Ensure displayed syringe 

manufacturer and size correctly identifies the installed syringe. 

Programming PCA with PCA Pause Protocol Enabled: 

1. Perform steps 1-10 of Initial Set-Up in previous section and 

continue with following steps. 

2. Review Clinical Advisory “Attach an SPO2 or EtCO2 Module 

Now”. 

3. Press CONFIRM. 

Note: If a monitoring module is not attached and started, 

PCA Pause Protocol WILL NOT activate. 

4. Choose desired Infusion Mode and follow onscreen prompts. 

5. Press NEXT key to verify medication parameters. 

6. Review Clinical Advisory “PCA Pause Limits Should be 

Reviewed”. 


8. Choose desired Infusion Mode and follow onscreen prompts. 

Change Syringe: 

1. Press PAUSE and close tubing clamp. 

2. Use key and unlock door and remove old syringe. 

3. Press SILENCE. 

4. Attach new syringe to tubing and load new syringe. 

5. Set key to “Program” position and close door. 

6. Press CHANNEL SELECT key. 

7. Choose correct syringe type and size. 


9. Press RESTORE if same drug and concentration. 

10. Verify drug and concentration and current settings. 

11. Lock door and open tubing clamp. 

12. Review settings and press START. 

Change Program/Mode: 


2. Press PROGRAM. 

3. Set key to “Program” position or enter authorization code 

Programming Guide 

(if enabled). 

WARNING: Do not prime while attached to patient! 4. Choose desired infusion mode and follow onscreen prompts. 

Initial Set-Up: 

1. Select administration set and attach set to syringe. 

Beginning of Shift/Summary Review: 

2. If priming manually, express air from administration tubing set. 1. Press CHANNEL SELECT key and verify settings. 

3. Load syringe with administration set attached. 

2. Press START key. 

4. Press SYSTEM ON key and select YES or NO to “New 

Patient”. 

Patient History/End of Shift/24hr History: 

5. Select appropriate profile. 


6. Press CHANNEL SELECT key and set key to “Program” 2. Press OPTIONS. 

position. 

3. Press PATIENT HISTORY. 

7. Press CONFIRM time setting and choose correct syringe 4. Press ZOOM key (time interval) as appropriate and review 

type and size. 

drug totals. 

Note: If installed syringe is not listed, press ALL SYRINGES 5. To clear patient history press CLEAR HISTORY and press 

and chose matching installed syringe type and size. 

YES or NO. 

8. Choose correct medication and concentration. 

6. To view 24 hour totals: Press 24 h Totals. 

9. At “Infusion Mode” screen: To Prime, press OPTIONS key. 7. Press EXIT then press START. 

10. Press PRIME SET WITH SYRINGE. 

Operator Precautions: For proper operation of the Alaris® System (formerly 

Medley®System) the user must be familiar with the features, disposables, 

11. Press and hold PRIME key to prime tubing. 

administration sets, set-up and programming. 

Note: Do not prime while attached to patient. 

This guide includes selected information and suggestions and is not intended 

12. Press EXIT when prime is complete. 

to be comprehensive instructions for the set-up and operation of the Alaris® 

13. Choose desired Infusion Mode and follow on-screen prompts. System. For complete instructions along with Warnings and Cautions, refer to 

Alaris® System Directions for Use (v8). 

14. Close and lock door and attach administration set tubing 

set to patient. 


page 1 page 2 

PCA/Monitoring Trend Data 

Note: This function requires use of Alaris® monitoring 

module(s). 

1. Press CHANNEL SELECT on the monitoring module. 

2. Press OPTIONS. 

3. Press PCA/Monitoring Trend data. 

4. To exit: Press MAIN. 

5. Press MAIN SCREEN. 

Give a Bolus Dose 


2. Press Bolus Dose. 

3. Set key to Program position or enter authorization code (if 

enabled). 

4. Enter bolus dose amount and lock door. 



Stop Bolus, Loading or PCA Dose 


2. Press Stop Bolus/Loading or PCA. 

3. Press YES or NO. 

Note: Programmed settings will resume. 

Change Dose Request Cord Setting 



3. Press “Dose Request Set-up”. 

4. Choose desired Dose Cord Profile. (1=light flashes, 

2=light on,3=light off). 

5. Press CONFIRM and press START. 

Troubleshooting 

Alarm/ Meaning 

Alerts 

Check 

Syringe 

PCA 

Pause 

Alarm 

Drive Not 

Engaged 

Max Limit 

Reached 

Module 

Enforcement 

Near End 

(NEOI) 

Syringe 

Empty 

Alerts and Alarms (NOTE: During alarm state - PCA module no longer infusing). 

Response 

• Plunger grippers opened during infusion and then 

closed. Infusion stops on affected channel. 

• Syringe barrel clamp opened during infusion and 

then closed. 

• Syringe plunger not captured while in idle mode. System 

alarms immediately to indicate potential siphoning 

condition. If security door is closed and syringe plunger 

is not captured, the system will immediately alarm. 

PCA infusion has paused due to a decline in respiratory 

status. 

Drive system disengaged during operation. 

Indicates the maximum amount of drug delivered based 

on Maximum Hourly Limit field. 

A user message will appear on the screen when the 

PCA module is NOT located directly to the right of the 

Alaris® PC unit. 

Near End of Infusion and remaining VTBI will alternate 

on screen until syringe is empty. Alert message 

will scroll in channel message display on the PCA 

module. The PCA module remains functional and will 

continue infusion 

Alarm message Syringe Empty will scroll in channel 

message display on the PCA module 

created 0808 

Change PCA Pause Alarm Limits 



3. Press “PCA Pause Limits”. 

4. Choose desired parameter and enter value. 

Note: If acceptable range value is not within hospital defined 

range a prompt is provided. 

5. Follow on screen prompts. 

6. Press CONFIRM and press START. 

Access Drug Event History 


2. Press OPTIONS then press DRUG EVENT HISTORY. 

Attaching and Detaching Dose Request Cord 

To attach the Dose Request Cord: 

Insert latching connector on the cord into Dose Request Cord attachment 

on the PCA module. The red marking on the latching connector 

should be aligned with the red marking on the Dose Request Cord 

attachment. 

To detach the Dose Request Cord: 

Hold the body of latching connector on the Dose Request Cord and pull 

straight away from the PCA module, without twisting or turning. 

Detaching Module: 

Use key to unlock door. Inside locate black lever and depress. At the 

same time, hold the PCA module and move the bottom of the PCA 

module sideways and away from the Alaris® PC Point-of-Care unit 

(“Alaris® PC unit”). 

Securely lock plunger grippers, press CHANNEL SELECT key, and 

reselect syringe. Securely lock syringe barrel clamp and press RE- 

START key. Check for potential siphoning. Ensure administration set 

clamp (roller/slide) is in closed position. Securely lock plunger grippers 

over syringe plunger. 

Assess patient status per hospital policy. Press CONFIRM once patient 

status and monitoring values have been addressed. Press RESTART 

key per hospital policy. To view trigger of PCA Pause Alarm, Press 

CHANNEL SELECT, Press, OPTIONS, Press DRUG EVENT HIS- 

TORY, Press Up/Down key to view text for monitoring value causing 

PCA Module to pause. Press EXIT and then START. 

Open and close plunger grippers. Ensure syringe is properly installed. 

To silence safety alarm tone, press SILENCE key. PCA module will remain 

silent. Alarm tone will re-sound if additional dose is requested during 

maximum limit reached alarm 

Remove the PCA module and attach directly to the right of the Alaris® PC unit. 

To silence safety alert tone, press SILENCE key. PCA module will remain 

silent until Syringe Empty alarm sounds. 

To silence safety alarm tone, press SILENCE key. PCA module will remain 

silent approximately 2 minutes and will re-sound.

PCA/EtCO2 Trend Data: 

Note: This function requires use of Alaris® PCA module. 



3. Select PCA/EtCO2 Trend Data. Navigate as described 

above in section titled Trend Data. 

Troubleshooting : 

High Priority Meaning/ Causes 

Alarm 

No Breath 

Detected 

High EtCO2 

Low EtCO2 

High RR 

Low RR 

High FiCO2 

Disconnect 

Occluded 

Disposable 

Autozero 

(in progress) 

Clearing 

Disposable 

Alaris® EtCO2 Module Guide 

Setting Alarm Limits: 

4. To exit press EtCO2 Main. 



2. Press LIMITS. 

3. Select limit parameter to be changed. 

4. Enter a numeric value using keypad or up/down arrow keys. Change Waveform Height: 





3. Select WAVEFORM HEIGHT. 

4. Select 60mmHg or 99mmHg. 

Trend Data: 



2. Select TREND. 

3. Press PAGE UP and PAGE DOWN to navigate through trend Change Waveform Time Scale: 

data pages. To move cursor bar press up or down arrow keys. 1. Press CHANNEL SELECT key. 

4. Press ZOOM to change time period. 


5. To exit press EtCO2 Main. 

3. Select WAVEFORM TIME SCALE. 


4. Select 5 or 10 seconds 

(for lower respiratory rates select 10 seconds). 


Alarms / Messages 

Response 

• Patient is not breathing 

• Assess patient, check disposable. 

• Disposable is not properly attached to patient and/or device • Consider using different disposable type 

• Disposable is not detecting exhaled breath (shallow breath) • Follow hospital protocol actions. 

• Patient has true measurement of high EtCO2 

• Fever or hypermetabolic state 

• Disposable is not properly attached to patient 

• Patient has true measurement of low EtCO2 

• Disposable not correctly attached to patient or 

securely connected to module 

Respiratory Rate is above the specified limit 

Respiratory Rate is below the specified limit 

• Patient is inspiring exhaled CO2 or disposable not 

properly attached to patient 

• O2 mask may not be properly attached (if patient 

is wearing an O2 mask) 

• O2 flow to mask may have stopped 

• Drapes or covers may be over patient’s face 

• Purging operation failed 

• The disposable is occluded or needs to be reset. 

The module is performing an autozero calibration. 

During this time no data is obtained 

Pre-Silencing Alarm: 

1. Press SILENCE to pre-silence monitoring alarms for 2 

minutes. 

Note: Infusion alarms will not be silenced. 

• Assess patient, check disposable 

• Compare value to baseline 

• Follow hospital protocol actions. 

• Assess patient, check disposable, 

• Check O2 flow 

• Check mask and/or drape position 

• Follow hospital protocol actions 

• Try disconnecting disposable and then reattach. 

• If the device again reads 

DISCONNECT OCCLUDED DISPOSABLE, 

• Obtain and attach a new disposable. 

Monitoring will automatically resume when completed. 

No intervention is necessary. 

The module is trying to clear the clogged disposable. If unable to clear, the module will go into a DISCONNECT 

If cleared, the module will automatically resume monitoring. OCCLUDED DISPOSABLE alarm. 

EtCO2 Waveform Examples 

The following are examples of common EtCO2 waveforms. The waveform trends are examples only and do not represent all potential abnormal waveforms. Analysis 

of these waveform trends may provide an early indication of the noted possible causes. The associated possible responses are suggestions only and are not meant 

to replace current clinical practice or hospital protocols. Always consult hospital protocols. Abnormal waveforms are not always associated with alarms 

Normal /Abnormal Waveform Clinical Findings Possible Causes Possible Responses 

Operator Precautions: For proper operation of the Alaris® System (formerly Medley®System) the user must be familiar with the features, 

disposables, administration sets, set-up and programming. This guide includes selected information and suggestions and is not intended to be 

comprehensive instructions for the set-up and operation of the Alaris® System. For complete instructions along with Warnings and Cautions, 

refer to Alaris® System Directions for Use (v8). © 2005 Cardinal Health, Inc. or one of its subsidiaries. All rights reserved. 3POC0331 

page 3 page 4 

References: 1. Capnography in the Management of the Critically Ill Patient, EducationPAK 

for Critical Care and Procedural Sedation - A Guide to Capnography, 

CD-ROM - Needham, MA Oridion Medical, 2003. 

2. AACN Procedure Manual for Critial Care 4th Ed. (2001). Ed. Lynn-McHale, 

D.J. & Carlson K.K., American Association of Critical-Care Nurses. 

3. Thalan’s Critical Care Nursing Diagnosis and Management 4th Ed. (2001) Ed. 

Urden, L.D., Stacy, K.M. & Lough, M.E., C.V. Mosby 

• Normal breathing, Normal EtCO2 

A - B: Baseline period of no CO2, End of inhalation 

B - C: Exhalation begins, Begin rapid rise in CO2 

C - D: Sustained exhalation, Alveolar plateau 

D: End of expiration, end tidal CO2 (EtCO2) value 

D - E: Inhalation, Rapid decrease in CO2 

Normal Waveform 

(Normal Ventilation; 35-45 mmHg) 

Always follow hospital protocols 

• Treat cause of increased respiratory rate 

• Assess ABCs (Airway, Breathing, Circulation) 

• Decrease pain stimulus or encourage calm 

• Notify RT or MD 

Increase in pain level or 

splinting area of pain 

• Increase in anxiety or fear 

• Respiratory distress or 

shortness of breath 

Hyperventilation 

• Rapid breathing, 

Low EtCO2 

• Always follow hospital protocols 

• Access ABCs 

• Assess sedation level 

• Stimulate patient 


• Over medication or 

increased sedation 

• Snoring or possible obstruction 

Hypoventilation 

• Slow breathing, 

High EtCO2 

created 0808 

• Always follow hospital protocols 

• Assess ABCs 

• Maintain patient airway 

• Encourage patient to take deep breaths 


• Over medication or increased 

sedation 

• Low tidal volume 

Hypoventilation with Shallow Breathing 

Slow breathing, 

Low EtCO2 followed by 

deep breath (see pointing 

arrow) 



• Encourage patient to take deep breaths 

• Perform a head tilt or chin lift; 

Check position of cannula 


• Poor head or neck alignment 

• Over medication or sedate 

Irregular breathing, possible 

audible sound or snoring, 

EtCO2 may be above 

or below baseline 

Partial Airway Obstruction 



• Stimulate patient 

• Open airway 


• No Breath or Apnea 

• Very shallow breathing 

• Over medication or sedate 

• Displaced cannula 

No Breath 

Sudden loss of EtCO2 

reading, Very shallow or no 

respiratory rate pattern 

observed

AlarisÂ® PCA Module Guide

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