(Delivery System)

Pocket Guide
Series 3 software

Automated Pre-Use Procedure

Integrated Pneumatic Backup INOMAX® Delivery
Transport Regulator/Cap Assembly
Oxygen Dilution Chart
INOMAX Cylinder Duration Chart
Circuit Connection Diagrams
Changing INOMAX Cylinders
High Calibration Connection Diagrams
INOmax DSIR Disposable Adapters

For 24 Hour Assistance

Call 1-877-566-9466

Part No. 20751 Rev-01

2014-08
IMPORTANT: This guide is provided as a convenience
and for general information only. Do not use
this product without clearly and thoroughly
understanding the most recent revision of the
INOmax DSIR® Operation Manual. The Operation
Manual is the source for specific, updated
information regarding warnings, cautions,
checklists, diagrams, and/or instructions
contained in this guide.

Part No. 20751 Rev-01 2

2014-08
Mallinckrodt, the “M” brand mark and the Mallinckrodt
Pharmaceuticals logo are trademark of a Mallinckrodt company.
Other brands are trademarks of a Mallinckrodt company or their
respective owner. ©2016 Mallinckrodt

3 Part No. 20751 Rev-01

2014-08
Contents

Automated Pre-Use Checkout.......................................................................5

Integrated Pneumatic Backup INOMAX Delivery..........................................8
Transport Regulator/Cap Assembly.............................................................10
Oxygen Dilution Chart.................................................................................14
INOMAX Cylinder 88-size Duration Chart...................................................15
INOMAX Cylinder D-size Duration Chart....................................................16
Connection to Various Breathing Systems..................................................17
Acutronics Medical Systems AG Fabian +nCPAP Evolution................ 18
Acutronics Medical Systems AG Fabian HFO...................................... 19
A-Plus Medical Babi-Plus Bubble CPAP.............................................. 20
Bagging Systems While Using the Injector Module...............................22
Bunnell Life Pulse High Frequency Ventilator Circuit............................24
Connecting INOmax DSIR Sample Tee to the Bunnell Life
Pulse Circuit.....................................................................................28
Connecting INOmax DSIR Injector Module to the Bunnell Life
Pulse Circuit.....................................................................................28
Circle Anesthesia System......................................................................29
Dräger Babylog VN500/Infinity Acute Care System and Heinen &
Löwenstein Leoni-plus Ventilator...........................................................30
Fisher & Paykel Healthcare Bubble CPAP............................................31
Fisher & Paykel Healthcare Infant Circuit Nasal Cannula.....................32
Fisher & Paykel Healthcare Optiflow Breathing Circuit.........................33
Hamilton Arabella Nasal CPAP..............................................................34
ICU Ventilator Circuit.............................................................................35
Sensormedics 3100A/B High Frequency Oscillatory Ventilator
with a Filtered Circuit........................................................................36
Sensormedics 3100A/B High Frequency Oscillatory Ventilator
with a Rigid or Flexible Circuit..........................................................38
SLE Life Support SLE5000....................................................................39
Spontaneous Breathing Patient on a Mask Circuit................................40
Spontaneous Breathing Patient on a Nasal Cannula............................41
Teleflex Medical Comfort Flo Humidification System.............................42
Transport Ventilator Circuit....................................................................43
Vapotherm 2000i...................................................................................46
Vapotherm Precision Flow.....................................................................47
Viasys Infant Flow CPAP System; Cardinal Airlife nCPAP System...............48
Viasys Infant Flow SiPAP......................................................................49
INOblender Circuit Connection....................................................................50
Fisher & Paykel Healthcare Neopuff Resuscitator................................51
Changing INOMAX Cylinders......................................................................52
High Calibration Connection Diagrams.......................................................56
INOmax DSIR Disposable Adapters.............................................................58
Part No. 20751 Rev-01 4
2014-08
 Pre-Use Checkout

Automated Pre-Use Checkout

1. Turn INOmax DSIR ON, verify speaker function.
Note: A low range calibration automatically starts
following the self test.
A Pre-Use wizard will be displayed on the main screen,
which will provide step-by-step instructions to complete
the automated Pre-Use procedure.

- Pressing the NEXT button initiates the Pre-Use wizard.

- Pressing the CANCEL button exits the Pre-Use
wizard. If you cancel the pre-use wizard, the
manual pre-use checkout procedure can be found
on the INOmax DSIR Plus Pre-Use card, or in the
INOmax DSIR Operation Manual, section 9/Appendix.
The Pre-Use wizard can also be initiated by entering
the menu screen and selecting the Pre-Use Checkout
button.

5 Part No. 20751 Rev-01

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Pre-Use Checkout

Part No. 20751 Rev-01 6

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 Pre-Use Checkout

(Intentionally left blank)

7 Part No. 20751 Rev-01

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Integrated Pneumatic
Backup INOMAX Delivery

Note: Use the integrated pneumatic backup function only for

a short time, until a replacement delivery system can
be obtained. The INOblender can also be used as a
backup.
If the main delivery system fails, the INOmax DSIR has an
integrated pneumatic backup delivery function that allows
the patient to remain connected to the ventilator. Backup NO
delivery does not rely on the operation of the main system.
The INOmax DSIR backup function:
· Uses a pneumatic on/off switch and a restrictor built into
the delivery side of the system.
· Provides a fixed flow of INOMAX (250 mL/min) into the
injector module. This fixed flow provides 20 ppm of NO
when added to a continuous ventilator gas flow of 10 L/min.
WARNING:
When using the integrated pneumatic backup with
breathing circuit gas flows of 5 L/min, the delivered NO
dose will be approximately 40 ppm. Breathing circuit
gas flows less than 5 L/min will deliver an NO dose
greater than 40 ppm.
The table below indicates the nominal concentrations
delivered for different ventilator gas flows.

Ventilator/Gas
5 7.5 10 15 20
Flow (L/min)
NO
Concentration 40 27 20 13 10
(ppm)

INOMAX cylinder conc. X 0.25 L/min / ventilator flow = estimated dose

Part No. 20751 Rev-01 8

2014-08
 Integrated Pneumatic
Backup INOMAX Delivery
The main screen:
· Indicates that backup delivery is on and that the set dose is
turned off.
· Displays the estimated dose that the patient should be
receiving, based on the ventilator flow.
· Displays the NO concentration table
Note: If the injector module is not functioning, the estimated
backup dose graphic will be inactive.

Backup delivery mode ON (with a Low Priority alarm).

Backup delivery mode OFF.

9 Part No. 20751 Rev-01
2014-08
Transport Regulator/
Cap Assembly

Transport Regulator/Cap Assembly

WARNING:
• A new INOMAX cylinder and regulator must be purged
before use to ensure the patient does not receive an excess
level of NO2.

• Loss of communication between the INOmax DSIR and the

INOMAX cylinder for more than one hour will result in
interruption of INOMAX delivery.

Caution: When using the Transport Regulator/Cap Assembly

(PN 10022) ensure the cap is in place on the cylinder
and the infrared cable is connected to the infrared
connector port on the back of the INOmax DSIR.

Note: Check the INOMAX cylinder for the correct product identity
labels, cylinder concentration and expiration date. Ensure
the INOMAX gas cylinder has more than 500 psig.

Step One
Note: Ensure the white plastic tip is in place on the regulator
connector and not chipped or cracked (see Figure 2).

Connect a high
pressure regulator
to an INOMAX
cylinder and tighten
the fitting to the
INOMAX cylinder
(see Figure 1).

Figure 1 Figure 2
Part No. 20751 Rev-01 10
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 Transport Regulator/
Cap Assembly

Step Two
Connect the INOMAX
regulator hose to one of
the INOMAX inlets on the
back of the INOmax DSIR
(see Figure 3).

Figure 3

Step Three
Connect the Infrared cable from the
Transport Regulator/Cap Assembly
to the back of the INOmax DSIR
(see Figure 4).

Figure 4

11 Part No. 20751 Rev-01

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Transport Regulator/
Cap Assembly

Step Four
Place the Cap Assembly over the INOmeter (see Figure 5).
Note: Be sure to align the keyway inside the Cap Assembly with the
iButton on the INOmeter (see Figure 5 and 6).

iButton

The electrical
cord exits the
cap directly
above the
iButton
keyway

Figure 5 Figure 6

Step Five
Grasp the Cap Assembly to open cylinder valve (see Figure 7 and 8).

-CLOSE +OPEN
Figure 7 Figure 8
Part No. 20751 Rev-01 12
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 Transport Regulator/
Cap Assembly

Final Set-up Diagram

The following diagram and photo illustrates all of the components connected.

Additional Information
Communication will take place between the INOmax DSIR and the
INOmeter after the boot up phase of the INOmax DSIR is complete.

Note: Cylinder icons are not visible and the dose control button
will remain inactive until the INOmax DSIR recognizes an
INOMAX cylinder.

Note: When using the Transport

Regulator/Cap Assembly
only one cylinder will be
displayed (see Figure 9).
Proceed with the
INOmax DSIR Pre-Use
Checkout
(see page 6)
Figure 9

13 Part No. 20751 Rev-01

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Oxygen Dilution Chart

For delivery with 800 ppm cylinder of

INOMAX (nitric oxide) for inhalation.
(Illustrative Only)

Set FiO2
.21 .40 .60 .80 1.00

10 0.21 0.40 0.59 0.79 0.99

INOMAX Dose

20 ! 0.20 0.39 0.59 0.78 0.98

40 ! 0.20 0.38 0.57 0.76 0.95

80 ! 0.19 0.36 0.54 0.72 0.90

Actual FiO2
Caution FiO2 less than 21%

Please Note:
The calculations on this chart have been determined based on an
800 ppm cylinder of INOMAX (nitric oxide) for inhalation.
This chart is representative of a range of doses available on the
INOmax DSIR and doses higher than 20 ppm are not intended as the
recommended therapeutic dose.
Calculations are considered estimates and may vary under clinical
conditions.
All numbers have been rounded to the nearest hundredth.

Part No. 20751 Rev-01 14

2014-08
 Duration Chart
(88-size)

INOMAX Cylinder 88-Size

For an 88-Size 800 ppm Cylinder Concentration*
(Illustrative Only)

FLOW
5 L/min 10 L/min 20 L/min 40 L/min
INOMAX Dose (ppm)

5 39 Days 19.5 Days 9.8 Days 4.9 Days

10 19.4 Days 9.7 Days 4.8 Days 2.4 Days

20 9.6 Days 4.8 Days 2.4 Days 1.2 Days

40 4.7 Days 2.3 Days 1.2 Days 14 Hours

80 2.2 Days 1.1 Days 13.3 Hours 6.6 Hours

This chart is representative of a range of doses available

on the INOmax DSIR and doses higher than 20 ppm are not
intended as the recommended therapeutic dose.
* All calculations in the table above are based on a full cylinder, 138 bar (2000
psig), 1963 liter “88” cylinder, with a cylinder change at 14 bar (200 psig). The
figures are calculated based on a total continuous breathing circuit gas flow and
a cylinder conversion factor of 14.2 liters per bar/0.98 liters per psig.
• INOMAX flow = [Desired dose × total ventilator flow] ÷ [Cylinder concentration
- desired dose]
• Cylinder volume = Cylinder conversion factor × cylinder pressure (bar/psig)
• Cylinder duration (hours) = (Cylinder volume ÷ INOMAX flow rate) ÷ 60
Calculations are considered estimates and may vary under clinical
circumstances. For more information, call 1-877-KNOW-INO (1-877-566-9466).

15 Part No. 20751 Rev-01

2014-08
Duration Chart
(D-size)

INOMAX Cylinder D-Size

FLOW
5 L/min 10 L/min 20 L/min 40 L/min
INOMAX Dose (ppm)

5 7.0 Days 3.5 Days 1.8 Days 21 Hours

10 3.5 Days 1.7 Days 21 Hours 10.5 Hours

20 1.7 Days 20.7 Hours 10.3 Hours 5.2 Hours

40 20 Hours 10 Hours 5 Hours 2.5 Hours

80 9.5 Hours 4.8 Hours 2.4 Hours 1.2 Hours

Typically used in transport

This chart is representative of a range of doses available
on the INOmax DSIR and doses higher than 20 ppm are not
intended as the recommended therapeutic dose.

* All calculations in the table above are based on a full cylinder, 138 bar (2000
psig), 353 liter “D” cylinder, with a cylinder change at 14 bar (200 psig). The
figures are calculated based on a total continuous breathing circuit gas flow
and a cylinder conversion factor of 2.6 liters per bar/0.18 liters per psig.

• INOMAX flow = [Desired dose × total ventilator flow] ÷ [Cylinder concentration

- desired dose]
• Cylinder volume = Cylinder conversion factor × cylinder pressure (bar/psig)
• Cylinder duration (hours) = (Cylinder volume ÷ INOMAX flow rate) ÷ 60
Calculations are considered estimates and may vary under clinical
circumstances. For more information, call 1-877-KNOW-INO (1-877-566-9466).

Part No. 20751 Rev-01 16

2014-08
 Circuit Connection
Diagrams

Proper use of these products depends on careful reading and

understanding of labeling and instructions. Please refer to the
INOmax DSIR and INOblender operation manuals for guidance. Also
refer to the specific breathing device operation manual or instructions
for use.

INOmax DSIR Warnings:

• INOmax DSIR subtracts gas from the breathing circuit via the
gas sampling system at 230 mL per minute; this can affect the
sensitivity of a flow triggered synchronized breath mode of
some ventilators. The trigger sensitivity of the ventilator should
be checked after connecting the INOmax DSIR to the breathing
circuit.

• Patient disconnect and high-pressure alarms are required for

the ventilator.

INOmax DSIR Cautions:

• Insert the Injector Module on the dry side of the breathing circuit
prior to the humidifier (this will ensure correct flow measurement).

• Avoid medications interfering with the gas monitoring system;

administer any aerosolized medications distal to the sampling tee.

17 Part No. 20751 Rev-01

2014-08
Circuit Connection
Diagrams

Acutronics Medical Systems AG Fabian

+nCPAP Evolution (validated for use outside
of the United States)
1 2 3 4

14
13 6

12

11 10 9 8
1. Fabian+ nCPAP Evolution 8. 22F X 15M Adapter
2. Patient Gas Sample Line with Nafion 9. Humidifier
3. Injector Module Electrical Cable 10. Inspiratory Breathing Circuit Hose
4. INOmax DSIR 11. Gas Sample Tee
5. NO/N2 Injector Tube 12. Patient Wye
6. Connecting Tube (15 inches) 13. Proximal Pressure Tube
7. Injector Module 14. Expiratory Breathing Circuit Hose
Part No. 20751 Rev-01 18
2014-08
 Circuit Connection
Diagrams

Acutronics Medical Systems AG Fabian HFO

(validated for use outside of the United States)
1 2 3 4

15 6
7
14
8
13 9

12 11 10
1. Fabian HFO Ventilator 9. 22F X 15M Adapter
2. Patient Gas Sample Line with Nafion 10. Humidifier
3. Injector Module Electrical Cable 11. Inspiratory Breathing Circuit Hose
4. INOmax DSIR 12. Gas Sample Tee
5. NO/N2 Injector Tube 13. Patient Wye
6. Injector Module 14. Proximal Pressure Tube
7. T-Connector Assembly, #7209.e 15. Expiratory Breathing Circuit Hose
8. Connecting Tube (15 inches)
19 Part No. 20751 Rev-01
2014-08
Circuit Connection
Diagrams

A-Plus Medical Babi-Plus Bubble CPAP

15 1

14 2

5 6
3
13
4

12 11 10 9 8 7

1. Oxygen Source 9. Tee Adapter

2. Oxygen Tubing 10. Breathing Circuit
3. Pressure Relief Manifold 11. Humidifier
4. Injector Module 12. NO/N2 Injector Tube
5. Temperature Probe 13. Injector Module Electrical Cable
6. 90 Degree Sample Port Adapter 14. INOmax DSIR
7. Nasal Prongs 15. Patient Gas Sample Line with Nafion
8. Babi Plus Bubble PAP Valve

Part No. 20751 Rev-01 20

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 Circuit Connection
Diagrams

(Intentionally left blank)

21 Part No. 20751 Rev-01

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Circuit Connection
Diagrams

Bagging Systems While Using the Injector

Module

WARNING: To minimize the delivered concentration of NO2,

the following steps should be taken for use with
the manual resuscitator bags:
• Use the smallest bag adequate to deliver the
desired tidal volume.
• Oxygen tubing lengths greater than 72 inches
should not be used.
• Use the highest fresh gas flow rate (up to 15
L/min) that is practical.
• Use the lowest practical inspired oxygen
concentration.
• After starting fresh gas flow, squeeze the bag
several times to empty residual gas in the
bag prior to using the system to ventilate a
patient.

Part No. 20751 Rev-01 22

2014-08
 Circuit Connection
Diagrams

12

11

10

2 3 4 5 6 7

1. O2 Flowmeter (wall outlet or cylinder)

2. O2 Tubing
3. 15M X 4.5 mm Adapter
4. 22M/15F X 22M/15F Adapter
5. Injector Module
6. 15M X 4.5 mm Adapter
7. O2 Tubing
8. O2 Tubing Sample Tee
9. Patient Gas Sample Line with Nafion
10. NO/N2 Injector Tube
11. Resuscitator Bag with O2 Reservoir
12. Injector Module Electrical Cable

23 Part No. 20751 Rev-01

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Circuit Connection
Diagrams

WARNING:
• The hyperinflation bag will, under some conditions, contain NO2 in excess of
1 ppm. Use of large tidal volume breaths may expose the patients to the NO2
present in the bag, for part of the breath. In general, if the inspiratory flow rate
induced by the manual ventilation does not exceed the fresh gas flow rate,
the patient should not be exposed to the concentrations of NO2 present in the
hyperinflation bag.
• Adult and infant hyperinflation bags generate more NO2 when used at lower
minute ventilation. If use of the bag is interrupted (for example, to adjust a
tracheal tube), before resuming ventilation of the patient, the user should
squeeze the bag several times to empty residual gas from the bag.
• Because of the potential for inhalation of excessive concentrations of
NO2, and the difficulty in monitoring the peak inhaled NO2 concentrations,
ventilation with a hyperinflation bag or self inflating bag is intended only for
short term use.
• The monitoring system within the INOmax DSIR will not detect generation of
NO2 within the hyperinflation bag or self-inflating bag devices and the alarms
for excessive NO2 cannot warn of NO2 produced within the manual bag
system.
• To minimize the delivered concentration of NO2, the following steps should be
taken for use with the manual resuscitator bags:
- Concentrations greater than 20 ppm NO should not be used because of
excessive NO2 generation.
- Use the smallest bag adequate to deliver the desired tidal volume.
- Oxygen tubing lengths greater than 72 inches should not be used.
- Use the highest fresh gas flow rate (up to 15 L/min) that is practical.
- Use the lowest practical inspired oxygen concentration.
- After starting fresh gas flow, squeeze the bag several times to empty
residual gas in the bag prior to using the system to ventilate a patient.

Part No. 20751 Rev-01 24

2014-08
 Circuit Connection
Diagrams

Bagging Systems While Using the Injector

Module

3
4
2
5

6
1

13 12 11 10 9 8

1. O2 Flowmeter 8. Pressure Gauge

2. Injector Module Electrical Cable 9. 15M X 4.5mm Adapter
3. NO/N2 Injector Tube 10. Injector Module
4. Patient Gas Sample Line with Nafion 11. 22M/15F X 22M/15F Adapter
5. O2 Tubing 12. 15M X 4.5mm Adapter
6. O2 Tubing Sample Tee 13. O2 Tubing
7. Hyper-Inflation Bag

25 Part No. 20751 Rev-01

2014-08
Circuit Connection
Diagrams

Bunnell Life Pulse

High Frequency Ventilator Circuit

WARNING:
• The INOmax DSIR backup mode (250 mL/min.) should not
be used with the Bunnell Life Pulse as ventilator flow rates
are normally below the recommended ventilator flows.

• Place the Life Pulse in Standby prior to suctioning the

patient to avoid NO delivery transiently exceeding the
set dose by up to 30 ppm. Press ENTER to reestablish
ventilation as soon as the catheter is removed from the
airway. This will limit the extent of over delivery above the
NO set dose.

Caution:
• If the set dose is below 5 ppm and the Servo pressure is 2.0 psig.
or less, this will result in flow rates outside of the specification of
the Injector Module and fluctuating NO values may result.
• A one-way valve should be placed between the injector module
and the humidifier chamber to prevent water from backing up into
the injector module if the Life Pulse is either put into Standby or
cycled OFF.
• There are higher pressures in the breathing circuit than normal;
use only parts provided in disposable package #50248 and tightly
secure all connections.

Part No. 20751 Rev-01 26

2014-08
 Circuit Connection
Diagrams

Bunnell Life Pulse

High Frequency Ventilator Circuit (cont.)

1 2 3 4 5

14
11 10 9
13 12

8 7

1. INOmax DSIR 8. Sample Tee

2. Bunnell Life Pulse 9. Patient Box
3. Humidifier 10. One-Way Valve
4. Humidifier 11. Injector Module
5. Conventional Ventilator 12. NO/N2 Injector Tube
6. Life Port Adapter 13. Injector Module Electrical Cable
7. Endotracheal Tube 14. Patient Gas Sample Line with Nafion

27 Part No. 20751 Rev-01

2014-08
Circuit Connection
Diagrams

Connecting INOmax DSIR Sample Tee to the

Bunnell Life Pulse Circuit
1. From Patient Box
2. Cut Green tube at midpoint 1
(approximately six inches from
the Life Port Adapter)
3. Patient Gas Sample Line with 2 4 5
Nafion
4. Insert Sample Tee 3
6
5. Life Port Adapter
6. Endotracheal Tube

Connecting INOmax DSIR Injector Module to the

Bunnell Life Pulse Circuit

1 2 3 4 5 6 7 8
1. Gas Out Tube from Vent 5. 15M X 4.5mm I.D. Adapter
2. 15M X 4.5mm I.D. Adapter 6. 3cm Piece of Green Gas Out Tube
3. 22M/15F X 22M/15F Adapter 7. One-Way Valve
4. Injector Module 8. Green Gas Out Tube to Humidifier

Part No. 20751 Rev-01 28

2014-08
 Circuit Connection
Diagrams

Circle Anesthesia System

1 2 3 4 5

14 13 12 11 10b 10 10a 9 8 7 6

1. Patient Gas Sample Line with 8. Absorber Inspiratory Port

Nafion 9. Absorber
2. Patient Gas Sample Line 10. Injector Module
Input Connection a. Injector Module Input End
3. INOmax DSIR b. Injector Module Output End
4. Bellows Assembly 11. Inspiratory Tubing
5. Ventilator 12. 22M/15F X 22M/15F Adapter
6. Ventilator Drive Gas 13. Gas Sample Tee
7. Absorber Expiratory Port 14. Patient Wye

WARNING: Fresh gas flow should be equal to or greater

than patient minute ventilation to avoid
recirculation of gases.
29 Part No. 20751 Rev-01
2014-08
Circuit Connection
Diagrams

Dräger Babylog VN500/Infinity Acute Care

System and Heinen & Löwenstein
Leoni-plus Ventilator (validated for use outside
of the United States)
1 2 3 4 5 6

15 14 13 12 11 10 9

1. Patient wye
2. Dräger Babylog VN500 / Leoni-plus Ventilator 9. Injector Module
3. Ventilator Expiratory Port 10. One-Way Valve
4. Ventilator Inspiratory Port 11. Humidifier Inlet
5. Patient Gas Sample Line Input Connection 12. Humidifier
6. INOmax DSIR 13. Humidifier Outlet
7. NO/N2 Injector Tube Front Panel Connection 14. Patient Gas Sample Line
8. Injector Module Electrical Cable Front Panel with Nafion
Connection 15. Gas Sample Tee

Part No. 20751 Rev-01 30

2014-08
 Circuit Connection
Diagrams

Fisher & Paykel Bubble CPAP

16 1

15 2

3
7 8
14 4 5
6

13 4 12 11 10 9

1. Oxygen Source 10. F/P Inline Infant Nebulizer Kit

2. Oxygen Tubing (RT010) Adapter
3. Bubble CPAP Pressure Manifold 11. Breathing Circuit
4. 22F X 15M Adapter 12. Humidifier
5. 22M/15F X 22M/15F Adapter 13. NO/N2 Injector Tube
6. Injector Module 14. Injector Module Electrical Cable
7. Temperature Probe 15. INOmax DSIR
8. Nasal Prong Infant Interface 16. Patient Gas Sample Line with Nafion
9. Bubble CPAP Generator

31 Part No. 20751 Rev-01

2014-08
Circuit Connection
Diagrams

Fisher & Paykel Infant Circuit Nasal Cannula

1 2

4
9
7
10
5 8
6

15 14 13 12 11

1. Patient Gas Sample Line with Nafion 9. Injector Module Electrical Cable
2. INOmax DSIR 10. NO/N2 Injector Tube
3. Oxygen Source 11. Humidifier
4. Oxygen Tubing 12. Breathing Circuit
5. 22F X 15M Adapter 13. Temperature Probe
6. Injector Module 14. Gas Sample Tee
7. Pressure Relief Manifold 15. Nasal Cannula
8. 22M/15F X 22M/15F Adapter

Part No. 20751 Rev-01 32

2014-08
 Circuit Connection
Diagrams

Fisher & Paykel Optiflow Breathing Circuit

1 2

17 6
4
7
5

16 8

15 14 13 12 11 10 9

1. Patient Gas Sample Line with Nafion 10. Breathing Circuit

2. INOmax DSIR 11. Temperature Probe
3. Oxygen Source 12. Gas Sample Tee
4. Breathing Circuit Hose 13. 22M/15F X 22M/15F Adapter
5. Injector Module 14. 22 mm ID X 22 mm ID Cuff Adapter
6. Injector Module Electrical Cable 15. Optiflow Tracheostomy
7. NO/N2 Injector Tube 16. Optiflow Nasal Cannula
8. 22F X 15M Adapter 17. Optiflow Mask
9. Humidifier
33 Part No. 20751 Rev-01
2014-08
Circuit Connection
Diagrams

Hamilton Arabella Nasal CPAP

1 2 3

13
12
11

10 9 8 7 6 5 4

1. Arabella 8. Humidifier
2. Patient Gas Sample Line with Nafion 9. Heated Delivery Circuit
3. INOmax DSIR 10. Temperature Probe
4. NO/N2 Injector Tube 11. Universal Generator
5. Injector Module Electrical Cable 12. Arabella Sample Tee
6. Injector Module 13. 90 Degree Sample Port Adapter
7. 22F X 15M Adapter

Part No. 20751 Rev-01 34

2014-08
 Circuit Connection
Diagrams

ICU Ventilator Circuit

1 2 3 4 5 6 7

8
9
10

17 16 15 14 13 12 11
1. Patient Wye
2. Patient Gas Sample Line with Nafion
3. Ventilator
a
4. Ventilator Expiratory Port
5. Ventilator Inspiratory Port c
6. Patient Gas Sample Line Input Connection
b
7. INOmax DSIR
8. NO/N2 Injector Tube Front Panel Connection a. Injector Module
9. Injector Module Electrical Cable Front Panel Connection b. 22F Inlet
10. 22M/15F X 22M/15F Adapter c. 22M / 15F Outlet
11. Injector Module Electrical Cable Connection
12. Injector Module NO/N2 Injector Tube Connection
13. 22F X 15M Adapter
14. Humidifier Inlet
15. Humidifier
16. Humidifier Outlet
17. Gas Sample Tee
35 Part No. 20751 Rev-01
2014-08
Circuit Connection
Diagrams

Sensormedics 3100A/B High Frequency

Oscillatory Ventilator with a Filtered Circuit

1 2 3 4 5
6

7
8

18 9
17
11
10

11
12

16 15 14 13
a
c
b

a. Injector Module
b. 22F Inlet
c. 22M / 15F Outlet

Part No. 20751 Rev-01 36

2014-08
 Circuit Connection
Diagrams

1. Sensormedics 3100A/B Ventilator 10. Paw Limit Valve Control

2. Ventilator Outlet 11. Filter
3. 22M Adapter 12. Humidifier Inlet
4. Injector Module 13. Humidifier Outlet
5. Injector Module Electrical Cable 14. Bias Flow Tube
Connection 15. Patient Gas Sample Line with Nafion
6. INOmax DSIR 16. 90 Degree Sample Port Adapter
7. NO/N2 Injector Tube 17. Dump Valve Control
8. 8 mm Tubing X 15M Adapter 18. Paw Control Valve
9. One-Way Valve

WARNING: Omission of the one-way valve may result in

high NO delivery.

37 Part No. 20751 Rev-01

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Circuit Connection
Diagrams

Sensormedics 3100A/B High Frequency Oscillatory

Ventilator with a Rigid or Flexible Circuit
1 2 3 4
5

8
13
9 a
c
b
10
a. Injector Module
b. 22F Inlet
c. 22M / 15F Outlet
12 11

1. Sensormedics 3100A/B Ventilator 9. Humidifier Inlet

2. Ventilator Outlet 10. Humidifier Outlet
3. 22M Adapter 11. Patient Gas Sample
4. Injector Module Line with Nafion
5. INOmax DSIR 12. 90 Degree Sample
6. NO/N2 Injector Tube Connection Port Adapter
7. Injector Module Electrical Cable Connection 13. Bias Flow Tube
8. One-Way Valve
WARNING: Omission of the one-way valve may result
in high NO delivery.
Part No. 20751 Rev-01 38
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 Circuit Connection
Diagrams

SLE Life Support SLE5000

Note: • Validated for use outside of the United States.
• A one-way valve is not required for use during high frequency
ventilation mode.

1 2 3 4

12 11 10 9 8 7

1. Patient Wye 7. Injector Module

2. Patient Gas Sample Line with Nafion 8. 22F X 15M Adapter
3. SLE5000 9. Humidifier
4. INOmax DSIR 10. Inspiratory Breathing Circuit Hose
5. NO/N2 Injector Tube 11. Expiratory Breathing Circuit Hose
6. Injector Module Electrical Cable 12. Gas Sample Tee

39 Part No. 20751 Rev-01

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Circuit Connection
Diagrams

Spontaneous Breathing Patient on a Mask

Circuit

16 15

17
14
13

1 2 3 4 5 6 7 8 9 10 11 12
1. O2 Tubing 10. One-Way Valve
2. 15M X 4.5 mm Adapter 11. Sealed Face Mask
3. 22M/15F X 22M/15F Adapter 12. One-Way Valve
4. Breathing Circuit Tee 13. Patient Gas Sample Line with Nafion
5. Breathing Circuit Bag 14. NO/N2 Injector Tube
6. Injector Module 15. INOmax DSIR
7. Breathing Circuit Hose 16. Injector Module Electrical Cable
8. Gas Sample Tee 17. O2 Flowmeter (wall outlet or cylinder)
9. 22M/15F X 22M/15F Adapter

Part No. 20751 Rev-01 40

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 Circuit Connection
Diagrams

Spontaneous Breathing Patient on a Nasal

Cannula
The INOmax DSIR can be used with nasal cannula to deliver
INOMAX concentrations from 5-80 ppm and an oxygen flow
rate as low as 2 L/min.

WARNING: Do not use the INOmax DSIR backup mode with

flow rates less than 5 L/min.

1 10
11

12

2 3 4 5 4 6 5 4 3 7 8

1. O2 Flowmeter 7. O2 Tubing Sample Tee

2. O2 Tubing 8. Patient Nasal Cannula
3. 15M x 4.5 mm Adapter 9. Patient Gas Sample Line with Nafion
4. 22M/15F x 22M/15F Adapter 10. INOmax DSIR
5. 300 mm of 22 mm Hose 11. Injector Module Electrical Cable
6. Injector Module 12. NO/N2 Injector Tube

41 Part No. 20751 Rev-01

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Circuit Connection
Diagrams

Teleflex Medical Comfort Flo Humidification System

1 2 3 4 5

13 14
7
15 8

16

18 17

12 11 10 9

1. Patient Gas Sample Line with Nafion 10. Temperature Probe Connector
2. INOmax DSIR 11. Second Temperature Probe Connector
3. Injector Module 12. Comfort Flo Cannula
4. System Pressure Relief Valve 13. Injector Module Electrical Cable
5. Air/Oxygen Blender or Oxygen Blender 14. NO/N2 Injector Tube
6. Oxygen Tubing 15. 22F X 15M Adapter
7. Temperature Probe (Short Cable) 16. ConchaTherm Heated Humidifier
8. Angled 22 mm Connector 17. Temperature Probe (Long Cable)
9. Patient Circuit 18. 90 Degree Sample Port Adapter

Part No. 20751 Rev-01 42

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 Circuit Connection
Diagrams

Transport Ventilator Diagram

5 6

4
3
2
1
7
8

11

9
13 12 10

1. Patient Wye 7. Ventilator Inspiratory Port

2. Expiratory Breathing Circuit Hose 8. 22M/15F X 22M/15F Adapter
3. Patient Gas Sample Line with 9. Injector Module Electrical Cable
Nafion 10. NO/N2 Injector Tube
4. Ventilator Expiratory Valve 11. Injector Module
5. Ventilator 12. Inspiratory Breathing Circuit Hose
6. INOmax DSIR 13. Gas Sample Tee

43 Part No. 20751 Rev-01

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Circuit Connection
Diagrams

Single-Limb Transport Ventilator Diagram

1 2 3 4 5
6

7
8

9
10
13 12 11

1. PEEP/Exhalation Valve 7. Ventilator Inspiratory Port

2. Patient Wye 8. 22M/15F X 22M/15F Adapter
3. Circuit Hose 9. Injector Module Electrical Cable
4. Patient Gas Sample Linewith 10. NO/N2 Injector Tube
Nafion 11. Injector Module
5. Ventilator 12. Inspiratory Breathing Circuit Hose
6. INOmax DSIR 13. Gas Sample Tee

Part No. 20751 Rev-01 44

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 Circuit Connection
Diagrams

(Intentionally left blank)

45 Part No. 20751 Rev-01

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Circuit Connection
Diagrams

Vapotherm 2000i 2

1
3

4
5

6
7
8

16 9
15

14

10

13 12 11
1. INOmax DSIR 9. 15M x 4.5mm Adapter
2. O2 Flowmeter 10. Vapotherm 2000i
3. O2 Tubing 11. Patient Delivery Tube
4. 15M x 4.5mm Adapter 12. O2 Tubing Sample Tee
5. 22M/15F x 22M/15F Adapter 13. Patient Cannula
6. 300mm of 22mm Hose 14. Patient Gas Sample Line
7. 22M/15F x 22M/15F Adapter with Nafion
8. Injector Module 15. NO/N2 Injector Tube
16. Injector Module Electrical Cable
Part No. 20751 Rev-01 46
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 Circuit Connection
Diagrams

Connection to the Vapotherm Precision Flow

• The INOmax DSIR adds NO/N2 gas flow to the breathing circuit flow in
proportion to the NO setting (up to 10% at 80 ppm) and subtracts gas
from the breathing circuit via gas sampling at a nominal flow rate of
0.23 L/min.
• These effects impact the delivered gas flow rate when using the
Vapotherm Precision Flow. It is recommended that after an NO setting
change the user checks the delivered gas flow rate and adjusts the
gas source flow rate as necessary.
• Follow all manufacturer instructions for connection to the Vapotherm
Precision Flow.
1 2 3

8 9

1. Patient Gas Sample Line

with Nafion
2. INOmax DSIR
3. Precision Flow Unit
4. Injector Module
5. Patient Delivery Tube
6. Oxygen Tubing Sample Tee
7. Patient Cannula
7 6 5 8. Injector Module Electrical Cable
9. NO/N2 Injector Tube
47 Part No. 20751 Rev-01
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Circuit Connection
Diagrams

Viasys Infant Flow CPAP System;

Cardinal AirLife nCPAP System
1 2 3

12

11 10 9 8 7 6 5

1. INOmax DSIR 7. Patient Gas Sample Line with Nafion

2. Heated Delivery Circuit 8. Humidifier
3. Infant Flow System 9. 22F X 15M Adapter
4. Infant Flow Generator 10. Injector Module
5. Sample Tee 11. NO/N2 Injector Tube
6. Temperature Probe 12. Injector Module Electrical Cable

Part No. 20751 Rev-01 48

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 Circuit Connection
Diagrams

Viasys Infant Flow SiPAP

1 2 3 4

12
5

14 13 11 10 9 8 7 6

1. INOmax DSIR 8. Heated Delivery Circuit

2. Abdominal Respiratory Sensor 9. Humidifier
3. Transducer Interface 10. 22F X 15M Adapter
4. Infant Flow SiPAP 11. Injector Module
5. Infant Flow Generator 12. Injector Module Electrical Cable
6. Sample Tee 13. NO/N2 Injector Tube
7. Temperature Probe 14. Patient Gas Sample Line with Nafion

49 Part No. 20751 Rev-01

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INOblender Circuit
Connection Diagram

INOblender Warnings:
• The purge procedure must be followed to help ensure NO2 is
purged from the pressure regulator, INOblender and hoses
before the manual resuscitator bag is connected to the patient.
The manual bag should be squeezed continuously during use
to avoid NO2 building up in the bag. If the bag is not squeezed
continuously while delivering INOMAX, the bag should be
removed from the patient and the purge procedure performed
before continuing.

• Persons using this device should be trained on and

experienced in the use of this device to assure effective
administration of INOMAX and to avoid injury to the patient or
others resulting from inhalation of excess INOMAX, nitrogen
dioxide or other reaction products.

INOblender Cautions:
• Refer to the manufacturer’s procedures for using the resuscitation
bag. When finished, turn the INOMAX cylinder off and continue to
flow O2 until the NO pressure gauge reads zero, then turn the O2
flow off and the NO dial to zero ppm.

Note: Connections to various ventilators as well as their corresponding

disposable circuits, are unique to each manufacturer. Please
refer to the specific breathing device operation manual or
instructions for use for guidance.

Part No. 20751 Rev-01 50

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 INOblender Circuit
Connection Diagram

INOblender Connection to the Fisher & Paykel

Neopuff Resuscitator

1 2 3

Oxygen Source

10 INOMAX Inlet

8
5
4

7 6 4

1. Oxygen Source
2. Neopuff
3. T-Piece Circuit (with Duckbill Port)
4. Patient Connection
5. Temperature Probe
6. Humidified Resuscitation System Circuit
7. Humidifier
8. Oxygen Tubing
9. INOblender
10. INOMAX Inlet

51 Part No. 20751 Rev-01

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Changing INOMAX
Cylinders

Changing INOMAX Cylinders

WARNING:
• A new INOMAX cylinder and regulator must be purged
before use to ensure the patient does not receive an
excess level of NO2.
• Loss of communication between the INOmax DSIR and
the INOMAX cylinder for more than one hour will result in
interruption of INOMAX delivery.

Caution:
• Replace an INOMAX cylinder when its pressure is
less than 200 psig.
• When using the Transport Regulator/Cap Assembly (PN 10022)
ensure the cap is fully seated and in place on the INOmeter
and the infrared cable is connected and latched to the infrared
connector port on the back of the INOmax DSIR.

Note: Ensure the

white plastic tip
is in place.

A. Attach a regulator
to an INOMAX
cylinder with
greater than
500 psig.

Part No. 20751 Rev-01 52

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 Changing INOMAX
Cylinders

B. Perform high
pressure leak test.

C. Purge the high

pressure hose.

D. Connect the
pressure hose.

53 Part No. 20751 Rev-01

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Changing INOMAX
Cylinders

Changing INOMAX Cylinders (cont.)

E. Open the cylinder valve (this

may activate the “Two Cylinders
Open” alarm until the empty
cylinder valve is closed).
Note: If using the INOmax DSIR
Transport Regulator/Cap
Assembly, transfer the cap from
the exhausted INOMAX cylinder
to the new INOMAX cylinder
at this time; the “Cylinder Not
Detected” alarm may occur.

F. Close the cylinder valve on the

empty cylinder and remove
the hose from the back of the
INOmax DSIR.

G. Depressurize and remove the regulator from the

empty cylinder.

Part No. 20751 Rev-01 54

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 Changing INOMAX
Cylinders

(Intentionally left blank)

55 Part No. 20751 Rev-01

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High Calibration
Connection Diagrams

Connection Diagram for NO and NO2 High

Range Calibration

To
INOmax DSIR

6a

6a. If the pressure is in the red or black

1. Cylinder Cap zone (0-25 psig) select another INOcal
2. Regulator Seal cylinder.
3. Regulator 7. Attach tube kit to sample line
4. Tubing Adapter 8. Calibrate sensor
5. Attach Tube Kit 9. Remove sample line from tube kit
6. Turn valve counter-clockwise to 10. Turn valve clockwise to stop gas flow
start gas flow 11. One-way Valve
Part No. 20751 Rev-01 56
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 High Calibration
Connection Diagrams

Calibration Setup for O2 High Range Calibration

3 4

1. 100% O2 Source
2. O2 Tubing
3. 15M x 4.5mm I.D. Adapter
4. Gas Sample Tee
5. Patient Gas Sample Line with Nafion

57 Part No. 20751 Rev-01

2014-08
INOmax DSIR
Disposable Adapters

INOmax DSIR Patient Circuit Disposables

(Note: Graphics not actual size)
Adapter, Adapter, 22F X 15M
15M Fits 4.5mm ID Tubing

Adapter, 22M/15F X 22M/15F Adapter, Cuff, 22mm ID X 22mm ID

Adapter, Gas Sample Tee Adapter, 90 degree Sample Port

Bunnell Life Pulse Disposable Disk Filter, 0.5 micron

Adapters Convenience Pack

Neonatal Tubing, NO/N2 Injector Tube

10mm (2 pieces)

Part No. 20751 Rev-01 58

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 INOmax DSIR
Disposable Adapters

One-way Valve, 22F X 22M Patient Gas Sample Line with

Nafion

Pediatric Extension, Sample Tee, O2 Tubing

15 mm (6 inches)

Sensormedics 3100A/B Water Separator Cartridge

Filtered Circuit
Disposable Adapters
Convenience Pack

59 Part No. 20751 Rev-01

2014-08
 Mallinckrodt Manufacturing LLC
6603 Femrite Drive,
Madison, WI 53718-6801 USA
1-877-566-9466

Part No. 20751 Rev-01 60

2014-08