Braun Marine Sanitation System HNS 11 User Manual

Stimuplex® HNS 11  
Nerve Stimulator for  
Regional Anaesthesia,  
Regional Analgesia, Neurology  
User manual  
 
Contents  
Page  
Checks before start-up................................................................................................................................................ 4  
Technical description ..................................................................................................................................................... 6  
Operating the nerve stimulator.......................................................................................................................... 7  
Switching on / switching off .................................................................................................................................................. 7  
Selecting the pulse frequency ............................................................................................................................................... 7  
Selecting the pulse width ........................................................................................................................................................ 7  
Selecting the current range .................................................................................................................................................... 8  
Checking the battery voltage................................................................................................................................................. 8  
Selecting the current display mode .................................................................................................................................... 8  
The LED displays.................................................................................................................................................................. 9  
Current display mode ................................................................................................................................................................. 9  
Current adjustment range ....................................................................................................................................................... 9  
Pulse width ...................................................................................................................................................................................... 9  
Pulse frequency ............................................................................................................................................................................. 9  
Pulse LED display .......................................................................................................................................................................... 10  
The LCD display.................................................................................................................................................................... 10  
The tone ........................................................................................................................................................................................11  
Initial set up, maintenance and general advice ................................................................................. 11  
Testing the Stimuplex® HNS 11 before an application ............................................................................................... 11  
Special technical features ....................................................................................................................................................... 12  
Technical data ................................................................................................................................................................................ 12  
Battery ............................................................................................................................................................................................... 13  
Cleaning and disinfecting the Stimuplex® HNS 11 ...................................................................................................... 14  
Maintenance and safety checks ........................................................................................................................................... 14  
Safety checks / Local law restricts ..........................................................................................................................15  
Caution, Notice ............................................................................................................................................................................. 16  
Safety information ...................................................................................................................................................................... 17  
Error messages ............................................................................................................................................................................... 17  
Instruments and accessories .................................................................................................................................................. 18  
Stimuplex® HNS 11 and Accessories, Stimuplex® and Contiplex® needles ............. 18  
Peripheral electrical nerve stimulation ...................................................................................................... 20  
Performing PNS with the Stimuplex® HNS 11 and the Stimuplex® needles........ 21  
Literature.................................................................................................................................................................................... 23  
Appendices A to D ............................................................................................................................................................ 24  
 
4
Checks before start-up  
The Stimuplex® HNS 11 is a class lla medical device according to  
Council Directive 93/42/EEC. An item of medical equipment may  
only be put into operation after the supplier has subjected the  
equipment to a function test on site and has instructed the  
person responsible for operating the equipment in the use of the  
equipment with the aid of the user manual.  
Before putting the Stimuplex® HNS 11 into operation, carry out the  
following tests.  
1. Turn the control knob clockwise out of the O position to switch  
on the Stimuplex® HNS 11.  
A brief click signals that this has taken place. At this instant, the  
devices automatically starts a self-test. This includes switching  
on all segments of the LCD display as a visual check.  
When the self-test is completed, the stimulator immediately  
switches to its normal operating mode. The LEDs on the button  
panel indicate the operating conditions selected. To conserve  
power, these extinguish after 8 seconds.  
If no display appears when the Stimuplex® HNS 11 is switched  
on, change the battery immediately. (Refer to the ”Battery”  
section, p. 13).  
If the self-test detects a defective function, the corresponding  
error code will appear in the LCD display and the instrument  
will then be inoperative! (Refer to the ”Error messages” section).  
When the LEDs are switched off, they can be reactivated by press-  
ing any button. This does not change the existing operating mode.  
The operating mode can only be changed when the LEDs are lit.  
2. Carry out a visual inspection of the electrode cable. Damaged  
cables must not be used.  
Connect the electrode cable to the front of the nerve stimula-  
tor. The plug connector configuration prevents wrong polarity  
connection.  
 
5
In the operating mode, the LCD display shows the preselected  
stimulation current set on the controller between 0.00 and  
approx. 1.00 mA (in the 1 mA range) or from 0.00 to approx.  
5.00 (in the 5 mA range). In the  
operating mode, the Stimu-  
plex® HNS 11 shows the stimulation current actually flowing  
via the stimulation electrodes through the tissue. A +sign on  
the LCD display signals this setting. The operating mode is  
switched by pressing the mAbutton.  
3. Select operating mode . Set the controller to 5 mA max. and  
try to get a connection with the insulated, black 2 mm male plug  
with a part of the red clamp. Compare – by briefly switching to  
operating mode – the measured value with the set value (ac-  
tual value and set value). These two values must be the same –  
with shorted cables. Reset to 1 mA max. and compare these two  
values (see Measuring Accuracy in Appendix A, if neccessary).  
A
symbol appears next to the symbol in the LCD display  
~
(Display) and the pulsed LED display (orange light-emitting di-  
ode) blinks according to the stimulation frequence.  
A "+" sign appears in front of each measurement displayed.  
When a current is set at O, the orange LED starts to blink at 0.02  
mA, when 1 mA max. is set, and at 0.10 mA when 5 mA max. is  
set.  
4. When the stimulation cable is disconnected (when is set),  
+0.00 appears in the display and the symbol disappears. The  
~
pulsed LED display is no longer lit.  
If the "BAT" symbol appears in the display, then the battery  
voltage is getting too low. Current application can be complet-  
ed without a problem, but exchanging the battery afterwards  
should be considered. Press the "BAT" button to display the re-  
maining battery voltage (in volts).  
When the battery voltage is approx. 6 volts, three horizontal  
dashes preceded by the "+" sign (or four dashes) appear in the  
display in addition to the "BAT" symbol. In this case, the stimu-  
lator shuts off automatically.  
To avoid having to abort a stimulator treatment, you should  
replace the 9 volt block battery as soon as the battery volt-  
age drops to 6.5 volts.  
5. To switch off the nerve stimulator, turn the control knob anti-  
clockwise to position O.  
To conserve the battery always switch off the Stimuplex® HNS 11  
after use. If you do not use it for a long period of time, remove  
the battery to prevent battery leakage.  
 
6
Technical description  
6. Refer to the Safety information section before using the Stimu-  
plex® HNS 11 on a patient.  
Any instrument behaving abnormally must not be put into  
operation. Contact customer service.  
Electromedical equipment may only be repaired by the manu-  
facturer or by an organization expressly authorized by the manu-  
facturer.  
The Stimuplex® HNS 11 nerve stimulator is designed for reliable  
identification and location of nerves for local anaesthesia.  
It generates consistent square pulses with selectable frequency,  
selectable pulse width and continuously adjustable stimulation  
current.  
The range of adjustment of the pulse current from 0 to 5 mA peak-  
to-peak can be reduced to 0 to 1 mA with the ”mA(max)” button.  
This 1 mA range allows precise adjustments for extremely thin and  
technically sophisticated needles.  
The stimulation frequency and the pulse width can be varied for  
different applications. The Stimuplex® HNS 11 nerve stimulator  
offers the facility for selecting a frequency of either 1 Hz or 2 Hz  
can be chosen together with pulse widths of 0.1 ms, 0.3 ms or  
1.0 ms.  
When the Stimuplex® HNS 11 is switched off, all set parameters  
remain stored.  
As a visual and audible check, the symbol and a tick occur in  
time with the stimulation. Stimulation current flowing through the  
electrodes is signalled by the symbol next to the and a + sign  
~
in front of the value for current in the display (in operating mode ).  
To conserve battery power, the LEDs on the button panel for the  
operating modes are switched off after approx. 8 seconds. They  
are reactivated by pressing any button. This does not change the  
operating mode setting, which can only be changed when the LEDs  
are lit.  
 
7
Operating the nerve stimulator  
Switching on / switching off  
Turn the control knob clockwise out of the O position to switch on  
the Stimuplex® HNS 11. A brief click signals that this has taken  
place. At this instant, the device automatically starts a self-test.  
This includes switching on all segments of the LCD display as a  
visual check. When the self-test is completed, the nerve stimulator  
immediately switches to its normal operating mode. The LEDs on  
the button panel indicate the operating conditions selected (see  
below). To conserve power, these extinguish after 8 seconds. They  
light up again immediately when a button is pressed, but this does  
not change the operating mode. The operating mode can only be  
changed when the displays are lit.  
To switch off the nerve stimulator, turn the control knob  
anticlockwise to position O.  
Selecting the pulse frequency  
The selected setting is displayed and stored. You can change the  
setting by pressing the "Hz" button when the LED display is lit. The  
Stimuplex® HNS 11 nerve stimulator offers the facility of selecting  
a frequency of 1 Hz or 2 Hz (one or two pulses per second).  
Selecting the pulse width  
The pulse width can be set by pressing the ”ms” button. It is possible  
to set a stimulation of 0.1 ms, 0.3 ms or 1.0 ms.  
The selected setting is displayed and stored. Setting can be changed  
by pressing the "ms" button when the LED display is lit.  
 
8
Selecting the current range  
The maximum current available can be selected by pressing the  
”mA (max)” button. The Stimuplex® HNS 11 nerve stimulator offers  
a choice between a range up to 5 mA max. or up to 1 mA max.  
Values between 0.00 mA and 1.00 mA can be selected in the 1 mA  
range with the on/off control knob. This also allows precise adjust-  
ments to be made for extremely thin and technically sophisticated  
needles. For safety reasons, while a patient current is flowing, it is  
not possible to switch from the 1 mA range to the 5 mA range. If  
this is required, turn the control to 0.00 mA and then switch over.  
The selected current range is displayed and is stored until the ”mA  
(max)” button is pressed again.  
Checking the battery voltage  
Pressing the ”BAT” button will display the existing battery voltage  
on the LCD display. Pressing this button does not affect the Stimu-  
plex® HNS 11 functions. All settings remain unchanged.  
Selecting the current display mode  
During operation of the nerve stimulator, the stimulation current is  
shown on the LCD display. Pressing the ”mA” button selects the cur-  
rent display mode: the stimulation current set (mA ) (displays set  
current) or the current actually flowing in the tissue (mA ) (dis-  
plays actual current). In addition, a ”+” appears in front of the cur-  
rent on the LCD display in the case of the actual current display.  
If a current display mode is set (check this by switching to operat-  
ing mode ) in the operating mode mA (actual current) and +0.00  
appears in the display, then the possible source of the error could be:  
-
-
-
-
the electrode cable is not connected to the device,  
the adhesive electrode is defective (possible too dry),  
the tissue resistance is very high,  
the connecting cables are defective.  
The measuring mode selected is displayed and is stored until the  
”mA” button is pressed again.  
 
9
The LED displays  
All LEDs directly assigned to the buttons are used to monitor the  
selected operating mode. Since LEDs require relatively high power,  
the Stimuplex® HNS 11 switches them off after 8 seconds (see p. 6  
Section 7).  
The individual displays have the following significance:  
Current display mode  
The LCD display shows the stimulation current set ( ).  
The LCD display shows the stimulation current actually flowing  
(
). In addition, a ”+” appears in front of the current displayed.  
Current adjustment range  
Setting range from 0.00 to 5.00 mA:  
Use the controller to dial a stimulation current up to 5 mA. The  
current is displayed in 0.02 mA digits.  
Setting range from 0.00 to 1.00 mA:  
Use the controller to dial a stimulation current up to 5 mA. The  
current is displayed in 0.01 mA digits.  
Pulse width  
Pulse width 1.0 ms: duration of stimulation pulse is 1.0 ms.  
Pulse width 0.3 ms: duration of stimulation pulse is 0.3 ms.  
Pulse width 0.1 ms: duration of stimulation pulse is 0.1 ms.  
Pulse frequency  
Pulse frequency 2 Hz (two pulses per second)  
Pulse frequency 1 Hz (one pulse per second)  
 
10  
Pulse LED display  
The small orange LED above the LCD display flashes according to  
the pulse frequency set (1 Hz: once per second; 2 Hz: twice per  
second) when current is flowing through the electrodes. At the  
same time, a louder tick can be heard.  
The LCD display  
According to the display mode selected, the LCD display shows the  
setting for, or the actually flowing stimulation current. The display  
is in mA.  
The  
there is a ticking sound in the same stimulation frequence. A  
symbol appears next to the symbol in the same stimulation  
symbol indicates the stimulation frequence. At the same time,  
~
frequence when the stimulation current is flowing and the ticking  
sound gets louder. When the actual value display is selected, the  
LCD display additionally shows a "+" in front of the current displayed.  
Exceptions:  
1. Pressing the ”BAT” button displays the battery voltage.  
2. Equipment-related error functions produce the corresponding  
error code in the display (see p. 17).  
3. The ”BAT” symbol in the display indicates that the battery must  
be exchanged soon.  
4. When the battery voltage drops to approx. 6 volts  
or  
appears on the display. The stimulator switches off automatically  
when these signs appear.  
Display:  
The ”BAT” symbol indicates that the battery voltage is too low.  
(Refer to the ”Battery” section, p. 13)  
 
11  
The tone  
Each generated pulse produces a tick. When a stimulation current  
flows to the electrodes (greater than 2% of the maximum stimula-  
tion adjustable), the tick becomes louder.  
If the stimulation current flowing exceeds the current set, then  
taking into account the measuring tolerance (see page 12 - Techni  
-
cal data - Measuring tolerance), the Stimuplex® HNS 11 institutes  
an error message consisting of several tone groups of rapid  
frequency (approx. 6 Hz). The device is no longer operational.  
Each time a button is pressed a short tone is produced of a differ-  
ent frequency as audible confirmation.  
A click confirms that the instrument has been switched on.  
Initial set up, maintenance, and general advice  
Testing the Stimuplex® HNS 11 before an application  
Switch on the Stimuplex® HNS 11 nerve stimulator by turning the  
control knob clockwise from position O. A short click confirms that  
switching on has taken place. When the self-test has been com-  
pleted, the unit changes over immediately to the normal operating  
mode. You can now select the frequency, pulse width and current  
range according to the application required (see Section ”Operat-  
ing the nerve stimulator”, p. 7).  
With the set current indication (mA ), do not connect both elec-  
trodes - check both current ranges (1 mA max and 5 mA max) up  
to maximum.  
Switch to actual current indication (mA ) - both mA ranges give  
a should reading of + 0.00 mA, independet from the set current.  
Connect the two electrodes (clip and plug) together: check the mA  
value in each case up to the maximum. All mA values have a ”  
+”  
sign in front of the display. As soon as current flows, the LED above  
the display flashes in time with the stimulation current. The  
~
symbol appears next to the  
and the tick becomes louder.  
Set an actual current of approx. 0.30 mA and switch to set current  
(mA ): the two values should be the same (see Page 12 - Techni-  
cal data - Measuring tolerance).  
If all adjustments have been found to be correct, your Stimuplex®  
HNS 11 is ready for application.  
 
12  
Special technical features  
The configuration of the electrode connection provides protection  
against a wrong polarity connection of the electrode cable.  
This new type of plug connection system ensures correct polarity  
of the electrodes at all times.  
A high stimulation voltage is associated with an unusually wide  
range of adjustment with extremely small stimulation electrodes.  
The Stimuplex® HNS 11 generates a negative, current-stabilized  
square pulse. In contrast to conventional instruments of this type,  
the pulse is shaped at both slopes by extremely fast active pulse  
drivers. An output amplifier specially designed for this application  
has an extraordinarily wide dynamic range and produces repro-  
ducible settings even below 0.1 mA.  
Use of the latest microcomputer technology has made it possible  
to integrate performance characteristics which until now could  
only be provided in large systems. For example: selection of cur-  
rent display mode, set and actual value display, display of battery  
charge, error messages.  
An internal quartz time base ensures precise pulse widths and  
frequencies.  
Technical data  
Type: Stimuplex® HNS 11 nerve stimulator  
Instrument type................BF  
Battery.................................9 V  
Power consumption.........3.3 mA  
Stimulation current.........max. 5 mApp / 0 - 12 k⏲  
Stimulation voltage ........max. 65 Vpp  
Stimulation frequency....1 Hz / 2 Hz  
Measuring tolerance .......Adjustment control display =3% (set point)  
Flowing current display = 2% (actual value)  
based on set mA max values (5 mA or 1 mA)  
Weight .................................250 g  
Due to its high maximum output voltage the nerve stimulator cov-  
ers a wide range of skin and needle impedance. This is especially  
important when using stimulation needles with an extremely small  
conductive area (pin point electrode tip) such as Stimuplex® D and  
Contiplex® D needles.  
 
13  
Battery  
The battery must be regularly checked for correct charge by press-  
ing the ”BAT” button. While the button is pressed, the existing  
battery voltage appears on the LCD display. The battery should be  
replaced under 7 volts – as soon as the BAT symbol appears.  
When the battery voltage drops below 6 V, the nerve stimulator  
stops operating. Four horizontal lines and the BAT symbol appear  
in the LCD display. Change the battery.  
When the Stimuplex® HNS 11 nerve stimulator is not used for a  
long period of time, the battery must be removed to prevent leak-  
age.  
Changing the battery  
The battery compartment is in the base of the nerve stimulator.  
Open the compartment by lightly pressing the OPEN symbol. At  
the same time, slide the cover in the direction of the arrow.  
Change the battery, ensuring correct polarity. After fitting the bat-  
tery, slide the cover of the battery compartment back on again  
right up to the limit stop.  
Use only 9 V alkaline manganese batteries (e.g. VARTA 4022,  
DURACELL MN 1604). These will provide you with a greatly  
extended operating time and thus considerably more reliable  
function.  
Warning!  
If the battery is leaking, the Stimuplex® HNS 11 should no longer  
be operated for safety reasons. Acid penetrating the inside of the  
instrument can damage or impair essential circuitry. It must be  
returned to the manufacturer for correct cleaning and a safety check.  
 
14  
Cleaning and disinfecting the Stimuplex® HNS 11  
Use only soft, damp cloths to clean and disinfect the Stimuplex®  
HNS 11 and the electrode cable. Water, soap or white spirits are  
especially suitable for this. Ensure that no moisture penetrates the  
Stimuplex® HNS 11.  
Use only wet disinfection, no spray disinfection! Avoid  
condensation!  
White spirit or commercially available methanol-free disinfectant  
in an ethyl alcohol base can be used for disinfection.  
Caution!  
The following substances must not be used:  
trichloroethylene, acetone, methyl ethyl ketone, benzene, metha-  
nol, cellulose thinner, 1-propanol and 2-propanol.  
Maintenance and safety checks  
Check the serviceable condition of the Stimuplex® HNS 11 and ac-  
cessories on each occasion before use. A defective instrument must  
not be used.  
Electromedical equipment may only be repaired by the manufac-  
turer or by an organization expressly authorized by the manufac-  
turer. An order for repairs must be accompanied by a detailed  
description of the fault (acc. separate Technical Service Manual).  
 
15  
For usage of HNS 11 please refer to the individual local law  
restricts (eg. maintaining a logbook, etc.).  
In case of conducting safety checks on the device, please refer  
to the enclosed inspection sheet.  
 
16  
Caution  
Electromagnetic fields may interfere with the function of the nerve  
stimulator. Do not use the stimulator in the proximity of equip-  
ment which produces strong electromagnetic fields such as HF  
high frequency surgical equipment, micro wave equipment or cord-  
less phones.  
Notice  
The cables of the nerve stimulator Stimuplex® HNS 11 should be  
positioned in such a way that they do not contact either the  
patient or other cables.  
All accessories have to be visually inspected at regular time inter-  
vals. The insulation of the cables must not exhibit any damage.  
Only original accessories from B. Braun labelled with the CE sign  
should be used.  
Regarding the disposal of the nerve stimulator and its accessories  
you should refer to the corresponding regulations in your country.  
Storage and shipping conditions:  
0 – 50° C, up to 90 % relative humidity, non condensation.  
Warranty  
Stimuplex® HNS 11 is guaranteed for two years against defects  
in material and workmanship if the device is used in accordance  
with the operationg instructions.  
Wear and tear parts such as electrode cables, batteries, etc. are not  
covered by this warranty. In addition, relevant sections of our  
General Sales Conditions (Allgemeine Verkaufsbedingungen) apply  
particularly in chapter IV No. 8.  
 
17  
Safety information  
The nerve stimulator should not be used on patients with  
implanted electrical devices (e.g. cardiac pacemakers) without  
prior consultation with an appropriate medical specialist. Possible  
interference with the implanted devices by the stimulation current  
could represent a danger to the patient.  
The adhesive electrodes must not be applied in the area of injuries.  
The Stimuplex® HNS 11 nerve stimulator must not be used in areas  
where there is an explosion hazard.  
The Stimuplex® HNS 11 nerve stimulator must not be used close to  
microwave therapy equipment. The possible pick-up of radio  
frequency currents by the stimulation electrode could damage the  
nerves.  
The patient current should not drop below a specific value (please  
refer to p. 21 points 8 and 9).  
If the battery has leaked, the Stimuplex® HNS 11 must not continue  
to be operated for safety reasons. It must be returned to the  
manufacturer for correct cleaning. The same applies if any liquid  
soaks through!  
In the event of warning tone sequences (tone groups of approx.  
6 Hz), the Stimuplex® HNS 11 must be switched off and returned to  
the manufacturer or distributor for repair.  
Error messages  
When the Stimuplex® HNS 11 nerve stimulator is switched on, it  
automatically carries out a self-test. If this detects a faulty function,  
the fault is shown on the corresponding error code on the LCD  
display. The Stimuplex® HNS 11 is then no longer operational. It  
must be returned to the manufacturer for repair. You should state  
the error code in the repair order.  
The following error codes are possible:  
- F1: Analogue data acquisition is faulty  
- F2: Error in the program  
- F3: Reference error in the analogue data acquisition system  
 
18  
Instruments and accessories  
The Stimuplex® HNS 11 nerve stimulator should only be operated  
with the accessories and instruments mentioned on page 13, 14,  
18 and 19 of this user manual.  
Check the accessories and instruments for serviceable condition  
before every occasion of use and comply with the care and disin-  
fection instructions supplied (p. 14).  
Stimuplex® HNS 11 and Accessories, Stimuplex® and Contiplex® needles  
Product discription  
Canula  
Code number  
Sales unit  
Ø x length  
Stimuplex® HNS 11 nerve stimulator  
– with electrode cable for Stimuplex® D-,  
Stimuplex® A- and Contiplex® D- needles  
4892097  
1
Knob for sterile handling  
4892283  
4892070  
1
1
Electrode cable for Stimuplex® D,  
Stimuplex® A and Contiplex® D needles  
Connection cable for Contiplex® A needles  
4892925  
1
Stimuplex® D needles, 15° bevel  
D 25/035; 25 G x 11/3"  
D 25/055; 25 G x 21/8"  
D 26/040; 23 G x 11/2"  
D 26/070; 23 G x 23/4"  
D 27/050; 22 G x 2"  
D 27/080; 22 G x 31/8"  
D 27/120; 22 G x 43/4"  
D 29/150; 20 G x 6"  
0.5 x 35 mm  
0.5 x 55 mm  
0.6 x 40 mm  
0.6 x 70 mm  
0.7 x 50 mm  
0.7 x 80 mm  
0.7 x 120 mm  
0.9 x 150 mm  
4894103  
4894111  
4894120  
4894138  
4894146  
4894154  
4894162  
4894170  
25  
25  
25  
25  
25  
25  
25  
25  
Stimuplex® D needles 30° bevel  
D 17/040; 22 G x 11/2"  
D 17/050; 22 G x 2"  
D 17/080; 22 G x 31/8"  
0.7 x 40 mm  
0.7 x 50 mm  
0.7 x 80 mm  
4894189  
4894197  
4894200  
25  
25  
25  
 
19  
Product discription  
Canula  
Code number  
Sales unit  
Ø x length  
Stimuplex® A needles, 30° bevel  
A 25; 24 G x 1"  
0.55 x 25 mm  
0.70 x 25 mm  
0.70 x 50 mm  
0.80 x 50 mm  
0.80 x 100 mm  
0.90 x 150 mm  
4894251  
4894539  
4894502  
4894375  
4894260  
4894278  
25  
25  
25  
25  
25  
25  
A 25; 22 G x 1"  
A 50; 22 G x 2"  
A 50; 21 G x 2"  
A 100; 21 G x 4"  
A 150; 20 G x 6"  
Contiplex® D needles, 15° bevel  
D 28/055/C; 18 G x 21/8"  
D 28/110/C; 18 G x 43/8"  
1.3 x 55 mm  
1.3 x 110 mm  
4894219  
4894294  
25  
25  
Contiplex® D needles, 30° bevel  
D 18/055/C; 18 G x 21/8"  
1.3 x 55 mm  
4894227  
25  
Contiplex® D Catheter Set  
– with polyamide catheter  
0.45 x 0.85 x 400 mm  
needle D 28/055/C; 18 G; 15° bevel  
needle D 18/055/C; 18 G; 30° bevel  
1.3 x 55 mm  
1.3 x 55 mm  
4894235  
4894243  
10  
10  
– with polyamide catheter  
0.45 x 0.85 x 1000 mm  
needle D 28/110/C; 18 G; 15° bevel  
Contiplex® A needles, 30° bevel  
1.3 x 55 mm  
4894391  
10  
A 45/C; 18 G x 13/4"  
A 55/C; 18 G x 21/8"  
1.3 x 45 mm  
1.3 x 55 mm  
4893611  
4893643  
25  
25  
Contiplex® A Catheter Set  
– with polyamide catheter  
0.45 x 0.85 x 400 mm  
needle A 45/C; 18 G; 30° bevel  
needle A 55/C; 18 G; 30° bevel  
Alphaplex® Catheter Set  
1.3 x 45 mm  
1.3 x 55 mm  
4893603  
4893638  
10  
10  
– with catheter 0.9 m x1.25 m x 330 mm,  
guide wire and Contiplex® D  
D 28/055/C; 15° and 30° bevel  
Basic Set, 15° bevel  
Super Set, 15° bevel  
Basic Set, 30° bevel  
Super Set, 30° bevel  
1.3 x 55 mm  
1.3 x 55 mm  
1.3 x 55 mm  
1.3 x 55 mm  
U 1800 210  
U 1800 200  
U 1800 201  
U 1800 203  
10  
10  
10  
10  
 
20  
Peripheral electrical nerve stimulation  
Principles  
By simplifying the accurate location of peripheral nerves, periph-  
eral electrical nerve stimulation (PNS) facilitates the performance  
of nerve and plexus blocks increasing their safety and reliability.  
The old rule ”no paraesthesia - no anaesthesia” (1) loses its valid-  
ity, because information from the patient concerning paraesthesia  
is eliminated, and the danger of a mechanical nerve lesion (8) is  
largely excluded. The principle consists of triggering depolariza-  
tions with electrical pulses at, but not within, the nerve, causing  
muscular contractions at the effector muscle or sensitive sensa-  
tions in the distribution area. Paraesthesia due to direct contact of  
injection needles and nerve is consciously avoided.  
PNS does not replace the anatomical knowledge required for re-  
gional anaesthesia, rather it assumes accurate knowledge of the  
topography and the nerve distribution area.  
The various types of nerve fibre differ in regard to their sensitivity  
to electrical stimulation. The A-alpha motor fibres have the short-  
est chronaxia (50 - 100 µs). The fibres of pain sensation (A-delta  
and C-fibres) require a longer pulse (150 and 400 µs respectively)  
at minimum current. Mixed peripheral nerves can be localized with  
short pulses (0.1 ms) without triggering pain sensations. For pure  
sensory nerves, a longer pulse (0.3 or 1.0 ms) is recommended.  
When using unipolar needles (needles with an insulated needle  
shaft and a conductive tip), the current necessary to trigger mus-  
cular contractions (= pulse amplitude) correlates with the distance  
of the tip of the needle from the nerve: the lower the threshold  
current the more accurately is the nerve localized, and the shorter  
the onset and more reliable the success of the block (4). The short-  
er the electrical pulse (= pulse width), the faster is the rise in cur-  
rent to the nerve, and the clearer the discrimination as to whether  
the needle tip is sufficiently close to the nerve (2,5). The stimula-  
tion needle should always be connected to the negative pole be-  
cause higher currents are required if the polarity is reversed (nee-  
dle positive) (6).  
The geometry of the electrical current field is dependent on the  
geometry of the conductive tip of the stimulation needle. The small-  
er the emission site of the electrons at the tip of the needle, the  
higher is the current density at this point and the lower the thresh-  
old current when the nerve is exactly localized.  
The Stimuplex® HNS 11 stimulator has been designed according to  
the most modern aspects and the requirements which originate  
from the theory and practice of peripheral electrical nerve stimu-  
lation (3,6). It is provided with alarm systems necessary for the  
 
21  
early detection of technical faults which could endanger the  
patient and place the success of the anaesthesia in jeopardy.  
Performing PNS with the Stimuplex® HNS 11 and the Stimuplex® or Contiplex® needles  
1. Check the Stimuplex® HNS 11.  
2. Check the skin electrode (ECG adhesive electrode) (the conduc-  
tive gel must not have dried) and apply it to a degreased area of  
skin which is not in the distribution area of the nerve to be  
blocked.  
3. Carry out patient positioning, skin disinfection, and if neces-  
sary, local infiltration of the needle puncture site.  
4. Connect the electrode cables to the stimulation needle (nega-  
tive) and skin electrode (positive), switch on the Stimuplex® HNS  
11 and set the mA controller current (mA ) to zero.  
After the automatic self-test of the stimulator, the  
symbol  
appears in the display in time with the stimulation pulse to  
indicate that it is ready to operate.  
Caution! A change to the stored parameters can only be made  
when the LEDs are lit. By pressing any button the LEDs will light up  
and indicate the value stored. To change press the appropriate  
button.  
5. Select pulse width (0.1 ms, 0.3 ms or 1.0 ms).  
6. Select pulse frequency (1 Hz or 2 Hz).  
7. Select amplitude range (1 mA max or 5 mA max.).  
8. Advance the Stimuplex® or Contiplex® needle through the skin  
and the subcutaneous tissue towards the nerve to be blocked.  
Set a current of approx. 0.30 mA (set value mA ) - the orange  
LED above the display flashes in time with the stimulation, the  
display shows a next to the  
is flowing in the tissue.  
Then switch to actual current flowing value indicator (mA  
and a tick signals that current  
~
)
and check that the actual value corresponds to the set value  
(see p. 12 - Technical data, measuring tolerance).  
 
22  
If the two values coincide, the total resistance is acceptable  
(impedance test) and the electric circuit is satisfactory. If the  
actual value is less than the set value, this indicates that the  
electrical resistance in the external circuit is too high. The cause  
must be found e.g. adhesive electrode too dry, skin resistance  
too high, broken cable.  
After the impedance test, leave in the mA position (current  
flowing at the tip of the needle indicated and a + sign in front  
of the current displayed) until the block is successful.  
9. Set an actual current of approx. 1 to 2 mA and advance the  
needle further until the first muscles supplied by contractions  
occur in the nerve sought. Then, while reducing the current,  
advance the needle to the nerve until the recommanded thres-  
hold current. (For values see, for example, literature references  
4, 7). The threshold current to be achieved depends on the pulse  
width and the geometry of the conductive tip of the needle.  
Warning! When using Stimuplex® or Contiplex® needles, it must  
be noted that muscular contractions with a current of 0.2 to  
0.5 mA and a stimulus duration of 0.1 ms - with a current of  
0.05 to 0.2 mA and a stimulus duration of 1.0 ms - indicate  
satisfactory proximity to the nerve sought. Any further reduc-  
tion in the ”threshold currents” may cause direct contact of  
the needle with the nerve, resulting in the danger of a me-  
chanical nerve lesion.  
If needles from other manufacturers are used, the threshold  
currents may be much higher. You would have to work out  
these yourself.  
10. After clearly visible muscular contractions are seen using the  
desired threshold current, inject local anaesthetic.  
The response to the electrical stimulation will reduce or disap-  
pear within a few seconds after an injection of 2 - 3 ml. If this  
effect is not definite, do not continue to search for the nerve  
at the same location. For safety reasons, a more peripheral site  
should be used.  
 
23  
Literature  
Literature  
1. Moore DC (1965), Regional block. A handbook for use in the  
clinical practice of medicine and surgery. Thomas, Springfield  
II. (4th ed.)  
2. Ford DJ, Pither CE, Raj PP (1984), Electrical characteristics of  
peripheral nerve stimulators. Implications for nerve Iocalizati-  
on. Reg Anesth 9:73.  
3. Ford DJ, Pither CE, Raj PP (1984), Comparsion of insulated and  
uninsulated needles for locating peripheral nerves with a peri-  
pheral nerve stimulator. Anesth. analg. 63:925  
4. Kaiser H, Niesel HC, Klimpel L (1988), Einfluss der Reizstrom-  
stärke der Nervestimulation auf Latenz und Erfolg der hinteren  
Ischiasdiskusblockade. Regional-Anaesthesie 11:92.  
5. Kaiser H, Niesel HC, Hans V (1990), Grundlagen und Anforde-  
rungen der peripheren elektrischen Nervenstimulation. Regio-  
nal-Anaesthesie 13:143  
6. Kaiser H, Niesel HC, Hans V, Klimpel L (1990), Untersuchungen  
zur Funktion peripherer Nervenstimulation für die Durchfüh-  
rung von Nerven- und Plexusblockaden. Regional-Anaesthesie  
13:172.  
7. März P, (1990), Kann bei der elektrischen Nervenstimulation  
aus der Intensität der Muskelkontraktion auf den Abstand zum  
Nerven geschlossen werden? Regional-Anaesthesie 13:179.  
8. Selander D, Edshage S, Wolff T (1979), Paraesthesiae or no pa-  
raesthesiae: nerve lesions after axillary block.  
Acta anaesthesiol. scand. 23:27.  
Further literature:  
Kaiser H, Die periphere Nervenstimulation  
In Niesel HC (dir.), Regionalanästhesie, Lokalanästhesie, Regionale  
Schmerztherapie. Thieme-Verlag Stuttgart New York (1994), 186-207.  
Prithvi Raj P (Editor), Clinical practice of regional anaesthesia.  
Churchill Livingstone New York (1991)  
Pinncock CA, Fischer HBJ, Jones RP, Peripheral nerve blockade.  
Churchill Livingstone New York (1996)  
Scott DB, Introduction to regional anaesthesia.  
Mediglobe Fribourg (1989)  
 
24  
Appendix A  
Stimulation current display in the mA range  
Patient current  
Measurement display Controller display  
Patient current  
Measurement display Controller display  
0.00 mA  
0.05 mA  
0.10 mA  
0.20 mA  
0.30 mA  
0.40 mA  
0.60 mA  
0.80 mA  
1.00 mA  
0.00 mA  
0.00 mA  
0.00 mA  
0.50 mA  
1.00 mA  
1.50 mA  
2.00 mA  
3.00 mA  
4.00 mA  
5.00 mA  
0.00 mA  
0.00 mA  
0.05 mA ± 0.02  
0.10 mA ± 0.02  
0.20 mA ± 0.02  
0.30 mA ± 0.02  
0.40 mA ± 0.02  
0.60 mA ± 0.02  
0.80 mA ± 0.02  
1.00 mA ± 0.02  
0.05 mA ± 0.03  
0.10 mA ± 0.03  
0.20 mA ± 0.03  
0.30 mA ± 0.03  
0.40 mA ± 0.03  
0.60 mA ± 0.03  
0.80 mA ± 0.03  
1.00 mA ± 0.03  
0.50 mA ± 0.1  
1.00 mA ± 0.1  
1.50 mA ± 0.1  
2.00 mA ± 0.1  
3.00 mA ± 0.1  
4.00 mA ± 0.1  
5.00 mA ± 0.1  
0.50 mA ± 0.15  
1.00 mA ± 0.15  
1.50 mA ± 0.15  
2.00 mA ± 0.15  
3.00 mA ± 0.15  
4.00 mA ± 0.15  
5.00 mA ± 0.15  
Appendix B  
Conversion table: Amplitude (mA) and pulse width (ms) to charge (nano-Coulomb, nC)  
Amplitude Pulse width  
mA ms  
Charge  
nC  
Pulse width  
ms  
Charge  
nC  
Pulse width  
ms  
Charge  
nC  
0.1  
0.2  
0.3  
0.4  
0.5  
0.6  
0.7  
0.8  
0.9  
1.0  
1.2  
1.6  
1.8  
2.0  
2.5  
3.0  
3.5  
4.0  
4.5  
5.0  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
0.1  
10  
20  
30  
40  
50  
60  
70  
80  
90  
100  
120  
160  
180  
200  
250  
300  
350  
400  
450  
500  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
0.3  
30  
60  
90  
120  
150  
180  
210  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
1.0  
100  
200  
300  
400  
500  
600  
700  
800  
900  
1000  
1200  
1600  
1800  
2000  
2500  
3000  
3500  
4000  
4500  
5000  
240  
270  
300  
360  
480  
540  
600  
750  
900  
1050  
1200  
1350  
1500  
0.3  
0.3  
0.3  
0.3  
1.0  
1.0  
1.0  
1.0  
 
25  
Appendix C  
Appendix C  
Stimuplex® HNS 11 Nerve Stimulator  
Operating range  
Max. stimulat
voltage [V]  
Operating range  
Stimuplex® HNS 11 Nerve Stimulator  
Max. stimulation current as a function of tissue resistance  
Max. stimulation  
current [mA]  
Battery voltage [V]  
 
26  
Appendix D  
Current density  
Stainless  
steel needle  
Bare and insulated needles  
Stimulation current  
[mA]  
Bare,  
uncoated  
needles  
Plastic  
insulation  
Coated  
needles  
bevel uncoated  
Stimuplex® A  
Contiplex® A  
Distance from the nerve [mm]  
Stimuplex® D and Contiplex® D needles (DP: DE 3919666)  
Only 0.2 or 0.0
stimulation cu
blunt  
pointed  
30°  
15°  
Stimulation  
current  
[mA]  
Fully insulated  
needle with  
bare tip  
Stimuplex® D  
Contiplex® D  
Distance from the nerve [mm]  
Threshold currents down to minimum 0.05 mA (with 1.0 ms pulse width)  
and minimum 0.2 mA (with 0.1 ms pulse width)  
allow reliable location of nerves.  
 
 
Caution:  
B. Braun Melsungen AG  
P.O. Box 1120  
D-34209 Melsungen  
h o s p i t a l c a r e  
Federal (U.S.A.) law restricts  
this device to sale by or on the order  
of physicians.  
Tel (0 56 61) 71-0  
Fax (0 56 61) 71-3811  
W. 01.08.01/7 Nr. 604 3895  
 

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