coVita ToxCO Handheld Breath Carboxyhemoglobin Monitor User Guide

coVita ToxCO Handheld Breath Carboxyhemoglobin Monitor

Sections

1. What is a ToxCO®?
2. Accessory Identification
3. ToxCO® monitor layout
4. What is carbon monoxide (CO)?
5. Typical CO levels for individuals
6. How to perform a breath test.
7. How to perform a face mask test.
8. How to adjust the Mouthpiece & Facemask Thresholds
9. How to use the ambient monitoring feature.
10. Calibration
    • Calibration Tips
    • Required Parts
    • Calibration Kit Set Up
    • Perform Calibration
    • Additional Screens & Tips
    • Reset & Calibration
    • Additional Screens & Tips
11. References

What is a ToxCO®?

The ToxCO® is a hand-held, breath carboxyhemoglobin (COHb) monitor, which is FDA cleared for determining CO poisoning.

• Designed for healthcare professionals such as EMTs, firefighters, paramedics, ER personnel, etc.
• Rugged monitor case included
• Provides clinical accuracy in the field
• Engineered to preform in extreme temperatures
• Breath test take seconds with instant results; triage large groups quickly for CO poisoning
• Instantly determine CO poisoning with 3 sampling options:
• Instant on—test immediately
• Simple to use color touch screen, works with gloves
• Low maintenance & 5 year warranty
• Tag readings with names or identifying information e.g. badge #, patient id, etc.
• Automatically logs last 1,000 readings with time & date
• Interacts with included ToxCOdata™ database software for tracking and accountability.

Accessory Identification

1. SteriBreath™ Eco
2. Mouthpiece Single Use
3. D-piece™
4. One way valve replaced monthly
5. Face Mask & Sampling System
6. Single Use
7. Calibration Kit ToxCO® required
8. calibration every 6 months

ToxCO® Monitor Layout

1. Display
2. Power Button
3. D-piece™ One way valve
4. D-piece™ Port
5. Exhaust port Do not cover with labels
6. USB connector for use with ToxCOdata™ Software
7. SteriBreath™ Mouthpiece
8. Battery Compartment 3 AA Batteries
9. Battery Compartment Opening Clip
10. Contact coVita before using the features below.
11. Reset Button
12. Programming Switch
13. Facemask & Sampling System
14. 50ppm CO Calibration Kit

What is carbon monoxide (CO)?

Carbon monoxide is a toxic, odorless, colorless, tasteless gas.1 It is formed from incomplete combustion of organic material at high temperatures with an insufficient oxygen supply.3 When inhaled, CO competes successfully with oxygen in the bloodstream to form carboxyhemoglobin (COHb). This starves the body tissues of the oxygen vital for repair, regeneration and general living. CO can remain in the bloodstream for up to 24 hours, depending on a range of factors including physical activity, gender and inhalation intensity9. The half-life is about 5 hours with no treatment (normal environmental conditions), 1.5 hours if 100% oxygen is given and 0.58 hours if hyperbaric oxygenation at 100% oxygen is given.8 Breath carbon monoxide is measured in parts per million (ppm) and blood carboxyhemoglobin in percentages (%COHb). The two measurements are compatible and convertible, CO relating to lung/breath and COHb to blood gas.

The monitor displays %COHb, but can also display in ppm if selected in the settings.

• %COHb reading shows the percentage of vital oxygen that has been replaced in the bloodstream.7
• CO ppm readings indicate the levels of poisonous inhaled CO

Clinical research has demonstrated that ‘the concentration of carbon monoxide in end-expired air after breath holding correlates closely with carboxyhemoglobin concentration.3

Typical CO levels for individuals

Description| Regular Daily

(Non-Pregnant) Smoker (%COHb)

| Pregnant Smokers (%COHb)
---|---|---
Non-Smoker| 0 – 1.59%| 0 – 1.11%
Moderate Smoker| 1.75 – 2.07%| 1.27 – 1.59%
Heavy Smoker| 2.23%+| 1.75%+

The “non-smoker ranges” are based on published data, while the other ranges provided are only meant to be guides of the typical expected levels.

CO CHART Why do I need to understand Smoker and Non-smoker CO levels?

• It’s important to establish a baseline of the typical levels that you should anticipate seeing on “non-CO poisoned” individuals, and to do this, you’ll need to know what you can expect to see on smokers and non-smokers alike.
• The “non-smoker ranges” are based on published research data, while the other smoking ranges provided are only meant to be guides of the typical expected levels in smokers. You should expect to see smoker and non-smoker CO levels fluctuate within the described ranges from day to day and throughout the day.
• Smokers’ CO levels can be a slightly more volatile depending on recent smoking or if they’ve smoked a substance like marijuana or cigars. Expect to see CO levels that might be consistent with CO poisoning in extremely heavy smokers (2+ packs per day), as well as in marijuana and cigar smokers.
• Pregnant smokers have slightly lower CO levels because research has demonstrated that the fetus absorbs some of the mother’s CO, as illustrated below.
• Keep in mind that while a smoker might be testing at levels that indicate CO poisoning, they may be tolerating those higher levels without any signs or symptoms because their bodies may have become accustomed to those high levels of CO.

How to perform a breath test

1. Turn on the ToxCO® by pressing & releasing the button on top of the monitor.
2. Insert a D-piece™ & SteriBreath™ mouthpiece into the monitor.
3. Press the Breath Test icon when ready to begin a test.
4. Instruct patient to take a deep breath and hold.
5. Patient should hold their breath during the 15 second countdown period.
6. At the end of the countdown when you hear the third beep instruct the patient to place mouth on the mouthpiece and exhale all of the air out of their lungs.
7. ToxCO® will display the reading in %COHb. The test is finished when the three icons appear at the bottom of screen.
8. Write down the result or to tag the result touch the Tag icon.
9. Note: The monitor auto logs the last 1000 results.
10. Enter any identifying information of your choice. To enter numbers press the Number icon.
11. To save the result press the Save icon.
12. After saving the results the ToxCO® will return you the home screen. To review the log press the Log icon.
13. Press the Breath Test icon to review or edit the tagged results.

How to perform a face mask test

Note: The appropriate size face mask should be used to avoid leaks around mask cushion.

1. Turn on the ToxCO® by pressing & releasing the button on top of the monitor.
2. Attach a face mask sampling system in conjunction with the D-piece™.
3. Press the Mask Test icon when ready to begin a test.
4. Place facemask over patient’s mouth and instruct patient to inhale and exhale normally.
5. Sampling will last 60 seconds as the %COHb levels rise and then hold at the peak level.
6. ToxCO® will display the reading in %COHb. The test is finished when the three icons appear at the bottom of screen.
7. Write down the reading or to tag the reading touch the Tag icon.
8. Note: The monitor auto logs the last 1000 readings.
9. Enter any identifying information of your choice. To enter numbers press the Number icon.
10. To save the reading press the Save icon.
11. After saving the ToxCO® will return you the home screen. To review the log press the Log icon.
12. Press the Breath Test icon to review or edit the tagged results.

How to adjust the Mouthpiece & Facemask Alarm Thresholds

1. Turn on the ToxCO® by pressing & releasing the button on top of the monitor.
2. Press the traffic light icon.
3. Press the ambient icon to adjust the threshold.
4. Drag the indicator up or down to the desired %COHb level & release. Press save icon to lock in changes.

Mouthpiece & Facemask Default Alarm Thresholds

Color| Description

Normal Reading

| Reading %COHb

< 2 **%COHb**

---|---|---
Blue
Red| Abnormal CO level on breath requiring further investigation| ≥ 2 %COHb

How to use the ambient monitoring feature.

Note: The ambient air can be tested to check for CO in the environment using the ToxCO® , alerting users to high CO levels in the atmosphere. Once switched on the device will start to sample immediately and the real-time reading will be shown on the home screen at all times, updating every second.

1. Turn on the ToxCO® by pressing & releasing the button on top of the monitor.
2. The home screen will display the real-time ambient CO levels.
3. When a CO threshold is breached, the monitor will log this event and continue to log the live reading every minute. The logging will continue for 8 hours or until the monitor is switched off. You can access the log by clicking book icon and then pressing the ambient icon.

Note: Ambient alarm thresholds are preset as per Acute Exposure Guideline Levels (AEGL’s)

Both thresholds can be reduced so that they are triggered at lower levels but cannot be increased to be triggered at higher levels. When an alarm is triggered, the device will automatically start to log in the history each minute for 8 hours or until the monitor is switched off, so that incidents can be pinpointed to a time and date.

How to adjust the ambient alarm thresholds

1. Turn on the ToxCO® by pressing & releasing the button on top of the monitor & then press the gears icon.
2. Press the traffic light icon.
3. Press the ambient icon to adjust the threshold.
4. Drag either of the two indicators up or down to the desired ppm level & release. Press save icon to lock in changes.

Calibration Tips

1. coVita calibration instructional videos can be found under the support section of www.covita.net.
2. You must calibrate every 6 months to correct for sensor drift using 50 ppm Carbon Monoxide (CO) calibration gas. On occasion your ToxCO™ may prompt you for an intermittent calibration.
3. Your ToxCO™ has built in calibration reminders to prompt you to calibrate every 6 months.
4. Be sure to identify your flow meter-regulator for correct instructions.
5. Remove flow meter-regulator from can for proper storage and replace dust cap. (You may hear a pop and this is normal.)
6. Ensure that the cali-adaptor tubing has no kinks while the gas is flowing.
7. Be sure you are using the compatible cali-adaptor tubing and D-piece to avoid issues with calibrating.
8. Be sure you are inserting the D-piece into the monitor correctly. The circle opening must be facing you. (Figure A & B)
9. Never block the air/vent hole on the ToxCO™ with labels etc.

Required Parts

• A. 50 ppm Carbon Monoxide (CO) Calibration Can
• B. Fixed Flow 1 lpm meter-regulator
• C. Cali-adaptor Tubing
• D. D-Piece
• E. ToxCO® CO Monitor

Calibration Kit Set Up

1. Remove white or black dust cap from can of gas
2. Ensure the control valve on the flow meter-regulator is in the off position.
3. Screw the regulator-flow meter onto the gas can (some slight pressure may be required). This can be done by screwing the gas can into the valve.
4. Attach the small end of the tubing onto the regulatorflow meter.
5. Insert the larger end of the cali-adaptor tubing into the D-piece. Ensure a tight fit.
6. Verify the gauge on the regulator-flow meter is registering gas (arrow is not on zero)

Perform Calibration

IMPORTANT: Do not connect the cali-adaptor or D-piece to the monitor until after the monitor zeros (Step 5)

1. Press Gear Icon
2. Press Calibration Icon to begin autozero process
3. Monitor will display hour glass while zeroing
4. Assemble calibration kit (already done) then press the arrow
5. Insert D-piece with the cali adaptor attached into monitor, then press the arrow.
6. Turn on the gas, then press the arrow.
7. Hour glass will display as the monitor is calibrating
8. Calibration is successful when a check mark is received.
9. IMPORTANT: Must press the check mark to lock in the calibration.

Additional Screens & Tips

1. Failed Calibration Screen You must perform a reset on the monitor. Please see section F.
2. Monitor temperature is too hot. You must turn off the monitor for a minimum of 5 minutes before calibrating.
3. Monitor temperature is too cold. You must move your monitor to a room-temperature environment before calibrating.
4. Calibration reminder to prompt you to calibrate every 6 months. Press the arrow to start calibrating.

Reset & Calibration

IMPORTANT: Do not connect the cali-adaptor or D-piece to the monitor until after the monitor zeros (Step 5)

1. Turn on your monitor. Be sure the D piece is removed from monitor until step 5.
2. Using an opened paper clip, press/hold the reset button located in the battery compartment in for 30 seconds until the monitor beeps & turns off and then release.
3. Turn on your monitor and the hour glass will appear while automatically zeroing
4. Assemble calibration kit (already done) then press the arrow
5. Insert D-piece with the cali adaptor attached into monitor, then press the arrow
6. Turn the gas on, then press the arrow
7. An hour glass & numbers will display as the monitor is calibrating.
8. Calibration is successful when a check mark is received.
9. IMPORTANT: Must press the check mark to lock in the calibration.

Additional Screens & Tips

• Failed Calibration Screen Allow 5 minutes with D-piece removed from monitor and then try calibrating again.
• Monitor temperature is too hot. You must turn off the monitor for a minimum of 5 minutes before calibration.
• Monitor temperature is too cold. You must move your monitor to a room temperature environment before calibrating.
• Calibration reminder to prompt you to calibrate every 6 months. Press the arrow to start calibrating.

References

1. Ernst, A. and Zibrak, J. D. (1998) ‘Carbon monoxide poisoning’, New England Journal of Medicine, 339(22), pp. 1603–1608. Guzman, J. A. (2012) ‘Carbon monoxide poisoning’, Critical Care Clinics, 28(4), pp. 537–548.
2. House of Commons All Parliamentary Gas Safety Group. (2009) ‘Raising Medical Professionals Awareness of Carbon Monoxide Poisoning’.
3. Humber, A. (2009) ‘A Feasibility study into the prehospital carbon monoxide poisoning of patients’, London Ambulance Service NHS.
4. Omaye, S. T. (2002) ‘Metabolic modulation of carbon monoxide toxicity’, Toxicology, 180(2), pp. 139–150.
5. Wright, J. (2002) ‘Chronic and occult carbon monoxide poisoning: We don’t know what we’re missing’, Emergency Medicine Journal, 19(5), pp. 386–390.
6. Clinical Resource Efficiency Support Team (CREST). GUIDELINES FOR THE PREVENTION OF INFECTION AND DECONTAMINATION OF RESPIRATORY EQUIPMENT IN NORTHERN IRELAND. BELFAST: Clinical Resource Efficiency Support Team (CREST); 2006.
7. Weaver LK, e. (2016). Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100% oxygen at atmospheric pressure. – PubMed – NCBI . [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/10713010 [Accessed 27 Oct. 2016]
8. Rapid estimation of carboxyhemoglobin level in fire fighters. Stewart, R. (1976). Rapid estimation of carboxyhemoglobin level in fire fighters. JAMA: The journal of the American medical association, 235(4), pp 390-3929. Weaver LK, e. (2016).
9. Kent Olson, C. (2008). Carbon monoxide poisoning (acute). BMJ Clinical Evidence, [online] 2008, p. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2907971/ [Accessed 28 Oct. 2016].
10. Richard D.Stewart MD, R.Scot Sterart, William Stamm, Richard P.Steelen; Rapid Estimation of Carboxyhaemoglobin Level in Fire Fighters; Journal of American Medical Association; 235:390-392; 1976.
11. Public Health England. An Evaluation of Filtration Efficiencies Against Bacterial and Viral Aerosol Challenges Report No. 17/001. London: Public Health England; 2017
12. Jarvis M et al (1986) “low cost carbon monoxide monitors in smoking assessment.” Thorax 41 pp 886-887.
13. Committee on Acute Exposure Guideline Levels., Committee on Toxicology., Board on Environmental Studies and Toxicology., & ebrary Academic Complete., 2010. Acute exposure guideline levels for selected airborne chemicals. Washington, D.C.: National Academies Press.

Instantly determine levels of CO Poisoning.™

• www.covita.net
• 800.707.5751

Copyright 2022 coVita LLC All Rights Reserved v110422

References

• National Center for Biotechnology Information
• Leaders in breath analysis since 1976 - coVita
• Carbon monoxide poisoning (acute) - PMC
• Carboxyhemoglobin half-life in carbon monoxide-poisoned patients treated with 100% oxygen at atmospheric pressure - PubMed

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