Scribd Logo
Upload

Welcome to Scribd!

  • Infusion Punp Abbott Lifecare 5000

    Uploaded by

    cckm
    58 views76 pages

    Copyright

    © © All Rights Reserved

    Available Formats

    PDF or read online from Scribd

    Did you find this document useful?

    Is this content inappropriate?

    Report this Document

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    58 views76 pages

    Infusion Punp Abbott Lifecare 5000

    Uploaded by

    cckm

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    Download as pdf
    of 76
    oA oncurrent Flow Infusion System With DataPort ™ List 2507-04 System Operating Manual Abbott Laboratories version ‘North Chicago, IL 60064 USA £90-09690001 (Rev. 786) ‘iuniae aston CHANGE HISTORY Part Number Description of Change Revised Pages 420-09680-001 Original issue 430-03680:A01 /Rev6i84) Updated cover page Cover Created Change History Page tov ‘See. 4: Deleted the color oft 451048 Flow Regulator 00,4: Deleted he color ofthe 417, 418 Flow Regulator See. 6: Doloted the color ofthe 641,62 Flow Flegulator Sec. 7: Deleted the color of the 7-110 7 Flow Regulator ‘Sec. 6: Updated Cleaning Solutions 8-1 08-4 ‘Sec. 9: Deleted he color ofthe 9-4, 22 Flow Regulator Updated Back Cover Back Cover 1430-09680-801 (Fev. 10/96) Updated cover part numb Cover Upsated Change History i Updated copyright date i Updated syringe information 549 Updated UL and CSA references; Back Cover updated shipping addres 430-09680-C01 (Rev. 7198) Updated Cover Cover, Back Updated Change History f Updated Tab of Contents iw Updated List of Figures . Updated Copyright Date wi Insertd instructions for Mode Section 4 (all) Configuration Note: Change 2age manuals assembled by Abbott laboratories include a change pase ‘Mentiier in the part number on the cover page, and at the bottom of each changed page. This change page manual Is identified as 490-09680-CO1. ‘acre S00 Sater . “a0 0880 01 78) “This page intentionally let blank, Si ag a Contents Contents Section 1 INTRODUCTION 2 Section 3 ‘SYSTEM FEATURES : ‘SYSTEM COMPONENTS Section 4 (CHECKOUT AND OPERATION . . “4 ‘USER QUALIFICATION 7 44 MODE CONFIGURATION at INSTRUCTIONS, at INSTRUMENT INSTALLATION PROCEDURE. 43 UNPACKING 6.5... c0. 05 7 43 INSPECTION 43 OPERATIONAL TEST 3 USING THE FLOW DETECTOR. “3 FLOW DETECTOR CONNECTED 7 45 NO FLOW DETECTOR CONNECTED. + FLOW DETECTOR CONNECTED WHILE PUMPING ‘i 46 FLOW DETECTOR DISCONNECTED WHILE PUMPING “6 USING THE DATAPORT eer) ATTACHING DATAPORT ACCESSORIES, 46 INFUSER SETUP. 46 PREPARING SET AND CONTAINER, 47 PROGRAMMING. 49 ‘CHANGING THE FLUID CONTAINER 18 DISCONTINUING ELECTRONIC FLOW CONTROL OR FLUID ADMINISTRATION «4-19 Section 5 USER OPTIONS : : sa USING CONCURRENT DELIVERY FEATURE. S41 ‘CONCURRENT FLOW GUIDELINES WHEN DELIVERING CRITICAL DRUGS, 54 DELIVERY RATE... : eee 4 CRITICAL DRUGS. 54 USE OF NURSE CALL BACK FEATURE, $5 BACKPRIMING 55 MANUAL BACKPRIMING 56 AUTO BACKPRIMING, 58 DBLIVERY SECONDARY OVERFILL OPTION 58 TNTRATING..... 59 ‘TITRATING PRIMARY RATE, 59 ‘TITRATING SECONDARY RATE, : 510 [LifeCare 5000 Serie au 480-03680-001 (Rev 798) Contents ‘TITRATING EITHER PRIMARY OR SECONDARY RATE IN CONCURRENT DELIVERY 510 MUTING THE TOUCHSWITCH TONE 510 (CHANGING THE PRESSURE LIMIT... : su USING RETROGRADE PROCEDURES 512 USING SYRINGES, VIALS, OR OTHER CONTAINERS FOR SECONDARY ADMINISTRATION, cS Section 6 [ALARMS AND TROUBLESHOOTING 61 [REVIEWING PREVIOUS ALAR 1 Section 7 OPERATIONAL PRECAUTIONS... 201¢c0s0s00 ‘i Section 8 MODE CONFIGURATION, MAINTENANCE, AND CLEANING 1 ‘MODE CONFIGURATION : Tea MAINTENANCE BATTERY MAINTENANCE. ea CLEANIIG 2 Section 9 [ADMINISTRATION SETS AND ACCESSORIES oa PLUMSETS® 9.1 SINGLE-CHANNEL SETS 4 DUAL-CHANNEL SETS. : iretea ACCESSORIES : 94 Section 10 SPECIFICATIONS . 01 Section 11 WARRANTY, *30-03680-C01 (Rv. 798) w System Operating Manual Figures Figures gt 3.1 Frat lew : aa igor 32. Cosap of Tnsowiches aa Figur 33. Diagram of Cant (Ds Chana Caste Shows) a3 Figure 34. Rear View : a3 Figue41.ip Switch Cowr “4 igure 42, ip Switch Stings for Each every Mode... a Figure 43 Sensor Fin : a Fur 4-4. Mode enifonionDipas. 4 Figur 45. reparng he Sand Container. “7 Fgwe 46 Pining he Canete : 48 igure 4-7. Inserting the Cassete Figure 4-8. Programming fr Primary Dolivery Figuto 49, Programming fr Single Dose Secondary Delivery 4 Figure 4-10, Programming fr Mutiple Dose Secondary Delivery. +n jute 4-11, Reviewing Setings ou Figure 4-12. Changing Setings a6 e413, Clearing Soigs ee ar e414, Changing the Fluid Container ae Figure 4-15 Discontinuing Electronic Flow Control and Seting Up Gravity Administration “9 Figure 4-16. Discontouing id Adminstration “9 Figure 5-1. Programming fer Concurrent Delivery ‘i 52 ip 5-2. Manual Backpriming (Dual Chanel Castes Only) . 56 Proximal Aiin-Line Alarm With Manos! Bakprining ool Catetes Only) : ‘i au 7 Figure 5-4 Sctigs and Reming Pressure Lite : 32 Figure 5-5. Using Retrogeace Procedare Pees : S12 Figure 5-6. Using lfser With Secondary Line, Syringe, or Vial su Figure 6-1. Accessing the Alarm History 6a Figue 8-1 Cleaning the Mechanical Blemeats Behid Cassete Door 8s iter 5000 Serie 7 430-03680-C01(Re¥-758) Tables ‘Table 1-1 LifeCe 5000 Pom Infusion Mode Contigrations ut ‘Teble 5-1 Delivery Rate Guidetines 4 “Table 6-1, Alara/Acton Table, 62 “Table $1, Cleaning Sotto 82 ©Copyright 1998 “Abbott Laboratories ‘All Rights Reserved “This document ad the sbjot mater dslosd bein are proprietary infomation. Abbot Laboratories rein al Be excise rights of dinsemination epeduction, manufacture and sale. Any prt wing this document ase itin conde, and agrees oto duplicate im whol rn pat nor sles 10 ‘ers witht the ariten coment of Abst Laborato. *90-03680-C01 (ev. 798) % ‘System Operating Manoa =m Section 1 INTRODUCTION ‘The LifeCare 5020 Plum Infusion System With DataPort is a multiline, general purpose, volumetric infusion system designed to meet the need for hospital-wide device standardization. By means of internal switch-settings, a qualifed blo-technieian can configure the system to best sult the clinical needs and census changes of the hospital ‘The infuser can be configured as shown in Table I-, 4feCare 5000 Plum Infusion Mode Configurations. “aie, LleCor 0 Pum feon Mods Contigo wowconcuenewr | concunmenr [Numaan or] ose Comune)” [Sgononey|anhenes| rare pose_| nafs ees | 8oSeee ae] vee] 2700 [com | none | ene busied muh mot mine mi Geese] oso | core |e | ere | as SS eo ee fa rd [eee Pero ae Saas pana | fuconl| tems [ono | aa cece ene nthe mk nthe rs Tans | ovsnnt| user dl xonal| caves ee | ae mena liane | eee |e oe mono | 21998 | crow | voms fone] ae Penmaes mee | tare ence | ee i vanaate ee my eetttron ‘The LiCare 5000 Plum Infusion System With DataPort 1s designed for accurate, ‘non-pulsaiile administration of single usd regimens, dual-channel regimens, piggybacks, And multidose regimens over a wide range of delivery rates and fuld viscosities. Te can ‘administer a varety of medical fuids, from 53 Dextrose Injection, USP, to enteral feeding Products and blood. Primary and secondary doses of compatible drugs can be delivered ‘concurrently. ‘A broad line of specially designed LifeCare 5000 PhumSet® administration sets and accessories permits the convenient and cost-efficient administration of general IV fuids land electrolytes potent drugs such as dopamine, heparin, oxytocin, nitroprusside, ‘ae na v7 ‘a FT) chemotherapeutic agents, antibiotics, blood and blood factions, hyperalimentation products, enter products, and solutions for gation procedures. ‘The avallabiliy of administration sets with either single-channel or secondary dual-channel cassettes faclitates the tse of a wide variety of standard IV piggyback, fulls, partis induding ADD- Vantage"), and pre-filled or user-prepared syringes and al “The DataPort communications function allows continuous monitoring of LifeCare 5000 ‘Plum Infusers With DataPort connected to a properly equipped host computer located at ‘a nursing station or other remote locations, ‘Additionally, the use of special PlumSels with capped secondary ports can reduce risks ‘of needle stick and facilitate "needleless” practice. “These features make the nfuser a universal device, usable in virtually all areas of patient ‘care, including! ieuyecu ‘Mobile Intensive Care on/arn Cardiae Cath Lab OR/Anesthesia Bum Unit General Flor Emergency Pediatrics Neonatology Post-Op/Recovery ‘Oncology Bateral Home Care cecococve0c00c0D “The sophistication of the variable pressure feature permits the user to set a maxirmum ‘occlusion pressure limit “The LifeCare 5000 Plum Infusion System With DataPort has been designed to be a cost-effective, bor-saving too for the healthcare professional. Its many features make {tthe infusion system of choice in virtually every elinical setting where the precise and dependable infusion of aids s required. ‘Beceem fon aH) Si Sprig Mad = Section 2 PRINCIPLES OF OPERATION ‘The LifeCare 5000 Plum Infusion System With DataPort isa positive displacement infusion system with four components: 1. LifeCare $000 Infuser—an electromechanical infuser with an array of status and ‘warning indicators. 2, LifeCare 5000 PlumSet Administration Sets—sterie, one-piece, disposable fald administration sets with in-line, easy-to-prime, single-channel or dual-channel 3. LifeCare Flow Detector (optional)—monttors the presence or absence of drops In the drip chamber of the primazy line. Ifthe ffoid container is empty, the ow ‘detector senses the absence of flow and triggers an audible alarm. The pump reverts tothe KVO rate. When the low detector is not sed, a dose Hmm must be 4. LifeCare8000 DataPort—cnables a healthcare professional to monitor the infuser from a remote location. Using optional communications accessories (see ‘Accessories, Section 3}, one or several infusers can be linked toa properly equipped hhost computer. ‘The infuser drives the eassette ata precisely controlled stroke length and rate to provide accurate volumetric ud delivery. Visual and auclble alarms are acuwated by deviations ‘from desired operation. ‘An internal microprocessor monitors and controls all hardware and circuitry. Whenever ‘a cassette is locked into the operating position, the infuser goes through a brief self-test to verily the integrity ofall nternal systems and performs a pressure test ofthe cassette, iste a Sates TT ‘Tals page intentionally left blank. 5) ‘ee er TH ‘Som Open Mand een Section 3 SYSTEM FEATURES Special features of the L1feCare 5000 Plum Infusion System With DataPort include: Precise volumetric accuracy ‘Microprocessor contrat ‘Touchswitch operation, with full user prompting Flow detector for detection of empty container (optional) DataPort Continuous secondary [Nurse Call Back ‘Micro and Macro Mode configurations Selectable single-channel/dual-channel delivery User-selectabie concurrent delivery ‘Simple operation ‘Wide chotce of administration sets "Deliver Secondary Overfil” option ‘Manual and automatic backpriming ‘Titration User-selectable occasion pressure limit Continuous pressure monitoring and readout ‘Sel promping Liquid Crystal Display (LCD) Light Emtung Diode numerals (LEDs) Operating symbols Dose end/EVO ‘Self-contained battery Air-trap cassette Safety and warning features, including: = Automatic self-test = Matfunetion detector ~ Proximal airin-line sensor occococccoccococKCeoCOKDD = Distal at-in-me sensor = Proximal and distal gclusion sensor = Cassette pressure test = "No free low” system design at “Ce Far TA SYSTEM COMPONENTS moTION svatBOL (wor SHOWN) wou cRYSTAL DISPLAY (MODE ‘conp@uRATION SHOWN HERE) Figure 3-1. Front View 8888.8 INFUSION SYSTEM CIRECARE® 5000 Figure 3-2. Closeup of Touchswitches mama ney Sten Opa Mana sysTew components szconany, FROM PRIMARY COMTAMER Figure 3-3. Diagram of Cassette (Ousl-Channel Cassette Shown) InTecRAL _—— MNPOLE ‘OPERATING INSTRUCTIONS. (wor SHOWN) LEFT Side PANEL _- RELEASE KNOB Low eTEcTon Pon. aa Co) “iv POLE CLAMP DaTAPORT [MURSE-CALL JACK —_ LUNE conD ~ _. “HOLDER (VELCRO? AUDIBLE ALARM (STRAP) ‘VOLUME CONTROL GteveLs ‘SERIAL NUMBER earteny access ~~ ‘DOOR (BOTTOM) ieee 500 ae aoa Fw. 8H “This page intentionally left blank. ‘Sememon Gey SSCS pring = Section 4 CHECKOUT AND OPERATION USER QUALIFICATION “The LifeCare 5000 Plum Infusion System With DataPortis for use atthe direction or under the supervision oflicensed physicians, or by leensed or eerlified healthcare professionals who are trained in the use of the infuser and the administration of parenteral or enteral fuids and drugs. MODE CONFIGURATION ‘The infuser ts internally configurable for a range of operating modes. When shipped. the Infaser is configured for Macro Mode, Dual-Channet Delivery. All other configurations ‘must be enabled by a qualified hospital technician, INSTRUCTIONS Figure 4-1. Dip Switch Cover 1, Remove dip switch cover (see Figure #1 2. Determine configuration requited for device. 3. Using a small screwdriver, (approximately 1/16 inch oF ‘equivalent, move the dip ‘Stitches to the desired. position. Figure 4-2 (next age) decals dip switeh Selling foreach delivery ‘mode, 4. Confirm setup by pressing, cassette sensor pin (sce Figure 4-3. The LCD display panel wll be activated and Indicate selected configuration. 5, Reattach ip switch cove. Figure 4-3. Sensor Pin a grea Seta Figure 42. Dip Switch Sotings for Each Delivery Mode a INSTRUMENT NSTALLATION PROCEDURE INSTRUMENT INSTALLATION PROCEDURE WARNING PRODUCT DAMAGE MAY OCCUR UNLESS PROPER CARE IS EXERCISED DURING THE UNPACKING AND INSTALLATION PROCESS, THE BATTERY MAY NOT BE FULLY CHARGED UPON RECEIPT. DO NOT PLACE UNIT IN SERVICE IF ITFAILS THE OPERATIONAL TEST OR SELF-TEST. Note: Instrument installation should be performed by qualified personne! only UNPACKING Use care when unsacking the infuser. Retain the packing sip and save all packing material In ease the device is damaged or fails the infuser SeitTest and has ta be returned tothe factory. INSPECTION Inspect the packing container for possible shipping damage to infuser. Should any damage ‘be found, contact the delivering carrier immediately. Freight claims or insurance claims ‘must be filed by the receiving party with the carrer within seven days. Recourse to the carrer is lost sPeltm is not timely "Next inspect infuser thoroughly for damage. Donot use infuserifit appears tobe damaged, OPERATIONAL TEST Note: Do not place infuser in service until the Operational Test has been conducted. The procedure provided below should be performed by qualified personnel only ‘To perform the Operational Test, proceed 2s follows: 1. Plug the AC tine cord into a grounded. hospital-grade, 100-130 VAC, 50-60 Hareceplacleand observe lighted AC power symbol plug) on the font panel 2. Lifthe doorlatch that operates the cassette receptacle and, holding a primed ‘cassette on a PhumSet administration set by its nger grip. insert it into the ‘door guides. Do not force the cassette. It should slide nto the guides easily 3. Push the doorlatch down to close and lock the cassette in plac, 4. fused, confirm thatthe flow detector securely connected tothe receptacle a the ear of the pump. Note: Ifthe flow detectors not connected properly and a dose limits not set, the nfuser vill nt start delivery. 7 EOS a TAS _Atthis potnt,theinfuser will automaticaly initiate a self-test sequence to check its interna systems, When complet, the display panel will read UFECARE 5000 (MODE IDENTIFICATION) SELF TEST : OK Note: Valve test will complete approximately 90 seconds ater SELF TEST OK is displayed, ‘Mode identification displays forthe various mode configurations are shown in Figure 4-4, ‘Mode Identification Display, ode] MODE DENTRCATION PLAY UFECARE po acre MICRO MODE as LUFECARE oy SECONDARY un. cnet, UFECARE oy aco MICRO MOOE SECONDARY uM onan anibose urroose oro ‘ticRO MoD MUSIbose Wahoos MODE AS SHPPED Figure 4-4. Mode Identiieation Displays Sa Re se THe FLow oeTEcrOR “The Mode identifvation display indicates thatthe infuser is ready for use. The display will change after a fey seconds to read! oMuHR PRESS +4 ORENTER, Alternately. if any settings remain in memory from previous use, the display wil read ‘SAVE SETTINGS YESORNO? 5. When the self-test is completed, unplug the infuser from the AC cireuit. A Dacklighed, red battery symbol will appear, indicating that the infuse has switched to battery power. To ensure the battery ts charged, plug the unit, back in and leave itn the AC etreut for a minimum of 16 hours. 6. Open the doorlateh, remove the cassette from its receptacle, and close the Iateh agun, Note: If any malfunction is detected by the setf-test, an aucible alarm will sound and the display wil show a malfunction code number. Should this occur. Fefer to Alarms and Troubleshooting, Section 6. USING THE FLOW DETECTOR ‘The LifeCare 500) Infuser (1.6 Series) works with the LifeCare Flow Detector. The flow ‘detector is an optional feature to be used only an the primary line for detecting an empty container. Using the flow detector wil reduce the chance of air entering the cassette ait wap. "Note: A 0 mi dese limit can be entered only if the flow detector ia attached, “The flow detector works with the infuser in the following manner: FLOW DETECTOR CONNECTED the low detectors plugged in during setup, a dose limit is not required. no dose limit 1s set, the infuserruns unt the primary container empties, The flow detector senses the absence offlow and an EMPTY CONTAINER PRIMARY alarm is triggered, During an EMPTY ‘CONTAINER PRIWARY alarm, the infuser automatically switches to the RYO rate yan pean ana aT NO FLOW DETECTOR CONNECTED flow detector isnot connected during setup, a dose limit must beset for primary delivery. ‘The pump will mx leave the setup mde tnless a dose limit is set. FLOW DETECTOR CONNECTED WHILE PUMPING If the flow detector Is connected while the infuser is pumping, a FLOW DETECTOR CONNECTED alarm is generated and the pump stops delivery. Press [RESET] touchsvttch to both silence the alarm and to put the purmp into the Reset mode. Press [STAI] touchswitch to continue delivery. If limit has been set, the infuser wall continue pumping ‘unt the empty container is detected or the dose limit s reached, whichever comes first FLOW DETECTOR DISCONNECTED WHILE PUMPING I the flow dete:tor is disconnected while pumping, a CONNECT FLOW DETECTOR ‘message is generated and the pump stops delivery. ‘To continue delivery without reconnecting the flow detector, press [RESET] touchswitch and follow the user prompts to set a dose limit for primary delivery USING THE DATAPORT “The LifeCare 50¢0 Infuser With DataPort can ullize optional communications accessories {establish a lik between one or several infusers and a host computer (sce Accessories, ‘Section 9) When the infusers linked to properly equipped host computer, infuser status ‘ean be monitored from a remote locaton, [Note:The communications link between the infuser and the host PC is monitor only, ‘The infuser cant be controled from a remote location, ATTACHING DATAPORT ACCESSORIES Note: See accompanying documentation packaged with LifeCare 6000 DataPort ‘accessories for inatallation procedures. Note: Attaching or removing accessories from the DataPort while the device ts pumping ball not affect inuser operation INFUSER SETUP ‘To setup the infuse, proceed as follows: 1. PlugtneACeord into hospital-grade AC receptacle, unless battery operation fs desired Note: Use AC power whenever possible, Store infuserplugged-in to ensure 2 fully charged tattery for emergencies. Note: Ifquality of earth grounding source i in doubt, se battery power Be eS i 2, Set the ube alarm switch on the rear of the infuse tothe desired volume level: low, medium. oF high, PREPARING SET AND CONTAINER WARNING ARRANGE TUBING, CORDS, AND CABLES TO MINIMIZE THE RISK OF PATIENT STRANGULATION OR ENTANGLEMENT. Figures 4-5 and 4-6 ilustrate the preparation of the PlumSet and container, gure 47, Inserting the Cassette, shows proper loading ofthe cassette into the infuse. NNote:_This procedure is only forthe baste dual-channel PlumSeta, List Numbers 6426-02 and 6482-02, See individual set instructions for use f other PlamSet administration sets, Note: Using aseptic technique, remove protective coverings as assembly progresses yy Seamer Ee eae . Preparing the Se a OC a) OD nem cassere Reishi / (. Me reuanoen & & Oe, 2 PUMPING CHAMBER, TURN Seem Figure 4-8. Priming the Cassette © Inset cassETTE, © coven NoFLoW Figure 4-7, Inserting the Cassette Ea RR rr PROGRAMMING ‘The LifeCare 5000 Plum Infuser With DataPort has the ability to perform several modes offsid administration as ited below: 1 Primary only Secondary delivery (Dual-Channel) ~ single dose = multiple dose ‘which may be run n either intermittent or continuous concurrent modes. Inonder to configure the device for desired utd administration, please refer tothe LfeCare [8000 Technical Service Manual. The LifeCare 5000 Infuser shauld only be configured by ‘qualified technical personnel, Note: When delvering in Multiple Dose Secondary (Dual-Channel) Mode, the total volume in the multidose secondary container must at least equal the cumulative total required volume as determined by volume per dose times the number of programmed doses. ‘See Figures 48 through 4-13 for programming, reviewing, and clearing procedures aan Orage 7 oo Fa ‘Serton 4 CHECKOUTAND OPERATION MACRO. MICRO UrECARE 5000] [UFECARE S000 MICRO MODE. seur-rest_: ox | | seur-test_; oK Vv NOTE: ONLY IF HISTORY IS PRESENT SETING (sae COMPLETE PRESS START on ReviewsonaNce | (RESET) ‘savesermnas | (YES YESORNO? i. RAE OMURR 2) (amen Press? s ORENTER yy [BOSE uM om | Sp) fewren) PRESS 14 ORENTER vy [ Nore: tf seconoARY ENABLED || seresconany | { YS | L_vesonnor No. ST) on nevewcrance | (Reser NOTE: AOMLDOSE Lint FORTHE PRIMARY CONTAINER (CANBE ENTERED ONLY IF THE, FLOW DETECTOR S ATTACHED PUMPING BEGINS Figure 4-8. Programming for Primary Delivery eee a Ta 7 Tatas Fa Poarawnane NOTE Pry Davey MUST RST BE ESTABLISHED AS SHOWN ‘cue 8 Papo aN FON PANE BENE ob bse. | BEE [ST] aor vesomor _|{ vo | See ow ees ser ze =] ae CT | ee [SIE] oo _] SNORT Ee )\—> secononry never aeons sering corre Figue Programming for Single Dose Secondary Delivery ‘See Opa a Figure 410. Programming for Multiple Dose Secondary Delivery (1 of 2) ORT Re ‘covnaeD FROM FIGURE «10, PROGRAMMING FOR MULTIPLE DOSE SECONDARY DELIVERY (1 OF 2) SEM, ‘SECONDARY DOSES ai wee) | YESORNO?, MULTIPLE DOSING 1. THE VOLUME IUTHE SECONDARY. a CONTAINER MUST AV LEAST CUAL ‘he bose VOLUME TIES THE "ES 1OP) | eee. an GUIDELINES TO ‘Doses. 2 2 DOSE NTEFVAL TIMES MUMBER OF PRESS OR ENTER Bases eannor EXCEED 24 HOURS| 8. DOSE Una ONIDED BY DELIVERY RATE CANNOT EXCEED DOSE’ SESoRGART nasa INTERNAL 80 (? fren) mess s” || on, CALERA] (ves vesonno? | {vo DELVER SECON] (Tes a UST oCSE Seonowreovenru maces |[Lno f, | onion sections ot TmUTODSE Wao serrncs sernwecowmuste ||") Sehtay Anreane erEa TO PRESS SIAAT SupEINEs ToMANPLE a Sone acre Fast 003 ‘SECONDARY DELIVERY aeons saan Figure 4-10. Programming for Multiple Dose secondary Delivery (2 of 2) ‘Sen Opa al a3 ——sarraanaar io i Sacon 4 CHECROUTAND OPERATION uucrete 208 SeconoAr DELNERY MODE APRN econ ae are fatty, “oe (wove) Figure 4-11. Reviewing Settings (2 of 2) PnocnaMNans sectin 4 tc were Sra) PRESS YESTO (CHANGE SETTING on RESET) z PRESS. ee JU) | No VES)» sce ncunesa (CHANGE Pri Page onpose™ || YESORNO? > SEE FIGURE 49 SETSECONOARY YESORNO? YES > see cranana re ‘SET PRES. LIMIT ed : nONS YES OR NO? NO cea ———_ Serine COMPLETE PRESS START. OR REVIEWCHANGE Figure 4-12. Changing Settings RTT TT a TT: rant) CLEAR’ REVIEW RESET] > (CHANGE, LEAR Yes }-—> TOTAL ‘TOTAL VOLUME ‘VOLUME CLEARED 200 ML ie 000K ML YESORNO? a — CLEAR Yes }—> SECONDARY SETTING YES ORNO? NO. —— NOTE: IFCALL BACK ENABLED ‘CLEAR Yes }> ALLSETTINGS: YESORNO? No Samm Opes ea ‘SECONDARY CLEARED ALLRATES, DOSES, SETTINGS CLEARED CLEARCALL BACK |(“Yes }—> CALL BACK FEATURE, ‘AT SECONDARY DISABLED DOSE END ‘YESORNO? eo RETURNTO ‘SETUP COMPLETE SCREEN Figure 4-19, Clearing settings ‘Stone CHECKOUT AND OPERATION CHANGING THE FLUID CONTAINER CAUTION: Before opening dos lose clamp on primary or secondary se oF remove secondary container fom sesonday porto prevent mixing of primary snd secondary aa, See Fagure 4-14 Changing the Fluid Container for instructions on changing a primary or secondary flu administration container. as © gga ger eoon O pgencrnsnon Ea meri, ORE Sen OBIS, Figure 4-14, Changing the Fluid Container RE ie 198s rrr DISCONTIVUNG ELECTRON FLOW CONTROL OR. DISCONTINUING ELECTRONIC FLOW CONTROL OR FLUID ADMINISTRATION CAUTION: Before opening door, close clamp om primary or secondary set or move secondary container fom secondary port to prevent mising of primary and secondary fds, electronic flow control needs to be stopped, the precision flow regulator on the cassette ‘can be used to manually set and maintain fluid flow in a gravity mode (see Figure 4-15, Discontinuing Electronic Mow Control and Setting Up Gravity administration). Figure 416, Discontinuing Flud Administration, iustrates how to properly remove an administration fet from the inf © press reser Oe INUPAIGHT POSTION. FRAEEE on ser concn ccin mes Ee Figure 4-15, Diecontinuing Electronic Flow Contro! and setting Up Gravity Administration £ he © pressneser ‘@ cose boon © rewve row © BetnsrrennSSe © oren 000%, newowe casserTe Froveoure Figure 4-16. Discontinuing Fluid Administration a oo ‘Seaton CHECAOUTAND OPERATION “This page intentionally left blank aaa eT i mem Section 5 USER OPTIONS USING CONCURRENT DELIVERY FEATURE ‘The LifeCare 5000 Plum Infuser With DataPort has the ability to delver primary and secondary aids concurrently at diferent rates (see Figure 5-1, Programing for Concurrent Delivery” Limitations are ae follows Netther the primary rate nor the secondary rate can be ess than 1 ml/h (0.5 mal Phe sm Micro Mede) The total of the primary rate plus the secondary rate cannot exceed 700 mL/hr in ‘Macro Mode or $9.9 ml/r in Miero Mode. 1 The selected doses of primary and secondary fide willbe delivered to the patient at the total programmed rate (primary plus secondary rate) per hour as prescribed, However, tre final concentration delivered may vary over Ume and depends on the ati ofthe bwo delivery rates. Note: Variation in patient response may occur with certain drugs with short half ‘Variations can be avolded by either maintalning a flow rate of greater than 5 ml/h for the short half-life drug or by ensuring that the rates of the concurrent infusions conform to the concurrent flow guidelines (see Concurrent Flow Guidelines When Delivering Creal Drags. this section, Note: When using the LifeCare 5000 Plum Infuser With DataPort for concurrent delivery of primary and secondary fuids, confirm that the drugs/‘huids being administered are ‘chemically and physically compatible. ieee S000 ales Fe Sean USER OFTONS NOTE: PRMUARY DELIVERY MUST FIRST BE ESTABLISHED, [AS eiown’ On PHGURE ¢8, PROORAIMHING FOR PRIARY DELIVERY (eam) PRESETS] (es reser} > Satna v0 yesonno? FRePear seconoanY soneEN ‘set seconmany |{ YE q SeEaoe vesonwor || wo Figure 5-1. Programming for Concurrent Delivery (1 of 2) eta SSCSCSCSCS~«S ‘igure 5-1. Programming for Concurrent Delivery (2 of 2) iia io Saar ea “Be eH ae TR ‘Seaton USER OPTIONS CONCURRENT FLOW GUIDELINES WHEN DELIVERING CRITICAL DRUGS. Delivery Rate When delivering short half-fe critical drugs (see Critical Drugs, this section) using the lifeCare 5000 Version 1.6 inthe concurrent mode, the following delivery rate guidelines should be observed: A. Ifthe ertteal drug (vith half-ife less than 6 minutes) isto be infused st lees than, ‘2.0 mir, the other infusion should be no faster than five timee the critical drvg's rate, Dopamine, for example, delivered at 1.5 ml/h should not be accompanied ‘by an infusion programmed any faster than 7.5 ml/h. B. the exitcal drug (vith half. Jess than 6 minutes) is to be infused at 2.0 0 5.0 ‘Libr, the ather infusion should be no faster than t#n times the critical drugs Fate, Dopamine, or example, delivered st 3,5 mL/hr should not be accompanied by an infusion programmed any faster than 35 ml/h. Ifthe ental crag (ith half. Hfe less than 6 minutes) isto be infused at 6.1 mL ‘or greater. the other infusion can be programmed at any desired rate. Note: The tota of the primary rate plus the secondary rate cannot exceed 700 mL/hr in ‘Macro Mode or 99.9 m-/hr in Micro Mode. ‘These guidelines apply only when infusing short halffe crtical drugs tn the Conexwrent ‘Mode. Individval patient responses may vary, requiring adjustment of delivery rates. “Table 5-1, Delivry Rate Guidelines ‘Shor Halle Maximum Rate of (loss man six minutes) ‘Accompanying infusion (Catical Drug itusion Rate 05-19mUhr Five Teste Gril Dg Rai 20-50mLAr Ten Tins the Ciicl Do Rate 25i01n Desied Ratio Critical Drugs Examples of drags witha short hal-uf approximately six minutes or less when given IV) fnchade: 1 Dobutamine @ Dopamine 1 Epinephrine Q Esmolol 1 Isoproterenol @ Lidocaine ‘Beoweew aor ew via) ait rig USE OF NURSE GALL BACK FEATURE 2 Nitrogycerine Q Nitroprussile Q Norepinephrine 2 Oxytocin, 2 Procainamite Q Timethaphan For these drugs. the concurrent flow guldelines should be followed when the infusion rate (of the drug will be 5 mL/hr or less. ‘Note: Thus lst of etical drugs ie not intended tobe all inclusive of ertical drugs or drugs ‘with a short hall ie ‘The clinician should become familiar with the pharmacodynamics of any erica drug Defore administration, USE OF NURSE CALL BACK FEATURE ‘When the optional Nurse Call Back feature (1.6 Series) is enabled, the Nurse Call Back ‘alarm sounds when delivery of the secondary dose ends. This allows an opportunity #0 ‘change the secondary container, i required ‘When the Nurse Call Back feature is enabled, the user has the option of then allowing the Pump to continue pumping secondary fuld after the Secondary Dose End. ‘Note: In the multidose delivery mode, ifthe Nurse Call Back feature is enabled, the alarm vill sound atthe end of every dose BACKPRIMING ‘The LifeCare 5000 Plum Infuser With DataPort offers the option of backpriming from the primary container into a secondary container, empty syringe, or vial, without opening the oor. Backpriming may be used to: © Clear air frum the proximal portion and alr trap of a dual-channel cassette 1 Reprime empty secondary tubing. 1 Flush secondary tubing between deliveries of incompatible drugs. Reprime secondary containers ‘Backpriming can be accomplished either manually or automaticaly, ‘Manval and aute backpriming cannot be used for clearing distal air-in-line alarms. Use standard reprinng techniques for these alarms (see Figure 4-3). istwe seine TT MANUAL BACKPRIMING “The manual backpriming feature can be used safely and convententy to clear air from ‘the prosimal portion of a dual-channel cassette (see Pgures 52 and 5-3). Mantal ‘backpriming can also be used to reprime empty secondary tubing. Fluid wlume delivered {nto the secondary Hine wil be recorded on the message dlsplay, but will not be included sm the total volume delivered. Manual baclpriming can be Snitiated in Reset Mode by simultaneously pressing and ‘holding the [RESET] and [ENTER] touchswitches and then following the prompt messages. Tis not necessary to open the door to activate this feature. Note: To avoid pressurization when backpriming into a syringe ora vial, the user must ‘ensure that these containers have sufficient emply space to accept the backprimed fd, Note: For syringes, pull up the plunger slightly before disconnecting the syringe to svold the fluid. For rig containers (e.., vals, open the door and remove and invert the cassette (ports down) before removing the container. This will minimize sping of ‘uid during replacement of the container, ‘Note: Manual backpriming is not recommended for reconstituting secondary containers containing dry powders. Note: If backpriming ls not successful, make sure that the clamps on the pump set are andr rae te ptmary cover or verte sendy conta, hen repeat Dbackpriming procedure, meee fe >(P™ER) wore: Passe Reser aND ENTER ness svaRr ato Stuutracovsur enue ‘OR REVIEW/CHANGE Beunery Was NOT PREMOUSLY (coun. PEASE WAIT ¥ al SER TEST selrerest venwomed | pueasewarr mera | SturancoostTe cove Press START —— Figure 62. Manual Backpriming (Ousl-Channel Casseties Only) RESET = ‘oats co er TAH aes Sn Open amt aoe — Seconoan Yesonno? Ae ser sine STAROARO PROCEDURE (Gernoune 63) ‘nme comramo aackommen a oth rer nes Figure 53. Clearing Proximal Alrin-Line Alarm With Manual Backpriming {(Dual-Channel Cassettes Only) ete 50 Soe a TT eaten USER OPTIONS AUTO BACKPRIMING ‘At the end of @ secondary dose or the last dose in a multidose mode, the infuser may {nitiate an automate backprime procedure to backprime excess accumulated air that has centered the camette since the door was closed. ‘his automatic feature clears only alr ‘fom the cassette; backpriming of fluid is minimal. Auto backpriming reduces potential for atr-tn-line alarms and facitates the DELIVER SECONDARY OVERFILL option. DELIVER SECONDARY OVERFILL OPTION ‘When programming for ether single dose or multiple dose secondary delivery using part for full containers, the user may elect to use the DELIVER SECONDARY OVERFILL ‘option to acommodate for fuld underfil or overfill of approximately 10%. ‘The following prompting screens will appese: ‘emote d08e OvERFL ‘seconoaRY ‘Yes onNo? DELIVER SECONDRY muunpts ose ‘OvERFiL. ‘SECONDARY ATLAS Dose If ESI is selected, the following examples describe interpretation of the dose delivered status sereen: EXAMPLE: OVERFILL Programmed dose: 50 ml. ‘Actial fluid Volume in container (including overfill: 54 ml ‘At completion f dose, the dose delivered status screen will read «Te total secendary volume delivered isthe sum of DOSE DELIVERED and OVERFILL (64 min this example) imeaan meray SC Sn Spring Ma EXAMPLE: UNDERFILL Programmed dose: 60 mL ‘Actual fuid volume in container: 46 ml ‘At completion of dose, the dose delivered status screen will read TITRATING ‘The titration feature allows the user to change delivery rates during pumping. In Multidose Sesondary Mode, the secondary rate cannot be titrated. During multidose concurrent delivery. primary rate cannot be titrated while secondary dove ls being delivered, Note: When using the infuser for concurrent delivery of enitical (short half.fe) drugfs), ‘the respective delivery rates an the primary and secondary lines should conform to the ‘concurrent flow guidelines (see Concurrent Flow Guidelines When Delwering Creal Drugs this section, Titrating Primary Rate ‘To trate primary rate only: PRESS AND HOLD NO AND+ OR} SIMULTANEOUSLY TO CHANGE FLOW RATE. PUMPING ves) {a rama & RATES XXX MUBR No TWTRATING PRIMARY RATE WILL CHANGE AND REMAIN AT THE NEW INDICATED VALUE WHEN THE TOUCHSWITCHES ARE RELEASED Tice Seimei TT Titrating Secondary Rate ‘To trate secondary rate only PRESS AND HOLD YES AND t OR} ‘SIMULTANEOUSLY TO CHANGE FLOW RATE = a PUMPING on RATE XXCMLUHR, cS v TTHRATING ‘SECONDARY RATE WILL CHANGE AND REMAIN AT THE NEW INDICATED VALUE WHEN THE TOUCHSWITCHES ARE RELEASED Titrating Hither Primary or Secondary Rate in Concurrent Delivery ‘To trate either primary or secondary rate in concurrent delivery: PRESS AND HOLD YES AND PRESS AND HOLD NO AND $0R}. SIMULTANEOUSLY 4 0R $ SIMULTANEOUSLY TOCHANGE SECONDARY RATE TO CHANGE PRIMARY RATE. a wes) E>( 4 BLY no Lv ‘PUMPING - CONCUR SEC. XXX MUHA, PRL XXX MUHA, TTRATING [RATES WILL CHANGE AND REMAIN AT THE NEW INDICATED VALUES WHEN THE TOUCHSWITCHES ARE RELEASED MUTING THE TOUCHSWITCH TONE ‘To avoid disturding a patient during setup ofthe infuser. the user may wish to mute the audible touchswitch tone. Press [CLEAR] touchswitch to mute the tone before pressing ‘another touchswitch, ‘To reactivate the tone, press [CLEAR] touchswitch again or press [START] touchewiteh. Tone will esume after one minute f no touchswitch ls pressed ‘Beceeaaa esti) SSS TSSSSSSC* tp ‘CHANGING THE PRESSURE UMN CHANGING THE PRESSURE LIMIT ‘The LifeCare 5000 Plum Infusion System With DataPort monitors distal line pressure at ‘he end of each delivery cycle. The infuser triggers an alarm if the pressure ges above set limits. The distal line pressure reading and upper limit can be reviewed by following, the procedure in Fgwre 48, Reviewing Settings. “The upper lit forthe distal line pressure is factory preset at 6 psig. The user may change ‘hls limit during initial setup of the infuser or at any other time during operation by following the precedure outlined in Figure 5-4, Seting and Retaining Pressure Limits. The mat can be set fom 0.1 to 10.0 psig © to 517 mmilg) m increments of 0.1 paig. This ‘range permits the nfuser tobe used ina variety of elnica situations where the monitoring ‘and Imitation af line pressure is important. ‘The guidelines in Table 6-2, Distal Line Pressure Limit Guldelines, allow selection of an appropriate distal Kne pressure mit. MAXIMUM PRESSURE sets ‘MIT 7 Frage Peripheral tow ‘Standard Seen ‘Sites Administration Sets Peripheral Fier a iespae ccna Medium ‘Acministation Sets oa Peripheral or ah Fier Soaueee Arif Stes Adswinistation Sete “The user may choose to retain the new pressure limit permanent (see Figure 5-4). If te [pressure limit is not retained permanently it will default o 6 paig after the infuser has been tumed off or four hours. ‘are 00 Sates a B61 FR.) |. ee Figure 5-4. Soting and Retaining Pressure Limits USING RETROGRADE PROCEDURES ‘See Figure 6:5, Using Retrograde Procedure, for instructions on retrograde administration ‘of small volumes of compatible medications. Note: For re ‘use any sulable lumSet administration set with two Yeaules, eg List Numbers 6468, 6433, 6445, ele. See Administration Sets and ‘Section 9, or see set carton labeling for retrograde volume contained ‘he Yeates. © ggetunyen wo Lowen — (© rseseneeer ioethctmone Grmoreranees © cveovecr nase Cerorcuure: Gnaewar \ =P Figure 5-5. Using Retrograde Procedure ‘ocean er Vin =e ‘Slam Opting Mana Vaio SYRINGES, VALS, OR OTHER CONTAINERS FOR SECONDARY ADMINSSTRATIN USING SYRINGES, VIALS, OR OTHER CONTAINERS FOR SECONDARY ADMINISTRATION CAUTION: Before attempting to fit a syringe or vial into the infuser, confirm that drug concentrations, delivery rates, and volumes are suitable for secondary infusion (see drug container labeling). Note: When delivering in Single Dose Secondary or Multiple Dose Secondary (Dual-Canned Mode, use an 18-oF 19-gauge needle with a maximums length of -1/4" 10 avoid bottoming needie in secondary port well when piercing reseal ‘When the above precautions are observed, the following conventional IV syringes or vials ‘may be used with the infuser for secondary drug administration @ Syringes 10 ccor larger can be attached directly tothe secondary port ofthe cassette. @ Syringes smaller than 10 ee. or 60 cc and larger require the use ofa special vented syringe adapter, List Number 9292. Syringes smaller than 3 ce should not be used. 1 Vials require the use ofa special vented vial adapter, List Number 9200, 1D Use suitatle secondary IV set with other secondary containers. Note: Before attaching a secondary container to the cassette, make certain that the alr traps full ofiquid. Hair is present, remove it using manual backpriming (see Figure 5-3). ‘Any secondary container can be attached to the cassette without opening the door. ‘Syringes 10 ec or larger When administering fluids using syringes 10 ce or larger. proceed as follows: 1, Prepare IV syringe using aseptte technique. 2. Invert the syringe and expel the excess a, i any, 3. Attach 19-gauge by 1-1/4” or larger needle to the syringe port or connect directly tocapped por. 4, Invert the syringe and insert into the reseal port ofthe dual channel cassette; oF attach dtecty tothe secondary port ifthe eassette has no reseal Secure the syringe tothe door with the container support, ist Number 9294, 6. Press [RESET] touchswitch and follow display prompts described in Figure 46, -Prograrmring for Single Dase Secondary Delisry, a oR 1086) Syringes 5 cc to 3.00 ‘The previous steps alo apply to syringes 9 ce to 5c, with the following conditions: 1. Attach eringe adapter tothe syringe and prime by inverting and actuating plunger ® Sopra 4 of a tot ring Til er the Iu one toe fipter ter nd hep vent the eyrnge dating dy vale ‘To administer Suds using ial, proced as follows: 1. Spite ds va cap withthe ial adapter. 2. Invert and attach to the secondary port ofthe caseette either directly or through the 18-gruge by 1-1/4" or larger needle ‘8 Press [RESET] touchswitch and manually backprime air out ofthe vial adapter. ‘Tis is meeessary since the Vial is rigid, and alr eannol be removed by manipulating the phanger. ‘The infuser wllappear as shown in Figure 5-6, Using Infuser With Secondary Line, Syringe, or Vial. proper ited with elther a compatible syringe or vial. The use of a sccondary ‘container support List Number 9294 (not shown, is recommended to secure syringes oF ‘ials to the Inftser door, ‘TUaNNEEDLE neuen FFTED WH oT) oc Section 6 ALARMS AND TROUBLESHOOTING “The LifeCare 5000 Pum Infusion System With DataPort wams the operator of problems that may affect uid delivery or proper operation of the equipment. fan alarm condition Is signaled, proceed as follows: 1. Press [SILENCE] touehswitch 2. Wdenuly alarm message 8. Press [RESET] touchsmitch 4. Correct the condition 5, Press [START] touchswitch Note: If the MALFUNCTION ALARM repeats the operator should discontinue use of the infer. Manual and auto backpriming cannot be used for clearing distal airtn-ine alarms. Use ‘standard reprining techniques for these alarms (see Figure 4-3). REVIEWING PREVIOUS ALARMS ‘As a conventen: indicator of alarm caus, the infuter automatically recards the previous 1Salarm condliions expressed as alarm codes (see Figure 6-1, Accessing the Alarmiston). INSERT CASSETTE. CLOSE DOOR, PRESS AND HOLD REVIEW. (WHEN “SELF TEST :OK" TFECARE— 5000 ‘APPEARS, RELEASE ‘TOUGHSWITCH, THEN PRESS 'ANO HOLD REVIEW seurtest:ox _| Eve ‘WHEL “REV X20" APPEARS, TREGARE —St00 RELEASE TOUCHSWITCH, "THEN PRESS AND HOLD review | Revxxx HOLD REVIEW To READ “ALAR HISTORY ALAR HISTORY. THE MOST 01, 04,17, 12.12, RECENT ALARM CODE 410,07, 06,3, APPEARS AT THE LOWER wea, TIGHT OF SCREEN Figure 6-1. Accossing the Alarm History ‘Common alarm codes are isted and explained in Table 6-1. Alarm Action Table, along with appropriate cerretive actions to be taken. ‘Table 6-1. AlarnvAction Table atanu — | ALARM POSSIBLE ‘CORRECTIVE messace | cove ‘CAUSE ‘ACTION ‘STOPPED ot | Distal tine kinked, distal | xan stale for kinks DISTAL LINE clamp cote: IV site ‘orintaral obsvuctons ‘OCCLUSION Pressure imi setto0 ow | Reset pressure iit Infuse postionedincorecty | Reposition infuser at or above mid-asitary ne of patent ‘STOPPED Proximal lie obstructed | Examine ine fo kinks, PROX. losed clamps or niarnal ‘OCCLUSION ‘secondary contsinernot | obstructions, Check (PRIMARY CR connected be sure 19-g2u90 or ‘SECONDARY) larger need fuse 08 | wrong administration set | Replace with-02 series set wih ow regulator 04 | Singechannelcassote | Replace with dual-channe! sed for dual channt cassote delvery ‘STOPPED 05 | Distal tine pressure outside | Poston infesor at PRESSURE normal ange rrig-axllary tne of patent OUT OF RANGE Dolectve cassette Foplace set ropeats. if recurs, discontinue uso otintuser STOPPED 08 | Airhasboondotoctedin | Roprime cassete using IRIN ‘asset proximal ine during | standard techniques when PROXIMAL, pumping due to: Using a single channel Ne *Emply container cassotlo + Cumulative airinsine volume exceaded dueto | using a dua-channa ‘utgassing or successive. | casseta, olow the spacial fic segments invoduced | backpriming technique by undorilodsocondaries | shown in Figure 5: or use = Damaged casseteor | standard repriming adapee techniques: = Proximal line oochudes aaa REVIEWING PREVOUS ALARMS Table 6-1. Alarmi/Action Table aLanM | ALARM POSSIBLE ‘connecTIVE. messace | CODE CAUSE ‘ACTION ‘STOPPED 07 | ‘Airhas been detectedin | Roprime cassette using AIRIN asset distal ine duet: | standard techniques. It DISTAL = Excessive airn artap | alam repeats, replace sot UNE: complet priming = Ouigassing = Damaged cassette damaged replace cassette pack prime | os | Airhasbeen detectedin | Reprime cassoto using TOCLEAR AIR asset artap chamber | standard techniques when NTO. using a single channel SECONDARY caseatte using a dua channel cassette, folow the special bbackpriming technique shown in Figure 5; or use standard reprining techniques EMPTY 09 | Empty container on Replace with new container ‘CONTAINER primary Ew ‘on primary line PRIMARYIKVO" “peat cota ‘Cocluded primary (tear cause of alarm cory to deed proximal ne yung ow dette Flow dotactr connected but | Attach flw detector tothe rot attachedto the primary | primary dip chamber

    You might also like