GE Medical Systems Information Technologies OU52014748-002 MedicalTelemetry Transmitter User Manual

Viewing real-time patient data

Real-time patient views

You can view real-time data for patients located in your care unit, and when networked with other CIC Pro centers, you may also view real-time data for patients located outside of your care unit.

The CIC Pro center allows you to view real-time patient data from two different patient viewers. Each viewer provides a different level of data granularity:

Multi-patient viewer

Single patient viewer

CAUTION

TREATMENT — Do not treat a patient based solely on the alarm messages and/or numerics presented via the connectivity device to the monitor. You must verify the accuracy of the alarm message and/ or numerics at the peripheral device itself before initiating treatment.

Treatment should be based on the information presented at the peripheral device.

Data synchronization

Information displayed on the ECG tab sheet is synchronized with the source

(transmitter) every two seconds. If differences are detected, the display is refreshed with new patient data.

Multi-patient viewer

maximum of 16 patients. You can do the following real-time tasks from the multipatient viewer:

View abbreviated real-time patient data.

View a snapshot of real-time Graphic Trends data for a maximum of two different parameters. See Configuring the real-time trend window on page 7-6.

Print parameter limits or waveform data for all patients in the care unit. See

Printing parameter limits or waveforms for all in-unit patient beds on page 7-9.

View a single patient’s detailed real-time parameter data. See Single patient viewer on page 7-3.

View a single patient experiencing an alarm condition. See Viewing in-unit patients experiencing an alarm condition on page 7-5.

Admit or discharge a patient. See Chapter 6.

View beds outside your care unit. See Out-of-unit patient beds on page 7-6.

Silence all alarms. See Silencing alarms on page 5-7.

The multi-patient viewer displays menu bar options similar to the following:

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Multi-patient viewer menu bar options

Option Function

Auto Display When enabled, the Auto Display button is selectable from the menu bar.

Clicking the Auto Display button while viewing the multipatient viewer automatically completes the following tasks:

Removes any un-locked, unoccupied beds.

Adds at least one empty patient window with an Admit button.

Resizes the remaining patient windows to maximize the amount of displayed patient data.

View Other View any patient bed on the Unity Network that is inside or

Browser

View the CIC Pro center default settings. You can customize CIC Setup

Silence Alarms

Graph All outside of the care unit, floor, or hospital. See In-unit patient beds on page 7-5.

See Out-of-unit patient beds on page 7-6.

some of the user-level defaults. See Customizing the system

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See Silencing

Print the parameter limits or the waveform data for all patients in the care unit.

Access stored patient data from the web access server.

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Single patient viewer

The single patient viewer displays detailed real-time parameter data for a selected patient. You can complete the following tasks from the single patient viewer:

View detailed real-time parameter data.

View, change, or print Alarm Control or parameter control settings for any inunit patient. These changes are also adopted by the monitor. See Adjusting alarm control settings on page 5-8.

See Adjusting parameter control settings on page 7-

11.

View Alarm Control or parameter control settings for out-of-unit patient beds on the Unity Network. See Adjusting alarm control settings on page 5-8.

See

Adjusting parameter control settings on page 7-11.

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NOTE

You cannot change the Alarm Control or parameter control settings of an out-of-unit patient.

Adjust the real-time trend window for any in-unit patient. See Configuring the real-time trend window on page 7-6.

Print real-time parameter data and waveforms for any in-unit patient. See

Printing real-time data on page 7-8.

The single patient viewer displays menu bar options similar to the following:

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Single patient viewer menu bar options

Option Function

Relearn

Sample

Real-Time View

Admit

Monitor Setup...

Patient Data...

System Utilities...

Return to the real-time display of patient data.

Display the Admit window.

Temporarily adjust a patient’s parameter, alarm, or print

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See Chapter 8.

Access web access server data.

View all ECG Display waveforms for ECG leads I , II , III , V , aVR , aVL , and aVF .

Record and store a 10-second sample of a patient’s real-time

ECG data. Data samples are stored in Events directory.

Monitor : Parameter numeric data and up to three waveforms.

Telemetry : ECG waveforms only.

Relearn the selected patient’s ECG rhythm after changes occur to heart rate or rhythm. The CIC Pro center uses 14 current complexes to relearn the patient’s ECG pattern.

The heart rate value appears briefly as X s during the relearn process and returns to numerics when the relearn process is complete.

Configure the selected patient’s real-time trend window. See

Configuring the real-time trend window on page 7-6.

Configuration

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In-unit patient beds

You can view any in-unit patient bed that is on the Unity Network.

Viewing in-unit patients experiencing an alarm condition

When an in-unit patient experiences an alarm condition, you can quickly display this patient’s data by displaying the single patient viewer.

You can use one of the following methods to display the single patient viewer of an alarming patient bed:

Click in the patient window.

Click the alarm button.

The CIC Pro center can display an alarm button for a maximum of four patients. This row of alarm buttons display across the top of the multi-patient viewer and show the unit name, bed number, and the cause of the alarm.

The color of the alarm button indicates the severity of the patient alarm condition.

Red indicates a Crisis alarm condition, yellow indicates a Warning alarm condition, and white indicates an Advisory alarm condition.

Another name for this row of alarm buttons is the Alarm Display Unit (ADU) line.

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Alarm buttons, also known as Alarm Display Unit (ADU) line

Viewing patient beds from another in-unit CIC Pro center

When you have more than one CIC Pro center in your care unit, you can view

(monitor) a patient bed from another in-unit CIC Pro center.

Complete the following procedure to view (monitor) in-unit patient beds from another in-unit CIC Pro center:

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1.

Go to the CIC Pro center in your care unit that has room to view additional admitted patient beds.

2.

From the multi-patient viewer, right click in an empty patient window displaying an Admit button. The right click menu displays.

3.

From the right click menu, choose Select Care Unit then Bed Number . A list of networked care units displays.

4.

From the list, choose the care unit and bed name you want to view. The patient bed is displayed in the multi-patient viewer.

Out-of-unit patient beds

You can view out-of unit patient beds that are not displayed at your CIC Pro center.

The bed you wish to view must be on the Unity Network.

NOTE

You cannot change the Alarm Control or parameter control settings of an out-ofunit patient.

Viewing an out-of-unit patient bed

Complete the following procedure to view networked out-of-unit patient beds:

1.

From the multi-patient viewer, click View Other . A list of networked care units,

2.

Click the + sign next to the desired unit, floor, or hospital to display the list of

3.

4.

floors, or hospitals displays. viewable beds.

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OK . The single patient viewer displays

(close button) on the top right side of the window.

Removing viewed out-of-unit patient beds

Complete the following steps to remove out-of-unit patient beds you are viewing from the multi-patient viewer:

1.

From the multi-patient viewer, right click on the patient bed you want to remove.

2.

From the right click menu, choose Select Care Unit then Bed Number > None .

Configuring the real-time trend window

You can configure the display of a real-time trend window in the multi-patient viewer.

The real-time trend window displays the recent patient trends for a maximum of two parameters.



Complete the following procedure to configure a patient’s real-time trend window:

1.

Choose one of the following methods to access the Real-time Trend Graph configuration window from the multi-patient viewer:

Right-click on the patient you want to configure and select Configuration .

The Real-time Trend Graph window displays.

Click on the patient you want to configure. The single patient viewer displays. From the single patient viewer, click Real-time View to display the real-time window.

2.

Click Configuration to display the Real-time Trend Graph window.

3.

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Real-time Trend Graph control settings

Option Function

Display Real-time Trend

Graph

Display Parameter 1

Display a real-time trend window with a maximum of two real-time parameter trends.

To display the Real-time Trend Graph , click in the empty check box to fill the box with a check mark.

Display the first real-time parameter trend.

To display one real-time parameter trend, click in the empty check box to fill the box with a check mark. Then, click the down arrow to set the display properties:

Parameter Name : Set the displayed parameter.

Scale : Set the size of the displayed waveform trend.

Color : Set the color of the displayed parameter text and waveform trend.

Display the second real-time parameter trend.

Display Parameter 2

To display a second real-time parameter trend, click in the empty check box to fill the box with a check mark.

Then, click the down arrow to set the display properties:

Parameter Name : Set the displayed parameter.

Scale : Set the size of the displayed waveform trend.

Color : Set the color of the displayed parameter text

4.

After making your selections, complete one of the following tasks:

Click

Click

Click

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See Viewing stored patient data on page 8-1.

Printing real-time data

and waveform trend.

While viewing the in-unit real-time patient data from the multi-patient viewer, you can manually print a continuous ECG strip for a single patient bed or print the parameter limits and waveforms for all displayed patient beds.

Printing a continuous ECG strip

From the multi-patient viewer, you can click in the ECG parameter window of any displayed in-unit patient bed to print a continuous ECG strip. A print icon appears as you position the cursor over the ECG parameter window.



NOTE

When using a digital writer, click in the ECG parameter window of any displayed in-unit patient bed.

Then, press the ( Graph Stop) button on the front of the digital writer to stop printing a continuous ECG strip.

NOTE

The printing formats are controlled by the data source device (monitor or telemetry system). This includes printed waveforms, speed, and graph location.

See the operating instructions for the devices you are using.

Printing parameter limits or waveforms for all in-unit patient beds

You can print the parameter waveform data for all in-unit patients displayed at a CIC

Pro center by using the Graph All function. In addition, you can also print the parameter limits for telemetry beds.

Selecting the Graph All function results in printing a 10-second graph for each admitted telemetry bed and a 20-second graph for hard-wired beds. The graph speed of a telemetry graph is 25 millimeters per second and the graph speed of a hard-wired graph is determined by the monitor.

NOTE

Close any open single patient viewer windows before selecting the Graph All function. Otherwise, only the single patient viewer data prints.

The following conditions apply when using the Graph All function:

When you press the the next patient.

( Graph Stop) button on the local digital writer, the

Graph All function request is started, this patient’s data is not included in the

Graph All Patients graph. This patient’s data graphs independently of the Graph

All Patients graph.

When you click in the ECG parameter window of a patient whose data is saving, this cancels the Graph All Patients request for that patient.

 When an arrhythmia alarm sounds for a patient while a Graph All Patients request is running, the alarm data replaces the data that was saved for the Graph

All Patients request.

 When a telemetry patient initiates a graph from a transmitter while a Graph All

Patients request is running, the Graph All Patients graph for that patient is replaced by a transmitter graph.

Complete the following procedures to print parameter limits or waveforms for all patient beds displayed in the multi-patient viewer:

Printing limits

NOTE

The Limits option only prints parameter limits for telemetry beds.

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Complete the following procedure to print telemetry bed parameter limits:

1.

From the multi-patient viewer, click Graph All . The Graph All Patients window displays.

2.

From the Graph All Patients window, click Limits .

3.

Click OK to begin printing.

Printing waveforms

Complete the following procedure to print parameter waveforms for all displayed patient beds:

1.

From the multi-patient viewer, click Graph All . The Graph All Patients window displays.

2.

From the Graph All Patients window, click Waveforms .

3.

Click OK to begin printing.

Stopping a print job

You must stop a print job from the same CIC Pro center you used to send the print job to the printer.

Stop printing to a laser printer

Complete the following procedure to stop printing all print jobs sent to the laser printer:

1.

From the multi-patient viewer, click CIC Setup > CIC Defaults . The CIC

2.

3.

Defaults

Under printing to.

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for the printer you want to stop

After making your selection, complete one of the following tasks from the CIC

Defaults window:

Click OK to apply your changes and close the CIC Defaults window.

Click Cancel to cancel your changes and close the CIC Defaults window.

Click Apply to apply your changes without closing the CIC Defaults window.

Stop printing to a local digital writer

Complete the following procedure to stop printing all print jobs sent to a local digital writer:

1.

Locate the digital writer.

2.

Press the ( Graph Stop ) button located on the front of the digital writer to stop the print job.



Monitored parameters

The CIC Pro center can display data for many monitoring parameters.

NOTE

For a complete list of supported parameters, refer to the CIC Pro Clinical

Information Center Operator’s Manual.

Adjusting parameter control settings

The following guidelines apply to adjusting parameter control settings at the CIC Pro center:

You may view and adjust parameter settings for any in-unit patient. Any changes are temporary and return to the default settings when a patient is discharged.

These changes are also adopted by the monitor.

You may not be able to adjust some of the control settings for non-GE acquisition devices that are interfaced via the Unity Network Interface Device.

You may view parameter settings for any out-of-unit patient. However, you cannot adjust these settings.

To permanently change the parameter default settings, see the CIC Pro Clinical

Information Center Bedrock Hardware Platform Service Manual.

This section briefly covers adjusting control settings for the following parameters:

ECG

ECG control settings

ECG

SpO

2

Non-invasive pressures

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Complete the following procedure to adjust the control settings.

1.

From the multi-patient viewer, click on the patient you want to view. The single patient viewer displays.

2.

From the single patient viewer, click Monitor Setup .

3.

Click ECG to display the control window.

4.

Change any of the undimmed setting options. When an option appears dimmed, you cannot change it unless you enter the service-level password.

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ECG control settings

Option Function

Display Lead Set the top or first lead displayed on the monitor and on the

CIC Pro center. This is the lead data that prints during an alarm or manual graph.

Relearn button Relearn the selected patient’s ECG rhythm after changes

Size occur to heart rate or rhythm. The CIC Pro center uses 14 current complexes to relearn the patient’s ECG pattern.

Remove the V Fail message or activate the second V-lead

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X s during the relearn process and returns to numerics when the relearn is complete.

Set the waveform size. 1X is standard.

Detect Pace Set the pacemaker detection mode:

 Pace 1 : Alternate pacemaker detection mode when Pace

2 does not adequately detect pacemaker spikes.

Pace 2 : Normal pacemaker detection mode.

For more information, refer to Monitoring pacemaker patients on page 7-13 .

Pace Help button

Lead Analysis

View solutions to common pacemaker detection problems.

Set the leads for ECG and arrhythmia data processing:

Single-Lead : Use the top Display Lead .

Multi-Lead : Use leads I, II, III and V lead.

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ECG control settings

Option Function

Arrhythmia

PVC Limit

Set the arrhythmia detection level:

Full : Detect all arrhythmia conditions defined by the software.

Lethal : Detect lethal arrhythmia conditions.

Off : Turn off arrhythmia detection.

Arrhythmia detection remains off until you choose Full or

Lethal , or the patient is discharged.

NOTE

OFF appears dimmed and is not selectable when the following option is set: CIC Setup > CIC

Defaults > Allow Alarms OFF on this CIC > No .

The Allow Alarms OFF on this CIC setting is a service-level default and is protected by the Service

Password .

Turn On to count PVCs per minute. A PVC counter appears in the ECG parameter window.

NOTE

To display the PVC counter, the Arrhythmia detection level must be set to Full .

Turn On to display, store, and enable ST alarms.

ST

V Lead Label the V Lead position.

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window.

Monitoring pacemaker patients

Be aware of the following when monitoring a patient with a pacemaker.

WARNING

FALSE CALLS—False low heart rate indicators or false asystole calls may result with certain pacemakers because of electrical overshoot.

WARNING

MONITORING PACEMAKER PATIENTS—Monitoring of pacemaker patients can only occur with the pace program activated.

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WARNING

PACEMAKER SPIKE—An artificial pacemaker spike is displayed in place of the actual pacemaker spike. All pacemaker spikes appear uniform. Do not diagnostically interpret pacemaker spike size and shape.

WARNING

PATIENT HAZARD—A pacemaker pulse can be counted as a QRS during asystole in either pace mode. Keep pacemaker patients under close observation.

WARNING

RATE METERS—Keep pacemaker patients under close observation. Rate meters may continue to count the pacemaker rate during cardiac arrest and some arrhythmias. Therefore, do not rely entirely on rate meter alarms.

CAUTION

FDA POSTMARKET SAFETY ALERT—The United States FDA

Center for Devices and Radiological Health issued a safety bulletin

October 14, 1998. This bulletin states “that minute ventilation rateadaptive implantable pacemakers can occasionally interact with certain cardiac monitoring and diagnostic equipment, causing the pacemakers to pace at their maximum programmed rate.”

The FDA further recommends precautions to take into consideration

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NOTE

ECG monitoring with patients on non-invasive transcutaneous pacemakers may not be possible due to large amounts of energy produced by these devices.

Monitoring ECG with an external device may be needed.

The Detect Pace option enables/disables the pacemaker detection program. It must be used whenever the monitored patient has a pacemaker.

There are two pacemaker processing modes, Pace 1 and Pace 2 . The modes use different algorithms for pacemaker artifact rejection. The clinician must be the judge as to which mode is better for each patient. The pacemaker detection program defaults OFF , so if you have a patient with a pacemaker, you will have to select a mode. For more information, refer to ECG control settings on page 7-11 .



The Pace 1 mode allows successful detection of the largest variety of paced QRS morphologies. As a direct consequence, this mode does have a higher risk of counting pacemaker artifact as QRS complexes during ASYSTOLE . For this reason, it is imperative that the user keep patients with pacemakers under close observation. It is also recommended that the user set the low heart rate limit on the monitor close to the minimum pacing rate, and that the BRADY arrhythmia alarm level be elevated to a

Warning or Crisis level.

The Pace 2 mode is much more conservative in recognizing paced QRS morphologies and is recommended for use whenever possible. It is designed to minimize the possibility of counting pacemaker artifact as QRS complexes during

ASYSTOLE . If the monitor does not adequately detect paced beats in the Pace 2 mode, then the user may wish to try the Pace 1 mode.

When either pace mode is enabled, the software places an artificial spike on the waveform whenever the pacemaker triggers. When pacemaker detection is on, it is indicated by a “P” in the patient’s ECG parameter window.

For successful monitoring of pacemaker patients follow these suggestions:

Use recommended electrode placement.

Brady , Pause , and Low Heart Rate are additional alarms available for use when monitoring pacemaker patients.

Problems you may experience are:

heart rate double counting; inaccurate alarms for low heart rate or asystole;

pacemaker spikes not recognized by the software.

Multi-vector pace detection

Possible solutions to above problems are:

relearn arrhythmia; try an alternate electrode placement; try

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The T14 transmitter uses multi-vector pace detection. Here are some additional guidelines for successful monitoring pacemaker patients when using the T14 transmitter.

When using the 5- or 6-leadwire set with all the electrodes attached, pace detection occurs on two ECG leads simultaneously.

The default leads used for detection are II and V. If these leads are not available, multi-vector pace detection switches to available leads.

Pace detection switches to Single-Lead when using a 3-leadwire set.

For more information, refer to “Pacemaker troubleshooting” on page D-3.

Pace help

Clicking on the Pace Help button opens a window that shows common problems and solutions in regard to pacemaker detection. This window is shown below.

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Lead analysis

The Lead Analysis control signals the transmitter to process the ECG in Single-Lead or Multi-Lead mode. Use the mouse to click on your selection. Multi-Lead analysis is the default setting for Adult .

NOTE

ECG is relearned whenever Lead Analysis is changed.

Multi-Lead analysis

Single-Lead analysis

Multi-Lead analysis simultaneously examines ECG leads I, II, III, and V (whether they are displayed or not) to help eliminate false alarms and improve the ability of the system to:

Draft available, another lead is provided for display.

Continue arrhythmia processing even after a lead change.

Single-Lead analysis uses only the lead displayed on the CIC Pro center screen to process ECG and arrhythmia information. To change the lead used for Single-Lead analysis, you must change the displayed lead.

Single-Lead ECG may be acquired using a 3-, 5-, or 6-leadwire set. However, only a

Single-Lead ECG is transmitted or processed.

Single-Lead analysis is beneficial when troubleshooting pacemaker detection and/or arrhythmia detection. Single-Lead analysis must always be used when monitoring with a 3-leadwire set. Single-Lead analysis can be set up as a unit default. Refer to

Customizing the system on page 4-4 for more information.

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Single-Lead ECG telemetry data

NOTE

When acquiring Single-Lead ECG data using a 5- or 6-leadwire set, it is not necessary to connect the V leads or the right leg lead to the transmitter or to the patient.

The following constraints apply when using Single-Lead ECG telemetry data.

Function Single-Lead Constraints change the displayed lead select graph waveforms

The factory default Display Lead is lead II.

Contact your local service representative to change the default displayed lead.

Display Lead appears to be selectable at the CIC Pro center. However, your selection is temporary and will revert back to the transmitter’s default displayed lead.

NOTE

When the clinical situation dictates monitoring a lead other than the default lead, you can move the leads and/or electrodes to view a different lead. Be aware that the label on the display and on the printout will show the default lead label.

Lead Analysis Multi-Lead analysis may appear to be selectable at the

CIC Pro center. However, your selection is temporary and will revert back to the Single-Lead analysis mode.

select a V lead V leads may appear to be selectable at the CIC Pro select displayed leads from a single viewer center. However, your selection does not change the transmitter’s default displayed lead.

Leads other than the default displayed lead may appear to selection is temporary and will revert back to the transmitter’s default displayed lead.

Leads other than the default displayed lead may appear to be selectable at the CIC Pro center. However, you must select the transmitter’s default displayed lead to obtain a graph of the waveform.

Arrhythmia

WARNING

INCORRECT ALGORITHMS, ARRHYTHMIA PROCESSING

AND CALCULATIONS BASED ON PATIENT AGE — After manually updating or automatically retrieving patient demographic information from a network database, always confirm that the entered patient’s date of birth matches the patient’s actual date of birth. Otherwise the appropriate age-related algorithms, arrhythmia detection, and calculations will not be applied.

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WARNING

SUSPENDED ANALYSIS—Certain conditions suspend arrhythmia analysis. When suspended, arrhythmia conditions are not detected and alarms associated with arrhythmias do not occur. The messages which alert you to the conditions causing suspended arrhythmia analysis are: ALL ALARMS OFF, ALARM PAUSE, ARR OFF,

ARR SUSPEND, DISCHARGED, LEADS FAIL, and NO

TELEM. Additionally, the alarms off with reason options and disabling the Alarm Pause Breakthrough feature also suspend arrhythmia analysis.

WARNING

VENTRICULAR ARRHYTHMIAS—The arrhythmia analysis program is intended to detect ventricular arrhythmias. It is not designed to detect atrial or supraventricular arrhythmias, with the exception of atrial fibrillation. Occasionally it may incorrectly identify the presence or absence of an arrhythmia. Therefore, a physician must analyze the arrhythmia information in conjunction with other clinical findings.

The arrhythmia control signals the CIC Pro center to ignore or accept arrhythmia calls. To modify arrhythmia settings, use the mouse to click on Full, Lethal, or Off .

NOTE

Full arrhythmia processing is suspended when the level 1 ARTIFACT message is displayed. Lethal arrhythmia is still active but its accuracy may be hindered by the artifact.

NOTE

Draft mode, the program counts the number of

Turning arrhythmia on automatically starts a relearn procedure.

When arrhythmia is turned off, ARR OFF appears in the ECG parameter window.

No arrhythmia detection with 7015 software level patient monitors

If an ApexPro system patient is admitted to a patient monitor at the 7015 software level (ECG source is telemetry, not the monitor), the following scenario may occur when monitoring in Combo or Rover Combo monitoring modes:

Since the 7015 software level does not support arrhythmia processing, arrhythmia detection for the telemetry patient is reduced from full arrhythmia detection to no arrhythmia detection (arrhythmia OFF). This occurs because the software is designed to take on the attributes of the bedside monitor when in

Combo or Rover Combo monitoring modes.



CAUTION

Under these conditions, arrhythmia detection is OFF. There is NO

INDICATION of this at the bedside monitor, central station or CIC

Pro center.

Full arrhythmia conditions

If the patient is later discharged from the monitor, and monitoring continues from telemetry, the message ARR OFF will then appear at the central station or CIC

Pro center. Arrhythmia monitoring remains OFF.

NOTE

Solar 7000 monitors, Solar 8000 monitors, Dash monitors, and Eagle monitors may include the 7015 software level.

The following is an alphabetical list of the Arrhythmia messages that are displayed when full arrhythmia is selected and the condition occurs. Definitions of each condition are included. The CIC Pro center’s response to each condition is determined by the alarm level to which the arrhythmia has been assigned.

BRADY

COUPLET

ACC VENT Adult —Accelerated ventricular occurs when six or more ventricular beats are detected with an average heart rate for the ventricular beat between 50 and 100 beats per minute.

0-2 years —Occurs when six or more ventricular beats are detected with an average heart rate for the ventricular beat between 60 and 160 beats per minute.

Atrial FIB

3-10 years —Occurs when six or more ventricular beats are detected with an average heart rate for the ventricular beat between 60 and 140 beats per minute.

11-13 years —Occurs when six or more ventricular beats are detected

Draft waves proceeding the QRS complex.

NOTE

AFIB alarms can take up to 90 seconds to display while the algorithm verifies the event.

ASYSTOLE

BIGEMINY

Ventricular asystole occurs whenever the displayed heart rate drops to zero.

Occurs when three or more bigeminal cycles (a ventricular beat followed by a non-ventricular beat) are detected.

Bradycardia is the average of the most recent eight R-to-R intervals at a heart rate less than the set LOW heart rate limit.

NOTE

The Brady limit matches the low heart rate limit. If the low heart rate limit is changed, the Brady limit changes.

Occurs when two ventricular beats are detected and have non-ventricular beats before and after the couplet. The coupling interval must be less than

600 milliseconds.

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IRREGULAR

PAUSE

PVC

PVC limit

R ON T

TACHY

TRIGEMINY

Occurs when six consecutive normal R-to-R intervals vary by 100 milliseconds or more.

Occurs when a 3-second interval without a QRS complex is detected.

NOTE

Some bedside monitors allow the Pause time interval to be adjusted.

For more information, refer to the appropriate bedside monitor’s operator’s manual.

Isolated premature ventricular complexes occur when a premature ventricular beat is detected and has non-ventricular beats before and after.

When on, the PVC Limit control displays a PVC counter in the ECG parameter window. When off, the PVC counter is not displayed. Use the mouse to turn the PVC Limit control On or Off . The PVC limits are preset in

Alarm Control defaults.

Occurs when a ventricular complex is detected within the repolarization period of a non-ventricular beat.

Tachycardia is four R-to-R intervals at a heart rate greater than the set HIGH heart rate limit.

NOTE

The Tachy limit matches the high heart rate limit. If the high heart rate limit is changed, the Tachy limit changes.

Occurs when three or more trigeminal cycles (a ventricular beat followed by two non-ventricular beats) are detected.

V BRADY Adult —Ventricular bradycardia occurs when a run of three or more ventricular beats is detected with an average heart rate that is less than or

VFIB/ VTAC equal to 50 beats per minute.

0-2, 3-10, and 11-13 years —Occurs when a run of three or more ventricular beats is detected with an average heart rate that is less than or equal to 60 beats per minute.

Draft

VFIB/VTAC should not be considered a substitute for the V TACH arrhythmia call. Efforts to lower the V TACH alarm level can result in missed ventricular tachycardia alarms.



V TACH

VT > 2

Adult —Ventricular tachycardia occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 100 beats per minute.

0-2 years —Occurs when a run of six or more ventricular beats is detected with an average heart rate greater than or equal to 160 beats per minute.



Adult —Ventricular tachycardia >2 occurs when a run of ventricular beats is detected with a duration of less than six beats but longer than two beats and with an average heart rate that is greater than or equal to 100 beats per minute.

0-2 years —Occurs when a run of ventricular beats is detected with a duration of less than six beats but longer than two beats and with an average heart rate that is greater than or equal to 160 beats per minute.



Lethal arrhythmia conditions

When Lethal arrhythmia is selected, the following conditions (as defined for Full

ASYSTOLE

VFIB/VTAC

V TACH

Draft

AFIB identification

BRADY (if the Patient Age range selected is 0-2 years or 3-10 years )

NOTE

AFIB trending is only available when the bedside monitor supports this feature.

If your bedside monitor does not support AFIB trending, this feature is not available. Contact your sales/service representative for more information.

Atrial fibrillation (AFIB) is characterized by random, chaotic, low-amplitude deflections of the supraventricular component of the ECG waveform, resulting in irregular timing of QRS complexes and an absence of uniform P waves preceding the

QRS complex.

2001989-301A- draft 1 ApexPro™ 7-21


Alarms

7-22

ST analysis

The AFIB algorithm feature identifies atrial fibrillation arrhythmias for the transmitter. When an AFIB event is detected, the ATRIAL FIB alarm text replaces the IRREGULAR arrhythmia alarm text.

AFIB event patient data is stored for review in the Graphic Trends and Vital Signs tab sheets.

A patient status alarm is triggered when an AFIB arrhythmia is detected. The message

ATRIAL FIB is displayed in the message area of the display.

NOTE

There is approximately a 90 second delay while the AFIB algorithm verifies the

AFIB arrhythmia condition.

The AFIB alarm defaults to a Message alarm level but can be changed under

Arrhythmia Alarm Level , in the Telemetry Alarm Control Defaults tab sheet on the

CIC Pro center. How the monitor responds to each condition is determined by the alarm level to which the AFIB arrhythmia detection has been assigned. When set for

Advisory or greater, AFIB alarms will be recorded and displayed in the alarm area on the CIC Pro center.

NOTE

AFIB alarms can only be adjusted at the CIC Pro center. If AFIB is not available/ enabled at a bedside monitor in Combo mode, you will not be able to immediately adjust the alarm. You must discharge the patient from the bedside monitor, adjust the alarm setting at the CIC Pro center and then admit the patient at the bedside monitor.

Draft

ON to display the numerics

GE identifies the ST segment of the QRS complex as beginning at the J point and ending 60 milliseconds following the J point in Adult mode. The ST measurement factory defaults are:

Adult — J+ 60ms

0–2 years — J+ 30ms

3–10 years — J+ 40ms

11–13 years — J+ 50ms

The ST numeric displayed (millimeters) indicates either a positive or negative elevation in relation to the isoelectric reference point (which is also determined by the arrhythmia program and the patient’s age).

When ST is on, numerics are displayed under each ECG lead label on the screen. (A negative deflection is preceded by a minus sign.) These numerics are updated about every 15 seconds.



The ST value shown in the ECG parameter window is the lead with the greatest ST deviation. This may or may not be the lead that is in alarm, since a lead with a lesser deviation from the isoelectric line may have changed more than the lead with the greatest deviation.

NOTE

ST numerics are always calculated with reference to 1X size. Displaying the

ECG waveform at a different size does not affect the ST values.

NOTE

When a new dominant beat is detected or a relearn occurs, the arrhythmia program calculates ST based on the new beat. This could affect the ST values displayed. This may not necessarily represent a change in the patient’s condition.

The clinician needs to assess the patient any time there is an ST change.

NOTE

Adjustable ST alarms are only available when using a CIC Pro center running software version 5 or later. If your CIC Pro center is running an earlier version of software, this feature is not available. Contact your sales/service representative for more information.

ST deviation alarm

Adjusting ST limits

When any individual ST value is beyond the limit, an ST deviation alarm occurs. It is considered a parameter alarm, and the default alarm level is Warning . This can be modified in the parameter alarm level setup.

NOTE

When the ST program is turned on, or a relearn is done with ST on, the ST deviation values are set for all leads of ST.

The current ST value is determined in all eight leads.

Draft

Alarm Control tab.

ST limits can also be adjusted at the CIC Pro center from Monitor Setup > ECG .

ST alarm limits and levels for telemetry patients are typically controlled by the default ST alarm levels from the CIC Pro center. Some bedside monitors allow users to adjust ST alarm limits and levels at the bedside when the patient is admitted in combination monitoring mode. For more information on adjusting ST limits, refer to the bedside monitor operator’s manual.

2001989-301A- draft 1 ApexPro™ 7-23

7-24


SpO2

Introduction

NOTE

SpO2 and SPO2 are used interchangeably throughout this manual to refer to pulse oximetry.

The transmitter supports the Apex oximeter and the Xpod oximeter. Unless specified, oximeter refers to both units.

The Xpod oximeter connects to the transmitter and provides the following oximetry vital signs for display at the CIC Pro center:

arterial oxygen saturation (SpO2) peripheral pulse rate (PPR) perfusion quality indicator

The Apex oximeter functions as a stand-alone device, and displays digital values for

SpO2 and pulse rate. When the Apex oximeter is connected to the transmitter, digital values for SpO2 and pulse rate are also displayed at the CIC Pro center.

NOTE

When monitoring SpO2 using an transmitter, an SpO2 waveform is neither generated nor displayed on the Apex oximeter or CIC Pro center. Additionally, no alarm histories are generated or stored.

SpO2 in the multi-patient viewer

Draft

SpO2 Value

Signal Strength

Indicator

Pulse Rate Value

346B

SpO

2

control settings


1.


2.




3.

Click SPO2/Resp to display the control window.

NOTE

The SpO2 tab is labeled SpO2/Respiration because respiration monitoring settings are available on this tab sheet for bedside monitored patients only.

Respiration monitoring is not an option for telemetry patients. Therefore only SpO2 information appears on this tab sheet when monitoring a telemetry patient.

4.

Change any of the undimmed setting options.

Rate

Size

Option

SpO2 control settings

Function

Turn On to display the SpO

2

heart rate.

Set the waveform size. No waveform is displayed for telemetry patients. This option will appear dimmed.

5.


Click a different Monitor Setup option to apply your changes without closing the Monitor Setup window.

Click the (close button) on the top right side of the window to apply your changes and close the Monitor Setup window.

064A

SpO2 probe safety

Be sure to read all literature accompanying probes for specific safety information. Be aware of the following safety precautions when using SpO2 probes.

2001989-301A- draft 1 ApexPro™ 7-25

7-26


WARNING

DATA VALIDITY—Do not expose probe detector to strong ambient light while monitoring a patient. A poor signal may result.

Do not allow tape to block the probe light detector.

WARNING

PATIENT SAFETY—Prolonged monitoring may require changing the probe site periodically. Move the probe if there is any sign of skin irritation or impaired circulation. Change the probe site AT

LEAST every four hours to prevent ischemic skin necrosis. If required, reduce the application periods to HALF the times recommended above.

If a probe is damaged in any way, discontinue use immediately.

CAUTION

Use only Nonin SpO2 probes with the Apex oximeter and Xpod oximeter. The reliability of SpO2 data obtained with any other probe has not been verified.

Infants and pulse oximetry

extent.

WARNING

The display of inaccurate pulse oximetry (SpO2) values has been

Draft

When using pulse oximetry on infants, always observe the following precautions.

Precautions

We recommend the application of the following criteria when using the pulse oximetry function on infants:

1.

The peripheral pulse rate (PPR) as determined by the SpO2 function must be within 10% of the heart rate, and

2.

the SpO2 signal strength indicator must have 2 or 3 asterisks displayed, and

3.

stable SpO2 values are displayed for six seconds.



Procedures or devices previously applied in your facility for SpO2 monitoring should be used in the event that the SpO2 value from the equipment cannot be validated by the above criteria.

CAUTION

Do not use the Apex oximeter on neonatal patients. It is not designed for use on neonates.

Signal and data validity

It is extremely important to determine that the probe is attached to the patient correctly and the data is verifiable. To make this determination, the signal strength indicators on the Apex oximeter and the CIC Pro center are of assistance.

Signal strength indicator

A signal strength (perfusion) indicator is displayed on the Apex oximeter display and at the CIC Pro center in the appropriate patient window.

On the Apex oximeter, this indicator is a perfusion LED that blinks with each SpO2 pulse detected. The LED blinks green for each acceptable strength pulse. It blinks yellow for SpO2 signals of marginal quality, and blinks red when the SpO2 signal is too weak or the quality is very poor. When the perfusion LED blinks red, the numeric data displayed on the Apex oximeter will be replaced by dashes within 10 seconds.

At the CIC Pro center, the signal strength indicator consists of 0, 1, 2, or 3 (strongest) asterisks, depending on the strength of the signal.

Proper environmental conditions and probe attachment help ensure a strong signal.

Draft artifacts are capable of simulating a plausible parameter reading, so that the monitor fails to sound an alarm. In order to ensure reliable patient monitoring, the proper application of the probe and the signal quality must be checked at regular intervals.

Error messages

If the probe is not correctly attached to the patient and data is not verifiable, one of the following error messages may appear in the patient’s bed window at the CIC Pro center:

SPO2 PROBE OFF

SPO2 PROBE

If either of the above messages appears, check the position of the probe or replace the probe. If the problem persists, call GE Service or contact your sales/service representative.

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7-28


Pressures

The Pressures tab sheet allows you to view and modify settings specific to the viewed telemetry patient’s NBP display. Settings may be viewed for any patient. However, you can only modify settings for patients who are admitted to a bed in your unit.

NOTE

The NBP tab is labeled Pressures because other invasive pressures settings are available on this tab sheet for bedside monitored patients only.

Invasive pressure monitoring is not an option for telemetry patients. Therefore, only NBP information appears on this tab sheet when monitoring a telemetry patient.

Non-invasive blood pressure control settings


1.


2.


3.

Click Pressures to display the control window.

4.

Change any of the undimmed setting options.

Draft

065A



Auto

Cuff Size

Option

Clear Message

Non-invasive blood pressure control settings

button

Function

Turn Off automatic NBP measurements.

When turned On at the monitor, NBP measurements are acquired automatically at regular intervals.

NOTE

This option does not apply to telemetry beds and cannot be turned on from the CIC Pro center.

Set the inflation pressure used during the first NBP measurement and for calculating the NBP pressure:

NOTE

For more information, refer to the appropriate bedside monitor’s operator’s manual.

Clear the display of inflation messages and current NBP readings.

5.


Click a different Monitor Setup option to apply your changes without closing the Monitor Setup window.

Click the (close button) on the top right side of the window to apply your changes and close the Monitor Setup window.

NBP monitoring with telemetry

Draft

WARNING

The following conditions may affect the accuracy of noninvasive blood pressure readings: seizures, tremors, extreme hypotension or hypertension, arrhythmias, or extremely high or low heart rate.

Patient preparation

Blood pressure cuff selection and application are important. Inappropriate selection or improper application of the cuff will result in erroneous measurements.

Most people use their non-dominant arm for acquiring ambulatory noninvasive blood pressure readings.

Follow these steps to prepare the patient for NBP monitoring:

2001989-301A- draft 1 ApexPro™ 7-29


1.

Place the K-sound microphone in the microphone pad (or blood pressure cuff).

For more information on microphone placement, refer to Microphone placement on page 7-30 .

2.

Locate the patient’s brachial artery on the inside of the arm, just above the elbow.

Mark the location with a pen for easy microphone placement.

3.

Remove the backing from the microphone pad and adhere it in the location marked on the patient’s arm. Do not bend or squeeze the microphone. Route the microphone cable up, toward the patient’s shoulder.

4.

Wrap the blood pressure cuff around the arm. Be sure that the artery marker is aligned over the brachial artery.

5.

Drape the cuff hose over the patient’s shoulder and attach an adhesive cuff anchor to the snap on the cuff hose. Do not adhere the cuff anchor to the patient at this time.

6.

Place the blood pressure monitor in its pouch and attach it to the patient using the belt or shoulder strap provided.

7.

Adhere the cuff anchor to the patient’s upper arm by removing the adhesive backing and pressing firmly.

When attached, the blood pressure cuff and hoses should be positioned like those in the following illustration.

Draft Hoses Routed Over

Shoulder

Cuff Anchor Clip

Cuff/Microphone

Connections

408A

Microphone placement

A microphone is used to hear the Korotkoff sounds (K-sounds) that the blood pressure monitor uses to determine the systolic and diastolic pressure readings. The microphone can be placed in a microphone pad and adhered to the patient’s arm under

7-30 ApexPro™ 2001989-301A- draft 1

Viewing real-time patient data the blood pressure cuff, or alternatively, it can be placed directly into the microphone pocket inside the blood pressure cuff.

Placement in the microphone pad

Using a microphone pad is recommended. Place the microphone in the pad as illustrated below. Do not bend or squeeze the microphone when placing it in the pad, or when adhering the pad to the patient’s arm.

Microphone Cable

K-sound Microphone

Microphone Pad

Placement in the blood pressure cuff

As already stated, using the microphone pad is recommended, especially in the case of ambulatory patients or patients with weak K-sounds. However, as an alternative, the microphone can also be placed directly in the blood pressure cuff. Follow the directions below.

NOTE

1.

2.

Blood pressure readings taken with the microphone in the blood pressure cuff

Draft

3.

Open the Velcro pocket flap and gently insert the microphone into the pocket.

4.

When the microphone is completely inserted, close the Velcro flap over the microphone cable and turn the cuff right side out.

5.

Replace the bladder and exit the bladder hose and microphone cable out of the same exit site, either right arm or left arm, as marked on the cuff.

410A

7-31 2001989-301A- draft 1 ApexPro™

7-32


Safety considerations

WARNING

The Accutracker DX blood pressure monitor is designed for use with adult patients only. Do not use on neonates or on patients known to be susceptible to bruising.

Do not attach the blood pressure cuff to a limb being used for IV infusions as the cuff inflation can block the infusion, causing harm to the patient.

CAUTION

The blood pressure monitor’s safety and effectiveness in neonates has not been established.

Blood pressure measurements may be affected by the patient’s position, physical condition, and other factors.

Do not use the blood pressure monitor if it has failed its diagnostic self test or if it displays a pressure greater than zero with no cuff attached. The values displayed by such a unit may be inaccurate.

If you must ship the Accutracker DX blood pressure monitor for service or other reasons, place it in a sealable plastic bag, seal it tightly, then package it in a cardboard box. Label the shipping container –20 to +50° C and ship appropriately. Failure to follow these instructions can result in device failure due to improper shipping/storage conditions.

Draft then the display shows the following:

INT= 5 (***)

INCR DECR START?

NOTE

The number 5 above represents any measurement interval, including MAN

(manual). When the blood pressure monitor is turned on, the number displayed is the last measurement interval set as the default.

Use the YES + button or the NO – button on the blood pressure monitor to increase or decrease the interval ( INT ) at which the blood pressure readings are taken.

The available measurement intervals are: MAN (manual), or 5, 6, 7, 8, 9, 10, 15, 20,

25, 30, 35, 40, 45, 50, 55, 60, 90, 120 , or 240 minute intervals.



When the desired measurement interval is reached, press the START/STOP button.

The blood pressure monitor immediately begins a measurement cycle. It will attempt one retry if the first measurement cycle fails.

Measurements are taken at the selected interval. A measurement may be initiated in between intervals by pressing the START/STOP button. This wakes up the blood pressure monitor from sleep mode, and offers the option to change the measurement interval as described above, as well as the option to view the time left until the next measurement. A manual measurement is initiated by pressing the START/STOP button a second time. The next measurement will then be taken at the scheduled interval (X number of minutes) after the manual measurement is complete.

The patient’s blood pressure is displayed for one minute on the blood pressure monitor and for two hours on the CIC Pro center. The blood pressure reading is updated each time a measurement is successfully completed.

Measurements are taken at the selected interval until the blood pressure monitor is turned off, or until the monitor determines that the batteries are too weak for additional measurements.

A measurement may be stopped by pressing the START/STOP button while the measurement is in progress.

Setting test parameters

The maximum and minimum inflation pressures, dynamic or fixed inflate, and deflate rate can be adjusted. Follow these steps:

1.

Turn the blood pressure monitor on while holding down the NO – button. The

2.

3.

display shows:

CHANGE TEST

Press the

The

Draft

250, 240, 230, 220, 210, 200, 190,

180, 170, 160, 150, 140, 130, 120, 110 , or 100 mmHg using the YES + and NO – buttons. A setting of 200 to 250 mmHg is recommended for the maximum cuff inflation pressure.

4.

When the maximum pressure has been set, press the NEXT button to set the

MINIMUM PRESSURE . It can be set to: 100, 90, 80, 70, 60, 50, 40, 30, 20, or

10 mmHg using the YES + and NO – buttons. A setting of 40 mmHg is recommended for the minimum cuff deflate pressure.

5.

When the minimum pressure has been set, press the NEXT button to select

DYNAMIC INFLATE or FIXED INFLATE . Press the YES + button to turn dynamic inflate on, or press the NO – button for fixed inflate.

When dynamic inflate is turned on, the blood pressure cuff inflation pressure automatically ranges 30 mmHg above the most recent systolic reading.

Fixed inflate always inflates the blood pressure cuff to the set maximum inflation pressure.

2001989-301A- draft 1 ApexPro™ 7-33


Dynamic inflate is recommended for most patients. However, if a patient’s systolic pressure readings vary by 25 mmHg or more, fixed inflate may be more comfortable for the patient. In all likelihood, dynamic inflate would not inflate the cuff high enough for such a patient, prompting the blood pressure monitor to retry, and causing the patient to endure two inflations for each reading. A fixed inflation to the set maximum pressure eliminates the double inflation and increases the patient’s comfort. Reducing the maximum cuff inflation pressure setting for a patient being monitored with fixed inflate will also increase the patient’s comfort.

6.

After selecting dynamic or fixed inflate, the DEFLATE RATE can be set. It can be set to: 6, 5, 4, 3 , or 2 mmHg, using the YES + and NO – buttons. A deflate rate of 3 mmHg per second is recommended.

NOTE

A patient with a slow heart rate requires a slower deflation rate than a patient with a faster heart rate. If the cuff deflates too quickly, it may not be possible to determine a blood pressure. If the cuff deflates too slowly, it may be uncomfortable for the patient. The recommended deflate rate of 3 mmHg per second meets most patients’ requirements, but it can be adjusted when needed.

7.

Press the NEXT button to return to the CHANGE TEST PARAMETERS?

prompt, then press the NO – button to return to:

INT= 5 (***)

INCR DECR START?

Setting limits

limit, at which the blood pressure monitor will reject a systolic, diastolic, or pulse pressure reading and attempt a new measurement. Contact technical support for more information about setting these limits.

Software and hardware versions

To verify what software and hardware versions your blood pressure monitor has, turn on the blood pressure monitor while holding down the LAST button. A display similar to the following appears:

K3:

Vsn: XX/ZZ

0 PR: 0

Your hardware version appears in place of the XX in the above example; your software version appears in place of the ZZ in the above example.

NOTE

Although it is not shown on the blood pressure monitor display, both the software and hardware version have a period in them. For example, if the hardware version reads 11 on the display, this actually indicates that it is hardware version

1.1.

7-34 ApexPro™ 2001989-301A- draft 1

8

Viewing stored patient data

Draft

2001989-301A- draft 1 ApexPro™ 8-1

8-2

Viewing stored patient data

Stored data

The CIC Pro center can retrieve in-unit parameter data from patient monitors connected to the Unity Network and retrieve parameter data from secondary devices connected through a Unity Network Interface. Stored events, parameter numeric data, graphic trends, and full disclosure patient data is identified by the date and time the data was collected. As a result, stored data is linked to a specific time focus.

You can review or print stored patient data from the following data review tools:

Events directory

Event Strip

FD Strip (full disclosure) (purchased option)

FD Page (full disclosure) (purchased option)

Graphic Trends

Vital Signs

Calipers

NOTE

(parameter numeric data)

When using a second display, the second display will always open the most recently used data review tool.

NOTE

Time focus data

Solar 9500 information monitor parameters not supported by the CIC Pro center will not be available for viewing or printing at the CIC Pro center. However, this data will be available locally at the Solar 9500 monitor.

Vital Signs

Draft

Graphic Trends ) that was collected and stored at that same time focus.

As a result, when viewing a patient’s parameter numeric data (vital signs) that was collected and stored at 7:28 pm on January 10, you can select Graphic Trends to view the graphic trend data that was also collected and stored at 7:28 pm on January 10.

NOTE

When reviewing stored ECG data samples or strips, the degree of linking between time focus and the data is determined by your Full Disclosure license.

You can only view full disclosure data that was stored within the time span identified by your Full Disclosure license. If you attempt to view data that exceeds your Full Disclosure license, the CIC Pro center displays the following message: No data is available for requested time .

NOTE

When using a second display, you can display data from two different data review tools using the same time focus in the top and bottom halves of the display screen.



Events directory

From the Events directory, you can view information about any Crisis , Warning , or

Advisory level arrhythmia or ST event that is stored at a bedside monitor. You can also view any ECG data sample that is also stored at a bedside monitor from the

Events directory.

Up to 131 alarm events are stored for each admitted patient, with the following maximum number of event types:

100 arrhythmia alarm events

20 ST limit alarm events

10 samples

1

NOTE

ST reference

The Events directory can be displayed along with the other data review tools. If it is not displayed, you can display the directory by clicking Events .

NOTE

To review stored non-ECG parameter data, use the FD Strip and FD Page data review tools.

Viewing the Events directory

Complete the following procedure to view the Events directory:

1.

From the multi-patient viewer, click on the patient you want to view. The single

2.

patient viewer displays.

Draft

Patient Data...

> Events . The Events

066A

Event list. When the list is sorted by type, click the plus sign to expand the list or the minus sign to collapse the list.

Sort tool. Click the down arrow to sort stored events and data samples by the date and time the event occurred or by the type of event (e.g. arrhythmias).

ApexPro™ 8-3 2001989-301A- draft 1

8-4


Scroll bar. Move up or down through the directory.

Print directory button. Print the list of events displayed in the Events directory.

Up and down buttons. Move up or down through the directory one event at a time.

Delete event button. Delete the selected event or data sample from the Events directory.

Printing the Events directory

Complete the following procedure to print a list of events and data samples stored in the Events directory:

1.

From the single patient viewer, click Patient Data...

> Events . The Events directory displays.

2.

Sort the data by event time or by event type.

3.

Click (print directory button) located under the Events directory to print the displayed list of events.

Counting how many events occurred

Complete the following procedure to identify how many events occurred in each event category (e.g. V TACH or VFIB/VTAC ):

1.


> Events . The Events

2.

When the

Time

Draft

Sort by:

from the displayed list. The list sorts itself by

3.

Use the scroll bar to move up or down through the list. The quantity of each event category is listed in square brackets next to the event name (e.g. V TACH [2] ).

Identifying the most recent occurring event

Complete the following procedure to identify the most recent occurring event:

1.


> Events . The Events directory window displays.

2.

When the Events list is not sorted by date and time, click the down arrow next to

Sort by: Type and choose Sort by: Time from the displayed list. The list sorts itself by event time.

3.

To move up or down through the list of events one at a time, click arrows located under the Events directory.



4.

Use the scroll bar to move up or down through the list of events and data samples.

Deleting a stored event or data sample

NOTE

Deleting an event or data sample from the CIC Pro center Events directory also deletes the corresponding data from the monitor or telemetry system.

When the Patient Data Server ( PDS ) is active, the delete events button is dimmed and you cannot delete any events or data samples from the Events directory.

To delete a stored event or data sample, use the with the red X.

(delete event button)

Complete the following procedure to delete an event or data sample stored in the

Events directory:

1.



2.


3.


4.

Click the single event or data sample you want to delete, or hold down CNTRL and continue to click the left mouse button to select multiple events or data samples.

5.

Click the directory and has a red-colored X on it. A window displays a message similar to the following,

(delete event button). This button is located under the Events

6.

Verify you selected the correct event or data sample for deletion:

Click OK to delete this event or data sample.

Click Cancel if you do not want to delete this event or data sample.

Viewing or printing an Event strip

You can view or print a maximum of a 10-second strip for any arrhythmia event or

ECG data sample stored in the Events directory. You can also view or print the current and reference ST complexes for all available ECG leads.

The following is an example of an Event Strip .

2001989-301A- draft 1 ApexPro™ 8-5


Complete the following procedure to view or print an event strip or data sample stored in the Events directory:

066A

1.



2.


3.


4.

Click on a single event or data sample you want to view or print.

5.

From the patient data menu, click Event Strip . The selected event strip displays.

6.

To print this strip, click single patient viewer.

(print button) located in the upper right corner of the

Full disclosure data

NOTE information, refer to the CIC Pro Clinical Information Center Operator’s Manual.

An admitted patient’s parameter waveforms and numeric data is continually collected for a maximum of 72 hours (license dependent). After the maximum hours of data collection have elapsed, the oldest data is deleted to accommodate newer data.

NOTE

The amount of full disclosure data collected for a patient is determined by the type of licenses installed on the CIC Pro center. One hour of full disclosure data collection and storage is standard without additional licensing.

You can view full disclosure data using the following data review tools:

Full disclosure strip: Automatically scan forwards and backwards through full disclosure data for specific areas of interest.

Full disclosure page: View full disclosure waveform data in a full page format and view specific areas of interest.

8-6 ApexPro™ 2001989-301A- draft 1


Full disclosure strip

A full disclosure strip displays a maximum of 10-seconds of available full disclosure parameter waveforms and numeric data. You can choose to view the waveforms and numeric data for all monitored parameters or all of the ECG waveforms and numeric data.

You can automatically scroll backward or forward through the displayed data, view, and print a selected full disclosure strip.

For more information, refer to the CIC Pro Clinical Information Center Operator’s

Manual.

Viewing or printing a full disclosure strip

NOTE

Requires a laser printer to print.

NOTE

When viewing the full disclosure strip, the arrhythmia label text follows the waveform event and is displayed to the left of the cursor.

Complete the following procedures to view or print a full disclosure strip:

Display the full disclosure strip window

1.


2.


> FD Strip . The full

Draft

1 2 3 4 5 6

8 7

067A

8-7 2001989-301A- draft 1 ApexPro™

9

8-8


FD Strip window

Item Description

1

2

3

4

5

6

7

Parameter numeric data corresponding with the cursor’s time focus.

Speed . Adjust the sweep speed of the scanned waveforms.

For example, when you choose 25 mm/s , the displayed data scrolls in 8second increments.

Scan Older . Scan through the older full disclosure data. When the end of the data has been reached, the scan automatically stops.

During the scanning process, this button function changes to Stop . Click

Stop to stop the scan at any time.

Scan Newer . Scan through the newer full disclosure data. When the end of the data has been reached, the scan automatically stops.

During the scanning process, this button function changes to Stop . Click

Stop to stop the scan at any time.

Print button. Print the full disclosure waveform and parameter numeric data displayed in the FD Strip window.

The print duration of the FD Strip is determined by the in the Strip >

Duration setting in the Full Disclosure Defaults window.

Close button. Close the FD Strip window.

View All ECG . Display all of the available ECG leads and parameter numeric data. Once selected, this button function and label changes to Monitor .

9

8

Monitor . Display all of the parameter waveforms and numeric data displayed at the monitor when the CIC Pro center collected the full disclosure data.

Once selected, this button function and label changes to View All ECG .

Scroll bar. Move backward or forward in time.

Draft

Clicking inside the scroll bar moves the displayed data in time increments defined by the Speed setting.

Clicking the scroll bar arrows moves the displayed data in onesecond increments.

Cursor. Identify the date and time of the parameter waveform and parameter numerics data you are currently viewing.

You can move the cursor by using the scroll bar or by clicking on the waveform to move the cursor to that position.

Print a full disclosure strip

Once you have placed the cursor on an area of interest, you can print a strip of this full disclosure data. The printed strip displays the parameter waveform and numeric data for the selected time focus.

The duration of the printed FD Strip is determined by the in the Strip > Duration setting in the Full Disclosure Defaults window.



Complete the following procedure to print a full disclosure strip:

1.

Position the cursor on the waveform area of interest.

2.

Click (print button) located in the top right corner of the FD Strip window.

The full disclosure strip prints.

Full disclosure page

The full disclosure page allows you to view and examine the full range of stored waveforms, zoom in on areas of interest, and print a customized full disclosure report.

Viewing or printing a full disclosure page

NOTE

Can print to a laser printer or DDW.

Complete the following procedures to view the stored full disclosure waveforms:

Display the FD Page window

1.


2.


> FD Page . The full disclosure page displays.

NOTE

When you select a specific time focus or an alarm event from the Events ,

Event Strip , Graphic Trends , or Vital Signs data review tools, the FD Page

NOTE

Draft full disclosure license, a message similar to the following displays: No patient data is available for the selected time .

8-9 2001989-301A- draft 1 ApexPro™


1 2 3 4 5 6

8-10

8

FD Page window


1

2

Time and date stamp for this row of waveform data.

Zoom box.

Click inside the small blue-colored zoom box to display an enlarged view of the selected waveform area.

Click on another area of interest to re-position the zoom box.

Graphic trends data

3

4

5

6

7

8

Waveform data.

Tools icon. Customize the on-screen display of full disclosure data.

Draft

window.

Scroll bar. Display older or newer data.

Zoom Window . View the enlarged waveform selected in the small bluecolored zoom box.

7

068A

The CIC Pro center can retrieve parameter numeric data from patient monitors connected to the Unity Network and retrieve parameter numeric data from secondary devices connected through a Unity Network Interface. The CIC Pro center can display this collected data in a graphical format, over a specified period of time.

Depending how your CIC Pro center is configured, you can view a maximum of six graphic trends in half-screen mode and a maximum of 12 graphic trends in the fullscreen mode. You can view graphic trends in varying time scales and print them at a laser printer or a digital writer.

A patient’s parameter numeric data is continually collected for a maximum of 24 hours. After the maximum hours of data collection have elapsed, the oldest data is deleted to accommodate the newer data.



The CIC Pro center retrieves non-episodic parameter data at one-minute resolution from the patient monitor and displays it at one-minute resolution. Episodic parameter events (e.g. NBP) are retrieved every time episodic events are recorded. If more than one episodic event occurs during the same minute, the more recent episodic event overwrites the older episodic event.

The CIC Pro center also retrieves AFIB trend data from telemetry patients. AFIB event patient data is stored for review in the Graphic Trends and Vital Signs tab sheets.

Viewing graphic trends

NOTE

From the multi-patient viewer, you can click in the real-time trend window to automatically display the current Graphic Trends window for this patient.

NOTE

When two trends are displayed across from each other in the Graphic Trends window and both trends have the same data values, those graphic trend waveform areas will overlap each other. The overlapping waveform colors will not blend together. This is a normal behavior. As the trend values change, the waveform shape will also change, allowing its individual waveform color to become visible.

NOTE

If you position the time cursor inside a visible gap of trended data, parameter numerics are displayed. Depending upon the position of the time cursor within the gap, the displayed parameter numerics are either the last known parameter values before the gap or the first known parameter values after the gap.

NOTE

Draft

Complete the following procedures to view the graphic trends of parameter numeric data:

Display the graphic trends window

1.


2.


> Graphic Trends . The

Graphic Trends window displays the current parameter trends.

2001989-301A- draft 1 ApexPro™ 8-11


1

2 3

8-12

6 5 4

Graphic Trends window


Graphic Trends window.

Graphic trend scales.

1

2

3 Graphic trend buttons. Identify the trended data and the associated parameter numeric values. Click on a graphic trend button to change the scale of this graphic trend.

4

5

6

Scroll bar. Move backward or forward in time.

Time focus cursor (yellow line) and time focus label (yellow label). Landmark

Draft

Event summary. Display a brief overview of the type and number of events that occurred during a specific time focus.

Choose the trend group you want to display

Complete the following procedure to display trends from a preset group of parameters:

1.

From the Graphic Trends window, click Groups . A list of trend groups displays.

2.

Choose the trend group you want to display.

073A

Adjust the displayed time period

NOTE

The Graphic Trends window displays the current trends.



Complete the following steps from the Graphic Trends window to adjust the start and stop time of the displayed graphic trends:

1.

To make minor time adjustments, use the scroll bar to move backward and forward in time.

2.

To display a specific time range (e.g. 30 Minutes ), complete the following steps: a.

Click Range to display a list of time ranges.

b.

Choose the time range for the displayed trended data. You can choose from

15 , 30 minutes or 1, 2, 4 , 8 , 12 , 24 hours.

Adjust the trend scale size

Complete the following steps to adjust the scale size of a parameter trend:

1.

From the Graphic Trends window, click on the parameter trend you want to adjust. A window displays the parameters scales available for the selected parameter trend.

2.

Choose the desired scale. The window closes and the scale setting is automatically applied.

3.

Repeat step 1 and step 2 for each parameter trend scale you want to adjust.

Printing graphic trends data

When printing graphic trends data, the following factors apply:

Graphs print in the same scale as displayed on screen.

A maximum of four graphs can be printed on each page.

The event trend prints on its own page and includes all the event calls that line.

Draft center print only to a laser printer. If the graphic trend printout is initiated from a patient’s bedside, it can print to a digital writer or to a laser printer (depending on how the print functions are configured on the monitor).

For telemetry patients, graphic trend printouts can print to a laser printer or to a digital writer.

NOTE

When printing graphic trends data from telemetry patients to a digital writer, the time duration of the printed output is as follows:

Digital writer output for stored telemetry graphic trends data

Printed output Displayed data

15, 30, 60 minutes

2 hours

4 hours

90 minutes

3 hours

6 hours

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8-14


8 hours

24 hours

Digital writer output for stored telemetry graphic trends data

Displayed data Printed output

12 hours

24 hours

To print the displayed graphic trends data, click right corner of the Graphic Trends window.

(print button) located in the top

Vital signs data

The CIC Pro center can continuously retrieve parameter numeric data (vital signs) from in-unit or out-of-unit patient monitors connected to the Unity Network and retrieve parameter numeric data from secondary devices connected through a Unity

Network Interface.

You can view trended parameter numeric data for varying time intervals. When the

CIC Pro center is connected to a laser printer, you can also print the trended parameter numeric data. Telemetry beds can print to a writer if a laser printer is not connected to the CIC Pro center.

For non-episodic parameters (e.g., HR), a median value is determined and stored for display at one-minute resolution. Episodic parameters (e.g., NBP) are stored every time one occurs. If more than one episodic event occurs during the same minute, the more recent event overwrites the earlier one.

NOTE

NOTE

When the first parameter on the list is an episodic parameter (e.g. NBP), all other

Draft

Episodic data is displayed at the closest time interval for the selected time. If the time for the measurement occurred before or after the displayed time, an ellipses symbol (...) is appended after the episodic value.

The CIC Pro center also retrieves AFIB trend data from telemetry patients. AFIB event patient data is stored for review in the Graphic Trends and Vital Signs tab sheets.

Viewing vital signs data

Complete the following procedure to view periodic and episodic trend data in a tabular format:

1.




2.


> Vital Signs . The Vital

Signs window displays.

1 2 3

2001989-301A- draft 1

6

Vital Signs window


1 Vital Signs sort tool. Click the down arrow to choose the data group you want to display.

2 Print button. Print the list of events displayed in the Events directory.

3

4

5

6

Draft

3.

Click the down arrow next to the Vital Signs sort tool and choose the data group you want to display. The data sorts itself by your chosen category.

NOTE

Close button. Close this window.

Scroll bars. Move up and down or left and right through the displayed data.

Focus indicator. Highlights one event for easier viewing.

Interval button. Click the down arrow to choose the time interval of the displayed data.

When reviewing data in the Vital Signs window, be aware that if you changed to monitoring a different V lead, both the current and previous V lead data is trended and both V lead labels will appear in the Vital Signs window. In addition, the V lead numeric data appears at the time the V lead data was collected.

4.

Click the Interval button to choose the time interval of the displayed data. You can choose from 1 , 5 , 15 , 30 , or 60 minutes.

5.

Use the up and down or left and right scroll bars to move through the displayed data.

4

074A

5

ApexPro™ 8-15

8-16


Printing vital signs data

NOTE

Up to five events of the Vital Signs data for telemetry patients can be printed to a digital writer.

Complete the following procedure to print periodic and episodic trend data in a tabular format to a laser printer:

1.


> Vital Signs . The Vital

Signs window displays.

2.

Click the down arrow next to the Vital Signs sort tool and choose the data group you want to display. The data sorts itself by your chosen category.

3.

Click the Interval button to choose the time interval of the displayed data.

4.

Click window.

(print button) located in the top right corner of the Vital Signs

Measuring ECG waveform intervals and amplitude

NOTE

This section provides a brief overview of the calipers function. For more information, refer to the CIC Pro Clinical Information Center Operator’s Manual. window:

When full disclosure data is collected and stored at the CIC Pro center, you can use the Calipers measurement tool to measure the PR, QRS, QT, and R-R waveform intervals and the ST waveform amplitude.

Draft

Calipers

1.


2.


Then, choose the data review tool you want to use to locate a waveform segment or waveform strip you want to measure.

NOTE

When an event or ECG data sample occurs outside of the time limit of your full disclosure license, the data will not be available to view from the

Calipers measurement tool.

3.

Click Calipers to display the Calipers window. Ten seconds of waveform data displays.


2001989-301A- draft 1

1 2


6 6

5 4

Calipers window


1 Measurement table. Enter or clear the waveform measurement values for the

PR, QRS, QT, R-R, and ST intervals or amplitudes.

NOTE

The QTc value is a calculated value.

2 Measurement window. View, measure time intervals and amplitude for displayed waveforms, and compare the interval of multiple waveform

3

4

5

6 complexes.

Scroll bars. Move up and down or left and right through the displayed data.

Draft

Measurement : Choose one of the following leads to measure: I, II , III , V ,

AVR , AVL , and AVF . For telemetry only, a second V lead would be available for display.

Reference : Fill the Enable box with a check mark and choose one of the following reference leads for display: I , II , III , V , AVR , AVL , and AVF . For telemetry only, a second V lead would be available for display. Measurements taken on a reference lead are not recorded in the measurement table.

Gain : Adjust the gain of the displayed waveform.

Marching Calipers : Compare the rate of multiple waveforms.

Grids : Apply a background grid.

Zoom : Zoom in for a closer look at the waveform.

Speed : Change the sweep speed of the displayed waveform.

3

079A

ApexPro™ 8-17


4.

Click (print button) located in the top right corner of the Calipers window.

All measurements are lost when the window is closed.

Reports

The following reports are available for telemetry patients if a laser printer is configured for the CIC Pro center. These reports are enabled and configured through

Webmin. Refer to the CIC Pro Clinical Information Center Bedrock Hardware

Platform Service Manual for more information.

Patient discharge summary report

The Patient Discharge Summary report automatically prints to a configured laser printer for the CIC Pro center when a telemetry patient is discharged. The report provides general patient, system status alarm and patient status alarm information.

8-18

Draft

Transmitter battery status report

The Transmitter Battery Status report prints to a configured laser printer for the CIC

Pro center on a user demand basis. The report lists all transmitters with admitted telemetry patients, the associated unit and bed name and transmitter’s current battery level.


9

Printing

Draft

2001989-301A- draft 1 ApexPro™ 9-1

9-2

Printing

Print devices

You can print real-time and stored parameter data to the following Unity Network print devices:

PRN 50-M digital writer

Laser printer

Print output

You can print displayed real-time or stored parameter data from a CIC Pro center or from other GE patient monitors that are connected to the Unity Network.

The type of parameter data available to print depends on the source of the patient data

(e.g., hardwired bed, Combo bed, or telemetry bed) and from where you choose to initiate the printing of this information (e.g., CIC Pro center or patient monitor).

Telemetry bed parameter data

The following table identifies the telemetry bed parameter data available to print from a CIC Pro center or GE patient monitor.

Telemetry bed parameter data

Parameter data

Vital Signs

Graphic Trends

Alarm history

Events directory

Alarm control

Data printed from a CIC

Yes

Yes

Yes

Yes

Yes

Pro center

Writer

Draft

Printer

Yes

Yes

Yes

Yes

Yes

View patient Yes Yes

Alarm graph

Full disclosure strip

Full disclosure report

Calipers

--

--

Yes

--

Yes

Yes

Yes

Yes

Writer

--

--

Yes

Yes

Yes

--

Yes

Yes

Yes

Yes

Data printed from a monitor

Printer

--

--

Yes

Yes

Yes

--

Yes

Yes

Yes

Yes

Graph location

Where your data prints out (graph location) is first determined by the default Graph

Setup control settings and second, by other operating conditions.


Use the following guidelines to identify the operating conditions that determine where your data prints out (graph location):

Manual graphs and print windows: These print at the CIC Pro center where the graph was requested, provided that CIC Pro center has the same type of writer or printer as the graph location set for the patient for that type of graph. If the CIC

Pro center where the graph was requested does not have the same type of writer or printer, the graph prints to the patient’s specified graph location.

When the CIC Pro center is not connected to a printer: When viewing a patient on a CIC Pro center that is not connected to a printer, the graph settings default to the graph location configured in the Graph Setup defaults.

Patient moved to a different bed: When you move a patient bed, the patient’s graph settings are retained as set on the CIC Pro center where the patient was first admitted.

Duplicated telemetry patient: When a telemetry patient is duplicated on another

CIC Pro center, alarm graphs continue to print at the CIC Pro center where the patient was first admitted.

No graph location for a telemetry patient: When no graph location is defined for a telemetry patient at the time of admission, the message Saving displays. Graphs are not sent to printers outside the unit.

Printing real-time data

In addition to patient alarm graphs printing automatically, you can print a continuous strip for a single patient, or print parameter waveforms or parameter limits for all patients displayed in the multi-patient viewer.

To print real-time data, see the following sections of this manual:

Printing a continuous ECG strip on page 7-8 .

Draft

.

You can print patient data that has been collected and stored at this CIC Pro center.

To print stored patient data, see the following sections of this manual:

Printing the Events directory on page 8-4 .

Viewing or printing an Event strip on page 8-5 .

Viewing or printing a full disclosure strip on page 8-7 .

Printing graphic trends data on page 8-13 .

Printing vital signs data on page 8-16 .

Initiating a manual graph

If you click on a patient’s ECG parameter window, a continuous graph is initiated for the patient. Clicking on the ECG parameter window again will stop the graph.

Printing

2001989-301A- draft 1 ApexPro™ 9-3

9-4

Printing

The PRN 50 digital writer and the Direct Digital Writers (DDW) print patient data

(generally referred to as a graph or graph strip). Data can also be printed on a laser printer.

The waveforms graphed and graph speed are controlled in the individual patient’s

Graph Setup tab sheet. Unit defaults for telemetry patients can be set in the CIC

Defaults tab sheet and the Telemetry Unit Defaults tab sheet. Refer to Telemetry unit defaults on page 4-7 for more information on setting Telemetry Unit Defaults .

Transmitter initiated graphs (manual graphs)

When the Graph button on the transmitter is pressed, a 20-second graph strip is printed at a speed of 25 millimeters per second and the event is stored in alarm history.

When an IMPACT.

wf paging system (version II or later) is also available in the same care unit, pressing the Graph button enables the View on Demand feature (also called the Apex Graph Button Push feature). The IMPACT.

wf server generates a manually initiated sample page or snapshot of the patient’s ECG waveform and any other enabled/monitored non-arrhythmia parameters.

When you press the Graph button on the transmitter, it generates both an IMPACT.

wf update page as well as a standard ECG waveform graph at the CIC Pro center. The

IMPACT.

wf page is labeled Sample when this data is displayed on the IMPACT.

wf receiver and stored in history. Additionally, all pagers assigned to the patient receive a page.

Automatic alarm graphs

A graph prints automatically when a patient experiences a Crisis or Warning alarm

Draft

Graph messages

This saved graph will print when a printer becomes available.

One of the following messages is displayed on the CIC Pro center screen during graphing:

GRAPH ALARM —An alarm graph was initiated and is running.

GRAPH MANUAL —A manual graph was requested and is running.

GRAPH TTX —The Graph button on the transmitter was pressed and a 20-second graph strip is running.

PRINTING —A non-real time graph is currently being printed.

SAVING —An alarm or a manual graph has been requested but the writer is in use; the writer door is open; or the writer is out of paper. The graph is being saved until the


Graph all patients

writer is available. The most recent 20-second alarm or manual graph will be saved in alarm history. Additional data maybe available with Full Disclosure.

Clicking on the Print button at the bottom of the CIC Pro center display sends a

Graph All Patients request to all beds displayed on the CIC Pro center, initiating a 10second graph for all telemetry and Combo patients and a 20-second graph for all bedside patients. When this option is selected for telemetry patients, graph requests always print at a speed of 25 millimeters per second.

NOTE

This Graph All Patients function is only available when the single patient viewer is closed. If a single patient viewer is open, selecting Print from the main menu initiates a printout of whichever tab sheet is in front.

The print process stops automatically. If the Graph Stop control key is pressed on the external DDW, the current patient’s graph stops and the writer begins to print a graph for the next patient.

If a patient’s data is currently printing or is being saved to print when a Graph All

Patients request is initiated, this patient’s data will not be included in the Graph All

Patients graph. This patient’s data will print independently of the Graph All Patients graph.

Clicking on the ECG parameter window for a patient whose data is saving will cancel the Graph All Patients request for that patient.

If, while a Graph All Patients request is in progress, an arrhythmia alarm occurs for a patient, the alarm data will replace the data that was saved for the Graph All Patients request. The alarm data will then appear on the graph printout.

Draft

Initiating a graph all patients request

To initiate a Graph All Patients request, follow these steps.

1.

Click on the Print button at the bottom of the CIC Pro center display. The Graph

All Patients window opens.

2.

Click on Limits or Waveforms .

Selecting Limits graphs all patient limits.

Selecting Waveforms graphs all patient waveforms.

3.

Click on the OK button to complete the Graph All Patients request.

Printing

2001989-301A- draft 1 ApexPro™ 9-5

9-6

Printing

Stopping a print job

You must stop a print job from the same CIC Pro center you used to send the print job to the printer.

Stop printing to a laser printer

Complete the following procedure to stop printing all print jobs sent to the laser printer:

1.

From the multi-patient viewer, click CIC Setup > CIC Defaults . The CIC

Defaults window displays.

2.

Under Printer/Writer , click Cancel Print Jobs for the printer you want to stop printing to.

3.

After making your selection, complete one of the following tasks from the CIC

Defaults window:

Click

Click

Click

OK

Cancel

Apply window.

to apply your changes and close the CIC Defaults

to cancel your changes and close the

to apply your changes without closing the

window.

CIC Defaults window.

CIC Defaults

Stop printing to a local digital writer

Complete the following procedure to stop printing all print jobs sent to a local digital writer:

1.

2.

Press the

Draft

To temporarily adjust the graph location and settings for a specific patient, complete the following procedure:

NOTE

All changes are temporary and return to the default settings when the patient is discharged. To permanently change these settings, see the CIC Pro Clinical

Information Center Bedrock Hardware Platform Service Manual.

1.


2.

From the single patient viewer, click Monitor Setup > Graph Setup to display the Graph Setup window.


Printing

081A

3.

Change any of the undimmed setting options. When an option appears dimmed, you cannot change it unless you enter the service-level password.

Option

Graph Waveforms

Graph Location

Enable Transmitter Graph

Speed

Function

Set the print order of the ECG waveforms:

ECG 1: Set the lead and its associated waveform to print first.

Waveform 2 : Set the ECG lead or parameter and its associated waveform to print second.

Waveform 3 : Set the ECG lead or parameter and its associated waveform to print third.

Waveform 4 : Set the ECG lead or parameter and its associated waveform to print fourth.

Choose from available printers to set the graph location of the manual, alarm, and print window graphs:

Manual : Any real-time patient data you initiate the

Alarm : An alarm graph that is triggered by a patient

printing of.

or Warning alarm condition.

: Any stored patient data you initiate the printing of. This graph location also prints the

Graph All > Limits data.

Turn on or turn off the ability to initiate graph printing from a transmitter.

Set the print speed. The slower the speed, the more condensed the data. 25 mm/second is standard.

Enable transmitter graph

The Enable Transmitter Graph option allows you to turn off/on the Transmitter

Graph function for telemetry patients. When this option is enabled at the CIC Pro center, you can initiate a graph by pressing the graph button on the transmitter. When this option is disabled at the CIC Pro center, no graph can be initiated from the transmitter. To enable or disable this option, follow this procedure:

1.

To enable the Transmitter Graph option, point and click with the mouse to place a check mark in the Enable Transmitter Graph check box.

2001989-301A- draft 1 ApexPro™ 9-7

9-8

Printing

Enable

Transmitter

Graph Check Box

2.

To disable the Transmitter Graph option, point and click with the mouse to remove the check mark in the Enable Transmitter Graph check box.

357C

Alarm graphs enabled/disabled

This message line indicates whether the graph on alarm feature is on ( Alarm Graph

ENABLED ) or off ( Alarm Graph DISABLED ). This feature cannot be set on an individual patient basis. Use the Alarm Graph option in the Telemetry Unit Defaults tab sheet to set it for all patients admitted to the CIC Pro center.

Graph paper out indicator

When there is no graph paper in the writer (or the door is open), the message Graph

Paper Out/Door Open is displayed at the top of the screen.

When printing to a laser printer, a similar status message is displayed if the printer is unable to print.

NOTE

Draft


A

Abbreviations and symbols

Draft

2001989-301A- draft 1 ApexPro™ A-1

Abbreviations and symbols

Abbreviations

ANT

Arr, Arrhy

ART

Auto

Aux

A-V

AVG

AVOA

AC

Acc

ACI

AD

ADU

AFIB

ALRM

AMI

Abbreviations and symbols that you may encounter while reading this manual are listed below with their meanings.

12SL 12-lead ECG analysis

A alternating current accelerated acceleration index adult alarm display unit atrial fibrillation alarm acute myocardial infarctions anterior arrhythmia arterial automatic

BIS

BP

Brady

BT

C

Cal

Calc, calcs cc

CC

CCO

CD automatic view on alarm

B bispectral index blood pressure bradycardia blood temperature

C celsius calibrate calculation(s) cubic centimeter computation constant continuous cardiac output compact disc

A-2 ApexPro™ 2001989-301A- draft 1

2001989-301A- draft 1 comm

CP

CPP

CRG

CSA

CVP

CI

CIC cm

CO

CO

CO

2

D

DES

DIDCA

DSC cardiac index

CIC Pro Clinical Information Center centimeter cardiac output carbon monoxide carbon dioxide communication cardiopulmonary cerebral perfusion pressure cardiorespirogram

Canadian Standards Association central venous pressure

D diastolic desflurane direct interface device connection adapter digital signal converter

E

F

FEM et al

ET CO

2 etc.

ETO

EXP

ESU

E e.g.

ECG

EEG

EMC

EMI

ENF eDO2I expired for example electrocardiograph

Draft electromagnetic interference enflurane electrosurgical cautery unit and others end-tidal carbon dioxide etcetera ethylene oxide expired

F

Fahrenheit femoral


ApexPro™ A-3

A-4

Abbreviations and symbols kg

L, LD

L l

LA

LA

LAN g gHz gtt

HAL

Hb

HR

Hz

I

IABP

ICG

ICP

ICU

ID in

INDV

G gram gigahertz drops

H halothane hemoglobin heart rate hertz

I inspired intra-aortic balloon pump impedance cardiography intracranial pressure intensive care unit identification inches individual

INF

INSP

INT

ISO

IT

IV

J

Inject infusion, inferior injectate inspired

Draft intravenous

J

ST measurement point

K kilogram

L lead left liter left arm left arterial local area network


2001989-301A- draft 1

P

PA

PAD

Par

PAW

PC

LAT lbs

LCWI

LED

LIS

LL

LVET

LVSWI

M

MAC

MAP

Min mm mmHg

MPSO

MRI ms lateral pounds left cardiac work index light emitting diode lab information system left leg left ventricular ejection time left ventricular stroke work index

M mean minimum alveolar concentration mean arterial pressure minimum millimeters millimeters of mercury multiple portable socket outlet magnetic resonance image milliseconds

OR

O

2

CI

N

2

O

O

2 mV

N/A

NBP, NIBP

Neo millivolt not applicable

Draft

N non-invasive blood pressure neonatal oxygen

O oxygen consumption index operating room

P pace pulmonary artery pulmonary artery diastolic parameter pulmonary artery wedge personal computer


ApexPro™ A-5

A-6

Abbreviations and symbols partial pressure of arterial carbon dioxide pCO

2

, pO

2

PED

PEP

PVC

QRS

Qty

R

R

R&TTE

RA

RA

REF

Reprep

RES

Resp

RF pediatric pre-ejection period premature ventricular resistance

Q interval of ventricular depolarization quantity

R right rate

Radio and Telecommunication Terminal Equipment right arm right artial reference re-prepare resistance respiration radio-frequency

SP

SpO

2

SQI

ST

Stat

STR

SV

SvO2

RL

RR

S sec

SEV

SIM

Sol

RHY rhythm right leg respiration rate

Draft

S sevoflurane simulator solution special arterial oxygen saturation (pulse oximetry) signal quality index interval of ventricular repolarization right away systolic time radio stroke volume mixed venous oxygen saturation


Symbols

2001989-301A- draft 1

SVR

SVRI

Sync

T1, T2

Tachy

TC

Tech

Temp, TMP, TP

TFC

TIR

UAC

UO

UVC

V

V

X

X systemic vascular resistance systemic vascular resistance index synchronized

T temperature sites tachycardia transcutaneous technical temperature thoracic fluid content technical information report

U umbilical artery catheter urometer umbilical venous catheter

V volt version

WF, WFS

V

Vent

VFib

VI

VOA

Vol

VTach ventrical lead ventilator ventricular fibrillation

Draft ventricular tachycardia

W waveform(s)

X multiplier (2X) invalid data


&

°

ApexPro™ and degree(s)

A-7

A-8


"

µ

%

±

-

#

>

< greater than less than minus number percent plus or minus inches micro

Draft


B

Customized defaults worksheet

Draft

2001989-301A- draft 1 ApexPro™ B-1

B-2

Customized defaults worksheet

NOTE

Before filling out this worksheet, you should make additional copies for future use.

Use this worksheet to record customized settings for the following defaults:

Alarms Off selection on page B-2 .

Telemetry Unit Defaults on page B-2 .

Telemetry parameter limits and alarm levels on page B-3 .

Alarms Off selection

This telemetry setting is located in CIC Setup > CIC Defaults .

Allow Alarms Off On this CIC ? (Circle one) Yes No

Telemetry Unit Defaults

ECG

Graph Setup

Default Locations for this CIC

Telemetry unit default

Waveforms

Manual

Alarm

Print Window

ECG 1

Waveform 2

Waveform 3

Waveform 4

Alarm Graph

Draft

Transmitter Graph

II

V

Off

Off

On

Always On

Event Marker Graph On

Default setting

Display Lead

Arrhythmia

Lead Analysis

ST Analysis

Va Lead

Vb Lead

Detect Pace

V1

V2

Off

II

Full

Multi-Lead

On



Telemetry unit default

Patient Age

Transmitter Pause

Alarm Pause Breakthrough

Event Marker

1

1

The Event Marker Graph and Event Marker features are not applicable to all transmitters.

Adult

Enabled

Always On

On

Default setting

Telemetry parameter limits and alarm levels

ST-V4

ST-V5

ST-V6

ST-AVR

ST-AVL

ST-AVF

NBP-S

NBP-D

Parameter Limits and Alarm Levels

HR bpm

ST-I

ST-II mm mm

ST-III

ST-V

ST-V2

ST-V3 mm mm mm mm mm mm mm mm mm mm mmHg mmHg

NBP-M

SPO2

SPO2-R

RR

RR-APNEA

PVC mmHg

% bpm breaths/min seconds

#/min

30

30

6

120

140

105

150

2.0

2.0

2.0

200

-2.0

-2.0

80

20

-2.0

-2.0

-2.0

-2.0

40

90

50

5

-2.0

-2.0

-2.0

-2.0

Low

50

-2.0

-2.0

2.0

2.0

2.0

2.0

High

150

2.0

2.0

Level

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Warning

Advisory

Arrhythmia Alarm Levels

Asystole

VFIB/VTAC

V Tach

VT > 2

V Brady

Acc Vent

Pause

Couplet

Bigeminy

Trigeminy

PVC

Irregular

Atrial Fib

Advisory

Advisory

Message

Message

Message

Message

Message

Message

Message

Levels

Crisis

Crisis

Crisis

Crisis

Crisis

Advisory

Advisory

System Alarm Levels

CHANGE BATTERY

OFF NETWORK

ARR SUSPEND

LEADS FAIL

PROBE OFF

Levels

System Warning





2001989-301A- draft 1 ApexPro™ B-3


B-4

Draft


C

Maintenance

Draft

2001989-301A- draft 1 ApexPro™ C-1

C-2

Maintenance

Biocompatibility

When used as intended, the parts of the product described in this operator manual, including accessories that come in contact with the patient during the intended use, fulfill the biocompatibility requirements of the applicable standards. For more information, contact your local sales/service representative.

Supplies

To ensure patient safety, use only supplies manufactured or recommended by GE. For more information, contact your local sales/service representative.

Inspection

An effective maintenance schedule should be established for your monitoring equipment and reusable supplies. This should include inspection as well as general cleaning on a regular basis. The maintenance schedule must comply with the policies of your institution’s infection control unit and/or biomedical department.

CAUTION

Failure on the part of the responsible hospital or institution employing the use of this monitoring equipment to implement a satisfactory maintenance schedule may cause undue equipment

failure and possible health hazards.

Check with your biomedical department to be sure preventive maintenance and

Draft

Inspect the equipment for obvious physical damage.

Inspect all cords for fraying or other damage.

Inspect all plugs and connectors for corrosion, contaminants, bent prongs or pins.

Inspect all cable insulation for cracks, tears, or other damage.

In the U.S., GE Service is available 24-hours a day by calling 800-558-7044. Outside the U.S., please contact your local sales/service representative.

NOTE

Refer to the appropriate service manuals for more comprehensive checkout procedures.


Maintenance

Disposal

Cleaning

2001989-301A- draft 1

WARNING

PACKAGING DISPOSAL—Dispose of all packaging material, observing all applicable waste control regulations and keeping out of children’s reach.

WARNING

DISPOSAL—At the end of its service life, the products described in this manual, as well as its accessories, must be disposed of in compliance with guidelines regulating the disposal of each product.

If you have any questions concerning disposal of a product, please contact GE or its representatives.

All equipment should be cleaned on a regular basis. Comply with the policies of your institution’s infection control unit and/or biomed department. The decision to disinfect or sterilize must be made per your institution’s requirements with an awareness of the effect on the integrity of the transmitter and leadwire.

WARNING

Disconnect AC-powered equipment from the power line before cleaning or disinfecting its surface. Turn off the power to battery-

Draft cause infection. Always follow the skin preparation guidelines and leadwire cleaning instructions provided in this manual.

WARNING

IMPROPER TRANSMITTER/LEADWIRE APPLICATION —

Applying a transmitter and/or leadwire that is not thoroughly dry to a patient can result in an electrically conductive path being established and a Leads Fail alarm not being provided if leadwires come off the patient.

CAUTION

Never immerse devices, cables, or leadwires in any liquid.

ApexPro™ C-3

C-4

Maintenance

CAUTION

Do not pour or spray any liquid directly on cables or leadwires or permit fluid to seep into connections or openings.

CAUTION

Never use conductive solutions, solutions that contain chlorides, wax, or wax compounds to clean devices, cables or leadwires.

CAUTION

Never use solutions or products that contain the following:

Any type of Ammonium Chloride such as, but not limited to:

Dimethyl Benzyl Ammonium Chloride

Quaternary Ammonium Chloride solutions

Abrasive cleaners or solvents of any kind

Acetone

Ketone

Betadine

Alcohol-based cleaning agents

Sodium salts

Results of improper cleaning

CAUTION

Never autoclave or steam clean devices, cables or leadwires.

Draft

Appearance of waveforms when the device is not connected to a patient, causing false alarms instead of a Leads Fail alarm and may not provide a visual and/or audible Leads Fail alarm.

Brittle and breaking device case.

Overall system performance degradation.

Melting, dulling, or distorting the case.

Total handheld medical device failure requiring replacement.

Unit malfunction.

Void warranty.


Maintenance

Cleaning products to avoid

Cleaning products known to cause the types of problems listed above include, but are not limited to:

Sani-Cloth Wipes

Ascepti Wipes

HB Quat

Clorox Wipes (they do not contain bleach)

Over-the-counter detergents (e.g. Fantastic, Tilex, etc.)

Products that contain active ingredients and solutions similar to these products should also be avoided.

Transmitter/device cleaning

These instructions apply to transmitters and any other devices, such as oximeters, blood pressure monitors, etc.

Cleaning/disinfecting

1.

Remove all batteries and leadwires.

2.

Close the battery door before cleaning the device.

3.

Wipe the exterior of the device with a soft lint-free cloth, using the following solution as recommended in the APIC Guidelines for Selection and Use of

Disinfectants (1996):

Sodium hypochlorite (5.2% household bleach) minimum 1:500 dilution

NOTE

Draft

Wring excess disinfectant from wipe before using.

NOTE

Any contact of disinfectant solutions with metal parts may cause corrosion.

4.

Allow disinfectant solution to remain on device for a minimum of one minute or per hospital guidelines.

5.

Wipe off cleaning solutions with a clean, moist cloth.

6.

Dry thoroughly with a dry lint-free cloth and let air dry for at least 30 minutes.

NOTE

Drying times may vary based on the environmental conditions.

7.

Take care not to let fluid pool around connection pins. If this should happen, blot dry with a soft, lint-free cloth.

2001989-301A- draft 1 ApexPro™ C-5

C-6

Maintenance

Storage

Always remove batteries when the device is not in use (even for short periods of time).

Store in a dry well-ventilated area.

Hang the device, use a holder if available.

If leadwires/cables are attached, they should hang straight.

Do not coil leadwires/cables tightly around the device.

ECG cable/leadwire cleaning

Results of improper cleaning

Product discoloration.

Metal part corrosion.

Brittle wires.

Brittle and breaking connectors.

Reduced cables and leadwires life.

Unit malfunction.

Void warranty.

Cleaning/disinfecting

1.

Remove cables and leadwires from the handheld device or system before

2.

3.

cleaning.

Draft

4.

For disinfecting the cables and leadwires, wipe exterior with a soft lint-free cloth, using the following solution as recommended in the APIC Guidelines for

Selection and Use of Disinfectants (1996):

Sodium hypochlorite (5.2% household bleach) minimum 1:500 dilution

(minimum 100 ppm free chlorine) and maximum 1:10 dilution.

Any sodium hypochlorite wipe product that meets the above guidelines of can be used.

NOTE

Wring excess disinfectant from wipe before using.

NOTE

Any contact of disinfectant solutions with metal parts may cause corrosion.

5.

Do not immerse either end of a cable or leadwire connector. Immersing or soaking the connector ends may corrode metal contact ends and affect signal quality.


Sterilizing

Storage

Maintenance

6.

Wipe off cleaning solutions with a clean, lightly moistened cloth.

7.

Dry thoroughly with a dry lint-free cloth and let air dry for at least 30 minutes.

NOTE

Drying times may vary based on the environmental conditions.

8.

Take care not to let fluid pool around connection pins. If this should happen, blot dry with a soft, lint-free cloth.

9.

Do not use excessive drying techniques, such as oven, forced heat or sun drying.

NOTE

EtO sterilization is not recommended , but may be required for cables and leadwires. Frequent sterilization will reduce the useful life of cables and leadwires.

Sterilize with ethylene oxide gas (EtO) at a maximum temperature of 50° C (122° F).

After EtO sterilization, follow the recommendations from the sterilizer manufacturer for required aeration.

Store in a dry well-ventilated area.

Vertically hang cables and leadwires.

Do not coil leadwires or cables tightly around any medical device.

Draft

C-7 2001989-301A- draft 1 ApexPro™

Maintenance

C-8

Draft


D

Troubleshooting

Draft

2001989-301A- draft 1 ApexPro™ D-1

D-2

Troubleshooting

ECG

Arrhythmia troubleshooting

Problem: Inaccurate heart rate and/or false asystole

Solution: Check ECG signal from patient:

1.

Check/adjust lead placement.

2.

Check/perform skin preparation.

3.

Check/replace electrodes.

Check amplitude of ECG waveform:

1.

Click on the patient’s ECG tab.

2.

Click on all ECG leads in the Display section and check for 0.5 mV amplitude at normal (1X) size. (At least 0.5 mV amplitude is required for QRS detection.) For borderline signals, validate on a graph.

3.

If amplitudes are low, electrodes may need to be repositioned or replaced.

Relearn arrhythmia:

1.


2.

Click on the Relearn button.

Problem: False ventricular calls

IF PROBLEM CONTINUES: Change to Single-Lead ECG detection and processing:

1.


2.

3.

Click on

Draft

section.

Click on the ECG leads in the Display section and change top ECG waveform to display the lead with the greatest amplitude. (At least 0.5 mV amplitude is required for QRS detection.)

Solution: Check ECG signal from patient: (V leads may exhibit polarity changes which may occasionally cause an inaccurate call.)

1.


2.


3.

Check/replace electrodes. (If V lead is a problem, move the V lead to another V position.)

4.

Relearn ECG:



IF PROBLEM CONTINUES:

1.

Remove the V lead(s).


Troubleshooting

2.


3.


Problem: ARR Suspend

Solution : Check ECG signal from patient.

1.


2.


3.


4.

Correct artifact source.

Pacemaker troubleshooting

There are two general things that occur when the pace mode is activated for pacemaker patients:

1.

Beats that would otherwise be classified as ventricular are instead classified as Vpaced if a ventricular pacemaker event is detected.

2.

Residual pacemaker energy that might otherwise appear in the ECG is removed, and a white pacemaker enhancement spike is artificially placed in the ECG.

Pace detection is indicated visually in the ECG parameter box. When watching the

ECG waveform, pace detection is indicated by uniform, upright pacemaker enhancement spikes in the ECG data (both displayed and graphed).

NOTE

To improve pacemaker detection, reposition the electrodes and ensure a good page 6-2 .

Draft

Electrode placement on

During telemetry monitoring, the pacemaker signal is acquired from lead II or on II and V simultaneously when using the T14 transmitter. Changing the displayed lead has no effect on pacemaker detection.

NOTE

With all leads connected, pacemaker signal acquisition occurs on lead II or on II and V simultaneously when using the T14 transmitter. In a Leads Fail condition, signal acquisition occurs on any available lead. When a 3-leadwire set is used, single channel acquisition occurs on the programmed lead.

To improve pacemaker detection, reposition the electrodes and assure a good skin preparation to maximize R-wave detection. The following is a suggested configuration:


Troubleshooting

D-4

RA

V1

LA

LL F

L

R

C1

RL N

369B, 374B

The right arm electrode is moved down to the fifth intercostal space, and the left leg electrode is moved up to the fifth intercostal space.

NOTE

After all electrodes are in place, ensure that a minimum of 1/2 mV of signal is present on each lead (I, II, III, V).

Interface connector ports

Notes

Pace detection performance is optimized with proper lead application and correct use of the serial interface connector ports. If you are experiencing degraded pace detection performance, verify that all leads are properly attached to the patient and verify that any connected serial device(s) are in the appropriate serial interface connector ports.

The inside port, labeled 2 on the dust cover, is for use with episodic monitoring serial devices, such as NBP.

Draft

Solution: Use pacemaker processing:

1.


2.

In the Detect Pace section, select either Pace 1 or Pace 2 .

Solution : Exchange the right and left arm leads and perform a relearn.

In general, BE AWARE that a pacemaker pulse could be falsely counted as a

QRS during asystole.

Pace 1 mode analyzes the presence of a pacer spike, assesses the waveform for residual pacemaker energy, and determines the presence of an R wave following the pacer spike. If an event occurs during the first few milliseconds following the pacer spike, it will be counted.


Troubleshooting

Pace 2 mode analyzes waveforms with the added capability of minimizing the chance of counting severe residual pacemaker energy as QRS complexes. In relation to the event rejection capability of Pace 2 pace mode, certain morphologies may not be detected. Arrhythmia calls like asystole or pause may be made with heart rate identified as less than actual.

Again, pacemaker patients should be kept UNDER CLOSE OBSERVATION. The appropriate pace mode may be determined at the time the pacemaker patient is admitted to the monitoring system. The Pace 2 mode is recommended for use whenever possible.

Check ECG signal from patient:

1.


2.


3.


ST troubleshooting

Problem: ST numerics changed to Xs

Solution: An ST value changes to Xs when the patient’s dominant morphology has not been detected 16 times in the last 30 seconds. The program waits one minute and then automatically relearns. ST numerics will be displayed after the relearn.

IF PROBLEM CONTINUES:

SpO2 messages

1.

Check for morphology change.

2.

Check for noise on ECG.

3.

Relearn: a.

b.

Draft

Below is a list of system status alarm messages that may be displayed in the patient’s bed window during monitoring. SpO2 messages appear in abbreviated form in graph headers. If you are unable to resume SpO2 monitoring, contact your sales/service representative.

NOTE

The Xpod oximeter can display the same SpO2 system status messages as the

Apex oximeter, except for the CHANGE BATTERY message. The Xpod oximeter uses the battery power supplied by the transmitter and therefore does not support this message.


Troubleshooting

D-6


SPO2 PROBE

SIGNAL

NO DATA

SPO2 PROBE OFF

The saturation value is X

Message displayed with SPO2 data displayed—The batteries in the Apex oximeter are low. There is approximately 1 hour of reserve power left in the batteries.

Change the batteries.

Message displayed, no SPO2 data displayed—The batteries in the Apex oximeter are depleted. Replace the batteries. This is a system

Warning

alarm. The alarm will sound, and a red alarm button will appear on the CIC Pro center display. If the batteries are not replaced within 20 minutes, all SPO2 parameter information will be removed from the display. If the batteries are replaced within 20 minutes, SpO2 monitoring will resume.

The probe has been disconnected from the oximeter (no data is displayed).

SpO2 data continues to be displayed, but the quality of the signal is questionable.

Check the patient and the probe.

The oximeter is still connected, but no valid data is being transmitted to the receiver. Check that the patient is within antenna range. If the problem persists, contact GE Service.

The probe is off the patient. Check the probe.

The oximeter is still connected, but no valid data is being received at the receiver.

The patient may be in an area of poor antenna reception, where some, but not all data is being transmitted.

This message remains on the CIC Pro center for three minutes. If no data is detected after three minutes, the message changes to NO DATA.

NBP

Troubleshooting

Problem: Erroneous NBP measurement

Solution:

1.

Draft

Too large a cuff can give an erroneously low value.

NOTE

For proper fit of an NBP cuff, the arm should be measured from the top of the shoulder joint to the elbow. Divide the length by 2 and measure from the middle of measurement on the arm. Measure the circumference in centimeters around the arm. Refer to the NBP cuffs for proper fitting size.

2.

Check for residual air left in the cuff from a previous measurement. This could indicate a hardware problem that may require service.

3.

Make sure the cuff is not too tight or too loose.

4.

Make sure the cuff and the heart are at the same level; otherwise hydrostatic pressure will offset the NBP value.

5.

Watch for pulsus paradoxis.

6.

Check for leak in cuff or tubing.


Troubleshooting

NBP status messages

7.

Patient may have a weak pulse.

8.

Calibration may be necessary.

NBP status messages appear in abbreviated form in graph headers, when applicable.

A message will clear when the next measurement is initiated, or a message can be cleared manually with the Clear Message option on the NBP tab sheet.

The following system status alarm messages may be displayed in the patient’s bed window during monitoring.


FAIL

LEAK

An NBP measurement was attempted with low batteries. Change the batteries in the blood pressure monitor and try another measurement.

A hardware failure has been detected in the blood pressure monitor. In the U.S., contact GE Service. Outside the U.S., contact your local sales/service representative.

The NBP cuff is loose or there is an air leak in the cuff or tubing. Check that the cuff is on snugly. Check the connection between the cuff and the tubing. Check the connection between the tubing and the blood pressure monitor. Try another measurement. If the problem persists, contact your local sales/service representative.

LOW INFLATION PRESS This message appears when K-sounds are detected immediately upon inflation.

The inflation pressure is too low for proper NBP measurement. Try another measurement or adjust dynamic/fixed inflate. If the problem persists, contact your local sales/service representative.

MOVEMENT

SENSOR?

This message appears when there is excessive patient arm movement, or if the patient’s arm was bent during the measurement. Check the patient and try another measurement.

Draft

WEAK PULSE The patient’s heart rate is erratic. Check that the microphone cable is plugged firmly into the patient cable, and check that the microphone is positioned correctly on the patient. Try another measurement. If the problem persists, it could indicate a defective microphone, microphone cable, or patient cable. Contact your local sales/service representative.

Messages

Alarm messages

The following messages appear in the patient’s bed window at the CIC Pro center.


D-8

Troubleshooting

ALARM PAUSE

ALL ALARMS OFF

All alarms for this patient have been turned off for five minutes. This is initiated from the transmitter by pressing both the Verify Leads and Graph buttons simultaneously.

Refer to ALL ALARMS OFF.

All alarms for this patient have been turned off. No graph strips run, arrhythmia events are not stored, and no audible tones sound if an alarm condition should occur.

ARR OFF The arrhythmia program for a selected patient has been turned off. No arrhythmia messages are displayed, arrhythmia event s are not stored, no graph strips run, and no audible tones sound if an arrhythmia alarm condition occurs.

ARTIFACT ARR SUSPEND All artifact begins at level 1. Sustained artifact progresses to level 2 when noise on ECG lasts for 20 of the last 30 seconds.

Level 1 — Upon immediate detection of artifact, the message ARTIFACT is displayed. There is no alarm tone. Only lethal arrhythmia processing is available.

Level 2 — Arrhythmia monitoring is suspended in this condition. A system warning alarm sounds, no arrhythmia messages are displayed, no graph strips run and no arrhythmia events are stored. Heart rate and

PVC values change to X, an additional message, ARR

SUSPEND , is displayed.

LEADS FAIL All leads have failed, right leg lead failed, lead wires unplugged or reference lead failed. If set to Warning or

Advisory level, a system alarm is heard. This will selfsilence if condition is corrected, or the user can silence for one minute with the Silence Alarms button at the bottom of the CIC Pro center display.

Draft


NO TELEM

OFF NETWORK

Troubleshooting

The NO TELEM alarm occurs in two situations:

1.

The patient moves out of range.

If the transmitter is out of range for more than 30 seconds, the NO TELEM message displays. Should a

LEADS FAIL condition occur prior to a NO TELEM condition, the LEADS FAIL condition takes priority. The

LEADS FAIL message is displayed along with the NO

TELEM message.

2.

Transmitter batteries are extremely low or dead.

If batteries are extremely low or completely dead, the

NO TELEM message appears, a CHANGE BATTERY message appears in the patient’s bed window, and the audible alarm sounds. Activating the ALL ALARMS

OFF feature prevents the audible alarm from sounding.

In the Combo mode, telemetry patient data is provided from the bedside monitor to the CIC Pro center. If the bedside monitor is removed from the network or becomes otherwise unavailable, the NO COMM message displays first on the

CIC Pro center and there is a loss of monitoring for about 45 seconds, then waveforms return and the OFF NETWORK message is displayed below the HR parameter window.

The CIC Pro center will then display patient data directly from the telemetry bed along with this message in that CIC Pro center bed window. Should the bedside monitor reappear on the network, the Combo monitoring application will automatically resume and the alarm will be cleared.

This alarm is also generated if the receiver system is removed from the network or becomes otherwise unavailable. The bedside monitor does not sound alarms, but the alarms must be turned back on at the bedside monitor if they were previously paused or off.

Graph messages

display. These relate to running graphs at the printer.

GRAPH ALARM

GRAPH MANUAL

GRAPH TTX

PRINTING

SAVING

An alarm graph was initiated and is running.

A manual graph was requested and is running.

The Graph button on the transmitter was pressed and a

20-second graph strip is running.

A non-real time graph is currently being printed.

An alarm or a manual graph has been requested but the writer is in use, the writer door is open, the print location is not correct, or the writer is out of paper. The request is saved and will run as soon as the writer is available.


D-10

Troubleshooting

Transmitter-related messages

The following messages appear in the patient’s bed window on the CIC Pro center display.


LEADS FAIL

RA (LA, LL, V) FAIL

NO TELEM

This message flashes when the batteries are low. There is approximately 1 hour of use left after this message appears. If the batteries are extremely low or completely dead, a NO TELEM message flashes, and an audible alarm sounds.

All leads have failed, right leg lead failed, right arm lead failed, leadwires unplugged or reference lead failed. If set to System Warning or System Advisory level, a system alarm occurs. This will self-silence if condition is corrected, or user can silence for one minute with Silence

Alarms button at the bottom of the CIC Pro center display.

NOTE

LEADS FAIL will not result in a NO TELEM alarm message after 30 seconds.

One of these may appear, indicating failure of a lead.

The transmitter was out of range for more than 30 seconds. If this condition persists, contact GE Technical

Support.

If a LEADS FAIL condition occurs prior to a NO TELEM condition, the LEADS FAIL condition takes priority

TTX number is already in This message displays when attempting to admit a use

System status messages

transmitter that is sequentially numbered with another admitted transmitter. For example, you cannot admit TTX

ID number 54078 and 54079 at the same time. Use another transmitter with a non-sequential TTX ID number

Draft

System status alarms (generated by mechanical conditions) are displayed in the lower left corner of the CIC Pro center screen. Each message is preceded by the receiver system’s name, if it has been entered, or a name created by using the last six numbers of the receiver system Ethernet address.

DUPLICATE TOWER NAME

DUPLICATE NAME

A network problem exists. Restart the system. If this condition persists, contact GE Technical Support.

A network problem exists. Restart the system. If this condition persists, contact GE Technical Support.

Patient status messages

Patient status messages are also displayed in the lower left corner of the CIC Pro center screen. They are not, however, preceded by the receiver system name or

Ethernet address.


Troubleshooting

“Unit/Bed” IS

UNMONITORED

“Unit/Bed”: DUPLICATE

NAME

A telemetry patient is admitted but is not displayed (and therefore is unmonitored) on any CIC Pro center. If an alarm occurs on an unmonitored bed, the information will appear in the alarm text line and an audible tone will sound. You must view the patient first if you would like to silence the alarm. To view an unmonitored bed, click on the View Other button.

There is another device on the network with the same bed name. The duplicate device must be renamed.

Draft


Troubleshooting

Draft

D-12 ApexPro™ 2001989-301A- draft 1

E

Technical specifications

Draft

2001989-301A- draft 1 ApexPro™ E-1

E-2

Technical specifications

ECG

T14 transmitters

NOTE

Specifications are provided to help you determine the space, ventilation, air conditioning and power requirements to ensure proper operation of your system.

Specifications are approximate and may change with the actual unit shipped.

Specifications are subject to change without notice. Contact your sales or service representative for more information.

Power requirements

Battery type

Battery life

Polarity

ANSI/NEDA 15 A, 1.5V AA alkaline (2 required) hours

Electronic reverse polarity protection

Alarms and controls

Battery integrity

Leads Fail indication

Transmitted and indicated via LED

Transmitted and indicated via LED

Transmission

Channel spacing

Frequency stability

Bit rate

Antenna

25 kHz

10 kbps

Formed by leadwire shield

Multi-channel configuration

(5- or 6- leadwire)

Leads analyzed simultaneously

Single-channel (3-leadwire) configuration

Heart rate detection

QRS detection range

Frequency response

I, II, III, Va, Vb, aVR, aVL, aVF

Four (I, II, III, V)

I, II or III, configurable

30 to 300 BPM

0.5 to 5 mV

0.05 to 40 Hz (-3 dB)



A/D converter resolution

Sample rate

Environmental specifications

Operating conditions

Temperature

Relative humidity

Storage conditions

Temperature

Relative humidity

Pressure

Device specifications

10 bits, 9.75 µV (RTI)

240 samples/seconds

5 to 40° C

15 to 95% (non-condensing)

-20 to 70° C


700 to 1060 hPa

Water resistance IEC 60529 IPX7 rating (can survive inadvertent submersion)

Input configuration

Frequency range

Modulation

Serial I/O ports

Alarm pause

Graph request

3, 5 or 6 electrodes

GFSK

Draft

Event Marker

Attendant request

Transmitted

Transmitted

Maximum transmitters 239 active within WTMS at a single facility

Dynamic range

Input offset

Input impedance

ECG gain selection

ECG gain accuracy

Common mode rejection

Defibrillator protection

Defibrillator recovery time

± 5 mV (RTI)

± 400 mV (RTI)

15 M ohm minimum differential @ 10 Hz

5, 10, 20, 40 mm/mV (RTI)

± 5% @ 15 Hz

100 dB minimum @ 60 Hz

± 5000 VDC, 360 joules into 100 ohm

Transmitter recovers within 2 seconds


E-4


Physical specifications

Pacemaker detection

Patient leakage current

Serial communications

± 2 mV to ± 700 mV (RTI); 100 µsec to 2 msec; either polarity; on multiple leads

Meets UL/IEC 60601-1

2 ports at 9600 baud asynchronous

Height

Width

Depth

Weight

FCC compliance information

This device complies with Part 95 of the FCC Rules and RSS-210 of Industry

Canada.

Operation of this equipment requires the prior coordination with a frequency coordinator designated by the FCC for the Wireless Medical Telemetry Service.

Certifications

UL/IEC/EN 60601-1

IEC/EN 60601-1-1

Draft

608.025 to 613.975 MHz - FCC Part 95

ApexPro telemetry server

Display specifications

13.7 cm (5.38 in)

7.3 cm (2.875 in)

2.3 cm (0.91 in)

141.8 g (0.275 lb) without battery; 170.1 g (0.375 lb) with battery

Video output 1024 X 768 @ 75 Hz

Power specifications

Power supply 300 watt ATX dual-redundant





Temperature

Relative humidity

Vibration

Altitude

Acoustic noise

Storage conditions


Temperature

Relative humidity

10 to 35° C (50 to 95° F)


5 to 500 Hz, 0.5 G RMS

0 to 3048m (0 to 10000 ft)

Less than 52 dB sound pressure at 5 to 28° C (41 to 82° F)

-23 to 49° C (-10 to 120° F)


8.8 cm (3.46”)

45 cm (17.7”)

Height

Depth

Width

Weight

48.2 cm (19”)

15.8 kg (35 lb)


Canada.

Draft


Certifications

IEC/EN/UL 60950-1

CAN/CSA C22.2 No.950

IEC/EN 60601-1-4

EN 55022 (Class A)

EN 55024

EN 61000-3-2

EN 61000-3-3

CE marked to the Medical Device Directive 93/42/EEC


E-6


ApexPro receiver system

Performance specifications

RF module type

UHF frequency range

Frequency step resolution

Receiver system capacity

Frequency stability

Bit rate

Sensitivity

GFSK and GMSK digitally demodulated

560.025 to 613.975 MHz (U.S.)

420 to 460 MHz (International)

Synthesized tuning to any transmitter; 25 kHz spacing

1 to 4 quad receiver modules (4 to 16 receivers)

± 0.0003% (3 PPM) of assigned channel frequency

10 kbps

8.7 µV (-90 dB) minimum for 1 bit error/million bits received

Network requirements

Physical

Serial protocol

IEEE 802.3 compatible, physical connector via 10 base T

19200 baud, 1 stop bit, 8 data bits, no parity, XON/XOFF flow control

System status indicators 7 bicolor LEDs

Power requirements

Cooling

Input voltage

Input frequency

Draft

Free air convection



Temperature

Relative humidity

5 to 40° C




Storage conditions


Temperature

Relative humidity

Pressure

-20 to 50° C


700 to 1060 hPa

Height

Width

Depth

Weight

17.0 cm (6.7 in)

32.5 cm (12.8 in)

25.0 mm (9.8 in)

6.4 kg (14 lb)


This device complies with Part 95 of the FCC Rules and RSS-210 of Industry

Canada.


Certifications

UL/IEC/EN 60601-1

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E-7 2001989-301A- draft 1 ApexPro™


E-8

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Index

A admit ..................................................................... 6-11 alarm control settings ................................................. 5-8 levels .............................................................. 5-10 notification ........................................................ 5-2 patient status alarms ........................................ 5-3 pause breakthrough.......................................... 5-6 silence .............................................................. 5-7 system status alarms........................................ 5-4 unit defaults .................................................... 5-12 volume ............................................................ 4-18 automatic graphs .................................................... 9-4

6-leadwire................................................... 6-3 neonate patients......................................... 6-5 pediatric patients ........................................ 6-5 measurements ................................................ 8-16 setting source ................................................. 6-21 signal ................................................................ 6-6 skin preparation ................................................ 6-2 troubleshooting arrhythmia .................................................. D-2 pacemaker ................................................. D-3

ST............................................................... D-5 electrode placement................................................ 6-3 events directory....................................................... 8-2

B battery blood pressure monitor................................... 3-11 transmitters....................................................... 3-3 bed number ........................................................... 6-15 blood pressure monitor ......................................... 3-10

F

FCC compliance.................................................... 1-16

RF exposure ................................................... 1-16 full disclosure .......................................................... 8-7

G graph location.......................................................... 9-2 graphic trends ....................................................... 8-11 C calipers.................................................................. 8-16

I

CE marking information ....................................... CE-1 compliance .................................................... CE-1 exceptions ..................................................... CE-1 compliance ............................................................ 1-15

FCC ................................................................ 1-16 configuration

Draft licenses............................................................. 4-5 configure control settings ............................................... 4-18

IMPACT.wf paging system...................................... 3-3 lead analysis ......................................................... 7-16 multi-lead analysis .......................................... 7-16 single lead analysis ........................................ 7-16 licenses ................................................................... 4-5 manual graph .......................................................... 9-3 monitoring mode combo ............................................................. 6-10 rover ............................................................... 6-10 rover combo.................................................... 6-10 control settings ...................................................... 4-18

L

M standard.......................................................... 6-10

D defaults ................................................................... 4-6 discharge .............................................................. 6-19 display primary.............................................................. 4-3 secondary ......................................................... 4-3 move patient.......................................................... 6-17 multi-patient viewer ................................................. 7-2

N

NBP control settings ............................................... 7-28 microphone placement ................................... 7-30 patient preparation.......................................... 7-29 troubleshooting ................................................. D-6

E

ECG calipers ........................................................... 8-16 control settings ............................................... 7-11 electrode placement ......................................... 6-3

3-leadwire................................................... 6-4

5-leadwire................................................... 6-4

P parameter alarm limits........................................... 5-10 patient demographics............................................ 6-13 primary display ........................................................ 4-3

2001989-301A- draft 1 ApexPro™ 1

2 print alarm graphs................................................... 5-17 all patients ........................................................ 9-5 automatic graphs .............................................. 9-4 control settings ................................................. 9-6 devices ............................................................. 9-2 graph location ................................................... 9-2 manual graph.................................................... 9-3 real-time data.................................................... 9-3 stop................................................................... 9-6 stored data........................................................ 9-3 telemetry data................................................... 9-2 transmitter graph .............................................. 9-7

R

R&TTE ................................................................. CE-1 real-time data .......................................................... 7-2 real-time trend window ............................................ 7-6

S secondary display ................................................... 4-3 single patient viewer................................................ 7-3

SpO2 ..................................................................... 7-24 control settings ............................................... 7-24 messages ......................................................... D-5 signal .............................................................. 7-27

ST analysis............................................................ 7-22

ST troubleshooting .................................................. D-5 stored data .............................................................. 8-2

T transmitter graph ..................................................... 9-7 transmitters ............................................................. 2-2 battery............................................................... 3-3 buttons/LEDs .................................................... 3-2 electrodes ......................................................... 3-5 leadwires .......................................................... 3-5

V vital signs .............................................................. 8-14

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GE Medical Systems

Information Technologies, Inc.

8200 West Tower Avenue

Milwaukee, WI 53223 USA

Tel: + 1 414 355 5000

1 800 558 5120 (US only)

Fax: + 1 414 355 3790

GE Medical Systems

Information Technologies GmbH

Munzinger Straße 3-5

D-79111 Freiburg

Germany

Tel: + 49 761 45 43 - 0

Fax: + 49 761 45 43 - 233

Asia Headquarters

GE Medical Systems

Information Technologies Asia; GE (China) Co., Ltd.

24th Floor, Shanghai MAXDO Center,

8 Xing Yi Road, Hong Qiao Development Zone

Shanghai 200336, P.R. China

Tel: + 86 21 5257 4650

Fax: + 86 21 5208 2008

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GE Medical Systems Information Technologies, a General Electric Company, going to market as

GE Healthcare.

www.gehealthcare.com

0459

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