MASIMO RADICAL 7 Signal Extraction Pulse CO

MASIMO RADICAL 7
Signal Extraction Pulse
CO-Oximeter
Approved by:
Women’s Health Manual
MCH Only
Policy Group:
Cardiovascular
Date Effective
Heather Crosland
Director, Women’s Health, Covenant Health, GNH/MCH
Site Lead Anesthesia-MCH
Site Lead Obstetrics-MCH
November, 2012
Next Review
July, 2015
Purpose
To provide staff with guidelines for safe use and application of Radical 7.
To ensure that the equipment is available for use at all times.
To ensure that the equipment is cleaned according to infection control guidelines. Policy
Statement
This policy provides clear direction as to the responsibilities for those who use Masimo
Radical 7 equipment.
Applicability
All Misericordia Labour and Delivery Staff, anesthetists and respiratory technicians.
Responsibility
It is the responsibilty of all staff who use this equipment to follow the policy and procedure
as outlined below.
To make sure that the Radical 7 is continuously plugged in and kept in either theatre 345
or 348 ready for use .
The uses are outlinesd in the Indication section
Equipment
Masimo Radical 7 (Signal extraction pulse CO-Oximeter with rainbow technology)
The Radical 7 is
capable of assessing
hemoglobin.
This machine is mounted on
a pole and kept plugged in
one of the L&D theatres.
The screens give data of
SpO2, SpCO ,SpMet and
SpHb .
New supplies will be kept in sterile core in the drawers as marked.
Masimo Radical 7
Procedure
Date Approved
November 2012
Policy Group
Page 2 of 7
Indications
The Radical 7 can be used for continuous and non-invasive measurement of :
• Arterial oxygen saturation in blood.
• Measurement of the levels of total hemoglobin (SpHb) in arterial blood.
• Levels of metheglobin concentration(SpMet) in arterial blood.
• Levels of carbon monoxide concentration (SpCo).
Contraindications
• Does not replace laboratory work required when Mass Transfusion Protocol initiated.
• May need laboratory verification of accuracy for patients that are hemodynamically
unstable.
• Patients with extremely impaired peripheral circulation may have a delayed reading or
no reading at all. This maybe due to cold, shivering or shock.
Sensor Limitations
• Patients who have nail varnish on and false nails may not have an accurate reading due
to inability of sensor to read.
• Patients with long nails may also give an inaccurate reading due to the difficulty of
applying the sensor correctly.
• If the cover is not applied over the sensor, a false reading may be produced. This may
be especially true if there is excessive ambient light sources eg. OR lights.
• Elevated levels of Carboxyhemoglobin = inaccurate SpO2
• Methehemoglobin = inaccurate SpO2
• Bilirubin = may cause erroneous SpO2, SpMet, SpCO and SpHb readings
• Sensors applied too tightly = inaccurate readings
• Low arterial perfusion = may give inaccurate SpHb and SpOC readings.
Cautions
• Caution when comparing SpO2, SpCO, SpMet and SpHb results from Radical 7 to
results from laboratory blood gases that are drawn . As it is dependant on when blood is
drawn and results received and when the readings from the Radical 7 are taken to
compare as well as amount of IV fluid that is rapidly being infused at that time.
• The Radical 7 reads and adjusts with the pulse. Skin erosion and pressure necorsis
caused by high levels of bilirubin may cause erroneous readings of SpO2, SpCO, SpMet
and SpHb.
Potential Complications
Tissue damage can be caused by incorrect placement of the sensor when wrapped too
tightly.
Secure arm safely above level of heart to avoid injury to patient. Sensor placed below the
heart, e.g. arm dangling off the table would give inaccurate reading.
Masimo Radical 7
Procedure
Date Approved
November 2012
Policy Group
Page 3 of 7
Principles of Operation
Oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin and methemoglobin and blood
plasma constitutes differ in their absorption of visible and infrared light.
The amount of arterial blood in tissues changes with your pulse (photoplethysmography).
Can distinguish a true arterial oxygen saturation.
Visual look at the display.
Normal View
Allows for continuous monitoring of all parameters along with a plethysmograph (pleth) wave
form and Signal IQ indicator (below pleth) to provide confidence in the quality of the values
displayed. If the device is RRa-enabled*, its waveform can be overlayed on the pleth
waveform, enabling deeper understanding of the patient’s respiratory status.
Masimo Radical 7
Date Approved
November 2012
Policy Group
Page 4 of 7
Procedure
Trend View
The quick-trend feature allows for one-touch access to vital parameter trending information to
instantly evaluate patient condition and illness severity. Auto-scaling feature allows the y-axis
to automatically change with fluctuations in the measurement value.
Simplified Alarm Management
One-touch menu provides quick access to the most commonly used features and allows for
quick configuration and management of parameter alarm settings.
Nursing
See next page for diagrams
Attach the direct cable to the optical sensor and monitoring can begin by:
• Make sure Radical-7 is plugged in.
• Press the Power/Standby button to turn on the Pulse Co-Oximeter.
• Make sure the display window is free of alarm and failure messages.
• Verify high and low alarms if necessary.
Attaching the sensors :
1.
2.
3.
Before the Radical-7 can be used you need to check that it is fully charged.
The Radical-7 must be plugged in at all times and can be located in one of the OR’s.
When requested for use by anesthesia, collect the equipment you need. This
includes the cable, disposable sat probe and reusable optical sensor as well as the
ambient shield accessory.
Connect direct patient cable firmly into the front of the Radical-7 port on the right
side.
Masimo Radical 7
4.
5.
Date Approved
November 2012
Policy Group
Page 5 of 7
Attach the disposable sensor (adhesive) to the reusable optical sensor by clipping
together black area of sensor and optical sensor and clipping in both white areas of
sensor and optical sensor together. Make sure that they are locked in place.
(if the reusable sensor does not attach or lock in place a new reusable sensor may
be required.)
Apply Sensor to the finger by following the diagram on the sensor applying to the
fleshy part first. (The finger should be well perfused and clean of debris). Make sure
that the red lines become one continuous line when attached for accurate readings.
(Do not use extra tape as this may cause an inaccurate reading and ischemia).
Avoid placing the sensor on any extremity that has arterial catheter or blood
pressure cuff.
Successful Monitoring = Place sensor on area that has unrestricted blood flow and do not
secure with tape. Do not place near potential electrical interference (e.g. cautery machine)
NOTE: Monitor will read saturation first it may take up to 2mins to get an
accurate hemoglobin
To adjust the screen view, use the button circled in green.
Safety
Sensors must be repositioned every 4hrs to a new site
If circulation is inadequate and especially if patient has poor perfusion, please
reposition sensor every 2hrs.
Radical 7 disposable equipment
is DPO. Please let the Unit
Clerk know when you have used
to the critical level.
Take the direct cable sensor and
connect to right hand side of the face
of the Radical 7.
Masimo Radical 7
Date Approved
November 2012
Policy Group
Page 6 of 7
Shield cover is placed over sensor when on
patient to protect sensor from light from
ambient light
Ambient shield cover
Disposable sat probe sensor.
Connect to the patient by following diagram on sensor
(Placing over fingernail)
1. Place over fingernail and wrap
remainder around finger.
Note: Please make sure that the red lines are
CONTINUOUS with each other .
2. Fold over the
finger 1st and
wrap around
finger
3. Clip black to
black and white
to white
Connect to main
cable on front of
machine
Reusable Optical Sensor Do not dispose of unless probe not
working . New one in attached basket or sterile core
Masimo Radical 7
Date Approved
November 2012
Policy Group
Page 7 of 7
DOCUMENTATION BY ANESTHESIA
• Order for application required.
• Once it is applied probe must be assessed and assessment charted every 3060mins.
• The sensor should be checked every 30-60mins for circulation distal to the
sensor and this check documented.
DOCUMENTATION BY NURSING
• Please chart who requested the use of the Radical 7, the reason for the request,
the time applied and by whom.
Removing the sensor
• Detach main cable from the optical sensor.
• Remove the adhesive sensor from the optical sensor.
• Remove and discard the disposable patient adhesive sensor.
Cleaning the Reusable optical sensor
• Wipe the reusable optical sensor by wiping with 70% isopropyl alcohol pad.
• Wipe cable outside of the Radical 7 with Virox or CPS wipes.
• Wipe screen with the Grand & Toy computer wipes.
References
Masimo Corporation : Radical -7 Signal Extraction Pulse CO-Oximeter with Rainbow Technology:
Operator Manual can be obtained from
http://www.masimo.com/pdf/radical-7/LAB4540E_radical-7_brochure.pdf
Masimo Corporation : Rainbow ReSposable Pulse Co-Oximeter Sensor System package insert for
Adhesive and reusable Sensors.2012 for 20R2-25a adult disposable optical sensor and R225r adult reusable opt Radical 7 rainbow information about product and technology.
Retrieved on July 5th 2012 from http://www.masimo.com/rainbow /Radical7.htm on
Masimo Corporation : Radical -7 Signal Extraction Pulse CO-Oximeter with Rainbow
Technology: Operator Manual can be obtained from
http://www.masimo.com/pdf/radical-7/LAB4540E_radical-7_brochure.pdf
Masimo Corporation : Rainbow ReSposable Pulse Co-Oximeter Sensor System package
insert for Adhesive and reusable Sensors.2012 for 20R2-25a adult disposable
optical sensor and R2-25r adult reusable optical sensor.
Radical-7 rainbow information about product and technology. Retrieved on July 5th 2012 from
http://www.masimo.com/rainbow /Radical7.htm.