S12/S19 TABLE OF CONTENTS USER MANUAL

S12/S19 TABLE OF CONTENTS USER MANUAL
TABLE OF CONTENTS
REF 9515-183-50-ENG Rev C1
S12/S19
SURVEYOR PATIENT MONITORS
USER MANUAL
Manufactured by Mortara Instrument, Inc., Milwaukee, Wisconsin U.S.A.
CAUTION: Federal law restricts this device to sale by or on the order of a physician.
Copyright © 2014
by Mortara Instrument, Inc.
7865 N. 86th Street
Milwaukee, Wisconsin 53224
This document contains confidential information that belongs to Mortara Instrument, Inc. No part of this document
may be transmitted, reproduced, used, or disclosed outside of the receiving organization without the express written
consent of Mortara Instrument, Inc. V1.10
Mortara is a registered trademark of Mortara Instrument, Inc. Surveyor™, AM12™, and VERITAS™ are
trademarks of Mortara Instrument, Inc.
Nellcor™, Covidien™, C-LOCK™, SatSeconds™, OxiMax™, MAX™, Max-Fast™, SoftCare™, Oxiband™,
Dura-Y™, PediCheck™, OxiCliq™, and Durasensor™ are trademarks of Nellcor Puritan Bennett Inc.
Smart Capnography™, Smart Breath Detection Algorithm™ (BDA™), Smart Alarm Respiratory Analysis ™
(SARA), Integrated Pulmonary Index™ (IPI), Microstream®, Filterline® and Capnoline® are trademarks or
registered trademarks of Oridion Medical Ltd.
Edwards® is a registered trademark of Edwards Lifesciences Corporation.
Oridion CO2 License Information -- NO IMPLIED LICENSE – Possession or purchase of this bedside monitor
does not convey any express or implied license to use the bedside monitor with unauthorized consumable CO2
sampling products which would, alone, or in combination with this bedside monitor, fall within the scope of one or
more patents relating to this bedside monitor and/or CO2 sampling consumable products.
The capnography component of this product is covered by one or more of the following US patents: 6,428,483;
6,997,880; 6,437,316; 7,488,229; 7,726,954 and their foreign equivalents. Additional patent applications pending.
All other trademarks and registered trademarks are the property of their respective owners.
TABLE OF CONTENTS
1. GENERAL STATEMENTS ....................................................................................................................... 1 TECHNICAL SUPPORT AND SERVICE ..................................................................................................................................... 1 2. NOTICES .................................................................................................................................................. 2 MANUFACTURER’S RESPONSIBILITY .................................................................................................................................... 2 RESPONSIBILITY OF THE CUSTOMER .................................................................................................................................... 2 EQUIPMENT IDENTIFICATION ............................................................................................................................................. 2 COPYRIGHT AND TRADEMARK NOTICES ............................................................................................................................... 2 OTHER IMPORTANT INFORMATION ..................................................................................................................................... 2 3. WARRANTY INFORMATION................................................................................................................... 3 YOUR MORTARA WARRANTY ............................................................................................................................................ 3 4. USER SAFETY INFORMATION .............................................................................................................. 5 SAFETY REGULATIONS ...................................................................................................................................................... 5 WARNINGS.................................................................................................................................................................... 5 Power Warnings .................................................................................................................................................... 6 Accessories, Cables, and External Connections Warnings ..................................................................................... 7 Use with Electro Surgery Devices Warnings .......................................................................................................... 9 Installation and Mounting Warnings ................................................................................................................... 10 ECG Warnings ...................................................................................................................................................... 10 ECG Calculated Heart Rate Warnings .................................................................................................................. 11 Warnings for Patients with Pacemakers ............................................................................................................. 12 Respiration Warnings .......................................................................................................................................... 12 SpO2 Warnings .................................................................................................................................................... 13 NIBP Warnings ..................................................................................................................................................... 14 Invasive Pressure Warnings ................................................................................................................................. 15 CO2 Warnings ...................................................................................................................................................... 15 Cardiac Output Warnings .................................................................................................................................... 16 CAUTIONS ................................................................................................................................................................... 17 NOTES ........................................................................................................................................................................ 18 5. EQUIPMENT SYMBOLS AND MARKINGS .......................................................................................... 21 SYMBOL DELINEATION ................................................................................................................................................... 21 6. GENERAL CARE ................................................................................................................................... 23 PRECAUTIONS .............................................................................................................................................................. 23 INSPECTION ................................................................................................................................................................. 23 CLEANING ................................................................................................................................................................... 23 MAINTENANCE ............................................................................................................................................................. 25 BATTERY REPLACEMENT ................................................................................................................................................. 27 Battery Life and Charge Time .............................................................................................................................. 28 Battery Conditions ............................................................................................................................................... 28 DECOMMISSIONING AND DISPOSAL .................................................................................................................................. 29 CALIBRATION ............................................................................................................................................................... 29 CO2 Calibration .................................................................................................................................................... 29 Invasive Pressure Calibration ............................................................................................................................... 30 NIBP Calibration ................................................................................................................................................... 30 i
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7. ELECTROMAGNETIC COMPATABILITY (EMC) ................................................................................. 31 8. INTRODUCTION..................................................................................................................................... 35 GENERAL INFORMATION ................................................................................................................................................ 35 INDICATIONS FOR USE ................................................................................................................................................... 35 CONTRAINDICATIONS..................................................................................................................................................... 35 SYSTEM OVERVIEW ....................................................................................................................................................... 35 Front View ............................................................................................................................................................ 36 Left Side View....................................................................................................................................................... 36 Right Side View .................................................................................................................................................... 37 Back View ............................................................................................................................................................. 37 9. INSTALLATION AND SETUP ................................................................................................................ 39 UNPACKING AND CHECKING ............................................................................................................................................ 39 INSTALLATION METHODS ............................................................................................................................................... 39 Rolling Stand ........................................................................................................................................................ 40 Wall Mount .......................................................................................................................................................... 40 POWER ON/OFF .......................................................................................................................................................... 40 TO CONNECT FOR CENTRAL STATION COMMUNICATION ....................................................................................................... 41 TO CONNECT FOR 3RD PARTY EMR SOFTWARE ................................................................................................................... 42 10. MAIN SCREEN DISPLAY .................................................................................................................... 43 OVERVIEW .................................................................................................................................................................. 43 PARAMETER AREAS ....................................................................................................................................................... 43 Waveform Parameter Area ................................................................................................................................. 43 Numeric Parameter Area ..................................................................................................................................... 44 QUICK‐ACTION KEY AREA .............................................................................................................................................. 45 Alarm Silence Quick‐Action Key ........................................................................................................................... 46 All ECG/12‐Lead ECG Quick‐Action Key ............................................................................................................... 46 NIBP Start/Stop Quick‐Action Key ........................................................................................................................ 46 Trends Quick‐Action Key ...................................................................................................................................... 46 Standby Quick‐Action Key .................................................................................................................................... 46 Print Quick‐Action Key ......................................................................................................................................... 47 Setup Quick‐Action Key ........................................................................................................................................ 47 Home Quick‐Action Key ....................................................................................................................................... 47 MESSAGE AREA ............................................................................................................................................................ 47 SYSTEM CLOCK AREA ..................................................................................................................................................... 48 DEMOGRAPHIC AND STATUS AREA ................................................................................................................................... 48 Patient Information ............................................................................................................................................. 48 Patient Mode Icon ............................................................................................................................................... 48 Network Status Icon ............................................................................................................................................ 48 11. PATIENT MANAGEMENT ................................................................................................................... 49 OVERVIEW .................................................................................................................................................................. 49 PATIENT INFORMATION DIALOGUE ................................................................................................................................... 49 Patient Mode Specifics ......................................................................................................................................... 50 ADMIT ........................................................................................................................................................................ 51 STANDBY MODE ........................................................................................................................................................... 51 Standby: Hibernation Mode ................................................................................................................................ 52 Standby: Discharge Mode .................................................................................................................................... 53 12. ALARM BEHAVIORS AND MANAGEMENT ...................................................................................... 55 ii
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GENERAL ALARM BEHAVIOR ........................................................................................................................................... 55 PHYSIOLOGICAL ALARMS ................................................................................................................................................ 55 Alarm Levels ......................................................................................................................................................... 55 TECHNICAL ALARMS ...................................................................................................................................................... 55 INFORMATIONAL ALERT MESSAGES .................................................................................................................................. 56 ALARM CONFIGURATION DEFAULTS ................................................................................................................................. 56 Factory Default Settings ...................................................................................................................................... 56 Departmental Default Settings ............................................................................................................................ 56 ALARM NOTIFICATIONS .................................................................................................................................................. 56 Visual Alarm Notifications ................................................................................................................................... 56 Alarm Light Notifications ..................................................................................................................................... 57 Audio Alarm Notifications .................................................................................................................................... 57 Audio Annunciation Type ..................................................................................................................................... 57 Audio Silence ........................................................................................................................................................ 58 Alarm Paused/Suspend ........................................................................................................................................ 58 Alarm Off Icon ...................................................................................................................................................... 59 ALARM LATCHING ......................................................................................................................................................... 59 ALARM DELAY .............................................................................................................................................................. 59 MULTIPLE ACTIVE ALARMS: HIERARCHY OF DISPLAY ........................................................................................................... 60 Different Alarm Priorities ..................................................................................................................................... 60 Same Alarm Priorities .......................................................................................................................................... 60 AUTOMATIC PRINT ON ALARM ........................................................................................................................................ 60 ADJUSTING ALARM LIMITS ............................................................................................................................................. 61 Adjusting Non‐ST Numeric Parameter Alarm Limits ............................................................................................ 61 Adjusting ST Alarm Limits .................................................................................................................................... 61 ADJUSTING ALARM LEVELS ............................................................................................................................................. 62 Lethal Arrhythmia Alarm Levels ........................................................................................................................... 62 Non‐Lethal Arrhythmia Alarm Levels ................................................................................................................... 62 Non‐ST Numeric Parameter Alarm Levels ............................................................................................................ 62 ST Alarm Levels .................................................................................................................................................... 63 ALARM AUTO SET ......................................................................................................................................................... 63 ALARM INTERFACES....................................................................................................................................................... 64 Alarm Output/Nurse Call ..................................................................................................................................... 64 Surveyor Central Station ...................................................................................................................................... 64 13. ECG MONITORING .............................................................................................................................. 65 OVERVIEW .................................................................................................................................................................. 65 QUALITY ECG DATA ACQUISITION ................................................................................................................................... 65 Skin Preparation .................................................................................................................................................. 66 Electrode Placement ............................................................................................................................................ 66 ELECTRODE LOCATIONS .................................................................................................................................................. 67 Using a 3‐Wire ECG Lead Set ............................................................................................................................... 67 Using a 5‐Wire ECG Lead Set ............................................................................................................................... 68 Lead II Monitoring ............................................................................................................................................... 69 Modified Chest Lead (MCL) Monitoring ............................................................................................................... 70 Pacemaker Patients ............................................................................................................................................. 71 Using the AM12 for Continuous ECG Monitoring ................................................................................................ 72 Using the AM12 for Diagnostic Resting 12‐Lead ECG Acquisition ....................................................................... 73 CHECKING THE ECG SIGNAL ........................................................................................................................................... 74 ECG WAVEFORM TILE ................................................................................................................................................... 74 ALL ECG/12‐LEAD DISPLAY MODE ................................................................................................................................. 74 iii
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RESTING 12‐LEAD ECG INTERPRETATION .......................................................................................................................... 75 14. ECG/HEART RATE/PULSE RATE MONITORING.............................................................................. 77 OVERVIEW .................................................................................................................................................................. 77 HEART RATE/PULSE RATE TILE ........................................................................................................................................ 77 HR/PR ALARM BEHAVIORS ............................................................................................................................................ 77 HEART RATE/PULSE RATE SOURCING ............................................................................................................................... 77 SETUP HR/PR DIALOGUE .............................................................................................................................................. 78 HR/PR Alarm Limits .............................................................................................................................................. 78 Auto Set HR/PR Alarm Limits ............................................................................................................................... 78 HR/PR Alarms On ................................................................................................................................................. 79 HR/PR Print on Alarm .......................................................................................................................................... 79 ECG Lead Set ........................................................................................................................................................ 79 ECG 12‐Lead Enabled ........................................................................................................................................... 80 ECG Top Channel Lead ......................................................................................................................................... 80 ECG Size ............................................................................................................................................................... 80 HR/PR Source ....................................................................................................................................................... 81 HR/PR Tone .......................................................................................................................................................... 81 ECG Filter ............................................................................................................................................................. 81 HR/ARR Lead Select ............................................................................................................................................. 81 Analyze Pacers ..................................................................................................................................................... 82 ST Enabled ........................................................................................................................................................... 83 15. ECG ARRHYTHMIA MONITORING .................................................................................................... 85 OVERVIEW .................................................................................................................................................................. 85 NOISE AND ARTIFACT .................................................................................................................................................... 85 ABERRANT BEATS ......................................................................................................................................................... 85 ATRIAL RHYTHMS ......................................................................................................................................................... 86 ARRHYTHMIA/ST ALGORITHM LEARNING .......................................................................................................................... 86 Automatic Learn .................................................................................................................................................. 86 Manual Relearn ................................................................................................................................................... 86 ARRHYTHMIA ANALYSIS METHODOLOGY ........................................................................................................................... 87 First Step: Beat Detection ................................................................................................................................... 87 Second Step: Heart Rate Calculation .................................................................................................................. 87 Third Step: Beat Typing and Template Memory ................................................................................................. 88 ECG Leads Used for Analysis ................................................................................................................................ 88 ARRHYTHMIA DEFINITIONS ............................................................................................................................................. 89 Lethal Arrhythmias .............................................................................................................................................. 89 Non‐Lethal Arrhythmia Classifications ................................................................................................................ 90 ARRHYTHMIA SETUP...................................................................................................................................................... 91 ARRHYTHMIA SETTINGS ................................................................................................................................................. 92 16. ECG ST MONITORING ........................................................................................................................ 93 OVERVIEW .................................................................................................................................................................. 93 ENABLE/DISABLE ST ANALYSIS ........................................................................................................................................ 93 ST TILE ....................................................................................................................................................................... 94 ST ALARM BEHAVIORS .................................................................................................................................................. 94 Physiological ST Alarms ....................................................................................................................................... 94 Technical ST Alarms ............................................................................................................................................. 94 ST TILE ALARM BEHAVIORS ............................................................................................................................................ 95 ST ALARM DELAY ......................................................................................................................................................... 95 SETUP ST DIALOGUE ..................................................................................................................................................... 95 iv
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Arrhythmia and ST Algorithm Learning ............................................................................................................... 96 ST Alarm Levels .................................................................................................................................................... 97 ST Print on Alarm ................................................................................................................................................. 97 ST Alarm Limits .................................................................................................................................................... 97 Display Averages .................................................................................................................................................. 98 ST Display ............................................................................................................................................................. 98 ST Delay After J‐Point .......................................................................................................................................... 99 Enable ST Leads ................................................................................................................................................... 99 17. NON-INVASIVE BLOOD PRESSURE MONITORING ...................................................................... 101 OVERVIEW ................................................................................................................................................................ 101 BLOOD PRESSURE TECHNOLOGY .................................................................................................................................... 102 PEDIATRIC PATIENT NIBP CONSIDERATIONS .................................................................................................................... 102 HYPERTENSIVE PATIENT CONSIDERATIONS ....................................................................................................................... 102 NIBP MONITORING PROCEDURE ................................................................................................................................... 103 NIBP TILE ................................................................................................................................................................. 103 NIBP ALARM BEHAVIORS ............................................................................................................................................ 104 NIBP START/STOP QUICK‐ACTION KEY .......................................................................................................................... 104 SETUP NIBP DIALOGUE ............................................................................................................................................... 104 NIBP Alarm Limits .............................................................................................................................................. 105 Auto Set NIBP Alarm Limits ................................................................................................................................ 105 NIBP Alarms On ................................................................................................................................................. 106 NIBP Print on Alarm ........................................................................................................................................... 106 NIBP Interval ...................................................................................................................................................... 106 NIBP Initial Inflation Pressure ............................................................................................................................ 107 NIBP Format ....................................................................................................................................................... 108 Show NIBP Trends .............................................................................................................................................. 109 CUFF OVERPRESSURE .................................................................................................................................................. 109 18. SPO2 MONITORING .......................................................................................................................... 111 OVERVIEW ................................................................................................................................................................ 111 Mortara SpO2 Technology ................................................................................................................................. 111 Nellcor OxiMax Technology ............................................................................................................................... 111 SPO2 MONITORING PROCEDURE .................................................................................................................................. 112 SPO2 DISPLAY ........................................................................................................................................................... 112 Pleth Waveform Parameter Tile ........................................................................................................................ 112 SpO2 Numeric Parameter Tile ........................................................................................................................... 112 SPO2 ALARM BEHAVIORS ............................................................................................................................................ 113 SETUP SPO2 DIALOGUE ............................................................................................................................................... 113 SpO2 Alarm Limits ............................................................................................................................................. 113 SpO2 Auto Set Alarms ........................................................................................................................................ 113 SpO2 Alarms On ................................................................................................................................................. 114 SpO2 Print on Alarm .......................................................................................................................................... 114 SpO2 Alarm Pause ............................................................................................................................................. 114 HR/PR Tone ........................................................................................................................................................ 115 Sat Seconds (Nellcor only).................................................................................................................................. 115 Response Mode (Nellcor only) ........................................................................................................................... 116 SPO2 FUNCTIONAL TESTING ......................................................................................................................................... 116 19. TEMPERATURE MONITORING ........................................................................................................ 117 OVERVIEW ................................................................................................................................................................ 117 v
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TEMPERATURE MONITORING PROCEDURE ....................................................................................................................... 117 TEMPERATURE DISPLAY ............................................................................................................................................... 117 TEMPERATURE ALARM BEHAVIORS ................................................................................................................................ 117 SETUP TEMPERATURE DIALOGUE ................................................................................................................................... 117 Temperature Alarm Limits ................................................................................................................................. 118 Temperature Alarms On .................................................................................................................................... 118 Temperature Print on Alarm .............................................................................................................................. 119 Temperature Display Mode ............................................................................................................................... 119 20. RESPIRATION MONITORING ........................................................................................................... 121 OVERVIEW ................................................................................................................................................................ 121 RESPIRATION ACQUISITION ........................................................................................................................................... 121 Respirations: ECG Thoracic Impedance ............................................................................................................. 121 Respirations: CO2 Measurement ...................................................................................................................... 121 RESPIRATION ALARM BEHAVIORS ................................................................................................................................... 122 RESPIRATION DISPLAY.................................................................................................................................................. 122 Respirations Waveform Parameter Tile ............................................................................................................. 122 Respirations Numeric Parameter Tile ................................................................................................................ 122 SETUP RESPIRATION (RR) DIALOGUE .............................................................................................................................. 122 Respiration Alarm Limits .................................................................................................................................... 123 Respiration Alarms On ....................................................................................................................................... 123 Respiration Print on Alarm ................................................................................................................................ 124 Respiration Enabled (Disabled) .......................................................................................................................... 124 21. CO2 MONITORING ............................................................................................................................ 125 OVERVIEW ................................................................................................................................................................ 125 PRINCIPLES OF OPERATION ........................................................................................................................................... 125 INTEGRATED PULMONARY INDEX (IPI) PARAMETER ........................................................................................................... 126 CO2 MONITORING PROCEDURE .................................................................................................................................... 127 CO2 DISPLAY ............................................................................................................................................................ 127 CO2 Waveform Parameter Tile .......................................................................................................................... 127 CO2 Numeric Parameter Tile ............................................................................................................................. 127 CO2 ALARM BEHAVIORS ............................................................................................................................................. 128 SETUP CO2 DIALOGUE ................................................................................................................................................ 128 CO2 Alarm Limits ............................................................................................................................................... 128 IPI Low Alarm Limit ............................................................................................................................................ 129 CO2 Auto ............................................................................................................................................................ 129 CO2 Alarms On ................................................................................................................................................... 130 CO2 Print on Alarm ............................................................................................................................................ 130 CO2 Waveform Size ........................................................................................................................................... 130 IPI Enabled/Disabled .......................................................................................................................................... 131 IPI Age Range (Pediatric Only) ........................................................................................................................... 131 22. INVASIVE PRESSURE MONITORING .............................................................................................. 133 OVERVIEW ................................................................................................................................................................ 133 INVASIVE PRESSURE MONITORING PROCEDURE ................................................................................................................ 133 INVASIVE PRESSURE DISPLAY ......................................................................................................................................... 134 Invasive Pressure Waveform Parameter Tile ..................................................................................................... 134 Invasive Pressure Numeric Parameter Tile ........................................................................................................ 134 INVASIVE PRESSURE ALARM BEHAVIORS .......................................................................................................................... 135 SETUP INVASIVE PRESSURE DIALOGUE ............................................................................................................................ 135 Invasive Pressure Alarm Limits .......................................................................................................................... 135 vi
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Auto Set Invasive Pressure Alarm Limits ............................................................................................................ 136 Invasive Pressure Alarms On .............................................................................................................................. 136 Invasive Pressure Print on Alarm ....................................................................................................................... 137 Invasive Pressure Label ...................................................................................................................................... 137 Invasive Pressure Format ................................................................................................................................... 138 Invasive Pressure Waveform Size ...................................................................................................................... 138 Invasive Pressure Zero Set ................................................................................................................................. 138 Invasive Pressure Zero All .................................................................................................................................. 139 MEASURING PAWP ................................................................................................................................................... 140 Printing the PAWP Waveform ........................................................................................................................... 142 OVERLAPPING INVASIVE PRESSURES ............................................................................................................................... 142 23. THERMODILUTION CARDIAC OUTPUT .......................................................................................... 145 OVERVIEW ................................................................................................................................................................ 145 CO DISPLAY .............................................................................................................................................................. 145 CO ALARM BEHAVIORS ............................................................................................................................................... 146 SETUP CO DIALOGUE .................................................................................................................................................. 146 Computation Constant ....................................................................................................................................... 146 Injectate Probe Type .......................................................................................................................................... 147 Measure PAWP .................................................................................................................................................. 147 Begin CO Measurement ..................................................................................................................................... 148 Hemodynamic Calculations ............................................................................................................................... 151 Height ................................................................................................................................................................ 151 Weight ............................................................................................................................................................... 152 24. HEMODYNAMIC CALCULATIONS ................................................................................................... 153 OVERVIEW ................................................................................................................................................................ 153 HEMODYNAMIC CALCULATION PARAMETERS ................................................................................................................... 153 HEMODYNAMIC CALCULATION DIALOGUE ....................................................................................................................... 153 HD Calcs Input Parameters ................................................................................................................................ 154 HD Calcs Output Parameters ............................................................................................................................. 155 Resample ........................................................................................................................................................... 155 Print ................................................................................................................................................................... 155 25. LIST TRENDS..................................................................................................................................... 157 OVERVIEW ................................................................................................................................................................ 157 TRENDS DIALOGUE...................................................................................................................................................... 157 Trends and Alarm Behaviors .............................................................................................................................. 158 Page Up/Page Down Arrows ............................................................................................................................. 158 Interval ............................................................................................................................................................... 158 Clear Trends ....................................................................................................................................................... 158 Print Trends ........................................................................................................................................................ 158 Close Trends ....................................................................................................................................................... 159 26. SETUP ................................................................................................................................................ 161 OVERVIEW ................................................................................................................................................................ 161 PATIENT INFORMATION................................................................................................................................................ 161 PARAMETERS ............................................................................................................................................................. 161 WAVEFORMS ............................................................................................................................................................. 162 RECORDER ................................................................................................................................................................. 164 ARRHYTHMIA ............................................................................................................................................................. 165 vii
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ALARM SUSPEND ........................................................................................................................................................ 166 ALARMS .................................................................................................................................................................... 166 AUDIO ...................................................................................................................................................................... 168 RESTORE DEPARTMENTAL DEFAULTS .............................................................................................................................. 169 ADMINISTRATION ....................................................................................................................................................... 169 Configuration ..................................................................................................................................................... 170 Communications ................................................................................................................................................ 170 Connectivity ....................................................................................................................................................... 171 When interfacing to 3rd party EMR applications, the connectivity type must be defined. The typical setting for
most EMR applications is “1”. .......................................................................................................................... 171 Screen Cleaning ................................................................................................................................................. 172 Administration Setup Alarms Dialogue.............................................................................................................. 172 Administration Setup System Dialogue ............................................................................................................. 174 Administration Setup Service Dialogue .............................................................................................................. 175 Administration Setup Factory Dialogue ............................................................................................................. 175 27. PRODUCT SPECIFICATIONS ........................................................................................................... 177 GENERAL SPECIFICATIONS ............................................................................................................................................ 177 ENVIRONMENTAL CONDITIONS ...................................................................................................................................... 178 POWER REQUIREMENTS & BATTERY ............................................................................................................................... 178 DISPLAY SPECIFICATIONS .............................................................................................................................................. 178 RECORDER SPECIFICATIONS ........................................................................................................................................... 179 MOUNTING SPECIFICATIONS ......................................................................................................................................... 179 TRENDING ................................................................................................................................................................. 179 28. PARAMETER SPECIFICATIONS ...................................................................................................... 181 PATIENT POPULATION ................................................................................................................................................. 181 WAVEFORMS ............................................................................................................................................................. 181 ECG ........................................................................................................................................................................ 181 ARRHYTHMIA ANALYSIS ............................................................................................................................................... 182 ST ANALYSIS .............................................................................................................................................................. 183 NON‐INVASIVE BLOOD PRESSURE (NIBP) ....................................................................................................................... 184 PULSE OXIMETRY (SPO2) ............................................................................................................................................ 184 TEMPERATURE ........................................................................................................................................................... 185 RESPIRATIONS: VIA ECG IMPEDANCE ............................................................................................................................ 185 CAPNOGRAPHY (CO2) ................................................................................................................................................. 186 INVASIVE PRESSURES ................................................................................................................................................... 187 CARDIAC OUTPUT ....................................................................................................................................................... 188 29. PARAMETER ALARM LIMIT RANGES ............................................................................................ 189 ADULT PATIENT MODE ................................................................................................................................................ 189 PEDIATRIC PATIENT MODE ........................................................................................................................................... 191 30. ALARM SPECIFICATIONS ................................................................................................................ 193 GENERAL ALARMS ...................................................................................................................................................... 193 ECG AND HR MESSAGES ............................................................................................................................................. 193 NON‐INVASIVE BLOOD PRESSURE (NIBP) MESSAGES ........................................................................................................ 194 PULSE OXIMETRY (SPO2) MESSAGES ............................................................................................................................. 197 TEMPERATURE MESSAGES ............................................................................................................................................ 198 RESPIRATION MESSAGES .............................................................................................................................................. 199 CAPNOGRAPHY (CO2) MESSAGES ................................................................................................................................. 200 INVASIVE PRESSURE MESSAGES ..................................................................................................................................... 202 viii
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CARDIAC OUTPUT MESSAGES ....................................................................................................................................... 203 31. TROUBLESHOOTING ....................................................................................................................... 205 POWER AND BATTERY .................................................................................................................................................. 205 DISPLAY AND TOUCH SCREEN ........................................................................................................................................ 205 ECG, ARRHYTHMIA, AND ST......................................................................................................................................... 206 NON‐INVASIVE BLOOD PRESSURE (NIBP) ....................................................................................................................... 207 PULSE OXIMETRY (SPO2) ............................................................................................................................................ 207 TEMPERATURE ........................................................................................................................................................... 208 RESPIRATIONS: VIA ECG THORACIC IMPEDANCE .............................................................................................................. 208 CAPNOGRAPHY (CO2) ................................................................................................................................................. 208 INVASIVE PRESSURES ................................................................................................................................................... 209 CARDIAC OUTPUT ....................................................................................................................................................... 209 32. ACCESSORIES .................................................................................................................................. 211 33. APPLIED STANDARDS ..................................................................................................................... 217 ix
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x
TABLE OF FIGURES
Figure 1 Battery Replacement .....................................................................................................................................28 Figure 2 Calibration Dialogue .....................................................................................................................................29 Figure 3 Surveyor Patient Monitor: Front View Example ..........................................................................................36 Figure 4 Surveyor Patient Monitor: Left Side Patient Cable Connector Ports ............................................................36 Figure 5 Surveyor Patient Monitor: Right Side View of S12 with Optional Bedside Recorder .................................37 Figure 6 Surveyor Patient Monitor: Top Back View of S12 .......................................................................................37 Figure 7 Surveyor Patient Monitor: Back View of S12 with Optional Bedside Recorder (1) ....................................38 Figure 8 Surveyor Patient Monitor: Back View of S19 ..............................................................................................38 Figure 9 Mounting Plate for S12 .................................................................................................................................39 Figure 10 Power On/Off Button ..................................................................................................................................40 Figure 11 New Patient Confirmation Dialogue ...........................................................................................................41 Figure 12 Main Screen (example) ...............................................................................................................................43 Figure 13 Main Screen Quick-Action Keys ................................................................................................................45 Figure 14 Message Area ..............................................................................................................................................47 Figure 15 Demographic and Status Area .....................................................................................................................48 Figure 16 Example Network Status Icon: Successfully Communicating with Central Station ..................................48 Figure 17 Example Network Status Icon: Not Actively Communicating with Central Station ................................48 Figure 18 Patient Information Dialogue ......................................................................................................................49 Figure 19 Confirm Patient Mode Change Dialogue ....................................................................................................50 Figure 20 Example Onscreen Keyboard (Last Name) .................................................................................................50 Figure 21 Example Onscreen Keypad (Birth Year) ...................................................................................................51 Figure 22 Example Drop Down List Box (Patient Mode) ..........................................................................................51 Figure 23 Standby Mode Choice Dialogue .................................................................................................................51 Figure 24 Standby Mode Display ................................................................................................................................52 Figure 25 Confirm Same Patient Prompt.....................................................................................................................53 Figure 26 Confirm Discharge Patient Message ...........................................................................................................54 Figure 27 Discharged Monitor screen .........................................................................................................................54 Figure 28 Setup Arrhythmia Dialogue ........................................................................................................................62 Figure 29 Electrode Locations: 3-Wire Lead Set ........................................................................................................67 Figure 30 Electrode Locations: 5-Wire Lead Set ........................................................................................................68 Figure 31 Electrode Locations: Lead II Monitoring ....................................................................................................69 Figure 32 Electrode Locations: MCL Monitoring .......................................................................................................70 Figure 33 Electrode Locations: Pacemaker Patients....................................................................................................71 Figure 34 Electrode Locations: Continuous 12-Lead Monitoring ...............................................................................72 Figure 35 Electrode Locations: Diagnostic Resting 12-Lead Acquisition ..................................................................73 Figure 36 Example ECG Waveform Tiles...................................................................................................................74 Figure 37 All ECG Mode: 5-Wire ECG Set ................................................................................................................75 Figure 38 All 12 Lead ECG view ................................................................................................................................75 Figure 39 Resting 12-Lead Interpretation ...................................................................................................................76 Figure 40 Example HR Tile.........................................................................................................................................77 Figure 41 Example Setup HR/PR Dialogue ................................................................................................................78 Figure 42 ARR/ST Relearn: Setup Arrhythmia Dialogue ...........................................................................................87 Figure 43 Setup Arrhythmia Dialogue ........................................................................................................................91 Figure 44 Example ST Tile: Delta ST Values .............................................................................................................94 Figure 45 Example ST Decrease Alarm ......................................................................................................................95 Figure 46 Setup ST Dialogue ......................................................................................................................................95 Figure 47 ST Average Dialogue ..................................................................................................................................98 Figure 48 Example NIBP Tile ...................................................................................................................................104 Figure 49 Example NIBP Tile in Alarm ....................................................................................................................104 Figure 50 Setup NIBP Dialogue ................................................................................................................................105 Figure 51 Example of NIBP Mean Format................................................................................................................108 Figure 52 Example of NIBP Parameter Tile with NIBP Trends List ........................................................................109 xi
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Figure 53 Example Nellcor SpO2 Waveform and Numeric Tile ..............................................................................112 Figure 54 Example Temperature Tile ........................................................................................................................117 Figure 55 Example Setup Temperature Dialogue (T1 and T2 Display Mode)..........................................................118 Figure 56 Respiration Numeric Tile (ECG as Resp Source) .....................................................................................122 Figure 57 Example Respiration/CO2 Numeric Tile (CO2 as Resp Source) ..............................................................122 Figure 58 Example Setup Respiration Dialogue (ECG as Resp Source) ..................................................................123 Figure 59 Example CO2 Waveform and Numeric Parameter Tiles ..........................................................................127 Figure 60 Example Setup ETCO2 Dialogue .............................................................................................................128 Figure 61 Example of an Arterial Line Manifold Setup ............................................................................................133 Figure 62 Main Screen Example: Four Invasive Pressures ......................................................................................134 Figure 63 Example Invasive Pressure Waveform and Numeric Parameter Tiles ......................................................135 Figure 64 Invasive Pressure Setup Dialogue .............................................................................................................135 Figure 65 Example Pulmonary Artery Invasive Pressure Dialogue ..........................................................................140 Figure 66 Example Measure PAWP Dialogue ..........................................................................................................141 Figure 67 Example Measure PAWP Dialogue: Stop Waveform..............................................................................142 Figure 68 Example of Two Overlapped Invasive Pressure Waveforms ....................................................................142 Figure 69 Example of Four Overlapped Invasive Pressure Waveforms ...................................................................143 Figure 70 Example Cardiac Output Tile ....................................................................................................................146 Figure 71 Setup CO Dialogue ...................................................................................................................................146 Figure 72 Example Measure PAWP Dialogue ..........................................................................................................147 Figure 73 Measure CO Dialogue ...............................................................................................................................149 Figure 74 Hemodynamics Calculations Dialogue .....................................................................................................154 Figure 75 Example Trends Dialogue .........................................................................................................................157 Figure 76 Example Setup Dialogue ...........................................................................................................................161 Figure 77 Example Setup Parameters Dialogue ........................................................................................................162 Figure 78 Example Setup Waveform Area Dialogue ................................................................................................163 Figure 79 Example Setup Recorder Dialogue ...........................................................................................................164 Figure 80 Setup Arrhythmia Dialogue ......................................................................................................................165 Figure 81 Example Setup Alarms Dialogue ..............................................................................................................167 Figure 82 Example Setup Audio Dialogue ................................................................................................................168 Figure 83 Restore Departmental Defaults .................................................................................................................169 Figure 84 Example Administration Dialogue ............................................................................................................169 Figure 85 Example Setup Configuration Dialogue ...................................................................................................170 Figure 86 Example Setup Communications Dialogue ...............................................................................................171 Figure 87 Administration Setup Alarms Dialogue ....................................................................................................172 Figure 88 Quick-Disconnect (M-Series) Wall Mounting Components .....................................................................214 Figure 89 Value (Vesa M-Series) Wall Mounting Components ...............................................................................215 Figure 90 Premium (VHM-25) Wall Mount Components ........................................................................................215 Figure 91 Surveyor S12 Roll Stand Components (not to be used with S19) ............................................................216 xii
1. GENERAL STATEMENTS
Technical Support and Service
Headquarters
Mortara Instrument, Inc.
7865 North 86th Street
Milwaukee, WI 53224
U.S.A.
Tel:
414.354.1600
Tel:
800.231.7437
Fax:
414.354.4760
Internet:
http://www.mortara.com
European Union
Representative
Mortara Instrument Europe s.r.l.
(European Headquarters)
Via Cimarosa 103/105
40033 Casalecchio di Reno (BO)
Italy
Tel:
+39.051.298.7811
Fax:
+39.051.613.3582
Service/Technical
Support Group
Mortara Instrument, Inc.
7865 North 86th Street
Milwaukee, WI 53224
U.S.A.
Tel:
414.354.1600
Service:
888.MORTARA
(888.667.8272)
Fax:
414.354.4760
E-mail:
[email protected]
Sales Support/
Supplies & Accessories
Mortara Instrument, Inc.
7865 North 86th Street
Milwaukee, WI 53224
U.S.A.
Tel:
414.354.1600
Fax:
414.354.4760
Hospital Customers:
Physician Practice:
U.S. Distribution:
[email protected]
[email protected]
[email protected]
Mortara Instrument Germany
Bonifaciusring 15
45309 Essen
Germany
Tel:
+49.201.18 55 69 70
Fax:
+49.201.18 55 69 77
Mortara Instrument Netherlands
Postbus 324
5680 AH Best
Industrieweg 160b
5683 CG Best
Netherlands
Tel:
+31.499.377310
Fax:
+31.499.377908
Mortara Instrument Australia
PO Box 7568
Baulkham Hills NSW 2153
Unit 28, 9 Hoyle Avenue
Castle Hill NSW 2154
Australia
Tel:
+61 2 8070 9303
Fax:
+61 2 9899 9478
Mortara Dolby UK Ltd.
Units 11 & 12, Scion House
Stirling University Innovation Park
Stirling FK9 4NF
Scotland
Tel:
+44.1786.444980
Fax:
+44.1786.446630
1
2. NOTICES
Manufacturer’s Responsibility
Mortara Instrument, Inc. is responsible for the effects on safety and performance of the patient monitor, as
indicated by the
•
•
•
•
•
label, only if article 2 of 93/42/EEC directive is applied, in particular:
WARNING: System installation and assembly operations, extensions, readjustments, modifications or
repairs are carried out by personnel authorized by Mortara Instrument, Inc. only.
The patient monitor is used in accordance with the instructions for use.
The patient monitor is correctly maintained according to the standards authorized by Mortara Instrument, Inc.
using original spare parts.
The patient monitor is used with original accessories and supplies that are in compliance with the standard
specifications described in this manual.
The electrical installation of the relevant room complies with the requirements of appropriate regulations.
Responsibility of the Customer
The user of this patient monitor is responsible for ensuring the implementation of a satisfactory maintenance
schedule. Failure to do so may cause undue failure and possible health hazards. This manual must be kept in a safe
place to prevent its deterioration and/or alteration. The user and Mortara Instrument, Inc. authorized personnel must
have access to this manual at any time.
The user of this patient monitor must periodically check the accessories, their functionality and integrity.
Equipment Identification
Mortara Instrument, Inc. equipment is identified by a serial and reference number on the back of the patient
monitor. Care should be taken so that these numbers are not defaced.
Copyright and Trademark Notices
This document contains information that is protected by copyright. All rights are reserved. No part of this
document may be photocopied, reproduced, or translated into another language without prior written consent of
Mortara Instrument, Inc.
Other Important Information
The information in this document is subject to change without notice.
Mortara Instrument, Inc. makes no warranty of any kind with regard to this material including, but not limited to,
implied warranties of merchantability and fitness for a particular purpose. Mortara Instrument, Inc. assumes no
responsibility for any errors or omissions that may appear in this document. Mortara Instrument, Inc. makes no
commitment to update or to keep current the information contained in this document.
2
3. WARRANTY INFORMATION
Your Mortara Warranty
MORTARA INSTRUMENT, INC. (hereafter referred to as “Mortara”) warrants that components within Mortara
products (hereafter referred to as “Product/s”) will be free from defects in workmanship and materials for the
number of years specified on documentation accompanying the product, or previously agreed to by the purchaser
and Mortara, or if not otherwise noted, for a period of twelve (12) months from the date of shipment.
Consumable, disposable or single use products such as, but not limited to, PAPER or ELECTRODES are warranted
to be free from defects in workmanship and materials for a period of 90 days from the date of shipment or the date
of first use, whichever is sooner.
Reusable product such as, but not limited to, BATTERIES, BLOOD PRESSURE CUFFS, BLOOD PRESSURE
HOSES, TRANSDUCER CABLES, Y-CABLES, PATIENT CABLES, LEAD WIRES, MAGNETIC STORAGE
MEDIUMS, CARRY CASES or MOUNTS, are warranted to be free from defects in workmanship and materials for
a period of 90 days. This warranty does not apply to damage to the Product/s caused by any or all of the following
circumstances or conditions:
a)
Freight damage;
b) Supplies, accessories and internal parts NOT approved by Mortara;
c)
Misapplication, misuse, abuse, and/or failure to follow the Product/s instruction sheets and/or information
guides;
d) Accident;
e) A disaster affecting the Product/s;
f)
Alterations and/or modifications to the Product/s not authorized by Mortara;
g) Other events outside of Mortara’s reasonable control or not arising under normal operating conditions.
THE REMEDY UNDER THIS WARRANTY IS LIMITED TO THE REPAIR OR REPLACEMENT WITHOUT
CHARGE FOR LABOR OR MATERIALS, OR ANY PRODUCT/S FOUND UPON EXAMINATION BY
MORTARA TO HAVE BEEN DEFECTIVE. This remedy shall be conditioned upon receipt of notice by Mortara
of any alleged defects promptly after discovery thereof within the warranty period. Mortara’s obligations under the
foregoing warranty will further be conditioned upon the assumption by the purchaser of the Product/s (i) of all
carrier charges with respect to any Product/s returned to Mortara’s principal place or any other place as specifically
designated by Mortara or an authorized distributor or representative of Mortara, and (ii) all risk of loss in transit. It
is expressly agreed that the liability of Mortara is limited and that Mortara does not function as an insurer. A
purchaser of a Product/s, by its acceptance and purchase thereof, acknowledges and agrees that Mortara is not liable
for loss, harm, or damage due directly or indirectly to an occurrence or consequence there from relating to the
Product/s. If Mortara should be found liable to anyone under any theory (except the expressed warranty set forth
herein) for loss, harm, or damage, the liability of Mortara shall be limited to the lesser of the actual loss, harm, or
damage, or the original purchase price of the Product/s when sold.
3
WARRANTY INFORMATION
EXCEPT AS SET FORTH HEREIN WITH RESPECT TO REIMBURSEMENT OF LABOR CHARGES, A
PURCHASER’S SOLE EXCLUSIVE REMEDY AGAINST MORTARA FOR CLAIMS RELATING TO THE
PRODUCT/S FOR ANY AND ALL LOSSES AND DAMAGES RESULTING FROM ANY CAUSE SHALL BE
THE REPAIR OR REPLACEMENT OF DEFECTIVE PRODUCT/S TO THE EXTENT THAT THE DEFECT IS
NOTICED AND MORTARA IS NOTIFIED WITHIN THE WARRANTY PERIOD. IN NO EVENT,
INCLUDING THE CLAIM FOR NEGLIGENCE, SHALL MORTARA BE LIABLE FOR INCIDENTAL,
SPECIAL, OR CONSEQUENTIAL DAMAGES, OR FOR ANY OTHER LOSS, DAMAGE, OR EXPENSE OF
ANY KIND, INCLUDING LOSS OF PROFITS, WHETHER UNDER TORT, NEGLIGENCE OR STRICT
LIABILITY THEORIES OF LAW, OR OTHERWISE. THIS WARRANTY IS EXPRESSLY IN LIEU OF ANY
OTHER WARRANTIES, EXPRESS OR IMPLIED, INCLUDING, BUT NOT LIMITED TO THE IMPLIED
WARRANTY OF MERCHANTABILITY AND THE WARRANTY OF FITNESS FOR A PARTICULAR
PURPOSE.
4
4. USER SAFETY INFORMATION
Warning:
Means there is the possibility of personal injury to you or others.
Caution:
Means there is the possibility of damage to the patient monitor.
Note:
Provides information to further assist in the use of the patient monitor.
NOTE: This manual may contain screen shots and pictures. Any screen shots and pictures are provided
for reference only and are not intended to convey actual operating techniques. Consult the actual screen
in the host language for specific wording.
Safety Regulations
•
Surveyor is a medical patient monitor.
•
Surveyor and its accessories are
labeled, according to European directive 93/42/EEC (MDD), as a class
IIb patient monitor, and class I medical patient monitors respectively.
Surveyor with all accessories that have a physical or logical connection with it, forms part of a Medical
Electrical System. Surveyor complies with various safety and performance regulations as mentioned in this
manual (Applied Standards).
•
Warnings
•
This manual gives important information about the use and safety of this patient monitor. Deviating from
operating procedures, misuse or misapplication of the patient monitor, or ignoring specifications and
recommendations could result in increased risk of harm to users, patients and bystanders, or damage to the
patient monitor.
•
Users are expected to be licensed clinical professionals knowledgeable about medical procedures and patient
care, and adequately trained in the use of this patient monitor. Patient monitor captures and presents data
reflecting a patient’s physiological condition that when reviewed by a trained physician or clinician can be
useful in determining a diagnosis; however, the data should not be used as a sole means for determining a
patient’s diagnosis.
•
Before attempting to use this device for clinical applications, the operator must read and understand the
contents of the user manual and other accompanying documents. Inadequate knowledge or training could
result in increased risk of harm to users, patients and bystanders, or damage to the patient monitor. Contact
Mortara Technical Service for additional training options.
•
The patient monitor provides the possibility to monitor multiple functions, but is not intended to be connected
to more than one patient.
•
Operation of the equipment beyond its specified ranges, or beyond normal physiological conditions of human
subjects, may cause inaccurate results.
•
A possible explosion hazard exists. Do not use the device in the presence of a flammable anesthetic mixture.
Do not mount any part of the device closer than 25 cm from outlets of flammable gases, including oxygen.
5
USER SAFETY INFORMATION
•
For proper operation and the safety of users or patients and bystanders, equipment and accessories must be
connected only as described in this manual.
•
Repairs and modification must be made by authorized and trained technical personnel. Unauthorized
modifications and repairs will void the Surveyor warranty and may pose a danger to patients and users.
•
The Surveyor, as all medical equipment or systems, needs special precautions regarding EMC and needs to be
installed and put into service according to the EMC information provided in the installation procedure in order
to obtain a sufficient degree of immunity as well as not to create disturbance to other equipment. Refer to the
specific EMC instructions in this manual.
•
The quality of the signal produced by the device may be adversely affected by the use of other medical
equipment, including but not limited to electrosurgery and ultrasound machines. Do not use the system in the
presence of imaging equipment such as magnetic resonance imaging (MRI) and tomography systems.
Simultaneous operation may damage the device or lead to erroneous results.
•
Portable and mobile RF communications equipment may affect medical electrical equipment or systems as
well as the Surveyor and its accessories. Do not operate the Surveyor near high frequency emissions (e.g.
microwaves).
•
Various alarm conditions require operator to adjust alarm configurations individualized according to patient
condition and demographics. Surveyor supports the selection of appropriate alarm profiles when a patient is
admitted. The operator should check these settings with each patient admission to ensure the alarm settings are
appropriate for the individual patient. Inappropriate alarm configuration settings may render the alarm system
useless.
•
Surveyor alarms can only be silenced and not reset. This means that visual representation of an alarm condition
remains present after an operator-silenced action until the alarm condition disappears (unless obscured by
another, higher level, alarm). The auditory alarm signal does not re-activate after a silence action if the alarm
condition remains the same. As soon as the alarm condition of a silenced alarm goes away, the alarm can be
reactivated. Always respond promptly to alarms.
•
A patient monitor is an addition to monitoring patient status and is not intended to replace clinical assessments
and clinical judgments. It is important that a qualified individual regularly supervise the patient.
•
In an environment where multiple systems, whether Surveyor and/or other systems, are utilized for monitoring
patients, use of different alarm presets on each system may pose a safety risk. Be careful in using different
alarm conditions on different systems.
Power Warnings
•
Only use the Mortara-provided external power adapter with the Surveyor. Ensure that the power adapter is
connected to a properly grounded power terminal and the electrical installation complies with local safety
requirements for the environment where it is used.
•
To ensure that electrical safety is maintained during operation from AC power, the Surveyor external power
adapter must be plugged into a hospital-grade outlet.
•
Where the integrity of external protective earth conductor arrangement is in doubt, the device shall be operated
from its internal battery power source.
6
USER SAFETY INFORMATION
•
Do not use the Surveyor power supply to power other devices, because of the risk of additional leakage currents
and of transformer overload.
•
The device is not operative if no image appears on the screen. If the device becomes inoperative during
monitoring, a medium level type alarm sounds and the system resets automatically.
•
Regularly check all mains power cables for damage and proper connection. Do not use equipment with a
damaged power cord.
•
The Surveyor contains a lithium ion battery. The following precautions should be taken regarding the battery:
o
o
o
o
o
o
Do not immerse the device in water.
Do not heat or throw the device in fire.
Do not leave the in conditions over 60 ºC or in a heated car.
Do not attempt to crush or drop the device.
Only use the approved Mortara battery pack with the Surveyor monitor.
Follow the instructions in the disposal section of this manual when the Surveyor monitor is taken out of
service.
•
The Surveyor battery must be initially fully charged prior to use. Ideally, the battery must be fully charged and
fully discharged several times to allow for optimal performance.
•
The Surveyor produces audible startup tones when powered on (two tones followed by two higher beeps). If a
patient monitor does not sound the startup tones when it is powered on, remove the patient monitor from
service and contact Mortara Technical Support.
•
If the AC power supply is interrupted or disconnected during monitoring, the Surveyor switches to battery
backup if the battery is properly installed and has sufficient charge. If power is completely interrupted,
including exhausting the battery supply, monitoring will cease until AC power supply has been restored or a
fresh battery is installed, and the monitor’s power switch is recycled.
•
For continued operation, always connect the Surveyor to a wall outlet when a Low Battery alarm indication
occurs. Failure to do this can lead to an interruption of monitoring.
•
Ensure the battery has sufficient charge prior to disconnecting the external power supply. To disconnect from
the AC power, disconnect the external power adapter from AC power first, then disconnect the power
connection from the back of the monitor.
•
Always reconnect the power cord to AC power after operating the patient monitor using battery power. This
ensures that the batteries are recharged for the next time the patient monitor is operated on battery power. A
light next to the on/off switch will illuminate indicating that the patient monitor is connected to mains power
and charging. The battery icon on the main display indicates when the battery is fully charged.
Accessories, Cables, and External Connections Warnings
•
The patient monitor is designed to meet applicable specifications when using Mortara-approved patient cables
and accessories. Use of non-approved cables and accessories may result in reduced performance and may pose
possible patient and user safety concerns.
7
USER SAFETY INFORMATION
•
It is the user’s responsibility to use only approved supplies, accessories and internal parts available through
Mortara Instrument, Inc. Product performance and patient safety require the use of supplies, accessories and
internal parts that comply with applicable standards. To maintain designed operator and patient safety,
peripheral equipment and accessories used that can come in direct patient contact must be in compliance with
applicable standards including IEC 60601-1, or other IEC standards (e.g., IEC 60950) as appropriate to the
patient monitor. Additionally, cables and accessories must comply with all EMC regulations. In Europe,
cables and accessories should bear the CE Mark. Only use parts and accessories supplied with the patient
monitor and available through Mortara Instrument, Inc.
•
Medical devices have been designed to have a higher degree of protection against electric shock than, for
instance, information technology equipment because patients often are connected to multiple devices and also
may be more prone to the adverse effect of electric currents than healthy persons. All equipment that is
connected to the patient, can be touched by the patient, or can be touched by another person while that person
touches the patient at the same time, should have the same level of protection against electric shock as medical
equipment. The Surveyor patient monitor is a medical device that has been designed to be connected to other
devices for the purpose of receiving and transmitting data. Certain measures must be taken to prevent the risk of
excessive electric current flow through the operator or patient when connected:
•
All electrical equipment that is not medical electrical equipment must be placed outside of the “patient
environment,” defined by applicable safety standards to be at least 1.5 meters (5 feet) from the patient.
Alternatively, non-medical equipment may be provided with additional protection such as an additional
protective earth connection.
•
All medical electrical equipment that has a physical connection to the Surveyor or the patient, or is in the
patient environment must comply with applicable safety standards for medical electrical devices.
•
All electrical equipment that is not medical electrical equipment and has a physical connection to the
Surveyor must comply with applicable safety standards, such as IEC 60950 for information technology
equipment. This includes information network equipment connected through the LAN connector.
•
Conductive (metal) parts that can be touched by the operator in normal use and that are connected to nonmedical equipment should not be brought into the patient environment. Examples are connectors for
shielded Ethernet or USB cables.
•
If multiple devices are connected to each other or to the patient, device chassis and patient leakage
currents may be increased, and should be measured for compliance with applicable standards for medical
electrical systems.
•
Avoid the use of portable multiple socket outlets. If used and not compliant with medical electrical
device standards, an additional protective earth connection is required.
•
To prevent electric shock due to unequal ground potentials that may exist between points of a distributed
network system or fault conditions in external network connected equipment, network cable shielding
(where used) must be connected to protective earth ground appropriate to the area where the device is used.
•
Do not use excessive force on any of the connection cables and handle all accessories with care.
•
Proper clinical procedure must be employed to prep the electrode and sensor sites and to monitor the patient for
excessive skin irritation, inflammation, or other adverse reactions. Electrodes and other sensors are intended for
short-term use and should be removed from the patient promptly following testing.
8
USER SAFETY INFORMATION
•
Conductive parts of the ECG patient cables, electrodes, and associated connections of type CF applied parts,
including the neutral conductor of the patient cable and electrode should not come into contact with other
conductive parts including earth ground.
•
To avoid the possibility of serious injury or death during patient defibrillation, do not come into contact with
patient monitor or patient cables. Additionally, proper placement of defibrillator paddles in relation to the ECG
electrodes is required to minimize harm to the patient.
•
To avoid potential for spread of disease or infection, single-use disposable components (e.g., electrodes, IBP
catheters, disposable SpO2 sensors, disposable temperature sensors, single-use blood pressure cuffs, etc.) must
not be reused.
•
Mortara-approved manufacturers of accessories provide separate user manuals (e.g., patient cables, electrodes,
etc.). Read these manuals thoroughly and refer to them for specific functions. It is recommended to keep all
manuals together.
•
To maintain safety and effectiveness, reusable sensors and cables - such as ECG electrodes and SpO2 sensors must not be used beyond their expiration date or useful life.
•
All accessories including hoses, cables, connectors, hoses and other patient-applied parts supplied with the
Surveyor do NOT contain any Latex. If the patient develops an allergic reaction or rashes, immediately remove
the accessory and inform Mortara Technical Support.
•
Check the date and integrity of the packing of all accessories that need to be sterilized before use.
•
Do not attach unauthorized devices such as a mouse or keyboard to the USB port.
Use with Electro Surgery Devices Warnings
•
The Surveyor is approved for use in the presence of electrosurgical (ESU) equipment providing the following
precautions are taken:
o To minimize the risk of patient burns, only use ESU equipment that monitors the impedance of the ESU
return wires.
o Users should be properly trained in the operation of the ESU equipment.
o The AM12 12-Lead ECG Acquisition Module should NOT be used when operating ESU equipment.
o Keep patient-applied cables (e.g., ECG lead wires) off of earth ground and away from the ESU knife and
return wires to prevent burns to measurement sites.
o To prevent burns to the patient in the event of a defective neutral ECG electrode of the device, it is
necessary to place ECG electrodes far from the neutral electrode, and as equidistant as possible from the
blade-neutral axis of the surgical patient monitor.
o When activating the ESU device, the ECG signals may be distorted or may disappear, and Lead Fail or
Noise alarms might be present. The signal should return once the ESU activation stops.
o When activating the ESU device, using the SpO2 parameter as the heart rate source rather than the ECG
parameter to determine heart rate may be clinically preferred.
9
USER SAFETY INFORMATION
Installation and Mounting Warnings
•
Place the Surveyor on a flat and leveled surface or mount it according to the manufacturer’s instructions. Place
the Surveyor in a well-ventilated place. Keep the Surveyor away from overly hot, cold or humid places, places
directly under sunlight, or dusty surroundings.
•
Ensure that the Surveyor is securely placed or mounted such that it does not tip or drop which may damage the
monitor and potentially create a hazard to patients and hospital personnel.
•
Only approved rolling stands and wall-mount fixtures should be used with the Surveyor.
•
A VESA-standard adapter is available on the back of the Surveyor system for wall, swivel-arm or rolling-stand
mounting. The user is responsible for correct installation of the system.
•
Do not mount the S12 on a rolling stand at a height exceeding 110 cm (43”).
•
The S19 should NOT be mounted on a rolling stand.
ECG Warnings
•
Excessive patient movement could interfere with the operation of the system.
•
Proper patient preparation is important to proper application of ECG electrodes and operation of the patient
monitor.
•
If the ECG amplifier input is out of normal operating range, the display will indicate a lead fail for the lead(s)
where this condition is present and if the signal is being displayed or printed, the respective lead(s) will print
out as blank. A lead fail alarm is generated on the Surveyor Central monitoring station
•
The AM12 acquisition module automatically calibrates when it is connected to the monitor or when the monitor
powers up. If there is a very high amount of electrical interference present at that time (usually because
electrodes make spurious contact with earth ground), the calibration may fail. The monitor is aware of the
failure and will not display the ECG waveforms. If this happens, the user should attempt to recalibrate by
reconnecting the AM12 to the monitor, making sure that there are no spurious contacts between electrodes and
earth ground.
•
Patient cables intended for use with the patient monitor include series resistance (9 Kilo Ohm minimum) in
each lead for defibrillation protection. Patient cables should be checked for cracks or breakage prior to use
•
ECG electrodes could cause skin irritation; patients should be examined for signs of irritation or inflammation.
•
Defibrillation protection is guaranteed when the original Mortara ECG patient cables are used.
•
The system captures and presents data reflecting a patient’s physiological condition that when reviewed by a
trained physician or clinician can be useful in determining a diagnosis. However, the data should not be used
as a sole means for determining a patient’s diagnosis. The system is equipped with Mortara’s VERITAS™ 12lead resting ECG interpretation algorithm. The VERITAS ECG algorithm can provide an over-reading
physician with a silent second opinion through diagnostic statements output on the ECG report.
10
USER SAFETY INFORMATION
•
12-lead ECGs acquired through Surveyor will normally use a modified lead system with the limb electrodes
positioned on the torso. Although this is a generally accepted practice (e.g., in stress testing), the different
electrode positions can cause morphology changes on the ECG, thus influencing their interpretation. Most
frequently seen differences are a vertical and rightward axis shift, minor changes of evidence of old inferior
infarction and changes in the T-wave in the limb leads. All 12-lead ECGs printed with Surveyor have a
warning message that alerts the physician that the ECG might have been acquired with torso positioned limb
leads. It is recommended that you place the electrodes as close as possible to the normal limb positions
avoiding the possibility of causing artifact. The right arm and left arm electrodes should be placed on the
clavicles as close as possible to the arms. The left leg electrode should be placed as close as possible to the left
leg without subjecting it to the possibility of motion artifact.
•
The ST algorithm has been tested for accuracy of the ST segment data. The significance of the ST segment
changes need to be determined by a clinician.
•
During periods of lead fail and when a reduced lead set is used for patient monitoring, 12-lead resting ECG
interpretation cannot be reliably used in determining a diagnosis.
•
For full diagnostic quality, the resting ECG should be printed on the Surveyor Central Station printer and not
on the S12 or S19 strip chart recorder.
ECG Calculated Heart Rate Warnings
•
Heart rate indication is usually not affected by pacemakers with direct cardiac application, ventricular or
supraventricular arrhythmias or irregular heart rates; however, in some conditions a pacemaker pulse can give
rise to double QRS detections. Also, not activating the “Analyze Pacers” field in the signals menu in the
presence of a pacemaker might lead to beat detections without a QRS complex due to the detection of the
pacemaker spike.
•
Heart rate is calculated over 16 beats at rates over 40 bpm and 4 beats at lower heart rates. This results in a
response time of 9 seconds or less when the heart rate changes suddenly from 80 bpm to 40 or 120 bpm, as
measured according to ANSI/AAMI EC13 and IEC 60601-2-27.
•
Tall and peaked T-waves may affect QRS detection resulting in doubled heart rates. Surveyor rejects tall
T-Waves less than or equal to 240% of a 1mV QRS in diagnostic mode, and 70% of a 1mV QRS in monitoring
mode, as well as a Q-T interval of 350 ms measured for both diagnostic and monitoring modes according to
ANSI/AAMI EC13 and IEC 60601-2-27.
•
The heart rate meter correctly detects all beats of the alternating beat type waveforms considered in
ANSI/AAMI EC 13 and IEC 60601-2-27 Figure 201.101 patterns A1-A4 if the QRS amplitudes exceed the
minimum detection threshold set by the user.
•
Time to tachycardia, as measured according to ANSI/AAMI EC13 and IEC 60601-2-27 Figure 201.101
patterns B1-B2 is less than 8 seconds.
•
Heart rate indication is not reliable during episodes of ventricular fibrillation.
11
USER SAFETY INFORMATION
•
The summarized performance of the QRS recognition and classification algorithm on standard databases, as
defined by ANSI/AAMI EC 57, is as follows:
MIT Database
Performance Measures
QRS Detection Sensitivity %
QRS Detection Positive Predictivity %
PVC Detection Sensitivity %
PVC Detection Positive Predictivity %
PVC Detection False Positive Rate %
Mortara
99.94
99.87
95.49
97.05
0.220
AHA Database
Performance Measures
QRS Detection Sensitivity %
QRS Detection Positive Predictivity %
PVC Detection Sensitivity %
PVC Detection Positive Predictivity %
PVC Detection False Positive Rate %
Mortara
99.86
99.90
93.49
98.32
0.162
•
Because of noise, artifact and the many different physiological manifestations of the ECG signal, it is inevitable
that some beats are not detected or correctly classified by the system. The user is advised not to rely completely
on automatic alarm systems for the monitoring of critical patients.
Warnings for Patients with Pacemakers
•
Rate meters may continue to count the pacemaker rate during occurrences of cardiac arrest or some
arrhythmias. Do not rely entirely upon rate meter alarms. Keep pacemaker patients under close surveillance.
•
When using the 3/5 lead ECG cable, pacemaker spikes are normally recognized and rejected by the software.
Signals are recognized as pacemaker spikes when they have a slew rate over 1.4 V/s, as measured according to
the ANSI/AAMI EC 13 and IEC 60601-2-27 standards.
•
When using the AM12 12-lead ECG Acquisition Module, pacemaker spikes in the range of 0.3 to 1.3 mS, +/-2
to +/-700 mV are recognized and rejected according to the ANSI/AAMI EC13 and IEC 60601-227:2011standards.
•
The pacemaker rejection software can be deactivated by the user. This should not be done for patients with a
pacemaker or suspected to have a pacemaker implanted because this can lead to a heart rate indication and
failure to alarm for cardiac arrest.
•
Other than the influence on beat detection as stated above, there is no known safety hazard if other equipment,
such as pacemakers or other stimulators, is used simultaneously with the system.
Respiration Warnings
• When using an ECG electrode to calculate respiration rate via the thorax impedance method, movement artifacts
may create inaccurate results. Respiration rates derived from CO2 parameter is not subject to such movement
artifacts.
12
USER SAFETY INFORMATION
SpO2 Warnings
•
Use only approved pulse oximetry sensors specifically intended for use with the patient monitor. Unapproved
components can result in degraded performance and/or device malfunction.
•
Use pulse oximetry sensors specified for the correct patient mode and for the correct application position.
•
Pulse oximetry sensors must be checked a minimum of every 4 hours and moved to a new site as necessary.
Reposition the sensor at least once every 24 hours to allow the patient’s skin to breathe.
•
Tissue damage or inaccurate measurements may be caused by incorrect SpO2 sensor application or use, such as
wrapping too tightly, applying supplemental tape, failing to inspect periodically, or failing to position
appropriately. Read the Instructions for Use provided with the SpO2 sensor carefully prior to use.
•
Do not sterilize or immerse pulse oximetry sensors in liquid. Clean and/or disinfect re-usable sensors between
patients.
•
Pulse oximetry sensors are susceptible to high ambient light interference including surgical lights, especially
xenon light sources, ambient photodynamic therapy (e.g., Bilirubin lamps), fluorescent lights, infrared heating
lamps, direct sunlight. Shield the sensor area as necessary.
•
SpO2 measurement may be adversely affected by dyes (e.g., methylene blue, indocyanine green, indigo,
carmine, fluorescein) introduced into the bloodstream
•
That factors that may cause inaccurate readings and alarms, decreased perfusion, and or low signal strength
include:
Interfering substances:
o Carboxyhemoglobin may erroneously increase SpO2 reading.
o Methemoglobin (MetHb) usually represents less than 1% of the total Hgb, but in the case of
methemoglobinemia that can be congenital or induced by some IV dyes, antibiotics (such as sulphas,)
inhaled gases etc. this level increases sharply and thus can confound the SpO2 reading.
o Intravascular dyes (such as indocyanine green, methylene blue, etc.).
Physiological conditions:
o Cardiac arrest
o Hypotension
o Shock
o Severe vasoconstriction
o Severe anemia
o Hypothermia
o Venous pulsations
o Ventricular septal defects (VSDs)
Sensor placement:
o Incorrect sensor placement
o Poor sensor fit
•
Any condition that restricts blood flow such as the use of a blood pressure cuff or supplemental tape, or
extremes in systemic vascular resistance may cause inability to determine accurate SpO2 readings.
•
Certain conditions such as physical movement (patient and imposed motion); diagnostic testing; low perfusion;
electromagnetic interference; electrosurgical patient monitors; dysfunctional hemoglobin; and inappropriate
positioning of the pulse oximeter sensor may result in pulse oximetry readings that are unreliable.
13
USER SAFETY INFORMATION
•
SpO2 signal inadequacy is indicated by error messages or alarms generated at the Surveyor patient monitors.
•
If the accuracy of any measurement does not seem reasonable, first check the patient’s vital signs, and then
check for conditions that may cause inaccurate SpO2 readings. If the problem is still not resolved, check the
monitor and the SpO2 module, cable, or sensor for proper functioning.
•
A pulse oximeter is not an apnea monitor. A pulse oximeter should be considered an early warning device. As a
trend toward patient deoxygenation is indicated, blood samples should be analyzed by a laboratory COoximeter to completely understand the patient’s condition. Check that the pulse oximetry waveform is
physiological in shape.
•
To prevent erroneous readings, do not use physically damaged sensors, cables or modules. Discard a damaged
sensor or cable immediately.
•
The performance of the pulse oximetry may be compromised by excessive motion including tremors or
shivering.
•
Nail polish and/or artificial fingernails can affect the accuracy of pulse oximetry and should be removed.
•
Pulse rate measurement is based on the optical detection of a peripheral flow pulse. While a pulse rate does
assist with the detection or absence of a peripheral pulse, the pulse oximeter should not be used as a
replacement or substitute for ECG-based arrhythmia analysis.
•
In certain situations such as low perfusion or weak signal strength, such as with patients who have pigmented
or thick skin, inaccurate SpO2 measurements may be reported. Verification of oxygenation should be made
through other means, particularly in preterm infants, and patients with chronic lung disease, prior to instituting
any therapy or intervention.
•
Always monitor ECG for arrhythmia detection purposes. HR calculated from pulsatile SpO2 waveform may
differ significantly from ECG HR measured values.
NIBP Warnings
•
Use only approved blood pressure (BP) cuffs specifically intended for use with the Surveyor patient monitors.
•
Use the correct size cuff for the intended limb (see indication of cuff size in cm printed on cuff) of the patient.
The terminology printed on some BP cuffs like “child,” “adult,” “thigh,” etc., is only an indication of the size of
the cuff and should not be used to determine if the cuff is suitable for the limb. Use the range markers on the
BP cuff’s to determine whether a particular cuff fits the patient’s arm or not.
•
The Surveyor patient monitor is not intended for use with neonates.
•
Do not fold, clamp, cut, or alter the pressure hose of the cuff or the monitor.
•
Periodically check the limb connected to the cuff for adequate perfusion, circulation, and function. Repeated
NIBP measurements can lead to hematomas, limb ischemia, and other limb injuries. Kinked or blocked hoses
can lead to prolonged impairment of blood circulation and lead to injury.
•
Educate the patient to relax, rest, and lie still during inflation and pressure measurements. Patient movement
can lead to artifacts or errors.
14
USER SAFETY INFORMATION
•
The pressure measurement might be influenced by patient position, physical conditions, and other factors.
•
Avoid placing the blood pressure cuff on the arm next to where a patient has had a mastectomy.
•
Avoid applying the cuff to a wounded limb as this can cause further injury. Use with caution in patients with
dermatological disease, subcutaneous laceration, or other integumentary compromise as there may exist a skin
damage hazard during electronic NIBP measurements. Follow prudent evidence-based clinical practice to
determine if an electronic blood pressure is safe for these patients.
•
There may be an increased risk of hematomas in patients with serious coagulation problems.
•
Avoid applying the cuff to a limb with a catheter, arterio-venous shunt or infusion pump applied. The cuff
pressure could produce damage to the tissues surrounding the catheter, shunt or the infusion needle, or
compromise the infusion flow.
•
To avoid the potential for spread of disease or infection, reusable blood pressure cuffs should be cleaned after
each patient use. Disposable blood pressure cuffs should not be used with multiple patients.
•
Inflation of the NIBP cuff can cause a temporary degradation of monitoring of other parameters derived from
the same limb, including invasive pressure and SpO2 measurements. If applicable, place the SpO2 sensor and
the NIBP cuff on different limbs.
•
NIBP measurements may be inaccurate in the presence of arrhythmias, motion artifacts, shivering, or trembling
patients.
•
NIBP cuffs and hoses supplied with the Surveyor do NOT contain any Latex. If the patient develops an allergic
reaction or rashes, immediately remove the cuff.
Invasive Pressure Warnings
•
All invasive procedures involve risks to the patient. Use aseptic technique. Follow catheter manufacturer's
instructions and established hospital guidelines.
•
Ensure that no part of the patient connections touches any electrically conductive material including earth.
•
Only use invasive pressures transducers that can withstand defibrillation as required by ANSI/AAMI BP22
standard.
•
Mechanical shock to the invasive blood pressure transducer may cause severe shifts in zero balance and
calibration, and cause erroneous readings.
CO2 Warnings
•
Always inspect the airway adapter for a tight connection and proper operation before attaching it to the patient.
•
Remove the airway sampling line from the patient’s airway while nebulized medications are being delivered.
•
Route all tubing away from the patient’s throat to avoid strangulation.
•
Do not apply pressurized air to any outlet or tubing connected to the monitor. Pressure may destroy sensitive
elements.
15
USER SAFETY INFORMATION
•
When monitoring an anesthetized patient in an operating room environment, it is recommended to connect the
CO2 exhaust port of the Surveyor to the hospital’s waste gas scavenging system so as to prevent exposure for
other patients and hospital personnel to the patient’s respiratory sample. Ensure that sampled gases are not
returned from the exhaust port to a breathing system such as a ventilator. Use standard clinical guidelines
and/or hospital procedures. Scavenge vacuum greater than 1mmHg may result in damage to the Surveyor.
•
When using a sampling line for intubated patients with a closed suction system, do not place the airway adapter
between the suction catheter and endotracheal tube. This is to ensure that the airway adapter does not interfere
with the functioning of the suction catheter.
•
Loose or damaged connections may compromise ventilation or cause an inaccurate measurement of respiratory
gases. Securely connect all components and check connections for leaks according to standard clinical
procedures.
•
Do not cut or remove any part of the sample line. Cutting the sample line could lead to erroneous readings.
•
If too much moisture enters the sampling line (i.e., from ambient humidity or breathing of unusually humid air),
the message Clearing FilterLine will appear in the message area. If the sampling line cannot be cleared, the
message FilterLine Blockage will appear in the message area. Replace the sampling line once the FilterLine
Blockage message appears.
Cardiac Output Warnings
•
Refer to the catheter package insert provided with each PA catheter for the appropriate computation constant,
specific instructions on catheter placement and use, warnings, cautions, and specifications.
•
Inaccurate Cardiac Output measurements may be caused by:
o Incorrect placement or position of the catheter.
o Excessive variation in pulmonary artery blood temperature, perhaps caused by bolus drug
administration.
o Clot formation on the thermistor port.
o Anatomical abnormalities, (for example, cardiac shunts).
o Excessive patient movement.
o Repeated intermittent flushes of cold fluid through the fluid lumens of the catheter.
o Electrocautery or electrosurgical device interference.
o Rapid changes in cardiac output.
o Using an incorrect computation constant.
16
USER SAFETY INFORMATION
Cautions
•
Cleaning must be performed with the system turned off. Let all parts dry well before turning the power
back on.
•
Prevent liquids from penetrating the system, components, and transmitters. Do not spray the system with liquid
cleaning agents. If liquids have penetrated the system, open by authorized personnel for inspection and let dry
completely.
•
Do not attempt to clean the patient monitor or patient cables by submersing into a liquid, autoclaving, or steam
cleaning as this may damage equipment or reduce its usable life. Wipe the exterior surfaces with a warm water
and mild detergent solution and then dry with a clean cloth. Use of unspecified cleaning/disinfecting agents,
failure to follow recommended procedures, or contact with unspecified materials could result in increased risk
of harm to users, patients and bystanders, or damage to the patient monitor.
•
No user-serviceable parts inside. Screw removal by authorized service personnel only. Damaged or suspected
inoperative equipment must be immediately removed from use and must be checked/repaired by authorized
service personnel prior to continued use.
•
The rechargeable internal battery is a sealed lithium ion type. If the battery appears to become defective, refer
to Mortara Technical Support.
•
Do not pull or stretch patient cables as this could result in mechanical and/or electrical failures. When not in
use, patient cables can be stored. Keep patient cables should be stored off of the floor away from bedrails and
wheels to avoid cable damage. Roll the patient cables into a loose loop prior to hanging for storage.
•
When necessary, dispose of the patient monitor, its components and accessories (e.g., batteries, cables,
electrodes), and/or packing materials in accordance with local regulations.
•
Do not connect the patient monitor to any unauthorized patient monitors or use any third-party accessories.
This may cause inaccurate measurements or harm the patient. Installation and connection to data networks
must be performed by properly trained personnel, authorized by Mortara.
•
Check that all operating and environment conditions such as ambient temperature meet the specifications of the
Surveyor.
•
Do not exert excessive pressure on the touch panel LCD. Excessive pressure may permanently damage the
display.
•
During MRI scanning, the module must be placed outside the MRI suite. When the module is used outside the
MRI suite, EtCO2 monitoring can be implemented using the FilterLine XL.
•
Use of a CO2 sampling line with H in its name (indicating that it is for use in humidified environments) during
MRI scanning may cause interference. The use of non H sampling lines is advised.
17
USER SAFETY INFORMATION
•
Microstream® etCO2 sampling lines are designed for single patient use, and are not to be reprocessed. Do not
attempt to clean, disinfect, sterilize or flush any part of the sampling line as this can cause damage to the
monitor.
•
Dispose of sampling lines according to standard operating procedures or local regulations for the disposal of
contaminated medical waste.
•
Before use, carefully read the Microstream® etCO2 sampling lines Directions for Use.
•
Only use Microstream® etCO2 sampling lines to ensure the monitor functions properly.
Notes
•
The Surveyor’s NIBP parameter is indicated for use with pregnant patients, including those with pre-eclamptic
or eclamptic conditions.
•
Patient movements may generate excessive noise that may affect the quality of signals and derived parameters
and waveforms.
•
Proper patient preparation is important to proper application of sensors and electrodes to ensure the correct
operation of the patient monitor.
•
There is no known safety hazard if other equipment, such as pacemakers or other stimulators, is used
simultaneously with the patient monitor; however, disturbance to the signal may occur.
•
If an ECG electrode is not connected properly to the patient, or one or more of the patient cable lead wires are
damaged, the display will indicate a lead fault for the lead(s) where the condition is present and if the signal is
being printed, the respective lead(s) will print out as blank.
•
This patient monitor is intended to be used in a hospital or doctor’s office setting, and should be used and
stored according to the environmental conditions specified.
•
During nebulization or suction for intubated patients, in order to avoid moisture buildup and sampling line
occlusion, remove the sampling line luer connector from the monitor.
•
Replace the sampling line according to hospital protocol or when a blockage is indicated by the device.
Excessive patient secretions or a build‐up of liquids in the airway tubing may occlude the sampling line,
requiring more frequent replacement.
•
When the caution message “Blockage” appears on the screen, indicating that the FilterLine which is attached to
the monitor is blocked, the monitor’s CO2 pump will stop pumping the patient’s breath into the monitor for
testing. Follow the instructions that appear in the Troubleshooting section of this manual: First disconnect and
reconnect the FilterLine. If the message still appears, disconnect and replace the FilterLine. Once a working
FilterLine is attached to the monitor, the pump will automatically resume operation.
•
18
Following connection of the CO2 sampling line to the monitor and patient, check that CO2 values appear on the
monitor display.
USER SAFETY INFORMATION
•
The device is ETL listed:
ETL-Listed device in the USA and Canada.
•
Upon request, Mortara can supply a Service Manual that includes additional calibration and test instructions as
well as list of spare parts and accessories that must be used with the Surveyor patient monitors.
•
The S12/S19 recorder may not properly print all characters in all languages. In particular, special characters in
certain languages such as accented characters in Polish, Hungarian and Croatian, may not be printed correctly
on the recorder and instead be displayed with a “?”.
19
USER SAFETY INFORMATION
20
5. EQUIPMENT SYMBOLS AND MARKINGS
Symbol Delineation
IPX1
IOIOI
Indicates compliance to applicable
European Union directives
Do not dispose as unsorted municipal waste. Per
European Union Directive 2002/96, requires
separate handling for waste disposal according to
national requirements
Indicates device has been tested for
safety from vertically dripping water;
specifically, it indicates DRIP PROOF,
a higher than ordinary level of
protection from drips, leaks, and spills
Defibrillator-proof type CF applied part
Tested for safety by the Intertek
according to applicable U.S. and
Canadian standards and requirements
External power AC/DC power supply; use only
Mortara Power Supply; REF 4101-012
Power On/Off switch
Consult accompanying documents
Caution
Recorder interface (S19 only)
Local Area Network interface
External alarm interface
Interface to external devices – Reserved
for future use
Connector for 3/5 lead ECG parameter
Connector for 12-lead ECG parameter
using Mortara AM12
Connector for non-invasive blood pressure
parameter
Connector for oxygen saturation
parameter
CO
Connector for cardiac output parameter
Connector for invasive pressure 1 & 2
parameters
Connector for invasive pressure 3 & 4 parameters
Connector for temperature 1 parameter
Connector for temperature 2 parameter
Connector for CO2 parameter
Connector for CO2 parameter exhaust port
Catalog number for relevant Mortara
part
SN
Serial number
21
EQUIPMENT SYMBOLS AND MARKINGS
22
This end up
Keep away from sunlight
Fragile, handle with care
Keep dry
Storage temperature range
10 rolls of recorder paper per case
6. GENERAL CARE
Precautions
•
•
•
•
•
Power off the patient monitor before inspecting or cleaning.
Protect the patient monitor from liquids.
Never immerse the patient monitor in water.
Do not drop the patient monitor or subject to shock and/or vibration.
Do not use organic solvents, ammonia-based solutions, or abrasive cleaning agents that may damage
equipment surfaces.
Inspection
Inspect your equipment daily prior to clinical operation. Do not use the equipment and contact an authorized
service representative for servicing if there are concerns about integrity of the system.
•
•
•
•
•
•
•
Verify that all cords and connectors are securely seated.
Check the case and chassis for any visible damage.
Inspect cables, cords, and connectors for any visible damage.
Inspect keys and controls for proper function and appearance.
Check for neat and well balanced screen images.
Inspect patient accessories such as cuffs, sensors, and wires for any visual damage.
Ensure that auditory and visual alarms are available and working appropriately.
Cleaning
The following section provides information on proper cleaning directions for the Surveyor patient monitor and
patient accessories. Accessories should be cleaned before they are applied to a new patient. The patient monitor
should be cleaned as per facility standard of care. Before cleaning, please refer to the cautions listed below.
CAUTION: Always disconnect the Surveyor patient monitor from AC (wall) mains power before
cleaning.
CAUTION: Do not use harsh chemicals for cleaning. Do not use disinfectants that contain
phenol as they can spot plastics. Do not steam autoclave, gas sterilize, irradiate, subject to intense
vacuum, or immerse in water or cleaning solution. Be careful to avoid getting cleaning liquids into
connectors or the patient monitor. If this occurs, allow the patient monitor to dry in warm air for 2 hours,
then check to make sure all monitoring functions are working properly.
CAUTION: Take particular care when cleaning the NIBP cuff, NIBP hose, and NIBP connector
on the Surveyor patient monitor to prevent fluid from entering the connectors or cuff. Fluid in the NIBP
system may affect blood pressure determination accuracy and damage the monitor.
23
GENERAL CARE
CAUTION: Keep the patient accessories off of the floor. Accessories that fall on the floor should
be inspected for defects, contamination, proper functionality, and cleaned or discarded according to the
approved recommendations.
CAUTION: The user has the responsibility to validate any deviations from the recommended
method of cleaning and disinfection.
Touch screen Display
Approved Cleaning Agents
•
Clean the touch screen with a soft cloth moistened with either a solution of 70%
isopropyl alcohol in distilled water or soapy water.
Do not spray cleaner directly onto the touch screen. Spray the cleaner onto a lint-free cloth
and then wipe the monitor.
To clean the touch screen display,
1. Select the Settings sidebar button.
2. Select the Administrative menu.
3. Select the Screen Cleaning mode. This action disables the monitor’s touch screen for
15 seconds for cleaning purposes. After the 15 seconds expires, the touch screen
controls are reactivated.
ECG Cables
TEMP Cable
SpO2 Cable
NIBP Hose
External Power Supply
Power Cord
24
Approved Cleaning Agents
•
Enzymatic detergent such as ENZOL (US) or CIDEZYME (outside the US)
•
Distilled water
•
Disinfectant solution (such as CIDEX OPA, or a 10% solution of household bleach
(5.25% sodium hypochlorite) in distilled water)
•
Soft, lint-free cloths and/or soft-bristled brushes
•
Protective gloves and eyewear
Procedure
1. Disconnect the patient monitor from the wall outlet.
2. Put on gloves and protective eyewear.
3. Prepare the enzymatic detergent according to the manufacturer's instructions, and also
the disinfectant solution, in separate containers.
4. Apply detergent to product using a soft, lint-free cloth. If material is dried on, allow
to sit for 1 minute. Do not immerse cable ends or lead wires in liquid as it can cause
corrosion.
5. Wipe smooth surfaces with the cloth.
6. Use a soft-bristle brush on visibly soiled areas and irregular surfaces.
7. Remove detergent from product using cloth dampened in distilled water.
8. Repeat as necessary.
9. Apply disinfectant solution on affected area using a soft cloth. Allow product to sit
for 5 minutes.
10. Wipe excess solution and clean product again with cloth dampened in distilled water.
11. Allow 2 hours for drying.
GENERAL CARE
Reusable NIBP Cuffs
Approved Cleaning Agents
•
Mild detergent and water
•
Non-chlorine bleach
Procedure
1. Prior to washing, remove any internal cuff bladders and engage the Velcro hook and
loop fasteners to prevent lint from collecting in the hooks.
2. For general cleaning of cuffs, use a soft, lint-free cloth lightly moistened with a mild
soap and water solution. Be careful not to get liquid inside the tubes. Allow to air dry.
3. For excessive perspiration marks or odor, the exterior of the cuff can be hand-washed
under running water with a mild detergent. Do not allow water to enter the cuff. Allow
to air dry.
4. If required, the use of non-chlorine bleach is acceptable. Using chlorine bleach
solutions will shorten the service life of the cuff.
5. Sterilize the cuff using commercially available disinfectants. Using dark colored
disinfectants may stain the cuff material. Test a single cuff to ensure that no damage or
staining occurs. Follow the manufacturer’s instructions. Thoroughly rinse each
component to remove any residual disinfectants. Once cleaned, wash off all disinfectant
material using a cloth dampened with a mild detergent. Failure to remove disinfectants
may lead to mild skin irritation on some patients. Allow the components to air dry for a
minimum of 2 hours.
6. Cuffs may be sterilized with Ethylene Oxide. Do not autoclave or iron the cuff as the
hook and loop fasteners will melt at temperatures above 325°F (162°C).
7. Use caution with excess liquid.
8. Do not use excessive drying techniques such as forced heat.
9. Prevent liquid from penetrating the cuff and do not attempt to clean/disinfect the cuff by
submerging into liquid, autoclaving, or steam cleaning.
SpO2 Reusable Sensor
Approved Cleaning Agents
•
70% isopropyl alcohol
Procedure
1. Remove sensor from patient and disconnect from sensor cable. Wipe off with alcohol
pad.
2. Allow sensor to dry before placing it on a patient.
Disposable:
SpO2 Sensors
Temperature Probes
CO2 Lines
These items are intended for use with a single-patient and must be properly disposed of after
use. Refer to the sensor/probe manufacturer instructions for further details.
Maintenance
The following table shows the recommended maintenance procedures for the Surveyor patient monitor and its
accessories. The Surveyor S12 and S19 patient monitors should be serviced and calibrated once a year by a Mortara
authorized service technician. However, it is good practice to periodically ensure the patient monitor is in proper
working order. Perform these checks at least every 12 months by a qualified biomedical engineer or other trained
service personnel. To accomplish these steps in their entirety and verify the correct operation of the system,
appropriate patient simulators or other equipment may be required.
25
GENERAL CARE
Refer to the service manual for further details.
Functionality
Procedure
Mechanical Integrity
Check for cracks, abrasive edges and other signs of damage.
Power LED
Verify that the green power LED is illuminated when the patient monitor is ON or charging.
Speaker
Power-cycle the Surveyor patient monitor and verify that the power-up speaker test tones are
generated.
Second Speaker
Power-cycle the Surveyor patient monitor and verify that the power-up second speaker test
tones are generated.
ECG / Respiration
•
•
•
•
Connect ECG leads to Patient Simulator.
Verify proper heart rate at 30 and 300 bpm (+/- 2 bpm or +/- 1%).
Verify 1 mV test pulse (Lead II).
Verify proper respiration rate at 15 and 120 bpm (+/- 3 bpm).
•
•
•
Connect to Patient Simulator (select appropriate sensor type).
Verify proper SpO2 value at 84% and 96% (+/- 2%).
Verify proper PR value at 30 and 240 bpm (+/- 5%).
SpO2
NOTE: Use only certified calibration gas apparatus [See “CO2 Calibration” section below]
that has not reached its expiration date. This cal gas can be applied to the Surveyor patient
monitor in pulses that simulate patient breaths.
1.
2.
3.
CO2
4.
5.
Connect an Oridion Microstream FilterLine single-use capnography sample line to the
Surveyor monitor’s gas inlet port.
Connect with a tight fit, the other end of the Oridion sample line to one of the two open
ports on the Cal Gas tubing apparatus.
Pulse the calibration gas actuator, holding it depressed for 10 seconds and released for
10 seconds (6 BPM). This will allow enough time for the ET CO2 to stabilize in both
inhaled and exhaled states.
Verify that the EtCO2 value reads the CO2 concentration stated on the canister ± the
accuracy tolerance stated in the product specifications.
Verify the FiCO2 value reads 0 ±2 mmHg.
NOTE: Factor a ±0.05 correction for every 100mmHg of ambient barometric pressure above
or below sea level respectively.
NOTE: The monitor should be returned to the manufacturer for periodic servicing of the
CO2 system after 30,000 hours of CO2 use.
26
GENERAL CARE
Functionality
Procedure
NOTE: Do not allow system to remain pressurized and stable below 20 mmHg. The monitor
will remove this pressure as a zero offset and this will affect the validity of the calibration
check.
NOTE: The following are required to perform this test: NIBP simulator or
sphygmomanometer along with a Y-cable and a hand inflation bulb.
Pressure Accuracy Test: Via the Service settings, put the NIBP in to calibration mode. Set
the pressure to 25 mmHg and 225 mmHg respectively and verify that the pressure values
reported by the Surveyor patient monitor matches ((±2 mmHg) of that reported on the
simulator or sphygmomanometer. Release pressure.
NIBP
Overpressure Test: Inflate cuff to 300 mmHg. Verify that the pressure is automatically
dumped at 300 +/- 30 mmHg.
Leak Test: Inflate a cuff to 150 mmHg. Allow cuff pressure to settle (thermal effect).
Verify that the pressure drops less than 4 mmHg in 1 minute. Verify that the pressure is
automatically dumped after 150 seconds of being above 15 mmHg.
Set the NIBP back to normal mode. Power cycle the monitor.
Measurement Accuracy Test: Connect to Patient Simulator and take a NIBP measurement.
Verify proper NIBP value at 120/80 (+/- 5 bpm).
•
Invasive Pressures
(P1-P4)
Temperature
•
•
Connect static pressure sources at 20 and later at 100 mmHg to IBP sensors P1-P4.
Verify correct pressure is displayed for each (+/- 2 mmHg).
Connect a patient simulator with dynamic IBP waveform for radial artery of 120/80.
Verify correct pressure waveform and values are displayed (+/- 2 mmHg).
None (self-checking).
Connect to Safety Analyzer.
WARNING: FOLLOW SAFETY INSTRUCTIONS AS INDICATED IN THE
MANUAL FOR THE ANALYZER.
Leakage Currents
•
•
•
•
•
•
Verify Patient Lead Leakage (to ground): < 10 uA.
Verify Patient Lead Leakage (inter-lead): < 10 uA.
Verify Patient Lead Leakage (mains applied to leads): < 50 uA.
Verify Leakage to ground (normal): < 500 uA.
Verify Leakage to ground (reversed polarity): < 1000 uA.
Verify Leakage to ground (neutral opened): < 1000 uA.
Battery Replacement
CAUTION: The battery should be removed from the monitor if the monitor is to be stored for an
extended period of time.
The battery may need to be replaced if it is no longer holding a charge. Under optimum conditions, the battery
lifetime is approximately two years. Replacing the battery should only be done by qualified service personnel.
27
GENERAL CARE
WARNING: Use only APPROVED BATTERIES as listed in the Accessories section. Use of
unapproved batteries may cause a hazard and will void the warranty.
CAUTION: Batteries should only be replaced by trained service personnel.
To replace the battery:
1.
2.
3.
4.
5.
6.
7.
8.
Obtain a replacement battery from Mortara (see Accessories section for part number).
Power-off the Surveyor patient monitor.
On the back of the Surveyor patient monitor, disconnect the external power supply from the monitor.
Remove the battery cover with the VESA mounting plate by removing the four screws holding the cover as
shown in the picture below.
Remove the battery by pulling on the top side of the battery as shown in Figure 1.
Insert new battery ensuring that the connector is properly engaged.
Carefully reinstall back cover and screws.
Properly dispose of the old battery (see Disposal section).
Figure 1 Battery
Replacement
Battery Life and Charge Time
Estimated Battery Life
S12: 3 hours*
S19: 2 hours*
*Fully charged new batteries at 25 °C for the following conditions: continuous ECG and SpO2, as well as NIBP
measurements at every 15 minute interval.
Estimated Battery Charge Time
When OFF, 5 hours
When ON, S12: 7 hours
When ON, S19: 20 hours
Battery Conditions
When the Surveyor S12 and S19 monitor’s battery has less than 5 minutes of power remaining, the battery icon
flashes, a battery alert message displays, and an audio technical tone is sounded.
28
GENERAL CARE
When the battery power is too low to continue normal operation, the Surveyor S12 and S19 monitor’s screen clears,
a Battery Nearly Depleted message displays in the center of the screen, and monitoring is discontinued. When AC
power is restored, the battery begins the recharge process and monitoring can resume once the clinician has
powered on the monitor.
Decommissioning and Disposal
Dispose of the patient monitor, its components and accessories (e.g., batteries, cables, electrodes), and/or packing
materials in accordance with local regulations. Do NOT incinerate or throw the battery in garbage.
Calibration
The Surveyor S12 and S19 patient monitors should be serviced and calibrated once a year by a Mortara authorized
service technician.
Refer to the service manual for further details.
Trained service technicians can perform the following test and calibration procedures via the Setup > Administrator
> Service (password required) > Calibration dialogue as shown below.
Figure 2 Calibration Dialogue
CO2 Calibration
The CO2 module within the patient monitor does not require calibration during normal clinical operation. The
Surveyor patient monitor displays a “CO2 Calibration Due” message when the manufacturer’s suggested number of
operating hours has been reached. Calibrate the CO2 module when this message is displayed. It is recommended to
calibrate the CO2 module on an annual basis or after 4000 hours of use, whichever comes first. In the first year,
the CO2 module should be calibrated after 1200 hours of use. The number of hours until calibration is due may be
found in the Surveyor patient monitor’s event log, which is accessed via the “Administration – System – Show
Event Log” menu.
NOTE: Calibration should be performed by a trained technician.
NOTE: Ensure that the calibration gas and regulator are functioning properly before calibration.
NOTE: Calibration of the CO2 module will require a calibrated gas mixture of 5% CO2, 21% O2, with
the balance N2. The calibration kit available from Air Liquide (Scott Medical); Part Number T4653ORFCD contains a canister of the above gas mixture, a T-piece connector and a Calibration Filterline.
29
GENERAL CARE
To calibrate the CO2 module:
1. Select “Start CO2 Calibration” via the “Administration - Service – Calibration” screen.
2. Prior to calibration initiation, connect the CO2 sampling line to the monitor.
3. Attach the calibrated CO2 gas mixture to the CO2 sampling line.
4. Select “Start CO2 Calibration” on the screen. The Surveyor patient monitor displays “CO2
Calibrating” for up to 1 minute.
5. Once completed, the Surveyor patient monitor displays “CO2 Calibration Complete” or “CO2
Calibration Failed”.
6. If the calibration fails, determine the cause of failure appropriate to the displayed error message given
then repeat the CO2 calibration procedure.
7. Upon successful completion, remove the calibration gas from the monitor.
NOTE: Between calibrations, the calibration gas can be applied to the Surveyor patient monitor in pulses
that simulate patient breaths. The EtCO2 value should read 38 ±2 mmHg. The FiCO2 value should read
0 ±2 mmHg and a ±0.05 correction factor for every 100 mmHg ambient pressure above or below sea level
respectively.
Invasive Pressure Calibration
The Invasive Pressure interfaces do not require calibration during normal clinical operation. In order to calibrate
the Invasive Pressure interfaces, perform the following:
1. Connect a static pressure source, such as ambient air, to pressure transducer that is connected to the P1
invasive pressure interface.
2. Select “Start P1 Calibration” via the “Administration - Service – Calibration” screen (password
required to access this screen).
3. Await “P1 Calibration OK” message, or similar if the interface is labeled something other than P1.
4. Repeat for interfaces P2 through P4.
NIBP Calibration
The NIBP interface does not require calibration during normal clinical operation. The accuracy of the NIBP
pressure sensor and overall functionality of the NIBP interface can be verified as detailed in the Maintenance
section in this manual. If further calibration is required, contact Mortara Technical Support or your authorized
service personnel.
30
7. ELECTROMAGNETIC COMPATABILITY (EMC)
When using the patient monitor, assess the electromagnetic compatibility with surrounding devices.
An electronic device may either generate or receive electromagnetic interference. Testing for electromagnetic
compatibility (EMC) has been performed on the bedside monitor according to the international standard for EMC
for medical bedside monitors (IEC 60601-1-2). This IEC standard has been adopted in Europe as the European
Norm (EN 60601-1-2).
The patient monitor should not be used adjacent to or stacked with other equipment. If the patient monitor is
used in this manner, verify the patient monitor operates in an acceptable manner in the configuration in which it
will be used.
Fixed, portable, and mobile radio frequency communications equipment may affect the performance of medical
equipment. See Table X-4 for recommended separation distances between the radio equipment and the patient
monitor.
The use of accessories, transducers, and cables other than those specified by Mortara Instrument may result in
increased emissions or decreased immunity of the equipment.
31
ELECTROMAGNETIC COMPATABILITY (EMC)
Table X-1 Guidance and Manufacturer’s Declaration: Electromagnetic Emissions
The equipment is intended for use in the electromagnetic environment specified in the table below. The customer or
the user of the equipment should ensure that it is used in such an environment.
Emissions Test
Compliance
Electromagnetic Environment: Guidance
RF Emissions
CISPR 11
Group 1
The Surveyor patient monitor uses RF energy only for its internal
function. Therefore, its RF emissions are very low and not likely to
cause any interference in nearby electronic equipment.
RF Emissions
CISPR 11
Class A
Harmonic Emissions
IEC 61000-3-2
Not Applicable
The Surveyor patient monitor is suitable for use in all establishments
other than domestic and those directly connected to the public lowvoltage power supply network that supplies buildings used for
domestic purposes.
Voltage Fluctuations/
Flicker Emissions
IEC 61000-3-3
Not Applicable
Table X-2 Guidance and Manufacturer’s Declaration: Electromagnetic Immunity
The equipment is intended for use in the electromagnetic environment specified in the table below. The customer or
the user of the equipment should ensure that it is used in such an environment.
Immunity Test
IEC 60601 Test Level
Compliance Level
Electromagnetic Environment: Guidance
Electrostatic
discharge (ESD)
EN 61000-4-2
+/- 6 kV contact
+/- 8 kV air
+/- 6 kV contact
+/- 8 kV air
Floors should be wood, concrete, or ceramic
tile. If floors are covered with synthetic
material, the relative humidity should be at
least 30%.
Electrical fast
transient/burst
EN 61000-4-4
+/- 2 kV for
power supply lines
+/- 1 kV for
input/output lines
+/- 2 kV for
power supply lines
+/- 1 kV for
input/output lines
Mains power quality should be that of a
typical commercial or hospital environment.
Surge
IEC 61000-4-5
+/- 1 kV differential mode
+/- 2 kV common mode
+/- 1 kV differential
mode
+/- 2 kV common mode
Mains power quality should be that of a
typical commercial or hospital environment.
Voltage
fluctuations and
interruptions
<5% UT for 0.5 cycles
40% UT for 5 cycles
70% UT for 25 cycles
<5% UT for 5s
<5% UT for 0.5 cycles
40% UT for 5 cycles
70% UT for 25 cycles
<5% UT for 5s
Note that monitoring is interrupted at the
level “< 5% UT for 5s”, but equipment
remains safe (as specified in
EN 60601-1-2).
Power frequency
(50/60 Hz)
magnetic field
IEC 61000-4-8
3 A/m
3 A/m
Power frequency magnetic fields should be
at levels characteristic of a typical location
in a typical commercial or hospital
environment.
NOTE: UT is the AC Mains voltage prior to application of the test level.
32
ELECTROMAGNETIC COMPATABILITY (EMC)
Table X-3 Guidance and Manufacturer’s Declaration: Electromagnetic Immunity
The equipment is intended for use in the electromagnetic environment specified in the table below. The customer or
the user of the equipment should ensure that it is used in such an environment.
Immunity Test
IEC 60601 Test
Level
Compliance
Level
Electromagnetic Environment: Guidance
Portable and mobile RF communications equipment should
be used no closer to any part of the equipment, including
cables, than the recommended separation distance calculated
from the equation applicable to the frequency of the
transmitter.
Recommended separation distance
Conducted RF
EN 61000-4-6
3 Vrms
150 kHz to
80 MHz
3 Vrms
150 kHz to
80 MHz
Radiated RF
IEC 61000-4-3
3 V/m
80 MHz to
2.5 GHz
3 V/m
80 MHz to
2.5 GHz
d = 1.2
d = 1.2
80 MHz to 800 MHz
d = 2.3
800 MHz to 2.5 GHz
Where P is the maximum output power rating of the
transmitter in watts (W) according to the transmitter
manufacturer and d is the recommended separation distance
in meters (m).
Field strengths from fixed RF transmitters, as determined by
an electromagnetic site surveya, should be less than the
compliance level in each frequency rangeb.
Interference may occur in the vicinity of equipment marked
with the following symbol:
a. Field strengths from fixed transmitters, such as base stations for radio (cellular/cordless) telephones and land
mobile radios, amateur radios, AM and FM radio broadcast, and TV broadcast cannot be predicted theoretically
with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site
survey should be considered. If the measured field strength in the location in which the equipment is used
exceeds the applicable RF compliance level above, the equipment should be observed to verify normal
operation. If abnormal performance is observed, additional measures may be necessary, such as reorienting or
relocating the equipment.
b. Over the frequency range 150 kHz to 80 MHz, field strengths should be less than [3] V/m.
33
ELECTROMAGNETIC COMPATABILITY (EMC)
Table X-4 Recommended Separation Distances Between Portable and Mobile RF Communications
Equipment and the Equipment
The equipment is intended for use in the electromagnetic environment in which radiated RF disturbances are
controlled. The customer or the user of the equipment can help to prevent electromagnetic interference by
maintaining a minimum distance between portable and mobile RF communications equipment (transmitters) and the
equipment as recommended in the table below, according to the maximum output power of the communications
equipment.
Rated Maximum Output
Power of Transmitter (W)
Separation Distance According to Frequency of Transmitter (m)
150 KHz to 80 MHz
d = 1.2
80 MHz to 800 MHz
d = 1.2
800 MHz to 2.5 GHz
d = 2.3
0.01
0.12 m
0.12 m
0.23 m
0.1
0.38 m
0.38 m
0.73 m
1
1.2 m
1.2 m
2.3 m
10
3.8 m
3.8 m
7.3 m
100
12.0 m
12.0 m
23.0 m
For transmitters rated at a maximum output power not listed above, the recommended separation distance d in
meters (m) can be estimated using the equation applicable to the frequency of the transmitter, where P is the
maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer.
NOTE: At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies.
NOTE: These guidelines may not apply in all situations. Electromagnetic propagation is affected by
absorption and reflection from structures, objects, and people.
34
8. INTRODUCTION
General Information
This User's Guide provides information for users of the Mortara Surveyor S12 and S19 patient monitors. The
Surveyor S12 and S19 patient monitors are small, lightweight patient monitors designed to acquire physiological
waveforms and parameters, and to transmit this data to the Surveyor Central monitoring station. The terms
Surveyor patient monitor, system, patient monitor, monitor, S12, S19, and patient monitor may be used
interchangeably in this document to refer to the Mortara Surveyor S12 and S19 patient monitors.
Prior to operating the Surveyor patient monitors, read all sections of this User's Guide. Failure to read and
understand the instructions may lead to misuse of the Surveyor patient monitor resulting in harm to the clinician and
patient.
Indications For Use
The Mortara Surveyor S12 and S19 patient monitors are indicated for use in adult & pediatric patient populations.
The Mortara Surveyor S12 and S19 patient monitors facilitate the monitoring of:
• Non-invasive blood pressure (NIBP)
• Impedance respiration
• Invasive blood pressures (P1-P4)
• Temperature
• Functional arterial oxygen saturation (SpO2)
• End-tidal & inspired CO2
• ECG monitoring with arrhythmia and ST-segment analysis
• 12-Lead resting ECG
• Cardiac output (CO)
The Mortara Surveyor S12 and S19 patient monitors are prescription devices intended to be used by knowledgeable
healthcare professionals within a healthcare facility.
Contraindications
The Surveyor S12 and S19 patient monitors are NOT intended to be used in neonate patient population or for apnea
monitoring. The Surveyor patient monitor is not intended for transport applications such as ambulances or aircraft.
System Overview
The Surveyor S12 patient monitor is designed for continuous monitoring in either stationary or portable
applications. The Surveyor S19 is intended for continuous monitoring in a stationary application. The S12 has an
11.6 inch display, and the S19 has an 18.5 inch display.
35
INTRODUCTION
Front View
Figure 3 Surveyor Patient Monitor: Front View Example
1
2
3
1.
2.
3.
Alarm Light
Main Screen Display Area
Power On/Off Button and LED
The S12/S19 front bezel provides a LED indicator to indicate when the monitor is connected to AC (wall) power.
Left Side View
Figure 4 Surveyor Patient Monitor: Left Side Patient Cable Connector Ports
1
The left side of the S12 and S19 contains the patient cable connections
for ECG monitoring, SpO2 NIBP, P1-P4, cardiac output, CO2
temperature, and 12-lead resting ECG.
NOTE: These cable connection ports are dependent upon the
purchased monitor configuration.
2
3
4
5
6
7
8
9
10
36
1. ECG Connector
2. SpO2
3. NIBP
4. P1 & 2
5. P3 & 4
6. Cardiac Output
7. CO2 Input Port
8. T1
9. T2
10. AM12 12-Lead ECG Acquisition Module/USB Port
INTRODUCTION
Right Side View
Figure 5 Surveyor Patient Monitor: Right Side View of S12 with Optional Bedside Recorder
The right side of the Surveyor S12 may contain the optional integrated dual
channel thermal recorder (1).
1
Back View
Figure 6 Surveyor Patient Monitor: Top Back View of S12
The top corner of the back of the Surveyor S12 and S19 contains the
communication ports, an opening for the audio speaker as well as a
connection for CO2exhaust.
This area contains the connections for wired Ethernet, an external alarm
indicator, a serial port for other medical device interfaces, and AC
power.
The right side of the S19 has a dedicated connection for its optional
dual-channel recorder.
Power is provided through an external medical-grade power supply or
an internal lithium-ion battery.
1
37
INTRODUCTION
Figure 7 Surveyor Patient Monitor: Back View of S12 with Optional Bedside Recorder (1)
1
Figure 8 Surveyor Patient Monitor: Back View of S19
38
9. INSTALLATION AND SETUP
Unpacking and Checking
The first step in using the Surveyor patient monitor is to ensure the appropriate accessories are available for patient
monitoring.
Depending on your exact configuration, your system may include the following components:
• Surveyor S12 or S19 monitor
• Surveyor patient monitor power supply with power cable
• ECG cables
• Mortara AM12 12-Lead ECG Acquisition Module
• ECG lead wire sets
• ECG electrodes
• SpO2 sensor(s) / extender cable
• Temperature cable(s)
• Temperature probe(s)
• NIBP hose
• NIBP cuff(s)
• Invasive pressure cables
• Invasive pressure Y cables
• CO2 FilterLines
• Cardiac Output cable
• Cardiac Output thermistor adaptors (in-line, bath probe)
A connector cable from the patient monitor to the “Surveyor Central” Ethernet a wall plate is required if the patient
monitor is to communicate to the Surveyor Central monitoring system. Refer to service manual for further details.
Installation Methods
The Surveyor S12 patient monitor can be mounted on a rolling stand or on the wall using a stationary or articulating
arm. The Surveyor S19 patient monitor can only be mounted on the wall using a stationary or articulating mounting
arm.
Attach the Socket Mount (8363-021-50 Socket Mount Roll Stand and Wall S12) to the back of the S12 Battery
Cover / VESA Mount using 4) M4 x 16mm socket button head cap screws as shown.
Figure 9 Mounting Plate for S12
39
INSTALLATION AND SETUP
Rolling Stand
The Surveyor S12 patient monitor can be mounted on a rolling stand using the Surveyor mounting plate. Carefully
follow the instructions included with the rolling stand mount for proper installation.
Wall Mount
The Surveyor S12 and S19 patient monitors can be mounted on a wall using the VESA mount on the back.
Carefully follow the instructions of the manufacturer of the wall mount for proper installation.
Power On/Off
Before making any connections, place the Surveyor patient monitor in relation to the patient where patient cables do
not tangle or trip individuals.
The dedicated ON/OFF switch, AC power LED, and the visual alarm indicator are located on the front of the patient
monitor.
To connect the Surveyor patient monitor to AC (mains) power:
1. Plug the Power Cable Plug into the power connector port on the back of the Surveyor patient monitor
(right hand side).
2. Connect the Surveyor patient monitor power cable into the AC wall outlet.
3. The Battery Charging LED indicator should now be illuminated.
Figure 10 Power On/Off Button
Power Button
To power on the Surveyor patient monitor:
1. Press and hold the power button on Surveyor patient monitor for 2 seconds (See figure above).
2. The monitor performs a self-test. Any faults or errors should be displayed on the main screen.
3. A proper power up produces audible startup tones (two tones followed by two higher beeps).
4. The monitor’s main screen display illuminates and then briefly shows the Mortara logo.
40
INSTALLATION AND SETUP
5.
When the Surveyor patient monitor is initially powered up, the New Patient confirmation message displays
on the main screen.
a. Select “Yes” to begin a new monitoring
Figure 11 New Patient Confirmation Dialogue
session for a new patient. This activity
erases previously stored monitoring data,
previously configured patient-specific
monitor settings, and previously entered
patient demographic information. This
activity restores the monitor configuration to
the departmental default settings.
b. Select “No” to retain previously stored
patient data and monitor configurations.
To power-down the Surveyor patient monitor:
1. Press the power button briefly.
NOTE: The patient mode selected is retained upon a power up/down sequencing. Ensure the monitor
configuration is appropriate to patient and patient mode upon powering up.
Best Practice Recommendation: Keep the monitor connected to the AC (wall) outlet to recharge the monitor’s
battery even if the monitor is not in use.
The Surveyor patient monitor settings (patient demographics, alarm limits, trend data and other information) are
stored via on-board non-volatile Flash memory. These settings are preserved when the monitor is turned off, or in
the event of power failure. Once power is reestablished, resumption of monitoring restores these values.
To Connect for Central Station Communication
To connect the Surveyor patient monitor to the Surveyor Central Station, a dedicated network connection is
required. Consult your authorized service representative to connect the Surveyor patient monitor to the Surveyor
Central via a dedicated Ethernet cable and wall-jack.
To communicate with the Surveyor central monitoring station,
1. Connect the network cable into the network connector port on the back of the Surveyor patient monitor.
2. Connect the other end of the network cable into the wall plate connector marked "Surveyor Central".
Refer to the service manual for further details on central station networking.
41
INSTALLATION AND SETUP
To Connect for 3rd Party EMR Software
To connect the Surveyor patient monitor to 3rd Party Electronic Medical Record (EMR) solutions, you will need:
•
•
•
42
Connect the S12 or S19 monitor to the EMR workstation via a dedicated serial cable.
Configure the Communications settings (available from the Setup – Administration – Communications
menu) of the S12 or S19 to be of type “Serial”.
Configure the Connectivity setting (available from the Setup – Administration – Connectivity). The typical
setting for most EMR applications is “1”.
10. MAIN SCREEN DISPLAY
Overview
The Surveyor S12 and S19 patient monitors feature a wide-screen resistive touchscreen with a display resolution of
1366 x 768 pixels. The high-resolution display presents patient monitoring information in an intuitive fashion
allowing clinicians to easily and quickly visualize important data.
Figure 12 Main Screen (example)
Waveform Parameter Area
Numeric Parameter Area A
Quick-Action
Keys Area
Numeric Parameter Area B
Message Area
System Clock Area
Patient Demographic,
Mode, and Network Status Area
Parameter Areas
The parameter areas of the main display are divided into an area for displaying the waveform parameters and two
areas for displaying the numeric parameters. The parameter areas display the available configured parameters.
The waveform and associated numeric parameters are displayed in the same color providing easy visualization of
both parameter formats. The colors of the waveform and numeric parameters are not clinician configurable.
Waveform Parameter Area
The waveform parameter area displays the available configured parameter waveforms. The waveform parameter
tile is always located to the left of the corresponding numeric parameter tile.
The main screen supports up to eight waveform parameters simultaneously. The top waveform parameter tile is
always reserved for an ECG tracing. When active, the bottom four waveform parameter tiles display the four
invasive pressure waveforms.
43
MAIN SCREEN DISPLAY
The ECG waveform parameter tiles contain the ECG calibration pulse indicator and unit of measure. The CO2 and
invasive pressure waveform parameter tiles contain the waveform gain setting.
When using the Mortara AM12 12-Lead ECG Acquisition Module, the waveform parameter area can change to a
split-screen format displaying all 12 ECG vectors.
When accessing advanced functions, the opened dialogue menus display in the waveform parameter area. The top
waveform tracing of ECG remains visible at all times.
The waveform parameter colors are not clinician configurable and are as follows:
• ECG: Green
• SpO2: Cyan
• CO2: Yellow
• Respirations (from ECG): White
• P1: Red
• P2: Light Blue
• P3: Yellow
• P4: Magenta
• ART: Red
• PA: Yellow
• RA: Light Blue
• LA: Light Blue
• CVP: Light Blue
• ICP: Magenta
• PAWP: Yellow
Numeric Parameter Area
The numeric parameter area displays the numeric values of the available configured parameters. The numeric
parameter area is divided into two areas:
Numeric Parameter Area A
This area displays the numeric values adjacent to the corresponding waveform parameter tile. The numeric
parameter tile is always located to the right of the corresponding waveform parameter.
Numeric Parameter Area B
Located in the lower portion of the main screen, this area displays numeric values that are not associated with
waveform parameters. This area contains the NIBP, CO/CI, and Temperature numeric values if actively being
monitored.
In addition to the numeric parameter values, the numeric parameter tile may also contain the configured high and
low alarm limit settings and the parameter’s units of measure. If alarms are disabled for a given parameter, the
Alarm Off icon appears next to the parameter value. For pressure numeric parameters, the alarm icon appears if
alarms are turned off for any of the three pressure values of systolic, mean, or diastolic.
Selecting the numeric parameter tile opens the parameter dialogues. Use the parameter dialogues to make
adjustments in that parameter. Refer to the specific parameter sections of this manual for further details on
parameter dialogues.
44
MAIN SCREEN DISPLAY
The numeric parameter colors are not clinician configurable and are as follows:
• HR: Green (if source is ECG)
• PR: Cyan (if source is SpO2)
• PR: Red (if source is ART invasive pressure)
• ST: Green
• RR (from ECG): White
• EtCO2: Yellow
• FiCO2: Yellow
• RR (from CO2): Yellow
• IPI: Yellow
• SpO2: Cyan
• P1: Red
• P2: Light Blue
• P3: Yellow
• P4: Magenta
• ART: Red
• PA: Yellow
• RA: Light Blue
• LA: Light Blue
• CVP: Light Blue
• ICP: Magenta
• PAWP: Yellow
• CO: Red
• CI: Red
• T1: White
• T2: White
• ∆T: White
• NIBP: Orange
Quick-Action Key Area
Figure 13 Main Screen Quick-Action Keys
The quick-action keys provide rapid access to commonly used functions.
45
MAIN SCREEN DISPLAY
Alarm Silence Quick-Action Key
Select this quick-action key to silence all current and future alarm tones for the configured time period, and to
remove displayed alarm messages. Once the latched alarm condition resolves, select the Alarm Silence quick-action
key to acknowledge the latched alarm discontinuing the latched alarm behaviors. Refer to the Alarm section of this
manual for further details on latched alarms.
All ECG/12-Lead ECG Quick-Action Key
This quick-action key is a toggle button and is context sensitive specific to the ECG lead set in use. When
configured for a 12-lead ECG set and connected as such, the All ECG quick-action key is re-labeled “12 Lead
ECG.”
All ECG
o When the 3 or 5 lead ECG wire set is selected, pressing this soft key shows the ALL ECG view
displaying all available ECG vectors simultaneously.
o When in the All ECG view, the quick-action key re-labels to “Normal.”
o Select the Normal quick-action key to return to the main screen display.
12-Lead ECG
o When the AM12 is selected, pressing the 12 Lead ECG quick-action key displays all 12 ECG vectors
simultaneously in a split-screen format.
o When in the 12 Lead ECG view, the quick-action key re-labels to “Normal.”
o Select the Normal quick-action key to return to the main screen display.
NIBP Start/Stop Quick-Action Key
This quick-action key is a toggle button and changes function based on the NIBP status.
•
•
Selecting this quick-action key during an NIBP idle or deflated status initiates a non-invasive blood
pressure (NIBP) measurement.
Selecting this quick-action key during an NIBP acquire mode (currently inflating status) stops the NIBP
measurement and deflates the NIBP cuff.
Trends Quick-Action Key
Select this quick-action key to display the patient’s trends or vital sign numeric values. Refer to the Trends section
of this manual for further details.
Standby Quick-Action Key
Select this quick-action key to place the monitor into the Standby Mode or sleep mode. The Standby quick-action
key is also used to discharge the monitor.
While in the Standby Mode, the main screen display is black and reads “Standby Mode.”
NOTE: During the Standby mode the patient monitor does not show or capture any patient monitoring
data, does not perform alarm surveillance, and does not perform any arrhythmia surveillance. Patients
must be closely observed during a Standby mode.
Refer to the Standby section of this manual for further details.
46
MAIN SCREEN DISPLAY
Print Quick-Action Key
Select this quick-action key to print a real-time waveform recording at the bedside thermal recorder. If configured
appropriately and actively communicating to the Surveyor Central Station, the Print quick-action key also prints a
real-time waveform at the central station. The waveforms printed are based on the configuration settings in the
Setup> Setup Recorder dialogue. Refer to the Setup Recorder dialogue in this manual for further details.
The following table lists specific reports and where they may be printed based on system configuration.
Recording type
Prints at
Strip chart (initiated by pressing the Print soft key on monitor)
Print location setting
(Bedside, Central, or both)
12 lead report
Print location setting
(Bedside, Central, or both)
Alarm report
Print location setting
(Bedside, Central, or both)
Trend report
Bedside
ST averages
Bedside
Setup Quick-Action Key
Select this quick-action key to access advanced functions such as arrhythmia settings, alarm settings, and other
monitor configuration menus. Refer to the Setup section of this manual for further details.
Home Quick-Action Key
Select this quick-action key to close open dialogues and return to the main screen display.
Message Area
Figure 14 Message Area
Message Area
47
MAIN SCREEN DISPLAY
The lower portion of the main screen is where alarm and system messages are displayed. These alarm messages
flash and display in the background color of the configured alarm level color for that condition. If multiple alarm
conditions occur, the most recent alarm condition having the highest level displays. If there are multiple alarm
conditions with the same level, the alarm messages rotate in the message area. Refer to the Alarms section of this
manual for further details on alarm messaging.
System Clock Area
This area displays the system time and date. The system date and time area displays in the format of HH:MM:SS.
When communicating to the Surveyor Central Station, the system date and time synchronizes between the patient
monitor and the central station.
Demographic and Status Area
Figure 15 Demographic and Status Area
The Demographic and Status area displays three categories of
information: Patient information, patient mode icon, and network
status icon.
Patient Information
This area displays entered patient information such as name, room number, and ID number. Select this area to open
the Patient Information dialogue for adjusting the patient information. Refer to the Patient Information section in
this manual for further details.
Patient Mode Icon
This area displays an icon for Adult patient mode and for Pediatric patient mode. The selected patient mode icon
displays in green and is noted by an up arrow below the icon. Select this area to open the Patient Information
dialogue for adjusting the patient mode. Refer to the Patient Information section in this manual for further details.
Network Status Icon
This area displays a network status icon when the S12/S19 is configured to communicate to the Surveyor Central
Monitoring system. The network status icon displays above the patient mode icon.
Figure 16 Example Network Status Icon:
Successfully Communicating with Central Station
48
Figure 17 Example Network Status Icon:
Not Actively Communicating with Central Station
11. PATIENT MANAGEMENT
Overview
The Surveyor S12 and S19 patient monitors ship with factory default configuration settings allowing the clinician to
begin safely monitoring a patient without making any monitor configuration adjustments. However, the department
administrator may choose to adjust the monitor configuration for specific departmental default settings for
waveforms, parameters, alarm settings, and other functions. These departmental default configuration settings may
present upon monitor discharge for new patient monitoring sessions. The factory and departmental configurable
default settings may be adjusted based on the specific monitoring needs of patients.
Patient Information Dialogue
The Patient Information dialogue provides controls for entering patient demographic information. There are two
ways to access the Patient Information dialogue:
1. Select the Settings quick-action key a. Select the blue Patient Information button.
b. This opens the Patient Information dialogue.
2. Select the black patient information area located above the system date and time a. This opens the Patient Information dialogue.
Figure 18 Patient Information Dialogue
To enter patient information,
1. Select the blue demographic indicator button.
2. Based on the demographic label selected, the onscreen keyboard, keypad, or dropdown list box open.
3. Enter the information.
4. Selecting OK enters the information and displays the Setup dialogue.
5. Selecting CANCEL cancels the function and displays the Setup dialogue.
6. When in the Setup dialogue, select CLOSE to close the Setup dialogue.
7. Select the HOME quick-action key to close all dialogues and return to the main screen.
Information that can be entered includes Last Name, Middle Initial, First Name, ID, Room number, Mode, Gender,
Ethnicity, Date of Birth, Height and Weight.
49
PATIENT MANAGEMENT
Patient Mode Specifics
The patient mode choices include Adult and Pediatric. The patient mode is not based on the entered date of birth
and must be adjusted manually.
If the patient mode is changed during an active monitoring session a Confirm Patient Mode Change message shall
be displayed on the main screen. This confirmation message consists of continuing and changing configuration
settings back to departmental defaults, or canceling the change in patient mode.
Figure 19 Confirm Patient Mode Change Dialogue
Figure 20 Example Onscreen Keyboard (Last Name)
50
PATIENT MANAGEMENT
Figure 21
Example Onscreen Keypad (Birth Year)
Figure 22
Example Drop Down List Box (Patient Mode)
Admit
To admit a patient, simply connect the appropriate parameter cables and sensors to the patient. The patient
demographic information may be entered as per hospital standard of care at any time during the active monitoring
session. Refer to the Patient Information section in this manual for details on entering patient information.
Standby Mode
The Standby mode can be used to temporarily suspend patient monitoring (patient returning to same monitor) or to
permanently discharge the patient monitor (patient not returning to monitor). Selecting the Standby quick-action key
displays the Standby Mode Choice dialogue.
Figure 23 Standby Mode Choice Dialogue
51
PATIENT MANAGEMENT
Standby: Hibernation Mode
The Standby hibernation mode discontinues active patient monitoring but maintains the patient data and monitor
configuration settings. This use of the Standby mode may be used when the patient is disconnected from the patient
monitor for ambulation purposes, for example. Use the Standby mode based on the hospitals’ approved standard of
care.
NOTE: During the Standby mode the patient monitor does not show or capture any patient monitoring
data, does not perform alarm surveillance, and does not perform any arrhythmia surveillance. Patients
must be closely observed during a Standby mode.
Entering the Standby hibernation mode:
• Places the main screen into the Standby mode.
• Suspends monitoring of all patient data.
• Suspends the capturing of any patient monitoring data.
• Suspends alarm surveillance for all arrhythmias and physiological patient parameters.
• Suspends any active NIBP intervals.
• Suspends the CO2 pump.
• Displays the system clock and a Standby Mode message on the main screen at the patient.
• Places the Surveyor Central Station into the standby mode for this patient monitor. Refer to the central
station operator’s manual for details of the Standby mode at the central station.
Figure 24 Standby Mode Display
To enter the Standby hibernation mode:
1. Select the Standby quick-action key on the right
side of the main screen.
2. The Standby Mode Choice dialogue displays.
3. Select the Enter Standby Mode choice.
4. The monitor enters the Standby hibernation
mode.
5. The Standby Mode screen displays.
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PATIENT MANAGEMENT
Figure 25 Confirm Same Patient Prompt
To exit the Standby hibernation mode:
1. Touch the main screen to resume monitoring.
2. The “Confirm Same Patient” prompt appears.
a. Exiting the Standby hibernation mode by
selecting the YES button (is the same
patient)ƒ Resumes monitoring of patient
parameter monitoring as previously
configured.
ƒ Resumes capturing of any patient
monitoring data.
ƒ Resumes alarm surveillance for all arrhythmias and physiological patient parameters as previously
configured.
ƒ Re-enables the CO2 pump for use as configured.
ƒ Initiates a relearn of the Arrhythmia and ST algorithms.
ƒ Resumes monitoring for this patient monitor at the Surveyor Central Station. Refer to the central
station operator’s manual for details of the Standby mode at the central station.
ƒ Select the START/STOP NIBP quick-action key to resume the previously configured NIBP
interval and to start the cuff inflation.
b. Exiting the Standby Mode by selecting the NO button (not the same patient)ƒ Erases the previous patient monitoring data at the patient monitor (and central station as
applicable).
ƒ Erases the entered demographic information at the patient monitor (and central station as
applicable).
ƒ Erases any previously set alarm configuration settings at the patient monitor (and central station as
applicable).
ƒ Returns the monitor to the departmental default configuration settings at the patient monitor (and
central station as applicable).
ƒ Begins a new monitoring session at the patient monitor (and central station as applicable.
Best Practice Recommendation: Upon resumption of monitoring, ensure the alarm settings and monitor
configuration is appropriate for the patient based on the hospital standards of care.
Standby: Discharge Mode
To Discharge a patient:
1. Select the Standby quick-action key on the right side of the main screen.
2. The Standby Mode Choice dialogue displays
3. Select the Discharge Patient choice
4. The Confirm Discharge Patient confirmation message displays.
a. Select the OK button to discharge all previous patient data. This actionƒ Erases the previous patient monitoring data at the patient monitor (and central station as
applicable).
ƒ Erases the entered demographic information at the patient monitor (and central station as
applicable).
ƒ Erases any previously set alarm configuration settings at the patient monitor (and central station as
applicable).
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PATIENT MANAGEMENT
ƒ
b.
Returns the monitor to the departmental default configuration settings at the patient monitor (and
central station as applicable).
ƒ Displays the Discharged monitor screen.
ƒ Touch the screen to begin a new monitoring session at the patient monitor (and central station as
applicable).
Select the Cancel button to return to previous monitoring session.
Figure 26 Confirm Discharge Patient Message
Figure 27 Discharged Monitor screen
NOTE: When connected to the Surveyor Central Station, ensure that patient demographics have been
defined for each monitoring session. Discharging a patient, placing the monitor in standby mode or
switching the monitor off when a monitoring session where no patient demographics have been defined,
results in the permanent loss of monitoring data on the Surveyor Central related to that monitoring
session.
NOTE: When moving a monitor from one Surveyor Central to another Surveyor Central, in order to avoid
mixing up patient and monitoring session data, ensure that the patient is discharged on the monitor before
establishing a new monitoring session. Changing the communications setup for the monitor will
automatically force a discharge of the current patient.
.
54
12. ALARM BEHAVIORS AND MANAGEMENT
General Alarm Behavior
The Surveyor S12 and S19 patient monitors may provide alarm notifications when a patient’s physiological status
changes, there is a specific technical issue, or there is a system monitoring issue. The alarms are categorized into
different priorities or levels to aid in clinician recognition of urgent situations.
Physiological Alarms
Physiological alarms occur when the patient’s monitored data violates the configured alarm threshold for that
parameter. Physiological numeric alarm limit violations occur when the current parameter exceeds the configured
high alarm limit for that parameter or when the current parameter is less than the configured low alarm limit for that
parameter.
Arrhythmia and ST segment alarms are also considered physiological alarms. Arrhythmia alarms present as
configured when the defined criteria for the arrhythmia exists. ST segment alarms present as configured when the
defined criteria for the ST alarm exists.
Alarm Levels
Physiological alarms may be considered high level, medium level, or low level based on monitor configuration.
Some physiological alarm responses may be configurable by the clinician while some physiological alarm responses
are set by the Surveyor patient monitor and are not configurable by the clinician.
Red Alarm
A red alarm is a high level alarm. A red high level alarm is a potentially life-threatening critical
alarm requiring immediate clinician interaction with the patient. Lethal Arrhythmias (Ventricular
Fibrillation, Ventricular Tachycardia, and Asystole) are examples of red alarms. Tachycardia and
Bradycardia can also be configured to be red high level alarms.
Yellow Alarm
A yellow alarm is a medium level alarm. A yellow medium level alarm is considered an urgent
alarm requiring clinician interaction with the patient. A high Non-Invasive Blood Pressure
(NIBP) alarm may be configured as a Medium level alarm.
Cyan Alarm
A cyan alarm is a low level alarm. A cyan low level alarm is considered a non-urgent alarm
notification. The clinician should check the patient status when a low level alarm occurs. An
example of a low level alarm may be a ECG Leads Off situation.
Technical Alarms
Technical alarms occur when there is a patient-specific issue with the cables or parameter sensors of the Surveyor
patient monitor. Technical alarms indicate a non-physiological condition exists and the patient monitor cannot
measure or detect certain alarm conditions reliably. An example of a technical alarm is an ECG Leads Off situation.
Technical alarms are considered to be of low level importance. Parameter values that are out of measurable range
are considered technical alarms displayed in cyan. Technical alarm responses are determined by the monitor’s
software and cannot be adjusted by the clinician.
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ALARM BEHAVIORS AND MANAGEMENT
Informational Alert Messages
Informational alert messages appear on the patient monitor providing helpful prompts for proper operation. These
alerts on the lower portion of the main screen appear in white letters on black background and are not considered
alarm notifications. An example of an informational alert is “CO2 Warming Up.”
Alarm Configuration Defaults
Physiological alarms limits for each parameter have factory and configuration departmental default minimum and
maximum values. These alarm limits are based on the chosen patient mode whether adult or pediatric.
Factory Default Settings
The Surveyor S12 and S19 patient monitors are shipped with certain factory default alarm settings. Factory default
settings may differ for the adult patient mode and the pediatric patient mode. These factory default settings allow
the clinician to quickly use the patient monitors in a safe manner without spending time configuring the device.
Departmental Default Settings
The factory default settings can be adjusted by the facility’s system administrator and saved as Departmental
Defaults. These departmental defaults are configured specific to the needs of the typical population cared for in that
particular department.
The Surveyor S12 and S19 patient monitors can be restored to the original factory default settings via the Setup
Administrator menu (password required)
Alarm Notifications
Alarm notifications consist of three categories:
• Visual alarm notifications
• Alarm light notifications
• Audio alarm notifications
The visual and audio alarm notifications vary according to the alarm level or importance of the condition. All alarm
visual and audio notifications meet IEC 60601-1-8 standards.
Visual Alarm Notifications
Visual alarm notifications may consist of alarm light activation, alarm messaging along the bottom portion of the
patient monitor’s main screen, a flashing parameter background color, or a combination of the previous behaviors.
The physiological visual alarm behavior varies based on the parameter and the alarm level configured for the
parameter.
Physiological visual alarm notifications are divided into three colors based on alarm level:
Red Alarm
56
A red alarm is a high level alarm. In a high level alarm condition, the Surveyor S12 and S19
patient monitor’s alarm light flashes red, the alarm messaging area on the main screen flashes red,
and the involved parameter such as Heart Rate for Ventricular Tachycardia flashes with a red
background.
ALARM BEHAVIORS AND MANAGEMENT
Yellow Alarm
A yellow alarm is a medium level alarm. In a medium level alarm condition, the Surveyor S12
and S19 patient monitor’s alarm light flashes yellow, the alarm messaging area on the main screen
flashes yellow, and the associated numeric parameter tile flashes yellow.
Cyan Alarm
A cyan alarm is a low level, non-urgent alarm notification. In a low level alarm condition, the
Surveyor S12 and S19 patient monitor’s alarm light flashes cyan, the alarm messaging area on the
main screen flashes cyan, and the associated numeric parameter tile flashes cyan.
Alarm Light Notifications
The system’s front bezel has an alarm light that annunciates the highest grade active alarm in concert with the visual
alarm annunciation on the display, using the same color palette (red, yellow or cyan).
Alarm Light
Audio Alarm Notifications
Alarm conditions produce specific audio tones based on their alarm level.
Red Alarm
A red alarm produces a high alarm level tone of three chime tones separated by one-second
intervals.
Yellow Alarm
A yellow alarm produces a medium alarm level tone of a set of two chime tones separated by twosecond intervals.
Cyan Alarm
A cyan alarm produces a low alarm level tone of a single chime tone separated by three-second
intervals.
Audio Annunciation Type
Each alarm condition has an associated annunciation type. The annunciation type may be one of the following:
•
Persistent - A persistent alarm annunciation continues as long as the alarming condition continues. An
example of persistent alarm annunciations is the visual and audio alarm notifications associated with
an Asystole alarm.
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ALARM BEHAVIORS AND MANAGEMENT
•
One-Time - A One-Time alarm annunciation is performed only once with the annunciation ending
once the clinician silences the condition even if the alarm condition is still current. An example of a
one-time alarm annunciation is a Low Battery technical alarm.
Audio Silence
Selecting the Alarm Silence quick-action key on the main screen silences the audio notifications for the current
alarm condition for the configured time period. During the alarm audio silenced period, the visual alarm
notifications continue to display on the main screen for the duration of the alarm condition. If the alarm audio
silenced period expires and the alarm condition continues, the audio alarm notifications resume.
When the Surveyor S12 or S19 patient monitor is actively communicating to a Surveyor Central Station, silencing an
alarm is communicated bidirectionally between the patient monitor and the Surveyor central station.
• Silencing an alarm at the central station silences that alarm at the patient monitor.
• Silencing an alarm at the patient monitor silences that alarm at the central station.
During an alarm audio silenced period, the audio for the active alarm condition is the only alarm that is silenced. If
a different alarm condition occurs during this time, the new alarm condition produces audio and visual alarm
notifications as configured.
Alarm Paused/Suspend
The ability to suspend all alarms is a configurable feature determined by the system administration and is protected
behind a password. Contact the system administrator for further details.
WARNING: IF this feature is enabled, suspending all alarms suspends ALL alarm conditions
including the lethal arrhythmias (VFib, VTach, and Asystole). Use this feature with extreme caution as
alarm checking is suspended for all alarm conditions including the lethal arrhythmias (VFib, VTach, and
Asystole). Patients must be closely observed if all alarms are suspended.
NOTE: Follow hospital standard of care for the use of this feature. This feature is only intended to be
used during end of life situations and only based on the hospital standard of care.
NOTE: This feature can be enabled/disable by the system administrator.
When this feature is enabled, during an Alarm Suspend mode, an Alarm Suspend message appears in the messaging
area of the main screen. Once the Alarm Suspend period ends the audio and visual alarm notifications automatically
resume.
When the Surveyor S12 or S19 patient monitor is actively communicating to a Surveyor Central Station and this feature
is enabled at the patient monitor, alarm suspension is communicated bidirectionally between the patient monitor and the
Surveyor central station.
• Suspending an alarm at the central station suspends that alarm at the patient monitor.
• Suspending an alarm at the patient monitor suspends that alarm at the central station.
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ALARM BEHAVIORS AND MANAGEMENT
When this feature is enabled, to enter the All Alarms Suspended Mode and suspend all alarm notifications
(including VFib, Vtach, and Asystole):
1. Select the Setup quick-action key on the main screen.
2. Select the Alarm Suspend button in the Setup menu.
o This displays the “Alarms Suspended” message in the message area on the main screen.
o ALL alarms are now suspended including the lethal arrhythmias (VFib, Vtach, and Asystole).
3. Select the Close button to close the Setup menu.
When this feature is enabled, to exit the All Alarms Suspended Mode and resume alarm notifications:
1. Select the Setup quick-action key on the main screen.
2. Select the Alarm Resume button in the Setup menu.
o This removes the “Alarms Suspended” message in the message area on the main screen.
o All configured alarms are now active.
3. Select the Close button to close the Setup menu.
Alarm Off Icon
The Alarm Off icon indicates that one or more subsets of that parameter’s alarm settings are disabled. For example,
if the Respiration low limit is set to Off and the Respiration high limit is set to a valid limit, the Alarm Off icon
displays in the Respiration digital parameter tile.
The Alarm Off icon
displays in the digital parameter tile as per definition.
Alarm Latching
For certain alarms the visual and audio alarm notifications continue even after the condition that caused the alarm
has resolved. This is called Alarm Latching. Once the alarm condition resolves, a latched alarm continues with the
audio and visual alarm notifications. Alarm Latching is intended to notify the clinician that an important episode
occurred that requires patient interaction. After assessing the patient and resolving the alarm condition, the alarm
must be acknowledged by the clinician.
The lethal arrhythmias (VFib, VTach, and Asystole) are always latched alarms.
Once the patient is assessed and the alarm condition is resolved, the clinician can acknowledge a latched alarm by
doing either of the following:
• Select the Alarm Silence quick-action key on the main screen.
• Acknowledging the alarm from the Surveyor Central monitoring station.
When the Surveyor S12 or S19 patient monitor is actively communicating to a Surveyor Central, acknowledging the
latched alarm is communicated bidirectionally between the patient monitor and the Surveyor central station.
• Acknowledging a latched alarm at the central station acknowledges that latched alarm at the patient
monitor.
• Acknowledging a latched alarm at the patient monitor acknowledges that latched alarm at the central
station.
Alarm Delay
If Alarm Delay is enabled by the facility’s system administrator alarms are indicated after a specific delay time.
This alarm delay is designed to lessen erroneous false alarm calls sometimes associated with brief, transient
fluctuations in parameter data. The alarm delay values are based on the specific parameter and as follows:
59
ALARM BEHAVIORS AND MANAGEMENT
Parameter
Lower limit violation delay
Upper limit violation delay
HR, PR (from SpO2), PR
(from IBP)
3 seconds
3 seconds
RR
5 seconds
5 seconds
Mortara SpO2, Nellcor SpO2
(SatSeconds disabled)
10 seconds
10 seconds
IPI
10 seconds
0 seconds
0
0
Nellcor SpO2 (SatSeconds
enabled), all other
parameters
Multiple Active Alarms: Hierarchy of Display
Different Alarm Priorities
If multiple alarm conditions having different alarm priorities occur, the monitor produces alarm visual and audio
notifications for the alarm condition having the highest alarm level. For example, if VTach (red high level alarm)
occurs and a low SpO2 alarm (configured to be a yellow, medium level) also occurs, the higher level VTach alarm
produces the visual and audio alarm notifications.
Same Alarm Priorities
If multiple alarm conditions having the same alarm level occur, the monitor produces alarm visual and audio
notifications based on the highest alarm level and scrolls the alarm messages for each of those highest alarm level
conditions in the alarm messaging area. For example, if a high HR alarm (configured to be a yellow, medium level)
occurs and a low SpO2 alarm (configured to be a yellow, medium level alarm) is also occurring, the medium level
audio tone is produced, the HR and SpO2 tiles flash in yellow, and the alarm messaging area scrolls the High HR
alarm and Low SpO2 alarm in the yellow background.
Automatic Print on Alarm
Alarm conditions can be configured to automatically print a real-time waveform report when the alarm occurs. If a
parameter is configured to automatically print on an alarm condition, a real-time waveform report may be printed at
the bedside thermal recorder and the Surveyor Central Station based on the system configuration settings.
On the patient monitor’s printout, the alarm condition message and corresponding numeric parameter (as applicable)
is located at the beginning of the printed waveform report. The waveforms printed at the bedside recorder are based
on the configuration settings in the Setup> Setup Recorder dialogue. Refer to the Setup Recorder dialogue in this
manual for further details.
There are two ways to enable/disable an automatic print on alarm for a numeric parameter1. Select the numeric parameter tile to open the numeric parameter dialogue.
a. Locate the Print on Alarm button.
ƒ Selecting Yes produces the automatic printout for that numeric parameter.
ƒ Selecting No disables the automatic printout for that numeric parameter.
b. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ALARM BEHAVIORS AND MANAGEMENT
2. Select the Settings quick-action key.
a. Select the Alarms button in the Setup menu.
b. Locate the parameter and the Print On Alarm column.
ƒ Selecting Yes produces the automatic printout for that numeric parameter.
ƒ Selecting No disables the automatic printout for that numeric parameter.
c. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
To enable/disable an automatic print on alarm for an arrhythmia alarm condition:
1. Select the Setup quick-function button on the main screen.
2. Select the Arrhythmia button in the Setup menu.
3. Locate the arrhythmia and the Print On Alarm column.
a. Selecting Yes produces the automatic printout for that arrhythmia condition.
b. Selecting No disables the automatic printout for that arrhythmia condition.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Adjusting Alarm Limits
Numeric parameters are associated with adjustable alarm limit settings. Ensure that numeric parameter alarm limit
settings are appropriate for the patient. Use patient-specific customization to maximize the provision of safe patient
care and to minimize false alarm calls.
When the Surveyor S12 or S19 patient monitor is actively communicating to a Surveyor Central Station, alarm limit
changes are communicated bidirectionally between the patient monitor and the Surveyor central station.
• Adjusting an alarm limit at the central station adjusts that alarm limit at the patient monitor.
• Adjusting an alarm limit at the patient monitor adjusts that alarm limit at the central station.
Adjusting Non-ST Numeric Parameter Alarm Limits
There are two ways to adjust the numeric parameter’s alarm limits at the patient monitor:
1. Select the numeric parameter tile.
a. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached.
b. Adjust the Lower alarm limit, select the up/down arrows to move the lower alarm limit box until the
desired value is reached.
c. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
2. Select the Settings quick-action key.
a. Select the Alarms button in the Setup menu.
b. Locate the numeric parameter.
ƒ Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box
until the desired value is reached.
ƒ Adjust the Lower alarm limit, select the up/down arrows to move the lower alarm limit box until
the desired value is reached.
c. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Refer to the specific parameter’s section in this manual for further details.
Adjusting ST Alarm Limits
1. Select the ST parameter tile:
a. Locate the ST Change Alarm Limit.
b. Select the up/down arrows to move the ST alarm limit box until the desired value is reached.
c. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ALARM BEHAVIORS AND MANAGEMENT
Refer to the ST section in this manual for further details.
Adjusting Alarm Levels
Patient physiological alarm conditions are associated with an alarm level. Some of these parameter’s alarm levels
can be adjusted by the clinician while other parameter’s alarm levels cannot be changed.
When the Surveyor S12 or S19 patient monitor is actively communicating to a Surveyor Central Station, alarm level
changes are communicated bidirectionally between the patient monitor and the Surveyor central station.
• Adjusting an alarm level at the central station adjusts that alarm level at the patient monitor.
• Adjusting an alarm level at the patient monitor adjusts that alarm level at the central station.
Lethal Arrhythmia Alarm Levels
The three lethal arrhythmias (VFib, VTach, and Asystole) are always considered red high alarm levels. The lethal
arrhythmia alarm levels cannot be adjusted by the clinician.
Non-Lethal Arrhythmia Alarm Levels
Figure 28 Setup Arrhythmia Dialogue
To adjust an alarm level for a non-lethal arrhythmia:
1. Select the Setup quick-action key on the main screen.
2. Select the Arrhythmia button in the Setup menu.
3. Locate the non-lethal arrhythmia.
4. Locate the Alarm Level column.
5. Select the arrow to display the list box of available alarm level choices (MED, LOW, or OFF).
a. Select MED to make that non-lethal arrhythmia a yellow medium level alarm level.
b. Select LOW to make that non-lethal arrhythmia a cyan low level alarm level.
c. Select OFF to disable that non-lethal arrhythmia. If the alarm level is set to OFF, the patient monitor
does not product alarm notifications for that non-lethal arrhythmia.
d. Tachycardia and Bradycardia have the choices of HIGH or OFF for the alarm level.
6. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Non-ST Numeric Parameter Alarm Levels
If enabled, non-ST numeric parameters are medium alarm levels and cannot be adjusted by the clinician.
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ALARM BEHAVIORS AND MANAGEMENT
ST Alarm Levels
The alarm level for the ST parameter is adjusted via the ST numeric parameter tile. To adjust the ST alarm level:
1. Select the ST numeric parameter tile.
2. Locate the ST Increase Alarm Level condition.
3. Select the arrow to display the list box of available alarm level choices (MED, LOW, or OFF).
a. Select MED to make the ST Increase alarm a yellow medium level alarm level.
b. Select LOW to make the ST Increase alarm a cyan low level alarm level.
c. Select OFF to disable the ST Increases alarm . If the alarm level is set to OFF, the patient monitor
does not product alarm notifications for the ST Increase alarm condition.
4. Locate the ST Decrease Alarm Level condition.
5. Select the arrow to display the list box of available alarm level choices (MED, LOW, or OFF).
a. Select MED to make the ST Decrease alarm a yellow medium level alarm level.
b. Select LOW to make the ST Decrease alarm a cyan low level alarm level.
c. Select OFF to disable the ST Decrease alarm. If the alarm level is set to OFF, the patient monitor does
not product alarm notifications for the ST Increase alarm condition.
6. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Alarm Auto Set
The Auto set feature automatically calculates the high and low alarm limits based on the current value for that
numeric parameter. The Auto set feature does not apply to the Arrhythmia, ST, or Cardiac Output parameters.
To Auto set an alarm:
• Select the numeric parameter tile.
• Select the Auto quick button in the parameter setup menu.
• Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ALARM BEHAVIORS AND MANAGEMENT
Refer to the following table for the auto set percentages of alarm limit adjustment.
Parameter
Lower limit adjustment
Upper limit adjustment
HR, PR, RR
Changes to 80% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Changes to 125% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
EtCO2
Changes to 80% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Changes to 120% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
FiCO2
Not applicable
Changes to 200% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
IPI
Changes to 80% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Not applicable
SpO2
Changes to 95% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Set to 100%
Changes to 80% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Changes to 120% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
T1, T2, ∆T
Changes to 95% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Changes to 105% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
NIBPs, NIBPm, NIBPd
Changes to 80% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Changes to 120% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
Ps, Pm, Pd,
P2s, P2m, P2d,
P3s, P3m, P3d,
P4s, P4m, P4d,
NIBPs, NIBPm, NIBPd
Alarm Interfaces
Alarm Output/Nurse Call
The Alarm Output/Nurse Call provides an “open collector” relay driver that can be used to remotely annunciate or
illuminate an audible or visual alarm as needed. The monitor interface is a 1/8-inch stereo audio jack type
connector and the cable can be linked to an audible or visual alarm as needed.
The Alarm Output/Nurse call interface is a single-close-on-alarm interaction.
Signals will not be sent out if the monitor is in the alarm paused or alarm off state.
Surveyor Central Station
If the Surveyor patient monitor is connected to Surveyor Central monitoring station, alarms may be acknowledged,
suspended or otherwise inactivated remotely through Surveyor Central monitoring station.
Refer to the Surveyor Central Monitoring Station User’s Manual for further details.
64
13. ECG MONITORING
Overview
The ECG monitoring capabilities of the Surveyor patient monitor includes:
• Simultaneous display of multiple ECG tracings.
• An All ECG mode that displays up to seven tracings of ECG when using a 5-wire lead set.
• An All ECG mode that displays up to twelve tracings of ECG in a split-screen format when using the
AM12.
• Display, analysis and interpretation of all 12 leads when using the AM12 12-Lead ECG Acquisition
Module and in diagnostic mode.
• Calculating the average heart rate in beats per minute (based on analysis of the top displayed ECG lead, or
Lead II if no ECG lead is displayed).
• Detecting Asystole and Ventricular Fibrillation (performed on the same lead as the heart rate calculation).
• Pacer pulse detection (performed on Lead II).
• Generating an audible pulse tone for each detected beat.
• Monitoring of Arrhythmia conditions as configured.
• Monitoring of ST segments as configured.
Quality ECG Data Acquisition
Obtaining quality ECG data is important in continuous ECG monitoring. A quality ECG signal depends largely on
the patient prep and electrode placement. Direct contact between the electrodes and the patient's skin and correct
placement of the electrode can help ensure obtaining quality ECG data.
A good quality ECG contains:
• Discernible P waves, QRS complexes, and T waves.
• Good R wave detection.
• Steady, even, crisp baseline.
• Absent of respiratory variability, artifact, noise, and other interference.
A good quality ECG may enhance the performance of the arrhythmia algorithm and may lessen false erroneous
alarm notifications.
A poor quality ECG may be caused by many factors:
• Poor site preparation may lead to poor quality ECG data.
• Poor electrode application may lead to poor quality ECG data.
• Patient movement may lead to poor quality ECG data.
• Interference by other equipment in the room may lead to poor quality ECG data.
• Poor quality ECG becomes synonymous with artifact and interference in the ECG waveforms.
A poor quality ECG may manifest in several ways:
• Superfluous baseline artifact.
• Erratic baseline.
• Sharp “spikes.”
• Rolling, wandering waveforms as seen with patient breathing patterns.
• Difficult to discern P waves from atrial fib waves from noise.
• Poor R wave detection.
• Inability to discern P waves, QRS complexes, T waves.
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ECG MONITORING
Artifact and interference in the ECG waveforms may be caused by using accessories, lead wires, and ECG cables
other than those specified to work with the Surveyor patient monitors. Always use accessories, lead wires, ECG
cables, and other accessories specified to work with the Surveyor patient monitors.
Skin Preparation
In continuous ECG monitoring, the goal of skin preparation is to maximize the surface area of direct contact
between the patient’s skin and the ECG electrode. Follow the facility’s standard of care when preparing the
patient’s skin for ECG electrode placement and ECG monitoring.
To prepare the patient’s skin for electrode placement:
1. Explain the procedure to the patient.
2. Maintain patient privacy during skin prep and electrode placement.
3. Locate the correct anatomical landmarks for electrode placement.
4. Clip or shave excess hair in the areas marked for electrode placement.
5. Remove residual skin oils, creams, and lotions by gently abrading the skin with a small gauze pad.
NOTE: With elderly or frail patients take care to not abrade the skin causing discomfort or bruising.
Clinical discretion should always be used in patient preparation.
Electrode Placement
To apply electrodes:
1. Use pre-gelled, Ag/AgCl disposable electrodes.
a. Do not use electrodes after their expiration date, or if the gel has dried out.
ƒ Store electrodes in an air tight container.
ƒ Electrodes dry out if not stored properly leading to loss of adhesion and conductivity.
b. Always use the same electrodes.
ƒ Do not mix electrode brands or types.
ƒ Using different types of electrodes may cause a fluctuation in the impedance and this can lead to
baseline artifact and noise in the ECG tracing.
2. Apply the electrodes in the following manner:
a. Attach the electrode to the ECG lead wires prior to attaching the electrode to the patient’s chest.
b. Place the electrode in the properly prepared, correct location by using a circular motion on the
electrode adhesive area.
c. Gently press the electrode adhesive to the patient’s skin until the entire outer surface of the electrode is
adhered to the patient’s chest.
d. Once the electrode adhesive is attached, gently press on the gel area to ensure proper gel to chest
contact. Avoid dislodging the gel as the displaced gel can increase baseline artifact and noise in the
ECG tracing.
e. Test for firm electrode contact by slightly tugging on the electrode to check for adhesion among the
entire electrode surface. If the electrode moves freely, change the electrode. If the electrode does not
move easily, a good adhesive contact has been obtained.
Refer to the Electrode Location section in this manual for further details on correct anatomical landmarks for
electrode placement.
Best Practice Recommendation: Change electrodes as per hospital standard of care, or at least every 24 hours to
enhance patient skin care and the acquisition of quality ECG data. Clinical discretion should always be used in
patient preparation.
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ECG MONITORING
Electrode Locations
The ECG electrodes sense the electrical signals generated by the electrical activity of the heart as it beats. The
Surveyor patient monitor amplifies the signals so they can be displayed on the screen. The Surveyor patient
monitor uses a 3-lead, 5-lead ECG cable set or the AM12 12-Lead ECG Acquisition Module. The 3-lead ECG
cable set provides monitoring of ECG vectors I, II and III. The 5-lead ECG cable set supports the following ECG
vectors: I, II, III, V, AVL, AVR, and AVF. The AM12 12-Lead ECG Acquisition Module supports the following
ECG vectors: I, II, III, AVL, AVR, AVF, V1, V2, V3, V4, V5, and V6.
Using a 3-Wire ECG Lead Set
Figure 29 Electrode Locations: 3-Wire Lead Set
3-Wire Lead Placement (AHA)
•
•
•
Place the RA (white) electrode under the patient’s
right clavicle, at the midclavicular line within the rib
cage frame.
Place the LA (black) electrode under the patient’s
left clavicle, at the midclavicular line within the rib
cage frame.
Place the LL (red) electrode on the patient’s lower
left abdomen within the rib cage frame.
3-Wire Lead Placement (IEC)
•
•
•
Place the R (red) electrode under the patient’s right
clavicle, at the midclavicular line within the rib
cage frame.
Place the L (yellow) electrode under the patient’s
left clavicle, at the midclavicular line within the rib
cage frame.
Place the F (green) electrode on the patient’s lower
left abdomen within the rib cage frame.
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ECG MONITORING
Using a 5-Wire ECG Lead Set
Figure 30 Electrode Locations: 5-Wire Lead Set
5-Wire Lead Placement (AHA)
•
•
•
•
•
68
Place the RA (white) electrode under the patient’s
right clavicle, at the midclavicular line within the rib
cage frame.
Place the LA (black) electrode under the patient’s
left clavicle, at the midclavicular line within the rib
cage frame.
Place the LL (red) electrode on the patient’s lower
left abdomen within the rib cage frame.
Place the RL (green) electrode on the patient’s lower
right abdomen within the rib cage frame.
Place the V (brown) electrode in one of the V-lead
positions (V1 – V6) depicted in the following
section.
5-Wire Lead Placement (IEC)
•
•
•
•
•
Place the R (red) electrode under the patient’s right
clavicle, at the midclavicular line within the rib
cage frame.
Place the L (yellow) electrode under the patient’s
left clavicle, at the midclavicular line within the rib
cage frame.
Place the F (green) electrode on the patient’s lower
left abdomen within the rib cage frame.
Place the N (black) electrode on the patient’s
lower right abdomen within the rib cage frame.
Place the C (white) electrode in one of the C-lead
(C1 – C6) positions depicted in the following
section.
ECG MONITORING
Lead II Monitoring
Figure 31 Electrode Locations: Lead II Monitoring
Lead II Monitoring (AHA)
•
•
•
Place the RA (white) electrode under the patient’s
right clavicle, at the midclavicular line within the rib
cage frame.
Place the LA (black) electrode under the patient’s
left clavicle, at the midclavicular line within the rib
cage frame.
Place the LL (red) electrode on the patient’s lower
left abdomen within the rib cage frame.
Lead II Monitoring (IEC)
•
•
•
Place the R (red) electrode under the patient’s right
clavicle, at the midclavicular line within the rib
cage frame.
Place the L (yellow) electrode under the patient’s
left clavicle, at the midclavicular line within the rib
cage frame.
Place the F (green) electrode on the patient’s lower
left abdomen within the rib cage frame.
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ECG MONITORING
Modified Chest Lead (MCL) Monitoring
Figure 32 Electrode Locations: MCL Monitoring
MCL Monitoring with 3-Wire Lead Set (AHA)
•
•
•
•
•
70
Place the RA (white) electrode under the patient’s
left clavicle, at the midclavicular line within the rib
cage frame.
Place the LA (black) electrode on the right sternal
border, at the fourth intercostal space within the rib
cage frame.
Place the LL (red) electrode on the patient’s lower
left abdomen within the rib cage frame.
Select ECG Lead I for MCL1 monitoring. Lead I is
the direct electrical line between the RA (white)
electrode and the LA (black) electrode.
Select ECG Lead II for MCL6 monitoring. Lead II is
the direct electrical line between the RA (white)
electrode and the LL (red) electrode.
MCL Monitoring with 3-Wire Lead Set (IEC)
•
•
•
•
•
Place the R (red) electrode under the patient’s left
clavicle, at the midclavicular line within the rib
cage frame.
Place the L (yellow) electrode on the right sternal
border, at the fourth intercostal space within the
rib cage frame.
Place the F (green) electrode on the patient’s lower
left abdomen within the rib cage frame.
Select ECG Lead I for MCL1 monitoring. Lead I is
the direct electrical line between the R (red)
electrode and the L (yellow) electrode.
Select ECG Lead II for MCL6 monitoring. Lead II
is the direct electrical line between the L (red)
electrode and the F (green) electrode.
ECG MONITORING
Pacemaker Patients
Pacemaker patients may require a modified electrode placement based on the physical location of the patient’s
pacemaker generator device. Do not place an ECG electrode directly over the pacemaker generator as this may lead
to artifact and noise on the ECG tracings.
Best Practice Recommendation: Place the electrode patches 3 – 5 inches away from the pacemaker generator
area. For example, if the pacemaker generator is located in the right subclavian area, relocate the Right Arm
electrode closer in towards the center of the chest.
Use the following lead placement for monitoring pacemaker patients:
Figure 33 Electrode Locations: Pacemaker Patients
3-Wire Lead Placement for Pacemaker Patients
(AHA)
3-Wire Lead Placement for Pacemaker Patients
(IEC)
5-Wire Lead Placement for Pacemaker Patients
(AHA)
5-Wire Lead Placement for Pacemaker Patients
(IEC)
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ECG MONITORING
Using the AM12 for Continuous ECG Monitoring
The Mortara AM12 may be used for continuous simultaneous monitoring of 12 vectors of ECG. Arrhythmia and
ST analysis on all 12 ECG leads may be performed by the patient monitor when the AM12 is in use.
Refer to the Arrhythmia and ST sections in this manual for further details.
The following diagram describes the recommended electrode placement for using the AM12 in a continuous
monitoring mode.
Figure 34 Electrode Locations: Continuous 12-Lead Monitoring
IEC
AHA
Lead Placement
R (red)
RA (white)
Just below the right clavicle.
L (yellow)
LA (black)
Just below the left clavicle.
N (black)
RL (green)
Lower right edge of the rib cage.
F (green)
LL (red)
Lower left edge of the rib cage.
C1 (white)
V1 (brown)
4th intercostal space, right sternal border.
C2 (yellow)
V2 (yellow)
4th intercostal space, left sternal border.
C3 (green)
V3 (green)
Midway between C2/V2 and C4/V4.
C4 (brown)
V4 (blue)
5th intercostal space, mid-clavicular line.
C5 (black)
V5 (orange)
Left anterior axillary line at C4/V4 level.
C6 (purple)
V6 (purple)
Mid-axillary line at C4/V4 and C5/V5 levels.
For accurate V-lead placement and monitoring, it is important to locate the 4th intercostal space. The 4th intercostal
space is determined by first locating the 1st intercostal space. Because patients vary with respect to body shape, it
may be difficult to palpate the 1st intercostal space with accuracy. Thus, locate the 2nd intercostal space by first
palpating the little bony prominence called the Angle of Lewis, where the body of the sternum joins the manubrium.
This rise in the sternum identifies where the second rib is attached, and the space just below it is the 2nd intercostal
space. Palpate and count down the chest until the 4th intercostal space is located.
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ECG MONITORING
Using the AM12 for Diagnostic Resting 12-Lead ECG Acquisition
The Mortara AM12 may be used for acquiring true diagnostic resting 12-lead data. The resting 12-Lead ECG
function can also provide a diagnostic 12-Lead interpretive report. This feature allows the patient monitor to
perform as a diagnostic resting 12-Lead ECG acquisition device and may limit the need for using an independent
diagnostic resting 12-Lead acquisition device.
Best Practice Recommendation: To be truly diagnostic and comparable to standard resting 12-Lead data
acquisition devices, it is recommended that the arm and leg electrodes be placed on the patient’s arm and legs as per
the following diagram prior to acquiring the resting 12-lead ECG.
WARNING: For full diagnostic quality, the 12-lead resting ECG should be printed on the Surveyor
Central Station printer and not on the S12 or S19 strip chart recorder.
The following diagram describes the recommended electrode placement for using the AM12 in a diagnostic resting
12-Lead acquisition mode.
Figure 35 Electrode Locations: Diagnostic Resting 12-Lead Acquisition
IEC
AHA
Lead Placement
R (red)
RA (white)
Right deltoid or wrist.
L (yellow)
LA (black)
Left deltoid or wrist.
N (black)
RL (green)
Right thigh or ankle.
F (green)
LL (red)
Left thigh or ankle.
C1 (white)
V1 (brown)
4th intercostal space, right sternal border.
C2 (yellow)
V2 (yellow)
4th intercostal space, left sternal border.
C3 (green)
V3 (green)
Midway between C2/V2 and C4/V4.
C4 (brown)
V4 (blue)
5th intercostal space, mid-clavicular line.
C5 (black)
V5 (orange)
Left anterior axillary line at C4/V4 level.
C6 (purple)
V6 (purple)
Mid-axillary line at C4/V4 and C5/V5 levels.
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ECG MONITORING
For accurate V-lead placement and monitoring, it is important to locate the 4th intercostal space. The 4th intercostal
space is determined by first locating the 1st intercostal space. Because patients vary with respect to body shape, it
may be difficult to palpate the 1st intercostal space with accuracy. Thus, locate the 2nd intercostal space by first
palpating the little bony prominence called the Angle of Lewis, where the body of the sternum joins the manubrium.
This rise in the sternum identifies where the second rib is attached, and the space just below it is the 2nd intercostal
space. Palpate and count down the chest until the 4th intercostal space is located.
Checking the ECG Signal
Once the patient has been properly prepared, the electrodes attached and in the correct anatomical location, the
patient ECG cable is connected to the Surveyor S12/S10, and the monitor is powered on, the main screen display
should display the ECG tracing(s).
Check to ensure the ECG tracing is free of artifact and noise with a clean ECG baseline as per patient condition
permits. If the ECG contains artifact or noise, review the steps for proper electrode site preparation and placement.
ECG Waveform Tile
The waveform parameter tile located in the top position of the main screen is always reserved for an ECG
waveform. The main screen normal display can display up to two ECG waveforms in waveform position 1 and 2.
The ECG vectors displayed in waveform position 1 and 2 are configurable via the Setup HR/PR dialogue. Each
ECG waveform tile contains the configured ECG waveform tracing, the lead label, and the cal pulse indicator.
Figure 36 Example ECG Waveform Tiles
All ECG/12-Lead Display Mode
The Surveyor S12 and S19 patient monitors can display multiple ECG waveforms on the main screen. This All
ECG view provides a real-time view of the available ECG waveforms. The waveforms available in the All ECG
view are based on the ECG lead wire set configured for use in the Setup HR/PR dialogue. The All ECG mode is an
additional view of the main screen. The All ECG view remains displayed until the clinician manually chooses to
return to the normal main screen view.
When in the All ECG/12-Lead display mode• Numeric parameter tiles continue to display in real time.
• Visual and audio alarm notifications continue as configured.
When configured for a 5-wire ECG lead set, the All ECG mode can display up to seven ECG waveform vectors.
When configured for a 12-lead ECG set, the All ECG mode displays all 12 ECG waveform vectors in a split screen
format. Refer to the Setup HR/PR dialogue section in this manual regarding details on configuring ECG lead sets.
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ECG MONITORING
Figure 37 All ECG Mode: 5-Wire ECG Set
To enter the All ECG mode when using a 3-wire or
5-wire ECG lead set:
• Select the All ECG quick-action key on the main
screen.
• The All ECG mode is now displayed.
• When in the All ECG view, the quick-action key
re-labels to “Normal.”
• Select the Normal quick-action key to return to
the main screen display.
When configured for a 12-lead ECG set, the All ECG quick-action key is re-labeled “12 Lead ECG.”
Figure 38 All 12 Lead ECG view
To enter the All ECG mode when using a 12-lead ECG
lead set:
• Select the 12 Lead ECG quick-action key on the
main screen.
• The all 12 Lead ECG view is now displayed.
• When in the 12 Lead ECG view, the quickaction key re-labels to “Normal.”
• Select the Normal quick-action key to return to
the main screen display.
Resting 12-Lead ECG Interpretation
The Surveyor patient monitor provides Mortara’s 12-lead resting ECG interpretation VERITAS algorithm when the
AM12 12-Lead ECG Acquisition Module is utilized. This generates the 12-lead complexes, QRS measurements,
and the interpretation statement.
To generate a resting ECG interpretation:
1. Enable the 12-lead via the Setup HR/PR dialogue.
2. Perform electrode site preparation as per hospital standard of care. Refer to Quality ECG section of this
manual for future details.
3. Select the 12-Lead ECG quick-action key on the right side of the main screen.
4. Select the Analyze button to have the algorithm analyze the 12-lead data.
5. Select the Interp button to display the 12-lead interpretation on the display.
6. Select the Print button to print the 12-lead interpretive report.
WARNING: For full diagnostic quality, the 12-lead resting ECG should be printed on the
Surveyor Central Station printer and not on the S12 or S19 strip chart recorder.
7.
Select the Close button to close the 12-lead interpretation view and return to the main 12-lead view display.
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ECG MONITORING
Figure 39 Resting 12-Lead Interpretation
The resting 12-lead interpretation includes global measurements and a standard advisory statement stating that a 12lead ECG obtained with torso-located limb electrodes is not equivalent to a conventional diagnostic ECG.
When connected to the Surveyor Central Station, the central station performs the 12-lead interpretation for the S12
and S19 patient monitors. This process may take several seconds to retrieve the analysis statements and display on
the patient monitors. Do not attempt to re-analyze, re-interpret or re-print until the initial process has been
completed and displays on the patient monitors.
Some resting 12-lead interpretation statements may be lengthy and extend beyond one screen/printed record.
WARNING: For full diagnostic quality, the 12-lead resting ECG should be printed on the Surveyor
Central Station printer and not on the S12 or S19 strip chart recorder.
76
14. ECG/HEART RATE/PULSE RATE MONITORING
Overview
The Surveyor S12and S19 patient monitors can monitor the patient’s heart rate (pulse rate) parameter. Alarm limits
can be enabled to detect high heart rate alarm conditions and low heart rate alarm conditions.
The algorithm calculates the heart rate from its available source:
• If the heart rate from the last four R to R intervals is greater than 48 beats per minute, the average heart rate
is determined by averaging the last 16 R to R intervals.
• If the heart rate from the last four R to R intervals is less than or equal to 48 beats per minute, then this rate
is used.
• Paced beats and PVCs are included in the heart rate calculation.
Heart Rate/Pulse Rate Tile
Figure 40 Example HR Tile
The Heart Rate/Pulse rate numeric parameter tile may display:
• The parameter label.
• The current heart rate/pulse rate numeric value.
• The “BPM” (beats per minute) HR/PR units of measure
label.
• The configured HR alarm limits if the HR alarm limits are
enabled.
• The Alarm Off icon if either the high or low HR alarm limit
is disabled.
• The “ARR” text to indicate arrhythmia analysis is enabled.
• The “Learning” text when the ARR/ST algorithm is in a
learn period.
HR/PR Alarm Behaviors
The HR tile flashes when in an high or low HR alarm condition. The alarm light, HR numeric parameter tile, and
HR alarm message in the alarm message area of the main screen flashes and displays in the color of the configured
HR alarm level.
When a lethal red high level arrhythmia occurs, the HR parameter tile, alarm light, and alarm message in the main
screen alarm message area flashes and displays in red.
Heart Rate/Pulse Rate Sourcing
The patient’s heart rate (or pulse rate) is displayed in the color of its source. The HR/PR sourcing hierarchy can
automatically obtain the parameter from the best available physiological source. The clinician may also manually
configure a HR/PR source.
The HR/PR parameter may be sourced based on the following hierarchy:
• Heart Rate (HR): Green when the source is ECG.
• Pulse Rate (PR): Cyan when the source is SpO2.
• Pulse Rate (PR): Red when the source is the P1/ART invasive pressure.
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ECG/HEART RATE/PULSE RATE MONITORING
Setup HR/PR Dialogue
Select the HR/PR tile to open the Setup HR/PR dialogue. This dialogue is used to make adjustments in the ECG,
Heart Rate (HR), and Pulse Rate (PR) parameters.
Figure 41 Example Setup HR/PR Dialogue
HR/PR Alarm Limits
To adjust the HR/PR alarm limits:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
a. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached.
b. Adjust the Lower alarm limit, select the up/down arrows to move the lower alarm limit box until the
desired value is reached.
2. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The HR/PR alarm limits may also be adjusted via the Settings quick-action key. Refer to the Alarm Limits section
in this manual for further details.
Auto Set HR/PR Alarm Limits
The Auto set feature automatically calculates the high and low HR/PR alarm limits based on the current value.
Parameter
Auto Lower limit adjustment
Auto Upper limit adjustment
HR, PR
Changes to 80% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
Changes to 125% of the current parameter
value (or the nearest allowable value given the
alarm limit settings rules)
To Auto set an alarm:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Select the Auto button. Notice the limit values in the Lower Limit window and the Higher Limit window
adjust.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ECG/HEART RATE/PULSE RATE MONITORING
HR/PR Alarms On
The ability to disable the HR/PR alarms is a configurable feature determined by the system administration and is
protected behind a password. Contact the system administrator for further details.
WARNING: Disabling the HR/PR alarm limits means that NO low or high HR/PR alarm
conditions will produce alarm notifications. Use this feature with extreme caution. Patients must be
closely observed if the HR/PR alarm limits are disabled.
NOTE: Follow hospital standard of care for the use of this feature. This feature is only intended to be
used during end of life situations and only based on the hospital standard of care.
NOTE: This feature can be enabled/disable by the system administrator.
If configured by the system administrator to allow the clinician to enable/disable the HR/PR alarm limits:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the Alarms On button.
a. Select Yes to enable HR/PR alarms.
b. Select No to disable HR/PR alarms.
ƒ The Alarm Off icon is displayed in the HR/PR numeric parameter tile.
NOTE: The Lower Limit and Higher Limit windows in the HR/PR dialogue may contain limit values but
these alarms ARE disabled if the Alarms On button is set to NO.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
HR/PR Print on Alarm
High and Low HR/PR alarm limit conditions can be configured to automatically print a real-time waveform report
when the alarm occurs.
To enable/disable the HR/PR alarm limit conditions to automatically print:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the Print On Alarm button.
a. Select Yes to enable the Print On Alarm.
b. Select No to disable the Print On Alarm.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Print On Alarm feature for the HR/PR alarm limit conditions may also be adjusted via the Settings quick-action
key. Refer to the Print On Alarm section in this manual for further details.
ECG Lead Set
The clinician must choose the ECG lead set in use on the patient. The ECG lead set chosen determines the number
of ECG tracings available for display on the patient monitor’s main screen and other settings within the user
interface.
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ECG/HEART RATE/PULSE RATE MONITORING
The choices for the ECG lead set are 3-wire and 5-wire lead sets. If 12-Lead is enabled and available, these
choices are hidden. To re-enable the 3-wire and 5-wire choices, disable the 12 Lead in the Setup HR/PR dialogue
or unplug the AM12.
To choose the proper ECG lead set:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the ECG Lead Set button.
a. Select the arrow to display the drop down list box with choices (3-wire, 5-wire).
b. Select the appropriate lead set.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ECG 12-Lead Enabled
When using the AM12 12-Lead ECG Acquisition Module, the clinician must enable the patient monitor to
recognize the AM12. Ensure the 12-lead is disabled when not in use.
To enable/disable the 12-lead:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the 12 Lead Enabled button.
a. Select Yes to enable the 12-lead feature.
b. Select No to disable the 12-lead feature.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
If 12-lead is enabled and the AM12 is plugged into the monitor, the ECG lead set choices are hidden. Disable the
12-lead to show the ECG lead set 3-wire and 5-wire choices.
ECG Top Channel Lead
The Top Channel Lead provides the ability to change the ECG vector displayed in waveform position one on the
patient monitor’s main screen. The choices for the top channel lead are dependent upon the ECG lead set
configured in the ECG Lead Set feature.
To adjust the top channel lead:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the Top Channel Lead label.
a. Select the arrow to display the drop down list box with choices (based on configured ECG lead set).
b. Select the appropriate lead.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ECG Size
The Size feature provides the ability to adjust the size of the ECG vectors displayed on the patient monitor’s main
screen. The Size setting affects all ECG vectors that are displayed on the main screen.
To adjust the size of the ECG waveforms:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the Size label.
a. Select the arrow to display the drop down list box with choices (2.5 mm/mV, 5 mm/mV, 10 mm/mV,
20 mm/mV).
b. Select the appropriate lead.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ECG/HEART RATE/PULSE RATE MONITORING
HR/PR Source
The HR/PR Source feature provides the ability to adjust which pulsatile source the monitor uses to provide the
HR/PR audible beep tone.
To adjust the HR/PR Source:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the HR/PR Source button.
a. Select the arrow to display the drop down list box with choices (AUTO, ECG, SPO2, and P1 /ART).
b. Select the appropriate HR/PR source.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
NOTE: When no IBP channels are available, there is no P1/ART available as the HR/PR source
HR/PR Tone
The HR/PR Tone feature provides the ability to configure an audio tone for each detected QRS complex or pulse. If
the HR/PR Tone feature is enabled, an audio tone is produced for each systole beat detected.
To enable/disable the HR/PR systole audio tone:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the HR/PR Tone button.
a. Select Yes to enable the HR/PR systole audio tone.
b. Select No to disable the HR/PR systole audio tone.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
When the HR/PR Source defined as SPO2 or AUTO with HR/PR determined by ECG, the HR/PR tone will
decrease in accordance to the patient’s SpO2 level. This is intended to provide audible feedback during a
procedure, such as surgery, without requiring constant viewing of the oxygen saturation level.
ECG Filter
The ECG Filter allows for filtering of the ECG signal depending on the type of cable currently in use. Specifically:
•
•
With the 3/5-lead cable, choices for ECG filter are: “0.67 – 40 Hz” or “0.05 – 40 Hz”.
When AM12 is used (connected and enabled), the choices for ECG filter are “0.05 – 40 Hz” or “0.05 – 150
Hz”.
HR/ARR Lead Select
This feature defines the ECG leads used for heart rate calculation and arrhythmia analysis. The choices for this
setting are dependent upon the configured ECG lead set.
3-Wire ECG Lead Set: Top Channel Lead as defined in the Setup HR/PR dialogue.
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ECG/HEART RATE/PULSE RATE MONITORING
5-Wire ECG Lead Set:
• When configured to Auto, the ECG leads used for HR and ARR processing start with II and V for
detection and III for confirmation while allowing the algorithm to switch to other available leads based on
signal quality.
• When configured to Single Lead, the ECG lead used for HR and ARR processing is the one specified by
the user from the set I, II, III, or V.
• When configured to Multiple Leads, the ECG leads used for HR and ARR processing are selected
internally from the set II and V for detection, and III for confirmation.
When using a 5-wire ECG lead set, to select the HR/ARR Lead Select for analysis:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the HR/ARR Lead Select button.
a. Select the arrow to display the drop down list box with choices (Multiple Lead, Single Lead, Auto).
b. Select the appropriate choice.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
AM12 12-Lead ECG Acquisition Module:
•
When configured to Auto, the ECG leads used for HR and ARR processing start with II and V5 for
detection and V1 for confirmation while allowing the algorithm to switch to other available leads based on
signal quality.
• When configured to Single Lead, the ECG lead used for HR and ARR processing is the one specified by
the user from the set I, II, III, or V (V1).
• When configured to Multiple Leads, the ECG leads used for HR and ARR processing are selected
internally from the set II and V5 for detection, and V1 for confirmation.
When using the AM12, to select the HR/ARR Lead Select for analysis:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the HR/ARR Lead Select button.
a. Select the arrow to display the drop down list box with choices (Multiple Lead, Single Lead, Auto).
b. Select the appropriate choice.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Analyze Pacers
The Surveyor patient monitor may be configured to automatically reject pacer pulses rather than calling them as
QRS complexes. The Analyze Pacer feature is enabled in the factory default configuration.
Best Practice Recommendation: When the patient has an implanted pacemaker generator, enable the Analyze
Pacer feature. This should maximize the algorithm’s ability to recognize pacemaker pulses and QRS complexes.
Proper electrode placement is crucial in continuous ECG monitoring of the patient possessing an implanted
pacemaker. Refer to the Electrode Locations section in this manual for further details on proper electrode location
in the pacemaker patient.
When the Analyze Pacer function is enabled and the patient possesses an active pacemaker, the patient monitor
displays an exaggerated tick mark at the point where a pacer pulse is detected on the ECG waveform. This pacer
spike display may assist the clinician identification of pacer-initiated complexes.
NOTE: Proper clinical assessment and close surveillance is recommended for patients possessing
pacemakers during continuous ECG monitoring. Do not rely entirely on rate meters for these patients.
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ECG/HEART RATE/PULSE RATE MONITORING
To enable/disable the system to automatically detect pacemaker pulses:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the Analyze Pacers button.
a. Select Yes to enable the automatic detection of pacer pulses.
b. Select No to disable the automatic detection of pacer pulses.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ST Enabled
To enable/disable ST analysis:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the ST analysis button.
a. Select Yes to enable ST analysis.
b. Select No to disable ST analysis.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ECG/HEART RATE/PULSE RATE MONITORING
84
15. ECG ARRHYTHMIA MONITORING
Overview
The Surveyor S12 and S19 patient monitors use the Mortara arrhythmia algorithm to monitor the patient’s ECG
waveform data. This algorithm analyzes the patient’s ECG waveform, “learns” the patient’s ECG baseline, and
establishes normal beat templates for that patient. The algorithm uses these beat templates to determine if the
subsequent ECG beats are the same or different than the patient’s normal ECG rhythm.
NOTE: Arrhythmia monitoring is designed to assist the clinician, not replace the clinician’s knowledge.
The arrhythmia analysis is an adjunct to the clinician’s knowledge and is not designed to replace clinical
expertise.
Noise and Artifact
The Mortara arrhythmia algorithm uses several techniques to differentiate and filter noise from the ECG data. If too
much ECG artifact occurs, the arrhythmia processing is hindered from properly analyzing the ECG data. Should
this occur, the monitor will alert the clinician informing of the suspension of arrhythmia processing during this
condition. This situation produces the cyan low priority visual and audio alarm notifications.
WARNING: Arrhythmia processing is suspended during periods of high ECG artifact. The
clinician should observe the patient directly should a high ECG artifact condition occur. The clinician
should correct the cause of the artifact in the patient’s ECG waveform to allow the algorithm to process
the patient’s ECG monitoring data.
During periods of ECG artifact the Surveyor S12and S19 patient monitors:
• Invalidates the heart rate numeric.
• Displays an “---“ in the numeric value area in the HR/PR numeric parameter tile.
• Displays an Artifact low level technical message in system’s message area.
• Produces the low level alarm audio tones.
• Displays the cyan low level alarm color in the alarm light.
The algorithm resumes processing of the patient’s ECG monitoring data once the ECG artifact is cleared.
Aberrant Beats
The Mortara arrhythmia algorithm is ventricular based and does not analyze P waves. Because of this, situations
may occur where the monitor is challenged in differentiating aberrant supraventricular beats and true ventricular
beats. In this situation, the algorithm may classify the aberrancy as ventricular. Patient experiencing aberrant
conduction rhythms should be closely observed by a trained clinician.
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ECG ARRHYTHMIA MONITORING
Atrial Rhythms
The Mortara arrhythmia algorithm is a ventricular based algorithm and does not analyze P waves. Identification of
discrete atrial rhythms is not performed. Variance in the R to R interval such as occurs in Atrial Fibrillation is
classified as an Irregular arrhythmia call.
Arrhythmia/ST Algorithm Learning
The Arrhythmia/ST algorithm analyzes the patient’s ECG waveform, “learns” the patient’s ECG baseline, and
establishes a normal beat template for that patient. This learning phase is how the Arrhythmia/ST algorithm collects
ECG information to differentiate between the patient’s normal ECG baseline and a change in the patient’s ECG or
QRS morphology.
A Learn updates the Arrhythmia/ST algorithm with the patient’s most current ECG information. During a learning
phase any previously stored arrhythmia templates are cleared from the algorithm.
WARNING: Arrhythmia/ST learning should be initiated when the patient’s dominant ECG rhythm
is free of noise artifact, and is non-ventricular based. Beats may not be properly detected or may be
classified erroneously if the learning phase occurs during a noisy ECG signal. If Arrhythmia/ST learning
occurs when the patient’s dominant ECG is ventricular, the ectopic ventricular beats may be classified as
the normal QRS template. This may result in a missed detection of subsequent ventricular events such as
PVC/min, Ventricular Run, Ventricular Rhythm, or even Ventricular Tachycardia. For optimal arrhythmia
performance, ensure the patient’s ECG waveform is noise-free and non-ventricular based during a Learn
period.
Automatic Learn
The patient monitor automatically initiates an Arrhythmia/ST Learn in the following situations:
• Initial power up.
• Resumption of monitoring post-Standby.
• ST Enabled.
• After a change in the patient mode.
Manual Relearn
A manual Arrhythmia/ST Learn should be initiated in the following situations:
• The patient’s ECG baseline has changed.
• The patient’s QRS morphology has changed.
• The patient’s ECG rhythm has changed.
• After ECG electrodes have been repositioned.
• The clinician observes erroneous arrhythmia alarm notifications.
• The patient’s ST baseline has changed.
• As per hospital standard of care.
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ECG ARRHYTHMIA MONITORING
Figure 42 ARR/ST Relearn: Setup Arrhythmia Dialogue
To perform an Arrhythmia/ST Relearn using the
Settings quick-action key:
• Select the Setup quick-action key on the
main screen.
• Select the Setup Arrhythmia button in the
Setup menu.
• Select the ARR/ST Relearn button.
• The “Learning” message is displayed in
the heart rate numeric parameter tile during
the learning period.
To perform an Arrhythmia/ST Relearn via the ST numeric parameter tile:
• Select the ST numeric parameter tile to display the Setup ST dialogue.
• Select the ARR/ST Relearn button.
• The “Learning” message displays in the heart rate numeric parameter tile during the learning period.
Arrhythmia Analysis Methodology
There are three main components to the arrhythmia analysis algorithm: Beat detection, heart rate calculation, and
beat typing.
First Step: Beat Detection
NOTE: The QRS amplitude must be greater than 0.3 mV for the algorithm to detect. Ensure the QRS
complexes are > 0.3 mV in amplitude to ensure accurate QRS detection.
The first step in the arrhythmia analysis is for the algorithm to detect the presence of QRS complexes.
• If no QRS complexes are present, a Ventricular Fibrillation (“VFib”) alarm is called.
• If QRS complexes are present, the algorithm then proceeds to the next step.
Second Step: Heart Rate Calculation
The arrhythmia algorithm next calculates the heart rate from the ECG data.
• If the heart rate from the last four R to R intervals is greater than 48 beats per minute, the average heart rate
is determined by averaging the last 16 R to R intervals.
• If the heart rate from the last four R to R intervals is less than or equal to 48 beats per minute, then this rate
is used.
• Paced beats and PVCs are included in the heart rate calculation.
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ECG ARRHYTHMIA MONITORING
Third Step: Beat Typing and Template Memory
The arrhythmia algorithm next begins matching beats according to their morphology. Templates are formed and
retained for beat typing and matching of subsequent QRS complexes.
•
•
•
•
The algorithm classifies each QRS complex into its template memory.
The templates are internal and not viewable to the clinician.
If the subsequent QRS complexes are not identical to the learned averaged QRS complex, then the
arrhythmia algorithm follows a decision tree to determine the differences in the complex.
o Normal Template: This is the most frequently-occurring, dominant beat. This excludes paced
beats.
o Ventricular Template: This is for detected ventricular beats such as premature ventricular beats.
o Paced Template: This template is for detected pacemaker-initiated beats.
o Unknown Template: This template is for non-QRS beat labels and for beats that cannot be
determined.
The arrhythmia algorithm classifies the abnormal beat and produces alarm notifications based on system
configuration.
ECG Leads Used for Analysis
3-Wire ECG Lead Set
When using a 3-wire ECG lead set, the ECG processing and arrhythmia analysis is performed on the ECG
vector displaying in top waveform position of the patient monitor’s main screen. This vector is used to
determine Heart Rate, beat detection, and Ventricular Fibrillation detection. The algorithm initiates a
Relearn event if the ECG vector displayed in the top waveform position is changed thereby updating the
algorithm inputs.
5-Wire ECG Lead Set
When using a 5-wire ECG set, the leads used for ECG processing and arrhythmia analysis are
configurable.
•
•
•
When configured to Auto, the ECG leads used for HR and ARR processing start with II and V for
detection and III for confirmation while allowing the algorithm to switch to other available leads
based on signal quality.
When configured to Single Lead, the ECG lead used for HR and ARR processing is the one
specified by the user from the set I, II, III, or V.
When configured to Multiple Leads, the ECG leads used for HR and ARR processing are
selected internally from the set II and V for detection, and III for confirmation.
When using a 5-wire ECG lead set, to select the HR/ARR Lead Select for analysis
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the HR/ARR Lead Select button.
a. Select the arrow to display the drop down list box with choices (Multiple Lead, Single Lead,
Auto).
b. Select the appropriate choice.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes
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ECG ARRHYTHMIA MONITORING
12-Lead ECG:
When using the AM12, the leads used for ECG processing and arrhythmia analysis are configurable.
•
•
•
When configured to Auto, the ECG leads used for HR and ARR processing start with II and V5
for detection and V1 for confirmation while allowing the algorithm to switch to other available
leads based on signal quality.
When configured to Single Lead, the ECG lead used for HR and ARR processing is the one
specified by the user from the set I, II, III, or V (V1).
When configured to Multiple Leads, the ECG leads used for HR and ARR processing are
selected internally from the set II and V5 for detection, and V1 for confirmation.
When using the AM12, to select the HR/ARR Lead Select for analysis:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the HR/ARR Lead Select button.
a. Select the arrow to display the drop down list box with choices (Multiple Lead, Single Lead,
Auto).
b. Select the appropriate choice.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Arrhythmia Definitions
Lethal Arrhythmias
A lethal arrhythmia is an arrhythmia that if left untreated may lead to patient death. The Surveyor patient monitor
classifies Asystole, Ventricular Fibrillation (VFib), and Ventricular Tachycardia (VTach) as the three lethal
arrhythmias. These lethal arrhythmias are red high level alarms and cannot be changed.
Asystole
Asystole is defined as a state of no cardiac electrical or mechanical activity. During Asystole, there is no
myocardial contraction, no heart rate, and no cardiac output. The ECG waveform has no recognizable P,
QRS, or T waves and is often referred to as cardiac standstill. Asystole is a lethal arrhythmia because there
is no blood pumped out of the heart. Asystole requires rapid recognition and clinical intervention.
The algorithm uses a four-second Asystole delay to prevent erroneous false Asystole calls. Asystole is
always a red high level alarm and cannot be changed. Asystole is always a latched alarm.
Ventricular Fibrillation (VFib)
Ventricular Fibrillation or “VFib” is when many ventricular foci are firing in rapid succession. The
electrical activity in the ventricles is chaotic and the myocardium is twitching rather than contracting.
There is no effective ventricular contraction, no heart rate, and no cardiac output. The ECG waveform is
distinctively chaotic with no recognizable P, QRS, or T waves. VFib is a lethal arrhythmia because there is
no blood pumped out of the heart. VFib requires rapid recognition and clinical intervention. VFib is
called when there are no recognizable P, QRS, or T waves in a 5 second window.
VFib is always a red high level alarm and cannot be changed. VFib is always a latched alarm.
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ECG ARRHYTHMIA MONITORING
Ventricular Tachycardia (VTach)
Ventricular Tachycardia or “VTach” occurs when one or more ventricular foci fires in rapid succession.
Because of the rapid ventricular fire, the ventricles may not have adequate time to fill. Therefore the
cardiac output may be compromised. During early VTach, there may be small amounts of blood being
pumped out of the heart but within seconds, the ventricular rate becomes so fast that there is limited
ventricular chamber filling time so no blood gets pumped out of the heart. This arrhythmia is considered a
lethal arrhythmia because the blood pumped out of the heart during VTach may be significantly
compromised.
To detect VTach, the VTach rate threshold AND the PVC Run length must be exceeded. Both conditions
must occur for a VTach alarm to be called.
VTach Rate Threshold: The VTach rate is calculated on a four beat average of the consecutive
ventricular beats. The VTach rate threshold can be configured from 100-200 beats per minute.
For a VTach condition to be considered, the rate of the ventricular rate must be greater than the
configured VTach rate.
The VTach rate threshold is configured in the Setup Arrhythmia dialogue.
VTach Count: The VTach count or PVC run length is the number of consecutive ventricular
beats in the waveform. They must be consecutive. A normal beat or an unknown beat will reset
the PVC Run length. The VTach length can be configured from 3-20 consecutive ventricular
beats. For a VTach condition to be considered, the length of the ventricular waveform must be
greater than the configured VTach length.
The VTach count threshold is configured in the Setup Arrhythmia dialogue.
VTach is always a red high level alarm and cannot be changed. VTach is always a latched alarm.
Non-Lethal Arrhythmia Classifications
All other arrhythmias are classified as non-lethal arrhythmias. Non-Lethal arrhythmias are never latched alarms.
Ventricular Run (VRun)
A Ventricular Run or “VRun” is detected when the number of consecutive ventricular beats is less than or
equal to the configured VTach count.
Ventricular Rhythm (VRhythm)
Ventricular Rhythm or “VRhythm” is detected when the rate of the ventricular beats is less than the
configured VTach rate.
Couplet
Couplet is detected when the last 4 beats have the following sequence: N, V, V, N.
PVC/min
The PVC/min condition is detected when the number of PVCs over the past rolling minute is ≥ the
configured PVC per minute value. The PVC/min value may be configured to between 1-30 PVCs per
minute.
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ECG ARRHYTHMIA MONITORING
Bigeminy
Ventricular Bigeminy or “Bigeminy” is detected when the last 9 beats have the following sequence:
N, V, N, V, N, V.
Pause
A Pause condition is detected when an RR interval is more than 140% of the current 16-beat averaged
heart rate, the previous beat is not a PVC, and the rhythm is not in the Irregular state. Compensatory
pauses after a PVC are excluded and the call is not made during the "Irregular” rhythm.
Irregular Rhythm
An Irregular Rhythm is detected when the variance in the RR interval over the running averaging exceeds
the limit established by the algorithm. The irregularity is computed in the following way:
Irregularity =
StandardDev
*100 [10 ms units
RRMean
]
Tachycardia
Tachycardia is detected when the averaged heart rate is 30 beats above the configured High Heart Rate
alarm limit. Adjusting the High Heart Rate alarm limit automatically adjusts the tachycardia alarm limit.
Bradycardia
Bradycardia is detected when the averaged heart rate is 10 beats below the configured Low Heart Rate
alarm limit. Adjusting the Low Heart Rate alarm limit automatically adjusts the bradycardia alarm limit.
Non Capture
This non-lethal arrhythmia is applicable to patients possessing a pacemaker device. A Non Capture
condition is detected when there are no QRS complexes detected within 300ms after a pacemaker induced
impulse. The used time interval is relatively large because atrial stimulation with normal ventricular
conduction is included in the factoring.
Arrhythmia Setup
Figure 43 Setup Arrhythmia Dialogue
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ECG ARRHYTHMIA MONITORING
To adjust Arrhythmia alarm settings:
1. Select the Setup quick-action key on the main screen.
2. Select the Arrhythmia button in the Setup menu.
3. Adjust the Arrhythmia alarm settings as desired.
o To adjust the Alarm Level:
ƒ Locate the Alarm Level button.
ƒ Select the arrow to display the drop down list box with choices (OFF, LOW, MED).
ƒ Select the appropriate choice.
o To adjust the Print on Alarm:
ƒ Locate the Print On Alarm button.
ƒ Select Yes to enable the Print On Alarm.
ƒ Select No to disable the Print On Alarm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
VFib, Asystole and VTach may not be turned off, are only available as high level alarms, and are labeled as
LETHAL.
To disable all the non-lethal arrhythmias with one action:
1. Select the Setup quick-action key on the main screen.
2. Select the Arrhythmia button in the Setup menu.
3. Select the Arrhythmia OFF button.
4. This action disables all the non-lethal arrhythmia alarms. Selecting OFF does NOT affect the alarm
notifications for the LETHAL arrhythmias.
5. To re-enable a non-lethal arrhythmia, select the individual non-lethal arrhythmia and configure.
Arrhythmia Settings
Alarm Level
Choices
Print on Alarm Choices
Asystole
Lethal*+
No* , Yes
VFib
Lethal*+
No* , Yes
Lethal*+
No* , Yes
VRun
Off*, Low, Med
No* , Yes
VRhythm
Off*, Low, Med
No* , Yes
Couplet
Off*, Low, Med
No* , Yes
Off*, Low, Med
No* , Yes
Off*, Low, Med
No* , Yes
Off*, High
No* , Yes
Off*, High
No* , Yes
Pause
Off*, Low, Med
No* , Yes
Irregular
Off*, Low, Med
No* , Yes
Non Capture
Off*, Low, Med
No* , Yes
Arrhythmia
VTach Rate
VTach Count
PVC/min
Limit Choices
100-200 (*125)
3-20 (*6)
1-30 (*30)
Bigeminy
Tachycardia
Bradycardia
ADULT: 80-280 (*150)
PEDS: 80-280 (*180)
ADULT: 10-90 (*40)
* Factory Default Settings
+ Lethal alarms are the same as High priority alarms but highlighted as such due to their severity
92
16. ECG ST MONITORING
Overview
ST analysis is done through the ECG tracing. The ST segment is the area of the ECG from the end of the QRS
complex to the beginning of the T wave. The computer utilizes an algorithm to identify specific points on the ECG
and to detect very minor changes in the ST segment. The clinician can adjust the PR or ISO point, the J point, and
the ST point to determine monitoring conditions.
The computer is assessing the ST segment for horizontal changes based on a learned template. The algorithm will
“learn” the ST segment, establish that template as the “norm” for that patient, and use that template for pattern
recognition on all ST segments thereafter. The ST segment is normally a horizontal isoelectric line. The ST
segment may go above or below the isoelectric baseline depending upon the patient’s condition. An elevated ST
segment or an ST segment that goes above the isoelectric line may indicate that the patient’s heart is in the process
of being injured as in the case of a heart attack. A depressed ST segment or an ST segment that goes below the
isoelectric line may indicate that the patient’s heart is in an ischemic state.
The Mortara ST algorithm analyzes the ST on ECG vectors available as configured. For each lead available and
configured, the ST algorithm computes the current ST offset, and the delta ST offset (how much the current has
changed from a reference value). During a learning period, the algorithm reviews the running 32 beats of ECG
complexes and establishes the averaged ST for each available, configured lead.
The ISO point is defined as the area between the end of the P wave and the beginning of the QRS complex. This
ISO point provides a baseline for determining the isoelectric line. The ST segment is defined as a fixed distance
after the QRS complex (the “J point”) and the ST point. The algorithm compares the ST segment to its learned
isoelectric line and reports the ST location value as equal to (the same as) the isoelectric line, elevated, or depressed.
ST measurements are factory defaulted to perform 60 ms after the detected J-point. The clinician can manually
adjust the ST location via the Setup ST menu.
Enable/Disable ST Analysis
Select the HR/PR tile to open the Setup HR/PR dialogue. This dialogue is used to enable/disable the ST analysis.
To enable/disable ST analysis:
1. Select the HR/PR numeric parameter tile to display the Setup HR/PR dialogue.
2. Locate the ST analysis button.
a. Select Yes to enable ST analysis.
b. Select No to disable ST analysis.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ECG ST MONITORING
After the ST analysis has been enabled, it is important to set a current reference by pressing “Set Reference” and
selecting “Display Averages” to view current ST averages and confirming that averages are established correctly.
Repeat this process whenever ECG-related alarms occur or as defined by clinical and hospital guidelines.
ST Tile
Figure 44 Example ST Tile: Delta ST Values
The ST numeric parameter tile may display:
• The current or delta ST numeric values (configurable).
• The current ST numeric values are displayed in green.
• The delta ST numeric values are displayed in red.
• The current or delta ST label.
• The “REF” label and time stamp indicating the time of
the last ST learn event.
• The ECG Lead labels.
• The “mm” ST units of measure label.
ST Alarm Behaviors
The ST alarms are based on the relative variation between the current ST value and the value of the last reference
ST values. Therefore the ST alarms are always based on the Delta ST value. The Surveyor patient monitor
generates alarms when the ST variation exceeds the configured ST alarm settings. When the ST alarms are
configured properly, the clinician can be notified when the patient’s ST value worsens (moving further away from
isoelectric) and when the patient’s ST values improve (moving towards isoelectric).
Physiological ST Alarms
The Surveyor patient monitor generates alarm conditions based on the ST-increase and ST-decrease values,
according to the following rules:
•
ST-Increase: Delta ST is above configured threshold in a single lead or above 70% of the threshold in 2
leads simultaneously. The alarm sounds if the condition exists continuously for 60 seconds (independent
of the lead(s)). This is a worsening condition.
•
ST-Decrease: Delta ST is above configured threshold in a single lead or above 70% of the threshold in 2
leads simultaneously. The alarm sounds if the condition exists continuously for 60 s (independent of the
lead(s)). This is an improving condition.
NOTE: The Surveyor S12/S19 will not automatically establish a new reference on ST alarm conditions.
Establish a new reference when considered necessary.
Technical ST Alarms
If the patient has a dominant rhythm change that is different than the previously learned ST references, the Surveyor
S12 and S19 patient monitors produces a low level ST technical message. When this ST technical alarm is
displayed, the clinician should relearn the ST reference for the new dominant rhythm.
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ECG ST MONITORING
ST Tile Alarm Behaviors
The ST parameter tile flashes the ECG lead label of the ECG vector that is causing the ST alarm condition. The
alarm light, ST numeric parameter in alarm and ST alarm message displays in the color of the configured ST alarm
level.
Figure 45 Example ST Decrease Alarm
ST Alarm Delay
The Surveyor patient monitor supports an ST alarm delay of 60 seconds. This means the ST changes must be
sustained for at least 60 seconds prior to any configured alarm notifications. This non-configurable ST alarm delay
is implemented to reduce possible false erroneous ST alarms.
NOTE: ST alarm events are not generated during a Learn phase, an ST Learn phase, Asystole, Ventricular
Fibrillation, or Ventricular Tachycardia episodes. ST alarm events are not generated during periods of
Low or High Frequency Suspend states.
Setup ST Dialogue
Figure 46 Setup ST Dialogue
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ECG ST MONITORING
Arrhythmia and ST Algorithm Learning
The Arrhythmia/ST algorithm analyzes the patient’s ECG waveform, “learns” the patient’s ECG baseline, and
establishes a normal beat template for that patient. This learning phase is how the Arrhythmia/ST algorithm collects
ECG information to differentiate between the patient’s normal ECG baseline and a change in the patient’s ECG or
QRS morphology.
A Learn updates the Arrhythmia/ST algorithm with the patient’s most current ECG information. During a learning
phase any previously stored arrhythmia templates are cleared from the algorithm.
WARNING: Arrhythmia/ST learning should be initiated when the patient’s dominant ECG rhythm
is free of noise artifact, and is non-ventricular based. Beats may not be properly detected or may be
classified erroneously if the learning phase occurs during a noisy ECG signal. If Arrhythmia/ST learning
occurs when the patient’s dominant ECG is ventricular, the ectopic ventricular beats may be classified as
the normal QRS template. This may result in a missed detection of subsequent ventricular events such as
PVC/min, Ventricular Run, Ventricular Rhythm, or even Ventricular Tachycardia. For optimal arrhythmia
performance, ensure the patient’s ECG waveform is noise-free and non-ventricular based during a Learn
period.
Before starting ST-monitoring or issuing a “Relearn”, make sure all leads are connected properly and
ECG quality is adequate. An ST-reference is established during the ST learn period, and leads that are of
poor quality or are disconnected during part of the learn period can result in incorrect reference values
and false ST-alarms. Always check proper ST average complexes.
Automatic Learn
The patient monitor automatically initiates an Arrhythmia/ST Learn in the following situations:
ƒ Initial power up.
ƒ Resumption of monitoring post-Standby.
ƒ After a change in the patient mode.
Manual Relearn
A manual Arrhythmia/ST Learn should be initiated in the following situations:
ƒ The patient’s ECG baseline has changed.
ƒ The patient’s QRS morphology has changed.
ƒ After ECG electrodes have been repositioned.
ƒ The clinician observes erroneous arrhythmia alarm notifications.
ƒ As per hospital standard of care.
There are two ways to perform an Arrhythmia/ST relearn.
1. To perform an Arrhythmia/ST Relearn via the ST numeric parameter tile:
a. Select the ST numeric parameter tile to display the Setup ST dialogue.
b. Select the ARR/ST Relearn button.
c. The “Learning” message displays in the heart rate numeric parameter tile during the learning period.
2. To perform an Arrhythmia/ST Relearn using the Settings quick-action key:
a. Select the Setup quick-action key on the main screen.
b. Select the Setup Arrhythmia button in the Setup menu.
c. Select the ARR/ST Relearn button.
d. The “Learning” message displays in the heart rate numeric parameter tile during the learning period.
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ECG ST MONITORING
ST Alarm Levels
The Surveyor S12 and S19 patient monitors provide the ability to configure a different alarm level for an increase in
the ST segment and a different alarm level for a decrease in the ST segment. This is beneficial based on the
patient’s specific cardiac condition.
To adjust the ST Increase/ST Decrease alarm levels:
1. Select the ST numeric parameter tile to display the Setup ST dialogue.
a. To adjust the ST Increase/ST Decrease Alarm Levelƒ Locate the ST Increase/ST Decrease Alarm Level buttons.
ƒ Select the arrow to display the drop down list box choices (OFF, LOW, MED).
ƒ Select the appropriate choice.
2. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ST Print on Alarm
The ST Increase and the ST Decrease alarm conditions can be independently configured to automatically print a
real-time waveform report when the alarm occurs.
To enable/disable the ST Increase/Decrease alarm limit conditions to automatically print:
1. Select the ST numeric parameter tile to display the Setup ST dialogue.
2. To adjust the ST Increase Alarm to print on alarm:
a. Locate the ST Increase Print On Alarm button.
ƒ Select Yes to enable the Print On Alarm.
ƒ Select No to disable the Print On Alarm.
3. To adjust the ST Decrease Alarm to print on alarm:
a. Locate the ST Decrease Print On Alarm button.
ƒ Select Yes to enable the Print On Alarm.
ƒ Select No to disable the Print On Alarm
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ST Alarm Limits
To adjust the ST alarm limits:
1. Select the ST numeric parameter tile to display the Setup ST dialogue.
2. Locate the ST Change Alarm Limit button.
3. Select the up/down arrows to move the alarm limit box until the desired value is reached.
a. The value selected is the Delta ST alarm limit absolute value.
b. Choices include 1-9mm in steps of 0.5mm.
c. The factory default is 2mm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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ECG ST MONITORING
Display Averages
The ST Averages dialogue replaces the ST menu and displays the overlapped current and referenced ST templates
for all ECG leads available. The current ST templates are displayed in green and the referenced ST templates are
displayed in yellow. Next to each ECG lead label is the current ST-value and the reference-ST value. A double and
single star indicates the two leads that currently have the most significant ST change. The ST Averages dialogues is
updated with fresh information every 30 seconds. The ST Averages dialogue remains displayed on the screen until
manually closed by the clinician.
Figure 47 ST Average Dialogue
To display the ST Averages dialogue:
1. Select the ST numeric parameter tile to
display the Setup ST dialogue.
2. Select the Averages button.
3. The ST averages dialogue displays showing
the Current ST templates and numeric
values in green and the Reference ST
templates and numeric values in yellow.
4. Select the Print button in the ST Averages
dialogue to print the templates to the
bedside recorder (optional). The ST
templates do not print to the Surveyor
Central Station’s printer.
5. When printed at the bedside recorder, both
the Current and Reference ST templates and
numeric values are printed.
6. Select the Close button in the ST Averages
dialogue to close the window and return to
Setup ST dialogue.
ST Display
The ST numeric parameter tile on the main screen displays valuable ST information.
ST Reference Time
The ST reference time is the time when the ST algorithm last learned and established the ST baseline. This
learned baseline is used as the reference baseline. The ST tile displays the ST reference time and “REF”
label. If the ST reference is more than 24 hours old, it will be indicated as such. For ECG leads that are not
available (such as during a Lead Off situation), the ST value will be displayed as invalid “---.”
ST Numeric Values
ST numeric values are displayed as either Delta or Current.
Delta ST – Delta ST values are defined as the ST segment location changes between the
learned/referenced ST templates and the current ST segments. The Delta ST signifies how much the
ST has changed when compared to the reference ST templates. Delta ST values are yellow and
labeled “ΔST.”
Current ST – Current ST values are defined as the ST segment locations currently observed in the
ECG leads. Current ST values are green and labeled "ST."
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ECG ST MONITORING
To select the ST numeric values displayed in the ST numeric parameter tile on the main screen:
1. Select the ST numeric parameter tile to display the Setup ST dialogue.
2. Locate the ST Display button.
3. Select the arrow to display the drop down list box.
a. Select Delta to display the delta ST numeric values.
b. Select Current to display the current ST numeric values.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ST Delay After J-Point
As previously discussed in this manual, the ST algorithm uses the ISO point as the baseline for determining the
isoelectric line. The ST segment is defined as beginning at a fixed distance after the QRS complex (the “J point”)
and the ST point. The algorithm compares the subsequent ST segment location relative to the learned ISO point.
The algorithm then reports the ST location value as equal to (the same as) the isoelectric line, elevated, or
depressed.
By factory default configuration, the ST algorithm automatically uses a 60 ms delay after the detected J point to
define the start of the ST segment. This J point setting can be manually adjusted by the clinician.
To select the ST numeric value displayed in the ST numeric parameter tile on the main screen:
1. Select the ST numeric parameter tile to display the Setup ST dialogue.
2. Locate the ST Delay After J Point button.
3. Select the arrow to rotate through the choices of 1-200 ms.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Enable ST Leads
The ECG leads on which the ST analysis is performed can be independently configured by the clinician. The
clinician can choose to exclude particular ECG leads from ST monitoring based on the patient’s monitoring needs
and condition. ECG leads that are excluded for ST monitoring continue to have their values appear in the ST
numeric parameter tile but are displayed in a different color.
NOTE: ST alarm surveillance will not be performed on ECG leads that have been excluded from ST
monitoring.
To enable/disable ST leads for monitoring and alarm surveillance:
1. Select the ST numeric parameter tile to display the Setup ST dialogue.
2. Locate the ECG lead labels.
a. Select Yes next to the ECG lead to include for ST alarm surveillance.
b. Select No next to the ECG lead label to not include in ST alarm surveillance.
3. To enable ALL ECG leads for ST alarm surveillance.
a. Locate the Enable All Leads button.
b. Select the Enable All Leads button to include all available ECG leads for ST alarm surveillance.
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ECG ST MONITORING
100
17. NON-INVASIVE BLOOD PRESSURE MONITORING
Overview
The Non-invasive Blood Pressure (NIBP) monitoring capabilities of the Surveyor patient monitor include
calculating the patient's systolic, mean, and diastolic non-invasive blood pressures. The clinician can use the
Surveyor patient monitor to obtain the patient’s blood pressure by a manual method, a stat acquisition, and through
an automatic interval acquisition setting.
The Surveyor S12 and S19 patient monitors function according to specifications in the presence of common
arrhythmias such as atrial or ventricular premature beats or atrial fibrillation. The Surveyor S12 and S19 patient
monitors can determine blood pressure over a heart rate range of 30 bpm to 240 bpm.
Blood pressure measurements can be affected by several factors including body position (ex. standing, sitting,
supine, etc.), exercise, mood, diet, medications, and other physiological conditions.
WARNING – In some cases, frequent and prolonged measurements can result in petechia,
ischemia, purpura or neuropathy. You should check the cuff site regularly when taking frequent
measurements over an extended time period. You should also check the patient for any signs of restricted
circulation in the extremities of the limb where the NIBP cuff is wrapped. Switch the blood pressure cuff
site as per hospital protocol or at least every few hours.
WARNING: Be sure that the NIBP hose is not compressed or kinked during a measurement.
Kinks in the hose could lead to excessive pressure in the blood pressure cuff, which could cause limb
damage to the patient.
CAUTION: Do not apply the NIBP cuff on the same limb as the SpO2 sensor. During blood
pressure measurements, the perfusion is temporarily reduced, which can result in inaccurate pulse
oximetry readings.
CAUTION: Do not allow the NIBP cuff or hose to come into contact with fluids. If this occurs,
consult the Cleaning section of this manual for drying instructions. Check the hose and cuff frequently for
signs of damage or debris. An obstruction in the hose may interfere with inflation and deflation, resulting
in inaccurate NIBP readings.
CAUTION: To obtain accurate blood pressure readings, keep the limb and the cuff motionless.
CAUTION: The NIBP cuff should be at the same level as the patient's heart.
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NON-INVASIVE BLOOD PRESSURE MONITORING
CAUTION: NIBP measurements may not be accurate if the patient is convulsive, experiencing
tremors, or is defibrillated during the measurement.
CAUTION: NIBP measurements may be affected by extremes of temperature, humidity and
altitude. Always ensure that the Surveyor patient monitor is operated and stored within its specified
environmental conditions.
Blood Pressure Technology
The Surveyor patient monitor uses an oscillometric method to measure the patient’s blood pressure. In this method,
a blood pressure cuff is quickly inflated above the patient’s systolic pressure and then slowly releases the cuff
pressure in a series of steps. This is referred to as a “stair step” method of obtaining the patient’s blood pressure.
At each cuff pressure step, oscillations in the cuff pressure are measured. These oscillations are made by the
underlying blood vessels that are pushing on the cuff during the cardiac cycle. From these oscillations, the patient’s
blood pressure can be derived.
This blood pressure technology works best when the patient is reminded to relax and lie still during the NIBP
acquisition. Encourage the patient to remain quiet during the NIBP acquisition.
Once the Surveyor patient monitor obtains an initial NIBP measurement, the monitor uses the previous systolic
pressure value to select the inflation cuff pressure.
Pediatric Patient NIBP Considerations
The initial NIBP inflation pressure can be adjusted in the Setup NIBP dialogue. The factory default value for the
pediatric patient mode is 120 mmHg. Use clinical discretion to manually adjust the NIBP initial inflation setting for
pediatric patients. Correctly setting the NIBP initial inflation pressure may lead to reduced measurement acquisition
time and increased patient comfort. The initial inflation pressure can be adjusted in the Setup NIBP dialogue. Refer
to the NIBP Initial Inflation Pressure section in this manual for further details.
Hypertensive Patient Considerations
With certain patients, the first attempt to obtain an NIBP may be unsuccessful. The Surveyor S12 and S19 patient
monitors automatically attempt to obtain a second NIBP if the first attempt is unsuccessful. The patient monitor uses
a higher inflation pressure on this second measurement attempt. If after the second attempt the monitor still cannot
obtain a successful measurement, the NIBP acquisition becomes idle and an NIBP technical message is displayed in
the system message area on the monitor’s main screen.
For patients known to be hypertensive, the clinician may want to adjust the NIBP inflation pressure to avoid this
situation. Correctly setting the NIBP initial inflation pressure may lead to reduced measurement acquisition time
and increased patient comfort. The initial inflation pressure can be adjusted in the Setup NIBP dialogue. Refer to
the NIBP Initial Inflation Pressure section in this manual for further details.
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NON-INVASIVE BLOOD PRESSURE MONITORING
NIBP Monitoring Procedure
NOTE: To obtain quality NIBP measurements, it is crucial to use the proper NIBP cuff appropriate to the
patient’s size. Using a NIBP cuff that is too large for the patient may result in erroneous NIBP numeric
values. Using an NIBP cuff that is too small for the patient may result in erroneous NIBP numeric values.
To begin NIBP monitoring:
1. Select the appropriate NIBP cuff for the size of the patient. Measure the circumference of the patient’s
limb. Compare this circumference to the size marked on the NIBP cuff.
2. Attach the NIBP cuff to the patient. Refer to the Accessories section of this manual for a list of approved
NIBP cuffs.
3. The patient should be comfortably seated or lying down, and the patient's arm or leg should be relaxed,
extended, uncrossed and resting on a stationary support.
4. Wrap the deflated cuff snugly around the patient's arm or leg according to current AHA guidelines, taking
care not to restrict blood circulation.
5. If using the arm, wrap the cuff at 2 to 5 cm above the elbow crease at the level of the right atrium of the
heart, and place the artery mark (↓) over the patient's brachial artery, pointing to the patient's hand.
6. If using the leg, wrap the cuff around the middle of the thigh, and place the artery mark (↓) over the
patient's femoral artery, pointing to the patient's foot.
7. Instruct the patient to remain still, relax as much as possible and not speak during the measurement. For
best results, it is recommended that the patient be allowed to relax for 5 minutes before initiating NIBP
measurements.
8. Connect the NIBP cuff to the NIBP hose, and connect the hose to the NIBP connection port on the side of
the Surveyor patient monitor.
9. Select the NIBP Start/Stop quick-action key on the Surveyor patient monitor front panel to start the NIBP
acquisition attempt.
NOTE: The Surveyor Central Station user interface allows the clinician to be at the central station and
start a blood pressure acquisition on the patient monitor. Use clinical discretion in the use of this feature,
always ensuring proper procedure for blood pressure acquisition is followed and that proper patient
surveillance exists. Refer to the Surveyor Central Station operator manual for further details.
NIBP Tile
The NIBP tile is always located in the lower left corner of Numeric Parameter B section on the Surveyor S12 and
S19 patient monitor’s main screen. When the NIBP measurement completes, the Surveyor patient monitor displays
the blood pressure numeric values in the NIBP Numeric Parameter B location. The NIBP tile is always located in
the lower left portion of the main screen. The numeric values in the NIBP tile automatically erase when the NIBP
measurement is older than 60 minutes.
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NON-INVASIVE BLOOD PRESSURE MONITORING
Figure 48 Example NIBP Tile
The NIBP tile may display:
• The NIBP parameter label
• The timestamp of the most recent NIBP values
• The systolic, diastolic, and mean arterial pressure numerics
(format configurable)
• The “mmHg” NIBP units of measure label
• The systolic alarm limits if NIBP alarm limits are enabled
• The Alarm Off icon if any of the NIBP sub-parameter alarm
limits are OFF
• The NIBP numeric values and alarm limits are shown in
orange color
NIBP Alarm Behaviors
Figure 49 Example NIBP Tile in Alarm
The NIBP parameter tile flashes during an NIBP alarm condition. The
alarm light, NIBP numeric parameter tile, and NIBP alarm message
displays in the color of the configured NIBP alarm level. The alarm
audio notification is produced according to the alarm level configured.
NIBP Start/Stop Quick-Action Key
The NIBP Start/Stop quick-action key on the main screen is used to start and stop blood pressure acquisitions. This
quick-action key is a toggle button and changes function based on the NIBP status.
• Selecting this quick-action key during an NIBP idle or deflated status initiates a non-invasive blood
pressure (NIBP) measurement.
• Selecting this quick-action key during an NIBP acquire mode (currently inflating status) stops the NIBP
measurement and deflates the NIBP cuff.
NOTE: The NIBP Start/Stop quick-action key does not stop an active NIBP interval. To suspend an active
NIBP interval, the clinician must enter the Setup NIBP dialogue and stop the NIBP interval. Refer to the
NIBP Interval section in this manual for further details.
Setup NIBP Dialogue
Selecting the NIBP parameter tile opens the Setup NIBP dialogue. Use the Setup NIBP dialogue to adjust alarm
settings, NIBP interval, initial NIBP inflation pressure, format, and to display the NIBP trends in the main screen.
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NON-INVASIVE BLOOD PRESSURE MONITORING
Figure 50 Setup NIBP Dialogue
NIBP Alarm Limits
High and low NIBP alarm limits can be configured independently for the Systolic (“NIBPs”), Mean (“NIBPm”),
and Diastolic (“NIBPd”) blood pressure parameters.
To adjust the NIBPx (where x= s, d, or m) alarm limits:
1. Select the NIBP numeric parameter tile to display the Setup NIBP dialogue
2. Locate the NIBPx label
a. Adjust the Lower alarm limit by selecting the up/down arrows to move the lower alarm limit box until
the desired value is reached
b. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes
The NIBPx alarm limits may also be adjusted via the Settings quick-action key. Refer to the Settings Alarm Limits
section in this manual for further details.
Auto Set NIBP Alarm Limits
The Auto Set feature for the NIBP alarm limits can be configured independently for the Systolic (“NIBPs”), Mean
(“NIBPm”), and Diastolic (“NIBPd”) blood pressure parameters. The Auto set feature automatically calculates the
high and low NIBPx alarm limits based on the current value.
Parameter
Lower limit adjustment
Upper limit adjustment
NIBP – Systolic, Mean &
Diastolic
Changed to 80% of the current parameter
value (or the nearest allowable value
given the alarm limit settings rules)
Changed to 120% of the current
parameter value (or the nearest
allowable value given the alarm limit
settings rules)
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NON-INVASIVE BLOOD PRESSURE MONITORING
To Auto set an NIBPx (where x= s, d, or m) alarm:
1. Select the NIBP numeric parameter tile to display the Setup NIBP dialogue
2. Locate the NIBPx label
3. Select the Auto button next to the NIBPx label. Notice the limit values in the Lower Limit window and
the Higher Limit window adjust
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes
NIBP Alarms On
The Alarms On feature for the NIBP alarms can be configured independently for the Systolic (“NIBPs”), Mean
(“NIBPm”), and Diastolic (“NIBPd”) blood pressure parameters.
WARNING: Disabling the NIBPx alarm limits means that NO low or high NIBPx alarm conditions
will produce alarm notifications. Use this feature with extreme caution.
To enable/disable the NIBPx (where x =s, m, or d) alarm limits:
1. Select the NIBP numeric parameter tile to display the Setup NIBP dialogue
2. Locate the NIBPx label
3. Locate the Alarms On button next to the NIBPx label
a. Select Yes to enable NIBPx alarms
b. Select No to disable NIBPx alarms
ƒ The Alarm Off icon displays in the NIBP numeric parameter tile
NOTE: The Lower Limit and Higher Limit windows in the Setup NIBP dialogue may contain limit
values but these alarms ARE disabled if the NIBPx Alarms On button is set to NO.
4.
Select the OK button to enter that change OR select the Cancel button to cancel the changes
NIBP Print on Alarm
To enable/disable the NIBPx (where x =s, m, or d) alarm limit conditions to automatically print:
1. Select the NIBP numeric parameter tile to display the Setup NIBP dialogue.
2. Locate the NIBPx label.
3. Locate the Print On Alarm button next to the NIBPx label.
a. Select Yes to enable the Print On Alarm.
b. Select No to disable the Print On Alarm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Print On Alarm feature for the NIBP alarm limit conditions may also be adjusted via the Settings quick-action
key. Refer to the Print On Alarm section in this manual for further details.
NIBP Interval
The Surveyor patient monitor can be configured to acquire NIBP measurements automatically at a preset interval.
The patient monitor automatically attempts to obtain an NIBP measurement according to the interval configured.
The clinician must manually change the interval to OFF to discontinue a previously active NIBP interval.
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NON-INVASIVE BLOOD PRESSURE MONITORING
To select an automatic NIBP interval:
1. Select the NIBP numeric parameter tile to display the Setup NIBP dialogue.
2. Locate the NIBP Interval label.
3. Select the arrow to display the drop down list box choices (OFF, 2m, 3 m, 5m, 10m, 15m, 30m, and 60
minutes).
4. Select the appropriate choice.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ƒ Selecting OK with an interval chosen prompts the patient monitor to begin that interval.
ƒ Selecting OK with an interval chosen displays that interval in the system message area below the
NIBP tile.
When in an active NIBP interval, the patient monitor attempts to acquire the blood pressure measurements based on
the o’clock as per the system time.
To stop an automatic NIBP interval:
1. Select the NIBP numeric parameter tile to display the Setup NIBP dialogue.
2. Locate the NIBP Interval label.
3. Select the arrow to display the drop down list box.
ƒ Select the OFF NIBP interval choice.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
ƒ Selecting OK with the OFF interval chosen prompts the patient monitor to discontinue the automatic
NIBP mode and places the patient monitor NIBP acquisition into an idle mode.
ƒ Selecting OK with the OFF interval chosen removes the NIBP interval message from the system
message area below the NIBP tile.
NIBP Interval Mode and Standby
If an NIBP interval is active and then the monitor is placed into a Standby mode, the NIBP interval enters a
holding mode during the Standby period. Upon resumption of monitoring post-Standby, select the NIBP
Start/Stop quick-action key on the main screen to restart the NIBP interval mode.
NIBP Interval Mode and Power Down/Up
The NIBP interval setting is remembered between power cycles. Upon resumption of monitoring post
Power Up, select the NIBP Start/Stop quick-action key on the main screen to restart the NIBP interval
mode.
NIBP Interval Mode and Manual/STAT NIBP Measurements
Even when in an active NIBP interval mode, a manual or STAT NIBP measurement can be obtained. To
begin a manual or STAT NIBP measurement, select the NIBP Start/Stop quick-action key on the main
screen. The automatic NIBP interval will resume and continue on the previous o’clock timer.
NIBP Initial Inflation Pressure
The Surveyor S12 and S19 patient monitors are factory defaulted to initially inflate the NIBP up to 160 mmHG
when in the Adult mode. When in Pediatric mode, the initial NIBP inflation pressure is factory defaulted to
120 mmHg. For some patients, this initial inflation may not be high enough to quickly obtain an accurate blood
pressure measurement. For other patients, this initial inflation may be too high.
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NON-INVASIVE BLOOD PRESSURE MONITORING
The initial inflation pressure can be manually adjusted to a higher or lower pressure setting based on the patient’s
physiological status. For patients assumed to be hypertensive, the clinician may want to increase the initial inflation
setting to a higher mmHg setting. For patients assumed to be hypotensive, the clinician may prefer to decrease the
initial inflation setting to a lower mmHg setting. Setting the NIBP initial inflation pressure appropriate to the
patient’s assumed blood pressure may allow for a quicker NIBP acquisition on the first attempt. Once the patient
monitor obtains the initial blood pressure, the monitor automatically adjusts the inflation pressure based on the
previously obtained systolic blood pressure.
NOTE: Always use clinical discretion when adjusting the NIBP initial inflation pressure.
To manually adjust the NIBP initial inflation pressure:
1. Select the NIBP numeric parameter tile to display the Setup NIBP dialogue.
2. Locate the Initial Inflation Pressure label.
3. Select the up/down arrows to reach the appropriate initial inflation pressure value.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
NIBP Format
The Surveyor S12 and S19 patient monitors provide the capability of display NIBP numeric values in two formats.
The format selected determines how the NIBP numeric values are displayed in the NIBP parameter tile.
Systolic/Diastolic Format
o In this format, the systolic and diastolic numeric values are in a larger, more prominent font in the
NIBP parameter tile.
o The systolic number is the top or numerator value and the diastolic number is the bottom or
denominator value.
o The mean numeric value is display in parenthesis.
o The NIBP Trends List and Tabular Trends always display the NIBP in the SYS/DIA format.
o The SYS/DIA format is the factory default NIBP format.
Mean Format
o In this format, the mean numeric value is in a larger, more prominent font in the NIBP parameter tile.
o The systolic number is the top or numerator value with the diastolic number as the bottom or the
denominator value.
o The mean numeric value displays in parenthesis.
o The NIBP Trends List and Tabular Trends always display the NIBP in the SYS/DIA format.
Figure 51 Example of NIBP Mean Format
To select the NIBP Format:
1. Select the NIBP numeric parameter tile to display the Setup
NIBP dialogue.
2. Locate the NIBP Format label.
3. Select the arrow to display the drop down list box (Choices
of SYS/DIA and MEAN).
4. Select the OK button to enter that change OR select the
Cancel button to cancel the changes.
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NON-INVASIVE BLOOD PRESSURE MONITORING
Show NIBP Trends
The Surveyor S12 and S19 patient monitors can display a mini-trend list of the most recent NIBP measurements on
the main screen. This “NIBP Trends” displays on the right side of the NIBP numeric parameter tile. The number of
recent NIBP measurements displayed in the NIBP Trend is based on the number of waveform parameters currently
being displayed.
Figure 52 Example of NIBP Parameter Tile with NIBP Trends List
To enable/disable the display of the NIBP Trends list:
1. Select the NIBP numeric parameter tile to display the Setup
NIBP dialogue.
2. Locate the Show NIBP Trends label.
a. Select Yes to display the NIBP Trends list in the NIBP
parameter tile on the main screen.
b. Select No to not display the NIBP Trends list in the
NIBP parameter tile on the main screen.
3. Select the OK button to enter that change OR select the
Cancel button to cancel the changes. Cuff Overpressure
During a measurement, a variety of safety checks are performed. If the monitor detects a cuff overpressure situation,
the NIBP measurement cancels and the cuff deflates automatically. The safety checks include an overpressure check
(to make sure the cuff pressure is not greater than 270 mmHg), a check to make sure the measurement does not take
longer than 2 minutes, and other checks for technical problems such as a blocked line. An error message is
displayed on the patient monitor should a cuff overpressure condition exist. If a cuff overpressure situation occurs,
the NIBP acquisition becomes idle and an NIBP technical message is displayed in the system message area on the
monitor’s main screen.
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NON-INVASIVE BLOOD PRESSURE MONITORING
110
18. SPO2 MONITORING
Overview
Pulse oximetry monitoring works by shining light of two different wavelengths through the patient's tissues (such as
a fingertip) and measuring the absorption of the light by the hemoglobin in the patient's arterial blood. The way the
blood absorbs the different wavelengths indicates the amount of oxygen in the blood. Since this amount is
constantly changing during each beat of pulse as new blood comes in and old blood returns to the heart, it is also
possible to detect a pulse rate from this signal.
The Surveyor patient monitor can monitor functional oxygen saturation of arterial hemoglobin (SpO2) and pulse
rate (PR). The patient monitor can display these numeric values and the associated plethysmograph (“Pleth”)
waveform. The pleth waveform corresponds to but is NOT proportional to the arterial pressure waveform.
Depending on the configuration of your Surveyor patient monitor, you will have one of the following two supported
technology and sensors:
• Mortara SpO2
• Nellcor OxiMax SpO2
The SpO2 parameter incorporates automatic calibration mechanisms. No other calibration is required.
Mortara SpO2 Technology
When using Mortara SpO2, the SpO2 algorithm uses the qualified pulsatile data averaged over a 60 second period
to report the SpO2 value.
Nellcor OxiMax Technology
The Nellcor OxiMax algorithm automatically extends the amount of data required for measuring SpO2 and pulse
rate depending on the measurement conditions.
•
•
•
•
During normal measurement conditions in the normal response mode, the averaging time is 6 to 7 seconds.
During difficult measurement conditions such as low perfusion, motion, ambient light, electrocautery,
other interference, or a combination of these factors, the OxiMax algorithm automatically extends the
dynamic averaging time required beyond 7 seconds.
If the resulting dynamic averaging time exceeds 20 seconds, the pulse search condition will be set, while
SpO2 and pulse rate values continue to be updated every second.
As the measurement conditions become even more difficult, the amount of data required continues to
expand. If dynamic averaging time reaches 40 seconds, the pulse timeout condition will be set and the
module will report a zero saturation indicating a loss-of-pulse condition.
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SPO2 MONITORING
SpO2 Monitoring Procedure
1.
Select the appropriate sensor and attach to the patient site (e.g., finger, ear, etc.) Reusable and disposable
sensors are available for specific sites on patients with designated sizes and/or weight ranges. To select the
appropriate sensor, consider the patient’s weight, level of activity, adequacy of perfusion, which sensor
sites are available, whether sterility is required, and the anticipated duration of monitoring.
CAUTION: It is important to select a SpO2 sensor that is appropriate for the size and weight of
the patient. For example, a clean pulse oximetry waveform may not be obtainable when an adult sensor is
used on a small child.
2.
3.
Attach the SpO2 patient cable to the sensor and plug the other end of the patient cable into the SpO2
connector located on the side panel of the Surveyor patient monitor.
The pleth waveform and numeric SpO2 value will be available as the third waveform and parameter area.
If the pleth waveform is not shown, it may be necessary to assign SpO2 to this slot in the Setup –
Waveforms menu.
SpO2 Display
Pleth Waveform Parameter Tile
The SpO2 pleth waveform may be shown in one of the available waveform slots. The amplitude of the pleth wave
is self-adjusted according to the height of the waveform area. The Pleth waveform can be located to the left of the
SpO2 numeric parameter tile. The SpO2 numeric parameter tile can be displayed independent of the Pleth
waveform location.
Under normal conditions, the SpO2 waveform corresponds to but is not proportional to the arterial pressure
waveform. Observing the SpO2 waveform can help the clinician find a sensor location with the fewest noise spikes.
SpO2 Numeric Parameter Tile
Figure 53 Example Nellcor SpO2 Waveform and Numeric Tile
The SpO2 numeric parameter tile may display:
• The SpO2 parameter label.
• The current SpO2 numeric value.
• The “%” SpO2 unit of measure.
• The SpO2 alarm limits if the SpO2 alarm limits are enabled.
• The Alarm Off icon if any of the SpO2 alarm limits are disabled.
• The SatSeconds indicator when using the Nellcor SpO2 technology and the SatSeconds indicator is
configured for display.
• The SpO2 numeric values and alarm limits are shown in cyan color.
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SPO2 MONITORING
SpO2 Alarm Behaviors
The Surveyor S12 and S19 patient monitors do not produce SpO2 alarms until a valid SpO2 signal is obtained. This
is intended to reduce nuisance alarms during initial patient hookup. The SpO2 numeric parameter tile flashes during
an SpO2 alarm condition. The alarm light, SpO2 numeric parameter tile, and SpO2 alarm message displays in the
color of the configured SpO2 alarm level. The alarm audio notification is produced according to the alarm level
configured.
Setup SpO2 Dialogue
Selecting the SpO2 numeric parameter tile opens the Setup SpO2 dialogue. Use the Setup SpO2 dialogue to adjust
alarm settings and to enable/disable the HR/PR tone.
SpO2 Alarm Limits
High and low SpO2 alarm limits can be configured independently.
To adjust the SpO2 alarm limits:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the SpO2 label.
a. Adjust the Lower alarm limit by selecting the up/down arrows to move the lower alarm limit box until
the desired value is reached.
b. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The SpO2 alarm limits may also be adjusted via the Settings quick-action key. Refer to the Settings Alarm Limits
section in this manual for further details.
SpO2 Auto Set Alarms
The Auto set feature automatically calculates the high and low SpO2 alarm limits based on the current value.
Parameter
Lower limit adjustment
Upper limit adjustment
SpO2
Changed to 95% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
Set to 100%
To Auto set the SpO2 alarm:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the SpO2 label.
3. Select the Auto button next to the SpO2 label. Notice the limit values in the Lower Limit window and the
Higher Limit window adjust.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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SPO2 MONITORING
SpO2 Alarms On
WARNING: Use this feature with extreme caution. Patients must be closely observed if the SpO2
alarm limits are disabled.
NOTE: Follow hospital standard of care for the use of this feature. This feature is only intended to be
used during end of life situations and only based on the hospital standard of care.
To enable/disable the SpO2 alarm limits:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the Alarms On button.
a. Select Yes to enable SpO2 alarms.
b. Select No to disable SpO2 alarms.
ƒ The Alarm Off icon displays in the SpO2 numeric parameter tile.
NOTE: The Lower Limit and Higher Limit windows in the SpO2 dialogue may contain limit values but
these alarms ARE disabled if the Alarms On button is set to NO.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
SpO2 Print on Alarm
To enable/disable the SpO2 alarm limit conditions to automatically print:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the SpO2 label.
3. Locate the Print On Alarm button next to the SpO2 label.
a. Select Yes to enable the Print On Alarm.
b. Select No to disable the Print On Alarm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Print On Alarm feature for the SpO2 alarm limit conditions may also be adjusted via the Settings quick-action
key. Refer to the Print On Alarm section in this manual for further details.
SpO2 Alarm Pause
The Surveyor S12 and S19 patient monitors do not produce SpO2 alarms until a valid SpO2 signal is obtained. This
is intended to reduce nuisance alarms during initial patient hookup. Once a valid SpO2 alarm is obtained and the
SpO2 sensor is removed, the patient monitor produces a technical message to inform the clinician that no SpO2 data
is being monitored. The clinician can remove and acknowledge the “SpO2 Check Sensor” technical message via
the Setup SpO2 dialogue if the monitoring of SpO2 data is no longer desired and the removal of the SpO2 sensor is
intentional.
To acknowledge the removal of the SpO2 sensor is intentional and to remove the “SpO2 Check Sensor” technical
alarm:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the SpO2 Alarm Pause button.
3. The “SpO2 Alarms Paused” message is briefly display in the system message area of the main screen.
The SpO2 alarms reactivate when the SpO2 sensor is reconnected to the patient.
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SPO2 MONITORING
HR/PR Tone
When the systole pulse tones are coming from SpO2, the tone pitch is a function of the SpO2 value, with decreasing
pitch as the SpO2 value goes from 100% down to 75%.
To enable/disable the systole audio tone:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the HR/PR label.
a. Select Yes to enable the HR/PR systole tone.
b. Select No to disable the HR/PR systole tone.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Sat Seconds (Nellcor only)
When the Nellcor OxiMax Technology and sensors are utilized, the Surveyor patient monitor can display Nellcor’s
SatSeconds indicator.
Nellcor’s SatSeconds™ Alarm Management feature offers an effective means of managing nuisance or false alarms
without sacrificing patient safety. Nuisance alarms are often triggered by minor and brief desaturation events that
are clinically insignificant and are often managed by widening alarm limits, turning OFF the alarm or monitor, or
simply ignoring the alarm. The SatSeconds feature distinguishes clinically insignificant events from events of
consequence.
When a SpO2 measurement exceeds the alarm limit, the SatSeconds indicator begins to fill clockwise. The
difference between the measurement and the limit multiplied by the time the measurement remains outside the limit
determines if or when the SatSeconds alarm occurs.
For example:
• The low SpO2 alarm is set at 90% and the SatSeconds “clock” is set to 25.
• If the measurement is 85% for 4 seconds (i.e., 5% below the limit for 4 seconds), then 5% X 4 seconds =
20 SatSeconds. This is less than the 25 SatSeconds setting, therefore no alarm will occur.
• If the measurement is 85% for 7 seconds (i.e., 5% below the limit for 7 seconds), then 5% X 7 seconds =
35 SatSeconds. This is greater than the 25 SatSeconds setting, therefore an alarm occurs at 5 seconds
because 5% X 5 seconds = 25 SatSeconds. The alarm continues for another 2 seconds.
When the SpO2 measurement returns to within the alarm limits, the SatSeconds indicator clears (empties) in a
counter-clockwise fashion. The clearing of the SatSeconds indicator takes the same amount of time it took for the
SatSeconds alarm condition to be acquired. The SatSeconds “clear” time is equivalent to the acquire time.
To configure the SatSeconds time:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the SatSeconds label.
3. Select the arrow to display the drop down list box (Choices of Off, 10s, 25s, 50s, 100 seconds).
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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SPO2 MONITORING
Response Mode (Nellcor only)
The Nellcor OxiMax algorithm automatically adjusts the signal processing during degradation conditions such as
those caused by low perfusion, interference (e.g. external interference such as ambient light, electromagnetic
interference, and patient motion), or a combination of these. The automatic adjustment in the signal processing
results in an increase in the dynamic averaging beyond the minimum as set by the Response Mode. If the result of
the dynamic averaging time exceeds 20 seconds for SpO2, the algorithm continues to search and displays the pulse
every second. As these conditions extend, the amount of data required continues to increase. If the dynamic
averaging time for SpO2 reaches 40 seconds, and/or reaches 50 seconds for Pulse Rate, a low priority alarm state
results.
The Nellcor OxiMax signal processing algorithm automatically extends the amount of data required for measuring
SpO2 and pulse rate depending on the measuring conditions. During normal measurement conditions, the SpO2
averaging time is six to seven seconds in Normal Mode and approximately three seconds in Fast Mode. The
OxiMax algorithm’s calculation of pulse rate is unaffected by the response mode setting.
To configure the Response Mode:
1. Select the SpO2 numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the Response Mode label.
3. Select the up/down arrows to display the drop down list box (Choices of Normal and Fast).
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
SpO2 Functional Testing
To manually test a SpO2 alarm test conditions: apply probe to finger, wait for SpO2 value to appear, lower the high
alarm limit below the value shown, and verify that the "SpO2 < [lower limit]" alarm is annunciated.
Some models of commercially available bench-top functional testers and patient simulators can be used to verify
proper functionality of pulse oximeter sensors, cables and monitors. While such units may be useful for verifying
that the pulse oximetry system is functional, they are incapable of providing the data required to properly evaluate
the accuracy of the system’s SpO2 measurements.
Many functional testers and patient simulators are designed to interface with the pulse oximeter’s expected
calibration curves, and may be suitable for use with the pulse oximeter monitor and sensors. Not all units, however,
are adapted for use with all digital calibration systems. While this will not affect use of the simulator for verifying
system functionality, the displayed SpO2 measurement values may differ from the setting of the patient monitor. For
a properly functioning monitor, this difference is reproducible over time and from unit to unit within the
performance specifications of the test unit.
116
19. TEMPERATURE MONITORING
Overview
The Surveyor S12 and S19 patient monitors can monitor up to two continuous temperatures using 400 series
compatible probes. Note that 700 series probes are NOT compatible with the Surveyor patient monitor. The
temperatures are shown as T1 and T2 or alternately represented as T1 and ∆T – the absolute value of the difference
between the two temperature probes.
The Temperature parameters at the patient monitors can be configured as in °C or °F via the Administrative Setup
menu.
NOTE: The units of measure for the temperature parameters are not bidirectional when the patient
monitor is communicating to the Surveyor central station.
Temperature Monitoring Procedure
Follow hospital standard of care and clinical discretion when monitoring continuous temperatures. Follow the
temperature probe instructions for use provided with the probe packaging for proper use and any warnings and
precautions noted therein.
Temperature Display
Figure 54 Example Temperature Tile
The Temperature numeric parameter tile may display:
• The parameter label.
• The current temperature numeric value(s).
• The temperature units of measure.
• The temperature alarm limits if the temperature alarm limits are enabled.
• The Alarm Off icon if any of the temperature alarm limits are disabled.
• The temperature numeric values and alarm limits are shown in white color.
Temperature Alarm Behaviors
The Temperature numeric parameter tile flashes during a temperature alarm condition. The alarm light, temperature
numeric parameter tile, and temperature alarm message displays in the color of the configured temperature alarm
level. The alarm audio notification is produced according to the alarm level configured.
Setup Temperature Dialogue
Selecting the Temperature numeric parameter tile opens the Setup Temperature dialogue. Use the Setup
Temperature dialogue to adjust alarm settings and the temperature display format.
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TEMPERATURE MONITORING
Figure 55 Example Setup Temperature Dialogue (T1 and T2 Display Mode)
Temperature Alarm Limits
The Temperature Display Mode selected determines which Temperature alarm limits are available for alarm
notifications and alarm configurations. Refer to the Temperature Display Mode section in this manual for further
details.
To adjust the temperature alarm limits:
1. Select the Temperature numeric parameter tile to display the Setup Temperature dialogue.
2. Locate the Temperature label.
a. Adjust the Lower alarm limit by selecting the up/down arrows to move the lower alarm limit box until
the desired value is reached.
b. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Temperature alarm limits may also be adjusted via the Settings quick-action key. Refer to the Settings Alarm
Limits section in this manual for further details.
Temperature Alarms On
WARNING: Disabling the Temperature alarm limits means that NO low or high Temperature
alarm conditions will produce alarm notifications.
To enable/disable the Temperature alarm limits:
1. Select the Temperature numeric parameter tile to display the Setup SpO2 dialogue.
2. Locate the Alarms On button.
a. Select Yes to enable Temperature alarms.
b. Select No to disable Temperature alarms.
ƒ The Alarm Off icon displays in the Temperature numeric parameter tile.
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TEMPERATURE MONITORING
NOTE: The Lower Limit and Higher Limit windows in the Temperature dialogue may contain limit values
but these alarms ARE disabled if the Alarms On button is set to NO.
3.
Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Temperature Print on Alarm
To enable/disable the Temperature alarm limit conditions to automatically print:
1. Select the Temperature numeric parameter tile to display the Setup Temperature dialogue.
2. Locate the Temperature label.
3. Locate the Print On Alarm button next to the Temperature label.
a. Select Yes to enable the Print On Alarm.
b. Select No to disable the Print On Alarm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Print On Alarm feature for the Temperature alarm limit conditions may also be adjusted via the Settings quickaction key. Refer to the Print On Alarm section in this manual for further details.
Temperature Display Mode
The Surveyor S12 and S19 patient monitors provide the capability of display Temperature numeric values in three
formats. The format selected determines how the Temperature numeric values are displayed in the Temperature
parameter tile. The format selected determines which temperature parameters are available for alarm notifications
and configurations.
T1 Only Format
In this format, the Temperature1 parameter is the only parameter displayed in the Temperature parameter
tile.
T1 and T2 Format
In this format, the Temperature1 and Temperature2 parameters are displayed in the Temperature parameter
tile.
T1 and ∆T Format
o In this format, the Temperature1 parameter and the ∆Temp displays in the Temperature parameter tile.
o The ∆Temp is the absolute value difference between the Temperature2 parameter and Temperature1
parameter.
To select the Temperature Display Mode format:
1. Select the Temperature numeric parameter tile to display the Setup Temperature dialogue.
2. Locate the Temperature Display Mode label.
3. Select the arrow to display the drop down list box choices (T1 Only, T1 and T2, and T1 and ∆T).
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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TEMPERATURE MONITORING
120
20. RESPIRATION MONITORING
Overview
The Surveyor S12 and S19 patient monitors can monitor respirations, provide a breath per minute rate, and display a
respiration waveform.
Respiration Acquisition
The Surveyor S12 and S19 patient monitors can monitor respirations two ways:
• Via Thoracic Impedance using the 3/5 Lead ECG cable, if available, connected and enabled. The
same electrodes as 3/5 Lead ECG are used for respiration monitoring.
• Via the CO2 parameter, if available and connected. The capnography sensors are used for respiration
monitoring. This method takes precedence if present.
Respirations: ECG Thoracic Impedance
Respiration monitoring works by measuring the impedance between the LL and RA electrodes (or the R and F
electrodes for IEC lead designations). The impedance changes as the patient's chest expands and contracts during
the breath cycle. To measure the changes in impedance, the Surveyor patient monitor passes a very small, highfrequency current between the electrodes. This current is too small to cause any harm to the patient or any
interference with ECG monitoring.
When you have correctly connected the ECG to the patient, the monitor should display a clean, slowly oscillating
respiration signal. This may take up to 30 seconds after the patient has been connected. The Surveyor patient
monitor should also display a numeric value for the patient's respiration rate (RR).
NOTE: If the Respiration waveform is not currently selected for display on the Surveyor patient monitor,
follow the instructions in this manual to select this waveform for display.
Pediatric Considerations - Cardiogenic artifact (heart rate pulsations that appear as “breaths” in the respiration
signal) can be quite pronounced in pediatric patients. This can cause the respiration rate to be artificially high
(approaching the heart rate). To reduce cardiogenic artifact, move the White RA electrode (AHA lead designation)
or the Red R electrode (IEC lead designation) from the right clavicle down to the right mid-clavicular line, 4th
intercostal space.
NOTE: The Respiration parameter is not available via ECG thoracic impedance when using the AM12 12Lead Acquisition Module.
WARNING: Respiration monitoring via ECG thoracic impedance is not intended to replace
clinical assessment, observation, and monitoring.
Respirations: CO2 Measurement
Refer to the CO2 section of this manual for further details.
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RESPIRATION MONITORING
Respiration Alarm Behaviors
The Respiration numeric parameter tile flashes during a Respiration alarm condition. The alarm light, Respiration
numeric parameter tile, and Respiration alarm message displays in the color of the configured Respiration alarm
level. The alarm audio notification is produced according to the alarm level configured.
Respiration Display
Respirations Waveform Parameter Tile
The Respiration waveform may be shown in one of the available waveform slots when the respiration source is
ECG. When the respiration source is CO2, the capnography waveform is displayed instead of the respiration
waveform.
Respirations Numeric Parameter Tile
When the respiration source is CO2, the Respiration Rate (RR) numeric value is displayed in the CO2 numeric
parameter tile.
The Respiration numeric parameter tile may display:
• The parameter label “RR-x” (where x = respiration source).
• The current respiration numeric value(s).
• The “RPM” (respirations per minute) units of measure.
• The respiration alarm limits if the respiration alarm limits are enabled.
• The Alarm Off icon if any of the respiration alarm limits are disabled.
• The respiration numeric values and alarm limits are shown in white color when the Resp source is ECG.
• The respiration numeric values and alarm limits are shown in yellow color when the Resp source is CO2.
Figure 56 Respiration Numeric Tile
(ECG as Resp Source)
Figure 57 Example Respiration/CO2 Numeric Tile
(CO2 as Resp Source)
Setup Respiration (RR) Dialogue
Selecting the Respiration numeric parameter tile opens the Setup Respiration Rate (RR) dialogue. Use the Setup
Respiration dialogue to adjust alarm settings and to enable/disable the respiration parameter.
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RESPIRATION MONITORING
Figure 58 Example Setup Respiration Dialogue (ECG as Resp Source)
Respiration Alarm Limits
To adjust the Respiration alarm limits:
1. Select the Respiration numeric parameter tile to display the Setup Respiration dialogue.
a. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached.
b. Adjust the Lower alarm limit, select the up/down arrows to move the lower alarm limit box until the
desired value is reached.
2. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Respiration alarm limits may also be adjusted via the Settings quick-action key. Refer to the Settings Alarm
Limits section in this manual for further details.
Respiration Alarms On
WARNING: Disabling the Respiration alarm limits means that NO low or high Respiration alarm
conditions will produce alarm notifications. Use this feature with extreme caution. Patients must be
closely observed if the Respiration alarm limits are disabled.
NOTE: Follow hospital standard of care for the use of this feature. This feature is only intended to be
used during end of life situations and only based on the hospital standard of care.
To enable/disable the Respiration alarm limits:
1. Select the Respiration numeric parameter tile to display the Setup Respiration dialogue.
2. Locate the Alarms On button.
a. Select Yes to enable Respiration alarms.
b. Select No to disable Respiration alarms.
ƒ The Alarm Off icon displays in the Respiration numeric parameter tile.
NOTE: The Lower and Higher Limit windows in the Setup Respiration dialogue may contain limit values
but these alarms ARE disabled if the Alarms on button is set to NO.
3.
Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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RESPIRATION MONITORING
Respiration Print on Alarm
High and Low Respiration alarm limit conditions can be configured to automatically print a real-time waveform
report when the alarm occurs.
To enable/disable the Respiration alarm limit conditions to automatically print:
1. Select the Respiration numeric parameter tile to display the Setup Respiration dialogue.
2. Locate the Print On Alarm button.
a. Select Yes to enable the Print On Alarm.
b. Select No to disable the Print On Alarm.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Print On Alarm feature for the Respiration alarm limit conditions may also be adjusted via the Settings quickaction key. Refer to the Print On Alarm section in this manual for further details.
Respiration Enabled (Disabled)
WARNING: Disabling the Respiration parameter means that NO low or high Respiration alarm
conditions will produce alarm notifications. Use this feature with extreme caution. Patients must be
closely observed if the Respiration parameter is disabled.
NOTE: Follow hospital standard of care for the use of this feature. This feature is only intended to be
used during end of life situations and only based on the hospital standard of care.
NOTE: The Respiration Enabled (Disabled) feature only applies when the respiration source is ECG
thoracic impedance. When capnography is the respiration source, respirations cannot be disabled using
this feature.
To enable/disable the Respiration parameter:
1. Select the Respiration numeric parameter tile to display the Setup Respiration dialogue.
2. Locate the RESP Enabled button.
a. Select Yes to enable the Respiration parameter.
b. Select No to disable the Respiration parameter.
ƒ The “RR-ECG (Disabled)” message displays in the Respiration numeric parameter tile.
ƒ The Respiration waveform does not display on the main screen.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
124
21. CO2 MONITORING
Overview
The Surveyor S12 and S19 patient monitors use Oridion Microstream® CO2 Capnography technology as well as its
patented FilterLine® and Capnoline® ETCO2 consumables. The CO2 capabilities of the Surveyor patient
monitor’s support the continuous monitoring of the patient’s:
•
•
•
•
•
End tidal carbon dioxide (ETCO2) - level of carbon dioxide in exhaled breath.
Respirations via the CO2 source (RR-CO2).
Respiration rate per minute (RPM).
Fractional inspired carbon dioxide (FICO2) - level of carbon dioxide present during inhalation.
Integrated Pulmonary Index (IPI).
Principles of Operation
Capnography is a non-invasive method for monitoring the level of carbon dioxide in exhaled breath (EtCO2) to
assess a patient’s ventilation status. The sample line is typically placed on the mouth or nose for non-intubated
patients and in-line with airway tubing for intubated patients.
The Surveyor S12 and S19 patient monitors use Microstream® non–dispersive infrared (NDIR) spectroscopy to
continuously measure the amount of CO2 during every breath, the amount of CO2 present at the end of exhalation
(ETCO2), the amount of CO2 present during inhalation (FICO2), and the Respiratory Rate.
Infrared spectroscopy is used to measure the concentration of molecules that absorb infrared light. Because the
absorption is proportional to the concentration of the absorbing molecule, the concentration can be determined by
comparing its absorption to that of a known standard.
The Microstream® ETCO2 consumables deliver a sample of the inhaled and exhaled gases from the ventilator
consumable or directly from the patient (via an oral/nasal cannula) into the monitor for CO2 measurement. Moisture
and patient secretions are extracted from the sample, while maintaining the shape of the CO2 waveform.
The 50 ml/min. sampling flow rate reduces liquid and secretion accumulation, decreasing the risk of obstruction in
the sample pathway in humid ICU environments.
Once inside the Microstream® CO2 sensor, the gas sample goes through a micro-sample cell (15 microliters). This
extremely small volume is quickly flushed, allowing for fast rise time and accurate CO2 readings, even at high
respiration rates.
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CO2 MONITORING
The Micro Beam IR source illuminates the micro-sample cell and the reference cell. This proprietary IR light source
generates only the specific wavelengths characteristic of the CO2 absorption spectrum. Therefore, no
compensations are required when different concentrations of N2O, O2, anesthetic agents and water vapor are
present in the inhaled and exhaled breath. The IR that passes through the micro-sample cell and the IR that passes
through the reference cell are measured by the IR detectors.
The microprocessor in the monitor calculates the CO2 concentration by comparing the signals from both detectors.
Integrated Pulmonary Index (IPI) Parameter
The Integrated Pulmonary Index (IPI) is a parameter that uses capnography, respiration rate, pulse rate, and pulse
oximetry to articulate a single numeric value to describe the patient’s overall ventilatory status. The IPI algorithm
integrates ETCO2, RR, PR, and SpO2 values into a single value that provides an uncomplicated, inclusive
assessment of a patient’s ventilatory status. All four values are necessary to calculate the IPI parameter. The IPI
may provide an early indication of ventilatory changes that may not be evident in any of the four parameters
individually. The IPI is only available is the patient is monitored with pulse oximetry and capnography, and the IPI
parameter is enabled.
NOTE: The IPI is not intended to replace accurate clinician assessment of the patient’s ventilatory status.
The IPI is can be used as another data point in the overall patient assessment.
The IPI is a numeric value ranging from 1 to 10, where 10 indicates optimal pulmonary status. According to
Oridion Medical (2009), the following table presents a guide for clinical intervention based on IPI numeric values.
Contact Oridion Medical for further details on IPI clinical intervention.
Oridion Medical. (2009). Integrated Pulmonary Index TM. Retrieved from
http://www.oridion.com/Assets/Products/Technology/IPIChart.jpg
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CO2 MONITORING
CO2 Monitoring Procedure
To monitor CO2 with the Surveyor patient monitor:
1. Select the proper Oridion Filterline single-use sample line based on clinical guidelines and hospital
standard of care.
2. Open Surveyor’s CO2 input connector located on the side panel of the S12 and S19 patient monitors.
3. Connect the orange or yellow connector of the FilterLine® sample line into the Surveyor’s CO2 input port.
a. Turn the sampling line connecter clockwise into the Surveyor’s CO2 input port gently to ensure a
secure connection. DO NOT OVER TIGHTEN. Over tightening the connector may warp the filterline
connector and affect the ability to measure CO2.
b. This assures that there is no leak of gases during measurement at the connection point and that
measurement accuracy is not compromised. Loose or damaged connections may compromise
ventilation or cause an inaccurate measurement of respiratory gases.
4. Securely connect all components and check connections for leaks according to standard clinical
procedures.
5. Connect the patient end of the filterline to the patient as per instructions included with the filterline tubing.
6. The CO2 waveform and numeric parameter values should appear within approximately 10 seconds.
CO2 Display
CO2 Waveform Parameter Tile
The CO2 waveform may be shown in one of the available waveform slots. The CO2 waveform can be located to
the left of the CO2 numeric parameter tile.
CO2 Numeric Parameter Tile
The CO2 numeric parameter tile may display:
• The CO2 parameter label.
• The current inspired and end-tidal CO2 numeric values.
• The “mmHg” CO2 unit of measure.
• The CO2 alarm limits if the CO2 alarm limits are enabled.
• The Alarm Off icon if any of the CO2 alarm limits are disabled.
• The “RPM” respirations rate per minute unit of measure.
• The “RR-CO2” respiration numeric value using CO2 as the source.
• The respiration alarm limits if the respiration alarms limits are enabled.
• The Alarm Off icon if any of the respiration alarm limits are disabled.
• If enabled, the IPI label.
• If enabled, the IPI numeric value.
• The CO2 numeric values and alarm limits are shown in yellow color.
Figure 59 Example CO2 Waveform and Numeric Parameter Tiles
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CO2 MONITORING
CO2 Alarm Behaviors
The Surveyor S12 and S19 patient monitors do not produce CO2 alarms until a valid CO2 signal is obtained. This
is intended to reduce nuisance alarms during initial patient hookup. The CO2 numeric parameter tile flashes during
a CO2 alarm condition. The alarm light, CO2 numeric parameter tile, and CO2 alarm message displays in the color
of the configured CO2 alarm level. The alarm audio notification is produced according to the alarm level
configured.
Setup CO2 Dialogue
Selecting the CO2 numeric parameter tile opens the Setup CO2 dialogue. Use the Setup CO2 dialogue to adjust
alarm settings, to adjust the CO2 wave gain, and to configure the IPI parameter.
Figure 60 Example Setup ETCO2 Dialogue
CO2 Alarm Limits
The High and Low End-Tidal CO2 (ETCO2), high and low Respiration Rate (RR), and high Fraction of Inspired
CO2 (FICO2) alarm limit conditions can be configured independently. Refer to the Alarm Limits section in this
manual for further details.
To adjust the CO2x (where x = ETCO2, RR, and FICO2) alarm limits:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
a. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached.
b. Adjust the Lower alarm limit, select the up/down arrows to move the lower alarm limit box until the
desired value is reached.
2. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The CO2x alarm limits may also be adjusted via the Settings quick-action key. Refer to the Settings Alarm Limits
section in this manual for further details.
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CO2 MONITORING
IPI Low Alarm Limit
The Surveyor S12 and S19 patient monitors support an IPI low alarm limit. The IPI low alarm limit produces alarm
notifications when the IPI value drops below the configured IPI low alarm limit setting.
To enable the patient monitor to alarm when the IPI gets below a specific value:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
2. Locate the IPI low alarm limit label.
• Select the up/down arrows to move the lower alarm limit box until the desired value is reached.
• Choices include OFF, 1-9 in increments of 1.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The IPI alarm limits may also be adjusted via the Settings quick-action key. Refer to the Settings Alarm Limits
section in this manual for further details.
CO2 Auto
The Auto set feature automatically calculates the high and low CO2 alarm limits based on the current values.
Parameter
Lower limit adjustment
Upper limit adjustment
ETCO2
Changes to 80% of the current parameter
value (or the nearest allowable value given
the alarm limit settings rules)
Changes to 120% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
RR-CO2
Changes to 80% of the current parameter
value (or the nearest allowable value given
the alarm limit settings rules)
Changes to 125% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
FiCO2
N/A
Changes to 110% of the current parameter value
(or the nearest allowable value given the alarm
limit settings rules)
IPI
Changes to 80% of the current parameter
value (or the nearest allowable value given
the alarm limit settings rules)
N/A
To Auto set an alarm:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
2. Select the Auto button. Notice the limit values in the Lower Limit window and the Higher Limit window
adjust.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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CO2 MONITORING
CO2 Alarms On
The Alarms On feature for the CO2 alarms can be configured independently for the End-Tidal CO2 (ETCO2),
Respiration Rate (RR), and Fraction of Inspired CO2 (FICO2) parameters.
WARNING: Disabling the CO2x (where x = ETCO2, RR, and FICO2) alarm limits means that NO
low or high CO2x alarm conditions will produce alarm notifications. Use this feature with extreme
caution.
To enable/disable the CO2x (where x = ETCO2, RR, and FICO2) alarm limits:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
2. Locate the CO2x label.
3. Locate the Alarms On button next to the CO2x label.
a. Select Yes to enable CO2x alarms.
b. Select No to disable CO2x alarms.
ƒ The Alarm Off icon displays in the CO2 numeric parameter tile.
NOTE: The Lower Limit and Higher Limit windows in the Setup CO2 dialogue may contain limit values
but these alarms ARE disabled if the Alarms On button is set to NO.
4.
Select the OK button to enter that change OR select the Cancel button to cancel the changes.
CO2 Print on Alarm
The High and Low End-Tidal CO2 (ETCO2), high and low Respiration Rate (RR), and high Fraction of Inspired
CO2 (FICO2) alarm limit conditions can be configured to automatically print a real-time waveform report when the
alarm occurs. The Print on Alarm feature for the CO2 alarms can be configured independently for the End-Tidal
CO2 (ETCO2), Respiration Rate (RR), and Fraction of Inspired CO2 (FICO2) parameters.
To enable/disable a CO2x (where x = ETCO2, RR, and FICO2) alarm limit conditions to automatically print:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
2. Locate the CO2x label.
3. Locate the Print On Alarm button.
a. Select Yes to enable the Print On Alarm.
b. Select No to disable the Print On Alarm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Print On Alarm feature for the CO2x alarm limit conditions may also be adjusted via the Settings quick-action
key. Refer to the Print On Alarm section in this manual for further details.
CO2 Waveform Size
To adjust the size or gain of the CO2 waveform:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
2. Locate the CO2 Size label.
3. Select the arrow to display the drop down list box choices (0-40 mmHg, 0-60 mmHg, and 0-80 mmHg).
4. Select the desired waveform size.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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CO2 MONITORING
IPI Enabled/Disabled
WARNING: Disabling the IPI parameter means that the monitor will NOT produce any IPI alarm
notifications. Use this feature with extreme caution.
For the patient monitor to perform IPI low alarm surveillance, the IPI parameter must be enabled via the Setup CO2
dialogue.
To enable/disable the surveillance of the IPI parameter:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
2. Locate the IPI Enabled label.
a. Select Yes to enable the display/alarm surveillance of the IPI parameter.
b. Select No to disable the display/alarm surveillance of the IPI parameter.
ƒ The IPI numeric value is removed from display in the CO2 numeric parameter tile.
ƒ The IPI low alarm limit is disabled.
NOTE: If the IPI is disabled, NO low IPI alarm notifications are produced.
3.
Select the OK button to enter that change OR select the Cancel button to cancel the changes.
IPI Age Range (Pediatric Only)
Because normal values for physiological parameters are different for different age categories, the IPI algorithm
differs for different age groups.
When the Surveyor S12 and S19 patient monitors are configured for the Pediatric mode, the appropriate IPI age
range must be configured.
NOTE: Entering the date of birth in the Patient Information dialogue does NOT set the IPI age range for
the Pediatric patient.
To configure the appropriate IPI age range:
1. Select the CO2 numeric parameter tile to display the Setup CO2 dialogue.
2. Locate the IPI Age Range label (Only available when in Pediatric mode).
3. Select the arrow to display the drop down list box.
ƒ Choices include 1-3 years, 3-6 years, and 6-12 years.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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CO2 MONITORING
132
22. INVASIVE PRESSURE MONITORING
Overview
Invasive pressure monitoring (Px) is a direct measurement of the patient’s arterial or venous pressure. The invasive
pressure setup, consisting of connecting tubing, a pressure transducer, and a fluid source to maintain pressure (all
connected together by stopcocks) is attached to the catheter. The transducer is placed at the same level with the
heart, and is electrically zeroed. The transducer is a piezo-resistive device that converts the pressure signal to a
voltage. The monitor interprets the voltage signal so that pressure data and pressure waveforms can be displayed.
Figure 61 Example of an Arterial Line Manifold Setup
The Surveyor patient monitor can display the invasive pressure waveform and numeric parameters. The invasive
pressure may be displayed as Systolic, Diastolic and/or Mean values based on the invasive pressure label. All
invasive pressure numeric values use “mmHg” for the units of measure. Pulse rate can be monitored with any
arterial site labeled as ART. PAWP can be measured for an invasive pressure site labeled as PA.
The Surveyor S12 and S19 beside monitors may monitor up to 4 channels of invasive pressures depending upon the
monitor configuration.
Invasive Pressure Monitoring Procedure
WARNING: Always follow the hospital standard of care and prudent clinical discretion for
connecting, zeroing, and monitoring invasive pressure lines.
To begin invasive pressure monitoring:
1.
2.
3.
4.
5.
6.
Connect the invasive pressure cable to the invasive pressure port on the side of the Surveyor patient
monitor. If your monitor supports multiple invasive pressure channels, the cable will be supplied with a
Y-cable where the pressure sensor will connect to two invasive pressure sensors.
Connect the transducer manifold to the invasive pressure cable.
Open the Setup Invasive Pressure dialogue for this particular channel.
Define the invasive pressure label for this channel as appropriate.
Verify the parameter format (Sys/Dia or Mean) and the waveform size is appropriate.
Zero the pressure by opening the transducer vent, and pressing “Zero Set” in the Setup Invasive Pressure
dialogue for that particular channel or “Zero All” in any of the Setup Invasive Pressure dialogues.
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INVASIVE PRESSURE MONITORING
7.
8.
9.
Close the transducer vent.
Verify the alarm limits for this invasive pressure channel as appropriate.
Connect the transducer to the patient per clinical guidelines. Follow standard hospital procedures for
zeroing and flushing the pressure line.
Best Practice Recommendation: If a bedside recording is needed for documenting the insertion of an invasive
pressure such as is common when inserting a Pulmonary Artery catheter, prior to patient insertion ensure the PA
waveform is chosen for printing in the Setup>Setup Recorder dialogue. Selecting the Print quick-action key on the
main screen during PA insertion can produce the bedside printouts.
Invasive Pressure Display
Figure 62 Main Screen Example: Four Invasive Pressures
Invasive Pressure Waveform Parameter Tile
The invasive pressure waveform may be shown in one of the bottom four available waveform slots. The invasive
pressure waveform is located to the left of the corresponding invasive pressure numeric parameter tile
Invasive Pressure Numeric Parameter Tile
The invasive pressure numeric parameter tile may display:
• The invasive pressure parameter label.
• The current systolic, diastolic, and mean invasive pressure numeric values.
• The “mmHg” unit of measure.
• The systolic invasive pressure alarm limits if the systolic invasive pressure alarm limits are enabled.
• The Alarm Off icon if any of the invasive pressure alarm limits are disabled.
• If the invasive pressure is labeled as the Pulmonary Artery (PA) parameter, the PAWP numeric value in the
PA tile automatically erases when the PAWP measurement is older than 60 minutes.
The invasive pressure parameter colors are
• P1: Red
• P2: Light Blue
• P3: Yellow
• P4: Magenta
• ART: Red
• PA: Yellow
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INVASIVE PRESSURE MONITORING
•
•
•
•
•
•
•
•
•
RA: Light Blue
LA: Light Blue
CVP: Light Blue
ICP: Magenta
PAWP: Yellow
LA: Light Blue
CVP: Light Blue
ICP: Magenta
PAWP: Yellow
Figure 63 Example Invasive Pressure Waveform and Numeric Parameter Tiles
Invasive Pressure Alarm Behaviors
The invasive pressure numeric parameter tile flashes during an invasive pressure alarm condition. The alarm light,
invasive pressure numeric parameter tile, and invasive pressure alarm message displays in the color of the
configured invasive pressure alarm level. The alarm audio notification is produced according to the alarm level
configured.
Setup Invasive Pressure Dialogue
To access the invasive pressure setup dialogue, select the invasive pressure numeric tile. The invasive pressure
setup dialogue provides controls for configuring the selected invasive pressure.
Figure 64 Invasive Pressure Setup Dialogue
Invasive Pressure Alarm Limits
High and low invasive pressure alarm limits can be configured independently for the Systolic (“Ps”), Mean (“Pm”),
and Diastolic (“Pd”) invasive pressure parameters.
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INVASIVE PRESSURE MONITORING
To adjust the Px (where x= s, d, or m) alarm limits:
1. Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
2. Locate the Px label.
a. Adjust the Lower alarm limit by selecting the up/down arrows to move the lower alarm limit box until
the desired value is reached.
b. Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box until
the desired value is reached.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
The Px alarm limits may also be adjusted via the Settings quick-action key. Refer to the Settings Alarm Limits
section in this manual for further details.
Auto Set Invasive Pressure Alarm Limits
The Auto Set feature for the invasive pressure alarm limits can be configured independently for the Systolic (“Ps”),
Mean (“Pm”), and Diastolic (“Pd”) blood pressure parameters. The Auto set feature automatically calculates the
high and low Px alarm limits based on the current value.
Parameter
Lower limit adjustment
Upper limit adjustment
Invasive Pressure (P) – Systolic,
Mean & Diastolic
Changed to 80% of the current
parameter value (or the nearest
allowable value given the alarm limit
settings rules)
Changed to 120% of the current
parameter value (or the nearest
allowable value given the alarm limit
settings rules)
To Auto set an Px (where x= s, d, or m) alarm:
1. Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
2. Locate the Px label.
3. Select the Auto button next to the Px label. Notice the limit values in the Lower Limit window and the
Higher Limit window adjust.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Invasive Pressure Alarms On
The Alarms On feature for the invasive pressure alarms can be configured independently for the Systolic (“Ps”),
Mean (“Pm”), and Diastolic (“Pd”) invasive pressure parameters.
WARNING: Disabling the Px alarm limits means that NO low or high Px alarm conditions will
produce alarm notifications. Use this feature with extreme caution.
To enable/disable the Px (where x =s, m, or d) alarm limits:
1. Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
2. Locate the Px label.
3. Locate the Alarms On button next to the Px label.
a. Select Yes to enable Px alarms.
b. Select No to disable Px alarms.
ƒ The Alarm Off icon displays in the invasive pressure numeric parameter tile.
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INVASIVE PRESSURE MONITORING
NOTE: The Lower Limit and Higher Limit windows in the Setup Invasive Pressure dialogue may contain
limit values but these alarms ARE disabled if the Px Alarms On button is set to NO.
4.
Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Invasive Pressure Print on Alarm
The Print on Alarm feature for the invasive pressure alarms can be configured independently for the Systolic (“Ps”),
Mean (“Pm”), and Diastolic (“Pd”) invasive pressure parameters.
To enable/disable the Px (where x =s, m, or d) alarm limit conditions to automatically print:
1. Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
2. Locate the Px label.
3. Locate the Print On Alarm button next to the Px label.
a. Select Yes to enable the Print On Alarm.
b. Select No to disable the Print On Alarm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
If the clinician requires the invasive waveform to be the waveform to print at the beside recorder when the invasive
pressure alarm occurs, ensure the correct invasive pressure waveform is selected for printing via the Setup>Setup
Recorder dialogue. Refer to the Setup Recorder dialogue section in this manual for further details.
The Print On Alarm feature for the invasive pressure alarm limit conditions may also be adjusted via the Settings
quick-action key. Refer to the Print On Alarm section in this manual for further details.
Invasive Pressure Label
Use the label field to assign the particular label to each invasive pressure input. Note that labels must be unique
across various different invasive pressure inputs. When changing labels, the associated ranges and alarm limits will
automatically change based on pre-defined values.
By default, the invasive pressure channels are labeled generically and displayed as P1 through P4. The pressure
channels can be assigned to any of the following labels:
Label
Definition
Art
Arterial Blood Pressure
PA
Pulmonary Artery Pressure
RA
Right Atrial Pressure
LA
Left Atrial Pressure
CVP
Central Venous Pressure
ICP
Intracranial Pressure
To label an invasive pressure channel:
1. Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
2. Locate the invasive pressure label.
3. Select the arrow to display the drop down list box.
• Choices include a generic P1-4 (dependent on channel chosen), ART, PA, RA, LA, CVP and ICP.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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INVASIVE PRESSURE MONITORING
Invasive Pressure Format
Generic invasive pressure inputs are those that have not been assigned a specific label. The generic invasive
pressure labels are P1, P2, P3, and P4. When using a generic invasive pressure inputs, the values can be displayed
in two formats:
• Sys/Dia with Mean pressure shown in parenthesis underneath.
• Mean pressure in parenthesis with the Sys/Dia shown underneath.
When the invasive pressure is labeled, the format is determined by the label chosen.
Label
Format
Art
Sys/Dia (Mean)
PA
Sys/Dia (Mean)
RA
Mean
LA
Sys/Dia (Mean)
CVP
Mean
ICP
Mean
To choose a invasive pressure format for a generic invasive pressure (P1-P4):
1. Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
2. Locate the invasive pressure format label.
3. Select the arrow to display the drop down list box choices (Sys/Dia, Mean).
4. Select the desired label.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes
Invasive Pressure Waveform Size
To adjust the size of the invasive pressure waveform:
1. Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
2. Locate the invasive pressure size label.
3. Select the arrow to display the drop down list box.
• Choices include:
o (-10 to 20 mmHg)
o (-10 to 60 mmHg)
o (0-150 mmHg)
o (0-200 mmHg)
o (0-300 mmHg)
4. Select the desired waveform size.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Invasive Pressure Zero Set
WARNING: Intracranial Pressure (ICP) monitoring should only be zeroed prior to patient
insertion. Follow hospital standard of care and clinical guidelines for maintenance of ICP monitoring.
As part of initial invasive pressure manifold setup prior to monitoring, the invasive pressure transducer must be
zeroed before initial patient measurements are taken.
NOTE: Always follow hospital standard of care and clinical guidelines when zeroing an invasive pressure.
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INVASIVE PRESSURE MONITORING
A general recommendation for zeroing a non-ICP invasive pressure is to zero:
• Upon initial startup prior to patient connection.
• When replacing an existing transducer with a new manifold set up.
• When connecting a new transducer, cable or tubing manifold set up.
• When replacing an existing transducer with a new manifold set up.
• When restarting the Surveyor patient monitor after a Standby Mode.
• Before initiating treatment changes reliant upon pressures data.
• Whenever the patient’s body position changes.
• In the event of incorrect or questionable pressure readings.
The Zero Set button allows the clinician to zero that particular invasive pressure. To zero a particular invasive
pressure:
1.
2.
3.
4.
5.
6.
7.
8.
Ensure the invasive pressure cable, pressure transducer, and flush tubing manifold is connected properly as
per hospital standard of care and clinical guidelines.
Ensure the invasive pressure cable is inserted into the proper invasive pressure port on the side of the
Surveyor S12/S19 patient monitor.
Select the invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
Open the non-ICP pressure transducer vent to atmosphere.
Select the Zero Set button in the Setup Invasive Pressure dialogue.
Observe the patient monitor for the following:
• A Zeroing in Progress message appears in the system message area briefly.
• The numerics in the invasive pressure tile goes to “0”.
• A Zeroing Complete message appears in the system message area briefly.
Close the pressure transducer vent from atmosphere.
If connected to the patient, the patient’s invasive waveform and numeric parameters should display as
configured.
NOTE: To reduce nuisance alarms, the invasive pressure alarms are inactivated for a few seconds during
the zeroing process. Invasive pressure alarms are reactivated shortly after the zeroing process has been
completed.
Invasive Pressure Zero All
WARNING: Intracranial Pressure (ICP) monitoring should only be zeroed prior to patient
insertion. Follow hospital standard of care and clinical guidelines for maintenance of ICP monitoring.
NOTE: Always follow hospital standard of care and clinical guidelines when zeroing an invasive pressure.
Refer to the Zero Set section in this manual for further details on zeroing invasive pressures.
The Zero All button allows the clinician to zero all invasive pressure at one time. To zero all invasive pressures at
one time:
1.
2.
3.
Ensure the invasive pressure cables, pressure transducers, and flush tubing manifolds are connected
properly as per hospital standard of care and clinical guidelines.
Ensure the invasive pressure cables are inserted into the proper invasive pressure ports on the side of the
Surveyor S12/S19 patient monitor.
Select an invasive pressure numeric parameter tile to display the Setup Invasive Pressure dialogue.
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INVASIVE PRESSURE MONITORING
4.
5.
6.
7.
8.
Open the appropriate non-ICP pressure transducer vents to atmosphere.
Select the Zero All button in the Setup Invasive Pressure dialogue.
Observe the patient monitor for the following:
• A Zeroing in Progress message for appears in the system message area briefly.
• The numerics in the invasive pressure tiles goes to “0”.
• A Zeroing Complete message appears in the system message area briefly.
Close the pressure transducer vents from atmosphere.
The patient’s invasive waveforms and numeric parameters should display as configured.
NOTE: To reduce nuisance alarms, the invasive pressure alarms are inactivated for a few seconds during
the zeroing process. Invasive pressure alarms are reactivated shortly after the zeroing process has been
completed.
Measuring PAWP
When an invasive pressure channel is labeled as Pulmonary Artery (“PA”), a pulmonary artery wedge pressure
(“PAWP”) can be obtained. The Measure PAWP dialogue is not available until an invasive pressure is labeled as a
PA waveform.
Figure 65 Example Pulmonary Artery Invasive Pressure Dialogue
The PA invasive pressure dialogue contains a Measure PAWP button that when selected accesses the PAWP
dialogue.
The Measure PAWP dialogue can also be accessed via the Setup CO dialogue. Refer to the Setup CO dialogue
section in this manual for further details.
To access the Measure PAWP dialogue:
1. Select the PA invasive pressure numeric parameter tile to display the Setup PA(Px) Invasive Pressure
dialogue.
2. Select the Measure PAWP button.
3. The Measure PAWP dialogue displays.
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INVASIVE PRESSURE MONITORING
Figure 66 Example Measure PAWP Dialogue
The Measure PAWP dialogue displays three real-time waveforms:
• The ECG tracing located in waveform position 1 of the main screen.
• The CO2 waveform (if being monitored) or the Respiration waveform.
• The PA waveform.
These three real-time waveforms can be used to sync the end-expiration phase of the patient’s breathing cycle with
the correct timing for obtaining the PAWP parameter.
NOTE: Always follow hospital standard of care and clinical guidelines for PAWP measuring.
To obtain a PAWP measurement:
1. Correlate the end-expiration point of the patient’s breathing pattern by clinical palpation of the patient’s
chest while viewing the CO2/Resp waveform.
2. Inflate the PAWP balloon of the PA catheter just until the PA waveform dampens.
NOTE: Always follow the manufacturer’s recommended instructions, hospital standard of care,
and clinical guidelines for using, inflating, and deflating the PAWP balloon of the Pulmonary
Artery catheter.
3.
4.
Select the Stop Waveforms button in the Measure PAWP dialogue to freeze the waveforms.
Passively allow the PAWP balloon to deflate.
WARNING: Leaving the PAWP balloon inflated for longer than 3 seconds can cause
serious patient consequences. Ensure the PAWP balloon is inflated for less than 3 seconds. If the
PA waveform does not dampen appropriately upon PAWP balloon inflation, stop, deflate the
balloon, and consult the physician as per hospital standard of care and clinical guidelines.
5.
With the waveforms stopped (frozen), the Measure PAWP dialogue changes:
a. A white cursor line is placed in the PA/PAWP waveform close to where the dampened PAWP is
located.
b. Use the Up and Down arrows to fine tune the location of the PAWP cursor line.
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INVASIVE PRESSURE MONITORING
c.
d.
6.
Notice the PAWP numeric changes as the PAWP cursor is adjusted.
When the PAWP cursor is placed in the desired location, select Save PAWP:
• Once saved, the waveforms in the Measure PAWP dialogue go to a real-time view.
• The PAWP numeric and timestamp displays in the PA numeric parameter tile in the main screen.
• The PAWP numeric value and timestamp automatically erase when the PAWP measurement is
older than 60 minutes.
• The PAWP numeric is placed into the Hemodynamics Calcs dialogue.
Select the Exit button to close the Measure PAWP dialogue.
Figure 67 Example Measure PAWP Dialogue: Stop Waveform
Printing the PAWP Waveform
Prior to measuring the PAWP, select the PA waveform as one of the waveforms to print to the bedside recorder via
the Setup> Setup Recorder dialogue. Refer to the Setup Recorder dialogue in this manual for further details. When
in the Measure PAWP dialogue, select the Print quick-action key on the main screen during the wedging process to
print the dampening PA waveform to the bedside recorder.
Overlapping Invasive Pressures
The Surveyor S12 and S19 patient monitors provide the ability to overlap invasive pressures in one expanded
waveform area. This feature allows the clinician to place the synchronized invasive pressure waveforms into one
large waveform area to check for the alignment of a waves, c waves, dicrotic notches, and other fluctuations in the
invasive waveforms. When selected to overlap, any available invasive pressure waveform will overlap into one
expanded waveform area.
Figure 68 Example of Two Overlapped Invasive Pressure Waveforms
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INVASIVE PRESSURE MONITORING
Figure 69 Example of Four Overlapped Invasive Pressure Waveforms
To enable/disable overlap invasive pressure waveforms:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Waveforms button to access the Setup Waveform Area dialogue.
3. Locate the Overlap Invasive Pressure label.
a. Select Yes to overlap all available invasive pressure.
o The invasive pressures will occupy the space of four waveform slots.
o The overlapped invasive pressure have independent waveform sizes.
b. Select No to keep the invasive pressure waveforms in separate waveform parameter tiles.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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INVASIVE PRESSURE MONITORING
144
23. THERMODILUTION CARDIAC OUTPUT
Overview
The Surveyor S12 and S19 patient monitors can support the use of intermittent thermodilution (bolus) Cardiac
Output (CO) based on purchased monitor configuration. Thermodilution Cardiac Output is performed using a
Pulmonary Artery (PA) catheter.
Cardiac Output is the amount of blood ejected by the heart over the course of one minute. A cool solution of known
temperature and volume (“Injectate”) is injected into the right atrium via the CVP port of the PA catheter. This
cooler injectate mixes with the warmer blood as it passes through the ventricle and into the pulmonary artery, thus
cooling the blood. So warm blood plus cool injectate equals a change in temperature in the heart for that brief few
seconds. The thermistor at the tip of the PA catheter measures the blood temperature. The patient monitor
computer measures the change in blood temperature over time as it flows over the thermistor surface. It is looking
for how long it takes for the blood temperature to return to its pre-injectate level.
The cardiac output computer in the patient monitor calculates flow (cardiac output from the right ventricle) using
the blood temperature information, and the temperature and volume of the injectate. A CO curve is drawn on the
patient monitor to show the temperature change over the course of about 1 minute. The faster the change back to
the pre-injectate blood temperature, the quicker the blood flow. The slower the change back to pre-injectate values,
the slower the blood flow.
The monitor draws an inverse curve with the change in temperature on the y-axis and the time on the x-axis. As the
injectate is introduced, mixes with the blood, and the temperature in the right atrium cools, the curve is drawn
inversely upwards. As the mixture warms and returns to normal temperature, the curve returns to baseline.
Cardiac Output is the amount of blood ejected from the left ventricle each minute and is expressed in liters per
minute (l/min). In addition to Cardiac Output, the Surveyor patient monitors also support the Cardiac Index (CI)
parameter. The Cardiac Index is displayed if the patient’s height and weight is entered and the CO parameter is
current.
CO Display
The CO tile is always located in the lower middle of Numeric Parameter B section on the Surveyor S12 and S19
patient monitor’s main screen. When the CO measurement is accepted, the Surveyor patient monitor displays the
CO numeric value in the CO tile. The Cardiac Index (CI) numeric value is also displayed if the patient’s height and
weight has been entered into the monitor. The CO tile is located in the lower middle portion of the main screen.
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THERMODILUTION CARDIAC OUTPUT
Figure 70 Example Cardiac Output Tile
The CO tile may display:
• The CO parameter label.
• The CO numeric value.
• The timestamp of the most recent CO value.
• The “l/min” CO units of measure label.
• The CI numeric value if the patient’s height and weight has been entered.
• The “l/min/m2” CI units of measure label.
• The CO numeric values are shown in red color.
• CO/CI numeric values older than 60 minutes are removed from the main
screen display.
CO Alarm Behaviors
There are no alarms associated with cardiac output, cardiac index, or hemodynamic calculation values.
Setup CO Dialogue
To access the Setup CO dialogue, select the CO numeric tile. The Setup CO dialogue provides controls for
configuring the computation constant, the injectate probe type, the ability to measure the CO, and provides access to
the Hemodynamic Calculations dialogue.
Figure 71 Setup CO Dialogue
Computation Constant
The computation constant is a numeric value based on the Pulmonary Artery catheter size, injectate temperature,
and volume of injectate. This computation constant must be entered into the Surveyor S12 and S19 patient monitors
before a Cardiac Output may be obtained. Once entered, the computation constant remains for that patient until
manually changed, the patient is discharged, or the monitor is powered down/on.
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THERMODILUTION CARDIAC OUTPUT
Refer to the Pulmonary Artery catheter manufacturer’s package insert for the correct computation constant.
Best Practice Recommendation: Always check to ensure the correct computation constant is entered prior to
obtaining the cardiac output.
To enter/adjust the CO computation constant:
1. Select the CO numeric parameter tile to display the Setup CO dialogue.
2. Locate the Computation Constant label.
3. Use the Up and Down arrows to fine tune the CO computation constant.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Injectate Probe Type
To enter/revise the CO injectate probe type:
1. Locate the Injectate Probe Type label.
2. Select the arrow to display the drop down list box.
• Choices include In-Line, and Bath.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Measure PAWP
When an invasive pressure channel is labeled as Pulmonary Artery (“PA”), a pulmonary artery wedge pressure
(“PAWP”) can be obtained via the Setup CO dialogue.
The Measure PAWP dialogue can also be accessed via the Setup PA Invasive Pressure dialogue. Refer to the Setup
PA Invasive Pressure dialogue section in this manual for further details.
To access the Measure PAWP dialogue:
1. Select the PA invasive pressure numeric parameter tile to display the Setup PA Invasive Pressure dialogue.
2. Select the Measure PAWP button.
3. The Measure PAWP dialogue displays.
Figure 72 Example Measure PAWP Dialogue
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THERMODILUTION CARDIAC OUTPUT
The Measure PAWP dialogue displays three real-time waveforms:
• The ECG tracing located in waveform position 1 of the main screen.
• The CO2 waveform (if being monitored) or the Respiration waveform.
• The PA waveform.
These three real-time waveforms can be used to sync the end-expiration phase of the patient’s breathing cycle with
the correct timing for obtaining the PAWP parameter.
NOTE: Always follow hospital standard of care and clinical guidelines for PAWP measuring.
To obtain a PAWP measurement:
1. Correlate the end-expiration point of the patient’s breathing pattern by clinical palpation of the patient’s
chest while viewing the CO2/Resp waveform.
2. Inflate the PAWP balloon of the PA catheter just until the PA waveform dampens.
NOTE: Always follow the manufacturer’s recommended instructions, hospital standard of care, and
clinical guidelines for using, inflating, and deflating the PAWP balloon of the Pulmonary Artery
catheter.
3.
4.
Select the Stop Waveforms button in the Measure PAWP dialogue to freeze the waveforms.
Passively allow the PAWP balloon to deflate.
WARNING: Leaving the PAWP balloon inflated for longer than 3 seconds can cause
serious patient consequences. Ensure the PAWP balloon is inflated for less than 3 seconds. If the
PA waveform does not dampen appropriately upon PAWP balloon inflation, stop, deflate the
balloon, and consult the physician as per hospital standard of care and clinical guidelines.
5.
6.
With the waveforms stopped (frozen), the Measure PAWP dialogue changes:
a. A white cursor line is placed in the PA/PAWP waveform close to where the dampened PAWP is
located.
b. Use the Up and Down arrows to fine tune the PAWP cursor.
c. Notice the PAWP numeric changes as the PAWP cursor is adjusted.
d. When the PAWP cursor is placed in the desired location, select Save PAWP.
• Once saved the waveforms in the Measure PAWP dialogue go to a real-time view.
• The PAWP numeric and timestamp is displayed in the PA numeric parameter tile in the main
screen.
o The PAWP numeric value and timestamp is removed from the PA numeric parameter tile in
the main screen after a lapse of 60 minutes.
• The PAWP numeric is placed into the Hemodynamics Calcs dialogue.
Select the Exit button to close the Measure PAWP dialogue.
Begin CO Measurement
To begin a CO measurement:
1. Select the CO numeric parameter tile to display the Setup CO dialogue.
2. Locate the Begin CO Measurement button.
3. Selecting the Begin CO Measurement button opens the Measure CO dialogue.
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THERMODILUTION CARDIAC OUTPUT
Figure 73 Measure CO Dialogue
Measure CO Dialogue Overview
The Measure CO dialogue contains:
• A CO status message area in the top left corner of the dialogue.
• The core Blood Temperature obtained from the Pulmonary Artery catheter (“BT”) in degrees
Celsius.
• The injectate temperature (“IT”) in degrees Celsius.
• The CO Mode feature (Choices are Auto, and Manual).
• One large box that shows the current CO measurement curve in progress.
• Four smaller boxes:
o Each box displays the previous CO curves obtained.
o The most recent CO curve is displayed in Box #1.
o The CO curves progress with the oldest CO curve displayed in Box#4.
o Each box is associated with the box label (#1-#4).
o Each box is associated with the CO numeric value for that particular CO curve.
• A Save Average action button.
• An Exit button.
The blood and injectate temperatures displays on the Measure CO screen. When the monitor is ready to
begin the CO run, a “Ready” message displays in the top left corner of the Measure CO screen.
As the CO solution is injected and sensed by the monitor, the CO curve begins displaying in the large box,
drawing from left to right. The CO curve stops drawing when the monitor senses the equilibration of
temperature. Once the CO curve stops drawing, it is removed from display in the large box and enters into
Box#1. The “Ready” message should display in the CO message area.
This cycle repeats as each CO curve is shot, moving the oldest CO curve into the next oldest box. The
Measure CO screen only displays up to four CO curves. If more than four CO curves are shot, the oldest
CO curve is deleted to allow room for the newer CO curves.
The CO curve has a fixed full-scale gain of 1 degree C (no auto-scaling) without waveform scales. The CO
curve has a fixed sweep speed of 6.25 mm/sec.
CO Mode
The Surveyor patient monitor supports auto and manual CO modes.
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To select the CO Mode:
1. Select the CO numeric parameter tile to display the Setup CO dialogue.
2. Locate the Begin CO Measurement button.
3. Selecting the Begin CO Measurement button opens the Measure CO dialogue.
4. Select the CO Mode button.
5. Select the arrow to display the drop down list box.
a. Choices include Auto, and Manual.
b. If Manual is selected, a Start button appears.
c. When in Manual mode, select the Start button to begin the CO curve.
Auto CO Mode: In auto mode, the patient monitor prompts the clinician when the patient monitor is ready
to begin a search for a thermodilution curve by displaying the “Ready” message in the Measure CO
message area. The “Ready” message is accompanied by an audible tone signifying to start injecting the
injectate fluid. The “Ready” message and audible tone occurs when the monitor determines the baseline
blood temperature is stable.
When a CO value has been calculated, the patient monitor sounds an audible tone. It then transitions back
to the ready state and sound a tone to indicate that it is ready for the next injection.
To begin a CO curve when in Auto Mode:
1. Connect the proper Cardiac Output cable and PA catheter.
2. From the PA catheter package insert, verify the correct computation constant for the catheter type,
injectate volume, and injectate temperature. Enter the computation constant which by default
starts at 0.500 and may be changed as appropriate. Note that the last computation constant is
remembered in between various monitoring session. Once entered, the computation constant
remains for that patient until manually changed, the patient is discharged, or the monitor is
powered down/on.
3. Verify proper PA catheter positioning.
4. When a baseline blood temperature is obtained, the monitor displays “Ready”.
5. Use correct injectate port. Inject correct volume in smooth motion.
6. Once a bolus is injected, the CO curve appears, the resultant CO measurement is displayed.
7. Up to 3 additional cardiac output runs may be performed as desired when the “Ready” message is
displayed.
8. When sufficient CO runs are completed, verify that all values are appropriate and deselect those
that may be erroneous or unwanted. Select “Save Average” and confirm with “OK” to display the
results in the CO tile and save it in the trend data.
Manual CO Mode: The manual mode allows the clinician to determine the appropriate time to begin the
injection of the solution. In manual mode, the ready status is indicated immediately and it is up to the
clinician to inject at the appropriate time. If the monitor cannot identify a change in temperature within 30
seconds, the manual mode times out.
To begin a CO curve when in Manual Mode:
1. Connect the proper Cardiac Output cable and PA catheter.
2. From the PA catheter package insert, verify the correct computation constant for the catheter type,
injectate volume, and injectate temperature. Enter the computation constant which by default
starts at 0.500 and may be changed as appropriate. Note that the last computation constant is
remembered in between various monitoring session. Once entered, the computation constant
remains for that patient until manually changed, the patient is discharged, or the monitor is
powered down/on.
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THERMODILUTION CARDIAC OUTPUT
3.
4.
5.
6.
7.
8.
Verify proper PA catheter positioning.
Select “Start” to begin the procedure. “Ready” will be displayed. You may begin to inject the
bolus within a 30-second period.
Use correct injectate port. Inject correct volume in smooth motion.
Once a bolus is injected, the CO curve appears, the resultant CO measurement is displayed.
Up to 3 additional cardiac output runs may be performed as desired when the “Ready” message is
displayed.
When sufficient CO runs are completed, verify that all values are appropriate and deselect those
that may be erroneous or unwanted. Select “Save Average” and confirm with “OK” to display the
results in the CO tile and save it in the trend data.
Save Average
The monitor automatically averages the CO curves displayed in the Measure CO dialogue. The averaged
CO numeric is displayed in the Measure CO in the Save Average label.
If necessary, any of the CO curves may be eliminated from the averaged CO numeric.
To exclude a CO curve from the averaged CO:
1. Select the box # label under the CO to eliminate.
2. Once selected, the CO numeric near the box # label chosen is grayed.
3. To include a CO curve in the averaged CO that has been previously excluded, select the CO box #
label a second time.
4. This enables the CO value for that CO curve and includes the value in the averaged CO numeric.
To Save the Averaged CO:
1. Once the clinician is satisfied with the CO curves and numeric values, select the Save Average
button.
2. A confirmation dialogue is displayed.
a. Selecting Yes to the Save the Averaged CO confirmation message places the CO numeric
values in the CO parameter tile on the main screen, into the Trends list, and into the
Hemodynamic Calculations dialogue. The Cardiac Index (CI) is also saved if the patient’s
height and weight have been previously entered.
b. Selecting No to the Save the Averaged CO confirmation message does not save the averaged
CO and returns to the Measure CO dialogue.
Once the Measure CO dialogue is exited, the previous CO curves and values are erased from view.
Hemodynamic Calculations
To enter the Hemodynamics Calculations dialogue:
1. Select the CO numeric parameter tile to display the Setup CO dialogue.
2. Locate the Begin CO Measurement button.
3. Select the Begin CO Measurement button to open the Measure CO dialogue.
4. Select the Hemodynamics Calculations button.
Refer to the Hemodynamics Calculations section in this manual for further details.
Height
To obtain the Cardiac Index and other indices in the Hemodynamic Calculations dialogue, the patient’s height and
weight must be entered. If the height has been previously entered in the Patient Information dialogue then the
patient’s height will also appear in the Hemodynamics Profile.
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THERMODILUTION CARDIAC OUTPUT
To enter patient height information:
1. Select the Height button.
2. Enter the information using the onscreen keypad.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Weight
To obtain the Cardiac Index and other indices in the Hemodynamic Calculations dialogue, the patient’s height and
weight must be entered. If the weight has been previously entered in the Patient Information dialogue then the
patient’s weight will also appear in the Hemodynamics Profile.
To enter patient weight information:
1. Select the Weight button.
2. Enter the information using the onscreen keypad.
3. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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24. HEMODYNAMIC CALCULATIONS
Overview
Hemodynamic Calculations (“HD Calcs”) is a package that takes all of the provided hemodynamic parameters and
calculates out other advanced HD parameters. This is typically the “end point” for obtaining hemodynamic
information. The patient monitor’s “brain” takes the monitoring data it sees and using industry standard formula
and calculates these advanced parameters for the clinicians.
In general, there is a chronology for obtaining hemodynamic parameters:
1. Obtain MAP numeric from the patient monitor.
2. Obtain CVP mean numeric from the patient monitor.
3. Obtain PA systolic, diastolic, and mean numerics from the patient monitor.
4. Obtain PAWP numerics from the patient monitor.
5. Obtain the CO runs using the patient monitor. In some cases, the clinician may shoot 3 or 4 CO runs,
delete outliers, and then accept the CO average.
6. Obtain Hemodynamic Calculations using the patient monitor.
7. Print HD Calcs to either strip channel or laser printer at central station (optional).
The PA, ART and CVP numeric values must be available for certain calculations to be made. Alternatively, if
known, these can be manually entered to determine the complete calculations. If these pressures are connected, resampling may be performed to calculate the hemodynamics based on the latest values. If a PWAP is not measured
or manually entered, the values for PVR, LCW and LVSW and associated indices are not shown.
Hemodynamic Calculation Parameters
The Surveyor S12 and S19 patient monitors support the following hemodynamic calculation parameters:
• Stroke Volume (SV)
• Stroke Volume Index (SVI)
• Systemic Vascular Resistance (SVR)
• Systemic Vascular Resistance (SVRI)
• Pulmonary Vascular Resistance (PVR)
• Pulmonary Vascular Resistance Index (PVRI)
• Left Cardiac Work (LCW)
• Left Cardiac Work Index (LCWI)
• Left Ventricular Stroke Work (LVSW)
• Left Ventricular Stroke Work Index (LVSWI)
• Right Cardiac Work (RCW)
• Right Cardiac Work Index (RCWI)
• Right Ventricular Stroke Work (RVSW)
• Right Ventricular Stroke Work Index (RVSWI)
The indices are only displayed if the patient’s height and weight are entered to allow for calculation of the Body
Surface Area (BSA).
Hemodynamic Calculation Dialogue
The Hemodynamic Calculation dialogue is available through the Measure CO dialogue.
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HEMODYNAMIC CALCULATIONS
To enter the Hemodynamics Calculations dialogue:
1. Select the CO numeric parameter tile to display the Setup CO dialogue.
2. Locate the Begin CO Measurement button.
3. Select the Begin CO Measurement button to open the Measure CO dialogue.
4. Select the Hemodynamics Calculations button.
Figure 74 Hemodynamics Calculations Dialogue
HD Calcs Input Parameters
The HD Calcs Input Parameters are numeric values that must be entered to perform the HD calculations. The input
parameters are used in the formulas to obtain the HD Calcs output parameters.
These input parameters can be entered automatically by the monitor or manually by the clinician.
1. If the monitor “sees” the numeric values (is actively monitoring), the monitor automatically inputs into the
HD Calcs dialogue.
2. If the monitor is not actively monitoring these parameters, the clinician can manually input by using the
Up/Down arrows.
HD Calcs Input Parameters are:
• CO
• HR
• ARTs
• ARTd
• ARTm
• PAs
• PAd
• PAm
• CVP
• PAWP
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HEMODYNAMIC CALCULATIONS
HD Calcs Output Parameters
The HD Calcs Output Parameters are parameters that are calculated based on the input parameters. The ability to
calculate certain output parameters is based on the input of the involved input parameters necessary for the
calculation formula. For example, if a PWAP is not measured or manually entered, the values for PVR, LCW and
LVSW and associated indices are not shown.
As the HD Calcs input numeric parameters are entered, the HD Calcs output numeric parameters automatically
update.
HD Calcs Output Parameters include:
• Stroke Volume (SV)
• Stroke Volume Index (SVI)
• Systemic Vascular Resistance (SVR)
• Systemic Vascular Resistance (SVRI)
• Pulmonary Vascular Resistance (PVR)
• Pulmonary Vascular Resistance Index (PVRI)
• Left Cardiac Work (LCW)
• Left Cardiac Work Index (LCWI)
• Left Ventricular Stroke Work (LVSW)
• Left Ventricular Stroke Work Index (LVSWI)
• Right Cardiac Work (RCW)
• Right Cardiac Work Index (RCWI)
• Right Ventricular Stroke Work (RVSW)
• Right Ventricular Stroke Work Index (RVSWI)
Resample
Once in the HD calculations dialogue, the HD calculations may be re-sampled based on the latest input values. The
resampling function is beneficial if the HD calculations are performed but the MAP, for example, was absent or
incorrect.
To Resample the HD calculations:
1. Select the Resample button in the HD calculations dialogue.
2. Notice the HD Calcs output numeric values change based on the new updated HD Calcs input values.
Print
To print the HD Calculations profile:
1. Select the Print button in the HD calculations dialogue.
2. The HD Calcs profile prints to the bedside recorder (optional) as configured.
3. The HD Calcs profile may print to the Surveyor Central Station (optional) as configured.
The HD Calcs numeric values are persistent upon exiting the HD Calcs dialogue until the patient is discharged, the
patient mode is changed, or the monitor is powered down/up.
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HEMODYNAMIC CALCULATIONS
156
25. LIST TRENDS
Overview
The Surveyor S12 and S19 patient monitors stores numeric parameter values every one minute, each time an NIBP
measurement is obtained, and every time an alarm condition occurs. The maximum trend storage is up to 72 hours
of tabular list trend data. If the maximum 72 hours has elapsed, the monitor discards the oldest list trend data on a
first in/first out basis. This is beneficial to the clinician because newest list trend data is always stored for review.
The clinician can determine the Trends display interval to maximize the visibility of the trend values.
The numeric parameter values that may be stored are:
• HR
• ST I, II, III, aVL, aVR, aVF, V1, V2, V3, V4, V5, V6
• RR
• NIBPs, NIBPd, NIBPm, NIBP timestamp
• EtCO2, FiCO2, IPI
• SpO2
• P1s, P1d, P1m
• P2s, P2d, P2m
• P3s, P3d, P3m
• P4s, P4d, P4m
• CO, CO timestamp
• T1, T2, ∆T
Trends Dialogue
The list Trends dialogue is where the list trends are displayed. The trends displayed are based on numeric
parameters that are currently monitored and those that have been monitored for that patient.
To access the Trends dialogue:
1. Select the Trends quick-action button on the right side of the main screen.
2. The Trends dialogue displays.
Figure 75 Example Trends Dialogue
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LIST TRENDS
The Trends dialogue shows list trends in a tabular format. The numeric parameters are displayed in the color of that
parameter on the main screen to allow for easier clinician visibility and identification. The most recent trend data is
observed at the top of the parameter column with the oldest data seen at the bottom of the parameter column.
Trends and Alarm Behaviors
Numeric parameters that are associated with an alarm condition are displayed in a reverse background in the color
of that parameter.
Page Up/Page Down Arrows
The page up and page down arrows are used to scroll through the pages of the patient’s vital signs trend data. Use
the arrows to view more list trend data than is observed on the screen.
To view newer data, select the Page Up arrow.
To view older data, select the Page Down arrow.
Interval
The display interval button allows the clinician to determine the display frequency of the trends in the Trends
dialogue. The display interval allows the clinician to zoom in and zoom out of trend data. The trend interval setting
only affects the display of trends and does not affect the storage of trends. The trends displayed contain the discreet
values associated with the displayed time stamp.
To adjust the display Interval of the list trends:
1. Select the Trends quick-action button on the right side of the main screen to display the Trends dialogue.
2. Locate the Interval label.
3. Select the arrow to display the drop down list box choices (1min, 5mins, 15mins, 1hour, 4hours).
4. The new display interval takes effect upon selection of the display interval.
5. The trends displayed contain the discreet values associated with the displayed time stamp.
Clear Trends
Trends clear upon discharge of the monitor. The Clear button allows the clinician to manually erase the list trends
stored in the patient monitor without performing a discharge.
To clear the list trends:
1. Select the Trends quick-action button on the right side of the main screen to display the Trends dialogue.
2. Locate the Clear button.
3. Selecting the Clear button displays a confirmation message.
a. Select OK to permanently delete the list trends.
b. Select Cancel to retain the list trends.
Print Trends
Trends may be printed to the bedside recorder and print what is displayed on the monitor.
It is also possible to print all available trends based on the currently defined interval. In this case, this will print all
available trend pages. This is helpful for documenting the patient conditions throughout an extended period, such
as in the case of a surgical procedure.
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LIST TRENDS
The Print and Print All button will only print trends on the local recorder and NOT on the Central Station. Note that
there is no means of stopping a print in progress. Take care in printing all of the trends when a long duration of
trends is available and the interval is set too narrowly, say every minute, as this will consume paper and may take
some time to complete.
To print list trends:
1. Select the Trends quick-action button on the right side of the main screen to display the Trends dialogue.
2. Select the Print button.
3. The trends displayed in the trend window are printed.
4. To print older trends:
a. Use the page arrows to display the desired trends for printing.
b. Select the Print button in the Trend dialogue.
To print all trends on the local recorder:
1. Select the Trends quick-action button on the right side of the main screen to display the Trends dialogue.
2. Confirm the interval setting.
3. Select the Print All button.
4. All trends are printed.
Close Trends
To close the Trends dialogue, select either the Close button in the Trends dialogue or select the Home quick-action
button on the main screen.
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LIST TRENDS
160
26. SETUP
Overview
The Setup quick-action key provides access to advanced functions such as arrhythmia settings, alarm settings, and
other monitor configuration menus.
Figure 76 Example Setup Dialogue
Patient Information
The Patient Information button provides access to the Patient Information dialogue. Access to this dialogue can also
be obtained by selecting the black patient information area located above the system date and time.
Information that can be entered includes Last Name, Middle Initial, First Name, ID, Room number, Mode, Gender,
Ethnicity, Date of Birth, Height and Weight.
Refer to the Patient Information dialogue section in this manual for further details.
To access the Patient Information dialogue from the Setup dialogue:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Patient Information button to access the Patient Information dialogue.
Parameters
The Setup Parameters dialogue is where the clinician can enable and disable the monitoring of certain parameters.
Disabling a parameter removes that parameter from the patient monitor’s main screen.
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SETUP
Figure 77 Example Setup Parameters Dialogue
To enable/disable a parameter:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Parameters button to access the Setup Parameters dialogue.
3. Locate the parameter label.
4. For ST Enabled, ETCO2 Enabled, and CO Enabled:
a. Select Yes to enable the parameter.
b. Select No to disable the parameter.
5. For IBP Channels, select the arrow to display the drop down list box:
a. Select 2 to enable P1 and P2.
b. Select 4 to enable P1, P2, P3, and P4.
c. Select None to disable all invasive pressure channels.
6. For Temperature Display Mode, select the arrow to display the drop down list box:
a. Select T1 only to display only T1 on the main screen.
b. Select T1 and T2 to display both temperatures on the main screen.
c. Select T1 and ∆T to display T1 and ∆T on the main screen.
7. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Waveforms
The Setup Waveform Area dialogue is where the clinician can choose which waveforms are displayed on the main
screen, the size of those waveforms, and the sweep speed of those waveforms. This dialogue is also where the
clinician can choose to overlap the invasive pressures on the main screen.
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SETUP
Figure 78 Example Setup Waveform Area Dialogue
The number of waveform slots available depends on a number of factors. For instance, when ST monitoring is
enabled an additional waveform slot is available. With ST monitoring disabled, this waveform slot is not available.
The number of IBP channels and whether all channels are shown and overlapped or not will also affect the total
number of waveform slots available. The maximum number of waveform slots is 8.
To select a waveform for display on the main screen:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Waveforms button to access the Setup Waveform Area dialogue.
3. The numbers 1-8 indicate waveform position on the main screen.
a. Waveform position #1 is always reserved for an ECG tracing.
b. Waveform positions #4-7 are reserved for an invasive pressure tracing when the “Show All Pressure
Wafeforms” is enabled. With this setting disabled, it is possible to use waveform slots 5 and 6 to
display waveforms for ECG or invasive pressure waveforms.
c. The waveform selections are based on monitor options, ECG lead set, and the parameters that have
been enabled/disabled in the Setup Parameters dialogue.
4. Choose the desired waveform position.
5. Select the arrow to display the drop down list box of available waveform choices.
6. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
To select a waveform size for display on the main screen:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Waveforms button to access the Setup Waveform Area dialogue.
3. Locate the Size label next to the parameter requiring adjustment.
4. Select the arrow to display the drop down list box of available waveform size choices.
a. The choices available are based on the specific waveform parameter.
b. Select the desired waveform size.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
To select the sweep speed for waveforms displayed on the main screen:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Waveforms button to access the Setup Waveform Area dialogue.
3. Locate the Sweep Speed label.
4. Select the arrow to display the drop down list box (Choices include 6.25 mm/s, 12 mm/s, and 25 mm/s).
5. Select the sweep speed desired.
6. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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SETUP
To enable/disable overlap invasive pressure waveforms:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Waveforms button to access the Setup Waveform Area dialogue.
3. Locate the Overlap Invasive Pressure label:
a. Select Yes to overlap all available invasive pressure.
b. The invasive pressures will occupy the space of four waveform slots.
c. The overlapped invasive pressure have independent waveform sizes.
d. Select No to keep the invasive pressure waveforms in separate waveform parameter tiles.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Recorder
The Surveyor S12 and S19 patient monitors may have a two-channel thermal bedside recorder as a purchasable
option. The Recorder dialogue provides configuration for which two waveforms print, the length of the recording
strip, and the recording delay.
Figure 79 Example Setup Recorder Dialogue
To select the two waveforms to print on the bedside recorder (optional):
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Recorder button to access the Setup Recorder dialogue.
3. Locate the Waveform 1 (prints in top waveform position of the thermal recorder printout) label.
4. Locate the Waveform 2 (prints in the bottom waveform position of the thermal recorder printout) label.
5. Select the arrow to display the drop down list box (Choices are dependent upon monitor configurations).
6. Select the waveform desired.
7. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
To select the recording length to print on the bedside recorder (optional):
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Recorder button to access the Setup Recorder dialogue.
3. Locate the Recording Time label.
4. Select the arrow to display the drop down list box (Choices are 5 seconds, 10 seconds, and 16 seconds).
5. Select the recording time desired.
6. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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SETUP
To select the recording delay for the bedside recorder (optional):
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Recorder button to access the Setup Recorder dialogue.
3. Locate the Recording Delay label.
4. Select the arrow to display the drop down list box (Choices are 0 seconds, 6 seconds, and 10 seconds).
5. Select the recording delay desired.
6. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Arrhythmia
Figure 80 Setup Arrhythmia Dialogue
To adjust Arrhythmia alarm settings:
1. Select the Setup quick-action key on the main screen.
2. Select the Arrhythmia button in the Setup menu.
3. Adjust the Arrhythmia alarm settings as desired.
a. To adjust the Alarm Level:
ƒ Locate the Alarm Level button.
ƒ Select the arrow to display the drop down list box with choices.
ƒ Select the appropriate choice.
b. To adjust the Print on Alarm:
ƒ Locate the Print On Alarm button.
ƒ Select Yes to enable the Print On Alarm.
c. Select No to disable the Print On Alarm.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
VFib, Asystole and VTach may not be turned off in this dialogue, are only available as high level alarms, and are
labeled as LETHAL.
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SETUP
To disable all the non-lethal arrhythmias with one action:
1. Select the Setup quick-action key on the main screen.
2. Select the Arrhythmia button in the Setup menu.
3. Select the Arrhythmia OFF button.
4. This action disables all the non-lethal arrhythmia alarms.
5. To re-enable a non-lethal arrhythmia, select the individual non-lethal arrhythmia and configure.
Alarm Suspend
The ability to suspend all alarms is a configurable feature determined by the system administration and is protected
behind a password in the Administration Setup Alarms dialogue. Contact the system administrator for further
details.
WARNING: IF this feature is enabled, suspending all alarms suspends ALL alarm conditions
including the lethal arrhythmias (VFib, VTach, and Asystole). Use this feature with extreme caution as
alarm checking is suspended for all alarm conditions including the lethal arrhythmias (VFib, VTach, and
Asystole). Patients must be closely observed if all alarms are suspended.
NOTE: Follow hospital standard of care for the use of this feature. This feature is only intended to be
used during end of life situations and only based on the hospital standard of care.
NOTE: This feature can be enabled/disable by the system administrator.
When this feature is enabled, during an Alarm Suspend mode, an Alarm Suspend message appears in the messaging
area of the main screen. Once the Alarm Suspend period ends the audio and visual alarm notifications automatically
resume.
When this feature is enabled, to enter the All Alarms Suspended Mode and suspend all alarm notifications
(including VFib, Vtach, and Asystole):
1. Select the Setup quick-action key on the main screen.
2. Select the Alarm Suspend button in the Setup menu.
• This displays the “Alarms Suspended” message in the message area on the main screen.
• ALL alarms are now suspended including the lethal arrhythmias (VFib, Vtach, and Asystole).
3. Select the Close button to close the Setup menu.
When this feature is enabled, to exit the All Alarms Suspended Mode and resume alarm notifications:
1. Select the Setup quick-action key on the main screen.
2. Select the Alarm Resume button in the Setup menu.
• This removes the “Alarms Suspended” message in the message area on the main screen.
• All configured alarms are now active.
3. Select the Close button to close the Setup menu.
Alarms
The Setup Alarms dialogue is where the clinician can make changes to several parameters are one time as opposed
to making changes through each individual numeric parameter’s tile.
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SETUP
Figure 81 Example Setup Alarms Dialogue
To adjust numeric parameter alarm settings:
1. Select the Setup quick-action key on the main screen.
2. Select the Alarms button in the Setup menu.
3. Locate the numeric parameter to adjust. Select the Next Page button to scroll to see more numeric
parameters (based on monitor configuration).
4. Adjust the numeric alarm settings as desired.
a. To adjust the Lower and High alarm limits:
ƒ Adjust the Lower alarm limit by selecting the up/down arrows to move the lower alarm limit box
until the desired value is reached.
ƒ Adjust the Upper alarm limit by selecting the up/down arrows to move the upper alarm limit box
until the desired value is reached.
b. To Auto adjust the alarm limit values:
ƒ Select the Auto button.
c. To adjust the Alarm On/Off:
ƒ Select Yes to enable that parameters’ alarms.
ƒ Select No to disable that parameters’ alarms.
ƒ The Alarm Off icon displays in that numeric parameter tile.
WARNING: Disabling the parameters’ alarm limits means that NO low or high alarm
conditions for that parameter will produce alarm notifications. Use this feature with extreme
caution.
NOTE: The Lower Limit and Higher Limit windows in this dialogue may contain limit values but
these alarms ARE disabled if that numeric parameters ’ Alarms on button is set to NO.
d.
5.
To adjust the Print on Alarm:
ƒ Locate the Print On Alarm button.
ƒ Select Yes to enable the Print On Alarm.
ƒ Select No to disable the Print On Alarm.
Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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SETUP
Audio
The Setup Audio dialogue is where the speaker volume and the HR/PR tone volume are configured. This area is
also where the HR/PR systole beep tone can be enabled and disabled.
Figure 82 Example Setup Audio Dialogue
To adjust the speaker volume:
1. Select the Setup quick-action key on the main screen.
2. Select the Audio button in the Setup menu.
3. Locate the Speaker Volume label.
4. The Speaker Volume choices are 1 to 10 in increments of 1.
a. Select the Up arrow to increase the speaker volume.
b. Select the Down arrow to lower the speaker volume.
c. As the volume is adjusted, an audible tone is played to indicate the volume of the speaker.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
To adjust the HR/PR systole beep tone volume:
1. Select the Setup quick-action key on the main screen.
2. Select the Audio button in the Setup menu.
3. Locate the HR/PR Tone Volume label.
4. The HR/PR Tone Volume choices are 1 to 10 in increments of 1.
a. Select the Up arrow to increase the HR/PR systole beep volume.
b. Select the Down arrow to lower the HR/PR systole beep volume.
c. As the volume is adjusted, an audible tone is played to indicate the volume of the HR/PR systole beep.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
To enable/disable the HR/PR systole beep tone:
1. Select the Setup quick-action key on the main screen.
2. Select the Audio button in the Setup menu.
3. Locate the HR/PR Tone label.
a. Select Yes to enable the HR/PR systole beep tone.
b. Select No to disable the HR/PR systole beep tone.
4. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
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SETUP
Restore Departmental Defaults
Figure 83 Restore Departmental Defaults
To restore the patient monitor back to the departmental default configuration:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Restore Departmental Defaults button.
3. Select the OK button to enter OR select the Cancel button to cancel the changes.
Administration
The Administration dialogue contains service and configuration related functions. The functions located on the left
of this dialogue do not require a password. The functions located on the right of this dialogue are passwordprotected. Contact the system administration for further details.
Figure 84 Example Administration Dialogue
169
SETUP
Configuration
Selecting this item displays the setup of this Surveyor including its serial number, Ethernet MAC address, internal
software version as well as those of accessories and modules integrated with this system. There are no
configuration options here but this information is helpful for service personnel when analyzing the system for
issues.
Figure 85 Example Setup Configuration Dialogue
Communications
Use this dialogue to configure the communication parameters of the Surveyor including the Bed ID, Unit ID as well
as the network parameters for both the Surveyor Central and this Surveyor patient monitor. Alternatively, if the
patient monitor is interfaced to a 3rd party EMR application, this setting can also be defined here. This information
is typically defined by authorized installation and service personnel.
Specific configuration parameters include:
• Bed ID and Unit ID for interfacing with Surveyor Central.
• TCP/IP network parameters including host name, IP address, and port number for Surveyor Central.
• Whether dynamic host control protocol (DHCP) is utilized by the Surveyor to obtain IP address
information for the bedside monitor. If not, the user can define specific static IP addresses including IP
address, subnet mask, gateway address and Domain Name System (DNS) address information.
• Define the Connect Type to “ZAC” for Surveyor Central.
• For interfacing to 3rd party EMR applications, define the Connect Type as “Serial”. All other settings in
this screen will not matter and may be blank.
170
SETUP
Figure 86 Example Setup Communications Dialogue
Connectivity
When interfacing to 3rd party EMR applications, the connectivity type must be defined. The typical setting for most
EMR applications is “1”.
NOTE: Contact Mortara Technical Support for a list of approved and supported EMR applications.
171
SETUP
Screen Cleaning
Based on the clinician’s discretion, the bedside monitor’s touch screen may require occasional cleaning. The touch
screen may be cleaned with a soft, lint-free cloth and a non-abrasive, gentle cleaner such as plain soap and water.
Avoid spraying cleaning agents directly onto the monitor’s touch screen. Spray the cleaning agent onto the lint-free
cloth first and then wipe the touch screen. Do not use any cleaning agents that may leave a film.
To clean the touch screen:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Administration button.
3. Select the Screen Cleaning button.
4. The “Screen Cleaning Mode” message displays in the alarm messaging area of the main screen.
5. During this 15 seconds, patient monitoring and alarm notifications continue.
6. After the 15 seconds has expired, the touch screen activates.
Administration Setup Alarms Dialogue
The Administration Setup Alarms dialogue is a password protected feature. Contact the system administrator for
further details.
Figure 87 Administration Setup Alarms Dialogue
Alarm Silence Time
This setting controls the length of silence time for the Alarm Silence quick-action key on the main screen.
To select the Alarm Silence Time:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Administration button.
3. Select the Alarms button to access the Administration: Setup Alarms dialogue.
4. Locate the Alarm Silence Time label.
5. Select the arrow to display the drop down list box (Choices are 1 minute, 1.5 minutes, 2 minutes,
5 minutes and 10 minutes).
6. Select the alarm silence time desired.
7. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
172
SETUP
Alarm Suspend Time
This setting controls the length of silence time for the Alarm Suspend function.
To select the Alarm Suspend Time:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Administration button.
3. Select the Alarms button to access the Administration: Setup Alarms dialogue.
4. Locate the Alarm Suspend Time label.
5. Select the arrow to display the drop down list box (Choices are 1 minute, 1.5 minutes, 2 minutes,
5 minutes and 10 minutes).
6. Select the alarm silence time desired.
7. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Can Suspend All Alarms
This setting controls if the clinician has the ability to suspend all alarms including the lethal arrhythmias
(Asystole, VTach, and VFib).
To configure:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Administration button.
3. Select the Alarms button to access the Administration: Setup Alarms dialogue.
4. Locate the Can Suspend All Alarms label.
a. Selecting Enabled means the clinician can suspend all alarms including the lethal
arrhythmias.
b. Selecting Disabled means the clinician cannot disable all alarms. If this choice is selected,
the Suspend All Alarms button will be hidden from the Setup dialogue.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Can Disable HR/PR Alarms
This setting controls if the clinician has the ability to disable the HR/PR alarms.
To configure:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Administration button.
3. Select the Alarms button to access the Administration: Setup Alarms dialogue.
4. Locate the Can Disable HR/PR Alarms label.
a. Selecting Enabled means the clinician can disable the HR/PR alarms.
b. Selecting Disabled means the clinician cannot disable the HR/PR alarms.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
173
SETUP
Alarm Delay
This setting determines if the monitor uses a delay before providing alarm notifications. This feature is
intended to reduce erroneous alarm notifications.
To configure:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Administration button.
3. Select the Alarms button to access the Administration: Setup Alarms dialogue.
4. Locate the Alarm Delay label.
a. Select Yes to enable the alarm delay.
b. Select No to disable the alarm delay.
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
If enabled, the alarm delay values are based on the specific parameter and as follows:
Parameter
Lower limit violation delay
Upper limit violation delay
HR, PR (from SpO2), PR (from IBP)
3 seconds
3 seconds
RR
5 seconds
5 seconds
Mortara SpO2, Nellcor SpO2 (SatSeconds
disabled)
10 seconds
10 seconds
IPI
10 seconds
0 seconds
Nellcor SpO2(SatSeconds enabled), all other
parameters
0
0
Second Speaker Time (Minutes)
The Surveyor has a second speaker that provides additional audible notification when the initial audible
alarm is not acknowledged and silenced. The second speaker begins sounding approximately 1 second
after a pre-defined amount of time has passed if the initial alarm sound has not been silenced.
To configure the second speaker alarm time:
1. Select the Setup quick-action key on the main screen to access the Setup dialogue.
2. Select the Administration button.
3. Select the Alarms button to access the Administration: Setup Alarms dialogue.
4. Locate the Second Speaker Time (Minutes) label.
• Select the Up/Down arrow to rotate through the choices (Choices include 0 minutes, 1
minute, 2 minutes, and 3 minutes).
5. Select the OK button to enter that change OR select the Cancel button to cancel the changes.
Administration Setup System Dialogue
The System dialogue is a password protected area intended for use by service and system administrative personnel
only. The Setup System dialogue is where the units of measure are configured for height, weight, and temperature.
This dialogue is also used to configure the print location, set the date and time, and to save departmental default
settings. Contact service or system administrator for further details.
174
SETUP
The following table lists specific reports and where they may be printed based on system configuration.
Recording type
Prints at
Strip chart (initiated by pressing the Print soft key on monitor)
Print location setting
(Bedside, Central, or both)
12 lead report
Print location setting
(Bedside, Central, or both)
Alarm report
Print location setting
(Bedside, Central, or both)
Trend report
Bedside
ST averages
Bedside
Administration Setup Service Dialogue
The Service dialogue is a password protected area intended for use by service and system administrative personnel
only. The Setup Service dialogue is where the demonstration mode for simulated data on the patient monitor is
enabled and disabled. This dialogue is also where the monitor settings can be transferred to and from a USB thumb
stick when configuring multiple monitors. The monitor can be returned to the factory default configuration settings
in this dialogue. Contact service or system administrator for further details.
Administration Setup Factory Dialogue
The Factory dialogue is a password protected area intended for use by service and administrative personnel only.
Contact service or system administrator for further details.
175
SETUP
176
27. PRODUCT SPECIFICATIONS
General Specifications
Dimensions
S12:
S19:
315 W x 203 H x 125 D mm (12.4 W x 8.0 H x 4.9 D inches)
468 W x 289 H x 97 D mm (18.4 W x 11.4 H x 3.8 D inches)
S12: 3 Kg (6.6 lbs)
Standard configuration; including battery and built-in recorder
Weight
S19: 5 Kg (11.2 lbs)
Standard configuration, including battery; excluding recorder
Type of Protection (Electrical)
Class I
Degree of Protection
(Electrical)
Type CF Applied Parts
Degree of Protection (Water)
Drip Proof (IPX1)
Disinfecting Method
Per the instructions in the General Care & Maintenance section
Degree of Safety (Flammable
Anesthetic Mixture)
Not suitable for use in the presence of a Flammable Anesthetic Mixture including O2 or
N2O
Mode of Operation
Continuous
Languages
English, Italian, German, Spanish, Portuguese, French, Dutch, Hungarian, Polish and
Croatian
Units of measure
(each set independently)
English (inches, lbs, °F, mmHg)
Metric (cm, kg, °C)
Network Interface
IEEE 802.3 100 Ethernet 10/100 RJ45 networking with static or dynamic IP for interface
to Surveyor Central monitoring station.
Serial Interface
Support for interfacing with approved EMR applications using RS-232 connectivity
Patient Risk Current
Complies with IEC 60601-1 Leakage Current Requirements
Casing Material
PC-ABS
177
PRODUCT SPECIFICATIONS
Environmental Conditions
Temperature
Operating temperature:
Storage temperature:
+0° to +40° C (+32° to +104° F)
-20° to +60° C (-4° to +140° F)
Humidity
Operating humidity:
Storage humidity:
15% to 90% RH, non-condensing
15% to 95% RH, non-condensing
Altitude
Operating:
Storage:
0 to 4572 m (0 to 15,000’)
0 to 12192 m (0 to 40,000’)
Cooling
Convection (no fan)
Shock
Per IEC 60068-2-27
Vibration
Per IEC 60068-2-64
Power Requirements & Battery
Power Source
AC Power / Battery
AC Power Source
External AC Power Adapter (Mortara REF: 4101-012)
100 – 240 VAC; 1.2 A max; 50 – 60 Hz
Class I, Continuous Use
Power Consumption
S12:
S19:
Startup Time
Less than 46 seconds
Battery Type
Internal Lithium-Ion Rechargeable 8700 mAh (Mortara REF: 4800-017)
Battery Life
S12:
S19:
Battery Charging Time
When off: 5 hours
When On:
S12: 7 hours
S19: 20 hours
18W nominal, 29W (when charging battery)
27W nominal, 29W (when charging battery)
3 hours*
2 hours*
Display Specifications
Type
High definition, antiglare 16:9 Color TFT-LCD with LED backlight and resistive touch
panel controls
Size & Resolution
S12:
S19:
178
11.6 inches diagonal; 256mm x 144 mm active area; 1366 x 768 pixels
18.5 inches diagonal; 410mm x 230 mm active area; 1366 x 768 pixels
PRODUCT SPECIFICATIONS
Recorder Specifications
Type
Thermal
Patient Monitors
S12: Optional, configured
S19: Optional, modular
Print Width
48 mm
Paper Width
50 mm
Recording
Strip chart printing of two selectable waveforms
Recorder Speed
25 mm/sec
Recorder Resolution
200 dpi (v) x 400 (h) dpi
Waveform Recording
Any two of
•
ECG (I, II, III, avR, avL, avF, or V)
•
SpO2
•
CO2
•
IBP (P1, P2, P3 or P4)
Recording Time
(Total duration of recording)
5, 10 & 15 seconds
Recording Delay
(Recorded data prior to
Alarm/Print condition)
0, 6 & 10 seconds
Mounting Specifications
Per the Flat Display Mounting Interface (FDMI), also known as VESA Mounting Interface Standard (MIS), of the Video
Electronics Standards Association.
Conforms to MIS-D 75 (75 mm × 75 mm) and MIS-D 100 (100 mm × 100 mm) standards for optional mounting on a rolling
stand (max. height 100 cm or 43 inches), wall mount or articulating wall mount using Mortara specified accessories.
Trending
Trending
Up to 72 hours of numeric parameter information
179
PRODUCT SPECIFICATIONS
180
28. PARAMETER SPECIFICATIONS
Patient Population
Monitoring Capabilities
Adult or Pediatric
Waveforms
8 total slots available
Top waveform (Position #1)always reserved for an ECG tracing
Bottom four waveforms (Position #5, 6, 7, and 8) always reserved for invasive pressures.
Waveform Slots
Configurable based on available parameters
•
ECG any of I, II, III, V, aVL, aVR or aVF
•
SpO2
•
CO2 or impedance respiration
•
IBP P1, P2, P3 or P4
Waveform Sweep Speed
6.25 ms, 12.5 ms, 25 ms & 50 ms
Waveform Delay
0.5 seconds on all parameters
ECG
ECG
3/5 Lead Cable or Mortara AM12 12-Lead ECG Acquisition Module
ECG Interpretation
Available with AM12 only
ECG Modes
Adult / Pediatric
Simultaneous Leads Available
3 Lead Cable:
5 Lead Cable:
AM12:
I, II, III
I, II, III, aVR, aVL, aVF, V
I, II, III, aVR, aVL, aVF, V1, V2, V3, V4, V5, V6
Acquisition Rate:
3/5 Lead Cable:
AM12:
250 samples/s
40,000 samples/s initially, reduced to 500 s/s for analysis
Resolution:
3/5 Lead Cable:
AM12:
2.5µV
1.17µV reduced to 2.5µV for analysis
Dynamic Range/Offset
Tolerance:
± 300mV
ECG Gain
2.5, 5, 10, or 20 mm/mV
CMRR:
According to AAMI EC13 and IEC60601-2-27
Max. Auxiliary Patient Current:
< 10 µA
3/5 Lead Cable:
Frequency Response Filtering:
AM12:
Input Impedance:
Diagnostic or ST Monitoring: 0.05 to 40 Hz
Monitoring: 0.67 to 40 Hz
Diagnostic: 0.05 to 150 Hz
>2.5 MOhm at 10 Hz
181
PARAMETER SPECIFICATIONS
Electrodes:
Must be compatible with EN 60601-2-27
Beat Detection:
Sensitivity 99.90%, positive predictivity 99.88% (AHA/MIT database)
Beat Recognition:
Normal, Ventricular, Paced, Unknown
The algorithm calculates the heart rate from its available source.
If the heart rate from the last four R to R intervals is greater than 48 beats per minute, the
average heart rate is determined by averaging the last 16 R to R intervals.
HR Averaging
If the heart rate from the last four R to R intervals is less than or equal to 48 beats per
minute, then this rate is used.
Paced beats and PVCs are included in the heart rate calculation.
HR Range:
15 to 300 bpm Adult and Pediatric
HR Resolution
1 beat per minute
HR Availability:
Within 6 s after appearance of traces
HR Measurement Accuracy
Measurement error (RMS) as measured according to ANSI/AAMI EC57: 2.8% AHA
database, 1.7% MIT database
HR Report Interval
1 second
Minimum QRS Amplitude:
300µV
Notch AC-Filter:
50, 60 Hz
Pacer Display/Analysis
Clinician selectable
Arrhythmia Analysis
Arrhythmia Detection
VFib, Asystole, VTach, PVC Run, VRhythm, Couplet, Bigeminy, Sustained Tachycardia,
Sustained Bradycardia, Irregular, PVC/m too high, Pause, Pacer Non-Capture
VFib Detection:
ECG Leads Used
3 lead: Displayed ECG vector
5 lead and AM12: II, V1, and V5.
3 lead:
Displayed ECG vector
Beat Detection:
ECG Leads Used
182
5 lead:
•
When configured to Auto, the ECG leads used for HR and ARR processing start with
II and V for detection and III for confirmation while allowing the algorithm to switch
to other available leads based on signal quality.
•
When configured to Single Lead, the ECG lead used for HR and ARR processing is
the one specified by the user from the set I, II, III, or V.
•
When configured to Multiple Leads, the ECG leads used for HR and ARR processing
are selected internally from the set II and V for detection, and III for confirmation.
PARAMETER SPECIFICATIONS
AM12:
•
•
•
When configured to Auto, the ECG leads used for HR and ARR processing start
with II and V5 for detection and V1 for confirmation while allowing the algorithm
to switch to other available leads based on signal quality.
When configured to Single Lead, the ECG lead used for HR and ARR processing
is the one specified by the user from the set I, II, III, or V (V1).
When configured to Multiple Leads, the ECG leads used for HR and ARR
processing are selected internally from the set II and V5 for detection, and V1 for
confirmation.
3 lead:
Displayed ECG vector
Beat Typing:
ECG Leads Used
5 lead:
•
When configured to Auto, the ECG leads used for HR and ARR processing start with
II and V for detection and III for confirmation while allowing the algorithm to switch
to other available leads based on signal quality.
•
When configured to Single Lead, the ECG lead used for HR and ARR processing is
the one specified by the user from the set I, II, III, or V.
•
When configured to Multiple Leads, the ECG leads used for HR and ARR processing
are selected internally from the set II and V for detection, and III for confirmation.
AM12:
•
•
•
When configured to Auto, the ECG leads used for HR and ARR processing start
with II and V5 for detection and V1 for confirmation while allowing the algorithm
to switch to other available leads based on signal quality.
When configured to Single Lead, the ECG lead used for HR and ARR processing
is the one specified by the user from the set I, II, III, or V (V1).
When configured to Multiple Leads, the ECG leads used for HR and ARR
processing are selected internally from the set II and V5 for detection, and V1 for
confirmation.
VTach Rate Threshold
Configurable from 100-200 beats per minute. For a VTach condition to be considered, the
rate of the ventricular rate must be greater than the configured VTach rate.
VTach Count (PVC Run)
Configurable from 3-20 consecutive ventricular beats. For a VTach condition to be
considered, the length of the ventricular waveform must be greater than the configured
VTach length.
ST Analysis
ST Segment Analysis
Sensing leads: Any ECG lead available based on lead set used
ST Measurement Accuracy
Range: 2500 to +2500 µV, Mean Error = 7 µV (Std Dev = 63 µV) per EC57 on ESC-ST
database
Averaging
Over rolling 32 beats
Alarm Delay
60 seconds
183
PARAMETER SPECIFICATIONS
Non-Invasive Blood Pressure (NIBP)
Type:
Oscillometric
Input Connector
Single Lumen Hose (Quick-Disconnect fitting)
Cuffs
Child, Small Adult, Regular Adult, Large Adult, Thigh
Rated Cuff Pressure Range
0 to 270 mmHg
Derived Parameters
Systolic, Mean, Diastolic
Resolution
1 mmHg
Measurement Range
Systolic: 30 to 250 mmHg
Mean: 20 to 230 mmHg
Diastolic: 10 to 210 mmHg
Measurement Accuracy
Sys: ±5mmHg (std. dev. < 8mmHg)
Mean: ±5mmHg (std. dev. < 8mmHg)
Dia: ±5mmHg (std. dev. < 8mmHg)
Pulse Rate Range
30 to 240 bpm
Pulse Rate Accuracy
±5% or ±2 bpm, whichever is greater
Update Interval
Upon measurement completion
Measurement Time
30 seconds (typical)
< 135 seconds (maximum)
Initial Cuff Pressure
Adults: 160 mmHg (clinician-selectable)
Pediatrics: 120 mmHg (clinician-selectable)
Repeated Cuff Pressure
Previous systolic + 40 mmHg
Static Cuff Pressure Accuracy
±3 mmHg
Overpressure Cutoff
290 ± 3 mmHg (normal means), 300 ± 30 mmHg (back-up)
Measurement Modes
Single Measurement or Auto (Interval) Measurement
Auto Measurement Settings
OFF, 2, 3, 5, 10, 15, 30, 60 minutes
Pulse Oximetry (SpO2)
Module
Nellcor or Mortara
Application
Adult / Pediatric
Method
Absorption – Spectrophotometric (dual wavelength)
(Functional oxygen saturation of arterial hemoglobin)
Parameters
Plethysmogram (trace), % SpO2, Pulse rate
Resolution
SpO2: 1% O2
PR: 1 bpm (beat per minute)
184
PARAMETER SPECIFICATIONS
Measurement Range
SpO2: 30 – 100 %, calibrated range 70-100%
PR: 30 – 240 bpm (Mortara)
PR: 25 – 250 bpm (Nellcor)
Measurement Accuracy
SpO2: from 70 to 100%: ±2% (O2%), < 70%: unspecified
PR: ±3 bpm
Measurement Test Method
Per ISO9919 Clause 50
(Mortara SpO2 ARMS = 1.73%)
(Nellcor SpO2 ARMS = 1.9%)
Report Interval
1 second. Numeric values held < 30 seconds
Pulse Tone
Yes (pulse tone pitch tied to SpO2 parameter value)
Temperature
Parameters
T1, T2 or ΔT; Direct-Mode
Compatibility
YSI 400-series probes
Input Connector
2-pin connector
Display Patient monitors
°F and °C (clinician-selectable)
Measurement Resolution
0.1 °C (0.1 °F)
Measurement Range
T1 & T2: 5.0 to 50.0 °C (41.0 to 122.0 °F)
ΔT: 0.0 to 50.0 °C (32.0 to 122.0 °F)
Measurement Accuracy
±0.1 °C plus probe tolerance
Transient Response
Within 30 seconds from 25 to 27 °C
Respirations: Via ECG Impedance
Method
Impedance Pneumography
Input Connector
Available via 3/5 ECG Cable only
Sensing Lead
II
RR Resolution
1 bpm (breaths per minute)
Measurement Range
2 to 120 bpm
Measurement Accuracy
±3 bpm
Measurement Sensitivity
0.25 ohms (minimum)
Report Interval
1 second
Bandwidth
0.17 to 3.3 Hz (-3dB)
Impedance Measuring Current
40 μA @ 28 kHz square wave across Lead II
185
PARAMETER SPECIFICATIONS
Capnography (CO2)
Method
Side-stream (Non-dispersive IR absorption)
Input Connector
Oridion Microstream FilterLine®. See Accessories chapter.
Displayed Parameters
End Tidal CO2, Respiration Rate, FiCO2 and Integrated Pulmonary Index (IPI)
Displayable Waveform
Continuous CO2
Measurement Resolution
EtCO2 + FiCO2: 1 mmHg
Respiration: 1 bpm (breath per minute)
Measurement Range
etCO2: + FiCO2: 0 to 150 mmHg
Respiration: 0 to 150 bpm
EtCO2: + FiCO2:
0 to 38 mmHg: ± 2 mmHg
38 to 150 mmHg: ± (5% of reading + 0.08% for every 1 mmHg > 38 mmHg)
Measurement Accuracy
(at sea level)
Accuracy applies for breath rates of up to 80 bpm. For breath rates above 80 bpm,
accuracy is 4 mmHg or ±12 % of reading whichever is greater, for EtCO2 values exceeding
18 mmHg. This is tested according to and is compliant with ISO 21647. To achieve the
specified accuracies for breath rates above 60 breaths/minute, the Microstream FilterLine H
Set for Infant/Neonatal (p/n 006324) must be used. Above 55°C module temperature, ±
1mmHg or ± 2.5% (whichever is greater) has to be added to the tolerance of the accuracy
specs.
Respiration:
0 to 70 bpm: ± 1 bpm
71 to 120 bpm: ± 2 bpm
121 to 150 bpm: ± 3 bpm
ETCO2, FICO2 and Respiration accuracy tested according to ISO21647 using a mixture of
gases (5% CO2, 21% O2, N2 balance) supplied via function generator and breath simulator
application. Respiration rates from 10-60 bpm for adults/pediatrics and 60-110 bpm for
infants as measured in 10 bpm discrete steps were tested for 1 minute before moving
forward to the next value and at the end of this one minute period modules readings were
taken.
Report Interval
1 second
Flow Rate
50 ml / min (-7.5 to +15 ml / min), flow measured by volume
Warm-up Time required to
meet accuracy specifications
Typical: 30 seconds
Max: 180 seconds
(Readings are not reported until warm-up has completed
Barometric Pressure Range
430 to 795 mmHg
Automatic Barometric
Compensation
Yes
Total System Response Time
3.5 seconds (typical) using standard Microstream FilterLine®
Drift of measurement
Accuracy
Meets accuracy specifications when the calibration schedule is followed in the General
Care & Maintenance section.
186
PARAMETER SPECIFICATIONS
Measurement Accuracy for
Gas Mixture
Meets ISO 21647 Clause 51.101.3 (Tables 101 and 103):
± (volume fraction of 0.43% + 8% of gas level)
Measurement Accuracy in the
Presence of Interfering Gases
Meets ISO 21647 Clause 101.1 (Tables 101 and 105):
± (volume fraction of 0.43% + 8% of gas level)
Invasive Pressures
Number of channels
P1, P2 (standard) and P3 or P4 (optional)
Sensitivity:
5µV/V/mmHg
Transducer Excitation Voltage
5V DC
Resolution:
1 mmHg
Measurement Range
-50 to 300 mmHg
Measurement Accuracy
±1 mmHg or ±1%, whichever is greater
Report Interval
Every 3 seconds
PR Range
30 – 250 bpm
PR Accuracy
±2 bpm or ±2%, whichever is greater
PR Resolution
1 bpm
Frequency Response:
0 – 12 Hz
Linearity Error:
< 1% or 1 mmHg
Measurement Patient monitors:
mmHg
Parameters:
Diastolic, Systolic, Mean for all types except Mean-only for CVP, RA, LA & ICP
Defibrillator Protection:
Requires transducers that withstand defibrillation as required by ANSI/AAMI BP 22
Zero Setting:
At connection of transducer, over complete pressure range, within 0.1 mmHg Manual
187
PARAMETER SPECIFICATIONS
Cardiac Output
Method
Thermodilution
CO Resolution
0.1 liters per minute
CO Measurement Range
0.3 to 20.0 liters per minute
CO Measurement Accuracy
±5% at 0 °C injectate
Update Interval
After each measurement
Measurement Start
Automatic, Manual
CO Averaging Support
Yes
Blood Temperature Probe
Compatibility
3 pin thermistor (Edwards)
Blood Temperature Patient
monitors
°C, °F
Blood Temperature Resolution
0.01 °C
Blood Temperature
Measurement Range
33.0 to 40.0 °C
Injectate Temperature Probe
Compatibility
In-line (Edwards), Bath (YSI)
Injectate Temperature Units of
Measure
°C, °F
Injectate Temperature
Resolution
0.1.°C
Injectate Temperature
Measurement Range
0.0 to 40.0 °C
Computation Constant
Resolution
0.001
Computation Constant Range
0.000 to 0.999
Hemodynamic Calculations:
CO, CI, BSA, SV, SVI, SVR, SVRI, PVR, PVRI, LVSW, LVSWI, RCW, RCWI, RVSW,
RVSWI, PAWP
188
29. PARAMETER ALARM LIMIT RANGES
The high and low alarm limit ranges are as per the tables below.
Adult Patient Mode
Parameter
Heart Rate
Lower Limit
Range
(Factory Default)
Off, 20 – 269 (50)
Upper Limit
Range
(Factory Default)
50 – 270, Off (120)
Alarm Level
(Factory Default)
Alarms On
Choices
(Factory Default)
Print on Alarm
Choices
*Med
No, *Yes
No* , Yes
Bradycardia
10 – 90 (40)
Off*, High
(Non Applicable)
No* , Yes
Tachycardia
80 – 280 (150)
Off*, High
(Non Applicable)
No* , Yes
ST Increase
(Non Applicable)
Off*, Low, Med,
(Non Applicable)
No* , Yes
ST Decrease
(Non Applicable)
Off*, Low, Med,
(Non Applicable)
No* , Yes
1.0 – 9.0 (2.0)
(Non Applicable)
(Non Applicable)
(Non Applicable)
ST Change
NIBP Systolic
Off, 30 – 258 (75)
32 – 260, Off (220)
*Med
No, *Yes
No* , Yes
NIBP Mean
Off, 20 – 253 (50)
22 – 255, Off (120)
*Med
No, *Yes
No* , Yes
NIBP Diastolic
Off, 10 – 233 (35)
12 – 235, Off (110)
*Med
No, *Yes
No* , Yes
SpO2
Off, 50 – 98 (90)
52 – 100, Off (100)
*Med
No, *Yes
No* , Yes
T1
°C : Off, 15.0– 44.9
(35.0)
°F: Off, 59.0 –
112.8 (95.0)
°C : 15.1 – 45, Off
(37.8)
°F : 59.2 – 113.0, Off
(100.0)
*Med
No, *Yes
No* , Yes
T2
°C : Off, 15.0– 44.9
(35.0)
°F : Off, 59.0 –
112.8 (95.0)
°C: 15.1 – 45, Off
(37.8)
°F : 59.2 – 113.0, Off
(100.0)
*Med
No, *Yes
No* , Yes
ΔT
°C: Off, 0.0 – 29.9
(0.0)
°F : Off, 0.0 – 53.8
(0.0)
°C : Off, 0.1 – 30.0
(2.8)
°F : 0.2 – 54, Off
(5.0)
*Med
No, *Yes
No* , Yes
Resp Rate
Off, 2 – 118 (5)
4 – 120, Off (30)
*Med
No, *Yes
No* , Yes )
ETCO2
Off, 0 – 97 (25)
2 – 99, Off (60)
*Med
No, *Yes
No* , Yes
FICO2
(Non Applicable)
1 – 25, OFF (5)
*Med
No, *Yes
No* , Yes
IPI
Off, 1 – 9 (4)
(Non Applicable)
*Med
No, *Yes
No* , Yes
*Factory Default Settings
189
PARAMATER ALARM LIMIT RANGES
Parameter
Lower Limit
Range
Upper Limit
Range
Alarm Level
Alarms On
Choices
Print on Alarm
Choices
P1 Systolic
Off, -30 – 298 (*75)
-28 – 300, Off (*220)
*Med
No, *Yes
No* , Yes
P1 Mean
Off, -30 – 298 (*50)
-28 – 300, Off (*120)
*Med
No, *Yes
No* , Yes
P1 Diastolic
Off, -30 – 298 (*35)
-28 – 300, Off (*110)
*Med
No, *Yes
No* , Yes
P2 Systolic
Off, -30 – 298 (*15)
-28 – 300, Off (*50)
*Med
No, *Yes
No* , Yes
P2 Mean
Off, -30 – 298 (*10)
-28 – 300, Off (*25)
*Med
No, *Yes
No* , Yes
P2 Diastolic
Off, -30 – 298 (*5)
-28 – 300, Off (*20)
*Med
No, *Yes
No* , Yes
P3 Systolic
Off, -30 – 298 (*35)
-28 – 300, Off (*110)
*Med
No, *Yes
No* , Yes
P3 Mean
Off, -30 – 298 (*15)
-28 – 300, Off (*50)
*Med
No, *Yes
No* , Yes
P3 Diastolic
Off, -30 – 298 (*10)
-28 – 300, Off (*25)
*Med
No, *Yes
No* , Yes
P4 Systolic
Off, -30 – 298 (*35)
-28 – 300, Off (*110)
*Med
No, *Yes
No* , Yes
P4 Mean
Off, -30 – 298 (*15)
-28 – 300, Off (*50)
*Med
No, *Yes
No* , Yes
P4 Diastolic
Off, -30 – 298 (*10)
-28 – 300, Off (*25)
*Med
No, *Yes
No* , Yes
*Factory Default Settings
190
PARAMATER ALARM LIMIT RANGES
Pediatric Patient Mode
Parameter
Heart Rate
Lower Limit Range
Off, 20 – 100 (50)
Upper Limit
Range
50 – 250, Off (150)
Alarm Level
Alarms On
Choices
Print on Alarm
Choices
*Med
No, *Yes )
No* , Yes
Bradycardia
10 – 90 (40)
Off, High
(Off)
No, Yes (No)
Tachycardia
80 – 280 (180)
Off, High
(Off)
No, Yes (No)
ST Increase
(Non Applicable)
Off, Low, Med
(Non Applicable)
(Med)
No, Yes (No)
ST Decrease
(Non Applicable)
Off, Low, Med
(Non Applicable)
(Med)
No, Yes (No)
ST Change
1.0 – 9.0 (2.0)
(Non
Applicable)
(Non Applicable)
(Non Applicable)
NIBP Systolic
Off, 30 – 158 (75)
32 – 160, Off (145)
*Med
No, *Yes
No* , Yes
NIBP Mean
Off, 15 – 138 (50)
17 – 140, Off (110)
*Med
No, *Yes
No* , Yes
NIBP Diastolic
Off, 10 – 128 (35)
12 – 130, Off (100)
*Med
No, *Yes
No* , Yes
SpO2
Off, 50 – 98 (90)
52 – 100, Off (100)
*Med
No, *Yes
No* , Yes
°C : 15.1 – 45, Off
(37.8)
°F : 59.2 – 113.0, Off
(100.0)
*Med
No, *Yes
No* , Yes
T1
°C : Off, 15.0– 44.9
(35.0)
°F: Off, 59.0 – 112.8
(95.0)
°C: 15.1 – 45, Off
(37.8)
°F : 59.2 – 113.0, Off
(100.0)
*Med
No, *Yes
No* , Yes
T2
°C : Off, 15.0– 44.9
(35.0)
°F : Off, 59.0 – 112.8
(95.0)
°C : Off, 0.1 – 30.0
(2.8)
°F : 0.2 – 54, Off
(5.0)
*Med
No, *Yes
No* , Yes
ΔT
°C: Off, 0.0 – 29.9
(0.0)
°F : Off, 0.0 – 53.8
(0.0)
Resp Rate
Off, 2 – 118 (10)
4 – 120, Off (45)
*Med
No, *Yes
No* , Yes
ETCO2
Off, 0 – 97 (25)
2 – 99, Off (60)
*Med
No, *Yes
No* , Yes
FICO2
(Non Applicable)
1 – 25, OFF (5)
*Med
No, *Yes
No* , Yes
IPI
Off, 1 – 9 (4)
(Non Applicable)
*Med
No, *Yes
No* , Yes
*Factory Default Settings
191
PARAMATER ALARM LIMIT RANGES
Parameter
Lower Limit Range
Upper Limit
Range
Alarm Level
Alarms On
Choices
Print on Alarm
Choices
P1 Systolic
Off, -30 – 298 (75)
-28 – 300, Off (145)
*Med
No, *Yes
No* , Yes
P1 Mean
Off, -30 – 298 (50)
-28 – 300, Off (110)
*Med
No, *Yes
No* , Yes
P1 Diastolic
Off, -30 – 298 (35)
-28 – 300, Off (100)
*Med
No, *Yes
No* , Yes
P2 Systolic
Off, -30 – 298 (15)
-28 – 300, Off (50)
*Med
No, *Yes
No* , Yes
P2 Mean
Off, -30 – 298 (10)
-28 – 300, Off (25)
*Med
No, *Yes
No* , Yes
P2 Diastolic
Off, -30 – 298 (5)
-28 – 300, Off (20)
*Med
No, *Yes
No* , Yes
P3 Systolic
Off, -30 – 298 (35)
-28 – 300, Off (110)
*Med
No, *Yes
No* , Yes
P3 Mean
Off, -30 – 298 (15)
-28 – 300, Off (50)
*Med
No, *Yes
No* , Yes
P3 Diastolic
Off, -30 – 298 (10)
-28 – 300, Off (25)
*Med
No, *Yes
No* , Yes
P4 Systolic
Off, -30 – 298 (35)
-28 – 300, Off (110)
*Med
No, *Yes
No* , Yes
P4 Mean
Off, -30 – 298 (15)
-28 – 300, Off (50)
*Med
No, *Yes
No* , Yes
P4 Diastolic
Off, -30 – 298 (10)
-28 – 300, Off (25)
*Med
No, *Yes
No* , Yes
*Factory Default Settings
192
30. ALARM SPECIFICATIONS
General Alarms
Alarms
Audible & visible alarm indication + external nurse call interface
Alarm levels: High, Medium & Low
Alarm Volume: 45 - 85 dB(A)
Visual Alarm Light
Color coded: Red, Yellow, Cyan
Complies with IEC60601-1-8
Audible:
High, medium, low level, no sound
Clinician adjustable volume control from 1 to 10 (45 – 85 dB)
Complies with IEC60601-1-8
Alarm Silence / Suspend Times
Configurable: 1, 1.5 or 2 minutes
ECG and HR Messages
Message
Parameter
Value
Possible Causes
Suggested Actions
Check the patient and provide any necessary clinical
care.
HR asystole
ASY
No QRS detected for
last 4 seconds
Check the ECG lead being used to calculate the heart
rate (the top displayed lead) -- make sure that the QRS
amplitude on this lead is at least 0.5 mV.
Change to another ECG lead to get adequate QRS
amplitude.
Reposition or change electrodes if no lead gives
adequate QRS amplitudes. Remember the importance
of good skin preparation techniques.
Check the patient and provide any necessary clinical
care.
HR ventricular
fibrillation
VF
No organized
ventricular rhythm
detected
Check the ECG lead being used to calculate the heart
rate (the top displayed lead) -- make sure that the QRS
amplitude on this lead is at least 0.5 mV.
Change to another ECG lead to get adequate QRS
amplitude.
Reposition or change electrodes if no lead gives
adequate QRS amplitudes. Remember the importance
of good skin preparation techniques.
193
ALARM SPECIFICATIONS
Message
Parameter
Value
Possible Causes
Unplugged cable
Broken cable
HR lead off
[blank]
Loose lead wire
Faulty lead wire
Suggested Actions
Check to make sure electrodes are still securely
attached to the patient, and reattach if necessary.
Remember the importance of good skin preparation
techniques.
Check to make sure all the lead wires are still
connected to the electrodes.
Dried out electrode
Check to make sure the lead wires are securely
connected to the Surveyor patient monitor.
Inoperable ECG circuit
Check to make sure there are no broken lead wires.
Turn monitor off, then back on
If message persists, contact Mortara technical support.
Calm the patient.
Patient movement
HR artifact
---
Electrical noise from
auxiliary equipment
Bad electrode contact
HR < [lower limit]
HR > [upper limit]
Isolate the patient from auxiliary equipment, if
possible.
Check to make sure electrodes are still securely
attached to the patient, and reattach if necessary.
Remember the importance of good skin preparation
techniques.
[number]
The patient's heart rate
has fallen below the
current lower alarm
limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's heart rate
has risen above the
current upper alarm
limit.
Check the patient and provide any necessary clinical
care.
The AM12 12-Lead
ECG Acquisition
Module has failed its
calibration
ECG Unable to
Calibration
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
Disconnect and reconnect the AM12, while making
sure that there are no spurious contacts between
electrodes and earth ground.
Non-Invasive Blood Pressure (NIBP) Messages
Message
NIBP weak signal
194
Parameter
Value
---
Possible Causes
Suggested Actions
Poor limb perfusion
Check the patient and provide any necessary clinical
care
Improper cuff
placement
Check to make sure the cuff is wrapped properly, with
the “artery” mark lined up over the brachial artery
Cuff size too large for
the patient
Check the limb circumference against the
recommended range as printed on the cuff, to insure the
cuff is not too big
ALARM SPECIFICATIONS
Message
NIBP artifact
Parameter
Value
---
Possible Causes
Persistent patient
movement or coughing
Check the patient and provide any necessary clinical
care
Hemodynamic
interference (varying
pulse amplitudes due to
breathing or cardiac
valve defects)
Calm the patient
Hose is clogged or
leaking
NIBP cuff leak
---
Suggested Actions
Move the cuff to another limb with less movement
If no obvious patient motion, switching to the other
limb may still help in the case of hemodynamic
interference
Check the cuff and hose for signs of damage
Leaky cuff or hose
Check for leaks in the cuff or hose and replace if
necessary
Cuff not applied to
patient
Check that cuff and hose are connected to the monitor
Check that cuff is applied to patient
Check the patient and insure that the cuff is deflated
NIBP blocked hose -check patient
---
Pinched Hose
Check for kinks or obstructions in the hose
Replace hose if necessary
NIBP measurement
time exceeded
---
The measurement time
limit (2¼ minutes) was
exceeded, usually due
to motion artifact
---
Monitor has detected a
hardware problem
See suggestions for “NIBP artifact”
Repeat the measurement
Check the patient and insure that the cuff is deflated
NIBP needs service
Turn the monitor off, then on.
If message persists, contact Mortara technical support.
NIBP cannot measure
---
Initial inflation pressure
may not have been high
enough (if patient’s
systolic pressure is
above 200 mmHg)
Repeat the measurement (monitor will automatically
adjust to using a higher initial inflation pressure if
needed)
Patient movement
NIBPs < [lower limit]
[number]
The patient's systolic
pressure has fallen
below the current lower
alarm limit.
Check the patient and provide any necessary clinical
care.
Change the alarm limit if it is no longer clinically
appropriate.
195
ALARM SPECIFICATIONS
Message
NIBPs > [upper limit]
NIBPd < [lower limit]
NIBPd > [upper limit]
NIBPm < [lower
limit]
NIBPm > [upper
limit]
196
Parameter
Value
Possible Causes
[number]
The patient's systolic
pressure has risen above
the current upper alarm
limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's diastolic
pressure has fallen
below the current lower
alarm limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's diastolic
pressure has risen above
the current upper alarm
limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's mean
pressure has fallen
below the current lower
alarm limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's mean
pressure has risen above
the current upper alarm
limit.
Check the patient and provide any necessary clinical
care.
Suggested Actions
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
ALARM SPECIFICATIONS
Pulse Oximetry (SpO2) Messages
Message
Parameter
Value
Possible Causes
Suggested Actions
Bad SpO2 sensor
SpO2 replace sensor
---
Incorrect set-up within
the Surveyor patient
monitor.
Sensor has become
detached from patient
SpO2 check sensor
placement
---
---
Contact Mortara Technical Support.
Check to make sure the sensor is attached fully and
securely to the patient
Sensor not fully
inserted on patient’s
finger
Cover the sensor with opaque material, such as a towel,
to reduce ambient light
Excessive ambient light
Reattach the sensor, possibly on a smaller or larger
finger
Bad sensor (no red light
coming from sensor)
Replace sensor if there is no red light coming from it.
Poor perfusion
SpO2 weak signal
Replace the SpO2 sensor.
Large tissue mass
Nail polish
Bad SpO2 sensor
Check the patient and provide any necessary clinical
care
Warm the patient’s extremities if needed
Reattach the sensor on a smaller finger
Remove any nail polish that may be interfering with
the red light
Replace the SpO2 sensor
SpO2 unplugged
SpO2 artifact
SpO2 < [lower limit]
SpO2 > [upper limit]
[blank]
---
SpO2 sensor not
connected to SpO2
cable
Patient movement or
coughing
Hemodynamic
interference
Check to make sure the SpO2 sensor is securely
connected to the SpO2 cable on the monitor
Calm the patient
Reattach the sensor on another finger with less
movement
Reattach the sensor on a larger finger
[number]
The patient's oxygen
saturation has fallen
below the current lower
alarm limit.
Check the patient and provide any necessary clinical
care
[number]
The patient's oxygen
saturation has risen
above the current upper
alarm limit.
Check the patient and provide any necessary clinical
care
Change the alarm limit if it is no longer clinically
appropriate
Change the alarm limit if it is no longer clinically
appropriate
197
ALARM SPECIFICATIONS
Message
PR < [lower limit]
PR > [upper limit]
Parameter
Value
Possible Causes
[number]
The patient's pulse rate
has fallen below the
current lower alarm
limit.
Check the patient and provide any necessary clinical
care
[number]
The patient's pulse rate
has risen above the
current upper alarm
limit.
Check the patient and provide any necessary clinical
care
Suggested Actions
Change the alarm limit if it is no longer clinically
appropriate
Change the alarm limit if it is no longer clinically
appropriate
Temperature Messages
Message
Parameter
Value
[number]
∆T < [lower limit]
T2 probe
disconnected
198
Verify that the values are not due to artifact by
checking the position of the patient and cables as well
as the placement of the probe.
Check the patient and provide any necessary clinical
care.
[number]
∆T > [higher limit]
T1 probe
disconnected
The patient's
temperature or different
between the two
temperature probes has
fallen below the current
lower alarm limit.
Change the alarm limit if it is no longer clinically
appropriate.
T1 > [higher limit]
T2 > [higher limit]
Suggested Actions
Check the patient and provide any necessary clinical
care.
T1 < [lower limit]
T2 < [lower limit]
Possible Causes
The patient's
temperature or different
between the two
temperature probes has
risen above the current
higher alarm limit.
Verify that the values are not due to artifact by
checking the position of the patient and cables as well
as placement of the probe.
Change the alarm limit if it is no longer clinically
appropriate.
--
Probe is not connected
to the Surveyor patient
monitor
Connect the probe to the Surveyor patient monitor and
the patient per clinical guidelines.
ALARM SPECIFICATIONS
Respiration Messages
Message
RR out of range (too
high)
Parameter
Value
---
Possible Causes
The patient's respiration
rate has risen above the
maximum value the
monitor can accurately
detect.
Electrical noise from
auxiliary equipment
Monitor confused by
signal artifact
Unplugged cable
Broken cable
Loose lead wire
RR lead off
[blank]
Faulty lead wire
Suggested Actions
Check the patient and provide any necessary clinical
care.
Isolate the patient from auxiliary equipment, if
possible.
Check to make sure electrodes are still securely
attached to the patient, and reattach if necessary.
Remember the importance of good skin preparation
techniques.
Check to make sure electrodes are still securely
attached to the patient, and reattach if necessary.
Remember the importance of good skin preparation
techniques.
Check to make sure all the lead wires are still
connected to the electrodes.
Dried out electrode
Check to make sure the lead wires are securely
connected to the Surveyor patient monitor.
Inoperable respiration
detection circuit
Check to make sure there are no broken lead wires.
Turn monitor off, then back on
If message persists, contact Mortara technical support.
Calm the patient.
Patient movement
RR artifact
RR < [lower limit]
---
[number]
Electrical noise from
auxiliary equipment
Bad electrode contact
Check to make sure electrodes are still securely
attached to the patient, and reattach if necessary.
Remember the importance of good skin preparation
techniques.
The patient's respiration
rate has fallen below
the current lower alarm
limit.
Check the patient and provide any necessary clinical
care.
No breath has been
detected for 30 seconds.
RR > [upper limit]
[number]
Isolate the patient from auxiliary equipment, if
possible.
The patient's respiration
rate has risen above the
current upper alarm
limit.
Change the alarm limit if it is no longer clinically
appropriate.
Check the patient and provide any necessary clinical
care.
Change the alarm limit if it is no longer clinically
appropriate.
199
ALARM SPECIFICATIONS
Capnography (CO2) Messages
Message
ETCO2 < [lower
limit]
ETCO2 > [upper
limit]
FICO2 > [upper limit]
IPI < [lower limit]
RR out of range (too
high)
Parameter
Value
Possible Causes
[number]
The patient's ETCO2
parameter value has
fallen below the current
lower alarm limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's ETCO2
parameter value has
risen above the current
upper alarm limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's FICO2
parameter value has
risen above the current
upper alarm limit.
Check the patient and provide any necessary clinical
care.
[number]
The patient's IPI
parameter value has
fallen below the current
lower alarm limit.
Check the patient and provide any necessary clinical
care.
---
The patient's respiration
rate has risen above the
maximum value the
monitor can accurately
detect.
Electrical noise from
auxiliary equipment
Monitor confused by
signal artifact
RR < [lower limit]
[number]
The patient's respiration
rate has fallen below
the current lower alarm
limit.
No breath has been
detected for 30 seconds.
RR > [upper limit]
200
[number]
The patient's respiration
rate has risen above the
current upper alarm
limit.
Suggested Actions
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
Change the alarm limit if it is no longer clinically
appropriate.
Check the patient and provide any necessary clinical
care.
Isolate the patient from auxiliary equipment, if
possible.
Check to make sure electrodes are still securely
attached to the patient, and reattach if necessary.
Remember the importance of good skin preparation
techniques.
Check the patient and provide any necessary clinical
care.
Change the alarm limit if it is no longer clinically
appropriate.
Check the patient and provide any necessary clinical
care.
Change the alarm limit if it is no longer clinically
appropriate.
ALARM SPECIFICATIONS
Message
Note: Changing
patient mode will
change current setting
values to saved
default values.
Note: Changing
patient mode will
clear IPI trend data,
even if other patient
data is saved.
Parameter
Value
--
--
Possible Causes
The patient mode has
changed.
The patient age has
changed.
The patient mode has
changed.
The patient age has
changed.
Suggested Actions
Verify that the correct patient mode (Adult/Pediatrics)
is being applied. Save or Purge patient data as
appropriate, or cancel selection.
Verify that the patient age is correctly entered. Clear
IPI trend data and continue, or cancel selection.
Verify that the correct patient mode (Adult/Pediatrics)
is being applied. Save or Purge patient monitoring
data as appropriate, or cancel selection.
Verify that the patient age is correctly entered. Clear
IPI trend data and continue, or cancel selection.
--
For pediatric patients,
the age range must be
set to correctly
determine IPI.
Set the age range in the CO2 setup screen.
CO2 Occluded Line
--
CO2 sampling line
cannot be cleared due to
moisture or other
obstruction.
Replace the sampling line. If connected to scavenging
system, remove to see if the message disappears.
CO2 Warming Up
--
CO2 module is
preparing to acquire
data.
Allow more time.
Probe Unplugged
--
CO2 interface is not
connected.
Connect the CO2 sample line to the monitor and
patient.
CO2 Problem
Detected
-
CO2 interface has
encountered a problem
Check the CO2 subsystem including sampling line and
exhaust port. Verify that the exhaust port is not
blocked.
IPI age range not set
201
ALARM SPECIFICATIONS
Invasive Pressure Messages
Message
Parameter
Value
IBPs < [lower limit]
IBPm < [lower limit]
[number]
IBPd < [lower limit]
IBPs > [higher limit]
IBPm > [higher limit]
[number]
IBPd > [higher limit]
IBP signal out of
range [low]
Possible Causes
The patient's invasive
systolic/diastolic/mean
pressure has fallen
below the current lower
alarm limit.
The patient's invasive
systolic/diastolic/mean
pressure has risen above
the current higher alarm
limit.
Suggested Actions
Check the patient and provide any necessary clinical
care.
Verify that the values are not due to artifact by
checking the position of the patient, cables and
transducer. Zero set the pressure if necessary.
Change the alarm limit if it is no longer clinically
appropriate.
Check the patient and provide any necessary clinical
care.
Verify that the values are not due to artifact by
checking the position of the patient, cables and
transducer. Zero set the pressure if necessary.
Change the alarm limit if it is no longer clinically
appropriate.
--
The invasive signal is
out of range.
Verify the position of the patient, cables and
transducer. Zero set the pressure if necessary.
IBP unplugged
--
IBP cable or transducer
not plugged
Verify that the cable and transducer are properly
connected.
Unable to zero
--
Stopcock is not open
Open the stopcock and check tubing and cables.
Zero required
--
IBP channel not zeroed
Zero the IBP channel
Zero required and 60
seconds has expired
--
IBP channel not zeroed
Zero the IBP channel
Calibration required
--
IBP channel requires
calibration
Arrange for calibration service of the IBP channel
Calibration in
progress
--
IBP channel calibration
is in progress
Wait until the calibration process is completed
Cannot calibrate
--
Calibration failed
Contact Mortara Technical Support
ART: Check
Transducer
--
ART IBP pressure
below 10mmHg
Check ART catheter to ensure that it is properly
positioned and connected.
IBP signal out of
range [high]
202
ALARM SPECIFICATIONS
Cardiac Output Messages
Message
Parameter
Value
Possible Causes
Suggested Actions
BT signal out of
range (high)
N/A
BT out of range (too
high)
Check the BT transducer
BT signal out of
range (low)
N/A
BT out of range (too
low)
Check BT transducer
IT signal out of range
(high)
N/A
IT out of range (too
high)
Check IT transducer
IT signal out of range
(low)
N/A
IT out of range (too
low)
Check IT transducer
No BT change in
manual mode
N/A
CO measurement
timeout
Restart the CO
BT transducer
unplugged
N/A
BT unplugged
Plug in the BT transducer
IT transducer
unplugged
N/A
IT unplugged
Plug in the IT transducer
203
ALARM SPECIFICATIONS
204
31. TROUBLESHOOTING
The following table provides guidance for investigating issues that may occur during operation of the Surveyor
patient monitors. Contact Mortara Technical Service for further assistance.
Power and Battery
Symptom
The Surveyor patient
monitor is not working and
displays an error message.
The patient monitor is
plugged in but does not
start up.
The patient monitor will
not run once on battery
power.
Possible Causes
Suggested Resolution
Internal system failure
Power cycle the Surveyor patient monitor and try
again. If problems persist, stop using the Surveyor
patient monitor and contact Mortara Technical
Support.
No AC power from outlet
Verify that the power outlet is working; verify the
green LED on the front panel is illuminated.
The monitor is powered off
Press the power switch to power on the patient
monitor.
Internal system error
Power cycle the Surveyor patient monitor. If problem
persists, stop using the Surveyor patient monitor and
contact Mortara Technical Support.
Battery needs charging
Connect the Surveyor patient monitor to AC power.
Verify that the green LED is illuminated and the
Surveyor patient monitor powers up.
Battery will not hold charge
Replace the battery according to instructions in the
General Care & Maintenance section.
Display and Touch Screen
Symptom
The touch screen is not
working properly.
The display is not working
properly.
Possible Causes
Suggested Resolution
Touch screen failure
Power cycle the Surveyor patient monitor and try
again. If problems persist, stop using the Surveyor
patient monitor and contact Mortara Technical
Support.
Display failure
Power cycle the Surveyor patient monitor and try
again. If problems persist, stop using the Surveyor
patient monitor and contact Mortara Technical
Support.
205
TROUBLESHOOTING
ECG, Arrhythmia, and ST
Symptom
ECG signal is noisy.
Possible Causes
Suggested Resolution
Notch filter selection may not be
appropriate for local settings.
Change the notch filter setting in the Service menu
based on local power frequency (50 or 60 Hz). Check
the proximity of the ECG lead cables to power cable or
high frequency noise sources.
Confirm electrode site preparation; confirm correct
ECG placement; instruct the patient to not move.
Patient movement
Calm the patient.
Electrical noise from auxiliary
equipment
Isolate the patient from auxiliary equipment, if possible.
Bad electrode contact
No ST numeric values
displayed
No ECG traces are
displayed
AM12 connected but no
ECG traces are
displayed
206
Check to make sure electrodes are still securely
attached to the patient, and reattach if necessary.
Remember the importance of good skin preparation
techniques.
ST is not enabled in the Setup HR
dialogue
Enable ST in the Setup HR dialogue
AND/OR
AND/OR
ST is not enabled in the
Setup>Parameters dialogue
Enable ST in the Setup>Parameters dialogue
Electrodes for display lead not
connected
Touch “all ECG” button, check which leads are
displayed without connection. Correct the displayed
lead per the attached electrodes.
Bad ECG cable
Touch “all ECG” button, short lead wires together and
observe which lead appear on the screen after circa 10
seconds. Change cable.
Bad electrode contact (high skinelectrode impedance)
Touch “all ECG” button, check electrode contact,
check electrodes not being dry, re-prep skin.
12-lead is not enabled in the Setup
HR dialogue
Enable 12-lead in the Setup HR dialogue
AND/OR
AND/OR
AM12 encountered an error during
power-up auto calibration
Unplug the AM12 from the device and plug it back in.
TROUBLESHOOTING
Non-Invasive Blood Pressure (NIBP)
Symptom
Possible Causes
Suggested Resolution
NIBP measurement fails
or inaccurate.
Cuff selection or placement, or patient
movement
Confirm the selection and placement of the NIBP cuff;
instruct the patient to not move during the
measurement cycle; confirm appropriate initial
inflation pressure settings. Re-attempt the
measurement. If problems persist, contact Mortara
Technical Support.
Audible beep heard
Successful completion of NIBP
measurement
No action. This is as per design. The NIBP End Tone
signifies to the clinician that the NIBP measurement
has completed.
Cannot obtain BP
measurement
Patient moving during BP acquisition
Improper cuff size
Cuff or tubing not properly connected
BP out of range
Improperly configured NIBP inflation
pressure
Use comfort measures to encourage patient to keep
NIBP limb still
Ensure proper BP cuff size
Check all NIBP connections
Use a manual or alternative BP acquisition mode
Adjust the NIBP inflation pressure based on the
patient’s systolic BP
BP values higher or
lower than clinically
anticipated
Improper cuff size or placement
Patient moving during BP acquisition
Ensure proper BP cuff size and placement
Use comfort measures to encourage patient to keep
NIBP limb still
Pulse Oximetry (SpO2)
Symptom
Possible Causes
Suggested Resolution
Pulse oximetry
measurement fails or
inaccurate
Sensor placement or patient
movement
Confirm the selection and placement of the pulse
oximetry sensor; instruct the patient to not move the
SpO2 sensor extremity; remove dark finger nail polish.
Cannot obtain SpO2
SpO2 sensor not connected to
patient
Sensor/cable not properly
connected
Patient moving
Overhead lighting interference
Patient has poor perfusion, slow
HR, low BP
Connect SpO2 sensor to patient
Check all SpO2 connections
Use comfort measures to encourage patient to keep
SpO2 limb still
Place SpO2 limb under the top sheet or blanket, for
example
Switch SpO2 to another limb
SpO2 waveform is erratic,
low amplitude
Patient moving
SpO2 sensor on same limb as
NIBP cuff
Use comfort measures to encourage patient to keep
SpO2 limb still
Move SpO2 and NIBP to different patient limbs
No waveform/parameter
SpO2 sensor not connected to
patient
Sensor/cable not properly
connected
Patient moving
Connect SpO2 sensor to patient
Check all SpO2 connections
Use comfort measures to encourage patient to keep
SpO2 limb still
207
TROUBLESHOOTING
Temperature
Symptom
Possible Causes
Suggested Resolution
No T1, T2, or ∆T numeric
values displayed
Incorrect display format
Select the temperature parameters to display via the
Setup Temperature dialogue
No parameter
Temperature sensor not properly
placed/connected
Check temperature sensor placement and connection
Respirations: Via ECG Thoracic Impedance
Symptom
No respiration waveform
displayed
Possible Causes
Suggested Resolution
3 or 5 lead cable:
Cable not connected
Electrodes not connected
Check that the ECG cable is properly connected into
the patient monitor.
Ensure ECG electrodes have good connection with the
patient’s skin.
AM12 in use
The AM12 12-Lead ECG Acquisition Module does not
support respirations. Alternative: Use 3 or 5 lead
cable, capnography.
Resp disabled
Enable Respirations via Setup Resp dialogue
Capnography (CO2)
Symptom
Possible Causes
Suggested Resolution
No CO2 waveform and
numeric values displayed
CO2 is not enabled in the
Setup>Parameters dialogue
Enable CO2 in the Setup>Parameters dialogue
208
TROUBLESHOOTING
Invasive Pressures
Symptom
Possible Causes
No Invasive pressure
waveform and numerics
displayed
Improper manifold setup
Loose pressure tubing connections
Pressure cable not connected into
monitor
Stopcock not in correct position
Transducer requires zeroing
Invasive pressure are not enabled
in the Setup>Parameters dialogue
Suggested Resolution
Ensure the pressure manifold is properly connected,
the invasive cable is inserted into the correct invasive
pressure channel of the patient monitor, and the
transducer is intact.
Zero the invasive pressure
Enable invasive pressures in the Setup>Parameters
dialogue
Invasive pressure
waveform is dampened
Air in invasive pressure tubing
Kinked or occluded patient
catheter
Check patient
Check invasive pressure tubing for patency
Follow hospital standard of care
Cannot zero the invasive
pressure
Stopcock not in correct position
Open stopcock to atmosphere
Check pressure manifold patency
Invasive pressure numerics
higher or lower than
clinically anticipated
Improperly leveled transducereither too high or too low
Re-level the transducer as per hospital standard of care
The PAWP dialogue is
hidden
Invasive pressure not labeled as
PA
Label the appropriate invasive pressure as PA
Symptom
Possible Causes
Suggested Resolution
No CO tile displayed
CO is not enabled in the
Setup>Parameters dialogue
Enable CO in the Setup>Parameters dialogue
Cardiac Output
CO curves not yet performed
CO average not saved
No CO numerics displayed
Perform CO measurements
Save CO average
CO is not enabled in the
Setup>Parameters dialogue
Enable CO in the Setup>Parameters dialogue
CO numerics higher or
lower than clinically
anticipated
Computation constant incorrect for
catheter and injectate volume
Enter computation constant as per PA catheter
manufacturers recommendation
Irregular CO curve
Improper CO injection technique
Patient movement during CO
injection
Reattempt CO bolus as per hospital standard of care
Use comfort measures to encourage patient to keep
still during CO procedure
CO curves not drawn
Monitor is in Manual CO mode
When in Manual CO mode, select START when
injecting the CO bolus to begin the CO curve drawing
Switch to Auto CO mode
209
TROUBLESHOOTING
210
32. ACCESSORIES
Use the following Mortara part numbers to obtain spare parts or to reorder accessories:
MORTARA PART #
DESCRIPTION
Blood Pressure
6901-021-02
CUFF BLOOD PRESSURE REUSABLE S12/S19 CHILD
6901-021-03
CUFF BLOOD PRESSURE REUSABLE S12/S19 SM ADULT
6901-021-04
CUFF BLOOD PRESSURE REUSABLE S12/S19 ADULT
6901-021-05
CUFF BLOOD PRESSURE REUSABLE S12/S19 ADULT LONG
6901-021-06
CUFF BLOOD PRESSURE REUSABLE S12/S19 LARGE ADULT
6901-021-07
CUFF BLOOD PRESSURE REUSABLE S12/S19 LARGE ADULT LONG
6901-021-08
CUFF BLOOD PRESSURE REUSABLE S12/S19 THIGH
6901-020-02
CUFF BLOOD PRESSURE DISPOSABLE S12/S19 CHILD - CASE 20
6901-020-03
CUFF BLOOD PRESSURE DISPOSABLE S12/S19 SM ADULT - CASE 20
6901-020-04
CUFF BLOOD PRESSURE DISPOSABLE S12/S19 ADULT- CASE 20
6901-020-05
CUFF BLOOD PRESSURE DISPOSABLE S12/S19 ADULT LONG - CASE 20
6901-020-06
CUFF BLOOD PRESSURE DISPOSABLE S12/S19 LARGE ADULT - CASE 20
6901-020-07
CUFF BLOOD PRESSURE DISPOSABLE S12/S19 LARGE ADULT LONG - CASE 20
6901-020-08
CUFF BLOOD PRESSURE DISPOSABLE S12/S19 THIGH - CASE 20
6901-022-01
EXTENSION HOSE BLOOD PRESSURE CUFF 3 M
ECG
41000-032-52
AM12 PATIENT CABLE AHA CLIP
41000-032-53
AM12 PATIENT CABLE IEC CLIP
9293-050-50
ECG CABLE 3 WIRE AHA CLIP
9293-050-51
ECG CABLE 3 WIRE IEC CLIP
9293-050-60
ECG CABLE 5 WIRE AHA CLIP
9293-050-61
ECG CABLE 5 WIRE IEC CLIP
9293-059-52
3 WIRE ECG LEAD SET, SNAP ENDS, AHA MARKINGS, GRAY
9293-059-53
3 WIRE ECG LEAD SET, SNAP ENDS, IEC MARKINGS, GRAY
9293-059-62
5 WIRE ECG LEAD SET, SNAP ENDS, AHA MARKINGS, GRAY
9293-059-63
5 WIRE ECG LEAD SET, SNAP ENDS, IEC MARKINGS, GRAY
9293-059-50
3 WIRE ECG LEAD SET, CLIP ENDS, AHA MARKINGS, GRAY
9293-059-51
3 WIRE ECG LEAD SET, CLIP ENDS, AHA MARKINGS, GRAY
9293-059-60
5 WIRE ECG LEAD SET, CLIP ENDS, AHA MARKINGS, GRAY
211
ACCESSORIES
ECG
9293-059-61
5 WIRE ECG LEAD SET, CLIP ENDS, IEC MARKINGS, GRAY
9293-059-70
ECG TRUNK CABLE 3/5 WIRE GRAY
PULSE OXIMETRY
9293-057-50
CABLE SPO2 ADAPTER AND EXTENSION – MORTARA INTERFACE ONLY
9293-057-60
SENSOR SPO2 REUSABLE FINGER CLIP – MORTARA INTERFACE ONLY
9293-057-61
SENSOR SPO2 DISPOSABLE ADULT CASE 24 – MORTARA INTERFACE ONLY
9293-057-62
SENSOR SPO2 DISPOSABLE PEDIATRIC CASE 24 – MORTARA INTERFACE ONLY
INVASIVE PRESSURE
9293-058-50
CABLE Y INVASIVE PRESSURE
9293-058-60
CABLE INVASIVE PRESSURE EDWARDS
9293-058-61
CABLE INVASIVE PRESSURE BECTON-DICKINSON
CARDIAC OUTPUT
9293-051-50
CABLE INVASIVE CARDIAC OUTPUT EDWARDS
9293-051-51
PROBE TEMPERATURE IN-LINE EDWARDS
9293-051-52
PROBE TEMPERATURE BATH EDWARDS
CO2
9293-052-50
STARTER KIT CO2 ADULT
9293-052-60
FILTERLINE H CO2 ADULT/PED - CASE 25
9293-052-61
FILTERLINE CO2 ADULT/PED - CASE 25
9293-052-62
CAPNOLINE CO2 +O2 ADULT - CASE 25
9293-052-63
CAPNOLINE CO2 +O2 PED - CASE 25
TEMPERATURE
9293-056-50
PROBE TEMP INTERNAL GENERAL PURPOSE
9293-056-51
PROBE TEMP INTRNL GEN PURPOSE SINGLE-USE - BOX 20
9293-056-52
PROBE TEMPERATURE SKIN SINGLE-USE - BOX 20
9293-056-60
CABLE ADAPTER TEMPERATURE DISPOSABLE PROBES
RECORDER
5450-007-50
THERMAL PRINTER 50 MM WITH HOUSING
9100-030-50
PAPER ROLL CASE SURVEYOR S12/S19
9100-030-01
PAPER ROLL PACK SURVEYOR S12/S19
212
ACCESSORIES
MORTARA PART #
DESCRIPTION
MOUNTING
8363-031-60
WALL MOUNT STANDARD S12/S19 GCX KIT; INCLUDES:
8363-031-50; WALL MOUNT STANDARD S12/S19
9920-001-50; CHANNEL WALL MOUNT 19 X 2.5 ID X 4W
9920-003-50; HANGER CABLE - GCX WALL CHANNEL
XXXX; BRACKET POWER BRICK WALL CHANNEL
8363-031-61
WALL MOUNT STANDARD W/MTG PLATE S12 GCX KIT; INCLUDES:
8363-031-51; WALL MOUNT STANDARD W/MTG PLATE S12
8363-019-50 MOUNTING PLATE SURVEYOR S12
9920-001-50; CHANNEL WALL MOUNT 19 X 2.5 ID X 4W
9920-003-50; HANGER CABLE - GCX WALL CHANNEL
XXXX; BRACKET POWER BRICK WALL CHANNEL
8363-021-50; SOCKET MOUNT ROLL STAND AND WALL S12
8363-032-60
WALL MOUNT ARTICULATING S12/S19 GCX KIT; INCLUDES:
8363-032-50; WALL MOUNT ARTICULATING S12/S19 GCX
9920-001-50; CHANNEL WALL MOUNT 19 X 2.5 ID X 4W
XXXX; BRACKET POWER BRICK WALL CHANNEL
8363-020-50
BRACKET RECORDER MOUNTING SURVEYOR S19 EXTERNAL
9911-019-50
ROLLING STAND; INCLUDES
MO-0006-60; CART ROLL STAND SURVEYOR S12 W/ BASKET
8363-019-50 MOUNTING PLATE SURVEYOR S12)
XXXX; BRACKET POWER BRICK WALL CHANNEL
8363-021-50; SOCKET MOUNT ROLL STAND AND WALL S12
POWER
4800-017
INTERNTAL LITHIUM-ION BATTERY
4101-012
EXTERNAL AC POWER SUPPLY
3181-008
AC POWER CABLE FOR S12/S19 EXTERNAL POWER SUPPLY - US AND CANADA
3181-012-01
AC POWER CABLE FOR S12/S19 EXTERNAL POWER SUPPLY – AUSTRALIA
3181-015-01
AC POWER CABLE FOR S12/S19 EXTERNAL POWER SUPPLY – UK
3181-002
AC POWER CABLE FOR S12/S19 EXTERNAL POWER SUPPLY – ALL OTHERS
OTHER
9960-067
SURVEYOR USB FLASH DRIVE
9960-074
ADAPTER, RJ45 FEMALE TO DB9 FEMALE
(FOR RS-232 SERIAL COMMUNICATION WITH EMR SOFTWARE USING CAT5
CABLING)
213
ACCESSORIES
The following are compatible with the Nellcor pulse oximetry interface and can be purchased directly through
Nellcor or authorized distributor.
PART NUMBER
DESCRIPTION
DOC10
PULSE OXIMETRY EXTENSION CABLE – 10’
DOC8
PULSE OXIMETRY EXTENSION CABLE – 7’
DOC4
PULSE OXIMETRY EXTENSION CABLE – 4’
DS100A
OXIMAX DURASENSOR REUSABLE FINGER-CLIP OXIMETRY SENSOR
D-YS
OXIMAX DURA-Y REUSABLE MULTI-SITE OXIMETRY SENSOR
OXI-A/N
OXIMAX OXIBAND ADULT/NEONATAL REUSABLE SENSOR
OXI-P/I
OXIBAND® PEDIATRIC/INFANT REUSABLE SENSOR
MAX-A/N
OXIMAX SENSOR ADHESIVE ADULT/NEONATAL
MAX-P/I
OXIMAX SENSOR ADHESIVE PEDIATRIC/NEONATAL
MAX-PACI
SENSOR ASSORTMENT PACK
SRC-MAX
PULSE OXIMETRY TESTER, OXIMAX
The Surveyor patient monitor’s invasive pressure interface is compatible with transducers which have
5µV/V/mmHg sensitivity and comply with the AAMI BP22 Standard including those available from Edwards
Lifesciences and Becton, Dickinson & Company.
The Surveyor patient monitor’s temperature interface is compatible with YSI 400 series temperature probes.
Figure 88 Quick-Disconnect (M-Series) Wall Mounting Components
214
ACCESSORIES
Figure 89 Value (Vesa M-Series) Wall Mounting Components
Figure 90 Premium (VHM-25) Wall Mount Components
215
ACCESSORIES
Figure 91 Surveyor S12 Roll Stand Components (not to be used with S19)
216
33. APPLIED STANDARDS
•
AAMI ES60601-1:2005 Medical electrical equipment Part 1: General Requirements for Basic Safety and Essential
Performance
•
CENELEC EN60601-1:2006 Medical Electrical Equipment Part 1: General Requirements for Basic Safety and Essential
Performance
•
CSA C22.2#601.1:1990 (R2005) Medical Electrical Equipment - Part 1: General Requirements for Safety-General
Instruction No 1; Update No 2
•
CSA C22.2#60601-1:2008 Ed:3 Medical Electrical Equipment - Part 1: General requirements for basic Safety and essential
performance
•
IEC 60601-1:1988 Ed:2 Medical Electrical Equipment Part 1: General Requirements for Safety; (Amd. 1-1991) (Amd. 21995) (Corrigendum-1995)
•
EN 60601-1:1990, + A1:1993, + A2:1995, + A13:1996, Medical Electrical Equipment, General Requirements for Safety,
Part 1
•
IEC 60601-1:2005 Ed:3 Medical electrical equipment Part 1: General requirements for basic safety and essential
performance
•
IEC 60601-1-2:2007 Medical Electrical Equipment – Part 1-2: General requirements for safety – Collateral Standard:
Electromagnetic Compatibility
•
IEC 60601-1-4:2000 Ed:1.1 Medical Electrical Equipment - Part 1-4: General Requirements for Safety - Collateral
Standard: Programmable Electrical Medical Systems; Edition 1:1996 Consolidated with Amendment 1:1999
•
IEC 60601-1-6:2006 Ed:2 Medical electrical equipment - Part 1-6: General requirements for safety - Collateral Standard:
Usability
•
IEC 60601-1-8:2006 Medical Electrical Equipment -- Part 1-8: General requirements for basic safety and essential
performance -- Collateral standard: General requirements, tests and guidance for alarm systems in medical electrical
equipment and medical electrical systems
•
IEC 60601-2-27:2005 Ed:2 Medical Electrical Equipment PT. 2: Particular Requirements for the Safety, including essential
performance, of Electrocardiographic Monitoring Equipment
•
ANSI/AAMI EC11:1991/(R)2007:
Surveyor Central Station.
•
IEC 60601-2-30: Second Edition Particular Requirements for the Safety, Including Essential Performance, of Automatic
Cycling Non-Invasive Blood Pressure Monitoring Equipment
•
IEC 60601-2-34:2000 Ed: 2 Medical Electrical Equipment - Part 2-34: Particular Requirements for the Safety, Including
Essential Performance, of Invasive Blood Pressure Monitoring Equipment
•
IEC 60601-2-49 Ed. 1.0 b:2006 Medical Electrical Equipment - Part 2-49: Particular requirements for the safety of
multifunction patient monitoring equipment
•
IEC 60601-2-51 Ed. 1.0 b:2005: Medical Electrical Equipment – Part 2-51: Particular Requirements for Safety, Including
Essential performance, of Recording and Analyzing Single Channel and Multichannel Electrocardiographs, section 51
(Protection Against Hazardous Output) only; for Electrocardiograms printed through Surveyor Central Station.
•
IEC 62366:2007 Medical equipment -- Application of usability engineering to medical equipment
Diagnostic Electrocardiograph Devices; for Electrocardiograms printed through
217
APPLIED STANDARDS
•
IEC 80601-2-30:2009 Ed:1 Medical Electrical Equipment- Part 2-30: Particular Requirements for the Basic Safety and
Essential Performance of Automated Non-Invasive Sphygmomanometers
•
ISO 80601-2-55:2010 Medical electrical equipment Particular requirements for the basic safety and essential performance
of respiratory gas monitors
•
ISO 80601-2-56:2009 - Medical electrical equipment - Part 2-56: Particular requirements for basic safety and essential
performance of clinical thermometers for body temperature measurement
•
ISO 80601-2-61:2011 - Medical electrical equipment -- Part 2-61: Particular requirements for basic safety and essential
performance of pulse oximeter equipment
•
ISO 9919 Issued:2005/03/15 Ed:2 Medical electrical equipment Particular requirements for the basic safety and essential
performance of pulse oximeter equipment for medical use
•
UL 60601-1:2003 Ed:1 UL Standard for Safety Medical Electrical Equipment, Part 1: General Requirements for Safety
•
IEC 60601-2-51 Ed. 1.0 b:2005: Medical Electrical Equipment - Part 2-51: Particular Requirements for Safety, Including
Essential performance, of Recording and Analyzing Single Channel and Multichannel Electrocardiographs – Section 51
Only
218
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